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경정맥 간내문맥 - 간정맥 단락술로 십이지장정맥류 대량 출혈을 성공적으로 치료한 1 예
윤영준(Young Joon Yoon),한광협(Kwang Hyub Hahn),이도연(So Yun Lee),백용한(Yong Han Paik),정재연(Jae Yeon Chung),김철(Chul Kim),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Duodenal varices can be resulted from either liver cirrhosis or extrahepatic portal hypertension. Bleeding from duodenal varices is rare but often severe and life threatening. Bleeding of duodenal varices can be treated with non-surgical or surgical treatment. Non-surgical treatments include endoscopic variceal ligation, endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Surgical treatments include shunt surgery, variceal ligation, variceal resection, and duodenectomy. However, endoscopic treatments are not so effective and surgical interventions have many limitations. A 68-year-old man with liver cirrhosis was admitted to our department and presented with mental change and melena. He received a large amount of transfusion and it was not possible to perform gastrointestinal endoscopy. Emergency angiography revealed marked dilatation of mesenteric veins, which was treated by TIPS. After TIPS, transfusion requirement was markedly reduced and gastrointestinal endoscopy demonstrated duodenal varices without bleeding. We conclude that TIPS may be an effective therapeutic option for control of hemorrhage from duodenal varices. (Korean J Gastroenterol 2001;38:292-295)
Desferoxamine 이 시험관내 인체 간암세포 성장에 미치는 영향
송시영(Si Young Song),김원호(Won Ho Kim),전미연(Mi Yun Chon),한광협(Kwang Hyub Han),정재복(Jae Bock Chung),전재윤(Chae Yoon Chon),문영명(Young Myung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park),최흥재(Heung Jai Choi),윤정구(Jung 대한내과학회 1994 대한내과학회지 Vol.47 No.3
Objectives: It has been known that excessive iron promote the growth of cancer cells aad suggested that iron oversupply in cancer patients may enhance tumor growth and adversely affect cancer therapy and that desferoxamine (DFO) as a iron chelating agent may have a place in anticancer agents, which acts as a potent inhibitor of DNA synthesis via inhibition of the ribonucleotide reductase. However there have been no reports on the combined effect of DFO with other chemotherapeutics in vitro, This study was done to answer the questions: Does DFO inhibit the growth of cultured hepatoma cells? and Does the combination of DFO and chemotherapeutic agents have a synergistic effect on inhibition of tumor growth? Methods: Using PLC/PRF/5 and Hep G2 cells as hepatoma cells and normal diploid cells of WI-38 as control, the MTT assay was performed for evaluation of the cytotoxicity and an isobologram method to analyze the combined effects of DFO and other chemotherapeutic agents. Results: 1) The hepatoma cells grew faster in an iron-enriched medium than in the medium without additional iron supplementation but the normal diploid cells of WI-38 did not. 2) The 50% inhibitory concentrations (IC50) on PLC/ PRF/5 and Hep 62 cells were 75.1 and 29.1 ㎍/ml, respectively. But the growth of WI-38 was not inhibited below 74.4% with even 200 ㎍/ml of DFO. 3) On both hepatoma cells, the growth inhibitory effects of DFO were reversed with simultaneous administration of stoichiometric doses of ferric citrate. 4) Adriamycin (ADR), 5-fluorouracil (5-FU) and cisplatin (DDP) inhibited the growth of all 3 cell lines, but larger doses were required to inhibit the WI-38 to obtain the same effect. 5) When DFO was combined with chemotherapeutic agents, a marked synergistic effect was observed with the combination of DFO and 5-FU on PLC/PRF/5 cells. The synergistic effect was also noted in Hep G2 cells with all three combinations of DFO-ADR, DFO-5-FU and DFO-DDP. Conclusion: Iron oversupply may enhance the hepatoma growth and this should be taken into consideration treating patients with hepatoma. And the antitumor effect of DFO and its synergistic effect with other chemotherapeutic agents may suggest that iron chelator like the DFO may be a useful treatment for patients with hepatoma in conjuction with other anticancer drugs.
