간경변증 환자에서 급성 정맥류 출혈에 대한 치료로서 somatostatin 과 vasopressin 의 효과에 대한 무작위 전향적인 비교연구

이헌영(Heon Young Lee),이헌주(Heon Ju Lee),이승민(Seung Min Lee),김준환(Jun Hwan Kim),권순욱(Soon Wook Kweon),이병석(Byung Seok Lee),김남재(Nam Jae Kim) 대한내과학회 2002 대한내과학회지 Vol.62 No.5

목적 : 간경변증 환자에서 정맥류 출혈의 급성기에 약물치료는 간문맥압을 감압하여 재출혈의 기회를 감소시키고 정맥류의 경화요법 또는 결찰요법 전에 환자의 상태를 안정화하는데 기여한다. 저자 등은 급성 정맥류 출혈이 동반된 간경변증 환자에서 somatostatin과 vasopressin의 치료 효과와 부작용 등을 비교하기 위하여 무작위 전향적 연구를 시행하였다. 방법 : 1997년 3월부터 1999년 4월까지 충남대학교병원과 영남대학병원에 내원한 급성 정맥류 출혈 환자 43명을 대상으로 하였다. 대상환자는 약물투여 전 또는 후에 위내시경으로 정맥류 출혈이 확인되고, 500 cc 이상의 급성출혈이 있었거나 임상적으로 혈류 역학적인 변화가 관찰되는 경우에 선정되었다. 대상환자는 무작위로 vasopressin 투여 군과 somatostatin 투여 군으로 분류하여 vasopressin 투여 군은 48시간 동안 분당 0.4IU의 속도로 정주하였으며, somatostatin 투여 군은 250 mcg을 bolus로 투여한 후 48시간 동안 시간당 250 mcg의 속도로 정주하였다. 약물 투여 후 조기 지혈된 환자에서 매 2~4시간마다 생체활력징후와 매일 혈액검사를 실시하여 재출혈 및 부작용 등을 관찰하였다. 결과 : 전체 대상 환자는 43명이었으며 vasopressin 투여 군은 23명, somatostatin 투여 군은 20명이었고 간경변증 원인의 대부분은 알코올성인 경우로 vasopressin 투여 군에서 65.2%이었고, somatostatin 투여 군에서 70.0%이었다. Child-Pugh class는 B인 경우가 가장 많았다. 치료 전의 평가로써 혈압 및 맥박, 헤모그로빈치, 혈소판수, 프로트롬빈 시간, 간기능 검사 그리고 출혈의 정도 등에서 양 군간의 통계적인 차이는 없었다. 약물 투여 6시간 내의 재출혈은 vasopressin 투여 군은 23명 중 3명 (13.0%)이었으며, somatostatin 투여 군에서는 20명 중 1명 (5.0%)으로 유의한 차이가 없었고, 5일간 관찰한 조기 재출혈은 vasopressin 투여 군에서 23명 중 5명 (21.7%)이었으며, somatostatin 투여 군에서 20명 중 5명 (25.0%)으로 유의한 차이가 없었다. 약물과 관련된 부작용은 vasopressin 투여 군의 5예에서 흉통 및 복통 등의 심혈관계 또는 소화기계의 허혈성 합병증이 발생하여 nitroglycerin의 투여가 필요하였으며, somatostatin 투여 군에서는 이러한 합병증이 관찰되지 않았다. vasopressin 투여 군 중 2예와 somatostatin 투여 군 중 1예는 정맥류의 재출혈로 인하여 사망하였으며, vasopressin 투여 군의 1예에서 정맥류 출혈 후 발생한 간부전으로 사망하였다. 결론 : 급성 정맥류 출혈 환자의 약물치료로써 vasopressin과 somatostatin의 조기 재출혈의 예방효과는 동등하였으며, 부작용은 somatostatin이 적었다. Background: Acute variceal bleeding is one of serious complications of liver cirrhosis that has an attendant mortality of approximately 60% during two years and a variety of treatments like balloon tamponade, sclerotherapy and vasoactive drugs have been used. The aim of the present trial was to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding. Methods: Fourty-three cirrhotic patients with endoscopically proven acute variceal bleeding were included. Both drugs were given as continuous intravenous infusions for 48 hour. Twenty patients received somatostatin (250 mcg per hour after a bolus of 50 mcg) and twenty-three recieved vasopressin (0.4 units per min). Results: There was no significant difference between two groups in relation to age, sex and etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding within 6 hour after beginning of therapy, that is failure of initial control of bleeding, was observed in 3 (13.0%)patients receiving vasopressin and in 1 (5.0%) of those treated with somatostatin (p>0.05). Five patients (25.0%) in the somatostatin group and 5 (21.7%) in the vasopressin group rebled during 5 days after initial therapy (p>0.05). The meaningful complications related with vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin) but serious complications of somatostatin were not found. Mortalities during hospitalization were similar in both treatment groups. Two of the vasopressin group and one of the somatostatin group died because of the uncontrolled rebleeding and one of the vasopressin group died due to hepatic failure. Conclusion : This study shows that the effectiveness of somatostatin and vasopressin was not different but somatostatin had a lower risk of the complication than vasopressin.(Korean J Med 62:497-503, 2002)

