비장절제 마우스에서 Naegleria fowleri 감염에 대한 면역효과

한광협(Kwang-Hyub Han),안명희(Myoung-Hee Ahn),민득영(Duk-Young Min) 대한기생충학열대의학회 1988 The Korean Journal of Parasitology Vol.26 No.1

종설 : FibroScan(R)을 이용한 간탄력도 검사

한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

Progressive liver fibrosis is a similar feature of all chronic liver diseases and eventually develops liver cirrhosis. The prognosis and treatment plans of chronic liver diseases depend strongly on the degree of liver fibrosis. These facts raise clinical interests in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative non-invasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new non-invasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few years notably with the appearance of several serological markers which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation, cost problems, and influences of extrahepatic conditions make it less accessible to clinicians. Recently, liver stiffness measurement using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally non-invasive and reproducible and gives an immediate result without intra- and inter-observer variability. Its clinical use in comparison with liver biopsy and several available serologic markers is now intensively being investigated. Here, we review the currently available data on FibroScan(R).(Korean J Med 74:463-471, 2008)

구연 / 제 4 회의장 / 간 18 : 문맥혈전증을 동반한 진행성 간암에서 chemoport 를 통한 간동맥내 항암제 주입과 방사선 병합요법의 치료효과

한광협(Kwang Hyub Han),윤영훈(Youn Young Hoon),이도연(Do Yun Lee),안상훈(Sang Hoon Ahn),성진실(Jin Sil Seong),김태일(Tae Il Kim),전재윤(Chae Yoon Chon),문영명(Young Myung Moon) 대한소화기학회 1999 대한소화기학회 추계학술대회 Vol.1999 No.-

시론 : 대한내과학회 발전방안 제안

한광협 ( Kwang Hyub Han ),박중원 ( Jung Won Park ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2

원발성 간암환자의 간염 바이러스 감염유형에 따른 임상양상 및 예후

한광협(Kwang Hyub Han),문희용(Hee Yong Moon),김범수(Bum Soo Kim),백용한(Yong Han Paik),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한내과학회 2001 대한내과학회지 Vol.60 No.1

N/A Background : Hepatocellular carcinoma(HCC) is one of the important causes of cancer-related mortality and morbidity in East Asia, including Korea. Most of the hepatocellular carcinoma in Korea are associated with hepatitis B and C virus infection. The clinical characteristics and prognosis of the patients with HCC were evaluated in relation to the type of hepatitis virus. Methods : A retrospective analysis of the clinical data and survival rate was done in 603 patients(M:F=4.9:1, mean age; 54.2 years) who were admitted to Yonsei medical center from April, 1991 through April, 1994. Results : Among 603 patients, tests for HBsAg and anti-HCV was done simultaneously in 455 patients. Out of the 455 HCC patients, 303 patients (66.6%) were classified as Group B(HBsAg+ve, anti-HCV-ve), 102 patients (22.4%) were classified as Group C (HBsAg-ve, anti-HCV+ve), 45 patients (9.9%) were classified as Group non-BC (HBsAg-ve, anti-HCV-ve), and 5 patients (1.1%) were classified as Group BC (HBsAg+ve, anti-HCV+ve). The mean age of the patients in Group C was older than that of Group B (64.9 vs. 51.3 yr) (p<0.05). Liver cirrhosis was frequently noticed in Group C than Group B (84.3 vs. 68.0%) (p<0.05). The number of the patients whose serum FP level was elevated (>400 ng/mL) was significantly higher in Group B than in Group C (70.0 vs. 52.0%)(p<0.05). According to the gross type, nodular type was more common in Group C than in Group B(72.0 vs. 38.1%) (p<0.01). The incidence of portal vein thrombosis was significantly lower in Group C compared with that in Group B (16.7 vs. 31.4%)(p<0.05). The number of the patients whose tumor size of less than 5 cm was significantly higher in Group C than in Group B (35.3 vs. 17.8%) (p<0.05). Using multivariant analysis, independent prognostic factors were found to be Child grading, FP level, size of the tumor, gross type, and the type of hepatitis virus. The cumulative survival rate of 1, 2, and 3 year in each Group was 31.5%, 17.5%, and 10.8%, respectively in Group B, and 55.7%, 30.2%, and 21.6%, respectively in Group C. The median duration of survival of Group B was significantly shorter than that of Group C(5.0 vs. 13 months)(p<0.05). Conclusion : About 90 % of HCC was associated with hepatitis B or C viral infection in Korea. Hepatitis B virus associated HCC had poorer prognosis compared with hepatitis C virus associated HCC in Korea.(Korean J Med 60:22-31, 2001)

