원발성 복막수염 4례

구자충,김병욱,유일영,전원중,채희복,박선미,이석우,윤세진 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.2

Primary epiploic appendagitis (PEA) occurs due to inflammation of an epiploic appendage, which is a peritoneal pouch that arises from the serosal surface of the colon. PEA is often associated with infarction caused by torsion or spontaneous venous thrombosis. PEA is a self-limited disease with a course of approximately 10 days, and it requires only symptomatic management for pain. But it clinically manifests with localized abdominal pain that is often mistaken for appendicitis, diverticulitis, or cholangitis. Therefore, PEA had been diagnosed at surgery for the past few decades. Making the preoperative diagnosis of PEA through ultrasound and computed tomography (CT) has recently become possible. We report here on four cases of PEA that were diagnosed and treated by symptomatic management.

Extended Spectrum-β-Lactamase or Carbapenemase Producing Bacteria Isolated from Patients with Acute Cholangitis

구자충,성문혁,심영광,이희승,한정호,신경섭,최재운,윤세진,박선미 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.2

Background/Aims: This study assessed the antibiotic resistance organisms isolated from the blood and bile of acute cholangitis and evaluated risk factors associated with them and their impact on clinical outcomes. Methods: The identities and antibiotic resistance profiles of bacteria isolated from 433 cases of acute cholangitis from 346 patients were analyzed. Risk factors and the outcomes of patients infected with them were assessed. Results: Microorganisms were isolated from 266 of 419 blood cultures and 256 of 260 bile cultures. Isolates from bile and blood were identical in 71% of the cases. A total of 20 extended spectrum-β-lactamase (ESBL)-producers and 4 carbapenemase-producing organisms were isolated from blood, and 34 ESBL-producers and 13 carbapenemase-producers were isolated from bile. Sixty-four (14.8%) cases were infected with any one of these bacteria isolated from blood or bile. Risk factors associated with them in blood were nosocomial infection and prior biliary intervention. In bile, indwelling biliary device was a risk factor associated with them. Antibiotic-resistant bacteria were associated with mortality, independent of other prognostic factors. Conclusions: ESBL or carbapenemase-producing bacteria were frequently isolated in acute cholangitis patients especially with prior biliary intervention and nosocomial infection. Isolation of antibiotic-resistant bacteria was an independent risk factor of mortality.

하부위장관 유암종 제거 후의 임상 경과

구자충 ( Ja Chung Goo ),김병욱 ( Byeong Uk Kim ),정지인 ( Jee In Jeong ),한정호 ( Joung Ho Han ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),이호창 ( Ho Chang Lee ) 대한장연구학회 2010 Intestinal Research Vol.8 No.2

목적: 내시경 검사의 빈도가 늘면서 이전에는 매우 드물던 유암종의 빈도도 늘고 있다. 특히 대장 내시경을 시행하면서 우연히 발견되는 작은 유암종들은 내시경적 절제술 및 외과적 국소절제술을 통하여 비교적 간단히 치료되고 있다. 저자들은 이러한 하부위관 유암종의 임상적 특징과 치료 결과 및 재발 등에 대해 분석하고자 하였다. 대상 및 방법: 1999년 9월부터 2009년 9월까지 10년간 충북대학교병원에서 하부위장관의 유암종을 진단받은 41명의 환자를 후향적으로 조사하였다. 결과: 41명의 환자 중 남녀비는 1:0.64 이었고, 평균 연령은 47.4±12.4세였다. 41명의 환자 중직장 유암종이 38예(92.7%), 충수돌기 유암종이 2예(4.9%), S자결장 유암종이 1예(2.4%)였다. 내시경을 통한 유암종의 육안적 평균 크기는 9.4±4.8 mm였다. 초기치료를 시행받은 41명 중 수술적 절제를 시행받은 사람이 12명(29.3%), 내시경적 절제를 시행받은 사람이 29명(70.7%)이었다. 수술적 절제를 시행한 군의 평균 크기는 13.8±5.8 mm였고 내시경적 절제를 시행한 군의 평균 크기는 8.0±3.4 mm로 차이가 있었다 (P=0.011). 초기 치료 후 절제연 종양 양성을 보인 예는 총 41예 중 10예(24.4%)로 용종절제술을 시행하였던 28예 중에서 10예 모두가 발생(35.7%)하여 용종절 제술이 다른 치료방법에 비하여 유의하게 높은 치료후 절제연 종양 양성을 나타내었다(P=0.013). 41명의 환자 중 29명(70.7%)에서 추적 관찰이 이루어졌다. 이들의 평균 추적 관찰 기간은 19.2±14.5개월이었다. 재발은 추적 관찰하던 29명 중 직장 유암종으로 치료받았던 2명(6.1%)에서 발생하였다. 결론: 하부위장관의 유암종은 내시경적 절제술을 통해 쉽게 절제될 수 있으나 용종절제술의 경우 비교적 높은 절제연 종양 양성률(35.7%)을 보여 보다 신중한 치료적 접근이 필요하다. 또한 작은 크기의 직장 유암종도 재발의 가능성은 있으므로 추적 관찰은 반드시 시행되어야 하겠다. Background/Aims: The increase of colonoscopy procedures has led to an increase in the diagnosis of carcinoid tumors in the lower gastrointestinal tract. The purpose of this study was to identify the clinical and pathological characteristics that affect the treatment and recurrence of carcinoid tumors of the lower gastrointestinal tract. Methods: A 10-year (1999-2009) retrospective analysis of 41 patients with carcinoid tumors of the lower gastrointestinal tract at the Chungbuk National University Hospital was conducted. Patient and tumor characteristics, treatment and recurrence were analyzed. Results: The mean age was 47.4±12.4 (range, 22-79 years) and the male to female ratio was 1:0.64. The mean tumor size was 9.4±4.8 (3-20) mm. In the lower gastrointestinal tract, the rectum was the most frequent location of the lower gastrointestinal carcinoid tumors (92.7%). Twenty-nine out of 41 patients were treated by endoscopy (mean size of tumor: 8.0±3.4 mm) and 12 were treated by surgery (mean size of tumor: 13.8±5.8 mm)(P=0.011). Among the patients treated by endoscopy, only one patient had a complete resection. However, the histology showed that 10 patients treated by endoscopy had positive resection margins; all 10 cases (35.7%) had a polypectomy (P=0.013). The mean follow-up duration was 19.2±14.5 months, and there were two recurrences of rectal carcinoid tumors. Conclusions: Both endoscopic and surgical resections were effective methods for the treatment of lower gastrointestinal carcinoid tumors. However, endoscopic polypectomy should be carefully considered because of the possibility of more frequent incomplete histological resections. Moreover, even for small rectal carcinoid tumors, follow-up examination should be performed to evaluate for tumor recurrence. (Intest Res 2010;8:142-150)

