1.A Prospective Study of Therapeutic Effect of 6 Months Trial with Lamivudine in Patients with Chronic Viral Hepatitis B.
Chang Woo GHAM ; Soong Hwan LEE ; Seung Woo NAM ; Byung Joo ROH ; Dong Hoo LEE
The Korean Journal of Hepatology 1999;5(4):282-290
BACKGROUND/AIMS: The purpose of this study was to evaluate the effectiveness of lamivudine treatment in patients with chronic liver disease caused by chronic infection of hepatitis B virus (HBV). METHODS: Thirty-ive patients with chronic infection of HBV were included in this study who were diagnosed at Hanyang University Hospital from January 1998 to January 1999. They received 150mg of lamivudine per oral once daily for 6 months with follow-p of liver function test, serum HBV DNA and serologic markers for hepatitis B virus every two months. Lamivudine was well tolerated. Eight patients underwent liver biopsies before entering the study and follow-p biopsies were done at 5 patients. RESULTS: Out of all 35 patients, chronic hepatitis patients histologically confirmed were 8, chronic hepatitis patients clinically diagnosed were 25 and liver cirrhosis patients clinically diagnosed were 2. The mean age was 35.7 years. Male-female ratio was 2.2:1. There was no hepatitis B surface antigen (HBsAg) negative seroconversion. The HBeAg loss rate was 26.9%(7/26) and HBeAg seroconversion rate was 10.7%(3/28) at the end of follow-p. Ten patients were anti-Be positive prior to treatment, 3 of them became anti-Be negative at the end of follow-p. Five patients underwent follow-p liver biopsies, in which histologic improvements were shown in 4 cases. Serum replicative HBV DNA by bDNA assay was decreased in all patients and HBV DNA was undetectable in 52.9%(9/17) at the end of treatment. Out of the 15 patients with abnormal alanine aminotransferase (ALT) levels at baseline, ALT level in 7 patients(46.7%) was normalized at treatment completion. Pretherapy ALT level was the only predictive factor for loss of HBeAg by stepwise logistic regression analysis(odds ratio : 1.0208) (95% Confidence Interval : 1.0023 ~ 1.0396) (p value=0.0271). CONCLUSIONS: Lamivudine induced sustained suppression of HBV replication during treatment in all patients. In treating patients with lamivudine, who had chronic liver disease due to chronic infection of HBV, the improvement of liver function test and suppression of viral replication appeared early and was sustained during the 6months treatment. This, in turn, may induce histological improvement as well. Pretherapy ALT level was the only predictive determinant for HBeAg loss during lamivudine therapy, and that should be kept in mind in selecting patients for treatment.
Alanine Transaminase
;
Biopsy
;
Branched DNA Signal Amplification Assay
;
DNA
;
Hepatitis B e Antigens
;
Hepatitis B Surface Antigens
;
Hepatitis B virus
;
Hepatitis B*
;
Hepatitis*
;
Hepatitis, Chronic
;
Humans
;
Lamivudine*
;
Liver
;
Liver Cirrhosis
;
Liver Diseases
;
Liver Function Tests
;
Logistic Models
;
Prospective Studies*
2.Periportal Distribution of Diethylnitrosamine-Induced Gamma-GTP Positive Foci in the Liver of Sprague-Dawley Rat.
Hong Joo KIM ; Soong Hwan LEE ; In Gyu BACK ; Chang Woo GHAM ; Dong Il PARK ; Cheol Hun JUNG ; Yong Hyeon JO ; Seung Woo NAM ; Dong Hoo LEE
The Korean Journal of Hepatology 1997;3(3):252-263
BACKGROUNR/AIMS: Heterogeneity of liver cell populations within the hepatic lobules can affect xenobiotic reaction. In this study, we attempt to clarify the stereological distribution of the y-GTP positive foci in hepatic lobule initiated by diethylnitrosamine and promoted by phenobarbital. METHODS/METERIALS: To the five Sprague-Dawley rats, one day after birth, diethylnitrosamine (0.15 pmole/pn) was intraperitoneally injected and by the weaning at four weeks of life, 0.035% phenobarbital in drinking water was fed for four weeks, at which time the rats were sacrified to obtain the livers. Livers were fixed in fresh cold ethanol acetic acid. Ihe 200 cotmecutive tissue sections were stained by histochemistry for y-GIP and countastained with toluidine blue ar HkE. Employing Zeiss microprojector, y-GTP foci wae traced. And then the largest cross-sectian (size class: 65-165 pm in diameter) of 52 y-GTP foci were selected. Using microscopic grid, distances fiom center of y-GlP foci to nearest centtal vein and bile ductule was measured. As a control group, out of 52 random points determined by rareken digit table, the distances were measured by the same romr. RESULT: the diameter Aom the central points of y-GIP positive foci to the neatest bile ductules was measured as 0.234620+0.14899mm (mean+SD) and the diameter from random points to the neatest bile ductules was measured as 0.303080+0.19582mm (mean+SD). Y-GTP positive foci located within 0.3mm diameter fram bile ductules were counted as 73.1% of 52 foci, whereas that of random points were only 55.8%. Accoring to Aequency table analysis by Shapiro-Wilk W test, there was significant difference by W-value (0.812065) and p-value (0.0144866). CONCLUSION: Stereologically, y -GTP positive foci initiated by diethylnitros;unine, promoted by phaxkarbital in neonatal Spague-Dawley rats were non-rarxlanly distributed in peripcetal atea (Rappaport zone I) in hepatic lobule during hepatocarcinogenesis.