간섬유화

한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2(S)

Liver fibrosis is the results of chronic injury and a similar feature of all chronic liver diseases. Beyond being a marker of injury, it appears to play a direct role in the pathogenesis of hepatocellular dysfunction and portal hypertension. Furthermore, the prognosis and treatment plans of chronic liver diseases strongly depend on the degree of liver fibrosis. Thus, from a clinical management viewpoint, accurately assessing the extent and progression of fibrosis is important and clinical interests are being raised in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative noninvasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new noninvasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few decades notably with the appearance of several serological markers, which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation and influences of extrahepatic conditions make it less accessible to clinicians. Recently, transient elastography using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally noninvasive and reproducible and gives an immediate result with low intra- and inter-observer variability. Here, we review the currently available data on transient elastography for assessing liver fibrosis.

소간세포암종의 치료적 접근

한광협 ( Kwang Hyub Han ),최종원 ( Jong Won Choi ) 대한간암연구회 2007 대한간암연구회 학술심포지엄 Vol.10 No.-

간세포암 환자에서 간동맥 화학색전술 후 발생한 급성 간부전의 위험인자

백용한 ( Yong Han Paik ),전재윤 ( Chae Yoon Chon ),조재용 ( Jae Yong Cho ),안상훈 ( Sang Hoon Ahn ),이관식 ( Kwan Sik Lee ),한광협 ( Kwang Hyub Han ),문영명 ( Young Myoung Moon ),이도연 ( Do Yeon Lee ),이종태 ( Jong Tae Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.6

