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간세포암 환자에서 간동맥화학색전술 후 발생한 간십이지장 누공
박윤혜 ( Yoon Hea Park ),강세훈 ( Se Hun Kang ),김승업 ( Seung Up Kim ),김도영 ( Do Young Kim ),박준용 ( Jun Yong Park ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.3
Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted. (Korean J Gastroenterol 2011;58:149-152)
만성 염증성 장질환 환자에서 항호중구 세포질 항체의 의의
문윤재(Yoon Jae Moon),배희동(Hee Dong Bae),박효진(Hyo Jin Park),김원호(Won Ho Kim),정석훈(Suk Hoon Chung),김현숙(Hyun Sook Kim),전재윤(Chae Yoon Chon),박인서(In Suh Park) 대한내과학회 1997 대한내과학회지 Vol.52 No.5
N/A Objective: Anti-neutrophil cytoplasmic antibody (ANCA), known as a useful diagnostic marker in patients with ulcerative colitis (UC), are specific for granule proteins of granulocytes and monocytes and induce distinct fluorescence patterns. To evaluate the significance of ANCA in chronic inflammatory bowel disease (IHD), the presence of ANCA in chronic IBD was studied using indirect immunofluorescent test (IIF), Methods: Between March, 1994 and September 1995, 51 patients with chronic inflammatory bowel disease were subjected in this study. We had analysed the correlation between duration, disease activity, location by colonoscopy and radiologic examinations, steroid treatment. Results: 1) Among 34 patients with ulcerative colitis (UC), ANCA was demonstrated in 23 patients (67.6%). Among 19 patients with other chronic IBD (4 Crohn's disease, 6 Behcet's colitis, 7 intestinal tuberculosis and 2 radiation colitis) 2 patients (10.5%) had ANCA. The positivity of ANCA in patients with UC was significantly higher than in patients with other chronic IBD. 2) In patients with UC, c-ANCA was positive in 2 (5.9%) patients and p-ANCA was positive in 21 (61.8%) patients. In patients with other chronic IBD, ANCA was positive in one patient with Behcet's colitis or one patient with intestinal tuberculosis but negative in all patients with Crohn's disease or radiation colitis. 3) The mean duration of disease in ANCA positive patients was 42.4±39.4 months and the mean duration of disease in ANCA negative patients was 44.9±36.8 months, but there was no significant difference. 4) The number of patients in clinically mild, moderate and severe group were 23 (37.6%), 6 (83.2%) and 5 (14.7%) respectively. Among these groups the number of ANCA positive patients were 15 (65.2%), 5 (83.2%) and 3 (60%) respectively, but there was no significant difference. 5) The number of patients with proctitis, left side colitis and pancolitis were 9 (26.5%), 14 (41.2%) and 11 (32.4%) respectively, Among these groups the number of ANCA positive patients were 4 (44.4%), 10 (71.4%) and 9 (81.8%) respectively, but there was no significant difference. 6) Among 13 patients with steroid treatment 9 patients (69.2%) were ANCA positive. Among 21 patients without steroid treatment 16 patients (76.2%) were ANCA positive, but there was no significant difference. Conclusion: Although there was no correlation between ANCA and duration, disease activity, location or steroid treatment in UC patients, ANCA could be a diagnostic marker of UC in chronic IBD patients.
만성 간질환 환자에 대한 고덱스 캅셀의 유효성.안정성에 관한 다기관, 무작위할당, 이중맹검 3상 비교임상시험
박문승,강주섭,전재윤,백승운,임규성,곽민정,전용철,이민호,Park, Moon-Seung,Kang, Ju-Seop,Chon, Chae-Yoon,Paik, Seung-Woon,Rim, Kyu-Sung,Kwak, Min-Jung,Jeon, Yong-Cheol,Lee, Min-Ho 대한임상약리학회 2001 臨床藥理學會誌 Vol.9 No.2
Background/Aims : Godex is a mixture of PMC(diphenyl-dimethyl-dicarboxylate) and Hepadif, each of which has been used for managing chronic liver disease in Korea and other countries. The purpose of this study was to evaluate the efficacy and safety of Godex in Korean patients with chronic liver disease. Methods : In this study, 154 patients with chronic hepatitis, who showed increased level of serum alanine aminotransferase(ALT), were randomly allocated into three groups. Fifty-two patients were administered 100mg/day of PMC, 48 patients were administered low dose of Godex(PMC 100mg+hepadif 600mg/day) and 53 patients were administered high dose of Godex(PMC 150mg+hepadif 900mg/day) orally for 8 weeks. To evaluate the efficacy and safety of Godex capsule, we considered primary variable as the proportion of patients who showed normal ALT blood level after treatment for 8 weeks and second variable as a proportion of patient who showed normal ALT at 4 weeks, the degree of difference of serum ALT level between 0 and 8 weeks, and incidence of adverse events during treatment period. Results : The percentage of subjects whose serum ALT levels decreased below upper normal level in control, low-dose and high-dose group were 64.54%, 67.35%, 81.13% after 8 weeks-treatment(p=0.0407) and 59.62%, 63.27%, 81.13% after 4 weeks-treatment of Godex(p=0.0790) using ITT analysis. There were no significant difference in incidence of adverse events among three groups. Conclusions : Response rate of high-dose group was significantly higher than those of low-dose group and control group. It is suggested that Godex 6 capsules per day(PMC 150mg+hepadif 900mg/day) is optimal dose for Korean patients with chronic liver disease who show elevated serum alanine aminotransferase(ALT) level.
