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신현필 ( Hyun Phil Shin ),차재명 ( Jae Myung Cha ),김범경 ( Beom Kyung Kim ),명대성 ( Dae-seong Myung ),문성훈 ( Sung-hoon Moon ),송명준 ( Myeong Jun Song ),윤승배 ( Seung Bae Yoon ),유인경 ( In Kyung Yoo ),이정훈 ( Jeong Hoon 대한소화기학회 2021 대한소화기학회지 Vol.77 No.5
목적: COVID-19 유행은 다양한 사회 문화적 변화를 야기하였지만, 소화기내과 전임의 교육에 대한 영향에 대한 연구는 거의 없었다. 이번 연구에서는 소화기내과 전임의 수련에 대한 COVID-19의 영향에 대해 조사하였다. 대상 및 방법: 2021년 2월 15일부터 3월 15일까지 국내 소화기내과 전임의들에게 온라인 기반 설문조사를 발송하였다. 설문은 소화기내과 전임의의 특성, COVID-19의 유행에 대한 인식도, COVID-19과 비대면 진료의 소화기내과 전임의 교육에 대한 영향에 대한 내용으로 구성되었다. 결과: 111건의 설문 결과들 중 94건의 설문 응답을 분석하였다. 소화기내과 전임의들은 COVID-19 유행에 대해 충분한 정보를 제공받고 있었으며(74.7%), 개인보호장구 착용에 대해 잘 교육받고 있었고, 충분히 제공받고 있었다(각각 74.7% 및 83.9%). 하지만, 외래 진료 스케줄과 환자 수는 각각 25.5%와 37.8%의 응답자들이 감소하였다고 응답하였고, 소화기 내시경 검사 세션과 환자 수도 각각 51.1%와 65.6%의 응답자들이 감소하였다고 응답하였다. 그 결과, 응답자들의 78.9%는 COVID-19의 유행으로 교육에 부정적인 영향을 받았다고 답변하였다. COVID-19 유행 동안에 도입된 비대면 진료가 각각 환자와 의사 측면에서 긍정적인 면이 있다고 답변한 응답자들은 불과 20.0%와 10.6%에 불과하였다. 게다가, 응답자들의 25.9%만이 수가가 적절하게 보상되더라도 비대면 진료를 이용하겠다고 응답하였으며, 68.2%의 응답자들은 비대면 진료가 교육에 부정적인 영향이 있다고 응답하였다. 결론: COVID-19 유행은 외래 진료 감소, 소화기 내시경 검사 감소, 온라인 컨퍼런스, 비대면 진료 도입을 통해 국내 소화기내과 전임의들의 교육에 부정적인 영향이 있었다. COVID-19와 같은 감염병 유행 시에 소화기내과 전임의 교육에 대한 대책 마련이 필요하다. Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak caused numerous social and cultural changes, but few studies focused on their effects on gastroenterology (GI) fellowship training. This study evaluated the impact of COVID-19 on GI fellowship training. Methods: A web-based questionnaire was sent out to GI fellows in Korea between 15 February and 15 March 2021. The questionnaire included questions regarding the characteristics of GI fellows, perception of COVID-19 outbreak, impact of COVID-19 outbreak, and telemedicine on the education of a GI fellowship. Results: Among 111 answers, 94 respondents were analyzed. The GI fellows were provided with sufficient information about the COVID-19 outbreak (74.7%), well educated, and provided with personal protective equipment use (74.7% and 83.9%, respectively). On the other hand, outpatient schedule and volume decreased in 25.5% and 37.8% of respondents, respectively. Moreover, endoscopy sessions and volume decreased in 51.1% and 65.6% of respondents, respectively. As a result, 78.9% of respondents were concerned that the COVID-19 outbreak adversely affected their education. Telemedicine utilization was introduced during the COVID-19 outbreak, but only 20.0% and 10.6% of respondents agreed that telemedicine has benefits from the patient’s and doctor’s perspectives, respectively. In addition, only 25.9% of respondents were willing to continue telemedicine if adequately reimbursed, and 68.2% of respondents were concerned that it adversely affected their education. Conclusions: The COVID-19 outbreak has adversely affected GI fellowship training in Korea for outpatient clinics, gastrointestinal endoscopy, educational conferences, and telemedicine. This study highlights that GI fellowship training needs more attention in the COVID-19 outbreak. (Korean J Gastroenterol 2021;77:205-213)
조기 간세포암종에서 간동맥 색전술과 경피적 고주파열 병합치료
임준욱 ( Jun Uk Lim ),신현필 ( Hyun Phil Shin ),이정일 ( Joung Il Lee ),박재준 ( Jae Jun Park ),전정원 ( Jung Won Jeon ),임규성 ( Kyu Seong Lim ) 대한간암학회 2012 대한간암학회지 Vol.12 No.1
In most early hepatocellular carcinoma (HCC), surgical resection or liver transplantation is the first choice of treatment. However, surgery is often impossible because of patient`s physical condition such as advanced liver cirrhosis, other comorbidities, and radiofrequency ablation (RFA) can be used as substitute treatment. Recently, it has been reported that clinical outcomes of transarterial chemoembolization (TACE) combined with RFA were similar to that of surgical resection. This report describes a 49-year-old male with 1.5 cm sized HCC. Because the patient could not undergo surgical resection and the tumor was not localized on ultrasonography (US), TACE was performed instead. But the residual tumor was still detected on follow-up contrast enhanced US, we performed additional RFA. After combined treatment with TACE and RFA, viable portion of the tumor was not detected on one month follow-up CT and MRI image. The patient remains well without recurrence, 12 months after combined treatment. It is suggested that TACE combined with RFA can be an alternative choice of early small HCC treatment.
