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유선홍,권정현 대한소화기학회 2019 대한소화기학회지 Vol.74 No.5
A HBV infection is a dynamic disease and long-term liver inflammation contributes to the development of liver cirrhosis and hepatocellular carcinoma. Currently available nucleos(t)ide analogues and pegylated interferon are effective in inhibiting HBV replication but rarely achieve HBsAg clearance. The present article introduces a new definition of HBV cure and several emerging therapies for HBV cure, including direct acting antivirals and immune modulatory antivirals.
유선홍,김순선,김상균,권정현,이한아,서연석,정영걸,임형준,송도선,강성희,김문영,안영환,한지은,김영석,장영,정승원,장재영,유정주 대한간암학회 2023 대한간암학회지 Vol.23 No.1
Background/Aim: Abdominal ultrasonography (USG) is recommended as a surveillance test for high-risk groups for hepatocellular carcinoma (HCC). This study aimed to analyze the current status of the national cancer surveillance program for HCC in South Korea and investigate the effects of patient-, physician-, and machine-related factors on HCC detection sensitivity. Methods: This multicenter retrospective cohort study collected surveillance USG data from the high-risk group for HCC (liver cirrhosis or chronic hepatitis B or C >40 years of age) at eight South Korean tertiary hospitals in 2017. Results: In 2017, 45 experienced hepatologists or radiologists performed 8,512 USG examinations. The physicians had a mean 15.0±8.3 years of experience; more hepatologists (61.4%) than radiologists (38.6%) participated. Each USG scan took a mean 12.2±3.4 minutes. The HCC detection rate by surveillance USG was 0.3% (n=23). Over 27 months of follow-up, an additional 135 patients (0.7%) developed new HCC. The patients were classified into three groups based on timing of HCC diagnosis since the 1st surveillance USG, and no significant intergroup difference in HCC characteristics was noted. HCC detection was significantly associated with patient-related factors, such as old age and advanced fibrosis, but not with physician- or machine-related factors. Conclusions: This is the first study of the current status of USG as a surveillance method for HCC at tertiary hospitals in South Korea. It is necessary to develop quality indicators and quality assessment procedures for USG to improve the detection rate of HCC.
유선홍,장정원,권정현,정승민,장보현,최종영 대한간학회 2016 Clinical and Molecular Hepatology(대한간학회지) Vol.22 No.4
Background/Aims: Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. Methods: This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. Results: Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P=0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P=0.013), hypoalbuminemia (HR=3.990, P=0.015), and absence of antiviral therapy (HR=7.597, P=0.006) were significantly associated with treatment-related hepatic decompensation. Conclusions: Our findings suggest that preemptive antiviral therapy significantly reduces the risk of acute hepatic deterioration. Preventing hepatic deterioration during TACE by applying such a preemptive approach may facilitate the continuation of anticancer therapy and thus improve long-term outcomes. (Clin Mol Hepatol 2016;22:458-465)
유선홍,진승원,허성호,윤희정,김형두,임윤선,승기배,김재형 대한심장학회 2009 Korean Circulation Journal Vol.39 No.6
Coronary stent fractures have been suggested as a potential new mechanism of restenosis. The mechanical properties of stents were designed not only to prevent vessel recoil, but also to resist the mechanical stress of vessel movement over millions of cardiac cycles. We present a case in which mechanical stress may have contributed to the fracture of a stent implanted in a saphenous vein graft (SVG) to the left coronary artery. The patient was admitted due to chest pain 2 years after receiving a coronary artery bypass graft. A coronary angiography revealed the culprit vessel to be the SVG to the left coronary artery. The graft was stenosed and was stented with a sirolimus- eluting stent. A 6-month follow-up coronary angiography revealed 80% in-stent restenosis with stent fracture. We re-intervened by balloon angioplasty. This is the first report of sirolimus-eluting stent fracture combined with restenosis of SVG in Korea. Coronary stent fractures have been suggested as a potential new mechanism of restenosis. The mechanical properties of stents were designed not only to prevent vessel recoil, but also to resist the mechanical stress of vessel movement over millions of cardiac cycles. We present a case in which mechanical stress may have contributed to the fracture of a stent implanted in a saphenous vein graft (SVG) to the left coronary artery. The patient was admitted due to chest pain 2 years after receiving a coronary artery bypass graft. A coronary angiography revealed the culprit vessel to be the SVG to the left coronary artery. The graft was stenosed and was stented with a sirolimus- eluting stent. A 6-month follow-up coronary angiography revealed 80% in-stent restenosis with stent fracture. We re-intervened by balloon angioplasty. This is the first report of sirolimus-eluting stent fracture combined with restenosis of SVG in Korea.
