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이창돈(Chang Don Lee),서정민(Chong Min Seo),조현미(Hyun Mi Cho),한남익(Nam Ik Han),최상욱(Sang Wook Choi),정진우(Jin Wu Jeong),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.6
N/A Previously, we reported that subcutaneous daily injections of 3 MU recobinant interferon alpha-2b (INTRON A®) for 28 days (short-term therapy) was safe and effective in the decrement of serum hepatitis B viral (HBV) replication markers and transaminase levels transiently in patients with chronic active hepatitis (CAH) type B. Therefore, to evaluate the safety and efficacy of INTRON A® in patients with CAH type B on the loss of HBV replication markers according to the duration of administration, we followed up (9~24 months) and compared patient, who were divided into two random long-term and short-term therapy groups (previously they were transient on each group). Negative conversion of DNA polymerase activities and HBV DNA, and normalization of ALT levels were observed in similar proportions in each group, but these changes were found to be transient in the short-term compared to the long-term group proportionally. In comparison of the characteristics between responders (10 cases) and nonresponders (12 cases) to INTRON A® just before treatment, 5 out of 6 females responded, compared to a male response of 5 out of 6; the younger patients (31.9±5.9 years) responded significantly better than the older (39.9±12.1 years), (p<0.05); but changes in serum ALT and AST levels, DNA polymerase activities and peripheral blood mono-lymphocyte counts were not significantly reported in the short-term group. (12 cases) and long-term therapy group (3 MU, thrice weekly for 12 weeks, 7 patients; or 24 weeks, 3 patients). On entry into the trial, there was no significant difference between each group in respect ot several clinical, biochemical and HBV replication markers and histology. With respect to changes in HBV replication makers during or after INTRON A® treatment, HBsAg negative conversion cases were absent on each group. However, HBeAg negative conversion cases were observed in only 3 of 12 cases on the short-term group but in 7 of 10 cases in the long-term group (2 cases in HBeAg negative conversion defference). We did not observe serious complication during and after the INTRON A® treatment. We concluded that subcutaneous injection of 3 MU of INTRON A® was safe and effective in decreasing the level of HBV replication markers and tran-saminase activities in patients with CAH type B, but long-term therapy rather than short-term therapy was necessary for the eradication of HBe antigenemia and clinical improvment for an extended period of time.
B 형 만성활동성간염 환자에서 합성 Interferon Alpha 2b ( INTRON A(R) ) 의 효능 및 안정성 - 제 1 보 -
이창돈(Chang Don Lee),강무일(Moo Il Kang),유혜신(Hye Sin Yu),권혁호(Hyuk Ho Kwon),김재유(Jae Yoo Kim),정진우(Jin Woo Jeong),김부성(Boo Sung Kim) 대한내과학회 1987 대한내과학회지 Vol.32 No.6
N/A To evaluate the efficacy and safety of recombinant interferon alpha-2b (INTRONA®), in eleven patients with chronic active hepatitis (CAH) type B, a course of 28-day Intron A® was given daily subcataneous injection at a dose of 1 milion unit (MU) on the first day, 3 MU on the second, 5 MU on the 3rd to 7th, 3 MU on the 8th to 28th each. In 10 patients with HBeAg positive CAH type B, DNA polymerase and transaminoferase activities were assessed and compared before, during and after INTRON A administration. The peripheral blood white blood cell (WBC), granulocyte and platelet counts were checked. The results were as follows: 1) during administration of INTRON A, DNA polymerase activities were decreased significantly within first week and sustained in spite of persistent HBe antigenemia in all patients (p<0.05). Serum alanine aminotransferase (ALT) and aspartate aminotransferase were decreased significantly from 2 and 3 weeks after therapy respectively (p<0.01). 2) After discontinuation of INTRON A, improved transaminase level lasted for 4 weeks but rebound phenomena of DNA polymerase activities were observed 7 cases (70%) within 2 weeks, 3) during follow up period, transient increase of serum ALT activities were observed 9 cases within 12 weeks. One case of seroconversion (Anti-HBe) and one case of transient loss of HBeAg were observed at 16 week during mean follow up period of 30.3 weeks (range 16-58 weeks). But transient increment of serum ALT activities were observed 9 cases (90%) within 16 weeks. 4) In all 11 patients, peripheral white blood cell, granulocyte, platelet counts were decreased significantly within first week but not decreased further during INTRON A administration and recovered within 2 weeks after discontinuation of INTRON A. 5) Myalgia and fever were noted in 10 cases (91%) and headache and high fever (>38'C) were noted in 5 cases (45%) within 4 days. Mild anorexia (36%), hair loss (27%), diarrhea (9%), nausea (9%) were noted after 2 weeks. It suggested that subcutaneous injection of 3 MU INTRON A was safe and effective in decrement of DNA polymerase and transaminase activities in patients with CAH type B transiently. Long term therapy will be nessessary for the eradication of HBe Antigenemia and clinical improvement.
