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이영석 ( Young-Sok Lee ) 대한간학회 2006 간학회 싱글토픽 심포지움 Vol.12 No.4
Hepatic fibrosis is characterized by the excessive accumulation of multiple matrix components in the liver including the interstitial collagens, basement membrane collagens, proteoglycans, and matrix glycoproteins. Activated hepatic stellate cells, portal fibroblasts, and myofibroblasts are the major source of extracellular matrix in response to fibrogenic cytokines such as TGF- . The fibrogenic process is dynamic and liver fibrosis is the net result of β the imbalance between the collagen fiber synthesis and decomposition. The progress in understanding fibrogenic mechanism provided the development of effective therapies to reverse hepatic fibrosis and even cirrhosis. Removing the injurious stimuli, suppressing hepatic inflammation, down-regulating stellate cell activation and promoting matrix degradation are the mainstay of antifibrotic therapy. Many potential antifibrotic strategies based on apoptosis of the activated stellate cells, drug targeting to the fibrogenic liver cells, and combination therapy of multiple drugs in small doses are emerging but testing of their clinical efficacy and safety remains to be clarified.
이영석(Young Sok Lee),한남익(Nam Ik Han),박일영(Il Young Park),김욱(Wook Kim),원종만(Jong Man Won),이종호(Jong Ho Lee),한석원(Seok Won Han) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
Solitary or multiple pancreatic stones are commonly associated with chronic pancreatitis, however, little is known of their pathogenesis. But they are believed to develop by the calcification of intraductal protein plugs which are composed primarily of calcium carbonate in the form of calcite and pancreatic stone protein. And choledochal cyst is a relatively rare anomaly usually presenting with abdominal pain, jaundice and palpable mass. The follwing is a report of 53 years female patient with intermittent RUQ abdominal pain, palpable mass and large calcification shadow on a abdominal plain radiography who showed no clinical and biochemical evidence of pancreatitis. Investigation revealed a simultaneously developed Type-I choledochal cyst with huge, multiple pancreatic duct stones which were treated by cholecystectomy, excision of choledochal cyst with Roux-en-Y choledochojejunostomy anddirect pancreaticolithotomy.
이준욱(Joon Wook Lee),이성수(Seung Su Lee),박영민(Young Min Park),배시현(Si Hyun Bae),신제현(Je Hyun SHin),변병훈(Byung Hun Byun),최종영(Jong Young Choi),윤승규(Seung Kew Yoon),이영석(Young Sok Lee),이창돈(Chang Don Lee),차상복(Sang 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Congenital non-parasitic splenic cysts comprise approximately 10% of all splenic cysts. Clinical manifestations in patients with splenic cyst are often nonspecific and ultrasound or CT is useful for its diagnosis. Total splenectomy has been the major way of treatment. However, currently, spleen-saving procedures are strongly recommended because of the immunological role of the spleen. One of such procedures, the percutaneous treatment with sclerosing agents has already been reported with a good result. In this report, we present a case of a 12×17 cm sized giant congenital splenic cyst treated with percutaneously using ethanol as a sclerosing agent. Seven-times of injections (total 140mL, 20mL/time, every 3 days) into the cystic cavity through the inserted catheter were performed for 3 weeks. After the treatment, the size of cyst decreased markedly in 8 months. On the basis of these results, we may conclude that the percutaneous ethanol ablation therapy is an alternative to surgical treatment for splenic cyst. (Korean J Gastroenterol 2001;38:300-303)
이성원(Sung Won Lee),이영석(Young Sok Lee),한석원(Suk Won Han),한남익(Nam Ik Han),김욱(Wook Kim),원종만(Jong Man Won),장은덕(Eun Deok Chang),이해규(Hae Giu Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3
Malignant fibrous histiocytoma is the major subset of soft tissue sarcomas which occurs most commonly in the extremities and trunk, but rarely in the visceral organs. This report documents a case of malignant fibrous histiocyoma arising in the omentum in 36 year-old female whose chief complaints were growing non-tender masses. After surgical resection, there are no evidences of recurrencee or metastasis during 4 months follow up period. Electron microscopic study of the tumor showed irregular, spindle-shaped histiocyte with large indented nuclei and prominent nucleoli. The cytoplaem was abundant with microfilament and distended mitochondria. There was no evidence of myofibril in the tumor.
