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초기 간세포암종을 동반한 간경변증 환자에서 생존 예측에 있어서의 간정맥압력차와 연관인자
김태엽 ( Tae Yeob Kim ),김문영 ( Moon Young Kim ),장재영 ( Jae Young Jang ),석기태 ( Ki Tae Suk ),정승원 ( Soung Won Jeong ),김동준 ( Dong Joon Kim ),손주현 ( Joo Hyun Sohn ),백순구 ( Soon Koo Baik ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1
Background/Aims: To analyze the usefulness of hepatic venous pressure gradient (HVPG) in survival prediction in cirrhotic patients with early and very early hepatocellular carcinoma (HCC). Methods: We consecutively collected data of 45 stable cirrhotic patients (male 41, median age 57.2 years, BCLC A 29) with early-stage HCC undergoing HVPG measurement. Prognostic accuracy of HVPG was analyzed by the area under curve (AUC). Survival curves and the associated factors of HVPG status were obtained using Kaplan-Meier method and logistic regression analysis, respectively. Results: The AUC value for prediction of survival by HVPG were 0.754 (95% CI, 0.603-0.870, P=0.006). The cut-off value of HVPG to predict death was 12 mmHg. Among the 45 patients, 11 patients (24.4%) died: 11 of 28 patients in the high HVPG group and none of 17 patients in the low HVPG group during followup period (P=0.003). The survival rate with high HVPG group was higher than those of low HVPG group (log rank P=0.008). In Child-Turcott-Pugh (CTP) class, the survival rate with CTP A class was higher than that with CTP B class (log rank P<0.001). The only associated factor with HVPG ≥12 mmHg in CTP A class and early-stage HCC was the presence of medium or large sized esophageal varices (odds ratio 66.8, 95% CI, 1.3-3530.4, P=0.038). Conclusions: HVPG ≥12 mmHg may be suggested a predictor of survival in cirrhotic patients with early-stage HCC. In CTP A class, the presence of medium or large sized esophageal varices were associated with high HVPG.
( Tae Yeob Kim ),( Joo Hyun Sohn ),( Soon Ho Um ),( Yeon Seok Seo ),( Soon Koo Baik ),( Moon Young Kim ),( Jae Young Jang ),( Soung Won Jeong ),( Young Seok Kim ),( Sang Gyune Kim ),( Dong Joon Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Carvedilol, a potent non-cardioselective beta blocker with vasodilating properties due to alpha-1 blockade, is more effective in reducing portal pressure than propranolol in randomized controlled hemodynamic studies. Recently, longterm low dose of carvedilol may be suggested an option for primary prophylaxis in patients with high-risk esophageal varices. The aim of this study is to evaluate long-term effect of carvediolol versus propranolol on reduction in portal pressure in patients with cirrhosis. Methods: We conducted this ongoing prospective randomized multicenter study (target sample size: 130 patients) between July 2011 and February 2013 and analyzed clinical and hemodynamic measurement data of 99 cirrhotic patients with severe portal hypertension (HVPG > 12 mmHg). During that period, these patients were randomized to either carvedilol (mean dose 11.6±2.2 mg/day in 50 patients) or propranolol group (mean dose 153.5±100.2 mg/day in 49 patients). After randomization, 8 patients and 11 patients were dropped out in carvedilol and propranolol group, respectively. The responders were defined to achieve a fall in HVPG to < 12 mmHg or a 20% reduction from baseline values 6weeks after treatment. Results: There were no significant differences between carvedilol and propranolol group in age, sex, etiology, Child-Turcott- Pugh score, MELD score, severity of HVPG, presence of ascites and baseline serum parameters. In per-protocol analysis, the rate of responder of patients with receiving carvedilol was 54.8% (23/42) as compared with 45.2% (16/38) of those with receiving propranolol (P=0.258). In intent-to-treat analysis, the rate of responder between carvedilol and propranolol group were 46.0% and 32.7%, respectively (P=0.174). The mean decrease of HVPG was 15.6±18.1% and 8.1±30.1%, respectively (P=0.188). Finally, there was no significant difference in adverse events between two groups. Conclusions: In this interim analysis, low dose of carvedilol showed similar effi cacy in reducing portal pressure compared to propranolol in cirrhotic patients with severe portal hypertension.
김기엽(Ki-Yeob Kim),윤규호(Kyoo-Ho Yoon),전인성(In-Sung Jun),김태열(Tae-Youl Kim),장정용(Jung-Yong Jang),반재혁(Jae-Hyurk Ban) 대한구강악안면외과학회 2004 대한구강악안면외과학회지 Vol.30 No.3
Actinomycosis is a rare form of disease that is caused by Actinomyces such as A. israelii and A. bovis, which may take the form of chronic, purulent inflammation of deep tissue evolves with necrosis, formation of sinuses and fibrotic mass. This disease arises in the head and neck area mainly in 55% and other places like that chest and the gastrointestinal tract occurs in 45%. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. Our case was 44-year-old man having painful indurated mass in his left TMJ area, otorrhea in his left ear and trismus. He was treated with surgical excision and biopsy confirmed actinomycosis. And after that, he was cured successfully with antibiotic therapy. We report this case of actinomycosis that developed in the left TMJ area with review articles.
( Jeong Won Jang ),( Jeong Ju Yoo ),( Young Seok Kim ),( Hyun Young Woo ),( Chung Hwan Jun ),( Sung Kyu Choi ),( Chang Hyeong Lee ),( Tae Yeob Kim ),( Yu Rim Lee ),( Won Young Tak ),( Jong Young Choi 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Background: Selection of high versus low potency antiviral drugs and the impact of maintained virologic response (MVR) on short-term and long-term outcome in patients with hepatitis B virus (HBV)-related decompensated cirrhosis are poorly established. This study aimed to evaluate the outcome regarding antiviral potency and HBV suppression in such patients followed for 10 years. Methods: This was an ancillary analysis of data collected in a prospective, multicenter study in which patients with first-onset decompensation were recruited since 2005. Eligible patients were HBV subjects who immediately initiated either entecavir or lamivudine at enrollment. The primary endpoint was liver transplantation (LT)-free survival. Other endpoints included the incidence of hepatocellular carcinoma (HCC) and changes in the Child-Turcotte-Pugh (CTP) and MELD scores on follow- up. Results: Of the 1,595 original cohorts, 295 (179 entecavir-treated and 116 lamivudine-treated patients) who met the eligibility criteria were included in this analysis. Overall, the median LT-free survival of the entire patients was 7.7 years. During the follow-up, 51 (17.3%) and 76 (25.8%) died or underwent LT before and after 6 months, respectively. Multiple decompensated complications and CTP class C were independent predictors of short-term mortality, whereas age and MVR remained independently predictive of long-term survival. The type of anti- HBV medications was not predictive of survival, but early and maintained VR predicted short-term and long-term survival, respectively. Particularly, MVR still significantly improved long-term survival for both the entire and baseline risk factor-adjusted groups. When stratified across the HBV DNA levels during follow-up, patients achieving maintained HBV suppression < 20 IU/mL exhibited a significantly better 10-year survival than those with fluctuating levels up to 200, 2,000, and persistently high >20,000 IU/mL (82.5%, 33.9%, 74.1%, and 45.9%, respectively; P<0.004). MVR resulted in significant improvement in hepatic function over time, but only marginal reduction in HCC development. Conclusions: Early and maintained suppression of HBV <20 IU/mL with anti-HBV therapy yields significant short- and long-term clinical benefits in decompensated patients. The survival benefits from MVR appear to be derived from progressive improvement in liver function rather than a reduction in HCC incidence.