소화기 종양에 대한 내시경적 완화치료

김혜강,정대영,Hye Kang Kim,Dae Young Cheung 대한소화기암연구학회 2014 Journal of digestive cancer reports Vol.2 No.1

Palliative care for cancer aims to relieve the discomfort and pain from the cancer itself and associated conditions. Gastrointestinal cancers originate from the tube like structure of gastrointestinal tract and cause complications such as obstruction, bleeding, adhesion, invasion, and perforation to adjacent organ. Recent advances in interventional endoscopy enables endoscopy physicians to do safe and effective care for gastrointestinal cancer patients. Endoscopic palliation includes stent, hemostasis, nutritional support and targeted drug delivery. Self expandable metallic stent is one of the most important modalities in gastrointestinal palliation. Through the endoscopy or over the wire pre-placed by endoscopy, stents restore the gastrointestinal luminal patency and relieve the obstructive condition. Endoscopic hemostasis is another important palliation in gastrointestinal cancer patients. Epinephrine injection, argon plasma coagulation and thermal cauterization are usual modalities for hemostasis. Histoacryl glue and fibrin glue are also available. Hemostatic nanopowder spray is newly reported effective in benign disease and is supposed to be effective also in cancer bleeding. Enteral feeding tubes including gastro- or jejunostomy and nosoduodenal tubes are placed by using endoscopic guidance. Enteral feeding tubes role as the route of easily absorbable or semi-digested nutrients and effectively maintain both patients calorie requirements and gut microenvironment. Photodynamic therapy is the one of the outstanding medical employments of photo-physics. Especially for superficial cancers in esophagus, photodynamic therapy is very useful in cancer removal and maintaining organ structure. In biliary neoplasm, photodynamic therapy is well known to be effective in cancer ablation and biliary ductal patency restoration. Targeted drug delivery is the lastest issue in palliative endoscopy. Debates and questions are still on the table. In this article, the role of endoscopic interventions in palliative care for the gastrointestinal tumors will be thoroughly reviewed.

증례 : 순환기 ; 우관상동맥에서 기원하는 영양혈관을 갖는 거대 좌심방 점액종 1예

김혜강 ( Hye Kang Kim ),이동현 ( Dong Hyeon Lee ),권태근 ( Tae Geun Gweon ),송미애 ( Mi Ae Song ),백명기 ( Myong Ki Baeg ),김정호 ( Jeong Ho Kim ),전희경 ( Hui Kyung Jeon ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1

심방 점액종은 심방 중격에서 발생하여 좌심방 혹은 우심 방으로 천천히 점진적으로 커지며, 대부분은 좌회선 관상동맥에서 혈관 공급이 이루어지나 우관상동맥에서의 혈관공급은 드문 일차성 양성 종양이다. 본 증례에서 저자들은 경·중등도의 호흡곤란을 주소로 내원한 여자 환자에서 관상동맥조영술을 통해 진단된 우관상동맥에서 기시한 거대 심장 종양의 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 55-year-old woman was referred to our hospital with a 6-month history of dyspnea (NYHA II-III). The physical examination revealed a grade 2/6 "tumor plop," i.e., a low-pitched sound heard during early or mid-diastole. The chest X-ray showed mild cardiomegaly with lung congestion in both lower lung fields. Two-dimensional echocardiogram showed a large myocardial mass, prolapsing into the left ventricle during diastole. Chest computed tomography showed a multi-lobulated mass (6.8×4.1 cm) attached to the interatrial septum during systole and prolapsing into the left ventricle during diastole. Coronary angiography demonstrated large tumor vessels arising from and surrounding the posterior lateral branch of the right coronary artery. The mass was excised and the patient recovered uneventfully. (Korean J Med 78:104-108, 2010)

크론병에 병발한 소장 반지세포암종 1예

김준성 ( Joon Sung Kim ),정대영 ( Dae Young Cheung ),박수헌 ( Soo Heon Park ),김혜강 ( Hye Kang Kim ),맹일호 ( Il Ho Maeng ),김수연 ( Su Yoen Kim ),김진일 ( Jin Il Kim ),김재광 ( Jae Kwang Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.50 No.1

Crohn`s disease and ulcerative colitis are well known risk factors of intestinal cancer in relation to the extent and duration of disease. Rarely, small bowel cancer can develop after a longstanding inflammation of Crohn`s disease with a relatively higher incidence than the general population. Signet ring cell carcinoma is a rare condition among intestinal cancers, and the diagnosis or detection is more difficult if the cancer originates from the small bowel. We report a case of a 30-year old female in whom signet ring cell carcinoma of ileum was diagnosed after a 15-year history of Crohn`s disease. (Korean J Gastroenterol 2007;50:51-55)