간세포암에서 담관 침범으로 다량 출혈을 일으킨 혈액담즙증
이경은 ( Kyung Eun Lee ),김창욱 ( Chang Wook Kim ),김민주 ( Min Ju Kim ),박진희 ( Jin Hee Park ),조규민 ( Gu Min Cho ),장정원 ( Jeong Won Jang ),이영석 ( Young Sok Lee ),이창돈 ( Chang Don Lee ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.1
Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin. (Korean J Gastroenterol 2013;61:46-49)
Phalloidin 으로 유발되는 간세포막 변형에 대한 트립신 효과
정규원(Kyu Won Chung),이영석(Young Sok Lee),서정민(Jeong Min Suh),심규식(Kyu Sik Shim),양진모(Jin Mo Yang),안병민(Byung Min Ahn),김재광(Jae Kwang Kim),한남익(Nam Ik Han),김환묵(hwan Mook Kim),오구택(Goo Taeg Oh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2
N/A Phalloidin, a bicyclic heptapeptide isolated from the mushroom Amanita phalloides, was reported as a membrane specific toxin inducing membrane protrusions in the isolated hepatocyte. The molecular basis of this injury most likely lies in the interaction of phalloirlin with the protein filaments of the plasma rnembrane. Trypsin was reported as one of the agents which preuent membrane protrusions of hepatocyte, from phalloidin. However, the exact mechanism of trypsin to the phalloidin action is still obscure. This study was designed to investigate the ultrastructures of isolated hepatoryte treated by phalloidin and trypsin, as a part of study to elucidate the mechanism of trypsin antagonisrn to phalloidin. In our experiments, multiple protrusions on the surface of isolated rat hepatocytes were observed, whereas trypsinized hepatocytes showed mild degree membrane protrusions along with hepatocyte aggregation after 20 min incubation with 10 ug/ml of phalloidin. The total number of aggregated cells were increased with gradual increase in trypsin concentration. These trypsin effects were disappeared spontaneously after twice washing of trypsinized heptocytes with Hank's balanced salt solution (HBSS) or treatment with soy bean trypsin inhibitor. Without trypsin, both Tween 80 trcated hepatocytes and hepatocyte ghosts were not aggregated but showed membrane protrusions with phalloidin. However, electron microscopy revealed mild membrane deformity on trypsin and phalloidin treated cells that was determined as normal under light microscopy. In conclusion, these results suggest that certain memmbrane structures in isolated rat liver cell, to which trypsin is reversely reartive, are required to recognze or to uptake phalloidin. These trypsin altered membrane structures lead to aggregation of hepatocytes upon reaction to phalloidin. And more studies should be performed to evaluate the mechanism of trypsin especially in regard to the hepatocyte aggregation.
연구논문 : 응급 간이식을 받은 전격성 A형간염 환자의 임상 양상: 다른 원인에 의한 급성 간부전 환자와의 비교
김진동 ( Jin Dong Kim ),최종영 ( Jong Young Choi ),박정화 ( Chung Hwa Park ),송명준 ( Myeong Jun Song ),장정원 ( Jeong Won Jang ),배시현 ( Si Hyun Bae ),윤승규 ( Seung Kew Yoon ),이영석 ( Young Sok Lee ),유영경 ( Young Kyoung Y 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1
목적: 최근 A형간염에 따른 전격성 간부전이 증가하고, 이에 따른 응급 간이식이 많이 시행되고 있다. 이 연구에서 전격성 A형간염으로 간이식을 시행받은 환자의 임상적 특징을 분석하고자 하였다. 대상 및 방법: 2007년 12월부터 2009년 5월까지 본 이식센터에서 기저 간질환 없이 IgM anti-HAV 항체 양성으로 간이식을 시행받은 환자 11명의 임상자료를 같은 분기에 다른 원인의 급성 간부전으로 이식을 받은 환자 10명의 자료와 후향적으로 비교하였다. 결과: A형간염에 의한 간부전군(HAV군)의 연령은 중앙값이 34세(범위: 15~43)였고, 남자가 3명(27.3%)이었다. HAV군에서 다른 원인의간부전군(non-HAV군)보다 헤모글로빈, AST, ALT, 레아티닌 수치가 높았고(각각 P=0.005, 0.001, 0.001, 0.010), 빌리루빈 수치는 낮았다(P=0.003). HAV군에서 임상증상을 처음 자각한 시점부터 간성뇌증의 발현까지의 기간은 중앙값이 5일(범위: 4~13)로 임상 경과가 빠르게 진행했다(P<0.001). HAV 군에서 간성뇌증의 진행은 실험실검사 소견 및 기존 예후예측모델의 점수와 연관성이 낮았고, 기존의 간이식 기준과 부합하는 경우도 적었다. 