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림프질 전이가 있는 하인두암과 하부식도암의 진단에 활용된 내시경초음파 유도하 Trucut 생검 1예
광명옥,이정환,문정섭,김유선,류수형,총배천,김형훈,김현태 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-
The incidence of double primary cancer is about 10% in all kinds of cancers. Double primary cancer is usually accompanied by gastrointestinal cancer. Esophageal cancer is supposed to be frequently accompanied by squamous cell carcinoma of the head and neck or the upper respiratory tract, because of such common carcinogens as smoking and alcohol ingestion. Esophageal cancer and hypopharyngeal cancer are usually diagnosed by esophagogastric endoscopy with biopsy. We performed endoscopic ultrasound-guided Trucut biopsy(EUS-TCB) to diagnose a mediastinal mass in a 49 year-old patient, who visited our hospital because of voice change. During procedure, we accidently found enlarged celiac lymph node, and obtained tissue from the mediastinal lymph node and the celiac lymph node. We confirmed double primary cancer of squamous cell carcinoma in the esophagus and the hypopharynx via esophagogastric endoscopy.
A case of giant left atrial myxoma presenting with severe mitral valve obstructive symptoms
Chuan, Tsung-Pei,Sir, Jung-Ju,Park, Il-Kwon,Park, Young-Il,Kim, Hyun-Tae,Park, Kyung-Jun,Min, Seon-Kyung,Kim, Yong-In,Cho, Wook-Hyun,Choi, Suk-Koo 인제대학교 2008 仁濟醫學 Vol.29 No.-
심장 내 점액종은 매우 드문 질환이다. 본 증례는 지속적으로 악화되는 양상의 호흡 곤란을 주소로 내원한 35세 남자에서 심장 초음파 검사 상 좌심방 내 거대 심장내 종괴가 발견되어 입원 후 개흉 수술로 종괴를 제거하였으며 조직 검사상 점액종으로 확진된 증례이다. 심장 초음파 소견 상 종괴는 매우 유동적으로 심실 이완기에 승모판막 입구를 폐쇄하여 유입 혈류를 제한하는 양상이었다. 수술 후 환자는 증상이 호전되어 퇴원하였다.
( Pei Chuan Tsung ),( Soo Hyung Ryu ),( In Hye Cha ),( Hee Won Cho ),( Jin Nam Kim ),( You Sun Kim ),( Jeong Seop Moon ) 대한간학회 2013 Clinical and Molecular Hepatology(대한간학회지) Vol.19 No.2
Background/Aims: Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified. Methods: This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascetic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed. Results: The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascetic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (≥3 mg/dL, P=0.002), a prolonged serum prothrombin time (I.e., international normalized ratio>2.3, p<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascetic fluid (<50 mg/dL, p<0.001) were independent predictive factors of overall survival rate. Conclusions: HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascetic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.
( Pei Chuan Tsung ),( Jong Hyeok Park ),( You Sun Kim ),( Sun Young Kim ),( Won Wo Park ),( Hyun Tae Kim ),( Jin Nam Kim ),( Yun Kyung Kang ),( Jeong Seop Moon ) 대한간학회 2013 Gut and Liver Vol.7 No.2
Background/Aims: Mini-probe endoscopic ultrasonography (mEUS) is a useful diagnostic tool for accurate assessment of tumor invasion. The aim of this study was to estimate the accuracy of mEUS in patients with early colorectal cancer (ECC). Methods: Ninety lesions of ECC underwent mEUS for pre-treatment staging. We divided the lesions into either the mucosal group or the submucosal group according to the mEUS findings. The histological results of the specimens were compared with the mEUS findings. Results: The overall accuracy for assessing the depth of tumor invasion (T stage) was 84.4% (76/90). The accuracy of mEUS was significantly lower for submucosal