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만성 B형간염 치료의 최신 지견: 2018 대한간학회 진료 가이드라인을 중심으로
윤아일린 ( Eileen L. Yoon ),임형준 ( Hyung Joon Yim ) 대한내과학회 2019 대한내과학회지 Vol.94 No.3
Chronic hepatitis B virus (HBV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma in Korea. The prevalence of HBV infection is gradually decreasing in Korea, but 3.0% of the total population still suffers from HBV- related chronic liver diseases. In this review, we summarize the updated clinical practice guideline for management of chronic hepatitis B, as revised by the Korean Association for the Study of the Liver in 2018. (Korean J Med 2019;94:252-262)
윤아일린 ( Eileen L. Yoon ) 대한간학회 2020 Postgraduate Courses (PG) Vol.2020 No.1
To diagnose minimal hepatic encephalopathy is difficult due to asymptomatic feature and limitation in the use of psychometric or neurophysiologic tests at bedsides. However, patients suffer impaired quality of life, increased risks of job loss, fall, fractures, car accidents, and mortality. There are many established tests but norm-based, validated tools are limited and should be specialized to the region where the tests are applicated. In that sense, Korean paper pencil test and Korean stroop test can be used as diagnostic tools in Korea for screening and diagnosis of minimal hepatic encephalopathy. Animal naming test is simple but should be validated in Korea. Every test measures a bit different domains of the brain. Additionally, hepatic encephalopathy involves wide range of cognitive function. Therefore, using more than two different tools is recommended for the objective diagnosis of minimal hepatic encephalopathy.
Acute-on-Chronic Liver Failure의 진단과 관리
윤아일린 ( Eileen L. Yoon ) 대한간학회 2017 Postgraduate Courses (PG) Vol.2017 No.1
Acute-on-chronic liver failure (ACLF) is a distinct syndrome which is different from acute liver failure or decompensated liver cirrhosis. The two most commonly used definitions of ACLF are those proposed by Asia-Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) and the European Association for the Study of the liver Chronic Liver Failure consortium (EASL-CLIF-C). The former suggested liver-centered definition regarding acute insult and organ failure. The latter paid attention to multiple organ failures, based on Chronic Liver Failure Sequential Organ Failure Assessment (CLIF-SOFA) score, which is directly related to high short-term mortality rates. EASL-CLIF-C developed easy-to-use CLIF-C Organ Failure Score (CLIF-C OFs) for the diagnosis of ACLF. Furthermore, CLIF-C ACLF score (CLIF-C ACLFs) has been developed for the risk stratification of ACLF patients, based on age, white blood cell counts, and CLIF-C OFs. Prompt identification and treatment of the acute insult (eg. precipitant) and etiology of chronic liver disease is fundamental to improve the prognosis of ACLF patients. Results of liver transplantation in ACLF patients are encouraging. Nevertheless, supportive care of the organ failures and effort to prevent impairment of function of uninvolved organs are the mainstay of the treatment for present.
