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Floxuridine 의 간동맥내 국소 투여를 이용한 전이성 간종양 치료의 임상체험
이종훈(Jong Hun Lee),한상영(Sang Young Han),김완수(Wan Soo Kim),박성욱(Seung Wook Park),이철종(Cheol Jong Lee),노명환(Myung Hwan Roh),최석렬(Seok Reyol Choi),신우원(Woo Won Shin),최홍조(Hong Jo Choi),박병호(Byeong Ho Park) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.5
Background/Aims: This study aimed to evaluate the outcome and the side effect of floxuridine (FUDR) hepatic artery infusion (HAI) in patients with metastatic liver cancer. Methods: From October 1997 to December 1999, FUDR HAI was performed for 10 patients with hepatic metastases from colorectal carcinoma (CRC) and gastric cancer and the regimen's effect and toxicity were evaluated. The primary cancer lesions had been resected before FUDR HAI. FUDR was continuously infused at a rate of 0.3 mg/kg/day for 14 days through hepatic artery by percutaneous catheter-guided chemoport. All patients received steroid to prevent hepatic toxicity. Some of the patients were also treated with systemic chemotherapy to treat the extrahepatic metastases. Results: Two patients showed complete response and five patients showed partial response. Stable disease and progressive disease were detected in two patients and one patient, respectively. Most patients revealed decreased lesion of hepatic metastases during the FUDR HAI. The systemic toxicities of the FUDR HAI were nausea, vomiting, diarrhea and mucositis. The hepatic side effect was not detected. Conclusions: In patients with CRC and gastric cancer, the regimen using FUDR HAI and steroid was effective against metastatic liver cancer and revealed no hepatic toxicity. Because of the limitation of this study due to small patient group and short duration of follow-up, further studies are needed for large group of patients. (Korean J Gastroenterol 2001;38:342-349)
라미부딘 장기투여 중 발생한 B 형 간염 바이러스 YMDD 영역의 유전자변이
이종훈(Jong Hun Lee),신우원(Woo Won Shin),안현숙(Hyun Sook Ahn),성명식(Myung Sik Seong),조정환(Jeong Hwan Cho),정동엽(Dong Yup Jung),강기태(Ki Tae Kang),김병희(Byung Hee Kim),노명환(Myung Hwan Roh),한상영(Sang Young Han),최석렬(Seok 대한내과학회 2001 대한내과학회지 Vol.61 No.4
N/A Background: The emergence of YIDD or YVDD mutant hepatitis B virus (HBV), with point mutation in the YMDD motif of DNA polymerase gene, has been reported in patient s with lamivudine treatment group. The aims of this study was to investigate the emergence of mutant HBV during long-term lamivudine therapy using nested polymerase chain reaction (PCR) method and direct DNA sequencing. Methods: Twenty-one chronic hepatitis B patients with HBeAg and HBV DNA positive were evaluated. During lamivudine therapy, there were reported breakthroughs of HBV DNA (over 50pg/mL) when investigated the emergence of YMDD mutants by nested PCR method using restriction fragment length polymorphism (RFLP) in all patients. Direct DNA sequencing of HBV DNA polymerase gene including YMDD motif was also performed. Results: There were 13 patients (61.9%) with YIDD mutant and 8 patients (38.1%) with YVDD mutant. The result s of direct DNA sequencing were consistent with those of nested PCR data based on RFLP. The breakthrough was occurred at 15 to 106 weeks (57.9±23.6). At the point of breakthrough, the level of ALT was 74.8±117.7 (14-546) IU/L, and it was lower than the level of ALT before the therapy. Conclusion: In the long-term therapy of lamivudine, the emergence of YMDD motif mutant HBV was related to the breakthrough of HBV DNA and YIDD mutant was frequent. The nested PCR method using RFLP may be simple and sensitive to detect the YMDD motif mutant HBV. (Korean J Med 61:374-383, 2001)
위선암에서 Helicobacter pylori 독성인자와 유전자 아형의 관련성