간세포암종 환자에서 경동맥화학색전술 이후 발생한 척수원추증후군
유선홍 ( Sun Hong Yoo ),배시현 ( Si Hyun Bae ),성필수 ( Pil Soo Sung ),김희언 ( Hee Yeon Kim ),송도선 ( Do Seon Song ),송명준 ( Myeong Jun Song ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),천호종 ( Ho Jong Chun ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Hepatocellular carcinoma (HCC) is the fourth most common cancer in Korea and a common cause of cancer death. Transcatheter arterial chemoembolization (TACE) is used as palliative therapy for patients with inoperable HCC. TACE is an effective treatments for inoperable HCC, but variable complications due to using embolic agents can occur after TACE. Complications due to embolic agents include pulmonary lipiodol embolism, splenic infarction, cerebral lipiodol infarction, and spinal cord injury. This is a rare case of spinal cord injury after a sixth TACE via right T9 intercostal artery.
유선홍 ( Sun Hong Yoo ),배시현 ( Si Hyun Bae ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Transcatheter arterial chemoembolization (TACE) is one of the most effective treatments for patients with inoperable hepatocellular carcinoma (HCC). However, variable complications can occur after TACE. Complications resulting from TACE contain postembolization syndrome, liver abscess, bile duct injury, ruptured HCC, acute hepatic failure, variceal bleeding, acute kidney injury, pulmonary lipiodol embolization, femoral artery pseudoaneurysm, femoral arteriovenous fistula, abdominal aortic dissection, spinal cord injury, and others. Complications after TACE are occasionally fatal. Therefore, it is important that we are well acquainted ourselves with these complications, and need care promptly the patient who develop symptoms of complication.
이재민,유선홍,손원,박영민,백소야 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
서론: 간세포암종은 주로 영상검사로 진단되며 고위험군에서 초음파로 선별된 1 cm 이상의 간 결절이 역동적 조영증강 CT 혹은 MRI, 간세포특이조영제 이용 MRI중 하나 혹은 둘 이상에서 합당한 소견이 있으면 대부분 진단되나 때때로 생검을 통한 확진이 요구된다. 영상학적으로 간세포암종이 의심되었으나 조직학적으로 부분 지방침착 결과를 보인 2예를 보고하고자 한다. 증례 1: 37세 남자 환자는 외부 시행 초음파 및 CT상 간세포암종 의심소견보여 입원하였다. 간경변증의 증거는 없었으며 HBsAg 및 Anti-HCV 음성, AFP 2.83 ng/mL, 2번 간구역에 1.5 cm의 동맥기 조영증강, 지연기 조영감소를 보이는 종괴가 관찰 되었다. MRI상 동일 간구역에 2 cm의 타원형 종괴가 T2 강조영상에서 중등도/고신호강도로, T1 강조영상에서 고신호강도로 나타났다. 또 동맥기 조영증강이 지연기 조영감소없이 나타났고 확산강조영상에서 제한보여 고분화도 간세포암종(LR4A) 혹은 고도의 이형성 결절이 의심되었다. 병변에 대한 침핵생검 시행하였고 심한 지방변성으로 진단되었다. 증례 2: 38세 카자흐스탄 남자는 알코올성 간경변증 환자로 카자흐스탄 병원에서의 영상검사상 간세포암종 진단받고 간동맥화학색전술 1회 시행 및 Sorafenib 투약 후 내원하였다. AFP 2.74 ng/mL, 초음파상 간 전체의 비균질 투과도와 함께 왼엽의 고에코성 종괴성 병변이 관찰되었고 MRI상 전체적 비균질 신호강도와 분엽상 간음영, 결절성 경계를 보였다. 초음파의 고에코성 병변에 대해 침핵생검 시행하였고 세포 주위 섬유증이 동반된 심한 지방변성으로 진단되었다. 고찰: 최근 CT, MRI의 질적 향상으로 간세포암종 영상 진단의 민감도가 높아 졌음에도 조직검사를 통한 확진이 요구되는 경우가 적지 않다. 이에 영상검사에서 간세포암종 의심되었으나 양성 병리소견 보인 증례를 보고하고자 한다.