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위장관 ; 위암의 원발 병소, 림프절 및 원격전이 평가에서 18F-fluoro-2-deoxyglucose Positron Emission Tomography의 유용성
윤나리 ( Na Ri Yoon ),박재명 ( Jae Myung Park ),정희선 ( Hee Sun Jung ),조유경 ( Yu Kyung Cho ),이인석 ( In Seok Lee ),최명규 ( Myung Gyu Choi ),정인식 ( In Sik Chung ),송교영 ( Kyo Young Song ),박조현 ( Cho Hyun Park ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: The usefulness of 18F-fluoro-2-deoxyglucose (FDG)-PET in detecting primary cancer, lymph node metastasis, and distant metastasis were studied in the gastric cancer patients. Methods: The subjects were 392 gastric cancer patients who received FDG-PET and an abdominal CT test prior to surgery. The results of FDG-PET and CT were compared with the surgical and pathologic results. Results: The primary site detection rate of FDG-PET was 74.4%, 50.3% in early gastric cancer and 92.0% in advanced gastric cancer. Detection rate was higher when tumors were larger than 3.5 cm, had deeper depth of invasion, and at a later stage (p<0.05, respectively). In multivariate analysis, tumor size, spread of tumor cells beyond the muscle layer (≥T2), and lymph node metastasis were statistically significant factors in primary site detection rate. The sensitivity, specificity, and positive predictive value of FDG-PET to lymph node metastasis were 59.6%, 88.8%, and 81.1% respectively, sensitivity being lower compared to CT while specificity and positive predictive value were higher. Sensitivity, specificity, and positive predictive value to distant metastasis were, respectively, 66.7%, 99.2%, and 88.0%, similar to CT. In 21 of the 392 patients (5.4%), synchronous double primary cancers were detected. Conclusions: In gastric cancer, usefullness of FDG-PET is limited to the advanced stage. Diagnostic value of this test was not superior to CT. However, FDG-PET may be useful in detecting synchronous double primary cancers. (Korean J Gastroenterol 2012;59:347-353)
김세희 ( Se Hee Kim ),최명규 ( Myung Gyu Choi ),정인식 ( In Sik Chung ),김상우 ( Sang Woo Kim ),김진일 ( Jin Il Kim ),이인석 ( In Seok Lee ),조유경 ( Yu Kyung Cho ),전해명 ( Hae Myung Jeon ),박조현 ( Cho Hyun Park ) 대한소화기기능성질환·운동학회 2003 Journal of Neurogastroenterology and Motility (JNM Vol.9 No.1
목적 : 위를 절제하면 많은 양의 음식이 소장으로 급격하게 들어가므로 여러 가지 소화관 증상을 일으킨다. 그러나 위절제술후 증후군의 증상들은 시간이 지남에 따라 좋아진다. 연구자들은 소장의 운동과 감각능의 변화가 위절제술 후의 적응 기전으로 중요한 역할을 할 것으로 가정하였다. 연구자들은 정상인과 위절제를 받은 환자를 대상으로 소장의 팽창도와 감각능을 조사하였다. 대상 및 방법 : 위절제를 시행받은 환자 39명과 정상대조군 32명을 대상으로 유동식 부하 Background/Aims: After gastrectomy, patients often experience various gastrointestinal symptoms due to the rapid emptying of ingested food into the small intestine. Symptoms of the postgastrectomy syndrome, however, decrease as time passes. The aim of thi
권낙기 ( Nak Ki Kwun ),최명규 ( Myung Gyu Choi ),이인석 ( In Seok Lee ),김세희 ( Se Hee Kim ),조유경 ( Yu Kyung Cho ),김상우 ( Sang Woo Kim ),정인식 ( In Sik Chung ),박두호 ( Doo Ho Park ) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2
Pseudo-obstruction is a clinical syndrome caused by ineffective intestinal propulsion and characterized by symptoms and signs of intestinal obstruction in the absence of an occluding lesion of the intestinal lumen. A 65-year-old male who complained of abdominal pain and obspitation. (not constipation?) was admitted. Simple abdominal radiographs revealed marked colonic dilatation without mechanical obstruction suggesting pseudo-obstruction. Clinical response with conservative care failed to improve the patient. 2.0 mg of neostigmine which was recently reported to be an effective way to decompress the colon in patients with acute colonic pseudo-obstruction, was administered. Immediate clinical response was achieved without complication.(Kor ean J ournal of Gastr ointestinal Motility 2002;8:197-201)