간세포암과 유사한 방사선학적 소견을 보인 간의 혈관근지방종 2예
나호균(Ho Guun Na),이용찬(Yong Chan Lee),윤영준(Young Jun Yun),정재연(Jae Yean Jung),조용석(Yong Suk Cho),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),김명진(Myeong Jin Kim),박영년(Young Nyun Park) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Hepatic angiomyolipoma (AML), a rare benign mesenchymal tumor, is composed of fatty tissue, proliferated blood vessels, and smooth muscle cells. Since the proportion of this three components is variable, radiologic and pathologic findings of the tumor can show different features, which makes its diagnosis difficult. On ultrasonography, it is usually a well defined hyperechoic mass and has occasional posterior enhancement of echoes as seen in hemangioma. On dynamic enhancement study, it shows not only prominent enhancement on the arterial-dominant phase and gradual hypoattenuation on the delayed phase, but also gradual and prolonged enhancement, and thus, it can be misdiagnosed as hepatocellular carcinoma or hemangioma. Positive reactivity for HMB-45, melanoma-specific antibody, makes the diagnosis possible and reactivity for smooth muscle actin confirms the diagnosis. We report two cases of hepatic AMLs, which were initially thought to be hepatocellular carcinomas because of early enhancement of the arterial phase and gradual hypoattenuation of the delayed phase on dynamic study of CT or MRI. One case was treated by chemoembolization of hepatic artery followed by hepatic resection, and the other was treated by hepatic resection after gun biopsy under ultrasound guidance. (Kor J Gastroenterol 2000;36:424 - 430)
절제불가능 원발성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법
성진실(Jinsil Seong),금기창(Ki Chang Keum),한광협(Kwang Hyub Han),이도연(Do Yun Lee),이종태(Jong Tae Lee),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),김귀언(Gwi Eon Kim),서창욱(Chang Ok Suh) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.2
목 적 : 간암의 최적치료는 수술적 절제로 알려져 있으나 진행성 병변 또는 동반된 간질환 등으로 인해 실제적인 절제는 매우 제한되고 있다. 이에 본 연구에서는 절제불가능 원발성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법을 시행하여 그 결과를 보고하는 바이다. 대상 및 방법 : 1992년 3월부터 1994년 8월까지 진행성 병변 및 간경변증 동반 등으로 절제 불가능으로 판정된 30명의 간암 환자가 본 연구에 포함되었다. 간외 전이가 있거나 간경변증의 정도가 Child’s C군으로 악화된 경우, 종양이 전체 간 용적의 2/3 이상을 차지하는 경우, 수행 능력이 ECOG 3기 이상인 경우 들은 제외되었다. 환자들의 특성은; 종양의 평균 직경이 8.95±3.4cm, UICC 병기 Ⅲ, ⅣA가 각각 10명, 20명, 간경변증 동반이 22명, 간문맥혈전증 동반이 11명, 혈중 alpha fetoprotein(AFP)은 모든 예에서 양성이었다. TACE는 리피오돌 5 ml와 항암제(Adriamycin 50mg)을 혼합하여 도관을 통하여 간동맥내 주입하고 이어서 교질 스폰지 입자(Gelfoam)로 색전술을 시행하였다. 방사선 치료는 TACE 후 7-10일 이내에 시작하였고 평균 조사량은 44.0±9.3 Gy로 전통적인 분할 방식으로 조사하였다. 결 과 : 30명중 19명에서 종괴의 부분관해를 보여서, 관해율은 63.3%를 보였다. 생존율은 1, 2, 3년에 각각 67, 33.3, 22.2%를 나타내었고, 중앙 생존기간은 17개월이었다. 부분관해를 보인 19명의 환자중 6명은 3년이상은 생존하였다. 치료로 인한 독성은 경미하였다. 일시적인 간기능 검사의 변화나 열감은 회복되었고 혈소판 감소증과 심한 오심 및 구토가 각각 4명, 1명에서 나타났으나 1-2 주의 치료 중단과 약물로써 회복되었다. 치료로 인한 독성과 관계되는 사망은 없었다. 결 론 : 절제불가능 원발성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법은 실질적으로 생존율 향상을 유도하면서 독성이 낮은 안전한 치료인 것으로 나타나, 향후 적극적인 임상적 적용으로 치료율의 향상이 기대된다. Purpose : The best prognosis for hepatocellular carcinoma can be achieved with surgical resection. However, the number of resected cases is limited due to the advanced lesion or associated liver disease. A trial of combined transcatheter arterial chemoembolization(TACE) and local radiotherapy(RT) for unresectable hepatocellular carcinoma(HCC) was prospectively conducted and its efficacy and toxicity were investigated. Materials and Methods : From 1992 to 1994, 30 patients with unresectable HCC due either to advanced lesion or to associated cirrhosis were entered in the study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child’s class C, tumors occupying more than two- thirds of the whole liver, and an ECOG scale of more than 3. Patient characteristics were : mean tumor size 8.95±3.4cm, serum AFP+ in all patients, portal vein thrombosis in 11 patients, liver cirrhosis in 22 patients, and UICC stage III and IVA in 10 and 20 patients, respectively. TACE was performed with the mixture of Lipiodol(5ml) and Adriamycin(50mg) and Gelfoam embolization. RT(mean dose 44.0±9.3Gy) was followed within 7- 10 days with conventional fractionation. Results : An objective response was observed in 19 patients(63.3%). Survival rates at 1, 2, and 3 years were 67%, 33.3% and 22.2%, respectively. Median survival was 17 months. There were 6 patients surviving more than 3 years. Distant metastasis occurred in 10 patients, with 8 in the lung only and 2 in both lung and bone. Toxicity included transient elevation of liver function test in all patients, fever in 20, thrombocytopenia in 4, and nausea and vomiting in 1. There was no treatment-related death. Conclusion : Combined TACE and RT appear to produce a favorable response and survival results with minimal toxicity.