국내에서 보고된 간의 국소 결절성 과형성에 대한 임상적 고찰

강하얀,김동우,신기철,윤세영,김석배,신정은,김홍자,송일한 대한소화기학회 2007 대한소화기학회 추계학술대회 Vol.2007 No.-

구연 : 블루벨 ; 간세포암종의 병기 분류 쳬계에 따른 예후 예측력 비교 (초)

강하얀,문성훈,신현덕,윤세영,김석배,신정은,김홍자,송일한 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3(S)

Phlebosclerotic Colitis in a Cirrhotic Patient with Portal Hypertension: The First Case in Korea

강하얀,노란,신현덕,윤세영,송일한,김소미 대한의학회 2009 Journal of Korean medical science Vol.24 No.6

Phlebosclerotic colitis is a rare form of ischemic colitis characterized by the thickening of the wall of the affected colon due to fibrous degeneration of submucosal layer of colon and fibrotic obstruction of the colono-mesenteric vein, resulting in the disturbance of venous return from the colon. The pathogenic mechanism of this entity remains unknown but chronic liver disease with portal hypertension is maybe thought to be one of the speculated mechanisms. Here we first report the case of surgically confirmed phlebosclerotic colitis, that was in the early stage but showed the aggressive nature, in a 61-yr-old cirrhotic patients with portal hypertension in Korea.

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

강하얀,이원경,김용현,권병운,강명수,김석배,송일한 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.

국내에서 보고된 간내 국소결절과형성에 대한 임상 분석

강하얀 ( Ha Yan Kang ),라성수 ( Sung Soo La ),공재환 ( Jae Hwan Kong ),이상석 ( Sang Seok Lee ),백두산 ( Doo San Baek ),임상수 ( Sang Soo Lim ),신기철 ( Ki Chul Shin ),신현덕 ( Hyun Duk Shin ),윤세영 ( Se Young Yun ),김석배 ( Suk 대한소화기학회 2008 대한소화기학회지 Vol.52 No.6

목적: 간의 국소결절과형성(FNH)은 간세포암종이나 간선종과 같은 수술 치료를 요하는 간내 종괴와 감별을 요하는 양성 종양 중 하나이다. 저자들은 국내에서 보고된 증례들을 통해 FNH의 임상, 영상의학 및 병리 특성을 알아보고자 하였다. 대상 및 방법: 인터넷 사이트 "http://koreamed.org"에서 "focal nodular hyperplasia"와 "liver"를 검색용어로 하여 간내 FNH을 검색하였다. 1997년부터 최근까지 검색된 17편의 논문에 발표된 증례 37예와 본원에서 경험한 1예 등 총 38예를 대상으로 하였다. 결과: 국내에서 보고된 FNH 총 38예의 발생 연령은 평균 34세(재태 36주-67세)였으며 남녀 성비는 1.2:1 (21예:17예)이었고 17명의 여성은 모두 경구 피임제를 복용한 병력이 없었다. 18예(47.4%)에서 무증상으로 우연히 발견되었으며, 증상이 있어 검사를 시행한 경우는 20예(52.6%)였으며 동반된 증상으로는 심와부 통증이 제일 많았고, 복부 종괴, 전신 쇠약, 오심 및 구토, 식욕부진 및 황달 등의 순이었다. 결절의 평균크기는 3.9 cm (0.5-16 cm)였으며 32예(84.2%)에서 단일결절을 보였다. 초음파검사에서는 55% (11/20)에서 저에코 결절로 보였다. 컴퓨터단층촬영에서는 85% (34/40)에서 동맥기에 조영증강되는 소견을 보였으나 지연영상에서는 다양하게 나타났다. 자기공명영상의 T1 강조영상에서 저신호 강도를 보인 경우는 60% (18/30), T2 강조영상에서 고신호 강도를 보인 경우는 73.3% (22/30)였다. 간동맥 조영술은 10예에서 시행되었으며 6예에서 고혈관 종괴를 나타냈다. 외과 절제를 시행한 20예 중 육안 소견이 확인된 13예에서 피막 형성을 동반하지 않은 경계가 명확한 결절이 관찰되었으며, 이 중 8예에서 중심부별모양 반흔이 확인되었다. 병리 소견에서는 비정상적인 결절과 섬유 격막이 관찰되었고 섬유 격막에는 혈관 및 쓸개세관 증식을 포함하는 전형적인 형태가 대부분이었다. 결론: 국내에서 보고된 간내 FNH은 기존의 역학 및 임상양상에 대한 보고와 비교하여 성비, 임상 증상, 경구용 피임약 복용 여부 등에서 차이를 보이고 있다. 하지만 국내에서 보고된 증례가 많지 않고 그 임상정보가 한정되어 있으며 비전형적인 임상상을 보이는 예가 많이 포함되어 있어 추후 전국적 임상 조사를 통한 전향 분석이 필요하리라 생각한다. Background/Aims: Focal nodular hyperplasia (FNH) is mandatory to be differentiated from other hepatic tumorous conditions such as hepatocellular carcinoma and adenoma. The purpose of this study was to explore the clinical, radiological and pathological features of FNH cases reported in Korea. Methods: We have searched the journals from the web site "http://koreamed.org" using keywords "focal nodular hyperplasia" and "liver"-total of 38 cases of FNH, 37 cases from 17 published articles and one case from our experience confirmed histologically, were reviewed and analyzed. Results: Thirty eight cases were diagnosed between gestational age of 36 weeks and 67 years. Seventeen female patients (45%) had no history of taking oral contraceptives. Twenty cases (52.6%) experienced clinical symptoms such as abdominal pain and palpable mass. Computed tomography revealed contrast-enhancement in 34 nodules (85%) and typical central stellate scar in 9 (22.5%) of 40 nodules. Magnetic resonance imaging showed T1 weighted low signal in 18 (60%) and T2 weighted high signal in 22 (73.3%) of 30 nodules. Six (60%) of 10 cases showed hypervascular staining on hepatic angiography. Among 38 cases, 32 (84.2%) cases had single nodule and their mean size was 3.9 cm (0.5-16 cm). Pathologically, fibrous septa, proliferation of bile ductules and arterial wall thickening were seen in most cases. Conclusions: Of all the FNH cases reported in Korea, there were some differences in clinical aspects of sex ratio, accompanying clinical symptoms, and relationship with oral contraceptives, compared with previous reports. Further prospective studies are needed by means of nation-wide clinical survey and analysis.

