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유태현,한광협,박성하,김형길,문영명,한재호,조상호 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2
Recent advances in both the diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the recently increasing distant metastases. Distant metastases found after successful treament of the primary lesions are of great clinical significance for the treatment of hepatocellular carcinoma. The duodenum is a rare site of hematogenous metastases or direct invasion from hepatocellular carcinoma. A 23 year old man was admitted with upper gastrointestinal bleeding. He had been diagnosed with hepatocellular carcinoma and treated by a left lobectomy and chemoembolization. The patient was admittted for 12 months after the treatment of the primary tumor. Endoscopic examination revealed a mass in the duodenal bulb that protruded into the lumen. He died due to massive hematemesis. We report on a rare case of hepatocellular carcinoma with duodenal invasion in a 23-year-old male patient.
침 시술로 발생한 Non-O1, Non-O139 Vibrio cholerae에 의한 패혈증
임태섭,지아영,이중희,장수연,김인수,김영주,김범경,김승업,박준용,안상훈,한광협,김도영 Ewha Womans University School of Medicine 2013 EMJ (Ewha medical journal) Vol.36 No.S
Vibrio cholerae is mainly known to cause gastrointestinal infection after seawater exposure or raw seafood intake. It is rarely reported to cause cellulitis or sepsis, but threre has been no known case after acupuncture. Herein, We report a 56-year-old cirrhotic patient of non-O1, non-O139 Vibrio cholerae septicemia caused by cellulitis of both lower extremities after acupuncture.
원발성 간암환자의 간염 바이러스 감염유형에 따른 임상양상 및 예후
한광협(Kwang Hyub Han),문희용(Hee Yong Moon),김범수(Bum Soo Kim),백용한(Yong Han Paik),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한내과학회 2001 대한내과학회지 Vol.60 No.1
N/A Background : Hepatocellular carcinoma(HCC) is one of the important causes of cancer-related mortality and morbidity in East Asia, including Korea. Most of the hepatocellular carcinoma in Korea are associated with hepatitis B and C virus infection. The clinical characteristics and prognosis of the patients with HCC were evaluated in relation to the type of hepatitis virus. Methods : A retrospective analysis of the clinical data and survival rate was done in 603 patients(M:F=4.9:1, mean age; 54.2 years) who were admitted to Yonsei medical center from April, 1991 through April, 1994. Results : Among 603 patients, tests for HBsAg and anti-HCV was done simultaneously in 455 patients. Out of the 455 HCC patients, 303 patients (66.6%) were classified as Group B(HBsAg+ve, anti-HCV-ve), 102 patients (22.4%) were classified as Group C (HBsAg-ve, anti-HCV+ve), 45 patients (9.9%) were classified as Group non-BC (HBsAg-ve, anti-HCV-ve), and 5 patients (1.1%) were classified as Group BC (HBsAg+ve, anti-HCV+ve). The mean age of the patients in Group C was older than that of Group B (64.9 vs. 51.3 yr) (p<0.05). Liver cirrhosis was frequently noticed in Group C than Group B (84.3 vs. 68.0%) (p<0.05). The number of the patients whose serum FP level was elevated (>400 ng/mL) was significantly higher in Group B than in Group C (70.0 vs. 52.0%)(p<0.05). According to the gross type, nodular type was more common in Group C than in Group B(72.0 vs. 38.1%) (p<0.01). The incidence of portal vein thrombosis was significantly lower in Group C compared with that in Group B (16.7 vs. 31.4%)(p<0.05). The number of the patients whose tumor size of less than 5 cm was significantly higher in Group C than in Group B (35.3 vs. 17.8%) (p<0.05). Using multivariant analysis, independent prognostic factors were found to be Child grading, FP level, size of the tumor, gross type, and the type of hepatitis virus. The cumulative survival rate of 1, 2, and 3 year in each Group was 31.5%, 17.5%, and 10.8%, respectively in Group B, and 55.7%, 30.2%, and 21.6%, respectively in Group C. The median duration of survival of Group B was significantly shorter than that of Group C(5.0 vs. 13 months)(p<0.05). Conclusion : About 90 % of HCC was associated with hepatitis B or C viral infection in Korea. Hepatitis B virus associated HCC had poorer prognosis compared with hepatitis C virus associated HCC in Korea.(Korean J Med 60:22-31, 2001)
Han, Kwang-Hyub,Kudo, Masatochi,Ye, Sheng-Long,Choi, Jong Young,Poon, Roonni Tung-Ping,Seong, Jinsil,Park, Joong-Won,Ichida, Takafumi,Chung, Jin Wook,Chow, Pierce,Cheng, Ann-Lii S. Karger AG 2011 Oncology Vol.81 No.suppl1
