밀란병기 이내로 진단된 간세포암 환자의 사망 원인분석

이현우 ( Hyun-woo Lee ),신동현 ( Dong Hyun Sinn ),강원석 ( Wonseok Kang ),곽금연 ( Geum-youn Gwak ),백용한 ( Yong-han Paik ),최문석 ( Moon Seok Choi ),이준혁 ( Joon Hyeok Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Pai 대한간암학회 2016 대한간암학회지 Vol.16 No.2

Background/Aims: Hepatocellular carcinoma (HCC) is a unique condition where the cause of death might not only be due to progressive cancer, but also from liver failure. We evaluated specific causes of death for HCC patients who were initially diagnosed within the Milan criteria. Methods: A retrospective cohort of 147 patients with mortality who were initially diagnosed with HCC within the Milan criteria between January 2008 and December 2012 at a single institution was reviewed. Results: During follow-up, 104 patients (70.7%) experienced one or more cirrhotic complications, such as ascites, variceal bleeding, or hepatic encephalopathy. Near mortality, cancer progression (exceeding the Milan criteria) was recorded for 102 patients (69.3%), while cirrhosis progression (greater than two-point increase in Child-Pugh score) was noted in 110 (74.8%) patients. Alphafetoprotein, protein-induced by vitamin K antagonist-II levels and treatment modality were associated with cancer progression, while age and Child-Pugh class were associated with cirrhosis progression. There were 61 patients with in-hospital mortality; cancer progression plus liver failure was noted in 34 patients (55.7%), liver failure without cancer progression was seen in 20 patients (32.8%), and only four patients (6.6%) showed mortality from extrahepatic metastasis without liver failure. Conclusions: Among HCC patients who were diagnosed within the Milan criteria, most of them had cirrhosis progression near mortality, and significant proportion died without uncontrolled cancer growth, mainly due to liver failure. These findings show the importance of liver function that should be considered in managing HCC patients. (J Liver Cancer 2016;16:101-107)

중합효소연쇄반응을 이용한 급성 C 형 간염 환자 혈청에서의 HCV RNA 의 검출

김상우(Sang Woo Kim),백승운(Seung Woon Park),김해엽(Hae Yob Kim),김은주(Eun Joo Kim),문인걸(In Gol Moon),한인권(In Kwon Han) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Background: Currently used anti-HCV (anti-C100-3) method to detect hepatitis C virus (HCV) shows relatively good sensitivity in the diagnosis of chronic non-A, non-R hepatitis infection, but poor results in acute hepatitis C infectin. Methods: We detected hepatitis C viral RNA (HCV- RNA) in a patient with transfuion-associated acute hepatitis by nested polymerase chain reaction (PCR) method. Results; By nested PCR method, HCV-RNA was detected at 11th week after transfusion, but by anti- C100-3 method, detected at 23th week. Conclusion: We report that the detection of HCV- RNA by nested PCR is more useful than anti-C100-3 in the early diagnosis of acute hepatitis C infection.

위암환자에서 이상 LDH 동위효소의 발현에 관한 연구

함기백(Ki Baik Hahm),김상우(Sang Woo Kim),백승운(Seung Woon Park),김은주(Eun Joo Kim),윤세옥(Se Ok Yoon),이성공(Sung Kong Lee),최광준(Kwang Jun Choi),김원호(Won Ho Kim),강진경(Jin Kyung Kang),박인서(In Suh Park),최흥재(Heung Jai Choi 대한내과학회 1992 대한내과학회지 Vol.43 No.1

N/A N/A

국내에서 개발된 대장통과시간 측정용 방사선 비투과성 표지자의 유용성

김지은(Jee Eun Kim),이풍렬(Poong Lyul Rhee),김영호(Young Ho Kim),성인경(In Kyung Sung),박동일(Dong Il Park),현재근(Jae Geun Hyun),이준행(Jun Haeng Lee),손희정(Hee Jung Son),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woo 대한내과학회 2001 대한내과학회지 Vol.60 No.4

N/A Background: Among various methods for measuring colon transit time, radio-opaque marker study is simple, reproducible and economical method. The commonly used marker, Sitzmarks? (Konsyl Pharmaceuticals Inc. Texas) had limitation in it s use due to expensiveness and difficulty in importation. We thought that the new domestic marker comparable to Sitzmarks is necessary and made a Kolomark (Korean colon marker )TM. The comparison of radio-opaqueness and the measurement of colon transit times by two markers were done. Methods: In two 1000 ml beakers, 350 ml of rice-gruel, sever al chicken-bones and ten rings of Sitzmarks? and KolomarkTM were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by Image and the value of pixels were obtained. These were repeated five times. Colon transit times were measured in 60 healthy persons stratified by age, 30 by Sitzmarks? and 30 by KolomarkTM. Results: The mean value of pixel of KolomarkTM was much lower than that of Sitzmarks?. The difference between background or beaker and KolomarkTM was much greater than that of Sitzmarks?. There was no significant difference between colon transit time studied by Sitzmarks? and KolomarkTM. Conclusion: KolomarkTM, a more radio-opaque and cheaper marker than Sitzmarks? will be applied usefully for measuring colon transit time.(Korean J Med 60: 337- 341, 2001)

십이지장 궤양을 동반한 진행성 위암 1예

김은주,백승운,함기백,김상우,홍성란,이성공,방수관,윤세옥 대한소화기내시경학회 1992 Clinical Endoscopy Vol.12 No.1

For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.