위 , 십이지장질환에서 Helicobacter pylori 감염에 대한 치료성적 비교 ( Original Articles : omeprazole , amoxicillin 및 clarithromycin 의 10일간 병합요법을 중심으로 )

김선영(Sun Young Kim),김진희(Jin Hee Kim),이경태(Kyung Tae Lee),이승민(Seung Min Lee),김석현(Seok Hyun Kim),이병석(Byung Seok Lee),김남재(Nam Jae Kim),정현용(Heon Young Jeong),이헌영(Heon Young Lee),김영건(Young Kun Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objective : Eradication of H. pylori not only results in ulcer healing, but reduces recurrences essentially curing peptic ulcer disease. The purpose of this study was to evaluate the eradication rate of H. pylori and side effects with regard to three drug regimens. Methods : 96 patients were included and divided into three groups: 14 patients(group 1: OA) received omeprazole(20 mg b.i.d.) and amoxicillin(1.0 gm b.i.d.) for 14 days ; 12 patients (group 2: BAM) received colloidal bismuth subcitrate(CBS)(120 mg b.i.d.), amoxicillin(500 mg q.i.d.) and metronidazole(250 mg q.i.d.) for 14 days. ; 70 patients(group 3: OAC) received omeprazole(20 mg b.i.d.), amoxicillin(500 mg q.i.d.) and clarithromycin(250 mg q.i.d.) for 10 days. The diagnosis of the status of H. pylori was made by histology or culture or rapid urease test(CLO test). Results : 1) The eradication rate of H. pylori was higher group 2(91.7%) and group 3(91.4%) than group 1(57.1%). 2) The total failure rate regardless of the regimens (n=96) was 13.5%(13 patients). 10 patients whose treatment failed were randomly assigned to receive retreatment with the alternative regimen of BAM or OAC. In retreatment group(n=10), the eradication rate of H. pylori infection was achieved in 100 %. 3) The side effects were oral burning sensation, odynophagia, nausea, epigastric pain, diarrhea, constipation, gas bloating. The side effects were negligible. Conclusions : 10-day therapy with omeprazole, amoxicillin and clarithromycin(OAC) achieved eradication rate of 91.4 %. The side effects were few and negligible. 10-day therapy with OAC was a safe and very effective regimen for the eradication of H. pylori infection.

만성 C형 간염에서 페그인터페론과 리바비린의 병합치료시 치료 순응도의 중요성

이헌영 ( Heon Young Lee ),고평곤 ( Pyung Gohn Goh ),김민정 ( Min Jung Kim ),김혜진 ( Hye Jin Kim ),은혁수 ( Hyuk Soo Eun ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),이엄석 ( E 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5

Background/Aims: The combination therapy with peginterferon and ribavirin is a standard treatment for patients with chronic hepatitis C. However, because of the long duration of the treatment and many complications, the reduction of adherence frequently occur. This study aimed to assess influences of reduced medication adherence in the combination therapy of chronic hepatitis C patients. Methods: We retrospectively reviewed the medical records of 82 patients with chronic hepatitis C who received a combination therapy with peginterferon and ribavirin. The patients were categorized into 3 subgroups on the basis of medication adherence. Group 1 comprised patients who received ≥80% of the recommended dosage of both peginterferon and ribavirin. Group 2 comprised those patients who received ≥80% of the recommended dosage of only 1 drug. The patients of Group 3 received <80% of the recommended dosage of both the drugs. Results: Sustained virologic response (SVR)s of patients in Group 1, 2 and 3 were 85.4% (41/48), 85.7% (18/21), and 38.5% (5/13), respectively (p=0.002). SVRs of genotype 1 patients in Group 1, 2 and 3 were 84.2% (16/19), 75% (9/12), and 14.3% (1/7), respectively (p=0.003). SVRs of genotype non-1 patients in Group 1, 2 and 3 were 86.2% (25/29), 100% (9/9), and 66.7% (4/6), respectively (p=0.196). Furthermore are SVRs significantly differed with the degree of medication adherence to either peginterferon or ribavirin (p=0.003 and 0.021, respectively). In multivariate analysis, the peginterferon dose was a significant independent factor associated with SVR. Conclusions: Medication adherence of chronic hepatitis C patients to the combination therapy with peginterferon and ribavirin is very important for achieving SVR. In particular, we think that genotype 1 patients should maintain higher adherence than genotype non-1 patients. (Korean J Gastroenterol 2011;57:294-301)