<P>Abstract</P><P>Hepatocellular carcinoma (HCC) is a highly prevalent disease in many Asian countries, accounting for 80% of victims worldwide. Screening programs improve the detection of early HCC and have a positive impact on survival, but the majority of HCC patients in Asia still present with advanced stage disease. The treatment outcomes of HCC are affected by multiple variables, including liver function, performance status of the patient, and tumor stage. Therefore, it is not easy to apply a multidisciplinary therapeutic approach for optimal management. At present, limited numbers of HCC patients are eligible for curative therapies such as surgery or ablation in Asia. Therefore, most patients are eligible for only palliative treatments. For optimal management, the treatment choice is guided by staging systems and treatment guidelines. Numerous staging systems have been proposed and treatment guidelines vary by region. According to the Barcelona Clinic Liver Cancer (BCLC) guideline based on evidence from randomized clinical trials, only transarterial chemoembolization (TACE) is recommended for intermediate stage HCC and sorafenib for advanced stage HCC. However, treatment guidelines from Asian countries have adopted several other therapeutic modalities such as a surgical approach, hepatic arterial infusion chemotherapy, external radiation, and their combinations based on clinical experiences for intermediate and advanced stage HCC. Although TACE is the main therapeutic modality in the intermediate stage, overall therapeutic outcomes depend on the tumor size. In the advanced stage, the prognosis depends on the tumor status, e.g. major vessel invasion or extrahepatic spread. Thus, a new staging system representing prognoses suitable for Asian HCC patients and a corresponding optimal treatment algorithm should be further investigated using evidence-based data, which will finally bring about an Asian consensus for the management of intermediate and advanced stage HCC.</P><P>Copyright © 2011 S. Karger AG, Basel</P>
사염화탄소에 의해 활성화된 간성상세포에서 G1 Cyclin 및 Rb-E2F 의 발현과 비타민 E 의 효과
이광재(Kwang Jae Lee),이관식(Kwan Sik Lee),한광협(Kwang Hyub Hahn),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),오상환(Sang Hwan Oh),김호근(Ho Keun Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Background/Aims: It is obscure when the activation of hepatic stellate cells and the expression of its related factors occur in acute liver injury. Vitamin E is expected to prevent hepatic fibrosis. The aims of this study were to establish the model of hepatic stellate cell activation in acute liver injury and to confirm the effect of vitamin E for preventing hepatic fibrosis. Methods: Male Sprague-Dawley rats were classified into two groups. The one group received a single injection of CCl4 and the other group received injection of vitamin E daily and a single injection of CCl4. The serial changes of serum ALT, and [3H]thymidine uptake, α-SMA, cyclin D1, CDK4, cyclin E, CDK2, Rb, E2F-1 and NF-κB of stellate cells were measured. Results: The serial changes of serum ALT levels, [3H]thymidine uptake, and α-SMA positive cells showed maximum increase at 32 hours after CCl4 injection. However, they were significantly decreased with injection of vitamin E. CDK4, cyclin E and CDK2 showed definite band at 16, 32, 48 hours after CCl4 injection, which diminished or disappeared with injection of vitamin E. Cyclin D1, Rb, E2F-1 and NF-κB showed definite band at 32 hours after CCl4 injection, which also diminished or disappeared with injection of vitamin E. Conclusions: We established an in vivo model of hepatic stellate cell activation in acute liver injury and confirmed the effect of vitamin E in preventing hepatic fibrosis. (Korean J Gastroenterol 2001;38:262-269)
종설 : FibroScan(R)을 이용한 간탄력도 검사
한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5
Progressive liver fibrosis is a similar feature of all chronic liver diseases and eventually develops liver cirrhosis. The prognosis and treatment plans of chronic liver diseases depend strongly on the degree of liver fibrosis. These facts raise clinical interests in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative non-invasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new non-invasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few years notably with the appearance of several serological markers which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation, cost problems, and influences of extrahepatic conditions make it less accessible to clinicians. Recently, liver stiffness measurement using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally non-invasive and reproducible and gives an immediate result without intra- and inter-observer variability. Its clinical use in comparison with liver biopsy and several available serologic markers is now intensively being investigated. Here, we review the currently available data on FibroScan(R).(Korean J Med 74:463-471, 2008)