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조성범,박상준,정환훈,이승화,박범진,강창호,김윤환,Cho, Sung-Bum,Park, Sang-Joon,Chung, Hwan-Hoon,Lee, Seung-Hwa,Park, Beom-Jin,Kang, Chang-Ho,Kim, Yun-Hwan 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1
Patients with impaired ability to eat require nutritional support enterally or parenterally. Gastrostomy is a preferred method because total parenteral nutrition has many complications and high cost. Surgical gastrostomy has been a traditional and well-established method prior to the development of percutaneous gastrostomy. Since then, percutaneous gastrostomy has been established as an effective, safe, easy technique with a low morbidity and mortality rate. Consequently, percutaneous gastrostomy has been the first method for long-term enteral nutrition. The purpose of this review is to describe the techniques, indications, complications of percutaneous radiologic gastrostomy/gastrojejunostomy and to compare with endoscopic method.
김윤환 ( Yun Hwan Kim ),조성범 ( Sung Bum Cho ),정환훈 ( Hwan Hoon Chung ) 대한간암학회 2010 대한간암학회지 Vol.10 No.-
Transarterial radioembolization (TARE) using Yttrium-90 (Y-90) microspheres is emerging as a mainstream treatment modality in the management of patients with primary and metastatic liver cancer. Yttrium-90 is a high energy beta particle emitting radioisotope. The intellectual basis of Y-90 microsphere treatment is the preferential distribution of microspheres, when injected in the hepatic artery, yielding much higher concentrations in the tumor compartment than the normal liver parenchyma. The technique involves the administration of Y-90 microspheres into the hepatic artery accessed via transfemoral route, showing almost similar procedure with transarterial chemoembolization (TACE). The Y-90 microspheres are entrapped within the microvasculature, and release beta radiation. The high tumor to liver concentration ratio results in an effective tumoricidal radiation absorbed dose whilst limiting the radiation injury to the normal liver. With such a therapeutic mechanism of this method, Y-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results. But preliminary evidence also suggests that the TACE and TARE provided similar effectiveness and toxicity in patients with unresectable HCC. In conclusion, we think that prospective, randomized controlled trials using current therapies are needed to better define optimal management of unresectable HCC.
혐색소형 신세포암의 나선식 CT 소견: 병리조직학적 소견 및 예후와의 비교
조규란,박철민,정환훈,김형래,박범진,이영흔,서보경,차상훈,이창희,정규병,Cho, Kyu-Ran,Park, Cheol-Min,Chung, Hwan-Hoon,Kim, Hyoung-Rae,Park, Bum-Jin,Lee, Young-Hen,Seo, Bo-Kyeong,Cha, Sang-Hoon,Lee, Chang-Hee,Chung, Kyoo-Byung 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1
목적: 혐색소형 신세포암의 특징적인 나선식 CT 소견을 알아보고 종양의 병리소견, 핵등급, 병기, 그리고 예후와의 연관성을 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 167예의 신세포암중 11예(6.6%)의 혐색소형 신세포암을 대상으로 나선식 CT와 조직소견을 후향적으로 분석하였다. CT상 종양의 크기, 내부 구조, 감쇠(attenuation), 경계, 정맥과 림프절로의 전이 여부를 관찰하였고 병리소견, Fuhrman의 핵등급, Robson 병기, 그리고 예후와의 연관성에 대해 알아 보았다. 열명의 환자에서 추적 CT로 종양의 재발 유무를 알아 보았는데 추적 기간은 27-80개월(평균 49.6개월)이었다. 결과: CT상 모든 예는 고형이고 신 실질과 경계가 좋으며 크기는 2.5-15 cm(평균 7.7 cm)이었다. 조영증강전 CT상 신 실질과 등음영(n=1)또는 저음영(n=10)이었고 조영증강 초기와 후기에 모두 저음영으로 보였다.3예에서는 내부에 국소적으로 괴사 또는 낭성 변화로 판단되는 저음영 부위가 있었는데 이는 병리조직 소견상 유리화로 확인되었다. 