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( Se Young Jang ),( Sang Jik Lee ),( Eun Jung Kang ),( Yoo Lim Lee ),( Young Oh Kweon ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: Endoscopic treatment for gastric variceal bleeding is sometimes difficult and ineffective to control compared to esophageal variceal bleeding. Balloon-occluded retrograde transvenous obliteration (B-RTO) was introduced for the treatment of gastric variceal bleeding, but reports regarding the long-term results about rebleeding are not well presented in Korea. The study was performed to evaluate the long-term follow up results of B-RTO. Methods: Forty four patients who underwent B-RTO for gastric variceal bleeding between 2001 and 2009 were included and analyzed retrospectively. We performed esophagogastroduodenoscopy (EGD) and/or abdominal CT during follow-up periods after B-RTO. Results: There were 34 males and 10 females and the mean age was 57.8±10.5 years. Patients were classified by Child-Pugh class (A=13, B=25, C=6) and followed up for 935.0±797.8 days. During follow-up, gastric varices disappeared in 13 (29.5%) and size of varices decreased in 15 (34.1%) patients. Rebleeding occurred in 19 (43.2%) patients, e sophageal variceal bleedings were more common than gastric variceal bleeding (11 vs 3). In cases of rebleeding of gastric varices, one-year and two-year cumulative bleeding rate were 4.5%, 7.7%, respectively. Conclusions: Long-term follow-up after B-RTO showed that even though rebleeding rate from gastric varix is low compared to TIPS or sclerothrapy, variceal bleeding was most common cause of death and bleeding from esophageal varices were more common than gastric variceal bleeding. These results suggest periodic endoscopic examinations and appropriate prophylactic measures are needed after B-RTO.
( Keun Young Shin ),( Jun Heo ),( Ji Yeon Kim ),( Sang Jik Lee ),( Se Young Jang ),( Soo Young Park ),( Min Kyu Jung ),( Chang Min Cho ),( Won Young Tak ),( Young Oh Kweon ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2
Radiofrequency ablation (RFA) is performed as an alternative to surgical resection for primary or secondary liver malignancies. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage occur in 8-9.5% cases. Hemocholecyst, which refers to hemorrhage of the gallbladder, has been reported with primary gallbladder disease or as a secondary event associated with hemobilia. Hemobilia, defined as hemorrhage in the biliary tract and most commonly associated with accidental or iatrogenic trauma, is a rare complication of RFA. Here we report a case of hemocholecyst associated with hemobilia after RFA for hepatocellular carcinoma that was successfully managed by laparoscopic cholecystectomy.
( Se Young Jang ),( Sang Jik Lee ),( Eun Jung Kang ),( Yoo Lim Lee ),( Young Oh Kweon ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Endoscopic treatment for gastric variceal bleeding is sometimes difficult and ineffective to control compared to esophageal variceal bleeding. Balloon-occluded retrograde transvenous obliteration (B-RTO) was introduced for the treatment of gastric variceal bleeding, but reports regarding the long-term results about rebleeding are not well presented in Korea. The study was performed to evaluate the long-term follow up results of B-RTO. Methods: Forty four patients who underwent B-RTO for gastric variceal bleeding between 2001 and 2009 were included and analyzed retrospectively. We performed esophagogastroduodenoscopy (EGD) and/or abdominal CT during follow-up periods after B-RTO. Results: There were 34 males and 10 females and the mean age was 57.8±10.5 years. Patients were classified by Child-Pugh class (A=13, B=25, C=6) and followed up for 935.0±797.8 days. During follow-up, gastric varices disappeared in 13 (29.5%) and size of varices decreased in 15 (34.1%) patients. Rebleeding occurred in 19 (43.2%) patients, e sophageal variceal bleedings were more common than gastric variceal bleeding (11 vs 3). In cases of rebleeding of gastric varices, one-year and two-year cumulative bleeding rate were 4.5%, 7.7%, respectively. Conclusions: Long-term follow-up after B-RTO showed that even though rebleeding rate from gastric varix is low compared to TIPS or sclerothrapy, variceal bleeding was most common cause of death and bleeding from esophageal varices were more common than gastric variceal bleeding. These results suggest periodic endoscopic examinations and appropriate prophylactic measures are needed after B-RTO.
