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장중첩증이 (腸重疊症) 동반된 대장지방종 (大腸指肪腫)
박인서 ( In Suh Park ),박찬일 ( Chan Il Park ),이경식 ( Kyung Sik Lee ),김기황 ( Ki Whang Kim ),최흥재 ( Heung Jae Choi ),양주영 ( Joo Young Yang ),박창윤 ( Chang Yoon Park ),윤용광 ( Yong Dwang Yoon ) 대한소화기학회 1982 대한소화기학회지 Vol.14 No.1
Excluding adenomataus polyps, lipomas represent the most common benign tumor of the colon. But lipomas of gastrointestinal tract are rarely encountered, and when seen they are usually an incidental finding at autopsy or operation. When small, these tumors are frequently asymptomatic. Constipation and colicky abdominal pain in wax and wane pattern are frequent symptoms in the larger tumor and intussusception is the main complication of the lipomas. A few hundreds of gastrointestinal lipomas were reported in the world, but only 6 cases of it were found in the literature in Korea. A case of lipomas in colon associated with intussusception in a 36-year-old woman and a brief review of the literature were presented.
증례 : 내분비-대사 ; ABCA1 유전자의 새로운 돌연변이로 인한 Tangier병 1예
박형기 ( Hyung Ki Park ),서승오 ( Seong O Suh ),안석진 ( Seok Jin Ahn ),정준오 ( Jun Oh Jung ),박상준 ( Sang Jun Park ),김희진 ( Hee Jin Kim ),박형두 ( Hyung Doo Park ) 대한내과학회 2010 대한내과학회지 Vol.78 No.2
본 증례의 환자는 Tangier병의 전형적인 임상양상을 가지고 있다. 극히 낮은 혈중 HDL-C, apo A-I 및 apo A-Ⅱ 수치를 나타냈다. 십이지장과 대장 점막의 육안적인 이상소견이 관찰되었고, 그 조직 검사에서 점막하층의 거품모양의 대식세포들이 확인되었다. 또한 세극등 검사에서 양안의 각막혼탁이 관찰되었다. 유전자 검사에서는 기존에 보고된 적이 없는 ABCA1 유전자의 새로운 점돌연변이 두 가지가 확인되었다. 본 환자는 HDL-C 감소를 유발할 Tangier disease (TD) is a rare autosomal recessive disorder of lipoprotein metabolism characterized by extremely low levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I resulting in accumulation of cholesterol esters in vari
이기종 ( Ki Jong Lee ),서지현 ( Ji Hyun Suh ),안영 ( Young Ahn ),하승혜 ( Sung Hae Ha ),박주상 ( Ju Sang Park ),장은정 ( Eun Jeong Jang ),박상종 ( Sang Jong Park ),김상중 ( Sang Jung Kim ),박상운 ( Sang Woon Park ),백현욱 ( Hyun 한국정맥경장영양학회 2011 한국정맥경장영양학회지 Vol.4 No.1
Purpose: In Korea, the prevalence of metabolic syndrome has increased. The relationship between metabolic syndrome, adiponectin, and dietary components is widely known. However, the relation between cytokine and dietary components is not yet well studied in Korea. Methods: Five hundred and ninety-six Korean adults between 30 and 59 years of age were recruited by advertisement to the Bundang Jesaeng General Hospital (BJGH), and those not taking regular medications and without diagnoses of fulminant disease were included. Data was collected on anthropometric measurements, diagnostic parameters for metabolic syndrome (MetS), and 3-day dietary intakes from individuals in the study. Results: Serum adiponectin level was positively correlated with serum HDL-cholesterol level and was negatively correlated with BMI, waist circumference, and systolic and diastolic blood pressure. Intake of dietary fiber was high in the high-adiponectin group. Conclusion: High-fiber diet and adiponectin can be helpful for improving metabolic syndrome. (JKSPEN 2011; 4(1):16-20)
증례 : 류마티스 관절염 환자에서 발생한 Bronchus-Associated Lymphoid Tissue (BALT) 림프종 1예
기성호 ( Sung Ho Ki ),권성렬 ( Seong Ryul Kwon ),강상용 ( Sang Yong Kang ),박인서 ( In Suh Park ),임미진 ( Mie Jin Lim ),박현주 ( Hyun Joo Park ),박원 ( Won Park ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2