장외파생상품 중앙청산기구(Central Counterparty, “CCP”) 도입에 따른 법적 과제

이헌영(Heon-Young Lee) 한국기업법학회 2014 企業法硏究 Vol.28 No.2

2008년 서브프라임 및 리먼브라더즈 사태 등으로 인한 금융위기 이후 장외파생거래 등의 결제불이행 위험을 축소하기 위한 움직임이 본격화되어 2009년 9월 G20 피츠버그 정상회의에서 장외파생상품의 중앙청산기구를 통한 결제제도 도입의 합의가 있었다. 이에 따라 우리나라에서도 2012년말까지 중앙청산기구를 도입키로 하였으나 입법일정이 늦어지면서 2013년 3월에야 관련법이 국회를 통과하고 같은 해 9월에야 한국거래소가 국내 최초로 장외파생상품에 대한 금융투자상품거래청산회사(“청산소”)로 인가를 받았으며, 2014년 6월 30일부터 원화이자율스왑거래에 대한 의무청산이 시작된다. 그동안 전 세계적으로 매우 정교한 법적체계 하에 이루어지던 장외파생거래를 청산소를 통한 의무청산으로 변경하는 작업은 매우 다사다난한 작업이며, 따라서 과거 중앙청산기구 추진 시 발표되었던 청산규정안과 현재 확정된 청산규정을 중심으로 향후 장외파생상품의 청산소를 통한 청산을 원활히 하기 위한 과제들을 살펴보았다. 우선 청산대상거래의 범위를 확실히 하기 위해 의무청산의 대상이 되는 ‘금융투자업자’의 범위를 명확히 하는 방향으로 자본시장법의 관련 조항을 개정할 필요가 있다. 한편 일괄청산 상계 의견서가 긍정적으로 나올 수 있도록 한국거래소가 청산소의 거래인수 방식을 처음 추진하였던 채무인수 방식에서 계약인수의 방식으로 수정한 것은 긍정적이나 이를 보다 명확히 하기 위해 채무자 회생 및 파산에 관한 법률 제120조 제2항을 개정할 필요가 있다. 또한, 청산위탁계약과 관련해서는 그 법적형태 및 청산위탁자와 청산회원간 권리?의무의 내용에 대해 보다 명확히 규정할 필요성가 있으며, 청산위탁증거금의 확실한 보호를 위해서는 하루빨리 자본시장법령에 관련 내용을 추가하도록 하여야 할 것이다. After the crisis from sub-prime mortgage and the bankruptcy of Lehman-Brothers Group., G20 decided to impose restrictions on OTC derivatives market. One of such restrictions is the mandatory clearing of OTC derivative transactions through Central Counterparty(“CCP”). At fisrt, G20 planned to start CCP clearing from the end of 2012 but, due to the complex issues, each countries postponed the schedule. In case of Korea, the relevant law (i.e. the revision of Financial Investment Services and Capital Markets Act, “FSCMA”) was enacted on March 5, 2013. and Korea Exchange(“KRX”) obtained the license of CCP under FSCMA on September 11, 2013. Finally, the mandatory clearing of KRW interest swap transactions through CCP is scheduled to start from June 30, 2014. KRX originally planned to apply‘assumption of obligation’method as a clearing structure but, due to uncertainty of clearing mechanism, it decided to change it into ‘Novation’method. It is a good progress considering the Close-Out Netting opinion issue and governing law issue etc.. However, there still remain several important legal issues regarding the mandatory clearing through CCP in Korea. The most serious issue is the scope of the transactions to be mandatorily cleared through CCP. The present provision in FSCMA is unclear whether eligible transactions with investment trusts or insurance companies etc. are to be cleared through CCP or not. Whether there is a ceiling of limitation in obligation by a CCP member is also unclear. The protection of a client margin given to KRX through a member in CCP clearing is to be clarified by the revision of law. For the smooth starting of mandatory clearing from the end of June this year, above legal issues shall be considered as soon as possible and I hope KRX and the related regulatory bodies find good solutions in the near future.

