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Guideline for Capsule Endoscopy: Obscure Gastrointestinal Bleeding
심기남,문정섭,장동경,도재혁,김지현,김진오,전성란 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.1
Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn’s disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.
원발성 간암 111예에 대한 임상적 고찰 : 생존기간 및 예후인자를 중심으로 The Study for Survival Period and Prognostic Factors
심기남,김도영,문일환 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1
이화여자대학교 의과대학부속 동대문병원에 입원하여 원발성 간암으로 진단받은 111예를 대상으로 후향적 조사로써 임상적, 생화학적 요인 및 기존 병기체계에 따른 생존기간을 비교하여 다음과 같은 결과를 얻었다. 1) 원발성 간암 환자의 연령 분포는 33세 부터 79세까지로 평균 연령은 54.8세였고, 50대가 47예(42.3%)로 가장 많았다. 남녀비는 4.6:1로 남자가 많았다. 2) 원발성 간암의 예후에 관한 인자로 혈청 albumin, SGOT, bilirubin치 및 치료(TAE) 시행 여부 등에 따른 중앙 생존기간은 albumin 3.0g/dl 이상인 군, SGOT 100U/L 미만인 군, bilirubin 3.0mg/dl 미만인 군 및 TAE 시행군에서 albumin 3.0g/dl 미만인 군, SGOT 100U/L 이상인 군, bilirubin 3.0mg/dl 이상인 군 및 TAE를 시행하지 않은 군에 비해 통계학적으로 유의하게 길었다. 3) 종양의 크기와 형태에 따른 생존기간은 유의한 차이가 없었다. 4) Primack 과 Okuda의 병기체계에 따른 생존기간에는 유의한 차이가없었으나 Child 분류에 따른 생존기간은 유의한 차이를 보여 A 군에서 C 군으로 갈 수록 생존기간이 짧았다. 5) TAE 시행군의 중앙생존기간은 11개월이었고 보존적 치료군의 중앙생존기간은 0.5개월로 TAE 시행군에서 중앙생존기간은 0.5개월로 TAE 시행군에서 중앙생존기간이 유의하게 길었다(p=0.0023). 6) 예후인자들의 상대 위험도를 조사한 결과 간암의 TAE 시행 여부가 가장 큰 상대 위험도(2.3배)를 보여 독립적 예후인자였다. 이상의 결과로 TAE 수술이 불가능한 간암에 대해 유용한 치료 방법으로 생각하며, 간암의 생존율을 더 향상시키기 위하여 TAE 시술 방법의 개선을 위한 전향적인 연구가 요망된다. Hepatocellular carcinoma(HCC), a highly malignant tumor with a poor prognosis, is one of the common cancers in Korea like other Asian and African countries. Despite of recent advances in diagnostic and surgical techniques, early diagnosis of HCC is difficult and chance of surgical resection is still very low due to the multiplicity of tumor and associated liver cirrhosis. Transcatheter arterial chemoembolization(TAE) is a proven effective method of treating HCC regardless of operability. The current study was undertaken on 111 cases to evaluate the survival period of the pat-ients with HCC and to find their prognostic factors. The results were as follows: 1) The mean age of the patients was 54.8 years, with a range from 33 to 79 years. The highest incidence of age was in the 6th decade and the male to female ratio was 4.6:1. 2) The survival period of the patients was significantly related to serum albumin, SGOT, bilirubin and treatment(TAE). 3) The survival period was not significantly related to size and type of tumor. 4) The revised staging systems by Primack and Okuda were not significantly related to the survival period. But Child's classification was significantly related to the survival period. 5) The median survival period of TAE group was 11 months while non-TAE group was 0.5 month(p=0.0023). 6) Multivariate Cox regression analysis showed that the treatment modality(TAE or non-TAE group) was the factor with the greatest relative risk and an independent prognostic value. Accordingly, it is suggested that TAE is an effective method for treating unresectable HCC, and the prospective investigations on TAE are needed.