Acetic Acid
;
Animals
;
Bile
;
Diethylnitrosamine
;
Drinking Water
;
Ethanol
;
Liver*
;
Parturition
;
Phenobarbital
;
Population Characteristics
;
Rats*
;
Rats, Sprague-Dawley*
;
Tolonium Chloride
;
Veins
;
Weaning
3.A Comparison of Patients With Hepatocellular Carcinoma Between A Short-term (Less Than 6 months) Survival Group and A Long-term (Over 24 Months) Survival Group After Treatment with Transcatheter Arterial Chemoembolization.
In Koo KANG ; Sung Woo KIM ; Sung Hee HAHN ; Seung Chul CHO ; Chang Woo GHAM ; Dong Hoo LEE
The Korean Journal of Hepatology 2002;8(2):189-200
BACKGROUND/AIM: Although hepatocellular carcinoma(HCC) shows poor prognosis, transcatheter hepatic arterial chemoembolization(TACE) can improve survival rate in some patient groups. This study investigated the synergy effect of the different clinical indices on the survival time in patients with HCC underwent TACE. MATERIALS AND METFODS: A retrospective study of 241 patients with HCC who underwent TACE with a mixture of lipiodol, mitomycin-C and adriamycin, alone or followed by gelfoam was conducted. Three different survival groups (A, less than 6 months; B, between between 6 and 23 months; and C, over 24 months) were compared. RESULTS: Alkaline phosphatase was lowest in group C (p=0.0001). The longer the survival, the lower (p=0.027, p=0.007) the AST and AST/ALT ratio were. Albumin was higher (p=0.032), GGT and LDH were lower (p=0.003, p=0.002) in the long-term survival group. The long-term survival group revealed an absence of both ascites(p<0.002) and portal vein thrombosis(p<0.001), and lower TNM stage (P<0.0001). The single nodular type of HCC was more frequent (P<0.0001) and the size of tumor was smaller in the long-term survival group (P<0.0001). Child-Pugh class was lower in the long-term survival group (p=0.017). The higher serum albumin and elder age, the higher albumin and the lower alkaline phosphatase or alpha-fetoprotein, represented synergic effects on a long term survival. The higher albumin and the smaller size or the lower tumor stage, the higher albumin and platelet revealed similar synergy effects. Although the age or platelet is high, low albumin showed poor prognosis. CONCLUSION: Patients with small-sized single, nodular HCC in a low Child-Pugh class without evidence of ascites and portal vein thrombosis, and the higher level of serum albumin but lower levels of alpha-fetoprotein, alkaline phosphatase, GGT, and LDH, can expect a long-term survival over 24 months by the treatment of TACE. There are meaningful synergies of the different clinical variables affecting the survival times in the patients with HCC undergoing TACE.
Adult
;
Aged
;
Aged, 80 and over
;
Carcinoma, Hepatocellular/mortality/*therapy
;
*Chemoembolization, Therapeutic
;
Comparative Study
;
English Abstract
;
Female
;
Human
;
Liver Neoplasms/mortality/*therapy
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Prognosis
;
Retrospective Studies
;
Survival Rate
4.Stereological Analysis of gamma-Glutamyl Transpeptidase Positive Foci in Diethylnitrosamine-Induced Hepatocarcinogenesis of Sprague-Dawley Rats.
