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원발성 간세포암 환자에서 반복적 간동맥색전술의 치료효과
김호정,박재성,최득린,원종호,조성원,홍대식,심찬섭,박희숙,김신애,유용규,봉형근 순천향대학교 1994 논문집 Vol.17 No.2
Hepatocelluar carcinoma(HCC) is one of the most common neoplasm in Korea. Systemic chemotherapy for HCC has been unsatisfactory (remission rate is not exceed 20% and complete remissions are rare). Recently, transcatheter arterial chemoembolization(TAE) has been reported to be an effective treatment for patients with unresectable HCC. Between March 1989 and December 1992, 39 patients (31 men and 8 women) with HCC were treated by TAE. TAE was performed using lipiodol(5-15ml by size variation) and mitomycin-C(10mg/㎡). After TAE, analgesics, antibiotics, and antacids were given if necessary. The results were summarized as follows ; 1) Response of 39 patients was 'complete' response in 1 case (3%), 'partial' in 19 cases(49%), 'stable' in 10 cases(26%), and 'poor or progression' in 9 cases(22%). Median survival time was 9(3-41+)months, probability of 1 year survival was 39.4%, and probability of 3 year survival was 27.5%. 2) In univariate and multivariate analysis for Cox regression method, the response rate to TAE significantly affected survival period of patients(p<0.05). 3) Side effects of TAE, fever(58.9%), abdominal pain(51.8%), abdominal distension(17.9%), nausea and vomiting(20.5%), chest tightness, back pain, and hemorrhagic gastritis were experienced. In conclusion, repetition of TAE is an effective treatment in patients with HCC and further evaluation for prognostic factors will be necessary.
봉형근(Hyung Keun Bong),이영흥(Young Heung Lee),조영덕(Young Doek Cho),김진오(Jin Oh KIm),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Jun Seong Lee),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),심찬섭(Chan Sup Shim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Objective: Intrahepatic stones provide a quite different spectrum of problems f by surgeons in the tem hemisphere. Although unilateral left intrahepatic stones have been treated by left hepatic lobectomy, bilateral or right intrahepatic stones can be even more troublesome because they frequently cannot be completely removed by conventional surgical stone extraction procedure. Recently, the use of a flexible fiberoptic choledochoscope, electrohydraulic lithotriptor (EHL) and dilators make it possible to completely remove intrahepatic stones by nonsurgi- cal procedures in the majority of c Methods: During the last 5 years, we treated intrahepatic stones in 114 patients with a fiberoptic choledochoscope, EHL and dilators via percutaneous transhepatic route. For construction of percutaneous transhepatic routes, we punctured intrahepatic ducts by ultrasonographic guidance and then dilated the tracts by PTBD set (Nipro Co., Japan) under fluoroscopic guidance. Choledochoscopy were performed at 4-6 weeks later, and Dormina basket, EHL, balloon or bougie dilators were used for removal of stones. Results: Success rates according to the locations of stones were 87.5% (14/16) in unilateral right intrahepatic stones, 92.9% (39/42) in unilateral left intrahepatic stones, and 89.3% (50/56) bilateral intrahepatic stones. Overall success rate was 90.4% (103/114). Causes of incomplete removal of the stones in our patients included the failure of construction or maintenance of percutaneous transhepatic routes in 4 cases, intrahepatic bile duct stricbm proximal to impacted stones in 3, acute ductal angulation in 2, and stones located at the very distal branches of intrahepatic ducts in 2 cases. Complications associated with the procedure were transient fever in 8 cases, severe hemobila in 2 cases and bihary perforation in 3 cases. Conclusion: These results suggest that gemutaneaus transhepatic choledochoscopic approach is a relatively safe and effective method for treatment of intrahepatic stones.
