Treatment Efficacy of Endoscopic Variceal Obturation for Gastric Variceal Bleeding According to the Type of Varices

( Hyun Gil Goh ),( Yeon Seok Seo ),( Han Ah Lee ),( Tae Hyung Kim ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyunggin An ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( Soon Ho 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: This study was performed to evaluate the treatment efficacy of endoscopic variceal obturation (EVO) in patients with gastric variceal (GV) bleeding according to the type of varices. Methods: All patients who treated with EVO for GV bleeding were included. Patients with previous history of endoscopic treatment for GV bleeding (n=4) and those combined with portal vein invasion by HCC (n=9) or other malignancy (n=7) were excluded. In addition, patients with IGV2 were also excluded because the number was too small for analysis (n=2). Results: Age was 59.4 ± 12.4 years and 72 patients (79.1%) were men. Alcoholic liver disease (47 patients, 51.6%) was most common cause of liver disease, followed by chronic hepatitis B (24 patients, 26.4%). HCC was combined in 28 patients (30.8%). Type of varices was GOV1, GOV2, and IGV1 in 33 (36.3%), 31 (34.1%), and 27 (29.7%) patients, respectively. Hemostasis was successful in 88 patients (96.7%). Hemostasis success rates according to the type of varices were 100%, 96.8%, and 92.6% in GOV1, GOV2, and IGV1, respectively, which were comparable among three groups (P=0.279). Hemostasis was successful in 88 patients (96.7%). GV was obliterated in 81 patients (89.0%). Number of EVO session was comparable among three groups (1.5 ± 0.7, 1.3 ± 0.4, and 1.7 ± 0.7 in patients with GOV1, GOV2, and IGV1, respectively), while amount of histoacryl was significantly smaller in patients with GOV1 (1.4 ± 0.7 ml) compared to those with GOV2 (2.6 ± 1.3 ml, P=0.042) and IGV1 (2.7 ± 1.4 ml, P=0.041). Among 81 patients with GV obliteration, GV recurrence rate at 24 months was 43.9%. GV recurrence was significantly lower in patients with GOV1 (18.7%) than those with GOV2 (65.0%; P=0.005) and those with IGV1 (47.0%; P=0.046). VB recurrence rate at 24 months was 21.3%. VB recurrence rate was significantly lower in patients with GOV1 (12.1%) than those with GOV2 (40.5%; P=0.021), but it was comparable with patients with IGV1 (11.6%; P-0.929). Conclusions: Size of varices and amount of histoacryl for GV obliteration were significantly lower in patients with GOV1 than those with GOV2 or IGV1. GV recurrence, GV rebleeding were significantly lower in patients with GOV1 than those with GOV2.

Evaluation of the Clinical Usefulness of Adding Serum AFP-L3 and/or PIVKA-II Levels to Serum AFP Level

( Hyun Gil Goh ),( Han Ah Lee ),( Tae Hyung Kim ),( Sun Young Yim ),( Young-sun Lee ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: This study was performed to investigate the clinical usefullness of the tumor-markers for hepatocellular carcinoma (HCC), including alpha-fetoprotein (AFP), AFP-L3, and prothrombin induced by vitamin K absence or antagonist-II (PIVKA-II). Methods: Patients who underwent serum AFP, AFP-L3, and PIVKA-II for elevation of space-occupying lesion (SOL) in the liver or elevated serum AFP level without liver SOL were retrospectively reviewed. AFP >5 ng/mL, AFP-L3 >5%, PIVKA-II >40 mAU/mL were used as the cut-off value, respectively. Results: Two-hundred fifty-two patients were included; patients with liver SOL were 219 (86.9%) and those with elevated AFP without liver SOL were 33 (13.1%). In patients with liver SOL, 85 (38.8%) patients were diagnosed as HCC. Twenty-four (17.9%) patients with benign SOL and 53 (62.4%) patients with HCC had elevated AFP level (P<0.001). AFP-L3 was elevated in 5 (3.7%) patients with benign SOL, and 30 (35.3%) patients with HCC (P<0.001). 6 (4.5%) patients with benign SOL and 43 (50.6%) patients with HCC had abnormal PIVK-II level (P<0.001). Sensitivity and specificity of AFP for the HCC diagnosis were 62.4% and 82.1%, respectively. Combination of AFP-L3 to AFP increased sensitivity to 68.2% without change in the specificity. Combination of PIVKA-II to AFP increased sensitivity to 76.5% with slight decrease in specificity (78.4%). Combination of all three tumor-markers increased the sensitivity to 80.0% with 78.4% of specificity. In patients with elevated AFP without liver SOL, 5 (15.2%) and 4 (12.1%) patients had increased AFP-L3 and PIVKA-II, respectively, while, no one had increased both markers. Conclusions: In patients with liver SOL, combination of AFP, AFP-L3, and PIVKA-II improved sensitivity of AFP, not having a significant effect on specificity. None of patients with elevated AFP without liver SOL showed parallel elevation of AFP-L3 and PIVKA-II. Therefore, combined evaluation of these tumor-markers would be beneficial in differential diagnosis.

