유럽통합과 유럽연합의 교육정책 - Erasmus-Program을 중심으로 -

노명환 ( Noh Myung-hwan ) 한국외국어대학교 EU연구소 1997 EU연구 Vol.- No.3

가성 낭종을 동반한 췌장의 동정맥 기형

한지은 ( Ji Eun Han ),노명환 ( Myung Hwan Noh ),남원욱 ( Won Wook Nam ),노미숙 ( Mee Sook Roh ),박병호 ( Byung Ho Park ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.2

췌장의 동정맥 기형은 주로 췌장의 두부에 생기는 매우 드문질환으로 주 증상은 위장관 출혈이며, 치료는 일반적으로 침범된 기관 또는 부위의 완전 절제이다. 저자들은 급작스런 복통으로 내원하여 췌장미부에 동정맥 기형이 진단된 64세 남자 환자의 임상소견과 수술적 치료경과를 보고하고자 한다. 췌장 컴퓨터단층촬영과 자기공명담췌관 조영술 상에서 췌장미부에 다발성의 혈관생성을 동반한 동정맥 기형에 합당한 소견이 관찰되었으며 인접한 근위부 췌장에 낭성병변 동반소견이 보였다. 같은 시기에 시행한 상장간막동맥 혈관조영술에서도 췌장미부에서 동맥영상 조기에 간문맥이 관찰되는 동정맥 기형 소견이 보였다. 치료는 복강경하 원위부 췌장 절제 및 비장 절제술을 시행하였으며, 조직검사에서 췌장 미부에 동정맥 기형에 합당한 소견과 근위부에 가성낭종의 소견이 보였다. 환자는 수술 후 1주만에 합병증 없이 퇴원하였다. Pancreatic arteriovenous malformation (PAVM) is very rare anomaly. It occurs most commonly in the pancreatic head portion and gastrointestinal bleeding is the most common symptom. The management of PAVM is rather complex, with complete treatment usually accomplished by a total extirpation of the affected organ or at least its involved portion. We report the clinical presentation and management of 64 year-old male patient with PAVM, which was developed in pancreatic tail portion with sudden abdominal pain. Pancreatic computed tomography and magnetic resonance cholangio-pancreatography were consistent with a vascular formation on pancreatic tail portion and simultaneously revealed with pseudocysts beside it. A subsequent superior mesenteric artery angiographic findings depicted PAVM on pancreatic tail portion. The patient underwent laparoscopic distal pancreatectomy and splenectomy and had a favorable outcome.

급성췌장염의 중증도 예측에 대한 혈청 Procalcitonin의 효용성 및 절단값

우수미 ( Su Mi Woo ),노명환 ( Myung Hwan Noh ),김병근 ( Byung Geun Kim ),형건덕 ( Chien Ter Hsing ),한지선 ( Ji Sun Han ),유승희 ( Seung Hee Ryu ),서정민 ( Jeong Min Seo ),윤현아 ( Hyun Ah Yoon ),장진석 ( Jin Seok Jang ),최석렬 ( 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1

Background/Aims: The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers. Methods: Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission. Results: Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021). Conclusions: Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis. (Korean J Gastroenterol 2011;58:31-37)

증 례 : 담낭에 발생된 전장낭 1예

한지은 ( Ji Eun Han ),노명환 ( Myung Hwan Noh ),김우재 ( Woo Jae Kim ),김동균 ( Dong Kyun Kim ),남화성 ( Hwa Seung Nam ),노미숙 ( Mee Sook Noh ),김관우 ( Guan Woo Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.1

Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported.We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings.Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6×1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.(Korean J Gastroenterol 2016;67:49-53)

증례 : 소화기 ; 신우 종괴 형성과 췌장 침범을 동반한 IgG4 연관 경화성 질환 1예

김우재 ( Woo Jae Kim ),노명환 ( Myung Hwan Noh ),류충헌 ( Choong Heon Ryu ),한승희 ( Seung Hee Han ),남화성 ( Hwa Seong Nam ),한지은 ( Ji Eun Han ),홍숙희 ( Sook Hee Hong ) 대한내과학회 2014 대한내과학회지 Vol.87 No.6