결론: A형간염에 의한 급성 간부전 환자의 임상 양상은 빠르게 진행하며, 실험실검사 소견이나 기존의 예후예측모델은 A형간염 환자에서 간이식 대상자를 선정하는 기준으로 충분하지 않다. Background/Aims: According to recent prevalence of hepatitis A virus (HAV) infection, acute liver failure ALF) due to HAV infection is observed frequently in parallel. The aim of this study was to elucidate the clinical, laboratory, and pathologic features of patients who have undergone emergency liver transplantation (LT) due to fulminant HAV infection. Methods: Clinical, laboratory, and pathologic data of 11 transplant recipients with anti-HAV IgM-positive ALF between December 2007 and May 2009 were analyzed, and compared with data of 10 recipients who underwent LT for the management of ALF due to other causes. Results: The median age of the patients with HAV-related ALF was 34 years (range: 15-43 years). The levels of hemoglobin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine were higher and the level of bilirubin was lower in the HAV-related ALF group than in the other group (P=0.005, 0.001, 0.001, 0.010, and 0.003, respectively). The time from the onset of initial symptoms to the development of encephalopathy was shorter in the HAV-related ALF group than in the other group (median 5 days, range: 4-13 days; P<0.001). In patients with HAV-related ALF, laboratory findings and clinical prognostic parameters including the Acute Liver Failure Study Group prognostic index, King`s College criteria, and model for endstage liver disease (MELD) and Child-Pugh scores were not associated with the grade of hepatic encephalopathy or time of progression to encephalopathy. Conclusions: The results of this study indicate that the clinical condition of patients with HAV-related ALF requiring emergency LT aggravates rapidly. Prognostic parameters are not sufficient for discriminating transplant candidates in patients with fulminant hepatitis A. (Korean J Hepatol 2010;16:19-28)
간장 및 담도 : 간성뇌증에 대한 분지아미노산 수액제제 ( Pamisol ) 의 임상효과
김부성(Boo Sung Kim),이창돈(Chang Don Lee),이영석(Young Sok Lee),정진우(Jin Woo Jeong) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.2
N/A A randomized clinical study ivas conducted in 30 hospitalized patients with protein-intolerant hepatic encephalopathy who were given a branched-chain enriched amino acid solution (Pamisol) until they developed stage I encephalopathy. In addition to this study, we determined fractional amino acid concentrations following infusion. The results were as follows: 1) Among thirty cases of hepatic encephalopathy the clinical manifestations were improved in 14 cases (78%) among 18 male patients while they were 9 cases (75%) among 12 female patients. 2) During tbis study twenty-five cases (83.3%) survived and 5 cases (16.7%) expired among 30 studied cases. 3) There were no significant differences in concentrations of branched-chain amino acid before and after infusion of pamisol. 4) In concentrations of aromatic amino acid during this study, there were significant decrease after infusion of pamisol. The results strongly suggest that infusion with branched-chain enriched amino acid solution (Pamisol4) is well tolerated with improvement in hepatic encephalopathy and it coincides with the achievement of nitrogen equilibrium and adequate nutritional support.
99mTc - DISIDA를 이용한 간 혈류 중 동맥 분획의 측정
양일권(Il Kwon Yang),박용휘(Yong Whee Bahk),이해규(Hae Giu Lee),임계연(Gye Yeon Lim),김학희(Hack Hee Kim),임정익(Jung Ik Lim),한석원(Sok Won Han),한남익(Nam Ik Han),이영석(Young Sok Lee) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2
N/A Arteriai fraction of total hepatic blood flow was estimated by a new method, slope method, on radionuclid angiogram using 99mTc-DISIDA and was compared with that from 99mTc-Phytate radionu clide angiogram. This study included ll of normal subjects, 37 of intermediate group with various liver diseases, and 25 patients with liver cirrhosis. We analyzed the datas with slope method from radionuclide angiograms and the results were compared with hepatic arterial fractions from uptake method, introduced by Lee et al. at 1986. The hepatic arterial fractions from radionuclide angiograms using Tc-DISIDA and 99mTc- Phytate were 0.32 +- 0.09 and 0.31 +- O.11 respectively in normal subjects, and 0.75+0.18 and 0.77+0.21 respectively in patients with liver cirrhosis. The hepatic arterial fractions by the slope method was well correlated with those of the uptake method on 99mTc-DISIDA scan. There was high correlation between the hepatic arterial fractions from 99mTc-DISIDA and 99mTc-Phytate scans. Hepatic arterial fraction estimated by the slope method is a useful index for the diagnosis of liver cirrhosis and the evaiuation of status of portal hypertension.