Jung, Jang Han,Lee, Hyun Jik,Lee, Hee Seung,Jo, Jung Hyun,Cho, In Rae,Chung, Moon Jae,Park, Jeong Youp,Park, Seung Woo,Song, Si Young,Bang, Seungmin Baishideng Publishing Group Inc 2017 WORLD JOURNAL OF GASTROENTEROLOGY Vol.23 No.18
<P><B>AIM</B></P><P>To clarify the role of neoadjuvant concurrent chemoradiotherapy (NACCRT) followed by surgical resection for localized or locally advanced perihilar cholangiocarcinoma (CCA).</P><P><B>METHODS</B></P><P>We retrospectively reviewed 57 patients who underwent surgical resection with or without NACCRT for perihilar CCA; 12 patients received NACCRT and 45 patients did not received NACCRT. Patients with locally advanced perihilar CCA requiring NACCRT were defined as follows: (1) a mass involving unilateral branches of the portal vein or hepatic artery with insufficient volume of the anticipated remnant lobe; or (2) an infiltrating mass in the main portal vein that was too long for reconstruction, identified at preoperative staging.</P><P><B>RESULTS</B></P><P>The median disease-free survival (DFS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 26.0 and 15.1 mo, respectively (<I>P</I> = 0.91). The median overall survival (OS) durations of the neoadjuvant and non-neoadjuvant CCRT groups were 32.9 and 27.1 mo, respectively (<I>P</I> = 0.26). The NACCRT group showed a downstaging tendency compared to the non-NACCRT group as compared with the tumor stage confirmed by histological examination after surgery and the tumor stage confirmed by imaging test at the time of diagnosis (<I>P</I> = 0.01).</P><P><B>CONCLUSION</B></P><P>NACCRT does not prolong DFS and OS in localized or locally advanced perihilar CCA. However, NACCRT may allow tumor downstaging and improve tumor resectability.</P>
말기신부전 환자에서 Epoetin Alfa (에스포젠) 주 1회 요법과 주 2-3회 피하투여의 효과 비교
이영기 ( Young Ki Lee ),이형석 ( Hyung Seok Lee ),주민하 ( Min Ha Joo ),김성균 ( Seong Gyun Kim ),서장원 ( Jang Won Seo ),오지은 ( Ji Eun Oh ),윤종우 ( Jong Woo Yoon ),구자룡 ( Ja Ryong Koo ),김형직 ( Hyung Jik Kim ),노정우 ( Jung 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2
목적: 말기 신부전 환자에서 에리스로포이에틴 (epoietin)을 주 2-3회 피하 주사 하는 방법은 자주 주사해야 하는 번거로움 뿐만 아니라 주사할 때마다 매번 통증이 발생하기 때문에, 고용량의 epoetin를 일시에 투여하여 투여 간격을 늘리는 주 1회 요법이 시도되고 있다. 본 연구에서는 혈액투석을 받는 말기 신부전 환자에서 고용량 epoetin alfa의 주 1회 요법을 주 2-3회 피하 투여와 비교하여 그 효과와 안전성을 시험하였다. 방법: Epoetin을 피하 투여 중인 혈액투석 환자 83명을 주 1회 투여군 (n=44) 또는 주 2-3회 투여군 (대조군, n=39)으로 무작위 분류하였다. 각 군의 환자는 총 10회 방문 (스크리닝 2회, 이후 8회)하여 12주간 치료 반응을 관찰하였다. 주 1회 투여군은 10,000 IU의 주사를 사용하여 정해진 용량의 epoetin alfa를 주 1회 투여하고, 대조군은 4,000 IU의 주사를 사용하여 정해진 용량의 epoetin alfa를 주 2-3회로 나누어 투여하고 혈색소 수치가 9.0-12.0 g/dL 유지하도록 용량을 조정하였다. 결과: 투여 시작시, 4주, 8주, 12주에 혈색소는 주 1회 투여군은 10.7, 11.1, 11.3, 11.0 g/dL, 대조군은 10.5, 11.3, 11.5, 11.3 g/dL로 유의한 차이가 없었다. 투여 시작시, 4, 8, 12주의 epoetin alfa의 평균 투여량은 주 1회 투여군은 142.8, 123.0, 116.7, 112.3 IU/kg/week이며, 대조군 128.4, 119.3, 103.5, 101.2 IU/kg/week으로서 주 1회 투여군에서 다소 많은 경향을 보였으나 통계적인 유의성은 없었다. Epoetin alfa의 용량을 증가시키지 않고 혈색소 수치가 유지된 환자의 비율도 주 1회 투여군 95.5%, 대조군 92.3%으로 차이가 없었다. 결론: 고용량 epoetin alfa의 주 1회 요법은 목표 혈색소를 유지하는데 있어 epoetin alfa를 2-3회 나누어 투여하는 방법과 효과와 안정성 면에서 비슷하였다. 따라서 안정적인 혈액투석 환자에서 고용량 epoetin alfa의 주 1회 요법이 효과적인 방법으로 생각된다. Purpose: Compared with the practice of administrating subcutaneous erythropoietin injection two or three times a week in end-stage renal failure, a weekly administration reduces the frequency of injection and the workload in renal units. We investigated whether subcutaneous epoetin alfa administered weekly was as effective as the same weekly dosage given in two or three divided doses. Methods: Eighty-three patients were randomized to treatment with subcutaneous epoetin alfa either once a week (n=44), or to their original dosage two or three times a week (control, n=39) for 12 weeks. If hemoglobin was out of range (9.0-12.0 g/dL), the dosage was changed. Results: Mean hemoglobin levels at randomization and after 4, 8 and 12 weeks were 10.7, 11.1, 11.3 and 11.0 g/dL, respectively, in the once weekly group compared with 10.5, 11.3, 11.5 and 11.3 g/dL, respectively, in the control group. The mean weekly epoetin alfa dosage at randomization and after 4, 8 and 12 weeks were 142.8, 123.0, 116.7 and 112.3 IU/kg, respectively, in the once-a-week group compared with 128.4, 119.3, 103.5 and 101.2 IU/kg, respectively, in the control group. No statistically significant differences between the groups were apparent in changes in hemoglobin levels or epoetin alfa dosages at week 12. There was no significant difference between the groups in number of patients who maintained stable hemoglobin levels without epoetin alfa dose increases. Conclusion: This study demonstrates that a weekly subcutaneous administration of epoetin alfa is as effective and safe as injecting it two or three times a week administration in maintaining hemoglobin levels in stable hemodialysis patients.