• 대한영상의학회지
• /
• 제82권3호
• /
• pp.638-653
• /
• 2021

목적 췌장선암으로 완치 수술을 시행 받은 환자들 중 수술 전 CT만 시행 받은 환자군과 추가적 MRI를 시행 받은 환자군의 재발 양상 및 생존율을 비교하고, 첫 재발 위치에 따른 예후 차이를 비교하고자 한다. 대상과 방법 췌장선암으로 R0 수술을 시행 받은 152명의 환자를 대상으로 하였다. 이중 103명은 수술 전 CT만 시행 받았고, 나머지 49명은 추가적 MRI를 시행 받았다. 두 명의 영상의학과 의사가 합의하에 각 환자의 첫 재발 위치와 재발 시기를 평가하였다. 두 환자군의 재발 양상, 무병 생존율, 전체 생존율을 비교하고, 첫 재발 위치에 따른 예후를 비교하였다. 결과 두 환자군 모두 간 전이가 가장 흔한 재발 양상이었고, 무병 생존율(p = 0.247)과 전체 생존율(p = 0.067)은 유의한 차이가 없었다. 첫 재발 위치에 따른 예후는 간 전이가 가장 나빴고, 그다음은 국소 재발이었다(p < 0.001). 결론 췌장선암으로 완치 수술을 시행 받은 환자에서 수술 전 CT만 시행 받은 환자군과 추가적 MRI를 시행 받은 환자군 사이에 재발 양상과 생존율은 유의한 차이가 없었다. 간 전이가 가장 흔한 재발 양상이었고, 다른 재발 양상과 비교하여 예후가 가장 나빴다.

• Advances in pediatric surgery
• /
• 제11권2호
• /
• pp.186-191
• /
• 2005

A 10-year-old-girl was referred to our hospital due to abdominal pain. She underwent Roux-en-Y cystojejunostomy for a choledochal cyst at another hospital at the age of 3 months. Abdominal ultrasonography (USG) and computed tomography (CT) showed type I choledochal cyst and multiple gallbladder stones. Because of severe inflammation and adhesion, partial resection of the choledochal cyst and Roux-en-Y hepaticojejunostomy was performed. Two and one half years later, intermittent abdominal pain, fever, nausea and vomiting occured. Abdominal CT scan showed a polypoid nodular lesion in the remnant of the choledochal cyst and probable metastasis at segment 7 of the liver. The duodenum was obstructed by the mass. Liver biopsy revealed moderately differentiated adenocarcinoma. A palliative gastrojejunostomy was performed to relieve duodenal obstruction. She died of hepatic insufficiency 4 months later.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권12호
• /
• pp.7675-7679
• /
• 2013

Background: A missense mutation in exon 7 (R249S) of the p53 tumor suppressor gene is characteristic of aflatoxin B1 (AFB1) exposure. AFB1 is believed to have a synergistic effect on hepatitis virus B (HBV) carcinogenesis. However, results of studies comparing R249S prevalence among patients are conflicting. The aim of this study was to determine the prevalence of the R249S mutation in hepatocellular carcinoma (HCC) patients with or without positive HBsAg. Materials and Methods: Paraffin embedded liver tissues were obtained from 124 HCC patients who underwent liver resection and liver biopsy in King Chulalongkorn Memorial Hospital. Restriction fragment length polymorphism (RFLP) was utilized to detect the R249S mutation. Positive results were confirmed by direct sequencing. Results: Sixty four (52%) patients were positive for HBsAg and 18 (15%) were anti-HCV positive. 12 specimens tested positive by RFLP. Ten HCC patients (8.1%) were confirmed to be R249S positive by Sanger sequencing (AGG to AGT). Out of these 10, six were HBsAg positive, and out of the remaining 4, two were anti-HCV positive. The R249S prevalence among HCC patients with positive HBsAg was 9.4% compared to 6.7% for HBsAg negative samples. Patients with the R249S mutation were younger ($55{\pm}10$ vs $60{\pm}13$ year-old) and tended to have a more advanced Edmonson-Steiner grade of HCC, although differences did not reach statistical significance. Conclusions: Our study shows moderate prevalence of aflatoxin B1-related p53 mutation (R249S) in HCC with or without HBsAg. HBsAg positive status was not associated with R249S prevalence.

