• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1994년도 춘계학술대회 and 제3회 신약개발 연구발표회
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• pp.202-202
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• 1994

G009의 hepatic cirrhosis animal model중 bile duct ligation/scission (BDL/S) rat에서의 항섬유화 효과를 조사하였다. BDL/S 수술 후 4주간 투약군에는 G009 saline soln.(5mg/rat/day)을, 대조군에는 saline을 경구투여하였다. fibrosis가 최고에 달하는 4주후 rat를 도살하여, 혈청중 N-terminal procollagen type III peptide(PIIINP) level, 간 조직중 hydroxy proline content, serum biochemical value(ALT, AST, choleterol, total bilirubin, creatinine) 측정 및 간조직검사를 실시하였다. 그 결과 1) 혈청중 PIIINP의 경우, 투약군 BDL/S group(10.3ng/ml$\pm$2.2)이 대조군 (20.5ng/m1$\pm$3.9)에 비해 약 50%정도 유의성 있게 감소하였다(p<0,01). 2) 간 조직중 hydroxy proline치 측정 결과, 투약군 BDL/S group(471$\pm$160$\mu\textrm{g}$/g liver)이 대조군(566$\pm$42.9$\mu\textrm{g}$/g liver)에 비하여 약 13%정도 유의성있게 감소하였다(p<0.05). 3) 간조직검사 결과 투약군의 BDL/S op. group이 대조군보다 necrosis, inflammetion, bile duct proliferation, connective tissue 침착 등이 약화되었다. 위 실험을 종합한 결과 G009는 biliary cirrhosis model에서 antifibrotic effect가 있음이 사료된다.

• Korean Journal of Radiology
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• 제22권2호
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• pp.253-262
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• 2021

Objective: To determine whether the values of hepatic apparent diffusion coefficient (ADC) can differentiate biliary atresia (BA) from non-BA or be correlated with the grade of hepatic fibrosis in infants with cholestasis. Materials and Methods: This retrospective cohort study included infants who received liver MRI examinations to evaluate cholestasis from July 2009 to October 2017. Liver ADC, ADC ratio of liver/spleen, aspartate aminotransferase to platelet ratio index (APRI), and spleen size were compared between the BA and non-BA groups. The diagnostic performances of all parameters for significant fibrosis (F3-4) were obtained by receiver-operating characteristics (ROCs) curve analysis. Results: Altogether, 227 infants (98 males and 129 females, mean age = 57.2 ± 36.3 days) including 125 BA patients were analyzed. The absolute ADC difference between two reviewers was 0.10 mm²/s for both liver and spleen. Liver ADC value was specific (80.4%) and ADC ratio was sensitive (88.0%) for the diagnosis of BA with comparable performance. There were 33 patients with F0, 15 with F1, 71 with F2, 35 with F3, and 11 with F4. All four parameters of APRI (τ = 0.296), spleen size (τ = 0.312), liver ADC (τ = -0.206), and ADC ratio (τ = -0.288) showed significant correlation with fibrosis grade (all, p < 0.001). The cutoff values for significant fibrosis (F3-4) were 0.783 for APRI (area under the ROC curve [AUC], 0.721), 5.9 cm for spleen size (AUC, 0.719), 1.044 x 10^-3 mm²/s for liver ADC (AUC, 0.673), and 1.22 for ADC ratio (AUC, 0.651). Conclusion: Liver ADC values and ADC ratio of liver/spleen showed limited additional diagnostic performance for differentiating BA from non-BA and predicting significant hepatic fibrosis in infants with cholestasis.

• Gut and Liver
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• 제12권6호
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• pp.714-721
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• 2018

Background/Aims: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been well-validated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p<0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (>2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p<0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.

• 대한핵의학회지
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• 제24권1호
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• pp.56-61
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• 1990

We evaluated 85 cases with atrophy of left lobe among 11,133 cases performed liver scan using $^{99m}Tc-phytate$ from January 1984 to January 1990 at Kyungpook National University Hospital in association with underlying causes and related conditions. Seventeen cases seemed to be due to biliary tract diseases, eg, cholelithiasis, cholangiocarcinoma, clonorchiasis and postcholecystectomy state. Fifteen cases were patients with primary and metastatic hepatic malignancies. One case had a history of hepatic irradiation. Thirty cases comprised acute hepatitis, chronic hepatitis, liver cirrhosis and fatty liver. However no causative abnormalities could be detected in 22 cases despite of meticulous diagnostic work-up.

• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.421-426
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• 2007

진행성 간질환의 합병증으로 발생하는 문맥폐고혈압은, 이차성 폐동맥고혈압 중에서 진행성 간질환에 의한 문맥고혈압과 연관된 폐동맥고혈압으로 분류되며, 독특한 임상적, 병태생리학적 특징을 보인다. 임상양상은 점진적인 운동성 호흡곤란, 흉통 등을 호소하지만, 증상 없이 우연히 발견되는 경우도 있다. 심초음파 검사를 통해 예비적으로, 우심장 도관삽입으로 직접 우심실 및 평균 폐동맥압을 측정하여 진단할 수 있다. 치료는 칼슘통로차단제, 프로스타노이드 등을 사용하지만, 근본적인 치료를 위해서는 간 및 폐이식을 고려해야 한다. 저자들은 53세 여자로 20년 전에 간경변을 진단받은 후 호흡곤란으로 내원한 환자에게서, 간경변의 원인으로 원발성 담관성 간경변을 진단하고, 호흡곤란의 원인으로 문맥폐고혈압을 진단하여 치료하였기에 문헌고찰과 함께 보고한다.

• 한국간담췌외과학회지
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• 제28권1호
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• pp.1-13
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• 2024

Hepatocellular carcinoma (HCC) is the sixth most diagnosed cancer worldwide. Healthcare resource constraints may predispose treatment delays. We aim to review existing literature on whether delayed treatment results in worse outcomes in HCC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till December 2022. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included post-treatment mortality, readmission rates, and complications. Fourteen studies with a total of 135,389 patients (delayed n = 25,516, no delay n = 109,873) were included. Age, incidence of male patients, Child-Pugh B cirrhosis, and Barcelona Clinic Liver Cancer Stage 0/A HCC were comparable between delayed and no delay groups. Tumor size was significantly smaller in delayed versus no delay group (mean difference, -0.70 cm; 95% confidence interval [CI]: -1.14, 0.26; p = 0.002). More patients received radiofrequency ablation in delayed versus no delay group (OR, 1.22; 95% CI: 1.16, 1.27; p < 0.0001). OS was comparable between delayed and no delay in HCC treatment (hazard ratio [HR], 1.13; 95% CI: 0.99, 1.29; p = 0.07). Comparable DFS between delayed and no delay groups (HR, 0.99; 95% CI: 0.75, 1.30; p = 0.95) was observed. Subgroup analysis of studies that defined treatment delay as > 90 days showed comparable OS in the delayed group (HR, 1.04; 95% CI: 0.93, 1.16; p = 0.51). OS and DFS for delayed treatment were non-inferior compared to no delay, but might be due to better tumor biology/smaller tumor size in the delayed group.

• Tuberculosis and Respiratory Diseases
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• 제41권5호
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• pp.504-512
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• 1994

연구배경 : 간경화 환자에서 심질환 또는 폐질환이 동반되지 않으면서 심각한 저산소혈증이 발생할 수 있다는 사실은 이미 오래전부터 알려져 있는 사실이다. 그 원인으로서 폐혈관 장애를 초래하는 것이 주된 역할을 하는 것으로 알려져 있는데 그 중에서도 특히 폐혈관 확정에 의한 폐내단락이 가장 중요한 기전으로 제시되고 있다. 폐내단락은 전모세혈관 수준에서 폐내혈관확장이 발생하거나 직접적인 동정맥 교통에 의해서 발생하는데 간경화 환자에서 흔히 관찰되는 피부 소견인 거미상 혈관종과 관련성이 있다. 이러한 폐내 모세혈관의 확장으로 인해 중심 혈류 속도가 빨라지고 모세혈관 통과 속도가 증가하여 결국은 폐확산 장애가 초래되는데 이러한 효과는 심박출량이 증가하는 과운동성 순환을 나타내는 간경화의 혈류학적 특성과 상승작용을 유발하여 저산소혈증이 발생한다. 또한 앙아위에서 기립자세로 체위변화를 하면 폐기저부위에서 중력에 의한 혈류량이 증가하여 폐내단락 효과가 배가되어 저산소혈증이 더욱 악화되므로 기립성 탈산소증과 편평호흡이 발생할 수도 있다. 그러나 이러한 소견들은 주정성 간경화와 원발성 담즙성 간경화를 주로하는 구미에서의 결과이고, B형간염과 이로 인한 간경화 및 간암의 유병율과 사망률이 세계적으로 가장 높은 우리나라에서는 이에 대한 연구가 거의 없는 실정이다. 이에 저자들은 후괴사성 간경화가 대종을 이루는 국내 간경화 환자에서의 저산소혈증과 기립성 탈산소증의 빈도를 조사하고 그 기전으로서 폐내단락의 중요성을 확인하기 위해 본 연구를 시행하였다. 방법 : 간경화 환자 중에서 심폐질환의 증거가 없고 복수, 상부위장관 출혈, 간성 혼수등과 같은 심한 합병증의 현증이 없는 비교적 안정상태에 있는 48명을 대상으로 하여 앙아위와 기립시 동맥혈분석검사를 시행하여 저산소혈증과 기립성 탈산소증의 빈도를 조사하고, 그 결과에 따라 저산소혈증군과 정상산서혈증군으로 분류하여 각각 폐기능검사 및 폐내단락율을 측정하기 위한 Tc-99m-MAA 주사를 실시하였다. 폐내단락율 계산은 뇌와 좌우신장의 혈류량은 전신 혈류량의 32%인 점을 기준하여 뇌와 좌우신장에서 측정된 방사성 계수를 전신 방사성 계수로 환산하고 이 값을 좌우폐의 방사성 계수와 합산한 후 이에 대한 전신 방사성 계수의 비율을 계산함으로써 결정하였다. 결과 : 동맥혈산소분압 80 mmHg 미만의 저산소혈증은 9명에서 관찰되어 18.8%의 빈도를 보였고 10 mmHg 이상의 기립성 탈산소증은 8명에서 관찰되어 16.7%의 빈도를 보였으나 동맥혈산소분양 60 mmHg 미만의 심각한 저산소혈증은 관찰되지 않았다. 동맥혈 산소분압은 거미상 혈관종이 관찰되는 환자군에서 유의하게 낮았으며 혈청학적 표지자와 간경화의 심한 정도를 반영하는 간기능검사 수치와는 유의한 상관관계는 없었다. 저산소혈증군과 정상산소혈증군으로 분류하여 시행한 폐기능검사 소견상 양군간에 유의한 차이는 없었으며 Tc-99m-MAA 전신주사를 이용한 폐내단락율은 저산소혈증군에서 $11.4{\pm}4.1%$로서 정상산소혈증군의 $4.1{\pm}2.0%$보다 유의하게(p<0.05) 높은 결과를 나타내었다. 결론 : 간경화 환자에서 저산소혈증은 적지 않은 빈도로 관찰되는 소견으로 그 기전으로는 폐내단락이 중요한 역할을 하는 것으로 생각되지만 후괴사성 간경화가 대종을 이루는 국내의 간경화 환자에서는 임상적으로 호흡곤란 및 청색증을 유발할 정도의 심각한 저산소혈증은 매우 드물다고 생각된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권5호
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• pp.479-486
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• 2019