이차성 비기능항진증에서 부분적 비장동맥색전술의 장기 치료 효과
이중민 ( Jung Min Lee ),전재윤 ( Chae Yoon Chon ),한재용 ( Jae Yong Han ),윤기태 ( Ki Tae Yoon ),문창모 ( Chang Mo Moon ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),이종태 ( Jong Tae Lee ),문영명 ( Young Myoung Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
목적: 간경변증 환자에서 이차성 비기능항진증이 동반되어 범혈구감소증이 생기면서, 그 중에서 특히 혈소판감소증이 임상적으로 문제가 되는 경우가 많다. 치료를 위해서는 과거에 비장적출술(splenectomy; SPL)을 시행하였는데 간기능 저하가 동반되어 있어서 수술 자체의 위험성이 많아 적응증이 안 되는 경우가 있다. 따라서 수술에 비하여 비침습적인 부분적 비장동맥색전술(partial splenic embolization; PSE)이 소개되고 있으며 결과가 양호한 것으로 알려져 있다. 간경변증으로 진단된 환자에서 PSE의 치료 효과에 대해서 고찰하고 SPL과의 치료 효과를 비교하였다. 방법: 1999년 1월부터 2003년 12월까지 간경변증 환자 중 PSE 또는 SPL을 시행한 환자를 대상으로 후향적 연구를 수행하였다. 이차성 비기능항진증에 의한 혈소판 감소증으로 출혈 증상이 있거나 혈소판감소증을 교정해야 할 목적으로 시행하였으며, 치료 전후의 혈액검사를 비교하였고 합병증의 유무를 확인하였다. 결과: PSE 군이 총 40명, SPL 군이 35명이었고, 남녀 비가 각각 27:13, 23:12로 남자가 더 많았으며, 평균 연령은 각각 50.8, 49.2세였다. 백혈구는 PSE 및 SPL 군에서 2년째에 4,450 및 5,560/μL로서 치료 전에 비해 유의한 증가를 보였고 혈소판도 양 군에서 2년째에 각각 144, 174 k/μL를 보여 유의한 증가를 보였으며 혈색소도 마찬가지로 2년째에 각각 13.7, 12.8 g/dL로서 치료 전에 비해서 유의한 증가를 보였다. Child-Pugh score를 계산하면 PSE 군은 치료 전 6.5에서 치료 후 5.5로 유의한 감소를 보였으며(p=0.04), SPL 군은 6.4에서 5.9로서 통계적인 차이가 없었다. 합병증은 양 군에서 경미하였고 사망, 출혈, 감염증의 심각한 합병증은 7.5% 이하에서 나타났으며 통계적 차이가 없었다. 결론: 이상의 결과로 PSE는 간기능이 비교적 양호한 환자에서 이차성 비기능항진증으로 의한 혈구감소증에 좋은 치료 방법으로 생각되며, 심각한 합병증의 발생은 적고 일부 간기능의 호전을 기대할 수 있어서 간경변증 환자에서 시행해 볼 수 있는 비교적 안전하고 효과적인 방법으로 생각된다. Background: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. Methods: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. Results: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. Conclusions: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism. (Korean J Med 72:470-479, 2007)
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)
다발성 폐전이를 동반한 진행성 간세포암종 환자에서 전신항암화학요법의 치료성적
윤기태 ( Ki Tae Yoon ),최종원 ( Jong Won Choi ),박준용 ( Jun Yong Park ),안상훈 ( Sang Hoon Ahn ),백용한 ( Yong Han Paik ),이관식 ( Kwan Sik Lee ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ),김도영 ( Do Young Kim ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.3