만성간염 환자에서 간 섬유화의 조직학적 활성도 예측에 대한 혈청학적 표지자의 유용성

방창석 ( Chang Seok Bang ),강하얀 ( Ha Yan Kang ),최규호 ( Gyu Ho Choi ),김석배 ( Suk Bae Kim ),이원애 ( Wonae Lee ),송일한 ( Il Han Song ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.5

Background/Aims: The invasiveness of a liver biopsy and its inconsistent results have prompted efforts to develop noninvasive tools to evaluate the severity of chronic hepatitis. This study was intended to assess the performance of serum biomarkers for predicting liver fibrosis in patients with chronic viral hepatitis. Methods: A total of 302 patients with chronic hepatitis B or C, who had undergone liver biopsy, were retrospectively enrolled. We investigated the diagnostic accuracy of several clinical factors for predicting advanced fibrosis (F≥3). Results: The study population included 227 patients with chronic hepatitis B, 73 patients with chronic hepatitis C, and 2 patients with co-infection (hepatitis B and C). Histological cirrhosis was identified in 16.2% of the study population. The grade of porto-periportal activity was more correlated with the stage of chronic hepatitis compared with that of lobular activity (r=0.640 vs. r=0.171). Fibrosis stage was correlated with platelet count (r=-0.520), aspartate aminotransferase to platelet ratio index (APRI) (r=0.390), prothrombin time (r=0.376), and albumin (r=-0.357). For the diagnosis of advanced fibrosis, platelet count and APRI were the most predictive variables (AUROC=0.752, and 0.713, respectively). Conclusions: In a hepatitis B endemic region, platelet count and APRI could be considered as reliable non-invasive markers for predicting fibrosis of chronic viral hepatitis. However, it is necessary to validate the diagnostic accuracy of these markers in another population. (Korean J Gastroenterol 2017;69:298-307)