증례 : 소화기 ; 간경변 환자에서 위부분절제술 후 발생한 암죽복수 1예
장원석 ( Won Seok Jang ),김은영 ( Eun Young Kim ),신현필 ( Hyun Phil Shin ),정성원 ( Sung Won Jung ),차재명 ( Jae Myung Cha ),주광로 ( Kwang Ro Joo ),이정일 ( Joung Il Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
본 저자는 간경변 환자에서 복강경 위부분절제술 후 발생한 이뇨제로 조절 되지 않는 복수를 경험하였고 검사상 수술에 따른 암죽 복수와 간문맥 고혈압으로 인한 복수가 동반된 소견이었다. 이후 저지방식이, 전비경구 영양과 octreotide 병용치료 뒤 암죽복수에서 중성지방 수치 감소하였고 남아있는 간문맥 고혈압에 의한 복수를 이뇨제를 사용하여 조절할 수 있었다. 이후 특별한 재발 없이 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. This condition can occur as a result of the disruption or obstruction of the abdominal lymphatics. Abdominal surgery, malignant neoplasms, and cirrhosis can cause chylous ascites. Here, we report a case of intractable ascites caused by chyle leakage and portal hypertension in a patient with alcoholic liver cirrhosis. The ascites occurred following a subtotal gastrectomy to treat stomach cancer and was not resolved with diuretics. Increasing the diuretic dosage was limited by the aggravation of renal function. The ascites was milky in color and analysis showed transudate caused by portal hypertension. Octreotide and diuretic treatments can resolve mixed ascites. In this article, we present the case and review the literature. (Korean J Med 2011;80:449-452)
민준기 ( Joon Gi Min ),최재호 ( Jae Ho Choi ),김은영 ( Eun Young Kim ),김현수 ( Hyun Soo Kim ),차재명 ( Jae Myung Cha ),이정일 ( Joung Il Lee ),주광로 ( Kwang Ro Joo ),신현필 ( Hyun Phil Shin ),박재준 ( Jae Jun Park ),정원규 ( Weo 대한장연구학회 2012 Intestinal Research Vol.10 No.2
Primary rectal mucosa-associated lymphoid tissue (MALT) lymphoma is a particularly rare disease, comprising <1% of gastrointestinal lymphomas. Although antibiotic therapy has been demonstrated effective for gastric MALT lymphoma, the optimal treatment for MALT lymphoma of the rectum is unknown. Radiotherapy or surgery is often used to treat limited stage MALT lymphoma of the rectum. Here, we describe a case of a 44-year-old-man, who was diagnosed with primary MALT lymphoma of the rectum through colonoscopy. Other staging evaluations, including upper gastrointestinal endoscopy, abdomino-pelvic CT, chest CT, 18F fludeoxyglucose-positron emission tomography, and a bone marrow examination showed no other abnormalities, except stage IA para-rectal lymphadenopathy. The patient received 2 months of radiotherapy without major toxicity. A follow-up abdomino-pelvic CT scan revealed marked improvement in the volume of rectal lymphoma and adjacent lymph nodes. Mucosal nodularity of the lower rectum had completely regressed at the follow-up endoscopy and complete remission was confirmed with a biopsy. (Intest Res 2012;10:201-205)
제1형 신경섬유종증 환자의 파열된 위십이지장동맥 동맥류에서 발생한 위중한 십이지장 궤양 출혈
임규성 ( Kyu Sung Im ),김선용 ( Sun Yong Kim ),임준욱 ( Jun Uk Lim ),전장원 ( Jung Won Jeon ),신현필 ( Hyun Phil Shin ),차재명 ( Jae Myung Cha ),주광로 ( Kwang Ro Joo ),이정일 ( Joung Ll Lee ),박재준(교신저자) ( Jae Jun Park ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.3
Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding. (Korean J Gastroenterol 2015;66:164-167)
홍인택 ( In Taik Hong ),차재명(교신저자) ( Jae Myung Cha ),이정일 ( Joung Ll Lee ),주광로 ( Kwang Ro Joo ),백일현 ( Ll Hyun Baek ),신현필 ( Hyun Phil Shin ),전정원 ( Jung Won Jeon ),임준욱 ( Jun Uk Lim ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.3
Lymphangioma is a benign vascular lesion with characteristics of subepithelial tumor which can proliferate in the lymphatic system. Lymphangioma of the small-bowel mesentery is rare, having been reported in less than 2% of all lymphangiomas. Lymphangioma does not require any specific treatment because it is absolutely a benign tumor. However, surgical exploration is rarely required for cases with disease-related symptoms or complications, or for those misdiagnosed as a malignant lesion. We recently experienced a case of mesenteric cavernous lymphangomas in a 53-year-old female who was misdiagnosed as having a liposarcoma. The final diagnosis was confirmed by a pathologic examination of the specimen that was obtained via laparoscopic exploration. Herein, we report a very rare case of mesenteric cavernous lymphangioma along with a brief review of relevant literature. (Korean J Gastroenterol 2015;66:172-175)