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심재준 ( Jae-jun Shim ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2
Liver cancer is one of the leading causes of cancer-related death in Korea. Liver cancer imposes a considerable societal burden due to its high incidence and high mortality rate in younger patients, as compared to other cancers. However, interest in liver cancer among researchers and health-policy makers is low. In this review, recent trends in the number of published articles on liver cancer in Korea and internationally were analyzed. The key finding is that the rate of growth in the number of published articles on liver cancer is slowly decreasing and financial investment for research into liver cancer is very limited, despite the increasing research and development investment budget in Korea. Meanwhile, the rate of growth of research into liver cancer in China has recently increased markedly. Therefore, the scale and rate of growth of research into liver cancer in Korea should be enhanced. (J Liver Cancer 2017;17:105-110)
심재준 ( Jae Jun Shim ),박현진 ( Hyun Jin Park ),김정욱 ( Jung Wook Kim ),황은정 ( Eun Jung Hwang ),이창균 ( Chang Kyun Lee ),장재영 ( Jae Young Jang ),박성진 ( Seong Jin Park ),최현림 ( Hyun Rim Choi ),김병호 ( Byung Ho Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5
목적: 간암 조기 검진을 위한 국가암검진사업의 유용성과 문제점을 조사하기 위해 단일 병원에서 일 년간 경험한 간암검진사업 결과를 분석하였다. 방법: 2011년 1월 1일부터 12월 31일까지 경희대학교병원에서 간암검진을 위해 복부 초음파 검사 또는 혈청 알파태아단백 검사(이하 AFP)를 받은 수검자를 대상으로 하였다. 이들의 기본적인 특성, 간암 발견율, 그리고 간암을 발견하기 위해 지출된 의료 비용을 위암과 비교 조사하였다. 결과: 일 년간 621명을 검진하여 총 5명(0.8%)의 간세포암(이하 간암)을 발견하였다. 이 중 4명은 복부 초음파 검사로 발견되었고 모두 근치적 치료(수술 2명, 고주파응고술 2명)를 받았다. 나머지 한 명은 AFP 상승으로 발견되었고 침윤성 간세포암으로 진단 후 2개월만에 사망하였다. 과거 병력을 조사할 수 있었던 492명 가운데 45%가 B형간염이었고 5%가 C형간염, 1%가 B형 C형 동시감염, 3%가 알코올성 간경변증을 포함한 기타 간경변증이었다. 나머지 46%의 수검자들은 간암 고위험인자를 하나도 가지고 있지 않았다. 간암 1명을 발견하기 위해 사용된 의료 비용은 총 842만원이었고 이는 위암의 4,506만원에 비해 낮은 수준이었다. 비대상자들을 제외하였을 때 간암 검진 비용은 556만원까지 낮출 수 있었다. Background/Aims: The aim of this study was to investigate outcomes and current status of the National Liver Cancer Screening Program in a single healthcare center. Methods: Subjects received abdominal ultrasonography (US) and/or serum alpha-fetoprotein (AFP) testing from January 2011 to December 2012. The clinical characteristics of the subjects, detection rate of liver cancer, and direct medical costs were investigated. Results: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. Conclusions: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer. (Korean J Med 2013;84:672-680)
심재준 ( Jae-jun Shim ) 대한간학회 2018 간학회 싱글토픽 심포지움 Vol.2018 No.2
Fatty liver results from imbalance between influx and efflux of fat metabolism and is a hallmark of subsequent liver injury, such as steatohepatitis, significant fibrosis, and liver cancer. The two most common causes of fatty liver are chronic alcohol consumption and energy surplus. However, other uncommon conditions such as drugs, malnutrition, rapid weight loss, and congenital disorders can be a cause of mild to severe non-alcoholic fatty liver disease. Understanding of their pathophysiology will broaden our knowledge of lipid metabolism and suggest new approach to treat non-alcoholic fatty liver disease.
심재준 ( Jae Jun Shim ),김병호 ( Byung Ho Kim ),황보영 ( Young Hwangbo ),이상욱 ( Sang Wook Lee ),이영주 ( Young Ju Lee ),하승형 ( Seung Hyung Ha ),장재영 ( Jae Young Jang ),동석호 ( Seok Ho Dong ),김효종 ( Hyo Jong Kim ),장영운 ( 대한간암연구회 2009 대한간암학회지 Vol.9 No.-
Long term results of hepatic resection for hepatocellular carcinoma (HCC) are not satisfactory due to a high incidence of postoperative recurrence. To improve the prognosis in patients who underwent hepatic resection, identification of risk factors for recurrence and development of effective preventive strategies are required. A single nodular mass was found in the right hepatic lobe of 53-year old male with B viral cirrhosis by surveillance ultrasonography. Dynamic abdominal CT showed a 3 cm-sized hypervascular mass in the right posteroinferior segment (S6). AFP was 359 ng/mL. Child-Pugh classification was A, and ICG R15 was 18.8%. After preoperative transarterial chemoembolization (TACE), right hepatic wedge resection was performed. Resection margin was free of tumor. Microinvasions in the surrounding vessels, lymphatics, bile ducts were not found and microsatellite nodules were absent in the resected specimen. Although there were no risk factors that associated with high postoperative recurrence, multifocal intrahepatic recurrence in the right lobe and left medial lobe occurred at 7 months after hepatic resection. He underwent two sessions of TACE.