저자들은 류마티스 관절염 환자에서 우연히 발견된 무증상의 BALT 림프종 1예를 확인하였다. 환자는 cyclophsphamide 항암요법과 항류마티스 치료를 병행하고 있으며, 4년이 경과한 현재 흉부 컴퓨터 단층촬영으로 추적관찰한 결과 폐결절은 변화가 없었다. 저자들이 아는 한 국내에서는 쇼그렌증후군에 병발한 BALT 림프종이 2예, 전신홍반성루프스에 병발한 BALT 림프종이 1예 보고되었으나, 아직 류마티스 관절염에 병발한 BALT 림프종은 없는 것으로 여겨진다. 류마티스 관절염 환자에서 폐결절을 발견 하였을 경우에는 류마티스 결절이나 기타 폐종양들과 함께 BALT 림프종 또한 반드시 감별진단에 포함하여야 할 것이다. 또한, 류마티스 관절염과 BALT 림프종의 인과관계도 추후 연구가 필요하다. Bronchus-associated lymphoid tissue (BALT) lymphoma is a rare disorder and it is a characteristic subgroup of low-grade B-cell extranodal non-Hodgkin`s lymphoma that is classified as marginal zone lymphoma. We report here on a patient with rheumatoid arthritis who developed BALT lymphoma. She had no pulmonary symptoms and the pulmonary nodules were incidentally detected by routine chest radiography. Chest CT showed a 2.8cm sized ill-defined focal consolidation of homogenous attenuation in the posterobasal segment of the right lower lobe. The histological diagnosis from the wedge resection specimen revealed low grade B cell lymphoma of BALT. To the best of our knowledge, this case is the first to report BALT lymphoma that developed in a Korean patient with rheumatoid arthritis. BALT lymphoma should be included in the differential diagnosis of the pulmonary nodules in patients with rheumatoid arthritis.(Korean J Med 73:228-232, 2007)
박원(Won Park),성진실(Jinsil Seong),금기창(Ki Chang Keum),서창옥(Chang Ok Suh),이상욱(Sang Wook Lee),임지훈(Ji Hoon Lim),민진식(Jin Sik Min),노재경(Jae Kyung Roh),김주향(Joo Hang Kim),정현철(Hyun Cheol Chung),이강규(Kang Kyu Lee),김귀 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4
목 적 : 에스자결장암으로 진단 받고 근치적 절제술이 시행된 환자를 대상으로 수술후 보조 요법으로서 방사선 치료의 역할을 평가하고자 하며, 방사선 치료를 받은 군과 받지 않은 군의 재발양상과 생존율을 비교하고, 방사선 치료를 추가함으로써 국소 제어율이나 생존율의 향상을 기대할 수 있는 요인을 분석해 보고자 하였다. 대상 및 방법 : 1988년 1월부터 1993년 12월까지 연세 의료원에서 에스자결장암이라고 진단받고 근치적 절제술을 시행받은 93례를 대상으로 하였다. 근치적 수술후 방사선 추가 여부에 따라 두 군으로 분류하였다. 에스자결장암으로 근치적 수술만 시행된 43례는 수술 단독군이라 하였고 수술후 보조 요법으로 방사선 치료가 추가된 50례는 방사선 치료군으로 분류하였다. 방사선 치료군에서 방사선 치료는 수술 후 1-2개월후부터 시작하였는데 원발 병소가 있었던 부위에 적어도 5cm의 여유를 두고 4 MV나 10 MV 선형 가속기를 이용하여 하루에 1.8Gy씩 50.4Gy-61Gy까지 조사하였다. 항암화학요법은 5-Fluorouracil을 이용하여 32례에서 시행하였는데 항암화학요법을 받은 예가 두 군간 의의있는 차이는 없었다. 결 과 : 5년 국소 제어율과 무병 생존율이 각각 85.1%, 68.5%였다. 수술 단독군과 방사선 치료군의 국소 제어율은 각각 76.2%와 91.7%였다. MAC Stage C3에서 방사선 치료군이 수술 단독군보다 국소 제어율과 무병 생존율이 높았다(P=0.01, P=0.06). MAC Stage B3에서 방사선 치료군이 수술 단독군보다 국소 제어율이 더 높았으나 통계적 의의는 없었다. 특히, 조직학적으로 원발 병소가 결장 주위를 넘어 다른 조직에 침윤이 있는 경우(Stage T4), 수술 단독군보다 방사선 치료군의 국소 제어율이 더 높았다. 결 론 : 에스자결장암에서 근치적 절제술후 MAC Stgae B3, C3 -특히, 주위 조직에 조직학적으로 침윤이 있는 경우-에서 방사선 치료를 추가함으로써 국소 제어율을 높이고, 생존율의 향상을 기대해 볼 수 있겠다. 그리고 에스자결장암에서 근치적 수술후 방사선 치료의 역할을 보다 명확하게 규명하기 위해서는 향후 전향적 연구가 필요하리라 생각된다. Purpose : To evaluate the role of postoperative radiation therapy after curative resection of sigmoid colon cancer Materials and Methods : From 1988 to 1993, a total of 93 patients with curative resectable sigmoid colon cancer of modified Astler- Coller (MAC) stage B2, B3, C2, C3 was divided into two groups on the basis of those who received radiation treatment and those who did not. Forty-three patients who treated by surgery alone were classified as postop RT (-) group. The remaining 50 patients who underwent postoperative radiotherapy were classified as postop RT (+) group. In all patients in postop RT (+) group, radiation therapy