Growth Differentiation Factor 15 Predicts Chronic Liver Disease Severity

( Eaum Seok Lee ),( Seok Hyun Kim ),( Hyun Jin Kim ),( Kyung Hee Kim ),( Byung Seok Lee ),( Bon Jeong Ku ) 대한간학회 2017 Gut and Liver Vol.11 No.2

Background/Aims: Growth differentiation factor 15 (GDF-15) belongs to the transforming growth factor-β superfamily. GDF-15 is emerging as a biomarker for several diseases. The aim of this study was to determine the clinical performances of GDF-15 for the prediction of liver fibrosis and severity in chronic liver disease. Methods: The serum GDF-15 levels were examined via enzyme immunoassay in 145 patients with chronic liver disease and 101 healthy individuals. The patients with chronic liver disease consisted of 54 patients with chronic hepatitis, 44 patients with compensated liver cirrhosis, and 47 patients with decompensated liver cirrhosis. Results: Of the patients with chronic liver diseases, the decompensated liver cirrhosis patients had an increased serum GDF-15 (3,483 ng/L) level compared with the patients with compensated liver cirrhosis (1,861 ng/L) and chronic hepatitis (1,232 ng/L). The overall diagnostic accuracies of GDF-15, as determined by the area under the receiver operating characteristic curves, were as follows: chronic hepatitis= 0.656 (>574 ng/L, sensitivity, 53.7%; specificity, 79.2%), compensated liver cirrhosis=0.886 (>760 ng/L, sensitivity, 75.6%; specificity, 92.1%), and decompensated liver cirrhosis= 0.984 (>869 ng/L, sensitivity, 97.9%; specificity, 94.1%). Conclusions: This investigation represents the first study to demonstrate the availability of GDF-15 in chronic liver disease. GDF-15 comprised a useful biomarker for the prediction of liver fibrosis and severity in chronic liver disease. (Gut Liver 2017;11:276-282)

담낭 용종의 진단과 관리에 대한 최신지견

이엄석 ( Eaum Seok Lee ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2

A polypoid lesions of the gallbladder (PLGs) is defined as any elevated lesion of the mucosal surface of the gallbladder wall. Even though most of the gallbladder polyps are benign in nature, malignant polyps are found in some cases. Because advanced gallbladder cancer displays poor prognosis, early detection and appropriate early measures are important for curative treatment and improvement in long-term survival. Patients who have GB polyps are usually almost always asymptomatic and often diagnosed incidentally by abdomen CT scan or transabdominal ultrasonography (TAUS) imaging. However TAUS and CT scan can not differentiate precancerous and cancerous lesions from cholesterol polyps. To increase the diagnostic accuracy, New imanging modality is being performed. Of the available tests, the accuracy of EUS (or CEH-EUS) for the differentiation of neoplastic from nonneoplastic polyps was higher than that of transabdominal US or CT scan. The cholecystectomy should be undertaken only in cases where there are clinical signs of gallbladder polyps, polyps with diameters greater than 10 mm, fast-growing polyps, sessile polyps or wide-based polyps, patient aged over 50, concurrent gallstones, polyps of the gallbladder in fundibulum or abnormal gallbladder wall US. Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations. guidelines on the screening interval are not yet available, but follow-up with the same modality is generally recommended after 3-6 months. If there are no changes in size, contour, or vascualrity, the follow-up should be individualized; most often a follow up after another 12-24 months could be recommended up to 5 years at least.

ERCP 연관 췌장염의 예방 및 치료

이엄석 ( Eaum Seok Lee ),김현수 ( Hyun Soo Kim ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.2

Complications that may occur after an endoscopic retrograde cholangiopancreatography (ERCP) procedure include pancreatitis, bleeding, cholangitis, cholecystis, perforation, and post-ERCP pancreatitis (PEP). Of these, PEP is the most common complication and 10% of patients can die from severe pancreatitis. Prevention of PEP requires the selection of an appropriate patient group according to their ERCP indications and a full awareness of the risk factors. The incidence rate can be reduced to some extent through medication and ERCP manipulation changes. The use of a spile through the guidewire during ERCP manipulation and temporary pancreatic duct stent insertion can be effective, and the administration of suppository NSAIDs as medication reduces the occurrence of PEP. Drugs such as glyceryl trinitrate (GTN), nafamostat, and somatostatin can be considered as the second best treatment in the cases where NSAIDs are contraindicated or where a plastic catheter cannot be inserted or fails after insertion into the pancreatic duct.