위전절제술 후 변형된 위장관 구조를 가진 환자에서 소장내시경을 이용한 총담관 담석 제거

이원경,권병운,김용현,이현숙,현경희,강하얀,신현덕,김홍자 대한췌담도학회 2011 대한췌담도학회지 Vol.16 No.2

Billroth II 또는 루앵Y (Roux-en-Y) 연결 등의 수술을 받은 환자의 경우 변형된 해부학 구조 때 문에 유두부 진입이 쉽지 않아 역행성 담췌관 조영술의 성공률이 낮고, 합병증 발생률이 높 다. 이 런 환자에서 성인용 또는 소아용 대장내시경, 캡을 장착한 직시경, 또는 소장내시경을 이용 한 방 법들이 시도되고 있다. 최근에 많이 보고되고 있는 소장내시경을 이용한 방법은 비교적 높은 유두 부 삽입 성공률과 시술 성공률을 보이나, 긴 부속기구가 필요하다는 단점이 있고, 이 때문 에 "짧 은" 이중풍선 소장내시경을 이용하는 방법도 이용되고 있다. 저자들은 단일풍선 소장내시경 과 overtube를 이용하여 유두부에 도달한 후 직시경으로 바꾸어 ERCP를 시행하여 총담관 담석 을 성공적으로 제거한 1예를 경험하였기에 보고하는 바이다. Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with surgically altered gastrointestinal anatomy such as total gastrectony with Roux-en-Y anastomosis because of the long length of afferent limb that makes it difficult to reach the major papilla. In such cases, alternative approaches, using adult or pediatric colonoscopies or conventional forward-viewing upper endoscopy with transparent cap, have been challenged. Recently, methods using double- balloon or single-balloon enteroscopies have been reported. However, these methods can be used limitedly as long length ERCP accessories are not commercially available. We here report a case of successful common bile duct stone removal by single-balloon enteroscopy (SBE)-assisted ERCP with an overtube-assisted technique in patients with surgically altered Roux-en-Y anatomy. Compared with others, conventional length of accessories can be used for therapeutic ERCP in this method. SBE-assisted ERCP with an overtube-assisted technique can be useful salvage technique in patients with surgically altered gastrointestinal anatomy.

초치료 폐결핵 환자들에 있어서 초회 약제내성률

공재환 ( Jae Hwan Kong ),이상석 ( Sang Seok Lee ),강하얀 ( Ha Yan Kang ),박재석 ( Jae Seuk Park ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2

연구배경: 결핵의 치료력이 없는 결핵환자에서 발생하는 초회 약제내성은 결핵관리에 있어서 심각한 문제이다. 그러나 우리나라, 특히 민간의료기관에서 치료받는 폐결핵환자들의 초회 약제내성률에 대해서 잘 알려져 있지 않다. 본 연구에서는 천안지방의 한 3차병원에서 폐결핵환자들의 초회 약제내성률과 약제내성의 위험요소에 대해서 알아보았다. 방법: 2005년 9월부터 2007년 9월까지 단국대학교병원에서 객담 결핵균 배양검사 양성인 초치료 폐결핵환자 모두에 대해서 일차약과 이차약에 대한 약제감수성 검사를 시행하고 초회 약제내성의 양상과 함께 약제내성의 위험요소을 분석하였다. 또한 약제감수성 검사 결과가 치료 처방에 미치는 영향을 분석하였다. 결과: 총 156명의 초치료 폐결핵 환자에 대해서 약제 감수성 검사를 시행하였는데 한 가지 이상의 약제에 내성을 보인 환자는 21명(15.6%)이었으며 이소니아지드와 리팜핀에 동시 내성을 보이는 다제내성 환자는 1명(0.6%)이었다. 임상소견 중 초회 약제내성을 예측할 수 있는 독립적인 위험요소는 없었다. 약제감수성 검사 결과에 의해 15명(9.6%)의 환자에서 치료처방의 변경이 있었다. 결론: 폐결핵에서 초회 약제내성은 흔히 관찰되며 초 치료 폐결핵환자에서 약제감수성 검사는 환자치료에 도움이 된다. Background: Drug resistant tuberculosis (TB) in patients who have not received previous TB treatment (initial drug resistance) is a serious problem for the control of TB. However, prevalence of initial drug resistance among pulmonary TB patients has not been well characterized in Korea, especially in the private sector. We assessed the prevalence of initial drug resistance and evaluated the risk factors for drug resistance in pulmonary TB patients, at a regional tertiary hospital in Cheonan. Methods: We performed a drug susceptibility test for both first and second line anti-TB drugs in all culture-confirmed pulmonary TB patients who had not received a previous TB treatment at Dankook University Hospital from September 2005 to September 2007. In addition, we evaluated the initial drug resistance pattern and clinical characteristics of patients to evaluate the risk factors for initial drug resistance. We also assessed the influence of the drug susceptibility test results on the treatment regimen. Results: Of the total 156 cases where the drug susceptibility test was performed, resistance to at least one anti-TB drug was found in 21 cases (15.6%) and multidrug resistance, where TB was resistant to at least isoniazid and rifampin, was found in one case (0.6%). Multivariate logistic regression showed no clinical characteristics were independently associated with initial drug resistance. Of the total 156 patients who underwent the drug susceptibility test, the treatment regimen was changed for 15 patients (9.6%) according to the results of the drug susceptibility test. Conclusion: Initial drug resistance is common and the drug susceptibility test is informative for pulmonary TB patients who have not received previous TB treatment. (Tuberc Respir Dis 2008;64:95-101)