lesions compared to mucosal lesions (p=0.003) and it was lower for large tumors (≥2 cm) (p=0.034). The odds ratios of large tumors and submucosal tumors affecting the accuracy of T staging were 3.46 (95% confidence interval [CI], 1.05 to 11.39) and 6.25 (95% CI, 1.85 to 25.14), respectively. When submucosal tumors were combined with large size, the odds ratio was 14.67 (95% CI, 1.46 to 146.96). Conclusions: The overall accuracy of T stage determination with mEUS was considerably high in patients with ECC; however, the accuracy decreased when tumor size was >2 cm or the tumor had invaded the submucosal layer. (Gut Liver 2013;7:163-168)
Chronic constrictive uremic pericarditis in a long-term hemodialysis patient : a case report
Kim, Hyun-Tae,Park, Kyung-Jun,Tsung, Pei-Chuan,Na, Hyun-Hee,Kim, Young-In,Kim, Mun-Cheol,Koh, Haeng-lI 인제대학교 2009 仁濟醫學 Vol.30 No.-
요독성 심낭염은 만성 선부전 환자에서 나타날 수 있는 합병증으로 투석치료의 도입이후 발생률이 감소하고 있으나 말기 산부전 환자의 투석시작 전후로 혈역학적 문제가 발생할 수 있는 심각한 합병증 중 하나이며 드물게 오랜 기간 투석 치료를 받은 환자에서도 발생할 수 있다. 요독성 심낭염이 진행되어 심낭삼출이 발생할 경우 기저 질환에 대한 치료와 요독의 효과적인 제거를 위한 고효율의 투석을 시행하지만 혈역학적으로 불안정 할 경우 심낭천자 및 심막절제술의 침습적인 치료가 필요하다. 저자들은 오랜 기간 동안 혈액투석을 시행받은 환자에서 발생한 만성 요독성 교착성 심낭염을 경험하여 이를 보고하려고 한다. 63세 남자 환자가 혈액 투석 중에 발생한 저혈압과 호흡 곤란으로 내원하였다. 2달 전 부터 투석 중 흉부 압박감이 있었고, 1 주 일 전부터는 투석 중 저혈압이 발생하고 호흡곤란이 동반되었다고 한다. 고혈압에 의한 말기신부전으로 9년 전부터 혈액 투석을 받고 있었다. 흉부 방사선 단순촬영에서 섬비대가 있었고, 심장 초음파와 흉부 컴퓨터 단층 촬영에서 교착성 심낭염을 발견하였다. 이후 섬막절제술을 시행하였고, 병리학적 소견으로 보아 만성 요독성 교착성 심낭염을 진단할 수 있었다. 환자는 수술 후 혈압은 정상이었고, 투석 중에도 저혈압은 발생하지 않았다. 현재 외래에서 추적관찰 중이다.
Jia-Ming Chen,Wan-Li Chiang,Bin-Chuan Ji,Ruei-Jhe Jhang,Pei-Hsin Chen,Ya-Lun Li,Che-Ju Chang,Sung-Yen Huang,Tsung-Chieh Lee,Chia-Yun Chen,Ching-Hsiung Lin,Sheng-Hao Lin 한국한의학연구원 2023 Integrative Medicine Research Vol.12 No.4
Background: In intensive care units, mechanical ventilation is an important therapy to help patients with dysp- nea. However, long-term ventilator dependence would consume huge medical resources and increase the risk of morbidity and mortality. The aim of the study was to examine the efficacy of the acupuncture combined with western medical care on ventilator parameters in ventilator-dependent patients. Methods: In this clinical trial, 80 ventilator-dependent patients aged 20 to 80 years old were randomly assigned to acupuncture group and control group in the respiratory care center (RCC) of Changhua Christian Hospital. Besides regular medical care and therapy, participants in the acupuncture group received acupuncture therapy at the same 17 acu-points for 20 minutes once a day, a total of 12 sessions. The ventilator parameters were recorded to evaluate the respiratory efficiency for all participants. The primary outcome was rapid shallow breathing index (RSBI), and secondary outcomes were respiratory rate (RR), tidal volume (TV) and ventilation per minute (MV). Results: Though there was no significant difference in the parameter between the acupuncture group and the control group, we found the trend of decreasing RSBI in the acupuncture group. In subgroup analyses, the mean of RSBI significantly decreased 16.02 (with the SD in 60.84) in acupuncture group, while it increased 17.84 (with the SD in 39.38) in control group (p = 0.036) after 12 sessions. Conclusion: Acupuncture treatment can improve breathing ability of patients with respirator dependence in respiratory care center.