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현종진 ( Jong Jin Hyun ),이홍식 ( Hong Sik Lee ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1
The etiology of chronic pancreatitis varies greatly as demonstrated in the TIGAR-O classification. However, due to the lack of correlation and reproducibility between the etiologic factors and the presentation of the disease, it is presumed that individual sensitivity such as genetic predisposition would play an important role in its pathogenesis. Although our understanding on the pathophysiology of chronic pancreatitis is still far from being adequate, we are gaining more insights on its underlying mechanism through active researches related to pancreatic stellate cells, and molecular/genetic studies. Since the clinical manifestations of chronic pancreatitis show significant variation according to its cause, stages of the disease, and presence of local complications, controversy still remains regarding the natural course of chronic pancreatitis and warrants further study. At present, it is generally agreed that acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis lie on the same spectrum of the disease.
하대정맥 및 우심방의 혈전을 동반한 간세포암을 효과적으로 치료한 증례
이현정 ( Hyun Jung Lee ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),이승화 ( Seung Hwa Lee ),김해림 ( Hae Rim Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재현 대한간암학회 2012 대한간암학회지 Vol.12 No.2
In patients with advanced hepatocellular carcinoma (HCC), tumor thrombus in inferior vena cava (IVC) and right atrium (RA) are not uncommon findings and are usually associated with extremely poor outcome. Although aggressive surgical interventions such as extracorporeal circulation and tumor excision have been performed, the reported results were still unsatisfactory. Herein, we report the favorable result of combined treatment with radiation therapy and transarterial chemoembolization in a patient with advanced HCC with extensive tumor thrombus through the IVC into the RA. In conclusion, noninvasive combined modalities, such as transarterial chemoembolization and radiation therapy may sometimes provide effective palliation for patients with far advanced HCC with IVC/RA tumor thrombus and who are not candidates for alternative treatment options.
간문맥 내 가스와 장관 포상 기종으로 발현한 괴사성 대장염
송종규 ( Jong Gyu Song ),구자설 ( Ja Seol Koo ),강효성 ( Hyo Sung Kang ),박진용 ( Jin Yong Park ),김승영 ( Seoung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),이상우 ( Sang Woo Lee ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3
Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient``s prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery. (Korean J Gastroenterol 2015;65:177-181)
이현주 ( Hyun Joo Lee ),정록선 ( Rok Seon Choung ),박민선 ( Min Seon Park ),표정희 ( Jeung Hui Pyo ),김승영 ( Seung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재 대한소화기학회 2014 대한소화기학회지 Vol.63 No.2
We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors. (Korean J Gastroenterol 2014;63:120-124)
췌관내 가성동맥류 파열로 인한 Hemosuccus Pancreaticus
이예진 ( Ye Jin Lee ),현종진 ( Jong Jin Hyun ),최주희 ( Ju Hee Choi ),심유라 ( Yu Ra Sim ),오홍권 ( Hong Kwon Oh ),김환일 ( Hwan Il Kim ),이홍식 ( Hong Sik Lee ),김창덕 ( Chang Duck Kim ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1
Pseudoaneurysm is one of life-threatening complications of chronic or acute pancreatitis. It can lead to massive bleeding into the abdominal cavity, the retroperitoneum, or the gastrointestinal tract. Hemosuccus pancreaticus, meaning hemorrhage through the pancreatic duct into the duodenum is an important diagnostic clue suggesting the presence of pancreatic pseudoaneurysm. A 74-year-old man presented with hematochezia and active bleeding from the ampulla of Vater was noted on upper endoscopy. Abdominal computed tomography scan demonstrated a nodular enhancing lesion within the pancreatic duct. Celiac trunk angiography also showed a nodular enhancing lesion suggesting pseudoaneurysm in the pancreas. However, due to the difficulty of identifying the feeder artery of pseudoaneurysm by selective angiography, embolization was not feasible. Therefore, distal pancreatectomy was performed and ruptured pseudoaneurysm within the pancreatic duct could be confirmed. Herein, we report a case of hemosuccus pancreaticus due to ruptured intraductal pseudoaneurysm that was successfully treated by surgical management.