신종민,한상영,금동주,김광진,지삼룡,홍기봉,이종훈,최석렬,신우원,Shin Jong Min,Han Sang Young,Keum Dong Joo,Kim Kwang Jin,Jee Sam Ryong,Hong Gi Bong,Lee Jong Hun,Choi Seok Ryeol,Shin Woo Won 대한위암학회 2002 대한위암학회지 Vol.2 No.1
Purpose: The H. pylori cagA gene, vacA gene and iceA gene are considered to be important virurence factors that have been implicated in the development of gastric adenocarcinoma. It was reported that the presence of IS605 elements may be responsible for rearrangements and lead to partial or total deletions of the cag pathogenicity island (PAI) and the virulence of cag PAI may be changed. However, different results regarding the association between these virulence factors and clinical disease have been reported from different geographic regions. This study evaluated the relationship between H. pylori virulence factors such as cagA, vacA, iceA, IS605 and gastric adenocarcinoma. Materials and Methods: H. pylori isolates were obtained from 54 infected patients (24 cases of gastric adenocarcinoma, 30 cases of control). H. pylori isolates were identified by PCR with ureC gene and 16S rRNA. PCR was performed to examine cagA, vacA, iceA and IS605 genotypes. Results: Significant difference was found in the negative rates of cagA between gastric adenocarcinoma group and control ($62.5\%\;vs.\;33.3\%$ P=0.033). No significant difference was found in the prevalence of iceA, vacA between gastric adenocar cinoma and control. The genotype of cagA+ vacA s1-m1 iceA1 was predominant in H. pylori isolates irrespective of the clinical outcome. IS605 in PAI was not found in gastric adenocarcinoma gruop and control. The positive rates of IS605 in genome were $33.3\%$ in gastric adenocarcinoma group and $36.7\%$ in control (P>0.05). In gastric carcinoma, the positive rate of $cagA^{+}/IS605$ was lower than in control ($12.5\%\;vs\;40.0\%$, P=0.025) and the positive rate of cagA-/IS605 was higher than in control ($54.2\%\;vs\;23.3\%$, P=0.02). Conclusion: H. pylori virulence factors had not related significantly with gastric adenocarcinoma. Further study is needed to examine the specificity of H. pylori strains.
간세포암의 직경과 위치에 따른 고주파 열치료의 치료효과 및 합병증에 관한 연구
유정남 ( Jung Nam Yoo ),신우원 ( Woo Won Shin ),강기태 ( Ki Tae Kang ),조정환 ( Jung Hwan Cho ),문성훈 ( Sung Hun Moon ),윤욱돈 ( Uk Don Yun ),장채령 ( Chae Ryeong Jang ),이태영 ( Tae Yeong Lee ),안원석 ( Won Suk An ),이종훈 ( Jon 대한내과학회 2002 대한내과학회지 Vol.63 No.5
N/A Background : Induction of coagulation necrosis by using thermal energy sources such as radio-frequency (RF), microwaves and lasers has recently been as a new, minimally invasive technique for percutaneous tumor ablation. RF ablation is considerd effective and safe for the local control of small HCCs. The aim of this study is to evaluate the therapeutic efficacy and complications according to the diameter and location of the HCC. Methods : Between May 1999 and December 2000, one hundred fifty patients underwent RF thermal ablation in Dong-A university hospital. Among them, forty nine patients were enrolled in this study who have no history of prior other treatment including hepatic resection, TAE, PEI, and chemotherapy, also who have follow-up CT performed at least six months after ablation. The patients devided into two groups, who have small HCC (.3 cm in diameter) and the others. Recurrence rate was also evaluated with spiral CT performd at least six months after treatment. Results : In large HCC group (>3 cm in diameter), the mean follow-up duration was 10.8 months and local recurrence rate was 51.0%?12.4. In small HCC group (.3 cm in diameter), the mean follow-up duration was 12.7 months. Local recurrence rate was 16.2%?8.6 in patients with small HCC. Among one hundred fifty patients underwent radio-frequency thermal