최명규,박수헌,양진모,조철수,김재광,김호연,정인식,선희식,김부성 대한내과학회 1992 대한내과학회지 Vol.42 No.1
저자들은 1989년 9월부터 1990년 8월까지 가톨릭의과대학 부속병원에서 내원한 전신성 공피증 환자에서 식도내압검사를 시행하여 다음 성적을 얻었다. 1) 대상은 American Rheumatism Association(ARA) 기준에 부합되는 전신성공피증환자로 16세부터 68세(평균 39.2세)의 13명(남 1명, 여 12명)이었고 이 중 2명은 CREST 증후군이었다. 대조군은 17세에서 67세(평균 35.7세)로 정상인 10명(남 1명, 여 9명)이었다. 2) 평균 이환기간은 3.5년±3.7년이고 위장관 증상은 연하곤란 23%(3/13), 속쓰림 23%(3/123), 신트림 15%(2/13), 흉통 7%(1/13), 오심 7%(1/13)순이었다. 전신증상은 Raynaud씨 증상(91.7%)과 근염 30%에서 관찰되었다. 모세혈관확장증과 석회침착증은 CREST 증후군환자(2/13)에서만 발견되었다. 심장침범은 8.4%에서 동반되었다. 3) 하부식도괄약근압은 대조군 24±7.24㎜Hg에 비해 공피증환자군은 1071±4.48㎜Hg로 현저히 저하되어 있었다(p<0.0001). 4) dry swallow시 하부식도수축압은 대조군 43.7±14.7㎜Hg에 비해 공피증환자군은 20.9±23㎜Hg으로 저하되어 있었고(p<0.005), wet swallow시 하부식도수축압은 대조군 64.1±15.2㎜Hg에 비해 공피증환자군은 30.7±24.9㎜Hg으로 저하되어 있었다(p<0.005). 5) 공피증환자군에서 정상식도내압검사인 환자는 13명 중 2례였고, 이상소견을 보인 환자 11명 중 연하곤란과 속쓰림 등의 뚜렷한 임상증세를 가진 환자는 3명에 불과하였다. 이상으로 전신성공피증환자에서 식도운동이상을 시고내압검사로 평가하였다. 84%의 공피증환자에서 이상소견이 확인되엇으며, 공피증의 식도침범에서는 식도증상보다 식도내압소견이 이상이 선행하므로 식도내압검사가 공피증의 식도침범에 대한 진단에 예민하고 정확한 검사로 생각된다. In systemic scleroderma, serious gastrointestinal involvement is present in approximately 50% of the patients. Management of esophageal manifestation of scleroderma is an important factor in the care of the patients of this disease. In the present study, history and symptoms were assessed using a designed questionnaire. Radiologic examination, echocardiographic examination, and skin biopsy were performed for evaluation of systemic manifestations of scleroderma. Esophageal function was assessed in 13 patients with systemic scleroderma by intraluminal manometry and compared with the results from 10 healthy subjects. The results were as follows: 1) All patients with systemic scleroderma were diagnosed based on the diagnostic criteria of the American Rheumatism Association (ARA). The mean age of the systemic scleroderma group was 39.2 years (range 16~68 year) and the male-to-female ratio was 1:9. 2) The mean duration of the disease was 3.5 years (rang 0~10 years) in systemic scleroderma patients. The most common symptoms of scleroderma esophagus were heartburn (3/13) and dysphagia (3/13). Other symptoms such as retrosternal pain, belching, and nausea were observed. It is remarkable that 8 out of 11 patients with systemic scleroderma were asymptomatic in spite of manometrically-proven motor abnormalities. Associated systemic manifestations were Raynaud's phenomenon (91.7%), sclerodactyly (91.7%), arthritis (70%), myositis (30%), telangiectasia (15%), calcinosis (15%), and cardiac involvement (8.4%). 3) Lower esophageal pressure was significantly decreased with a mean value of 10.71±4.48㎜Hg compared to the normal controls with 24±7.24㎜Hg (p<0.0001). 4) Contraction wave amplitudes of the lower esophageal body were decreased in systemic scleroderma with a mean value of 30.7±24.9㎜Hg compared to the normal controls with 64.1±15.2㎜Hg (p<0.001). Simultaneous contraction was observed in 7 patients of systemic scleroderma. Esophageal manometric abnormalities were present in four-fifths of the patients with systemic scleroderma. Since there is a great discrepancy between esophageal symptoms and objectively-proven esophageal involvement, manometry should be used in the assessment of patients with systemic scleroderma.