Atypical onset of liver injury case occurred by bicalutamide

( Seok Won Kim ),( Sung Hoon Kang ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Byung Seok Lee ),( Heon Young Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Androgen deprivation therapy has been the mainstay of treatment for metastatic prostate cancer and used for neoadjuvant or adjuvant treatment. It can cause gynecomastia, fatigue, and decreased libido through competitive androgen receptor blockade. Although not as common, drug-induced liver injury is possible with bicalutamide therapy. Typically bicalutamide induced hepatotoxicity occurred in a few days. Butin this case, hepatic injury occurred after 3 month later. An 62-year-old South Korean male with prostate cancer presented with jaundice started few days ago. He was took bicalutamide 100mg orally every day for 19 weeks prior to presentation of jaundice. Blood test revealed deranged liver function. Other etiologies of hepatitis were ruled out. Modified RUCAM scale score was 8. Abdomen CT finding was non-specific. Results of liver biopsy were acute intrahepatic cholestasis in zone 3 and sinusoidal dilation with moderate lobular inflammation. These mean that liver injury occurred by androgen, estrogen or glucocorticoid. Bicalutamide was discontinued right away and patient was managed with supportive care. He showed improvement of clinical and laboratory abnormalities within few weeks. While rare, clinically significant and potentially life-threatening liver injury can result from use of bicalutamide. Prompt recognition and discontinuation of bicalutamide is necessary to avoid serious complications. And regular liver function test should be checked during bicalutamide treatment not only in a few days but also after 3 month later.

ZLITHAMACR

( Byung Seok Lee ),( Seok Hyun Kim ),( Eaum Seok Lee ),( Ju Seok Kim ),( Jong Seok Joo ),( Hae Jin Shin ),( Hyuk Soo Eun ),( Woo Sub Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: To alert all the people to recklessly consuming herb medicines. Herbs are widely used in oriental medicine to treat various symptoms in South Korea. But, very few toxic effects have been described. Zizania latifolia, known as Manchurian wildrice is a plant easily accessible in rural areas in South Korea. It is believed that Zizania latifolia has beneficial effects for immunity, detoxification function, diabetes mellitus, arthritis as a folk remedy. Medicinal herb-induced liver injury reported on the literature ranges from mild elevation of liver enzymes to fulminant liver failure and liver cirrhosis. However, the toxicity of Zizania latifolia has not yet been described in the literature. A 57-year old woman was admitted to our hospital with the presentation of nausea, jaundice, generalized weakness, proximal muscle weakness that started from 1 to 2 weeks after consuming boiled wild rice. Laboratory investigations, imaging study, muscle biopsy were performed. The overall history, clinical manifestations and results of laboratory findings, histological findings, imaging study all are indicative of the diagnosis of Zizania latifolia-induced toxic hepatitis and symmetrical myopathy. She revealed fairly elevated aspartate aminotransferase: 1266U/L, alanine aminotransferase: 630U/L, total bilirubin: 11.1mg/dL, alkaline phosphphatase: 218U/L, lactate dehydrogenase: 2674U/L, creatine kinase: >15000U/L levels at peak hours. The recovery of her symptoms and elevated laboratory findings to some degree took approximately 2 weeks. She got discharged after 2 weeks of hospitalization with remaining mild muscle weakness and laboratory results of aspartate aminotransferase: 136U/L, alanine aminotransferase: 22U/L, total bilirubin: 5.5mg/dL, alkaline phosphphatase: 188U/L, lactate dehydrogenase: 673U/L, creatine kinase: 107U/L. Her follow-up 10 days after discharge showed remaining mild muscle weakness and still elevated laboratory findings. She has still been followed up. Here we report a rare case of Zizania latifolia-induced toxic hepatitis and myopathy to alert all the people to recklessly consuming herb medicines.

Case Report : A case of concomitant Gilbert`s syndrome and hereditary spherocytosis

( Hee Jung Lee ),( Hee Seok Moon ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Jae Kyu Sung ),( Byung Seok Lee ),( Hyun Yong Jeong ),( Heon Young Lee ),( Young Jae Eu ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3

We describe moderate hyperbilirubinemia in a 28-year-old man who suffered from gallstones and splenomegaly, with combined disorders of hereditary spherocytosis (HS) and Gilbert`s syndrome (GS). Since it is difficult to diagnose HS in the absence of signs of anemia, we evaluated both the genetic mutation in the UGT1A1 gene and abnormalities in the erythrocyte membrane protein; the former was heterozygous for a UGT1A1 allele with three mutations and the latter was partially deficient in ankyrin expression. This is the first report of the concomitance of HS and GS with three heterozygous mutations [T-3279G, A (TA)7TAA, and G211A] in the UGT1A1 gene. (Korean J Hepatol 2010;16:321-324)