급성 담낭염의 비수술적 담낭배액술 - 내시경적 경비 담낭배액술 및 경피경간 담낭배액술을 중심으로
봉형근(Hyung Keun Bong),문종호(Jong Ho Moon),이영홍(Young Hong Lee),조영덕(Young Deok Cho),김진오(Jin Oh Kim),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),심찬섭(Chan 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1
N/A Background/Aims: Acute cholecystitis is the most common biliary emergency and until now, the choice of the treatment of this disease is surgical operation. But, the. Mortality and morbidity associated with surgical cholecystostomy in those patients are relatively high. Recently, PTCCD and ENGBD were developed as a useful method of nonsurgical cholecystic drainage in high surgical risk group of acute cholecystitis. The purpose of this study was tn assess the usefulness of nonsurgical cholecystic drainage such as PTCCD and ENCrBD in the patients with acute cholecystitis. Methods: Of 59 patients with acute cholecystitis treated with nonsurgical cholecystic drainage, 47 were calculous cholecystitis and 12 were acalculous cholecystitis. Nonsurgical chole- cystic drainages were successful in all 59 cases: PTCCD in 45 patients, ENGBD in rernaining 14 patients. 39 patients were treated with nonsurgical cholecystic drainages due to high surgical risk. In remaining 20 patients there were cholangiocarcinoma in 5 patients, netastatic heptna in 2, gallstone pancreatitis in 1, advanced gastric cancer in 2, refusal of surgery in 10. Results: The prompt clinical recovery were achieved in 42 patients(93.3%) with PTCCD and cornpletely in all 2 cases with ENGBD. In the group with 35 calculous cholecystitis performed PTCCD, 28 under- went PTCCS-L, 4 elective surgery and 3 died because of the underlying condition, In the group with 10 acalculous cholecystitis performed PTC(D, 8 patients need nr further treatment except drainage and remaining 2 patients underwent elective surgery. Jn the group with 12 calculous cholecystitis treated by ENGBD, 10 underwent elective surgery, l F.SWI. And I gallstone dissolu- tion with MTBE. In 2 acalculous cholecystitis treated by ENGBD, the one patient took no further treatment and the other underwent elective surgery. Complications related to PT( CD occurred in 10 of 45 patients, but there was no mortality re]ated to this procedure. No complications were noted related to ENGBD. Conclusions: We conclude that nonsurgical cholecystic drainage witli ENGBD and PTCCD were safe, effective and useful procedures for the management of acute cholecystitis, especially in high surgical risk group, (Korean J Gastroenterol 1997; 30:81 - 89)
당뇨병 환자에서 임상증상 및 자율신경장애와 감각신경장애와의 상관관계
김진오,유용규,문승혁,김효석,봉형근,변동원,서교일,조용욱,유명희,김극배 순천향대학교 1994 논문집 Vol.17 No.2
In a group of 47 diabetic patients and 60 controls, we measured vibration perception threshold with biothesiometer, and autonomic nerve function by means of the five classical cardiovascular tests (Valsalva ratio, R-R interval variations during deep breathing, sustained handgrip, lying to standing, and postural hypotension). Results of cardiovascular reflex results were compared with symptoms of autonomic dysfunction and vibration perception threshold. The object of this study was to assess the physiological and clinical correlation of autonomic and sensory neuropathy in diabetic patients and results of this study could be applying patients for therapeutic approach and follow up diabetic neuropathy. Vibration perception threshold correlated with Valsalva ratio(p<0.01) and deep breathing(p<0.01). Patients score was significantly lower than controls in vibration perception threshold and all of the autonomic function tests. According to the results of cardiovascular tests, patients were divided into two different groups : presence(DAN+: ≥3) or abscence(DAN-: <3) of autonomic neuropathy. DAN () group(n=25, 53.2%) showed no significant differences from the DAN(+) group(n=22, 46.8%) in age, fasting and 2 hours postprandial blood sugar, body mass index, and cholesterol but associated with duration of diabetes. Vibration perception threshold measured at the first toe tip and at external malleolus in DAN(+) patients were significantly higher than DAN () patients and controls. We diagnosed sensory impairment when vibration perception threshold value is above 95th percentile of controls and we observed a significant correlation between autonomic and sensory neuropathy. These findings suggested that there is a correlation between autonomic and sensory neuropathy in diabetic patients, even in the absence of symptoms.
내시경적 유두괄약근 절개술후 발생한 기종격증 및 피하기종
조영덕(Young Deok Cho),봉형근(Hyung Keun Bong),김진오(Jin Oh Kim),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),심찬섭(Chan Sup Shim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3
Perforation, bleeding, cholangitis, and pancreatitis are common complications of endoscopic sphincterorny(EST) that is considered a common effective method for treatment of distal bile duct obstruction and removal of bile duct stones. Perforation of duodenutn complicates endoscopic sphincterotomy in approximately 1% of cases. But, retroperitoneal, mediastinal and subcutaneous emphysema are very rare complications of endoscopic sphincterotomy. A 50-year-old woman was admitted to our hospital due to right upper quadrant abdominal pain for 1 week. An ERCP revealed markdly dilated commom bile duct and rnultiple ductal filling defects. For removal of' stones, EST was performed with pull type papillotome. About 1 hour later after procedure, she complained of chest pressure, shortness of breath and abdominal distension. The chest X-ray film revealed a pneumomediastinum, segmental atelectasis of left lower lung fields and subcutaneous emphysema. The simple abdominal X-ray showed mottled air densities in the right midabdomen and crescentic air densities in the right perirenal space. We report on a rare case of retroperitoneal duodenal perforation, pneumomediastinum and subcutaneous emphyserna following endoscopic sphinctero- tomy, in a patient with common bile duct stones. (Korean J Gastroenterol 1997; 29:399-403)