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문인성 ( In Sung Moon ),권오상 ( Oh Sang Kwon ),정혁상 ( Hyuk Sang Jung ),김영남 ( Young Nam Kim ),설원종 ( Won Jong Seol ),정승기 ( Seung Ki Jeong ),주기탁 ( Ki Tak Ju ),김선숙 ( Sun Suk Kim ),서태석 ( Tae Seok Seo ),양달모 ( Dal 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6
Chronic mesenteric ischemia is characterized by postprandial pain and marked weight loss. It is provoked by inadequate intestinal blood flow and the increased metabolic demands associated with digestion. Diagnosis must be based on clinical symptoms, arteriographic demonstration of an occlusive process of the splanchnic vessels, exclusion of other gastrointestinal disorders, and the response to revascularization. Specially, angiography is indicated to confirm the diagnosis, to assess disease severity, and to plan revascularization. It can be treated by either surgical reconstruction of an artery or percutaneous transluminal balloon angioplasty with or without stenting. We had experienced a 63-year-old man who presented with postprandial abdominal pain and weight loss unexplained by conventional diagnostic studies. The aortography revealed about 80% of stenotic lesion in the superior mesenteric artery. After percutaneous transluminal angioplasty, postprandial abdominal pain was completely relieved. We report a case of chronic mesenteric ischemia with a review of relevant literature. (Korean J Gastroenterol 2003;41:499-503)
한상우 ( Sang Woo Han ),김진영 ( Jin Young Kim ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),문인성 ( In Sung Moon ),김동구 ( Dong Goo Kim ),고용복 ( Yong Bok Koh ),방병기 ( Byu 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.1
Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.
최성호 ( Sung Ho Choi ),김동구 ( Dong Goo Kim ),문인성 ( In Sung Moon ),이명덕 ( Myung Duk Lee ),김인철 ( In Chul Kim ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.1
Background/Aims: Living donor liver transplantation (LDLT) is one of the recommendable alternatives for cadaveric liver transplantation. However, it requires the balance between the graft volume and donor safety in adult patients. Methods: We performed LDLT using the right lobe in 29 adults at the Department of Surgery, Catholic University of Korea from October 2000 to September 2001. Results: The values of postoperative liver enzyme was significantly different according to the remaining liver volume of donors ( 30% vs. 30%, p 0.05). The mean regeneration rate of the remaining left lobe at postoperative 3 months was 212±43% compared to preoperative liver volume. The group that had the remaining liver volume of 35% showed a higher regenerative activity than the group that had remaining liver volume more than 35%. There was no donor mortality and postoperative complications were observed in 7 patients. The mean graft mass was 787 cm3, which was 1.35% of the recipient body weight and 67.8% of the standard liver volume. Twenty-six of 29 transplanted patients (89.7%) survived from operation. The causes of death were varix bleeding, peumonia-ARDS, and portal vein thrombosis. Conclusions: Our preliminary data suggest that the LDLT has produced favorable results in short-term period and the survival rate is quite high for patients with end stage liver disease. (Korean J Gastroenterol 2003;41:26-31)
"실폐소생술포기(DNR)"에 대한 요청서 및 지시서 개발
한성숙(Han Sung Suk),김중호(Kim Joong Ho),문인성(Moon In Sung),용진선(Yong Jin Sun) 한국생명윤리학회 2005 생명윤리 Vol.6 No.1
The subjects of the study are First, to accumulate DNR related guideline and DNR request and order, questionnaires were sent to 70 randomly selected university hospitals and general hospitals, and the data were collected between July and September 2004. Second, after the draft of DNR request and order was developed, the first professional group (total 12 people) to seek advise regarding the draft was formed including four doctors, three head nurses, two ministers, two philosophers, and one legal professional. The second professional group (5 people) included four doctors and a legal professional who presented significant opinions in the first advisory meeting, and they discussed the revised draft during the second advice. In this study, Delphi technique was used to develop DNR requests and order. The instrument was the draft of DNR request and order form developed by researchers for our hospital based on DNR request and order collected from 9 institutions at home and materials from abroad for the development of DNR instructions and requests. For the final revision of DNR request and order form, we've decided to prepare some space to write down the diagnosis, the progress of treatment, and the prognosis of patients on the back of the form, and us e it for explaining and seeking the consent in compliance with the regulation of the hospital ethics committee. Also we've decided to call the form "DNR request and order form". Regarding the suggestion from the hospital ethics committee, the legal interpretation is needed advised; the second suggestion from a legal professional could be an alternative. This "DNR request form" will be evaluated after one year of trial in our hospital from March 1 2005. Furthermore, for the proper use of this form, we are planning to publicize to develop and use "DNR guides". I suggest developing the forms of living wills or advance directives, for they are of use in case that patient can't make his own decision due to any abrupt accident.