was delivered using 4 or 10 MV linear accelerators to treat the tumor bed with approximately 5cm margin to a total dose 50.4-61Gy (median 54Gy) in 1.8Gy per fraction. Thirty-two patients were treated with 5- Fluorouracil based adjuvant chemotherapy at least 3 cycles, but these was no significant difference between two groups. Treatment failure pattern, 5-year local failure-free survival rates (LFFS), and 5-year disease-free survival rates (DFS) were compared between two groups. Results : Five year LFFS and DFS were 85.1%, 68.5%, respectively. In postop RT (-) group, LFFS was 76.2%, compared with 91.7% in postop RT (+) group. Improved LFFS and DFS were seen for patients with stage C3 sigmoid colon carcinoma with postoperative radiation therapy compared with postop RT (-) group (P=0.01, P=0.06 respectively). In stage B3, LFFS was higher in postop RT (+) group than that in postop RT (-) group, although it was not significant. Especially, local control was higher in stage T4 in postop RT (+) group than that in postop RT (-) group. Conclusion : This study showed significantly improved LFFS and DFS in MAC Stage C3 and improved tendency of LFFS and DFS in MAC Stage B3 disease. Large scale prospective study is required to verify the role of adjuvant radiation therapy in resectable sigmoid colon cancer.
박효진(Hyo Jin Pack),김범수(Pum Soo Ki m),이정운(Jung Woon Lee),박인서(In Suh Park) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3
N/A Background/Aims: Esophageal acid clearance is an important mechanism protective against the development of reflux esophagitis. Acid clearance from the esophagus after gastro-esophageal reflux depends on two important mechanisms: esophageal peristalsis to return the displaced gastric content to the stomach and swallowed saliva to neutralize the residual acid that coats the esopha- gea1 mucosa. The present study aims to investigate acid clearance and determine the contributions of esophageal peristalsis, salivation, and gravity. Methods: We performed the acid clearance test, ambulatory 24 hour esophageal pH study, esophageal manometry and saliva study in 16 consecutive patients with reflux esophagitis, and then compared them with normal controls. Results: The clearance of acid instilled into the esophagus was markedly delayed in patients with reflux esophagitis as compared with controls(p0.05). There was a trend towards a lower peristaltic amplitude in patients with reflux esophagitis, but this was statistically not significant. Of the motor events analyzed, there were simultaneous contractions in 4 patients(25.0%), poor wave progression in 4 patients(25.0%), and non-transmitted contraction in 2 patients(12.5%). In patients with reflux esophagitis, the number of reflux episodes, the mean number of reflux episodes greater than 5 minutes, and the percentage of time when the pH was less than 4 were significantly increased compared with controls(p <0.05). The basal and stimulated salivary pH and concentration of bicarbonate in patients with reflux esophagitis did not show a significant difference compared with controls. Conclusions: We found a significant impairment of acid clearance in patients with reflux esophagitis, and some alterations in esophageal peristalsis but no change in salivary functions. (Korean J Gastroenterol 1995;27:275 - 282)