위암환자 895예에 대한 임상적 고찰

함준수(Joon Soo Hahm),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),민경랑(Kyung Rang Min),한동수(Dong Soo Han) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

Stomach cancer is still the most common malignancy and one of the leading causes of cancer deaths in Korea, although its frequency is decreasing in the United States, western Europe and recently, even in Japan. In order to evaluate the incidence, epidemiology, clinical manifestations and surgical resectability, the authors analysed 895 cases of stomach cancer which were confirmed by endoscopic biopsy from March 1982 to July 1986 in Hanyang University Hospital. 1) Stomach cancer was most prevalent in 7th decade (29.5%), with average age of 54.8 in male and 53.6 in female. Male to female ratio was 2.2:1, with male preponderance. 2) The patients who had under 1 year duration of illness before confirmatory detection was found in 76.3% and those over 3 years duration in 7.8%. 3) Epigastric pain and/or discomfort were the most common symptoms complained (88.6%). Anorexia (55.3%), weight loss (51.9%), indigestion (48.5%) and belching (43.0%) were also frequently noted in order of frequency. In physical examination, epigastric tenderness was noted in 43.2% and epigastric mass was palpable in 26.5% of patients. 4) Anemia, defined as Hb<14 g/dl in male and <12 g/dl in female was found in 59.4% of patients and occult blood was demonstrable in the stool in 54.8% of patients. 5) Most of stomach cancer was found to involve the antrum and body (89.4%) and Borrmanns type III was found in more than 50% of patients. According to the histopathologic classification, adenocarcinoma was the most common microscopic type, involving 98.9% of patients. False positive and negative rates in detection of stomach cancer with gastrofiberscope were 7.0% and 5.7% respectively. 6) The serum levels of CEA and CA19-9 were significantly different in relation to the stages of stomach cancer, but revealed no remarkable changes in relation to the degree of cell differentiation. 7) Preoperative resectability of stomach cancer determined by radiographic staging was 53.6% and using of abdominal CT scan the accuracy of preoperative staging was 66.0%. 8) Curative operation was underwent in 320 cases (35.8%) and chemotherapy combined with operation was received in 115 cases (7.8%) among the 895 cases with stomach cancer.

전이성 수막암종증을 일으킨 표재확장성 조기위암 1예

박경남,이민호,이동후,기춘석,이종철,홍은경,민경랑,함준수,이성구 대한소화기내시경학회 1986 Clinical Endoscopy Vol.6 No.1

Meningeal carcinomatosis is an important neurological complication of systemic cancer, and is increasingly being recognized as a cause of reurologic disability in life. Also there is evidenee that the incidence of this form of metastasis is increasing. We reported a case of 52-year-old female patient, who was diagnosed as early gastric cancer by biopsy under gastrofiberscopy. Other Lab. findings were all normal range except high alkaline phosphatase level. And then performed Billroth II operation. On 7th post-operative day, she was encountered severe headache and insomnia. Abnormal neurologic signs and subjective symptoms were developed and progressed, Repeated lumbar punture was done and CSF was examed. There findings were abnormal, but no specific finding of certain disease. She died of severe neurologic deficit and sudden respiratory arrest. Autopsy was done, and confirmed leptomeningeal carcinomatosis.

위장관의 원발성 악성 림프종의 조직학적 및 면역조직화학적 연구

민경랑,이중달,박경남 한양대학교 의과대학 1992 한양의대 학술지 Vol.12 No.1

Histological and immunohistochemical studies were carried out on a series of 28 malignant lymphomas of the gastrointestinal tract(GIT). The GIT lymphomas were submitted for the study as resected specimens during a period of four years ad six months. Histological classification according to working formulation sponsored by National Cancer Institute was reassessed in view of centicytoid cell lymphoma arising in the mucosa-associated lymphoid tissue. Immunohistochemical stains for B-lymphocyte. T-lymphocyte, and histiocyte were carried out on formalin-fixed, paraffin-embedded tissue with biotin-streptavidin method using a variety monoclonal antibodies. The most common cytologic type of GIT lymphomas was a diffuse large cell type(17 of 28 cases). Other types were less frequently but consistently noted. One gastric lymphoma and two small intestinal lymphomas had cytologic features consi9stent with centricytoid cell lymphoma of the mucosa-associated lymphoid tissue. Malignant lymphomas of high grade malignancy(82.1%) out-numbered those of low grade malignancy. Immunophenotype of GIT lymphomas revealed 23 cases of B-cell lineage(82.1%) and three cases of T-cell lineage. True histiocytic lymphomas were not identified in this series. Three centricytoid cell lymphomas of mucosa-associated lymphoid tissue were all rezctive for pan-B antibodies. Gastric lymphomas(nine cases) and colorectal lymphomas (three casxes) were of B-lymphocyte origin, whereas T-cell lymphomas were noted in the small intestine(two cases) and ileocecal region (one case). Three cases of immunoblastic lymphomas were reactive for B-cell antibody, and two cases of lymphopblastic lymphomas were not reactive for both pan-B and pan-T antibodies. In summary of the results obtained above, the primary GIT lymphomas, which are mostly of B-cell lineage, were not cytomorphologically and immuno phenotypically distinctive from the nodal lymphomas. It was thought that centricytoid cell lymphomas were not necessarily classified separately among the primary GIT lymphomas.