신이식 환자에서 병발한 이식신동맥류와 신동맥성 고혈압 1예

김석환 ( Seok Hwan Kim ),김윤경 ( Yoon Kyung Kim ),김혜강 ( Hye Kang Kim ),오수진 ( Su Jin Oh ),이상주 ( Sang Ju Lee ),김지창 ( Ji Chang Kim ),장윤경 ( Yoon Kyung Chang ),김석영 ( Suk Young Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

신이식 환자에 병발한 갑상선기능저하증에 의한 횡문근융해증 1예

김윤경 ( Yoon Kyung Kim ),김석환 ( Seok Hwan Kim ),김혜강 ( Hye Kang Kim ),오수진 ( Su Jin Oh ),이상주 ( Sang Ju Lee ),장윤경 ( Yoon Kyung Chang ),김석영 ( Suk Young Kim ),방병기 ( Byung Kee Bang ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

상부위장관 점막근층 혹은 고유근층에서 기원한 중간엽종양의 내시경 특징에 대한 비교 연구

송준호 ( Jun Ho Song ),김진일 ( Jin Il Kim ),김현진 ( Hyun Jin Kim ),조형준 ( Hyung Jun Cho ),김혜강 ( Hye Kang Kim ),정대영 ( Dae Young Cheung ),박수헌 ( Soo Hern Park ),김재광 ( Jae Kwang Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.2

목적: 상피하종양은 대부분 무증상으로 내시경검사에서 우연히 발견된다. 이번 연구는 점막근층 기원의 상피하종양과 고유근층 기원의 상피하종양에서 상부위장관 내시경검사와 내시경초음파검사로 관찰되는 특징을 분석하였다. 대상 및 방법: 2006년 3월부터 2012년 2월까지 가톨릭대학교 여의도성모병원에서 상부위장관 내시경검사에서 상피하종양이 의심되어 내시경초음파검사를 받은 환자 중, 점막근층 혹은 고유근층에 병변이 있는 총 286명의 환자에서 총 307개의 병변을 후향적으로 조사하였다. 결과: 점막근층 기원의 상피하종양 크기는 10.5±6.9 mm로 고유근층 기원의 상피하종양 크기(14.3±13.9 mm)보다 작았다(p=0.035). 점막근층 기원의 상피하종양은 식도에서 69.1%로 많았으며, 고유근층 기원의 상피하종양은 위의 체부에 43.3%로 많았다(p<0.001). 점막근층 기원의 상피하종양이 조직 겸자에 의한 움직임이 있는 경우가 80.4%로 많았고 (p=0.001), 고유근층 기원의 상피하종양이 조직겸자에 의하여 눌러지지 않는 경우가 72.4%로 많았다(p<0.001). 내부에 코는 점막근층 기원의 상피하종양의 89.7%에서, 고유근층 기원의 상피하종양의 81.9%에서 균질하게 관찰되었다. 결론: 식도에서는 점막근층 기원의 상피하종양이 많이 발견되고 위에서는 고유근층 기원의 상피하종양이 많이 발견되었다. 점막근층 기원의 상피하종양은 크기가 작고, 움직임이 많으며, 단단하여 눌러지지 않았다. 내시경초음파검사에서 점막근층과 고유근층 기원의 상피하종양에서 내부 에코 차이는 없었다. Background/Aims: Subepithelial tumors are occasionally found during upper gastrointestinal endoscopy. The purpose of this study was to evaluate endoscopic characteristics of mesenchymal tumors originating from muscularis mucosa or muscularis propria. Methods: A total of 307 mesenchymal tumors of the upper gastrointestinal tract were diagnosed between March 2006 and February 2012 at Yeouido St. Mary`s Hospital (Seoul, Korea). Data on endoscopic and endoscopic ultrasonographic findings were collected and analyzed by retrospectively reviewing the medical records. Results: The mean size of the mesenchymal tumors originating from muscularis mucosa was significantly smaller than those originating from muscularis propria (10.5±6.9 mm vs. 14.3±13.9 mm, p=0.035). The most common locations of the mesenchymal tumors originating from muscularis mucosa and muscularis propria were esophagus (69.1%) and body of the stomach (43.3%), respectively (p<0.001). Rolling sign was more commonly observed with mesenchymal tumors originating from muscularis mucosa (80.4%, p=0.001), and cushion sign was more frequently absent with those originating from muscularis propria (72.4%, p<0.001). Internal echo was homogenous in 89.7% and 81.9% of mesenchymal tumors originating from muscularis mucosa and muscularis propria, respectively (p=0.092). Conclusions: The size, location, and movability of mesenchymal tumors originating from muscularis mucosa were different from those of mesenchymal tumor originating from muscularis propria.propria. (Korean J Gastroenterol 2013; 62:92-96)

전신홍반루푸스 환자에서 발생한 진행성 다초점 백색질 뇌증

고훈영 ( Hoon Young Ko ),민준기 ( Jun Ki Min ),김혜강 ( Hye Kang Kim ),이희연 ( Hee Yeon Lee ),심용수 ( Yong Soo Shim ),김지영 ( Jee Young Kim ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.2