김진영 ( Jin Young Kim ),송명준 ( Myong Jun Song ),정병하 ( Byung Ha Chung ),김민수 ( Min Soo Kim ),유혜영 ( Hyei Young You ),김영수 ( Young Soo Kim ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),문인성 ( In Sung Moon ),고용복 대한내과학회 2003 대한내과학회지 Vol.64 No.4
목적 : 신장이식환자들은 일반인들보다 암 발생률이 높으며 이 중 방광암이 많은 비율을 차지한다1,2,4,11). 신장이식환자에서 발생한 방광암의 발생률이나 특징에 대하여 국내에서 아직 보고된 바 없어 이에 저자들은 신장이식환자들에게서 높은 발생률을 보이는 방광암에 대해서 일반인들의 방광암과 구분되는 특징을 살펴보고 조기발견 및 치료에 도움이 되고자 연구를 시작하였다. 방법:가톨릭대학교 의과대학 강남성모병원에서 1969년 3월부터 2002년 4월까지 약 Background : With the rise in the number of renal transplantation procedures in the past years, the incidence of bladder cancer in transplant recipients has increased. This study undertaken to evaluate the clinical characteristics and outcome in renal tra
박재현 ( Park Jea Hyun ),김동구 ( Kim Dong Goo ),최성호 ( Choi Sung Ho ),문인성 ( Moon In Sung ),이명덕 ( Lee Myung Duk ),김인철 ( Kim In Chul ) 대한소화기학회 2003 대한소화기학회지 Vol.42 No.1
Background/Aims: Currently, the role of liver transplantation in the treatment of hepatocellular carcinoma (HCC) with cirrhosis is controversial. What remain to be determined are the best treatment protocol and who are likely to have a good outcome after liver transplantation. Methods: Twenty-five patients with hepatocellular carcinoma underwent liver transplantation between 1993 and 2001 at the Department of Surgery, Catholic University of Korea. The follow-up period was from one month to 51 months. The pathologic findings, the recurrence, and survival of the 25 cases were analyzed. Results: Two patients had a tumor larger than 5 cm in diameter and three patient had above 3 nodules in number. Five patients had bilobar tumors. Vascular invasion was present in 11 patients (45.8%). Among the 25 patients, postsurgical TNM staging was stage III in 3 patients, stage IVA in 5 patients, and stage IVB in 1 patient. Number of high risk patients were 16 (64%). During follow-up, 23 of the 25 patients (92%) were alive and the number of disease-free survivals was 21 among the 23 patients (91.3%). Conclusions: According to our small experience, HCC can be a good indication of liver transplantation, especially in low risk patients and even in the recurrent cases. A long-term survival can be achieved by aggressive treatment. However, the best protocol remains to be determined, especially for the case with large tumors. (Korean J Gastroenterol 2003;42:42-49)
김진영 ( Jin Young Kim ),이주하 ( Jennifer Lee ),이성은 ( Sung Eun Lee ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),문인성 ( In Sung Moon ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),고용복 ( Yong Bok Koh ),방병기 ( Byu 대한내과학회 2007 대한내과학회지 Vol.73 No.1
목적: 새로운 면역억제제의 도움으로 급성 거부반응의 발생률이 꾸준히 감소되고 신이식 환자의 수명을 증진되면서 이식 후 발생하는 악성종양이 사망의 중요한 원인이 되었다. 저자들은 신이식환자의 추적기간별 악성종양 발생률의 변화를 알아보고자 하였다. 방법: 1969년부터 2005년까지 가톨릭대학교 강남성모병원에서 신장이식을 시행 받은 1500예를 대상으로 하였다. 평균 추적관찰기간은 108±77개월이었다. 신이식환자의 악성종양 발생률, 임상경과, 치료 및 예후를 후향적으로 조사하여 일반인과 비교하였다. 결과: 7% (103명에서 105예)의 환자에서 악성종양이 발생하였다. 남자보다 여자의 암발생률이 높았고, 가장 흔한 암은 남자의 경우 위암, 여자의 경우 자궁경부암이었다. 1990년, 1995년, 2000년, 2005년 누적발생률은 0.72%, 2.91%, 4.62%, 7.0%로 점진적으로 증가하였다. 신이식환자의 암발생률은 일반인보다 높았고, 특히 악성 임파종, 피부암, 갑상선암, 카포시 육종, 비뇨 생식계암이 높은 발생률을 보였다. 초기 면역억제제에 따른 악성종양의 발생은 AZA 8.3%, CsA 7.6%, FK 506 3.4%이었으나 이식 후 발생시기는 AZA 172±61개월, CsA 91±49개월, FK 506 57±28개월로 AZA, CsA에 비해 FK506을 투여 받은 환자에서 악성종양이 보다 일찍 발생하였다. 임상적 경과는 37명이 사망하고(21명은 종양으로 인한 사망), 51명은 현재까지 생존하고 있다(7명은 이식신기능상실). 결론: 추적기간이 길어지면서 악성 종양의 발생률이 점진적으로 증가하고 있다. 암발생률을 감소시키기 위한 적극적인 암검진 프로그램이 필요할 것으로 생각된다. Background: Strong immunosuppressive regimens have steadily improved both graft and patient survival, but posttransplant malignancy is still a clinical issue that needs to be resolved. Methods: There were 1,500 transplant recipients between 1969 and 2005 at Kangnam St. Mary`s hospital. The mean follow-up period was 108 77 months. We retrospectively analyzed the incidence, clinical course, treatment and prognosis of malignancy in the kidney transplant recipients. Results: The incidence of malignancy after transplantation was 7.0% (10.5 cases out of 103 patients). The incidence of malignant lymphoma, thyroid cancer, renal cell carcinoma and Kaposi`s sarcoma were higher in the renal transplanted patients than in the general population. The cancer incidence for women was higher than that for men, with stomach cancer being the most common in males and uterine cervix cancer the most common in females. The cumulative incidence of posttransplant malignancy at 1990, 1995, 2000 and 2005 were 0.72%, 2.91%, 4.62% and 7.0%, respectively. The cancer incidence with the use of initial immunosuppressive agents was 8.3% for azathioprine, 7.6% for cyclosporine, and 3.4% for tacrolimus. The mean times for making the diagnosis of malignancy after transplantation were 172±61 months for azathioprine, 91±49 months for cyclosporine, and 57±28 months for tacrolimus, respectively. During the observational period, 37 patients died (21 patients died of cancer) and 51 patients were still alive (7 grafts failed). Conclusions: The incidence of malignancy after renal transplantation increases according to the longer follow-up period. An active screening program is needed to lower the incidence of malignancy in renal transplant recipients.(Korean J Med 73:67-75, 2007)