목적 : 간동맥 화학색전술은 수술적 치료가 어려운 진행된 간암 및 전이성 간암 환자의 고식적 치료방법의 하나로서 널리 시행되고 있다. 급성 간부전은 간동맥 화학색전술 후 비교적 드물게 발생하는 합병증이나 일단 발생하는 경우에는 대부분 예후가 좋지 못하므로 임상적으로 매우 중요하며 예방이 무엇보다 중요하다. 이에 본 연구에서는 간세포암의 치료목적으로 시행한 간동맥 화학색전술로 유발된 급성 간부전의 위험인자를 조사하였다. 방법 : 1994년부터 2000년까지 연세의대 세브란스병원에서 간세포암의 치료목적으로 간동맥 화학색전술을 시행받았던 163명을 대상으로 하였으며 이들의 치료경과를 추적관찰하여 이들에게 시행된 총 263회의 간동맥 화학색전술을 분석하였다. 대상환자들의 간동맥 화학색전술 시행시의 의무기록과 방사선학적 소견을 후향적으로 조사하였으며 이들의 경과를 추적조사 하여 합병증 발생을 조사하고 급성간부전 발생에 영향을 미치는 유발인자에 대하여 조사하였다. 결과 : ① 색전술 후 간내 합병증은 202회/263회(77%)에서 발생하였으며 색전술 후 증후군 187예(71.1%), 간기능 악화 90예(34.2%), 급성 간부전 13예(4.9%), 간동맥 손상 또는 폐색 9예(3.4%), 담즙종 4예(1.5%), 간경색 2예(0.8%), 간농양 2예(0.8%), 간암파열이 1예(0.4%) 발생하였다. ② 색전술 후 간외합병증은 26회/263회(10%)에서 발생하였으며 상부위장관출혈 14예(5.3%), 패혈증 3예(1.1%), 담낭경색 2예(1.1%), 혈소판감소증 2예(0.8%), 위천공 1예(0.4%), 폐렴 1예(0.4%), 조영제로 인한 두드러기 1예(0.4%), 감각신경성 난청 1예(0.4%), 대퇴동맥 천자부위 혈종 1예(0.4%)가 있었다. ③ 시술 후 급성 간부전이 발생했던 13예 중 12예가 3개월 이내에 사망하였으며 그 중 8예는 1개월 이내에 사망하였다. 사망원인은 간부전 8예, 간부전 및 상부위장관출혈 3예, 간부전 및 패혈증이 1예이었다. ④ 단변량분석상 색전술 후 급성 간부전발생과 연관이 있는 인자로는 혈청 알부민수치(p=0.003), 혈청 총 빌리루빈수치(p=0.000), 프로트롬빈 응고시간(p=0.003), Adriamycin 투여용량(p=0.013), 색전술 전 Child-pugh 등급이 C인 경우(p=0.024), 종양의 크기가 5 cm 이상인 경우(p=0.004), 종양의 형태가 미만형인 경우(p=0.000), 간문맥 색전이 있는 경우(p=0.002), TNM 병기가 3기 이상인 경우(p=0.022) 등으로 나타났다. ⑤ 급성 간부전발생과 연관이 있는 인자에 대한 다변량분석(multivariate analysis) 결과 혈청 총 빌리루빈 수치와 미만형 종양형태가 간동맥 화학색전술 후 간부전 발생과 유의하게 관계 있는 위험인자로 나타났다. 결론 : 간세포암의 치료목적으로 간동맥 화학색전술을 시행시 혈청 총 빌리루빈치와 미만형 종양형태가 급성 간부전 발생과 관계가 높은 위험인자로 나타났으며, 간동맥 화학색전술로 인한 급성 간부전의 발생을 예방하기 위하여 간동맥 화학색전술을 시행함에 앞서 이러한 위험인자들을 충분히 고려한 후 시행해야 할 것으로 생각한다. Background : Transcatheter Arterial Chemoembolization (TACE) has been the most widely used treatment for advanced hepatocellular carcinoma (HCC) in Korea. However a number of complications associated with TACE have been reported in many studies. Acute hepatic failure is one of the most serious complications of TACE, because of its grave prognosis. The aim of this study was to investigate the risk factors associated with acute hepatic failure after TACE. Methods : A total of 263 TACE procedures performed in 163 patients with HCC were included in this study. We reviewed retrospectively the complications that occurred after TACE and analysed the risk factors associated with acute hepatic failure after TACE. Results : Complications included post-embolization syndrome (187 cases), temporary hepatic insufficiency (90 cases), acute hepatic failure (13 cases), hepatic arterial injury (9 cases), intrahepatic biloma (4 cases), liver infarction (2 cases), liver abscess (2 cases), tumor rupture (1 cases), gastrointestinal bleeding (14 cases), septicemia (3 cases), gall bladder infarction (2 cases), thrombocytopenia (2 cases), gastric perforation (1 cases), pneumonia (1 cases), urticaria (1 cases), sensorineural hearing loss (1 cases), femoral artery aneurysm (1 cases). According to univariate analysis, risk factors associated with acute hapatic failure after TACE were serum bilirubin and albumin, prothrombin time, dose of adriamycin, pre-TACE Child-Pugh class, tumor size, diffuse tumor type, portal vein thrombosis and TNM stage. Multivariate analysis revealed that serum bilirubin {odd ratio=3.86 (95% CI: 1.59-9.32)}, and diffuse tumor type {odd ratio=5.29 (95% CI: 1.46-23.86)} were statistically significant risk factors. Conclusions : It is recommended that above mentioned risk factors should be considered carefully before TACE to prevent the occurrence of acute hepatic failure after TACE in HCC patients.(Korean J Med 69:622-630, 2005)

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)

구연 / 제 4 회의장 / 간 19 : Stage Iva 의 진행성 간암에서 간동맥내 항암제 주입약제에 따른 치료성적과 예후인자

안상훈(Sang Hoon Ahn),한광협(Kwang Hyub Han),윤영훈(Youn Young Hoon),김진석(Jin Suk Kim),전재윤(Chae Yoon Chon),문영명(Young Myung Moon),이도연(Do Yun Lee),이종태(Jong Tae Lee) 대한소화기학회 1999 대한소화기학회 추계학술대회 Vol.1999 No.-