Yong Keol YOO ; Hong Joo KIM ; Soong Hwan LEE ; Chang Woo GHAM ; Hee Soo KIM ; Jong Cheol KIM ; Seung Woo NAM ; Sung Woo KIM ; Byeong Hoon KIM ; Sung Kyu YANG ; Dong Il PARK ; Dong Hoo LEE
The Korean Journal of Hepatology 1998;4(1):46-58
BACKGROUND/AIMS: Hepatocarcinogenesis of microscopically altered foci could be shown to be progressed into a trabecular pattern of hepatocellular carcinoma. And it is reported that down-regulation of TGF beta II receptor and up-regulation of TGF alpha and c-myc reveal the progression of diethylnitrosamine-induced foci into liver cell cancer. Up-regulation of TGF beta II receptor, however, causes apoptosis of foci. To determine characteristic morphology and growth kinetics of putatively precancerous y glutamyl transpeptidase (GGT) positive foci and hyperplastic nodules, a stereological quantification was attempted in the Peraino's neonatal rat model initiated by diethylnitrosamine and promoted by phenobarbital. MATERIALS/METHODS: Fifteen Sprague-Dawley rats were I.p. injected with 0.15 pmole/g of body weight of diethylnitrosamine mixed in corn oil at one day after birth. From weaning at 4 weeks of life, the rats were continuously fed 0.035% phenobarbital in drinking water and sacrified 5 rats at each time point of 8 weeks, 16 weeks, and 32 weeks. Teklad standard diet was fed after weaning. The livers obtained were fixed in freshly prepared, cold ethanol-acetic acid (99:1 vo1%). For the GGT histochemical staining, Rutenberg's method was modified, and counterstained with H & E or toluidine blue. For the stereological analysis GGT positive foci and nodules were traced in 200 consecutive tissue sections and quantified the 3 dimensional volumes by computer assisted planimetry. Either spheroidal or non-spheroidal morphology was determined by parabola 2nd degree equation ' y=ax+bx+c (sphere a=-P,). RESULTS: Thirty nine (55.71%) out of 70 representative lesions were nonspheroidal. Especially at 8 weeks, the 28 out of 40 GGT positive foci were irregular, nonspheroidal shape. Later times, however, GGT positive foci and reprogrammed nodular lesions were become spheroidal. Lilliefors probabilities test for spheroidal frequency was statistically significant (p<0.05). CONCLUSION: Stereologically non-spheroidal characteristics of the early GGT positive foci limit growth kinetic estimation by 3 dimensional volume quantitation but permit in later times in spheroidal, GGT positive foci and reprogrammed nodules showing fade-out of GGT activity. In other words, GGT positive foci may be clonally selected for growing into hyperplastic nodules and hepatocellular carcinoma or regressed by apoptosis.
Animals
;
Apoptosis
;
Body Weight
;
Carcinoma, Hepatocellular
;
Corn Oil
;
Diet
;
Diethylnitrosamine
;
Down-Regulation
;
Drinking Water
;
gamma-Glutamyltransferase*
;
Kinetics
;
Liver
;
Models, Animal
;
Parturition
;
Phenobarbital
;
Rats
;
Rats, Sprague-Dawley*
;
Tolonium Chloride
;
Up-Regulation
;
Weaning
5.Autoradiographic Investigation for 3H-Thymidine Labeling Indicies of gamma-Glutamyl Transpeptidase Positive Foci during the Rat Liver Carcinogenesis.
Kee Woon KWEON ; Hong Joo KIM ; Soong Hwan LEE ; Yeong Jung CHO ; Jong Cheol KIM ; Sung Woo KIM ; Hee Soo KIM ; In Gyu BACK ; Cheol Hun JUNG ; Yong Hyeon JO ; Chang Woo GHAM ; Dong Hoo LEE
The Korean Journal of Hepatology 1998;4(2):162-178
No abstract available.
Animals
;
Autoradiography
;
Carcinogenesis*
;
Diethylnitrosamine
;
gamma-Glutamyltransferase*
;
Liver*
;
Rats*
6.Autoradiographic Investigation for 3H-Thymidine Labeling Indicies of gamma-Glutamyl Transpeptidase Positive Foci during the Rat Liver Carcinogenesis.
Kee Woon KWEON ; Hong Joo KIM ; Soong Hwan LEE ; Yeong Jung CHO ; Jong Cheol KIM ; Sung Woo KIM ; Hee Soo KIM ; In Gyu BACK ; Cheol Hun JUNG ; Yong Hyeon JO ; Chang Woo GHAM ; Dong Hoo LEE
The Korean Journal of Hepatology 1998;4(2):162-178
No abstract available.
Animals
;
Autoradiography
;
Carcinogenesis*
;
Diethylnitrosamine
;
gamma-Glutamyltransferase*
;
Liver*
;
Rats*
7.A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb with Pancreatic Duct Anomaly.
Sang Yon HWANG ; Hyeon Geun CHO ; Hyuk Jin KWON ; Geun Jun KO ; Chang Hwan CHOI ; Chang Woo GHAM ; Ki Joon HAN ; Jin Ho JEONG ; Mi Sung KIM
Korean Journal of Gastrointestinal Endoscopy 2006;32(5):352-356
The common bile duct normally enters the posteromedial aspect of the second part of the duodenum. However, anomalous drainage of the common bile duct into the stomach, pyloric channel, duodenal bulb and fourth portion of the duodenum has been reported in the literature. An anomalous pancreatic duct, with ectopic drainage of the common bile duct, is particularly rare. Herein, we report the case of a 69-year-old woman who showed pancreatic ductal variation and anomalous drainage of the common bile duct into the duodenal bulb. The patient required a cholecystectomy and choledochoenteric anastomosis to relieve the obstructive jaundice and abdominal pain.