동화 남성화스테로이드 유사체 남용 후 발생한 중증 지속 황달

고현길 ( Hyun Gil Goh ),이유진 ( Yoo Jin Lee ),김태형 ( Tae Hyung Kim ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.3

Hepatic disorders with prominent cholestasis can be caused by a range of conditions, and anabolic androgenic steroids have been considered a cause of protracted cholestasis. A 29-year-old man who had taken an anabolic androgenic steroid analogue for 2 months visited the hospital complaining of jaundice and indigestion. After stopping the medication, the hyperbilirubinemia tended to decrease, but a transiently elevated aminotransferase level was observed. The endogenous testosterone level also decreased initially but recovered soon after. The liver function profiles were normalized after 2 months of conservative management. This case emphasizes that close drug history taking, including anabolic steroids, is important for identifying the cause of unexplained persistent jaundice. (Korean J Gastroenterol 2020;76:167-170)

Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography

Han Ah Lee,Hyun Gil Goh,Tae Hyung Kim,Young-Sun Lee,Sang Jun Suh,Young Kul Jung,Hyuk Soon Choi,Eun Sun Kim,Ji Hoon Kim,Hyunggin An,Yeon Seok Seo,Hyung Joon Yim,Sung Bum Cho,Yoon Tae Jeen,Jong Eun Yeon 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.1

Backgrounds/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions: Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding.

Evaluation of Treatment Response after Endoscopic Variceal Obturation with Abdominal Computed Tomography

( Han Ah Lee ),( Hyun Gil Goh ),( Tae Hyung Kim ),( Sun Young Yim ),( Young-sun Lee ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Sung Bum Cho ),( Jong E 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Current guidelines recommend endoscopic variceal obturation (EVO) as the treatment of choice for the management of bleeding from gastric varices (GV). This study was performed to evaluate the usefulness of CT for the prediction of rebleeding after EVO for GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and performed CT before and after EVO were included. Those with a previous history of endoscopic treatment for bleeding from GVs (n=4) and those with accompanying portal vein invasion by hepatocellular carcinoma (HCC) (n=9) or other malignancy (n=7) were excluded. Results: Fifty-three patients were included. Age was 60.6±11.6 years and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (24 patients, 45.3%). Complete impaction of cyanoacrylate in GVs and in the feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in 9 patients and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in GV, while it differed significantly according to the complete cyanoacrylate impaction in feeding vessels: the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete cyanoacrylate impaction in feeding vessels and there was no rebleeding during the follow-up period in patients with complete cyanoacrylate impaction in feeding vessels (P=0.002) Conclusions: Abdominal CT was useful in evaluation of treatment response after EVO for GV bleeding. Because incomplete cyanoacrylate impaction in feeding vessels is the risk factor of GV rebleeding, detailed evaluation of feeding vessels on CT after EVO and determination of additional treatment is needed.