Progressive familial intrahepatic cholestasis (PFIC) is a group of severe genetic disorders, inherited in an autosomal recessive manner, causing cholestasis of hepatocellular origin, later progressing to biliary cirrhosis and liver failure. This is the first report of PFIC type 1 with novel compound heterozygous mutations in Korea. The patient was presented with intrahepatic cholestasis, a normal level of serum ${\gamma}-glutamyl$ transferase, steatorrhea, and growth failure. Genetic testing of this patient revealed novel compound heterozygous mutations (p.Glu585Ter and p.Leu749Pro) in the ATP8B1 gene. After a liver transplantation at age 19 months, the patient developed severe post-transplant steatohepatitis.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.33-37
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• 2009

Purpose: Liver transplantation is considered as the treatment of choice in many acute and chronic liver diseases, and it is becoming more common. Since successful microscopic anastomosis of hepatic artery is a crucial requirement of successful liver transplantation, we studied and analyzed the result of hepatic artery anastomosis of liver transplantation in our liver transplantation center. Methods: 145 liver transplantations were performed between February 2005 and May 2008. Male to female ratio of the liver transplantation recipients was 3.4 : 1. Anastomosis of portal vein, hepatic vein and biliary tract was performed by the general surgeon, and anastomosis of hepatic artery was performed by the plastic surgeon under the loupe or microscopic vision. After the hepatic artery was reconstructed, anastomosed site status and flow were checked with Doppler ultrasonography intraoperatively and with contrast enhanced CT or angiography postoperatively if necessary. Results: Out of 145 liver transplantations, cadaveric liver donor was used 37 cases and living donor liver transplantation was performed 108 cases including the 2 dual donor liver transplantations. As for the baseline diseases that resulted in the liver transplantation, there were 57 cases of liver cirrhosis and hepatocellular carcinoma due to hepatitis B, taking up the greatest proportion. Single donor hepatic artery was used in 114 cases, and mean artery diameter was 2.92 mm and mean artery length was 24.25 mm. Hepatic artery was used as the recipient artery in every case except the 8 cases in which gastroepiploic artery was used as alternative. Out of 145 cases of hepatic artery anastomosis, 3 cases resulted in the thrombosis of the hepatic artery, requiring thrombectomy and re - anastomosis. In all 3 cases, thrombosis was found in left hepatic artery and there was no past history of hepatic artery chemoembolization. Conclusion: Incidence of hepatic artery thrombosis after the anastomosis of hepatic artery during liver transplantation was 2.1%, which is considered sufficiently low.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.307-312
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• 2023

Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.