일개 대학병원의 연명치료 선택 및 사전의료의향서 작성 현황
윤호민,최윤선,현종진,Yoon, Ho-Min,Choi, Youn-Seon,Hyun, Jong-Jin 한국호스피스완화의료학회 2011 한국호스피스.완화의료학회지 Vol.14 No.2
목적: 이 연구는 첫째, 입원 당시 호스피스 암환자들이 작성한 사전의료의향서를 통해 연명치료에 대한 선호 및 호스피스 암환자들의 특성과 연명치료 항목간의 관련성을 분석하며, 둘째, 호스피스병동 입원 시 작성한 사전의료의향서의 내용과 임종 48시간 이전에 시행되었던 의료중재간의 일치 여부를 평가하는 데 있다. 방법: 2008년 3월 1일부터 8월 31일까지 대학병원 완화의료센터에 입원하여 사전의료의향서를 작성한 호스피스 암환자 102명의 전자의무기록을 검토하여, 그 중 사전의료의향서 작성 당시 의식이 명료했던($10{\geq}GCS$) 74명을 대상으로 선택항목에 대한 빈도와 환자의 어떤 특성이 항목선택 요인으로 작용하는지 단변량 로지스틱 분석을 통하여 알아보았고, 그 중 사망한 42명을 대상으로 환자의 선택과 의료중재의 일치 여부를 대상자 별로 나누어 빈도로 나타내었고, 항목별로는 맥네마 검정을 시행하였다. 결과: 환자들은 항생제, 정맥영양, 경관영양, 수혈, 검사실 검사 및 방사선 검사를 연명치료로서 선호하였다. 환자의 특성과 연명치료 선택과의 상관관계는 연명치료에 대한 편향된 선호로 인해 분석할 수 없었다. 사전의료의향서 작성 당시 환자가 선택한 연명치료 여부와, 사망 48시간 이전에 실제로 시행되거나 시행되지 않은 연명치료는 거의 모든 경우에서 불일치를 보였다. 결론: 호스피스 암환자들에게 있어서, 사전의료의향서의 작성은 그 시기도 중요하지만, 환자, 보호자 및 대리인의 선택이 바뀔 수 있음도 고려해야 하고, 가장 중요한 것은 사전의료의향서에 대하여 작성자가 충분히 이해하고 있는 가이다. 따라서 사회적, 법적 제도화가 이루어지지 않은 현 시점의 연명치료는 모든 가능성을 염두에 두고 항상 신중하게 이루어져야 한다. Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.
십이지장경 삽입 중 발생한 식도점막 열상으로 인해 진단된 동시성 식도암과 위암
김동우 ( Dongwoo Kim ),현종진 ( Jong Jin Hyun ),이종진 ( Jong Jin Lee ),최정완 ( Jung Wan Choe ),강규호 ( Kyu Ho Kang ),황수현 ( Su Hyun Hwang ),김대하 ( Dae-ha Kim ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.2
이전에 합병증 없이 내시경 역행성 담췌관 조영술(ERCP)을 여러 번 시행받은 71세 남자 환자에게 내시경 삽입 중 식도점막 파열이 발생하였다. 점막열상은 내시경클립(endoclip)을 사용하여 성공적으로 봉합되었으나, 이 합병증으로 인해 식도암과 조기 위암이우연히 동시에 발견되었다. 십이지장경은 위장관, 특히 식도 관찰에 제약이 있기 때문에 임상적으로 중요한 병변을 놓칠 가능성이 있다. 따라서 점막 손상이나 천공을 예방하기 위해 내시경선단에 충분한 윤활제를 도포하는 것과 함께 ERCP 중 상부내시경 검사를 시행하는 것도 고려되어야 한다. 어느 환자군에서 ERCP 중 상부내시경 검사가 유용할지에 대해서는 향후 대규모 연구가 필요할 것이다. Esophageal mucosal tear occurred during scope insertion in a 71-year-old male patient who previously underwent endoscopic retrograde cholangiopancreatography (ERCP) several times without any complications. The mucosal tear was successfully sealed with endoclips using a forward-viewing scope. However, this mishap leads to the incidental discovery of both esophageal cancer and early gastric cancer. Duodenoscope has inherent limitation in observing the gastrointestinal tract, especially the esophagus, and may miss clinically significant lesions. Therefore, in addition to applying sufficient lubricant to the scope tip and considering the possibility of anatomical variation to prevent mucosal injury or perforation, performing upper endoscopy during ERCP should be considered in a certain patient population, albeit the utility of and the population benefiting from it remains to be proven by a large-scale study.