ablation, 5 cases of intraperitoneal bleeding, 5 cases of pleural effusion and 3 cases of pneumothorax were observed. In most of cases, the necrotic area of HCC reached to the capsule of liver or located in hepatic dome. Conclusion : Radio-frequency ablation appears to be more effective and safe for the treatment of small HCC than that of large HCC and more attetion must be given to the RF ablation if the tumor is larger than 3cm or located close to the capsule of liver or in hepatic dome. (Korean J Med 63:507-512, 2002) Key Words : Radio - frequency Ablation, Carcinoma, Hepatocellular
포스터 발표 : 간 ; 만성 B형 간염환자에서의 라미부딘 단독치료의 효과
김광진 ( Kwang Jin Kim ),신우원 ( Woo Won Shin ),정동엽 ( Dong Yup Jung ),조정환 ( Jung Hwan Jo ),이종훈 ( Jong Hun Lee ),한상영 ( Sang Young Han ),최석렬 ( Seok Ryeol Choi ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
〈목적〉 라미부딘은 뉴클레오사이드 유도체로서 B형 간염바이러스의 증식을 억제하여 간기능과 조직학적 소견의 혼전을 일으키는 것으로 알려져 있다. 투약의 간편성과 부작용이 별로 없다는 장점이 있으나, 일부에서 약제 내성이 유발된다는 단점이 있다. 본 연구는 만성B형 간염환자들에서 라미부딘 단독투여로 치료효과와 내성 발생을 및 각각의 예측인자에 대해서 알아보기로 하였다. 〈대상과 방법〉 동아의대 동아대학교병원에 내원하여 만성 B형 간염을 진단받은 환자들 중
진성 혈소판증가증에 동반한 Budd - Chiari 증후군 1 예
서봉근(Bong Geun Seo),한상영(Sang Young Han),이종훈(Jong Hun Lee),장진석(Jin Seok Jang),이현수(Hyun Soo Lee),노명환(Myung Hwan Roh),최석렬(Seok Ryeol Choi),신우원(Woo Won Shin) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1
Budd-Chiari syndrome is an acute or subacute obstruction of hepatic venous outflow which causes post-sinusoidal portal hypertension, esophageal varix, and cirrhotic course. Its prognosis is usually poor. The cause and pathogenesis are unclear, but the primary cause is generally thought to be congenital. The main secondary causes are chronic myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, presence of lupus anticoagulant, protein C or protein S deficiency, hypercoagulability due to oral pills, tumor, trauma, and infection. It can be treated by shunt operation, balloon dilatation, stent insertion, or transjugular intrahepatic portosystemic shunt. We report one case of Budd-Chiari syndrome with essential thrombocythemia which has never been reported in Korea. (Korean J Gastroenterol 2002;39:64-67)
반복적인 하부위장관 출혈을 동반한 공장 평활근종 1 예
한상영(Sang Young Han),노명환(Myung Hwan Roh),최석렬(Seok Ryeol Choi),신우원(Woo Won Shin),강기태(Ki Tae Kang),김광진(Kwang Jin Kim),지삼룡(Sam Ryong Jee),이종훈(Jong Hun Lee) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2
Small bowel tumors are rare, constituting 1.7-6.5% of all gastrointestinal tract neoplasms. Leiomyomas are uncommon benign tumors of smooth muscle and may occur wherever smooth muscle is present. The small bowel is the most frequent site and leiomyomas make up 20-30% of all benign small intestinal neoplasms. Bleeding is the most commom symptom and is usually recurrent. A 33-year-old man who came to emergency room complained of 3-day history of melena and hematochezia. An arteriogram revealed significant hemorrhage from jejunal branch of the superior mesenteric artery. Arterial embolization was performed, followed by laparoscopy-assisted small bowel resection after 17 days. Pathologic examinaton confirmed a diagnosis of leiomyoma. (Korean J Gastroenterol 2001;38:128-131)
십이지장 궤양에서 Helicobacter pylori 독성인자 유전자 아형과 IS605의 역할
금동주 ( Dong Joo Keum ),한상영 ( Sang Young Han ),김광진 ( Kwang Jin Kim ),지삼룡 ( Sam Ryong Jee ),이종훈 ( Jong Hun Lee ),최석렬 ( Seok Ryeol Choi ),신우원 ( Woo Won Shin ),김정만 ( Jeong Man Kim ),홍숙희 ( Sook Hee Hong ),김 대한소화기학회 2003 대한소화기학회지 Vol.41 No.2
Background/Aims: The Helicobacter pylori (H. pylori) cagA, vacA, and ieeA are considered to be important virulence factors that have been implicated in the development of duodenal ulcers. It was reported that the presence of IS605 elements might be respon