포스터 전시 : 만성 간질환 환자에서 혈청 및 복수내 보체 3/4의 임상적 중요성

방승민,전재윤,김자경,박영수,박준용,백용한,문병수,이관식,한광협,문영명 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

배경/목적: 복수를 동반한 간경변증에 있어 낮은 농도의 복수내 단백질 및 알부민은 자발성 복막염의 위험인자로 널리 알려져 있다. 또한 일부 보고에 의하면 간경변증 환자군 중 혈청 또는 복수 C3/C4의 농도가 낮은 경우 자발성 복막염이 자주 발생한다고 보고되었다. 그러나 혈청 또는 복수 C3/C4 농도와 자발성 복막염 발생의 인과관계는 아직 명확히 규명된 바가 없다. 이에 연구자들은 만성 간염부터 자발성 복막염을 동반한 간경변증까지 만성 간질환 환자에서 질병의 중증도에 따른 혈청 및 복수 C3/C4의 변화를 관찰하여, 자발성 복막염과 C3/C4사이의 인과 관계를 규명하고자 하였다. 대상과 방법: 2002년 5월부터 2003년 2월까지 본원 소화기 내과에서 만성 간염 또는 간경변증으로 진단되어 추적 관찰 중인 총 104예를 대상으로 하였다. 환자들은 만성 간염군(I군), 복수를 동반하지 않은 간경변군(II군), 무균성 복수를 동반한 간경변증군(III군) 및 자발성 복막염을 동반한 간경변군(IV군)의 4군으로 분류하였다. 각각의 군에 있어 혈청 C3/C4 및 복수 C3/C4를 측정하였으며, IV군은 치료 시작 후 0, 3, 7일째 혈청 및 복수 C3/C4를 추가로 검사하였다. 결과: 총 104예 중 I군이 17예, II군이 18예, III군이 51예, IV군이 18예였다. 각 군의 혈청내 C3값은 A군이 89.8 mg/dl로 나머지 군들에 비하여 높게 측정되었으며, 이는 통계학적으로 유의미한 차이를 보였다(p-value<0.05). 복수를 동반한 간경변증군인 III군과 IV군의 복수 C3/C4값은 각각 7.60/ 1.88 mg/dL, 6.78 / 1.53 mg/dL로 자발성 복막염을 동반한 경우 보다 낮은 경향은 보였으나 통계적으로 유의한 차이는 보이지 않았다. 무균성복수를 동반한 환자군(III군)을 추적 관찰한 결과 Child-Pugh 분류상 C군이 혈청 C3가 낮았고, A, B군에 비하여 보다 짧은 기간에 자발성 복막염이 발생하였다. 결론: 만성 간질환 환자들에 있어 질환의 중증도가 심해짐에 따라 혈청과 복수 C3/C4가 감소하는 양상을 보이며, 특히 무균성 복수를 동반한 경우 간기능이 불량할수록 혈청 C3의 농도가 낮고, 이는 보다 짧은 기간에 자발성 복막염이 발생하는데 기여하는 것으로 생각된다.

원발성 비뇨생식기 림프종

방승민,한지숙,이정은,김귀언,양우익 대한내과학회 2003 대한내과학회지 Vol.65 No.3

상행결장 내장유충이행증

방승민,전태주,최창환,신성관,김태일,김원호,이우정,김호근 대한소화기내시경학회 2002 Clinical Endoscopy Vol.25 No.1

Visceral larva migrans is a syndrome presented chronic peripheral eosinophilia, hepatomegaly with eosinophilic granuloma. Originally it results from migration of second stage larva of Toxocara species, animal ascarides, but there are many other causative parasites. It's difficult to detect causative parasite, although immunohistochemical methods like ELISA or Ouchterlony method have been introduced. If the larva were dectected, it's not easy to discriminate causative one from others because of similarities of morphology. Most cases have self-limited course. Only in severe infection, antiparasitic treatment, augmented by corticosteroid when allergic symptopms are also present, is required. Clinical presentations have varieties of spectrum, hepatomegaly with eosinophilic granuloma is most common. Some cases of pulmonary, ocular and CNS symptoms were reported. We now report a case of visceral larva migrans, presented submucosal tumor or diverticulitis in the ascending colon and went through laparoscopic right hemicolectomy. The diagnosis was made with microscopic examination of operation tissue. (Korean J Gastrointest Endosc 2002;25:58-62) 내장유충이행증(visceral larva migrans)은 개나 고양이를 숙주로 하는 Toxocara 유충의 인체 감염에 의하여 간이나 폐 등에 호산구성 육아종을 형성하는 질환이다. 그러나 내장유충이행증은 Toxocara 뿐 아니라 다양한 다른 기생충에 의하여 발병하며, ELISA 등의 면역검사에 의한 진단방법이 사용되고 있으나, 감염된 유충의 인체 숙주 내 면역 반응으로 인한 퇴행성 변화가 심해 원인 기생충을 확진하지 못하는 경우가 많다. 내장유충이행증은 학령기의 어린이들에게 가장 빈번하게 발생하며, 기생충에 감염된 가축의 생식을 통하여 발병한 보고들도 있다. 간이 가장 흔한 호발 장기이며 폐 및 안구에도 호발하는 것으로 알려져 있다. 치료는 구충제 투약이 효과적인 방법으로 알려져 있다. 본 증례는 우측 하복부 통증을 주소로 입원하여 급성 충수돌기염이 의심되었던 예로 복부초음파 및 임상 경과가 전형적인 충수돌기염에 합당하지 않고, 바륨대장촬영검사 및 대장내시경검사에서 상행결장의 점막하 종양 또는 게실염이 의심되어 우측 결장절제술을 시행받은 예로 수술조직의 병리학적 검사상 내장유충이행증에 합당한 소견을 보여 이를 보고하는 바이다.