심기남,정성애,주양희,유권 이화여자대학교 의과대학 2005 EMJ (Ewha medical journal) Vol.28 No.2
목적: 본 연구는 암의 침윤과 전이에 필수적인 기질단백분해효소(matrix metalloproteinases, MMPs)와 억제인자(tissue inhibitor of metalloproteinase, TIMPs)의 발현정도를 위암의 생검조직에서 확인하고 임상적, 병리학적 소견과의 상관관계를 분석하여 임상적 유용성을 평가하고자 하였다. 방법: 2003년 8월부터 2004년 7월까지 본원에서 위암으로 진단되어 근치적 치료를 받은 30명의 환자를 대상으로 하였다. 조직은 위내시경 검사시 정상 점막 및 암으로 진단한 병변에서 생검겸자를 이용하여 얻었다. 역전사중합효소연쇄반응(RT-PCR)을 이용하여, 정상조직을 기준으로 암조직에서의 MMP-W, MMP-9, MT1-MMP, TIMP-1, TIMP-2의 발현정도를 반정량법으로 비교하였다. 결과: MT1-MMP의 발현정도는 위암의 분화도, 림프혈관계 침윤, 림프절 전이 및 암의 병기와 유의한 상관관계가 있었다.(p<0.05). 그 외의 MMP-2, MMP-9, TIMP-1,TIMP-2의 발현은 임상적 소견과 유의한 관계를 보이지않았다. 결론: 반정량적 역전사중합효소연쇄반응을 이용하여 MT1-MMP의 발현 증가 유무를 확인하는 것은 위암의 공격적 특성을 예측하는데 유용할 것으로 생각되며, 이러한 검사는 수술 전에 얻어진 생검조직을 이용하여 가능하므로 암의 공격성에대한 정보를 수술 전에제공할 수 있을 것으로 사료된다.
결핵성 복막염의 임상적 고찰 : A Review of 43 Cases
심기남,김도영,문일환 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.1
We studied the clinical features of 43 patients of trberculous peritonitis who had been admitted to Ewha Womans University Hospital from January, 1984 to December, 1994. The results are summarized as followings : 1) The male to female ratio was 1:2.3 and the peak incidence was between 21 and 30 years of age. 2) Chief complaints were abdominal distension(65.1%), and abdominal pain(51.2%). Besides these symptoms, indigestion, diarrhea, abdominal mass and general weakness were also noted. 3) Physical findings were abdominal tendemess(53.5%), abdominal mass(32.6%), jaundice(14.0%) and heparomegaly(2.3%) 4) The mean values of hemoglobin, WBC and ESR were 11.9g/dl. 8,300/mm^3, and 65mm/hr respectively 5) The ascitic fluid analysis showed that the specific gravity was 1.031, protein concentration 5.0g/dl, mean lymppcyte percentage 98%, and the mean ADA activity was 61u/l. 6) On chest X-ray, the findings related to the pulmonary tuberculosis were noted in 26 patients(60.5%).
심기남,김진일,김나영,김상균,조윤주,홍수진,신정은,김광하,박경식,최석채,권중구,김지현,김현진,김지원 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.5
Background/Aims: Irsogladine maleate, an enhancer of gastric mucosal protective factors, has demonstrated its efficacy for various gastric mucosal injuries. The aim of this study was to evaluate the efficacy and safety of irsogladine for prevention of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin-induced peptic ulcer and gastritis. Methods: In this multicenter, randomized, double-blind, exploratory clinical trial, 100 patients over 50 years of age who needed continuous NSAIDs or aspirin for more than 8 weeks were randomly assigned to either test group (irsogladine maleate 2 mg, twice daily, 39 patients for full analysis) or placebo group (37 patients for full analysis). Primary outcomes were incidence of peptic ulcer and ratio of modified Lanza score (MLS) 2 to 4. Secondary outcome was the number of acute erosions confirmed by endoscopy at 8 weeks. Adverse effects were also compared. Results: There were no significant differences in gastric protective effects between test and placebo groups. However, two cases of peptic ulcer in the placebo group but none in the test group were observed. These two cases of peptic ulcer were Helicobacter pylori-negative. In addition, H. pylori-negative group showed significant changes in MLS score (p = 0.0247) and edema score (p = 0.0154) after the treatment compared to those before treatment in the test group. There was no significant difference in adverse events between the two groups. Conclusions: The efficacy of irsogladine maleate was found in H. pylori-negative group, suggesting its potential as a protective agent against NSAIDs or aspirin-induced peptic ulcer and gastritis.