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정영걸,연종은,이광균,정은석,김정한,김지훈,서연석,임형준,엄순호,유호상,변관수 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.4
Background/Aims: We investigated the durability of the biochemical and virologic responses after adefovir (ADV)discontinuation in lamivudine-resistant (LMV-R) chronic hepatitis B (CHB) patients, and the outcomes of ADV discontinuation compared to that of ADV maintenance. Methods: The indication for ADV treatment cessation was an undetectable level of hepatitis B virus (HBV) DNA documented on two occasions at least 6 months apart. All patients received additional ADV for at least 12 months after the confirmation of undetectable HBV DNA (Cobas TaqMan PCR assay, <70 copies/mL). Of 36 patients who had a sufficient ADV therapeutic effect, 19 discontinued ADV treatment, while the others maintained it. A virologic rebound was arbitrarily defined as the redetection of HBV DNA at a level higher than 105 copies/mL. Results: In the ADV discontinuation group, ADV treatment and additional therapy were administered for medians of 33 months (range, 12-47 months) and 18 months, respectively. The patients were followed for a median of 12 months (range,3-30 months) after ADV cessation. During that period, 18 of 19 patients (95%) experienced viral relapse. Viral rebound was observed in six patients (32%). However, 12 of 18 patients (67%) exhibited serum HBV DNA levels of less than 105 copies/mL. Biochemical relapses were observed in four of the six patients with viral rebound. In the ADV maintenance group, patients were treated for a median of 53 months (range, 31-85 months), and 9 patients (53%) experienced viral breakthrough. Conclusions: During short-term follow-up after ADV discontinuation, most patients (95%) exhibited viral relapse, whereas and viral breakthrough occurred in about half of patients (53%) maintained on ADV therapy. Therefore,the durability of virologic response after ADV discontinuation in LMV-R patients was unsatisfactory. In addition, and viral breakthrough was not infrequent in the ADV continuation group.
정영걸,연종은,Jong Hwan Choi,Chung Ho Kim,Eun Suk Jung,김지훈,박종재,김재선,박영태,변관수 거트앤리버 소화기연관학회협의회 2010 Gut and Liver Vol.4 No.3
Adefovir dipivoxil (ADV) is commonly used as an antiviral agent in the treatment of chronic hepatitis B or human immunodeficiency virus infection. Nephrotoxicity has been shown to occur at daily dosages of 60-120mg. Fanconi’s syndrome is a generalized dysfunction of the renal proximal tubular cells, which is usually accompanied by complications. Here we report a case of Fanconi’s syndrome in a chronic hepatitis B patient who had been treated with a prolonged regimen of ADV at 10 mg/day. A 47-year-old man complained of severe back and chest-wall pain. He had chronic hepatitis B and had been treated with ADV at a daily dose of 10 mg for 38 months. He was hospitalized because of severe bone pain, and laboratory and radiologic findings suggested a diagnosis of Fanconi’s syndrome with osteomalacia. After discontinuation of the ADV, he recovered and was discharged from hospital. His laboratory findings had normalized within 2 weeks. This case indicates that Fanconi’s syndrome can be acquired by a chronic hepatitis B patient taking ADV at a conventional dosage of 10 mg/day. Therefore, patients treated with long-term ADV should be checked regularly for the occurrence of ADV-induced Fanconi’s syndrome.
정영걸,박종재,김정한,유상균,이지연,윤익,박기호,김진용,김재선,박영태,정운영,김철환,이창홍 대한소화기내시경학회 2004 Clinical Endoscopy Vol.28 No.1
바렛식도는 하부식도가 특수화된 원주상피로 변형된 것으로 식도선암의 중요한 발생인자로 알려져 있다. 위내시경 검사에서 위식도접합부 상방으로 편평원주상피접합부가 상승되어 있으면서 조직검사에서 배상세포(goblet cell)가 관찰되는 불완전 장상피화생이 보일 경우 진단이 가능하며, 편평원주상피접합부가 위식도접합부 상방으로 3 cm 이상 상승된 장분절 바렛식도와 3 cm 미만으로 상승된 단분절 바렛식도로 분류된다. 이 중 장분절 바렛식도는 내시경 소견으로 쉽게 진단이 가능하지만 단분절 바렛식도의 경우는 진단에 어려움이 있다. 최근 cytokeratin (CK) 면역염색법에서 특징적인 바렛 CK 7/20 양상은 바렛식도의 진단뿐만 아니라 위장의 장상피화생과의 감별진단에도 유용하다는 보고가 있다. 저자들은 위식도 역류 질환이 있고, 위내시경검사에서 편평원주상피접합부의 고분화 선암이 발견되어 위식도 역류에 의한 단분절 바렛식도에 합병된 식도선암 의심하에 내시경적 점막절제술 시행 후, 절제조직의 H&E 염색, alcian blue 염색, CK 면역염색법에서 단분절 바렛식도에 합병된 조기 식도선암으로 생각되는 2예를 경험하였기에 이를 보고한다. Barrett's esophagus is considered as a premalignant condition in which columnar epithelium replaces the normal esophageal squamous epithelium. The diagnosis of Barrett's esophagus is based on the endoscopic finding of columnar epithelium lining the distal esophagus and histologic confirmation of the presence of specialized intestinal metaplasia. According to the extent of the metaplastic lining from the esophagogastric junction, Barrett's esophagus has been divided into long-segment (≥3 cm in length) and short-segment (<3 cm in length). Long- segment Barrett's esophagus can be easily identified at endoscopy, but it is difficult to separate short-segment Barrett's esophagus from intestinal metaplasia of cardia. It has been reported that Barrett's CK 7/20 pattern is an objective marker of Barrett's mucosa, and can differentiate Barrett's mucosa from gastric intestinal metaplasia. We report here two cases of adenocarcinoma of esophagus arising from short-segment Barrett's esophagus, diagnosed by endoscopic and histologic findngs, and treated by endoscopic mucosal resection.