• Advances in pediatric surgery
• /
• 제13권2호
• /
• pp.135-143
• /
• 2007

Biliary atresia (BA) is an uncommon neonatal surgical disease that has a fatal outcome if not properly treated. The survival rates of the patients with native liver after Kasai's operation in countries outside Japan are not so good. We reviewed the results of 22 cases of biliary atresia treated in Kosin University Hospital between October 1987 and March 2001. There were 13 males and 9 females aged from 21 to 106 days (mean 52 days). There were 3 cases of Type I (13.6%), and 3 of Type II (13.6%), and 16 Type III (72.7%). The operative methods were resection of the common bile duct remnant and cyst followed by Roux-en-Y hepaticojejunostomy in 3 cases for Type I BA; Kasai I in 15 cases, Kasai II in 1 case, and Ueda's operation in 3 cases for Types II and III BA. There was no death within the first 30 days after operation. We were able to follow 21 of the 22 patients (95.4%) for more than 5 years. The actual 5 year survival rate (YSR) was 40.9%. One Type I case received a living-related liver transplantation at 6 years of age because of the multiple intrahepatic stones and liver cirrhosis. Five YSR after biliostomy group (Kasai II and Ueda op.) was 75 % (3/4) while that of Kasai I was 20% (3/15). One case had no bile duct in the resected fibrotic plaque on microscopic review and died 8 months after Kasai I operation, would have been a strong candidate for early liver transplantation. From the above result, our conclusions are as follows; (1) early liver transplantation should be considered for cases of no bile duct after pathologic examination of the resected specimen, (2) measures to prevent postoperative cholangitis and prevention of postoperative liver cirrhosis are needed, (3) liver transplantation program should be available for failed cases.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.8823-8828
• /
• 2014

Objective: To explore the most appropriate treatment for patients with hepatocellular cancer (HCC) >10 cm by using the Barcelona Clinic Liver Cancer (BCLC) classification. Materials and Methods: A total of 124 HCC patients undergoing surgery were selected. Disease-free survival (DFS), overall survival (OS) and prognostic factors were respectively assessed. Results: This study showed that the cumulative 1-, 3-, 5-year survival rates were 79.7%, 59.8% and 41.6% in BCLC-A patients, 76.2%, 9.5% and 0% in BCLC-B patients and 44.9%, 0% and 0% in BCLC-C patients, respectively. The 1-, 3-, 5-year DFS rates were 49%, 24.5% and 9.1% in BCLC-A patients, 7.5%, 0% and 0% in BCLC-B patients, respectively. No BCLC-C patients survived 1 year after surgery. Multivariate analysis indicated that hepatitis B surface antigen (HBsAg), vascular invasion, intra-hepatic metastasis, curative resection, tumor rupture and pathologic differentiation were independent prognostic factors. Conclusions: Surgery is effective and safe for patients with HCC >10 cm with sufficient hepatic reserve.

• Clinical and Experimental Pediatrics
• /
• 제54권6호
• /
• pp.260-266
• /
• 2011

Purpose: Infantile hepatic hemangioendothelioma (IHHE) is the most common type of hepatic vascular tumor in infancy. We conducted this study to review our clinical experience of patients with IHHE and to suggest management strategies. Methods: We retrospectively analyzed the medical records of 23 IHHE patients (10 males, 13 females) treated at the Asan Medical Center between 1996 and 2009. Results: Median age at diagnosis was 38 days (range, 1 to 381 days). Seven patients (30%) were diagnosed with IHHE based on sonographically detected fetal liver masses, 5 (22%) were diagnosed incidentally in the absence of symptoms, 5 (22%) had congestive heart failure, 3 (13%) had skin hemangiomas, 2 (9%) had abnormal liver function tests, and 1 (4%) had hepatomegaly. All diagnoses were based on imaging results, and were confirmed in three patients by histopathology analysis. Six patients were observed without receiving any treatment, whereas 12 received corticosteroids and/or interferonalpha. One patient with congestive heart failure and a resectable unilobar tumor underwent surgical resection. Three patients with congestive heart failure and unresectable tumors were managed by hepatic artery embolization with/without medical treatment. At a median follow-up of 29 months (range, 1 to 156 months), 21 (91%) patients showed complete tumor disappearance or >50% decrease in tumor size. One patient died due to tumor-related causes. Conclusion: IHHE generally has a benign clinical course with low morbidity and mortality rates. Clinical course and treatment outcome did not differ significantly between medically treated and non-treated groups. Surgically unresectable patients with significant symptoms may be treated medically or with hepatic artery embolization.

• 한국임상약학회지
• /
• 제31권2호
• /
• pp.153-159
• /
• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.