Abdominal Pain
;
Aged
;
Cholecystectomy
;
Common Bile Duct*
;
Drainage*
;
Duodenum
;
Female
;
Humans
;
Jaundice, Obstructive
;
Pancreatic Ducts*
;
Stomach
8.A Case of Successful Treatment of Stomal Variceal Bleeding with Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization.
Seo Goo HAN ; Ki Jun HAN ; Hyeon Geun CHO ; Chang Woo GHAM ; Chang Hwan CHOI ; Sang Yon HWANG ; Soon Young SONG
Journal of Korean Medical Science 2007;22(3):583-587
Variceal bleeding from enterostomy site is an unusual complication of portal hypertension. The bleeding, however, is often recurrent and may be fatal. The hemorrhage can be managed with local measures in most patients, but when these fail, surgical interventions or portosystemic shunt may be required. Herein, we report a case in which recurrent bleeding from stomal varices, developed after a colectomy for rectal cancer, was successfully treated by placement of transjugular intrahepatic portosystemic shunt (TIPS) with coil embolization. Although several treatment options are available for this entity, we consider that TIPS with coil embolization offers minimally invasive and definitive treatment.
Colectomy/adverse effects
;
Contrast Media/pharmacology
;
Embolization, Therapeutic/*methods
;
Esophageal and Gastric Varices/surgery
;
Gastrointestinal Hemorrhage/*therapy
;
Humans
;
Male
;
Middle Aged
;
*Portasystemic Shunt, Transjugular Intrahepatic
;
Rectal Neoplasms/surgery
;
Tomography, X-Ray Computed/methods
;
Treatment Outcome
9.A Case of Spontaneous Dissection of the Superior Mesenteric Artery Treated by Percutaneous Stent Placement.
Geun Jun KO ; Ki Jun HAN ; Seo Goo HAN ; Sang Yon HWANG ; Chang Hwan CHOI ; Chang Woo GHAM ; Hyeon Geun CHO ; Soon Young SONG ; Jin Ho JUNG
The Korean Journal of Gastroenterology 2006;47(2):168-172
Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.
Acute Disease
;
Aged
;
Aneurysm, Dissecting/complications/*therapy
;
*Angioplasty, Balloon
;
Female
;
Humans
;
Ischemia/etiology
;
*Mesenteric Artery, Superior
;
Mesenteric Vascular Occlusion/etiology
;
*Stents
10.A Case of Complete Resolution of Mediastinal Pseudocyst and Pleural Effusion by Endoscopic Stenting of Pancreatic Duct.
Dong Ju KIM ; Hye Won CHUNG ; Chang Woo GHAM ; Ho Gyun NA ; Seung Woo PARK ; Se Jun LEE ; Jun Pyo CHUNG ; Si Young SONG ; Jae Bock CHUNG ; Jin Kyoung KANG
Yonsei Medical Journal 2003;44(4):727-731
We report a case of a mediastinal pseudocyst with a pleural effusion that developed in a patient suffering from alcohol-related chronic pancreatitis. A 53-year-old man was admitted to another institution complaining of pleuritic chest pain and coughing. A chest X-ray revealed a pleural effusion with a collapse of the right middle and lower lobes. Pleural fluid taken by thoracentesis was exudative, and the patient was transferred to our institution. A CT scan showed a loculated cystic lesion in the mediastinum and pancreatic changes that were consistent with chronic pancreatitis. The endoscopic retrograde cholangiopancreatography (ERCP) findings were compatible with chronic pancreatitis showing severe pancreatic ductal stricture at the head with an upstream dilation and distal bile duct stricture. After a one week of treatment with fasting and octreotide without improvement, both pancreatic and biliary stents were placed endoscopically. After stenting, the pleural effusion and pseudocyst rapidly resolved. The stents were changed 3 months later, at which time a repeated CT demonstrated a complete resolution of the pseudocyst. Since the initial stenting, he has been followed up for 7 months and is doing well with no recurrence of the symptoms, but he will need to undergo regular stent changes. Overall, endoscopic pancreatic stenting appears to be a good option for managing selected cases of mediastinal pancreatic pseudocysts.
*Endoscopy
;
Human
;
Male
;
Mediastinal Neoplasms/*complications/radiography/therapy
;
Middle Aged
;
*Pancreatic Ducts
;
Pancreatic Pseudocyst/*complications/radiography/therapy
;
Pleural Effusion/*complications/therapy
;
Radiography, Thoracic
;
*Stents
;
Tomography, X-Ray Computed
;
Treatment Outcome