총담관 평활근종 1예

구자충 ( Ja Chung Goo ),이미연 ( Mi Yeoun Yi ),전원중 ( Won Joong Jeon ),서정철 ( Jeong Chul Seo ),채희복 ( Hee Bock Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),김석형 ( Seok Hyoung Kim ),최재운 ( Jae Woon Choi ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.1

대장내시경에서 다양한 모양을 보인 충수돌기 중첩증

김병욱,구자충,윤순만,채희복,박선미,윤세진,성노현 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.2

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp. 충수돌기 중첩증은 매우 드문 질환으로 급성 충수돌기염과 같은 임상증상을 일으키거나 만성적이며 반복적인 복통 및 출혈의 원인이 되는 등 다양한 임상증상을 보일 수 있으며, 증상 없이 우연히 발견될 수도 있다. 수술 전 진단이 매우 어려워 급성 충수돌기염의 양상으로 올 경우 수술 후 진단되거나 대장내시경 검사에서 용종으로 의심되어 용종절제술 시행 후 진단되기도 한다. 대장내시경 시행 시 충수돌기 구멍이 관찰되지 않으면서 그 위치에 용종성 병변이 있을 시에는 충수돌기 중첩증을 의심할 수 있다. 충수돌기 중첩증을 용종으로 오인하여 섣불리 내시경적인 제거를 하거나 기저 질환이 없음에도 부적절하게 수술하는 것은 피해야 한다. 저자들은 대장내시경 검사에서 관찰되었던 맹장의 용종 병변에 대해 용종절제술 또는 조직생검을 시행하였고 조직검사에서 충수돌기 중첩증으로 밝혀진 4예를 경험하여서 보고한다.

양성 간외 담관 협착에서 완전 피막형 자가팽창성 금속 스텐트의 유용성과 안전성

김병욱,구자충,조영심,한정호,윤순만,채희복,박선미,윤세진,유봉규 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.1

Background/Aims: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS. Methods: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed. Results: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps. Conclusions: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features. 목적: 플라스틱 스텐트는 내경이 제한되어 있어 양성 담관 협착의 치료로 널리 이용하기에는 어려운 점이 있다. 저자들은 양성 담관 협착에서 완전 피막형 자가팽창성 금속 스텐트(fully covered self-expandable metal stent, FCSEMS)의 유용성과 안전성을 알아보고자 하였다. 대상 및 방법: 양성 담관 협착으로 FCSEMS를 삽입한 후 6개월 이상 추적한 12예(남:여=4:8, 평균나이 67세)를 대상으로 하였다. 담관 협착 12예(재발성 담관염 9예, 담낭절제술 후 손상 2예, 만성 췌장염 1예)에서 내시경 역행성 담췌관조영술로 각각 1개의 FCSEMS를 유두부를 관통하여 삽입하였다. 스텐트 유치와 관련된 합병증을 조사하여 안정성을 평가하였고, 협착 해소 여부와 스텐트 제거 후 재협착으로 스텐트의 효능을 평가하였으며, 스텐트의 제거 용이성을 조사하였다. 결과: 담관 협착이 있었던 12예는 모두 시술 당일부터 증상이 완화되었다. FCSEMS는 6.0개월(중앙값)간 유치하였으며, 스텐트 제거 후 8.5개월(중앙값)에 8명은 지속적으로 협착 증상이 해소되었고 4명은 스텐트 제거 후 재협착이 발생하였다. 스텐트 유치와 관련한 합병증은 심한 복통 2예, 췌장농양 1예, 스텐트 이탈 6예(십이지장 이탈 5예, 근위부 담관 이탈 1예)였다. 스텐트를 제거를 시도한 7예 모두 겸자로 쉽게 제거하였다. 결론: 양성 담관 협착에서 FCSEMS는 치료 효과가 신속하고 안전하며 쉽게 제거할 수 있는 장점이 있다. 그러나, 스텐트 제거 후 재협착의 빈도가 높고 이탈율이 높은 점은 향후 해결해야 할 과제로 생각한다.