정맥이나 림프절로의 침범 또는 원격 전이를 보인 예는 없었다. 병리조직소견상 낭성 변화는 1예, 출혈이나 괴사는 5예, 완전한 피막화는 3예, 신주위 지방층으로의 파급은 3예에서 보였다. 핵등급은 II(n=6)나 III(n=5)였고 병기는 I(n=8)혹은 II(n=3)였다. 핵등급이 III인 5예중 3예는 병기 I이었고 2예는 병기 II였다. 추적 검사상 모든예에서 종양의 재발은 없었고 모두 생존하고 있다. 결론: 혐색소형 신세포암은 조영증강 전, 조영증강 초기 및 후기 나선식 CT상 신 실질보다 저음영이고 경계가 좋은 고형 종양이며 핵등급이 높은 경우에도 상대적으로 병기가 낮고 예후가 좋다. Purpose: To describe the spiral CT findings of CRCC and to correlate these with the pathologic features, nuclear grading, tumor staging, and prognosis. Materials and Methods: We encountered eleven cases of CRCC among 167 cases of histopathologically proven RCC, retrospectively evaluating the spiral CT findings of CRCC including tumor size, internal texture, attenuation, margin, and the involvement of veins or lymph nodes. In addition, the CT findings were correlated with the pathologic features, Fuhrman's nuclear grade, Robson’s staging, and the prognosis. Between 27 and 80 (mean, 49.6) months later, the follow-up CT scans of tea patients were examined for tumor recurrence. Results: All tumors, which ranged in size from 2.5 to 15 (mean, 7.7) cm, were solid and well demarcated from renal parenchyma. Pre-contrast CT scans showed that their attenuation was equal to (n=1) or slightly lower (n=10) than that of renal parenchyma, and on early and delayed phase post-contrast enhanced scans, attenuation was low in all cases. In three, focal areas in which attenuation was lower than in the rest of the tumor were observed; histopathologically, these represented hyalinization. There was neither venous nor lymph node involvement, and no distant metastasis. Histopathologic examination demonstrated cystic change (n=1), hemorrhage or necrosis (n=5), complete encapsulation (n=3) and perirenal fat infiltration (n=3). Nuclear grading was II (n=6) or III (n=5), and tumor staging was I (n=8) or II (n=3). Among the five cases in which the nuclear grade was III, three were stage I and two were stage II. Follow-up scans showed no evidence of tumor recurrence, and all patients survived. Conclusion: Pre-, early- and late-phase post-contrast enhonced spiral CT scans showed that the attenuation of a CRCC was lower than that of renal parenchyma. Even where the nuclear grade was higher, a well-demarcated soild mass was observed, the tumor stage was lower and the prognosis better.
쐐기절제술과 소라페닙으로 성공적으로 치료된 간세포암의 단일 폐전이
이순재 ( Sun Jae Lee ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),김해림 ( Hae Rim Kim ),윤아일린 ( Eileen L. Yoon ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),정록선 ( Rok Son Choung ),이상 대한간암학회 2012 대한간암학회지 Vol.12 No.1
35-year-old female patient was diagnosed with hepatocellular carcinoma and underwent hepatic resection. 12 months after hepatic resection, serum AFP rose (119.6 ng/mL) but no definite recurrence was found on imaging modalities. 30 months after hepatic resection, serum AFP rose up to 1008.5 ng/mL and metastatic nodule was found in right lower lung in chest CT. Video assisted thoracoscopic wedge resection was performed and 400 mg/day of sorafenib was intiated. Serum AFP returned to normal range after 2 months of pulmonary resection. No evidence of recurrence is noted after 30 months of pulmonary resection. We think that pulmonary resection plus sorafenib combination therapy resulted in favorable treatment outcome in this patient.