IgG4-related sclerosing disease is a disease entity that has recently attracted attention, manifesting as a multiorgan disease characterized by high serum IgG4 levels, extensive IgG4-positive plasma cells and lymphocyte infiltration of the affected organs, with the pancreas (autoimmune pancreatitis) and kidney as representative targets. In cases of renal involvement, parenchymal lesions are predominant, such as renal cortical lesions or diffuse renal enlargement. However, mass-like lesions involving the renal pelvis are very rare, and mass forming or pelvic involvement types should be distinguished from lymphomas, metastatic cancers and other genitourinary malignancies to avoid unnecessary surgery. Herein, we report a case of IgG4-related sclerosing disease involving the kidney as an unusual involvement pattern presenting as a mass-like lesion with pelvic and perirenal involvement. (Korean J Med 2014,87:710-715)

성인 미세변화신증후군 환자의 임상경과에 관한 연구

박정하(Jung Ha Park),배성진(Sung Jin Bae),배상문(Sang Moon Bae),노명환(Myung Hwan Noh),김재석(Jae Seok Kim),박희승(Hee Seung Park),정원태(Won Tae Jung),김성은(Seong Eun Kim),김기현(Ki Hyun Kim),김영훈(Yeong Hoon Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.6

N/A Objectives - A series of biopsy-proven 76adult onset minimal change nephrotic syndrome(MCNS) was analyzed to estimate the clinical courses including the rate and the pattern of response to corticosteroids or cytotoxic agents and the characteristics of relapse, Methods: The diagnoses of all cases were made between 1985 and 1994. Mean follow up duration was 2.4±2.0 years. All the patients had the apparent onset of their disease when aged 16or more and presented with a full-blown nephrotic syndrome (proteinuria>3.0gm/day, serum albumin<3.0gm/dl and edema). None had either past history of a nephrotic syndrome or other renal disease. All the cases were classified to five groups (16-25, 26-35, 36-45, 46-55, above 56) according to age and were analyzed. The clinical and laboratory information was obtained on each patient at the time of presentation and at last follow-up. Renal tissues were examined by light, fluorescence and electron micorscopy. The initial prednisolone was used at a dose of 40mg/day p.o. given up to 16weeks and the response to prednisolone therapy was evaluated, then tapered by 10mg every 2weeks. Cyclophosphamide was used at a dose of 2mg/kg/day p.o. given for 8-10weeks(maximal daily dose of 100mg) and the response to cyclophosphamide therapy was also evaluated. When there was no apparent response to cyclophosphamide therapy, the prednisolone regimen same as initial therapy was added consecutively after completion of cyclophosphamide therapy. All cases were reviewed retrospectively and analysed with SPSS/PC' program. Results: 1) The prevalence of young patients(16-25 year group) was higher(37cases, 49%). There was a preponderance of males(2.6:1). 2) The outcomes for sixty-nine patients, who given an initial course of prednisolone were 50cases (73%) in complete remission(CR), 9cases (13%) in a partial remission(PR) and 10cases(14%) remained nephrotic. The 34(68%) of 50cases who achieved complete remission were relapsed. 3) Cyclophosphamide was used in 35patients. The response to cyclophosphamide therapy were 7cases(20%) in CR, 12cases(34%) in PR and 16cases(46%) remained nephrotic till eighth weeks of treatment. A CR was obtained in 63%(10/16) with subsequent use of prednisolone after cyclophosphamide therapy because of poor response to cyclophosphamide. The cumulative CR rate was 60% (21/35) within 28th weeks of treatment. 4) The age of patients had no relationship to the response rate, time to response, relapse rate and number of relapse after prednisolone therapy. 5) At the final follow-up, 52cases(68%) were in CR, 6cases(8%) were in PR and 18cases(24%) were nephrotic, but all cases preserved normal renal function. Conclusion: Adult onset MCNS showed relatively good response with an daily 40mg of prednisolone as initial dose. The response to cyclophosphamide therapy in those who had inadequate response to initial prednisolone therapy or recurrent relapse was 60% of complete remission. Furthermore, the subsequent use of prednisolone after cyclophosphamide therapy is supposed to increase the response rate in case of poor cyclophosphamide response. Finally, as known the disease has a favorable out- come without renal function impairment.

