증례 : 악성 식도협착에 있어 티타늄 제재의 금속제 확장형 인공식도삽관술 최근 경험 5예

손봉준 ( Bong Jun Son ),유종현 ( Jong Hyeon Yoo ),황기은 ( Ki Eun Hwang ),장남수 ( Nam Soo Chang ),김기택 ( Ki Taek Kim ),전우규 ( Woo Kyu Jeon ),정을순 ( Eul Soon Chung ),이상종 ( Sang Jong Lee ) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6

Endoscopic esophageal endoprosthesis is a safe and effective procedure for the palliative treatment of obstructive esophagogastric malignancy. However, the placement of conventional plastic esophageal endoprosthesis is difficult in some cases and this procedure is associated with significant complications such as perforation, hemorrhage & dysfunction of the prosthesis in the long term. The self-expanding metallic stents offer an attractive alternative to conventional esophageal stents. Ultraflex(TM) esophageal prosthesis is knitted from a single strand of Elastalloy(TM) wire, and undulates to conform with normal esophageal peristalsis, maintaining patency and promoting patients` comfort. Recently developed EsophaCoil(TM) esophageal prosthesis is unique in that it is a simple coil with close loops made from a single flat wire of nickel titanium alloy. Because the radical force of this material is much stronger than stainless steel, expansion time is therefore faster and the stent is able to dilate even extremely resistant strictures. We report our recent experience in five patients with malignant esophageal obstruction palliated with the new self-expandable titanium stent(Ultraflex(TM) and EsophaCoil(TM)).(Korean J Gastroenterol 1997;29:826-835)

다발성 부전도로의 심장 전기생리적 특성

이영수(Young Soo Lee),권택근(Tak Gun Guen),김성열(Sung Yel Kim),손봉준(Bong Jun Son),조봉기(Bong Gi Jo),한성욱(Seong Wook Han),허승호(Seoung Ho Hur),김윤년(Yoon Nyun Kim) 대한내과학회 2002 대한내과학회지 Vol.63 No.4

목적 : WPW증후군 환자에서 고주파 전극 도자 절제술을 시행한 후 mapping이 정확해짐에 따라 과거에는 드물었던 다발성 부전도로의 발견이 많아졌으며 저자들은 본원에서 경험한 다발성 부전도로를 가진 환자의 임상양상과 다발성 부전도로의 전기 생리적 특성에 대해서 알아보고자 하였다. 방법 : 1993년 2월부터 2000년 6월까지 계명대학교 동산의료원에 심계항진을 주소로 내원한 환자 중에서 심장 전기생리학적 검사를 시행하여 부전도로를 가진 환자는 452예였고, 그 중에서 다발성 부전도로를 확인하고 고주파 전극 도자 절제술을 시행한 19예를 대상으로 하였다. 결과 : 모든 환자는 각각 2개씩의 부전도로가 있었으며 유병율은 4.2%(19/452)였고, 부전도로의 분포는 좌심실 유리벽(71.1%), 우심실 유리벽(18.4%), 후중격벽(10.4%)의 순이었고, 조합 형태는 좌심실 유리벽에 2개가 있었던 경우(57.9%)가 가장 많았으며, 더 자세한 해부학적인 위치는 좌심실 좌측벽과 좌심실 후벽(36.8%)에서 가장 많았다. 성공률은 84.2%였으며, 또한 1차 시술 후 5예에서 재발하였고, 가장 흔한 재발 장소는 좌심실 유리벽에서 3예였다. 결론 : 다발성 부전도로의 양상과 특성은 이미 보고된 외국의 결과와 비교하며 비슷한 결과를 보였다. 그러나 대상 환자의 수가 적어 우리나라에서의 다발성 부전도로의 특성을 대변하지는 못하므로 더 많은 대상 환자에 대한 조사가 필요하며 또한 심장 전기생리학적 검사의 가장 큰 문제점인 방사선 피폭 시간을 줄이기 위한 노력이 필요하겠다. Background : The purpose of this study was to investigate the clinical and electro physiologic characteristics of patients with multiple accessory pathways. Recently as endocardial mapping has become more and more accurate, multiple accessory pathways which were considered to be rare in the past, have become more commonly reported in patients with Wolff-Parkinson-White syndrome. Methods : From February 1993 to June 2000, there were a total of 452 patients, who were confirmed to have accessary pathway mediated-tachyarrhythmias diagnosed by electrophysiologic study. Among those, 19 patients had multiple accessory pathways, and were enrolled in this study. Results : Among the 19 patients, thirteen patients were male and six were female, and their mean age was 36.5±16.17 years. All patients had 2 accessory pathways. The distribution of the location of the accessory pathways was at the left free wall (71.1%), right free wall (18.4%) and posteroseptal wall (10.5%). The most common combination pattern was the left free wall and left free wall (57.9%) and the most common anatomical areas were the left lateral wall and left posterior wall (36.8%). The success rate of the catheter ablation was 84.2% (16/19). The recurrence rate after the radiofrequency catheter ablation was 31.3% (5/16) and the most common recurrence site was left free wall (60.0%, 3/5). Conclusion : These results indicated that the clinical and electrophysiologic characteristics of the multiple accessory pathway patients with WPW syndrome in our study were similar to those of western countries.(Korean J Med 63:394-401, 2002)