이창돈(Chang Don Lee),최상욱(Sang Wook Choi),박영민(Young Min Park),임계순(Kae Soon Im),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한내과학회 1988 대한내과학회지 Vol.34 No.6
N/A It is now generally accepted that the hpatitis R virus (HBV) is not directly cytopathic and that liver cell necrosis is dependent upon the hosts cellular immune response. To examine the pssible contribution of cellular immune regulatory mechanism to pathogenesis and progression of type B hepatitis in Korea, we evaluated the patterns of natural killer cell mediated cytotoxicity (NKMC) of peripheral blood lymphocyte in normal control subjects (25cases), asymptomatic carrier (AC; 18cases), acute viral hepatitis (AVH; 7cases) chronic active hepatitis (CAH;26cases), liver cirrhosis (LC;15cases) and primary hepatocellular carcinoma (HCC; 9 Cases). NKMC were assessed using 57Cr releasing cytotoxic assay against K562 target cells. The results were as follows: 1) In normal controls, NKMC were 52.8±8.1% (effector cell to target cell ratio; E:T=25:1) and 69.8±7.2% (E:T=50:1), No significant differences between male and female were seen. 2) In asymptomatic carrier, NKMC were 48.6±11.4% (E:T=25:1) and 68.1±7.8 (E:T=50:1). There was no significant difference between subjects with positive and negative hepatitis Be antigen. 3) In AVH and CAH, NKMC were 46.9±7.8%, 49.7±7.4% (E:T=25:1) and 65.4+4.5%, 67.5±6.2% (E:T = 50:1) respectively. There were no significant differences compared to normal controls, asymptomatic carrier, AVH and CAH. In eight cases of CAH combined with cirrhosis, NKMC (63.9±6.2) were significant lower than normal controls at E:T=50:1 (P<0.05). 4) In LC and HCC, NKMC were 37.3±13.1%, 37.2±13.8 (E:T=25:1) and 54.1±11.4%, 54.4±15.3% (E:T=50:1) respectively. They were significantly lower than in normal controls (P<0.01), And there were significant differencts compared to AVH 4 CAH (P<0.05). The NKMC of peripheral blood lymphocytes in asymptomatic HBV carrier and CAH were not significantly different each other. However, in LC and HCC there were significant differences compared to normal controls, 1t is suggested that NKMC was not relevant to the effector system af immunopathogenesis of liver cell injury in type B hepatitis virus infection Otherwise, depressed NKMC in LC might be one of the etiological factors in genesis of HCC in patient with LC.