Progressive multifocal leukoencephalopathy (PML) is a rare, serious, and usually fatal demyelinating disease that occurs predominantly in severely immunosuppressed patients. The disease is caused by the infection of oligodendrocytes with JC virus that is widely distributed as a latent infection in the general populations. PML has been described mainly in patients infected with the human immunodeficiency virus. However, other immune-suppressed patients including malignancies and organ transplants can be affected with JC virus infection. Recently it is suggested that rheumatologic diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis, dermatomyositis, polymyositis, wegener`s granulomatosis be known to be at risk of developing PML. We report a case of PML in a patient with SLE.

위장관 ; 대장 톱니샘종에서 p53, Bcl-2, Ki-67 단백의 면역조직화학 발현

정진환 ( Jin Hwan Jung ),권헌주 ( Heon Ju Kwon ),김태정 ( Tae Jung Kim ),조형준 ( Hyung Jun Cho ),김혜강 ( Hye Kang Kim ),정대영 ( Dae Young Cheung ),김진일 ( Jin Il Kim ),김재광 ( Jae Kwang Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.6

목적: 대장의 톱니샘종은 증식폴립과 샘종폴립의 특성을 동시에 가지는 샘종으로 기존의 샘종암종연쇄경로와는 다른 톱니 모양경로를 통해 암으로 진행한다. 전통 톱니샘종은 대롱샘종이나 증식폴립과 비교하여 어떤 분자유전학적인 특징이 있는지 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2012년 12월까지 가톨릭대학교 여의도성모병원에서 폴립절제술로 절제된 전통 톱니샘종, 증식폴립, 대롱샘종 각각 20예를 대상으로 나이, 성별, 위치, 크기 및 p53, Bcl-2, Ki-67단백의 면역조직화학적 발현을 비교하였다. 결과: 전통 톱니샘종과 증식폴립의 비교에서 p53, Bcl-2의 발현에 있어서 차이가 없었고, Ki-67의 발현은 전통 톱니샘종에서 더 높았다. 전통 톱니샘종과 대롱샘종의 비교에서는 p53과 Ki-67의 발현에는 유의한 차이가 없었고, Bcl-2의 발현은 대롱샘종에서 더 높았다. 전통 톱니샘종에서 p53, Bcl-2, Ki-67 발현은 나이, 성별, 위치 및 크기에 있어서 통계적으로 의미있는 차이가 없었다. 결론: p53의 발현은 세 군 간에 통계적으로 유의한 차이가 없어서, 전통 톱니샘종과 대롱샘종의 구분에 유용하지 않을 수도 있음을 시사했다. Ki-67의 발현은 전통 톱니샘종에서 증식폴립보다 높아서, Ki-67단백이 전통 톱니샘종과 증식폴립의 감별에 도움이 될 수도 있음을 보여주었다. 전통 톱니샘종은 대롱샘종보다 Bcl-2 발현이 낮아서 전통 톱니샘종의 종양 형성이 대롱샘종보다 낮을 것으로 나타났다. Background/Aims: Serrated adenomas of the colon show mixed characteristics of both hyperplastic and adenomatous polyps. Serrated adenomas are known to progress via the serrated pathway than the adenoma-carcinoma pathway. The aim of this study was to evaluate the characteristics of traditional serrated adenomas compared to hyperplastic polyps and tubular adenomas by using immunohistochemical staining for p53, Bcl-2, and Ki-67. Methods: Age, sex, location, size and the immunoexpression of p53, Bcl-2, and Ki-67 were retrospectively analyzed in 20 traditional serrated adenomas, 20 hyperplastic polyps, and 20 tubular adenomas from January 2007 to December 2012 at The Catholic University of Korea, Yeouido St. Mary`s Hospital. Results: There was no difference in Bcl-2 and p53 expression between traditional serrated adenomas and hyperplastic polyps. Ki-67 Expression of traditional serrated adenomas was higher than that of hyperplastic polyps (p=0.001). Ki-67 and p53 expression was similar between traditional serrated and tubular adenomas. Bcl-2 expression of traditional serrated adenomas was lower than that of tubular adenomas (p=0.001). Regarding the expression of p53, Bcl-2, and Ki-67 in traditional serrated adenomas, there were no statistical differences among age, sex, location, and size. Conclusions: Our study suggested that Ki-67 may be helpful in distinguishing traditional serrated adenomas from hyperplastic polyps, and p53 expression may be ineffective in distinguishing between traditional serrated and tubular adenomas. From Bcl-2 expression, it is suggested that the tumorigenesis of traditional serrated adenomas is lower than that of tubular adenomas. (Korean J Gastroenterol 2013;62:336-343)