직장 화농성 육아종의 재발 1 예

김은주,정형진,백승운,김상우,윤세옥,김해엽 대한내과학회 1991 대한내과학회지 Vol.41 No.1

The most common sites of pyogenic granuloma are the gingiva, finger, lips, face, and tongue. Gastrointestinal involvement is very rare and there were only 2 reported cases in world literature which showed involvement of the esophagus and ilem with each other. However, there was no reported case involving the lower gastrointestinal mucosa and showing resurrence in the gastrointestinal mucosa after local excision. We experienced a case of recurrent pyogenic granuloma of the rectum in a 36-year-old woman who had tenesmus and intermittent rectal bleeding. We report this case with a review of the literature.

혈액투석 중인 만성 신부전 환자에서 TT Virus의 감염률과 임상적 의의

이용욱,허우성,도재혁,백승운,최문석,김소정,이준행,고광철,이풍렬,이종철,최규완,박상종,이준혁,김재준,오하영,임윤정 대한소화기학회 2001 대한소화기학회지 Vol.37 No.1

Background/Aims: TT virus (TTV) is a unenveloped, single-stranded and circular DNA virus isolated from the serum of a patient with posttransfusion hepatitis of unknown etiology. We evaluated the prevalence, risk factors, and clinical significance of TTV in patients with chronic renal failure(CCRF) undergoing maintenance hemodialysis (HD). Methods: We examined TTV DNA in serum of HD-undergoing patients and healthy controls using the nested polymerase chain reaction. Results: TTV DNA was detected in 15 (20.0%) of 75 HD-undergoing patients and 10 (13.2%) of 76 healthy controls (p$gt;0.05). The prevalence of TTV did not differ according to the duration of HD or transfusion history of the patients. The prevalence of TTV was higher in IgG anti-HBc positive patients than IgG anti-HBc negative patients (27.5% vs. 4.2%, p=0.03). There was no relationship between TTV infection and liver diseases. Conclusions: The prevalence of TTV infection in CRF patients undergoing HD was similar with that of healthy controls. These results suggest that TTV infection may share the route of transmission with HBV infection in adults.

위장관 간질종양의 임상 및 병리학적 고찰

김영호,장우영,이순진,손희정,최규완,도재혁,백승운,이준행,이풍렬,이종철,박철근,임윤정,김갑철,김재준,임효근 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Background & Aims: Gastrointestinal stromal tumor (GIST) constitutes primary nonepithelial neoplasms of the gastrointestinal tract and includes most tumors previously designated as leiomyomas/leiomyosarcomas. GIST is pathologically divided into benign, borderline and malignanct tumor. This study was carried out to delineate the clinical and pathologic features of GIST and to establish the features predicting malignancy. Methods: Clinicopathologic data of 84 patients who had GIST from 1995 to 1999 were reviewed. Results: The subjects were 42 men and 42 women, and their mean age was 59.3±13.2 years. We located fifty-two tumors in the stomach, 28 tumors in the small intestine and 4 tumors in the colorectum years. Histopathology revealed benign tumors in 23 of the 84 patients, borderline tumors in 22, malignant tumors in 39. The average size of tumors was 6.23 cm in diameter (range, 0.6-26 cm). Metastasis was noted in 15.5% of the patients at diagnosis. On endoscopy, ulceration was more common in malignancy. Endsonographic findings except size were not significant statistically. On contrast enhanced computed tomography, malignancy showed more irregular shape and variable attenuation than benign lesions, which seemed to be valuable factor. Conclusions: The variables predicting malignancy were large tumor size (≥5 cm), location of the colorectum, palpable abdominal mass, ulceration on endoscopy, and less uniformity in shape and variable attenuation on computed tomography.

간이식 대기 중인 간경변 환자에서 의미 있는 폐내 단락의 빈도와 이와 연관된 인자에 관한 연구

이지민,최문석,이상철,박승우,배문희,이준혁,고광철,백승운,이풍렬,김재준,이종철 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3