하행 대장의 장간막에 발생한 악성 신경초종

김문범(Moon Beom Kim),한상영(Sang Young Han),강도영(Do Young Kang),김선택(Sun Tac Kim),박일(Il Park),배상문(Sang Moon Bae),김재석(Jae Seok Kim),노명환(Myung Hwan Noh),최석렬(Seok Reyol Choi),신우원(Woo Won Shin) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

Malignant schwannoma(peripheral nerve sheath tumor) is relatively rare tumor. The extremity, trunk, head and neck are most frequently affected. We experienced a case of malignant schwan- noma in descending mesocolon which is very rare site. The patient was a 45-year-old ma]e who complained of abdominal distension. Abdominal CT scan showed a huge lobulated heterogeneous mass on abdominal and pelvic cavity. Abdominal exploration revealed a yellowish gray, friable, nodular and huge mass infiltrating sma]l bowel, large bowel and peritoneum partially. The tumor was resected with left hemicolectomy and partial resection of peritoneum and small bowel. Both histological and immuno-histochemical stain with S-100 protein revealed that it was a malignant schwannoma. The patient has received two courses of systemic chemotherapy and visited regulary at out-patient department. (Korean J Gastroenterol 1996; 28:439-444)

서독의 탈나치화와 '새로운 독일'의 방향 1945-1963

노명환 韓國外國語大學校 歷史文化硏究所 1998 역사문화연구 Vol.8 No.-

급성 췌장염에서 복부 전산화단층촬영술 등급과 예후인자와의 상관관계

이성욱,한상영,신종민,최석렬,노명환,박건욱,신우원,이종훈 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1

Background/Aims : There are many different biochemical methods to evaluate the severity of acute pancreatitis. Recently, computed tomography (CT) grade was introduced as an, useful method. In this study, we examined the correlation between CT grade and clinical factors of acute pancreatitis including various biochemical tests, etiology, and duration of admission. Methods : We evaluated prospectively 26 patients with acute pancreatitis who were diagnosed by blood test and symptoms. They underwent CT within 72 hours after admission. We evaluated the severity of acute pancreatitis with Ranson score, the levels of C-reactive protein (CRP), lactate dehydrogenase, amylase, lipase and CT grade. Results: There was a statistical significanct correlation between duration of admission and CT grade, Ranson score, and the level of CRP (p$lt;0.05). The correlation index was 0.31 between CT grade and Ranson score (p$gt;0.05) and 0.67 between CT grade and CRP (p$lt;0.05). Conclusions : CT grade, Ranson score, and CRP were useful in evaluating the severity of acute pancreatitis. Moreover, there was a statistical significant correlation between CT grade and CRP.

폐출혈과 위장관출혈이 합병된 Henoch-Sch nlein Purpura 1예

김광진,한상영,이철종,최석렬,노명환,신우원,이종훈,양두경,허기영 대한소화기학회 2000 대한소화기학회지 Vol.36 No.4

Henoch-Sch nlein purpura is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tracts, joints, and kidneys. Henoch-Sch nlein purpura is a common vasculitic disease of childhood. It is diagnosed by characteristic clinical manifestations: nonthrombocytopenic purpura, arthritis or arthralgia, abdominal pain which may be complicated by gastrointestinal hemorrhage, and urinary sediment changes. Pulmonary hemorrhage is a rare complication which occurred predominantly in adolescent and adult according to previously reported cases. We experienced 34-year-old man with Henoch-Sch nlein purpura in whom gastrointestinal bleeding and bilateral, massive, pulmonary hemorrhage developed. He died of respiratory failure.