운동 후 측복통과 함께 발생한 급성신부전의 임상상

신윤미,한혜숙,구자충,박성순,임성우,김민옥,권순길,김혜영,한기석 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.1

중국의 산업집적과 경제성장 간 순환누적 효과에 관한 연구 ― 2007-2018년 현급 패널 데이터를 중심으로

호세전 ( Hu Shiqian ),범자충 ( Fan Zichong ),황명호 ( Huang Minghao ) 고려대학교 중국학연구소 2020 中國學論叢 Vol.0 No.70

In this paper, we take the mutual influences between the secondary industry agglomeration and economic growth in China’s county level as the research object. The panel data simultaneous equations models are specified to analyze the existence and change characteristics of the cyclical cumulative effects of industrial agglomeration and economic growth. The results show that industrial agglomeration and economic growth not only have a significant two-way relationship, but also they achieve their own cyclical cumulative effect based on the paths of “industrial agglomeration-economic growth-industrial agglomeration” and “economic growth-industrial agglomeration-economic growth” respectively. In terms of dynamics, compared to 2007~2013, the cumulative effect of agglomeration under the periodic impact of industrial agglomeration in 2014~2018 is weakened. The increasing diffusion effect leads to the decline of the role of industrial agglomeration in the economic growth cycle accumulation. In addition, the cumulative effects of different regions show heterogeneity characteristics. The cyclical cumulative effects of industrial agglomeration and economic growth are more significant in underdeveloped counties. In some economically developed counties, however, the industry isomorphism and the demand for the upgrading of industrial structure make the cumulative effect of industrial agglomeration become weak, and the crowding effect also makes the cumulative effect of economic growth decrease.

연구논문 : 만성 B형간염 환자에서 엔테카비어 투여 후 발생한 유전자형 내성

김병욱 ( Byeong Uk Kim ),구자충 ( Ja Chung Goo ),박병출 ( Byeong Chul Park ),김수옥 ( Soo Ok Kim ),홍선표 ( Sun Pyo Hong ),정지인 ( Jee In Jeong ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: The prevalence and clinical characteristics of entecavir (ETV) resistance is not well known. The aim of this study was to determine the frequency of genotypic resistance in nonresponders and virologic breakthrough (VBT) patients. Methods: The medical records of 76 chronic hepatitis B patients treated for a least 6 months from October 2006 to October 2008 were reviewed retrospectively. We divided patients into two groups: nucleoside analogue (NA)-na?ve patients (n=38) and lAM experienced patients (n=38). NA-na?ve and lAM experienced patients received ETV at 0.5 and 1.0 mg/day, respectively. The virologic response and VBT were investigated in both groups. We used the multiplex restriction fragment mass polymorphism (RFMP) method to test genotypic resistance at the rtI169, rtT184, rtS202, rtM204, and rtM250 sites. Results: Age, gender, serum AlT, and HBV DNA level before treatment did not differ between the groups. Neither VBT nor nonresponse was observed in the NA-na?ve group, whereas VBT and nonresponse were observed in three patients each in the lamivudine (lAM)-experienced group, all six patients had YMDD mutation at study enrollment, all three patients with VBT had genotypic resistance to ETV, but the three nonresponse patients did not have genotypic resistance to ETV. Conclusions: We suspect that VBT is mostly associated with genotypic resistance to ETV. However, nonresponse might be associated with the continuance or reselection of the YMDD mutant in lAM-experienced patients.

포스터 발표 : 미세변화 신증후군의 진단에 있어서 임상적 지표를 이용한 확률추정모델의 유용성

한혜숙 ( Han Hye Sug ),구자충 ( Gu Ja Chung ),김병욱 ( Kim Byeong Ug ),권순길 ( Kwon Sun Gil ),김혜영 ( Kim Hye Yeong ),김헌 ( Kim Heon ) 대한신장학회 2003 춘계학술대회 초록집 Vol.22 No.1