목적: 간폐증후군은 간질환이 있는 환자에서 저산소증이 유발되는 상태로서, 폐내 단락이 그 주된 기전으로 알려져있다. 간이식은 간폐증후군의 유일한 치료 방법으로 알려져 있고, 이식 후에 폐내 단락의 정상화가 일어날 수 있다. 그러나 간이식을 시행할 경우 가역성을 미리 예측할 수 없는 것이 문제이다. 국내에서는 이식 대기중인 간경변증 환자에서의 폐내 단락의 유병률에 관한 연구가 아직 없는 실정이다. 저자 등은 간이식 대기중인 간경변증 환자에서 의미 있는 폐내 단락의 유병률과 폐내 단락과 연관된 위험 인자를 알아보고자 하였다. 대상과 방법: 1999년 11월부터 2001년 2월까지 삼성서울병원 에서 간경변증이나 이에 동반된 간암으로 간이식 대기 중인 환자 57명 (남 : 여 = 38 : 19, 연령 18∼71 세, 중앙값 49세)을 대상으로 하였다. 간경변증의 원인은 B형 간염이 47명, C형 간염이 4명, 그 외 알코올과 윌슨병, 원발성 담도성 간경변증 등이 6명이었고, 전체 환자 중에 간암이 동반된 환자는 13명이었다. 이들에게 조영 증강 심초음파를 시행하여 폐내 단락의 유무 및 정도를 평가하였으며, Ⅱ등급 이상의 단락을 의미 있는 단락으로 보았다. 대상 환자를 의미 있는 단락을 가진 군과 그렇지 않은 군으로 나누어, 양 군 간의 간기능, 식도 정맥류 유무, 위 정맥류 유무, 복수, 간성 뇌증 유무를 비교하였다. 결과: 총 57명의 환자 중 의미 있는 폐내 단락을 가진 군 은 30명(52.6%)이었다. 의미 있는 폐내 단락은 Child- Pugh분류 C군에서 38명 중 24명(63.2%), A, B군에서 19명 중 6명(31.6%)으로 관찰되었다(p< 0.05). 의미 있는 폐내 단락이 있는 군과 없는 군 간의 성별, 나이, 간경변증 원인, 식도 정맥류 유무, 위 정맥류 유무, 복수, 간성 뇌증 유무 등에는 유의한 차이가 없었다. 결론: 이상의 결과로 폐내 단락은 간이식 대기중인 간경변증 환자에서 흔히 관찰되는 소견이며, Child-Pugh 분류 C군은 의미 있는 폐내 단락의 위험 인자임을 알 수 있었다. Backgrounds/Aims: Hepatopulmonary syndrome is a condition of severe hypoxia with intrapulmonary shunt (IPS) in the setting of hepatic dysfunction. Liver transplantation has been suggested as a definite treatment for hepatopulmonary syndrome with reversal of IPS in some patients. Inconsistency of response and inability to predict reversibility, however, are significant problems. We performed this study to evaluate the prevalence of significant IPS in pretransplantation cirrhotic patients and to find any risk factors of IPS. Methods: Fifty-seven patients (M:F = 38:19, median age 49 years (range 18 - 71)) with liver cirrhosis awaiting liver transplantation were serially included. Their IPS status was evaluated using contrastenhanced echocardiography. Significant shunt was defined as a shunt of grade ≥2. Results: Significant IPS was detected in 30 (52.6%) among 57 patients. Significant shunt was found in 24 (63.2%) of 38 Child-Pugh class C patients and in 6 (31.6%) of 19 Child-Pugh class A or B patients (p<0.05). No significant difference in prevalence of significant shunt was seen according to age, sex, presence or absence of hepatocellular carcinoma, ascites, hepatic encephalopathy, and gastroesophageal varix. Conclusion: Significant intrapulmonary shunt is a common finding in cirrhotic patients awaiting liver transplantation. Child-Pugh class C is the risk factor associated with high prevalence of significant shunt. (Korean J Hepatol 2002;8:271-276)

대장 선종성 용종의 악성화에 영향을 미치는 인자

김영호,이화영,김선우,박형석,손희정,김재준,배상수,최규완,백승운,고광철,이풍렬,이종철,박정호,박상종,천정학,심상군,김창섭 대한소화기학회 1999 대한소화기학회지 Vol.34 No.6

Background/Aims: The aim of this study was to investigate predictive factors for malignant transformation of colorectal adenomatous polyps in Korea. Methods: One thousand five hundred and eighty- nine sessions of colonoscopic polypectomy were performed from November 1994 to September 1998 for 1,375 patients with adenomatous polyps at Samsung Medical Center. We analyzed the 2,179 adenomatous polyps including 55 (2.5%) polyps with malignant transformation, retrospectively. Results: Six parameters showed significant differences in univariate (p$lt;0.01) and multivariate analysis. For each parameter, the proportions of malignant polyps were as follows: for number of polyps, 1.3% in cases of single polyp and 10.3% in cases of multiple polyps; for size, 1.4% of polyps less than 1 cm and 15.5% of polyps larger than 1 cm; for location, 4.6% of the polyps located in rectum or sigmoid colon and 1.1% of the polyps located in descending to ascending colon; for morphology, 0.9% in polyps of Yamada type I/II and 7.6% in polyps of Yamada type III/IV; for underlying histology, 1.4% in cases of tubular adenoma and 8.1% in cases of tubulovillous or villous adenoma; for degree of dysplasia, 1.2% in cases accompanied with low-grade dysplasia and 8.9% in cases accompanied with high-grade dysplasia. Conclusions: The malignant potential of colorectal adenomatous polyps in Korea is correlated with multiplicity, distal location, pedunculated shape as well as well-known factors like size, histologic type and degree of dysplasia.