간기능이 저하된 비대상성 간경변증 환자에서 약물방출미세구를 이용한 화학색전술을 통해 적극적으로 간암을 치료한 증례
윤아일린 ( Eileen L. Yoon ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),이승화 ( Seung Hwa Lee ),김해림 ( Hae Rim Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver cirrhosis patient who was not eligible for conventional TACE treatment.
하대정맥 및 우심방의 혈전을 동반한 간세포암을 효과적으로 치료한 증례
이현정 ( Hyun Jung Lee ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),이승화 ( Seung Hwa Lee ),김해림 ( Hae Rim Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재현 대한간암학회 2012 대한간암학회지 Vol.12 No.2
In patients with advanced hepatocellular carcinoma (HCC), tumor thrombus in inferior vena cava (IVC) and right atrium (RA) are not uncommon findings and are usually associated with extremely poor outcome. Although aggressive surgical interventions such as extracorporeal circulation and tumor excision have been performed, the reported results were still unsatisfactory. Herein, we report the favorable result of combined treatment with radiation therapy and transarterial chemoembolization in a patient with advanced HCC with extensive tumor thrombus through the IVC into the RA. In conclusion, noninvasive combined modalities, such as transarterial chemoembolization and radiation therapy may sometimes provide effective palliation for patients with far advanced HCC with IVC/RA tumor thrombus and who are not candidates for alternative treatment options.
괴상형 간세포암 간동맥화학색전술에 반응을 보이지 않은 거대 간세포암종을 간절제술로 치료한
김정한 ( Jeong Han Kim ),임형준 ( Hyung Joon Yim ),김승영 ( Seung Young Kim ),안재홍 ( Jae Hong Ahn ),김지훈 ( Ji Hoon Kim ),서연석 ( Yeon Seok Seo ),이승화 ( Seung Hwa Lee ),정환훈 ( Hwan Hoon Chung ),송태진 ( Tae Jin Song ),이 대한간암학회 2009 대한간암학회지 Vol.9 No.-
Surgical resection is the treatment of choice for hepatocellular carcinoma (HCC) in non-cirrhotic patients. The optimal indication for resection is a single tumor in a suitable location for resection. However, limit of the tumor size is not clear. We report a case of successful hepatic resection in patients with massive HCC sized more than 15 cm that did not respond to transarterial chemoembolization (TACE). A 49-year-old male patient had received TACE two times for massive HCC. However, the tumor size increased. Right hemihepatectomy was performed despite the extensive tumor size and underlying liver cirrhosis. Ascites and wound infection were developed after resection, but the patient`s general condition got recovered soon. Until 6 months after surgery, recurrence has not been detected. However, distant metastasis was noted at 7th month. Although recurrence with distant metastasis was noted, we think aggressive surgical approach prolonged this patient`s survival.
안재홍 ( Jae Hong Ahn ),임형준 ( Hyung Joon Yim ),김승영 ( Seung Young Kim ),김정한 ( Jeong Han Kim ),서연석 ( Yeon Seok Seo ),이승화 ( Seung Hwa Lee ),정환훈 ( Hwan Hoon Chung ),송태진 ( Tae Jin Song ),이홍식 ( Hong Sik Lee ) 대한간암연구회 2009 대한간암학회지 Vol.9 No.-
Hepatic resection is a standard curative therapy for hepatocellular carcinoma (HCC) although only 10~30% of patients are indicated due to advanced stage or poor hepatic reserve. Five year survival rate after resection was reported as a mean of 55% (25~93%), but cases of early recurrence after hepatic resection had poor prognosis. As early recurrence after hepatic resection is the one of the most important factors that determines the prognosis, many investigators have been trying to determine the factors associated with early recurrence. We report a case of early multiple recurrence of HCC after curative hepatic resection probably due to microvascular invasion of tumor and too close resection margin. We would like to suggest that additional prophylactic measures need to be sought in this group of patients because these factors may influence on early recurrence.