수술후 스트렙토조토신으로 치료한 악성 인슐린종 1 예

김명숙,이만호,임병훈,이상종,김병익,전윤창,손봉준,배원길 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.2

Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia. Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement. A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin. He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs. No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively. Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects. His condition is very good and enjoyed his life with full activity to date(J Kor Soc Endocrinol 9:150-155, 1994).

헤파린 부착 JO 스텐트와 미부착 JO 스텐트 삽입술 후의 장기 추적 성적 비교

남창욱,김권배,김기영,김성열,권택근,이영수,조봉기,손봉준,한성욱,김기식,김윤년 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.2

The risk of acute or subacute closure after angioplasty has been minimized by using stent deployment. However, restenosis rating 20% ∼30% after stenting is still most important limiting factor for stenting. We investigated a long-term effect of implantation of a heparin-coated JO stent compared with the use of un-coated JO steno. Thirty eight patients were assigned heparin-coated JO stent{21 patients, JO(H)} or uncoated JO stent(17 patients, JO). All clinical and angiographic parameters were retrogradely reviewed. They were followed up monthly and performed follow-up coronary angiography 7 months later. The clinical and angiographic parameters were statistically not different between two groups, except hypertension {JO:18%, JO(H):52%, p<0.05}. The reference diameter was 3.12±0.53mm in 10 and 2.85 ±0.43mm in JO(H) (p=0.071). The minimum luminal diameter after stenting was not significantly different{2.91±0.52mm in JO, 2.78±0.42mm in JO(H), p=0.381}. The restenosis rate of JO was 32% and JO(H), 35%(p=0.545). Over seven months follow up, it seems that a strategy of elective stenting with heparin-coated JO stent was not more effective than uncoated JO stent.

장간막 섬유종증 1 예

전우규,이상종,정을순,김명숙,배원길,편유장,손봉준,김경수,유영석 대한내과학회 1997 대한내과학회지 Vol.52 No.5

The fibromatosis is a broad group of benign fibrous tissue proliferations of similar microscopic appearance that are intermediate in their biological behavior between benign fibrous lesions and fibrosarcoma. Although various series have been reported of abdominal wall and extra-abdominal desmoid tumors, intra-abdominal desoids are extremely rare. We experienced a case with mesenteric fibroma-tosis occuring in a 30 year-old male. He was admitted to the Kangbuk Samsung hospital complaining of right lower quadrant abdominal mass and abdominal bloating sense. Utrasonography and computed tomography of the abdomen showed a solid mass in the left abdomen surrounded by loops of small bowel. At explorative laparotomy, there was a hard, well circumscribed round mass (25×15×12 cm) in the mesentery of the terminal ilem. After the tumor was dissected from the retro- peritoneum and surrounding tissues, segmental re- section of ileum with end-to-end anastomosis was performed. On the histopathologic examination, it was confirmed as mesenteric fibromatosis. A brief review of the literature on mesentery fibromatosis was done.

인슐린비의존성 당뇨병환자의 말초동맥에 대한 도플러 유량속도 파형분석

김범수,이만호,이상종,김병익,정을순,전윤창,권중혁,손봉준 대한당뇨병학회 1995 Diabetes and Metabolism Journal Vol.19 No.2