과형성 위용종의 내시경적 제거 후 헬리코박터 파일로리 감염상태에 따른 위용종 재발률
강규호 ( Kyu Ho Kang ),황수현 ( Su Hyun Hwang ),김동우 ( Dongwoo Kim ),김대하 ( Dae-ha Kim ),김승영 ( Seung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),정영걸 ( Young Kul Jung ),임형준 ( Hy 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4
목적: 본 연구는 과형성 위용종을 내시경으로 제거한 이후 최종 H. pylori 감염 상태와 H. pylori 제균 여부에 따른 과형성 위용종의 재발률에 대해 알아보고자 하였다. 대상 및 방법: 2011년 1월부터 2016년 12월까지 과형성 위용종을 내시경으로 제거하고, 상부위장관 내시경 추적 검사를 시행한 79명의 환자를 대상으로 진료기록을 후향적으로 분석하였다. H. pylori 감염과 성공적인 제균 여부는 내시경 생검조직의 cresyl violet 특수염색과 CLO test, 또는 요소호기검사를 통해 평가하였다. 상부위장관 내시경 추적 검사에서 과형성 위용종의 재발을 조사하고, 최종 H. pylori 감염 상태와 제균 여부에 따른 차이가 있는지 비교하였다. 결과: 평균 16.4개월의 대상 환자 추적 기간 동안, HP pos-itive status group이 HP negative status group보다 과형성 위용종의 재발률이 유의하게 더 높았다. HP eradicated group과 HP persistent group과의 비교에서는 HP persistent group에서 재발률이 더 높았으나, 통계적 유의성은 없었다. 위용종의 재발에 영향을 미치는 인자에 대한 단변량 및 다변량 분석결과, 최종 H. pylori 감염 상태가 재발률에 유의한 영향이 있었다. 결론: 최종 H. pylori 감염 상태는 과형성 위용종을 내시경으로 제거한 이후 위용종의 재발에 유의한 영향이 있었으나, H.pylori 제균 여부에 따른 위용종의 재발률은 통계적 유의성이 없었다. Background/Aims: Several previous studies suggest that eradication of Helicobacter pylori (H. pylori) leads to the disappearance of gastric hyperplastic polyps. However, little is known about the effect of H. pylori status and eradication on the recurrence of gastric polyps after endoscopic removal. Here, we investigated the recurrence of gastric polyps according to the final H. pylori status in patients who underwent endoscopic removal of gastric hyperplastic polyps. Methods: Between January 2011 and December 2016, patients who underwent endoscopic removal of gastric hyperplastic polyps and were followed-up for more than two months were enrolled. The success of H. pylori eradication was assessed by histology and rapid urease test or urea breath test, at least 4 weeks after the completion of eradication treatment. At follow-up, the recurrence of gastric polyp was evaluated via esophagogastroduodenoscopy. Results: Seventy-nine patients were enrolled. During the mean follow-up period of 16.4 months, the recurrence rate of gastric polyp was 25.3%. Among those who received H. pylori eradication therapy, the H. pylori persistent group showed a higher recurrence of polyp than the H. pylori eradicated group; but there was no statistical significance (42.9% vs. 21.7%, p=0.269). Regarding the final H. pylori infection status, the recurrence rate of gastric polyps was significantly higher in the H. pylori positive group than in the H. pylori negative group (42.9% vs. 18.9%, p=0.031). In multivariate analysis, the final H. pylori infection status was a significant risk factor for gastric polyp recurrence after endoscopic removal. Conclusions: The final positive H. pylori infection status is significantly associated with higher recurrence of gastric hyperplastic polyps after endoscopic removal. (Korean J Gastroenterol 2018;71:213-218)
간경변증 환자의 급성 정맥류 출혈에 있어 Terlipressin및 Somatostatin 조기 투여의 지혈 효과에 대한 전향(논평참조)
서연석 ( Yeon Seok Seo ),엄순호 ( Soon Ho Um ),현종진 ( Jong Jin Hyun ),김연호 ( Youn Ho Kim ),박상훈 ( Sanghoon Park ),금보라 ( Bo Ra Keum ),김용식 ( Yong Sik Kim ),진윤태 ( Yoon Tae Jeen ),이홍식 ( Hong Sik Lee ),전훈재 ( Hoon J 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.3