Attraction Effects to Various Conditions of Pinus koraiensis against Pine Sawyer, Monochamus saltuarius (Coleoptera: Cerambycidae)

Kang, Shin-Ho,Kim, Min-Ki,Yang, Jeong-Oh,Yoon, Chang-Mann,Goh, Sang-Hyun,Shin, Sang-Chul,Kim, Chul-Sa,Kim, Gil-Hah The Korean Society for Applied Biological Chemistr 2009 Applied Biological Chemistry (Appl Biol Chem) Vol.52 No.5

Recently, the pine sawyer Monochamus saltuarius has been proved as a vector of pinewood nematode, Bursaphelenchus xylophilus in South Korea. This pest causes serious concern that widely distributed in the middle of South Korea and most likely to spread fast. To understand their ecological behavior, the attraction behavior of the pine sawyer was tested in the volatile samples of Pinus koraiensis by emitting different host condition. The olfactory response of the immature (0~3 days old after emergence) adults of M. saltuarius preferred the volatiles from the fresh host condition (fresh twigs, just cut twigs which wrapped with the parafilm), whereas the mature (20~30 days old) adults preferred the volatiles from the 3-day old stressed host (twigs infested by male and female, 3-day old cut twigs that were artificially damaged). In the GC and GC/MS analyses, contrary to the samples from the fresh host condition having monoterpene volatiles only, the samples from the 3-day old stressed host were revealed to have more volatiles of oxygenated monoterpenes and sesquiterpenes. The attraction assay of M. saltuarius adults to the volatile mixtures of monoterpenes, oxygenated monoterpene, and sesquiterpene appeared to be efficient when the oxygenated monoterpene mixture was necessarily treated with monoterpene mixtures.

Urinary N-Acetyl-β-D-Glucosaminidase Is Useful for Differentiation of Type of Acute Kidney Injury in Patients with Liver Cirrhosis

( Tae Hyung Kim ),( Yeon Seok Seo ),( Han Ah Lee ),( Jung Mi Chang ),( Hyun Gil Goh ),( Dae Hoe Gu ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Considering the frequency and prognostic impact of acute kidney injury (AKI) in cirrhotic patients, early detection and appropriate management are very important. AKI could be divided into prerenal azotemia (PRA) and acute tubular necrosis (ATN). Although appropriate management is quite different between two conditions, appropriate tests for differentiation have not been presented. Urinary-N-acetyl- β-D-glucosaminidase (NAG) have been proposed as a good tubular injury marker in many studies, but its efficacy is not clear in cirrhotic patients. This study was performed to evaluate the usefulness of urinary NAG in cirrhotic patients. Methods: Hospitalized patients with liver cirrhosis who performed urinary NAG test from September 2016 to February 2017 were included. The patients with malignancy or chronic kidney disease were excluded. AKI was defined by IAC-AKI criteria. Results: A total of 59 cirrhotic patients were included. Age was 58.8±12.0 years and 41 patients (69.5%) were men. Serum creatinine and urinary NAG scores were 1.0±0.3 mg/dL and 30.0±29.6 U/g urinary Cr, respectively. AKI was not combined in 41 patients (69.5%), while PRA and ATN were combined in 15 (25.4%) and 3 (5.1%) patients, respectively. Serum creatinine level was significantly higher in patients with PRA (1.6±0.2 mg/dL, P<0.001) and those with ATN (1.5±0.4 mg/dL, P=0.002) than those without AKI (0.8±0.2 mg/dL), while it did not differ between patients with PRA and those with ATN (P=0.422). Urinary NAG level was comparable between patients without AKI and those with PRF (22.6±15.6 vs. 38.2±40.6 U/g urinary Cr, P=0.241), while it was significantly higher in patients with ATN (88.5±46.9 U/g urinary Cr) than those without AKI (P=0.001) and those with PRA (P=0.025). Conclusions: The urinary NAG level was significantly increased in patients with ATN in patients with liver cirrhosis. It could be useful for discrimination of cirrhotic patients with ATN among those with AKI.

Attraction Effects to Various Conditions of Pinus koraiensis against Pine Sawyer, Monochamus saltuarius (Coleoptera: Cerambycidae)

( Shin Ho Kang ),( Min Ki Kim ),( Jeong Oh Yang ),( Chang Mann Yoon ),( Sang Hyun Goh ),( Sang Chul Shin ),( Chul Sa Kim ),( Gil Hah Kim ) 한국응용생명화학회 2009 Applied Biological Chemistry (Appl Biol Chem) Vol.52 No.5