윤아일린 ( Eileen L. Yoon ) 대한간학회 2018 간질환 연수강좌 Vol.2018 No.1
간경변을 진단받은 환자에서 간경변성 복수의 발생은 좋지 않은 예후를 시사한다. 합병증이 동반되지 않은 복수의 경우 염분섭취제한과 이뇨제의 사용으로 치료하며 복수의 합병증인 난치성 복수, 자발성 세균성 복막염, 저나트륨혈증, 간신증후군 등의 발생을 면밀히 관찰해야 한다. 합병증을 동반한 복수의 경우 최선의 치료는 간이식이다. 그러나 현실적으로 간이식이 용이하지 않은 경우 복수의 합병증에 대한 적절한 관리가 중요하다. 난치성 복수의 경우 치료적 대량복수천자, 선택적인 TIPS의 적용은 환자의 삶의 질 향상에 도움이 될 수 있다. 자발성 세균성 복막염의 경우 이를 조기에 진단하고 조기에 적절한 항생제 사용하면 환자의 생존을 향상시킬 수 있다. 더불어 자발성 세균성 복막염의 일차적, 이차적 예방을 위해 선택적으로 예방적 항생제를 사용해야 한다. 자발성 세균성 복막염은 간신증후군 발생에 중요한 악화인자가 될 수 있어 자발성 세균성 복막염 치료시 간기능과 신기능이 좋지 않은 경우 알부민을 투여하도록 한다. 간신증후군은 최근에 조기에 진단할 수 있도록 개정된 급성신손상의 정의가 적용되었다. 조기에 혈관수축제와 알부민을 사용하여 적절히 치료하는 것이 환자의 삶의 질과 생존 향상에 도움이 될 수 있다. Ascites is the most common signs of decompensation in patients with liver cirrhosis. When ascites develops, the mortality of cirrhotic patients reaches 50% in 3 years. Refractory ascites, spontaneous bacterial peritonitis, dilutional hyponatremia, and progressive renal impairment are associated with complicated ascites. Adequate management of cirrhotic ascites and its complication is essential to improve the quality of life and survival of patients. Nevertheless, liver transplantation is the ultimate treatment of these complications. Herein, we summarized the diagnostic approaches and management of cirrhotic ascites and its complications based on the guidelines of Korean association for the study of the liver, European association for the study of the liver and American association for the study of the liver.
간기능이 저하된 비대상성 간경변증 환자에서 약물방출미세구를 이용한 화학색전술을 통해 적극적으로 간암을 치료한 증례
윤아일린 ( Eileen L. Yoon ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),이승화 ( Seung Hwa Lee ),김해림 ( Hae Rim Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver cirrhosis patient who was not eligible for conventional TACE treatment.
간세포암종 치료에서 Lipiodol의 특성과 역할에 대한 고찰
윤아일린 ( Eileen L Yoon ) 대한간암학회 2015 대한간암학회지 Vol.15 No.2
Lipiodol based conventional transarterial chemoembolization (TACE) is a standard of care for unresectable, non-invasive, and multinodular Hepatocellular carcinoma (HCC)s. The procedure relies on the intra-arterial administration of lipiodol/cytotoxic agent emulsion followed by the infusion of embolic material. Lipiodol, with its oily nature and radiopacifying properties, is in the center of the TACE procedure. Unstability and unpredictable therapeutic effect of hydrophilic cytotoxic drugs emulsified in the lipiodol and technical problems lie beyond the control of clinicians. Thus, interest in the properties and respective roles for lipiodol in the management of HCC is essential for the clinicians. (J Liver Cancer 2015;15:84-87)
백승석 ( Seung Suk Baek ),윤아일린 ( Eileen L. Yoon ),김현정 ( Hyun-jung Kim ),배경은 ( Kyung Eun Bae ),박경미 ( Kyeongmee Park ),최원충 ( Won-choong Choi ) 대한간암학회 2017 대한간암학회지 Vol.17 No.2
Heterogeneous features of liver cancer can mimic liver abscess. Therefore it is essential to double- check tumor markers in the diagnosis of liver abscess. Herein, we report a case of combined hepatocellular-cholangiocarcinoma (cHC) occurred in an unrecognized chronic hepatitis B patient initially misdiagnosed as liver abscess. A 49-year old male initially presented with chill, right upper quadrant pain, and a liver mass. Mass showed peripheral enhancement in arterial phase of computed tomography, which was not typical for hepatocellular carcinoma (HCC). Strikingly elevated alpha-fetoprotein and fine needle aspirated pathology revealed HCC. Despite discordant image findings he was treated with transarterial chemoembolization. He was treated with sorafenib due to metastatic retrocaval lymphadenopathy afterwards. The mass presumed to be HCC progressed with sorafenib. It was surgically resected and he was finally confirmed as cHC. Discordant tumor markers with presumptive image findings should prompt the suspicion of rare type of primary liver cancer, the cHC. (J Liver Cancer 2017;17:174-181)