• 대한방사선기술학회지:방사선기술과학
• /
• 제38권2호
• /
• pp.155-161
• /
• 2015

본 연구는 고주파 열치료 시 내부냉각방식 cool-tip의 냉각수 온도에 따른 소작 특성을 확인하기 위하여 소간을 이용하여 냉각수 온도변화에 따른 소간의 소작 특성의 변화를 통해 냉각수 온도변화와 소작 특성의 상관관계를 확인하고자 하였다. 실험에 사용된 소간은 2 cm cool-tip 사용 시 $4{\times}4{\times}4cm^3$, 3 cm인 cool-tip 사용 시에는 $6{\times}6{\times}6cm^3$로 소간을 절제하였으며, 소작된 소간은 MRI를 이용하여 영상검사를 실시하였으며, Freehand 기법으로 소작된 부위의 면적과 둘레를 측정하였다. 2 cm, 3 cm cool-tip을 사용하여 6분, 12분 소작 시 cool-tip 온도가 상승함에 따라 면적과 둘레는 감소함을 나타냈으며, cool-tip 온도와 면적 및 둘레의 상관관계는 통계학적으로 유의한 결과를 나타내었다(p=.000). 소작 범위에 대한 실제 측정과 MRI을 이용한 측정을 비교한 결과 MRI를 이용한 면적과 둘레 측정이 더 정확한 것을 확인하였으며, 대응표본 T-검정을 이용한 통계적 결과 또한 유의하였다(p=.038). 고주파 열치료 장비의 cool-tip 냉각수 온도가 증가함에 따라 소간의 소작 범위가 감소한 원인은 고주파 열치료 장비의 에너지가 정확히 전달되지 못하고 탄화가 발생하기 때문이다. 따라서 고주파 열치료에서 탄화의 발생을 줄이고, 고주파 에너지가 정확히 전달되어 치료 효과를 높이기 위해서는 냉각수의 온도를 낮은 온도로 일정하게 유지하여 사용하여야 고주파 열치료의 효과가 증대될 것이라 사료된다.

• Journal of Digestive Cancer Research
• /
• 제1권2호
• /
• pp.104-107
• /
• 2013

담낭암은 진행된 상태에서 발견되었을 경우 예후가 매우 불량한 암으로 전신항암화학요법으로 치료를 하게 되나 일반적으로 고식적인 역할에 그치는 경우가 대부분이다. 본 증례는 원위부 림프절 전이가 있어서 수술적 절제가 불가능한 담낭암 환자에서 gemcitabine과 cisplatin을 병합한 전신항암화학요법으로 여섯 주기 치료 후 부분 관해를 얻어서 확대 담낭절제술이 가능하였던 증례로 매우 드문 증례를 경험하였기에 보고하는 바이다. 담낭암에서 수술 전 항암화학요법의 효과는 아직까지 확립되어 있지 않으나, 최근 양호한 종양 반응률과 종양 억제율을 보이는 항암화학요법이 개발됨에 따라서 그 가능성이 기대되고 있다.

• Journal of Korean Neurosurgical Society
• /
• 제30권7호
• /
• pp.876-882
• /
• 2001

Objectives : Meningeal hemangiopericytoma is a rare tumor. Clinical and radiological features are similar to those of an ordinary meningioma. But its biological behavior is quite different from those of a meningioma as it brings profuse bleeding in the operation field, frequent recurrence and metastasis to other systemic organs even in the case of gross total resection. In order to find out the prognostic factors and to compare longterm outcome after various treatment modalities, the authors reviewed consecutive 20 operated cases of meningeal hemangiopericytoma to characterize their clinical features, surgical outcomes and effectiveness of the radiation therapy. Methods : Twenty patients with a hemangiopericytoma were treated between 1982 and 1999 in our department. They are composed of 13 patients of hemangiopericytoma and 7 patients who were initially diagnosed as angioblastic type meningioma and then confirmed as a hemangiopericytoma after review of their previous histopathology slides. The mean follow-up period was 99 months(1-256 months). The long-term outcomes after various treatment modalities were evaluated according to recurrence-free survival and image follow-up. Recurrence-free survival curves are compared between the patient groups according to the extent of removal and radiation therapy. Results : There were 10 cases of recurrence and 4 cases of distant metastases ; lung, liver and femur(2 cases) respectively. The 5-year recurrence rate was 37%, while the 10-year recurrence rose to 77%. There was also statistically significant difference of median recurrence-free survival between the completely-resected group(Simpson grade 1 or 2) and partially-resected group(Simpson grade 3 or 4 or 5) ; 137 months compared to 47 months, respectively(p=0.009). The median recurrence-free period after subtotal resection of tumor and postoperative radiotherapy was 47 months compared to 117 months of the patients who underwent gross total resection of tumor and did not receive radiotherapy. But radiation therapy alone did not show significant difference in recurrence-free survival. Marked tumor volume reduction and easy removal of tumors without bleeding were found in 2 recurred cases. Conclusion : The extent of tumor resection and presence of metastasis are the most important factors related to long-term outcome of the patients with hemangiopericytoma. Radiation therapy after the first operation did not have a role in extending the recurrence-free survival, but it affected favorably to decrease the size of residual mass and intraoperative bleeding during the second operation.