간기능 이상을 동반한 혈액질환 환자에서 복강경하 간조직검사의 유용성
정규원(Kyu Won Chung),민우성(Woo Sung Min),김부성,김춘추(Chun Choo Kim),최황(Hwang Choi),김병욱(Byung Wook Kim),김보경(Bo Kyoung Kim),이창돈(Chang Don Lee),박재명(Jae Myung Park),최상욱(Sang Wook Choi),조세현(Se Hyun Cho),이영석(Young 대한내과학회 1999 대한내과학회지 Vol.56 No.4
N/A Objective : Hepatic dysfunction frequently occurs in patients with hematologic malignancies and aplastic anemia who receive intensive chemotherapy or bone marrow transplantation (BMT). The role of laparoscopic liver biopsy in patients with hematologic disorders is very important to determine the etiological factors and to make treatment decisions. The aim of the present study was to evaluate the possible causes of liver disease in patients with abnormal liver function tests. Methods : Laparoscopy guided liver biopsy was performed in 38 subjects who were receiving intensive cytotoxic therapy with BMT or without BMT. Two to three pieces of liver tissues were obtained in each patients using Vim-Silverman needle with electrocoagulation on biopsy site. Platelet transfusions were given if platelet count was less than 50,000/mm3. 39 biopsies were obtained in 38 patients. Results : At the time of liver biopsy, platelet count was 170,000±138000/mm3 (range: 42,000 - 798,000/mm3). No procedure-related complications were observed. Biopsy findings after BMT (n=16) revealed graft versus host disease (GVHD) (n=9), drug induced hepatitis (n=6), veno-occlusive disease (n=2), viral hepatitis (n=1), and nonspecific reactive hepatitis (n=1). 3 patients of GVHD associated with other liver diseases such as drug-induced hepatitis, veno-occlusive disease and chronic active hepatitis B. The authors compared histologic diagnosis with laparoscopic findings. Laparoscopic findings of the liver surface were classified by Shimada's code number system. 5 patients who were biopsed before BMT showed cholestasis and fatty changes and it was possible to be treated with allogenic BMT. Histologic diagnosis in patients without BMT (n=18) showed viral hepatitis (n=6), drug induced hepatitis (n=5), non-specific reactive hepatitis (n=1), and others (n=6). In 12 cases (31%) laparoscopic liver biopsy led to a change in medical management. Conclusion : Laparascopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients with hematologic disorders. The diagnosis obtained at laparoscopic liver biopsy could be changed the therapeutic plan in 12 of 39 (31%) patients.
김창욱 ( Chang Wook Kim ),이창돈 ( Chang Don Lee ) 대한간암학회 2013 대한간암학회지 Vol.13 No.1
Patients with hepatocellular carcinoma (HCC) may be suffered by various emergency conditions such as spontaneous rupture of HCC with intraperitoneal hemorrhage, variceal bleeding with portal vein tumor thrombus, hemobilia, obstructive jaundice, distant metastasis of HCC in central nervous system, spinal bone metastasis of HCC with cord compression and so on. These emergencies can be categorized into 4 types, conditions with spontaneous rupture of HCC, distant metastasis of HCC, direct invasion of HCC and paraneoplastic syndrome. According to HCC status and liver function, some these patients showed more beneficial effects with active palliative treatments than with best supportive cares. Various palliative treatments can be used such as surgical resection, transarterial chemoembolization, radiotherapy, systemic chemotherapy and combination of above therapies. We reviewed the emergencies in patients with HCC for improving survival and quality of life.
만성 간질환 환자에서 간섬유화의 정도와 혈청 히알루론산치를 이용한 간섬유화의 예측
김창욱 ( Kim Chang Ug ),윤승규 ( Yun Seung Gyu ),조병식 ( Jo Byeong Sig ),신주엽 ( Sin Ju Yeob ),장정원 ( Jang Jeong Won ),최종영 ( Choe Jong Yeong ),한남익 ( Han Nam Ig ),이창돈 ( Lee Chang Don ),정규원 ( Jeong Gyu Won ),선희식 ( 대한소화기학회 2003 대한소화기학회지 Vol.42 No.6
Backgrounds/Aims: The extent of hepatic fibrosis is important in chronic liver disease. Liver biopsy is essential for diagnosis of fibrosis. However, biopsy is invasive and may not represent the whole liver state. Serum hyaluronic acid (HA), a major component of connective tissues, was introduced as a useful non-invasive index of hepatic fibrosis. The aim of this study was to evaluate the relationship among HA, the degree of fibrosis, several hematologic and biochemical parameters in patients with chronic liver diseases or post state liver transplantation (PSLT). Methods: Total 102 cases were divided into 4 groups: 57 chronic hepatitis (CH), 12 cirrhosis, 21 hepatocellular carcinoma (HCC), 12 PSLT. HA was measured by enzyme-linked binding protein assay and evaluated in relation the degree of fibrosis, several hematologic and biochemical parameters. Results: Among four groups, HCC showed the highest HA and HA of HCC significantly higher than that of CH. The degree of fibrosis were correlated with HA. HA was correlated with age, platelet count and albumin but, not with ALT and PT. There is no significant relation between HA and the presence of acute rejection in liver transplantation. Conclusions: In chronic liver diseases, HA is a useful non-invasive index of hepatic fibrosis and disease severity. (Korean J Gastroenterol 2003;42:510-518)