23 최근에 대전지역에서 발생한 A형 간염에 대한 연구

이헌영 ( Heon Young Lee ),김선문 ( Sun Moon Kim ),박기오 ( Ki Oh Park ),김석현 ( Seok Hyun Kim ),김남재 ( Nam Jae Kim ),이태희 ( Tae Hee Lee ),강영우 ( Young Woo Kang ),박성규 ( Sung Kyu Park ),안병민 ( Byung Min Ahn ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

회귀 기반의 다중지니계수분해법을 이용한 임금 불평등의 요인별 및 지역간 분해

이헌영(Lee, Heon-Young),남기찬(Nam, KiChan),임업(Lim, Up) 대한국토·도시계획학회 2012 國土計劃 Vol.47 No.1

담도침윤 증례 간외담관의 폐쇄를 유발한 간세포암의 증례

이헌영 ( Heon Young Lee ),김남재 ( Nam Jae Kim ),이병석 ( Byung Seok Lee ),성재규 ( Jae Kyu Sung ),송인상 ( In Sang Song ),강대영 ( Dae Yeong Kang ) 대한간암학회 2001 대한간암학회지 Vol.1 No.-

간 스캔에서 관찰되는 폐 방사능에 관한 임상적 고찰

소영(Young So),이강욱(Kang Wook Lee),이헌영(Heon Young Lee),이원우(Won Woo Lee) 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.3

N/A Purpose: We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Materials and Merhods:Forty-nine patients with pulmonary radioactivity were classified into 5 disease froups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence or absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clincal course were checked. Results: Of total 49 patients 25 had CLD: there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver drsease and ischemic necrosis of liver;on one-way ANOVA,these rise were statistically significanrt (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infecrion group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pumonary radioactivty. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-pugh class C. Conclusion: pulmonary radioactivity of radiocolloid liver scintlgraphy could be attrivuted to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver destruction in liver diseases. (Korean J Nucl Med 2002;36;185-94)

우측 손목 방형 회내근으로 간외 전이된 원발성 간세포암 1예

송영욱 ( Young Wook Song ),이병석 ( Byung Seok Lee ),김석현 ( Seok Hyun Kim ),이엄석 ( Eaum Seok Lee ),이헌영 ( Heon Young Lee ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1

Hepatocellular carcinoma (HCC) is usually associated with chronic liver disease such as liver cirrhosis. Primary HCC lesions and even recurrent intrahepatic lesions can be treated successfully by using variable modalities applicable to intrahepatic lesions. HCC can cause intrahepatic multiple occurrence and extrahepatic metastasis. Extrahepatic metastasis occurs in up to about 60% of patients of HCC, and a major of patients with extrahepatic HCC had late intrahepatic stage of tumor. Themost frequent site of extrahepatic metastasis of HCC was the lung. HCC metastasized to soft tissues was unusually reported. Extrahepatic metastasis of HCC, especially to unusual site, should not be overlooked and must be able to be controlled. We experienced a case that HCC was metastasized to the pronator quadratus muscle of right wrist and chould be removed surgically. (Journal of Liver Cancer 2015;15:41-45)

B 형 만성활동성간염 환자에서 Prednisolone 단기 이탈 및 Alpha Interferon 병합요법의 효과

이종선(Chong Sun Lee),김병호(Byung Ho Kim),성자원(Ja Won Sung),허승식(Sung Sik Hur),이기천(Ki Cheon Lee),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.5

N/A Background: There is no satisfactory method of treatment for chronic active hepatitis caused by hepati- tis B virus(CAH-B). Randomized controlled studies on a limited number of patients with CAH-B using alpha interferon or combination with corticosteroid showed some promise in reducing or eliminating viral replication. We evaluated thc safety and efficacy of prednisolone withdrawal followed by recombinant alphaInterferon 2b therapy. Methods: Sixteen patients (treatment group) with CAH-R were injected alpha-Interferon for 16 weeks after prednisolone tapered for 6 weeks, and compared to 12 controlled patients (control group). We measured serum aminotransferase activities, HBsAg, Anti-HBs, HBeAg, Anti-HBe and HBV-DNA before and after therapy. Results: I) Serum levels of AST and ALT were decreased significantly in treatment group (AST: 36±17, ALT: 38±14 IU/L) compared to control group (AST: 188±152, ALT: 272±155 IU/L). The responses were maintained for 1 year after therpy. 2) The negative conversion rates of HBeAg and HBV-DNA were significantely higher in treatment group (HBsAg: 50%, HBV-DNA: 87%) than control group (I4Be Ag: 0%, HBV-DNA: 14%) after treatment. But there was no significant differenee in follow up period (36 & 43%: 17 & 25%, 1yr. after). 3) Loss of HRsAg was not observed in both groups. 4) Mild tolerable side effects were observed; fever (94%), myalgia (75%), headache (19%) and hair loss (13%). 5) Leukocytopenia (19%) and thrombocytopenia (19%) were transient. Conclusions: Prednisolone withdrawal followed by recombinant alpha-Interferon 2b therapy was effective for decreasements of serum aminotransferase activities, for the loss of HBeAg and HBV-DNA, and relatively safe for patients with CAH-B. But it is necessary for study with larger number of patients, more prolonged duration of follow up and more strict control study.