HCC : PE-072 ; Hilar inflammatory pseudotumor mimicking hilar cholangiocarcinoma

( Min Jung Kim ),( Hee Seok Moon ),( Eaum Seok Lee ),( Seok Hyun Kim ),( Byung Seok Lee ),( Heon Young Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Inflammatory pseudotumor (IPT) of the biliary tract is a benign disease, and is a rare clinical and pathological entity. These tumors were so named because of the difficulty in distinguishing them from malignant lesions preoperatively. Thus, the clinical manifestations and imaging appearance of the tumor are similar to those of a malignant neoplasm of the biliary tract, its diagnosis often depends on pathological examination after operation. We present a case of IPT located at the porta hepatis, and elucidate that IPT in the right hepatic duct is especially difficult to distinguish from hilar cholangiocarcinoma. Case: A 81-year-old woman was admitted to our hospital with right upper quadrant abdominal pain. Blood tests showed increased serum ALP (239IU/L) and GGT (393IU/L), but hepatic parenchymal enzymes were normal. The level of serum AFP, CEA and CA19-9 were within normal ranges. The MRI showed abrupt obstruction of confluent portion of right IHD at liver hilum with dilatation of perihilar IHD, suggesting hilar cholangiocarcinoma initially. The patient underwent Rt. hepatectomy with Roux-en-Y hepaticojejunostomy. Histologically, the tumor confirmed a diagnosis of IPT of the plasma cell type. Conclusions: IPT is a non-specific chronic inflammatory lesion, however its pathogenesis and etiology remains unknown. Patients with IPT of the hepatic hilar biliary duct present with fever, jaundice, and manifestations indistinguishable from those of cholangiocarcinoma. Thus, patients with symptoms such as abdominal pain and jaundice, cases in whom the tumor mass tends to increase, and those in whom making the diagnosis is difficult, should be recommended to undergo surgical resection.

증례 : 소화기 ; 췌장 전이를 동반한 원발성 후두 소세포암 1예

홍순창 ( Sun Chang Hong ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),문희석 ( Hee Seok Moon ),정현용 ( Hyun Yong Jeong ),강대영 ( Dae Young Kang ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

원발성 폐외 소세포암은 드문 질환으로 위장관, 두경부, 비뇨생식기 등 전신에 걸쳐 발생하는 것으로 알려져 있다. 두경부의 소세포암은 후두부에 가장 흔하고, 절반 이상에서 경부 림프절 전이를 보이며, 14-18%에서 원격 전이를 보여, 예후가 불량한 것으로 알려져 있다. 저자들은 42세 남자의 후두에서 발생한 소세포암이 췌장으로 전이된 매우 드문 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Small cell carcinoma (SCC) is predominantly found in the lungs, and extrapulmonary small cell carcinoma (EPSCC) is a relatively rare disease, encompassing 2.5-4% of all SCCs. EPSCCs are commonly found in the esophagus, pancreas, skin, uterus, breasts, and prostate. SCC of the head and neck is aggressive and has a propensity for distant and regional spread. However, solitary metastasis to the pancreas is very rare. We report a case of laryngeal SCC with pancreatic metastasis in a 42-year-old man. The patient underwent resection of a primary SCC followed by a pylorus preserving pancreatoduodenectomy. (Korean J Med 2011; 80:S126-S130)

A Case of Spontaneous Esophagopleural Fistula Successfully Treated by Endoscopic Stent Insertion

강구흠,윤범용,김범희,문희석,정현용,성재규,Eaum Seok Lee 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.1

The most common cause of esophagorespiratory fistulas (ERFs) is associated with malignancy. The use of self-expandable metal stents is effective for the treatment of malignant ERFs, but benign ERF is rare, which is why its optimal treatment is not defined yet. There have been few reports describing benign esophagopleural fistula and its treatments in South Korea. Here, we report a rare case of spontaneous esophagopleural fistula, which was successfully treated by endoscopic placement of a membrane covered metal stent.

간경변을 동반한 간세포암종 환자에서 문맥 혈전증에 대한 항응고치료 3예

안병무 ( Byung Moo Ahn ),이엄석 ( Eaum Seok Lee ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),이헌영 ( Heon Young Lee ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1

The reported prevalence of PVT is in the range of 0.6-15.8% in patient with liver cirrhosis or portal hypertension. If the patient has hepatocellular carcinoma, thrombus is likely to be malignant thrombus. Malignancy, frequently of hepatic origin, is responsible for 21-24% of over all cases. The overall mortality rate of chronic PVT has been reported to be less than 10%, but is increased to 26% when associated with hepatocellular carcinoma and cirrhosis. However, no treatment guideline has been established on anticoagulant therapy for PVT in patients with concomitant hepatocellular carcinoma and cirrhosis. Because actually it is not easy to distinguish between malignant thrombus and benign thrombus in clinical aspect, PVT in hepatocellular carcinoma are still debatable whether or not treatment when it diagnosed. We present 3 cases of portal vein thrombosis successfully treated with anticoagulation in hepatocellular carcinoma and liver cirrhosis, and we include a literature review. (Journal of Liver Cancer 2015;15:57-63)