궤양성 대장염 28예에 대한 임상적 고찰

박경남,이민호,기춘석,함준수,안명주,민경랑 대한소화기내시경학회 1987 Clinical Endoscopy Vol.7 No.1

The ulcerative colitis is a relatively common disease in the European and North American countries aince Dr. Wilks has first reported the cases in 1895, But in Korea, this disease is a rare entity and only a few case have been reported. However, rescently the diagnoetic methods for ulcerative colitis are much developed we have experienced 28 cases of ulcerative colitis which were diagnosed by endoscopy, barium enema exam and biopsy. Therefore a total of 28 patient with ulcerative colitis diagnosed and treated at the department of internal medicine of HYUH from June 1979 to June 1986 was reviewed. We obtained the results as follows; 1) The sex distribution assumed a ratio of 1 to 1.33 with 12 males and 16 females. 2) The age dietribution was relatively even but the majority of cases were between 5th and 6th decade (32.1%), 3) The most prominent clinical symptoms were rectal bleeding, abdominal pain, diarrhea, fever, wight loss and vomiting. 4) Significant laboratory findins were anemia, eleveited ESR, leukocytosis, positive stool OB, electrolyte imbalance and decreased serum albumin level. 5) As to the extent of disease determined by the barium enema examination and endoscopic exam., rectum or rectosigmoid colon is involved in majority of the cases (92.8%). 6) The endoscopic examination was performed in all 28 cases and showed significant findings such as ulceration, hyperemia, mucosal friability, bleeding etcs. 7) The barium enema examination was performed in 19 cases and showed positive findings such as ulceration, luminal narrowing, bowel shortening and rigidity in 17 cases. 8) 21 of 28 patients treated by medical therapy showed relatively improved but 4 of 28 patients was exacerbated or relapsed and one has expired.

신장이식후에 발생한 골조직의 무혈관성 괴사에 대한 연구

박한철,박찬현,곽진영,민경랑,강종명 대한내과학회 1987 대한내과학회지 Vol.32 No.3

Avascular necrosis of bone is a disabling complication of renal transplantation. Its reported incidence after transplantation varies from 3% to 41%, but the, incidence has dramatically decteased since 1970s introducing the law-doseprednisolone and vit-D supply. Many hypothesis have been offered to explain the reason why the corticosteroids predispose to avacular necrosis of bone but the exact mechanism remains obscured. And other factors, such as the time on dialysis before transplantation, 1iver function, and secondary hyperparathyroidism have also been considered risk factors. This study was undertaken to determine the prevalence and clinical features of avascular necrosis in 64 renal transplant patients(recipients) at Hanyang university hospital from Jan. 1979 to May 1986, to assess the role of the following putative risk factors; 1) Steroid therapy. 2) Duration of dialysis before transplantation. 3) Secondary hyperparathyroidism. 4) Liver dysfunction. and to stress the importance of its early diagnosis. The results; 1) The incidence of avascular necrosis of bone was 21.8% and there is no statistically significant difference between high dose steroid group and low dose steroid group(p>0.05). 2) Avascular bone necrosis was developed mean 14mo. after renal transplantation and the received cummulative dose of prednisolone was 7.12±0.58 gm. 3) The total dose of prednisolone administered at one month and four months after transplant was significantly higher in patients who developed avascular necrosis(p $lt; 0.01). 4) Hip joints were most commonly involved(11cases), and 7 of them, bilateral. And affected side of hip was not related to side of transplantation. 5) Patients who were diagnosed in its early stage (stage 1,2) was 5cases and in late stage was 9cases. Of theses, 2cases was markedly improved with analgesics and rest of joints, but others gradually progressed. 6) Our results showed that the development of avascular necrosis after transplantation is not related to parathyroid function, liver function and duration of dialysis before transplantation.