An unusual case of Hodgkin's disease showing complete spontaneous remission only with single cycle of COPP-ABV chemotherapy followed by infectious complications

방승민,정준원,양우익,한지숙 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.3

Advanced Hodgkin's disease is usually treated with six or more cycles of combination chemotherapy. Spontaneous regression of the cancer is very rarely reported in patients with Hodgkin's disease. We present an unusual case of a patient with Hodgkin's disease who experienced complete remission with a single cycle of chemotherapy, followed by pneumonia. The case was a 36-year-old man diagnosed with stage IVB mixed cellularity Hodgkin's disease in November 2000. After treatment with one cycle of COPP-ABV (cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine) chemotherapy without bleomycin, the patient developed interstitial pneumonia and was cared in the intensive care unit (ICU) for two months. Follow-up chest computerized tomography (CT), performed during the course of ICU care, revealed markedly improved mediastinal lymphomatous lesions. Furthermore, follow-up whole body CT and 18-fluorodeoxyglucose positron emission tomography showed complete disappearance of the lymphomatous lesions. Four years later, the patient is well and without relapse. This report is followed by a short review of the literature on spontaneous regression of Hodgkin's disease. To the best of our knowledge, this is the first case report of spontaneous remission of Hodgkin's disease in Korea.

한국인에서 가족성 췌장암의 빈도 및 BRCA-2 유전자 돌연변이 검사의 유용성

방승민,송시영,박승우,이세준,정준표,정재복,강진경 대한내과학회 2002 대한내과학회 추계학술발표논문집 Vol.63 No.-

Endoscopic Papillary Balloon Dilation with Large Balloon after Limited Sphincterotomy for Retrieval of Choledocholithiasis

방승민,김명환,박정엽,박승우,송시영,정재복 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.6

Endoscopic papillary balloon dilation (EBD) for choledocholithiasis is known to be comparable to endoscopic sphincterotomy (EST) especially in cases of small stones. With larger stones, EBD with conventional balloon, which have a diameter of 6-8 mm, was reported as less effective for extraction of stones. We evaluated the efficacy and complications of EBD with large balloons (10-15 mm) after limited EST for retrieval of choledocholithiasis. From February 2005, we have performed EBD with limited EST for retrieval of common bile duct (CBD) stones. The patients who admitted with hyperamylasemia and gallstone pancreatitis were excluded. In cases without CBD dilation, EPBD with 12 mm for 40 seconds was performed. And in cases with CBD dilation, we dilated the sphincters with 15 mm sized balloon for 40 seconds. Total 22 patients (11 of male) were performed EBD with limited EST for retrieval of CBD stones. The median diameter of the stones was 10 mm (5-25 mm). Ten cases had multiple stones and 6 cases periampullary diverticuli. Successful stone removal in the initial session of ERCP with EBD was accomplished in 16 patients (72.7%). And complete retrieval of bile duct stones was achieved in all patients with repeated ERCP. In the aspect of complications, any episodes of perforation, bleeding was not developed. Only one case of mild grade of post-procedural pancreatitis was noted. However, post-procedural hyperamylasemia was developed in 16 cases (68.2%). EBD with larger balloon seems to be a feasible and safe alternative technique for conventional EST in CBD stone extraction.

선행 질환 없이 발생한 Klebsiella Pneumoniae에 의한급성 화농성 심낭염 1예

방승민,권승현,김병창,맹호영,김재학,조덕규,윤영원,유승기,최동훈 대한심장학회 2002 Korean Circulation Journal Vol.32 No.1

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

방승민,서정훈,박병규,박승우,송시영,정재복 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.2

The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure- related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

배전급 전력기기 개발현황

방승민 한국조명·전기설비학회 2020 조명.전기설비 Vol.34 No.3

Concomitant Statin Use Has a Favorable Effect on Gemcitabine-Erlotinib Combination Chemotherapy for Advanced Pancreatic Cancer

방승민,문도창,이희승,이용일,정문재,박정엽,박승우,송시영,정재복 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.5

Purpose: Erlotinib-gemcitabine combined chemotherapy is considered as the standard treatment for unresectable pancreaticcancer. This study aimed to determine the clinical factors associated with response to this treatment. Materials and Methods: This retrospective study included 180 patients with unresectable pancreatic cancer who received ≥2 cyclesof gemcitabine-erlotinib combination therapy as first-line palliative chemotherapy between 2006 and 2014. “Long-term response”was defined as tumor stabilization after >6 chemotherapy cycles. Results: The median progression-free survival (PFS) and overall survival (OS) were 3.9 and 8.1 months, respectively. On univariateanalysis, liver metastasis (p=0.023) was negatively correlated with long-term response. Locally advanced stage (p=0.017), a history ofstatin treatment (p=0.01), and carcinoembryonic antigen levels <4.5 (p=0.029) had a favorable effect on long-term response. Onmultivariate analysis, a history of statin treatment was the only independent favorable factor for long-term response (p=0.017). Prognosticfactors for OS and PFS were significantly correlated with liver metastasis (p=0.031 and 0.013, respectively). A history of statintreatment was also significantly associated with OS after adjusting for all potential confounders (hazard ratio, 0.48; 95% confidenceinterval, 0.26–0.92; p=0.026). Conclusion: These results suggest that statins have a favorable effect on “long-term response” to gemcitabine-erlotinib chemotherapyin unresectable pancreatic cancer patients. Statins may have a chemoadjuvant role in stabilizing long-term tumor growth.