Recent Management of Chronic Hepatitis C
Jae-Jun Shim(심재준) 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4
Chronic hepatitis C is now accepted as a curable viral disease. Recently, we have seen the advent of blockbusters in the treatment of chronic hepatitis C. Direct-acting antiviral agents (DAAs) are now used as a standard treatment of chronic hepatitis C in western countries and they will be introduced in Korea within no more than few years. The new regimens using combination of DAAs with or without pegylated interferon (Peg-IFN) or ribavirin (RBV) has been proved to be more effective, easier, and more tolerable. However, high cost of drugs might be an obstacle for the future treatment. Until DAAs are widely used, combination therapy of Peg-IFN and RBV might remain in a standard therapy in most countries. In this topic, we will review the current problems of interferon-based treatment and future direction of novel treatments using DAAs in patients with chronic hepatitis C.
스테로이드 불응성 궤양성 대장염 입원 환자에서 Infliximab 구조요법의 효과
조준형 ( Jun Hyung Cho ),이창균 ( Chang Kyun Lee ),김효종 ( Hyo Jong Kim ),심재준 ( Jae Jun Shim ),장재영 ( Jae Young Jang ),동석호 ( Seok Ho Dong ),김병호 ( Byung Ho Kim ),장영운 ( Young Woon Chang ) 대한장연구학회 2012 Intestinal Research Vol.10 No.2
Background/Aims: In hospitalized patients with acute steroid-refractory UC, infliximab has been demonstrated to be one of the medical rescue therapies to avoid colectomy. We report the result of a retrospective observational study to find the efficacy and safety of infliximab as a rescue therapy in our hospital. Methods: Between January 2007 and January 2010, 9 hospitalized patients with steroid-refractory UC were selected to receive three infusions of infliximab (5 mg/kg), at weeks 0, 2, and 6. Efficacy of treatment was evaluated at 8 weeks after the first infliximab infusion and at the end of follow-up period. Adverse events related to infliximab rescue therapy were also collected. Results: Seven patients (77.8%) had completed 3 infusions of infliximab and achieved clinical response at 8 weeks after the first infliximab infusion. Clinical remission rate and the rate of mucosal healing at 8 weeks were 57.1% (4/7) and 71.4% (5/7), respectively. They were followed up for median time of 24.9 months (19.5-53.6 months). One patient underwent emergency colectomy at weeks 2, due to colon perforation, while another patient had discontinued infliximab treatment at weeks 4, because of Clostridium difficile-associated colitis. Finally, colectomy was avoided in 77.8% (7/9) of cases. There was no mortality. Conclusions: Rescue therapy with infliximab has sustained clinical benefit in 88.9% of our hospitalized patients with acute steroid-refractory UC. Future prospective and long-term follow-up trials with a large number of patients are needed to confirm the efficacy and safety of the treatment. (Intest Res 2012;10:152-160)
장재영 ( Jae Young Jang ),이준성 ( June Sung Lee ),김형준 ( Hyung-joon Kim ),심재준 ( Jae-Jun Shim ),김지훈 ( Ji Hoon Kim ),김보현 ( Bo hyun Kim ),권준혁 ( Choon Hyuck Kwon ),이승덕 ( Seung Duk Lee ),이해원 ( Hae Won Lee ),김정훈 대한간암학회 2017 대한간암학회지 Vol.17 No.1
The General Rules for the Study of Primary Liver Cancer was published in June 2001 as the first edition. Since then, the 5th edition of the General Rules for the Study of Primary Liver Cancer was published by the 17th Committee of the Korean Liver Cancer Association based on the most recent data. The 5th edition of the General Rules for the Study of Primary Liver Cancer ranged over numerous topics such as anatomy, medical assessment of the patients, staging of hepatocellular carcinoma, description of the image findings, summary of hepatic resection, description of the surgical specimens, liver transplantation, reporting the pathological findings, pathological examinations of liver specimen, non-surgical treatment, radiotherapy, and assessment of tumor response after non-surgical treatment of hepatocellular carcinoma. The 5th General Rules for the Study of Primary Liver Cancer will not only become the basis of academic development for liver cancer studies in Korea, but also serve as the primary form of national liver cancer data accumulation based on standardized rules. (J Liver Cancer 2017;17:19-44)