증례 : 혈액종양 ; 대장암 환자에서 복막 전이에 의한 상장간막 동맥 증후군 1예

방창석 ( Chang Seok Bang ),이순일 ( Soon Il Lee ),박건우 ( Geun Woo Park ),강하얀 ( Ha Yan Kang ),라성수 ( Sung Soo La ),공재환 ( Jae Hwan Kong ),강진모 ( Jin Mo Kang ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

저자들은 고식적 항암화학요법 치료 중인 대장암 환자에서 오심, 구토 등의 소장 폐색 증상을 호소하여 영상 의학적 검사들을 시행하여 상장간막 동맥 증후군을 진단하였으며, 수술적 치료를 통해 대장암의 복막전이에 의한 전이성 결절이 상장간막 동맥을 외부에서 직접 압박하여 발생한 상장간막 동맥 증후군으로 밝혀진 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Small bowel obstruction can develop from adhesions, hernias, and less frequently from tumors. Superior mesenteric artery (SMA) syndrome is an uncommon cause of small bowel obstruction. We experienced a case of SMA syndrome caused by peritoneal seeding from colon cancer. A 57-year-old woman presented with nausea, post-prandial vomiting, and weight loss. She had been receiving palliative chemotherapy for 12 months to treat colon cancer with peritoneal seeding. Abdominal computed tomography and a small bowel series revealed typical findings of SMA syndrome. As conservative treatment including nutritional support and positional change was ineffective, she was treated surgically. An adhesive mass compressing the SMA and duodenum was found at the third portion of the duodenum. The pathologic diagnosis was metastatic adenocarcinoma of colorectal origin. Adhesiolysis and duodenojejunostomy relieved her symptoms. This case shows that SMA syndrome can develop via peritoneal seeding in cancer patients. (Korean J Med 76:380-384, 2009)

Analysis of prognostic factors and 5-year survival rate in patients with hepatocellular carcinoma: a single-center experience

이상석,신현성,김형준,이수진,이현석,현경희,김용현,권병운,한진형,최훈,김배환,이준혁,강하얀,신현덕,송일한 대한간학회 2012 Clinical and Molecular Hepatology(대한간학회지) Vol.18 No.1

Background/Aims: Hepatocellular carcinoma (HCC), which is the third most common cancer in Korea, has a very poor prognosis. However, only a few studies have performed a comprehensive survival-related analysis in all patients who were consecutively diagnosed and treated over a given period of time. The aim of this study was to determine the 5-year survival rate and its prognostic factors among HCC patients. Methods: In total, 257 patients who were consecutively diagnosed with HCC between January 2000 and December 2003 were followed until death or until December 2008. We analyzed their survival outcomes according to their clinical characteristics, tumor staging, and treatment modalities, and determined the independent prognostic factors affecting survival. Results: The patients were aged 59±10 years (mean±SD). During the follow-up period, 223 patients (86.8%) died and the overall median survival was 10.8 months; the 1-, 3-, and 5-year survival rates were 44.4%, 21.0%, and 12.1%, respectively. The outcomes in patients with tumor node metastasis (TNM) stage I or II and Child-Pugh class A or B were significantly better with surgical resection than with other treatment modalities (P<0.01). Patients who underwent supplementary transcatheter arterial chemoembolization as a second-line treatment after surgical resection had better outcomes than those who underwent surgical resection alone (P=0.02). Initial symptoms, Child-Pugh class, serum alpha-fetoprotein, tumor size, portal vein thrombosis, and TNM stage were found to be independent prognostic factors for survival among HCC patients. Conclusions: This retrospective cohort study elucidated survival outcomes and prognostic factors affecting survival in HCC patients at a single center. (Korean J Hepatol 2012;18:48-55)