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소화기; 조기위암에서 내시경점막하박리술 후 국소 재발의 위험인자
김정호 ( Jung Ho Kim ),이정현 ( Jung Hyun Lee ),정준원 ( Jun Won Chung ),안정석 ( Jung Suk An ),원인식 ( In Sik Won ),이지원 ( Ji Won Lee ),하민수 ( Min Su Ha ),김주승 ( Ju Seung Kim ),안홍대 ( Hong Dae Ahn ),박재찬 ( Jae Chan Par 대한내과학회 2013 대한내과학회지 Vol.85 No.3
목적: 내시경 점막하 박리술(endoscopic submucosal dissection, ESD)은 림프절 전이가 없는 조기위암에서 널리 시행되고 있는 치료 방법이다. 하지만 국소 재발과 관련된 위험인자에 관한 연구는 부족하다. 본 연구에서는 조기위암에서 ESD 후국소 재발의 위험인자를 알아보고자 하였다. 방법: 2008년 2월부터 2011년 7월까지 가천대 길병원에서 조기위암으로 진단받고 ESD를 시행받은 214명의 환자, 222예의 병변을 대상으로 의무기록을 후향적으로 검토하였다. ESD 후 추가적인 치료를 시행한 경우와 동일 부위 조기위암재발로 ESD를 2차로 시행한 경우 그리고 12개월 이내의 추적관찰이 시행된 경우를 제외하여 총 150예가 연구에 포함되었다. 결과: 평균연령은 63.9 ± 9.8이었으며 74.3%가 남자였다. 일괄 절제율은 139/150 (92.7%)이고 완전 절제율은 131/150(87.3%)이었다. ESD 시행 부위에서 국소 재발은 5예(3.3%)에서 발생하였으며 평균 추적관찰기간은 24개월이었다. 다변량 분석에서 수평 절제면 양성[HR: 13.12 (1.19-145.10); p =0.036], 분할 절제[HR: 25.31 (1.24-517.57); p = 0.036], 그리고 맥관 침습[HR: 485.06 (2.30-102449.79); p = 0.024]이 국소 재발의 독립적인 위험인자로 확인되었다. 결론: 조기위암의 ESD 후 국소 재발의 독립적인 위험인자는 수평 절제면 양성, 분할 절제, 그리고 맥관 침습으로 확인되었다. 그러므로 이러한 위험인자를 갖고 있는 환자들에서는 국소 재발을 조기에 확인할 수 있는 주의 깊은 추적관찰이 필요하다. Background/Aims: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. Methods: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. Results: The mean age of the patients was 63.9 ± 9.8 years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. Conclusions: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence. (Korean J Med 2013;85:285-293)
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윤능기,윤형렬,서석권,이승훈,이무식,안은주,홍대용,이종영 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.1
To investigate low back pain in rural women, 452 housewives living in the rural areas of Kyungnam province were interviewed during August 1990, and 444 subjects completely done were used for analysis. Attack rate of low back pain during the previous six months was 50.2%. In logistic regression analysis,a history of back injury(odds ratio - 3.439) and presence of other mus-culoskeletal disorders(odds ratio=2.047)were sighificantly independent of attacks of low back pain(p<<0.001), but age and parity were not. Excluding those 70 years old and over or no parity , the frequency of parity showed a significantly independent effect as odds ratio of 1.199(p<0.01)
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Streptococcus constellatus에 의한 경막 외 농양이 동반된 화농성 척추염 1예
안홍대,박재찬,서종구,김진용,김수연,박윤수,서일혜,조용균 대한감염학회 2008 감염과 화학요법 Vol.40 No.5
We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomveltis with epidural abscess to be reported in Korea.
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서종구,박재찬,안홍대,이서영,김진용,박윤수,조용균 대한감염학회 2008 감염과 화학요법 Vol.40 No.6
Klebsiella pneumoniae is a pathogen that causes a wide range of infections in human, and has a tendency to metastasize to multiple organs. We report two rare cases of K. pneumoniae infection that have spread to multiple organs without being accompanied by liver abscess. A 59-year-o1d man (case 1) was admitted due to left knee pain. Microbiologic and radiologic studies revealed bacteremia, septic arthritis, pneumonia, Prostatitis, and endophthalmitis caused by K. pneumoniae. A 48-year-o1d man (case 2) was admitted due to febrile sensation. Microbiologic and radiologic studies revealed bacteremia, pneumonia, urinary tract infection, endophthalmitis, and cerebritis caused by K. pneumoniae. With appropriate use of effective antibiotics and therapeutic measures, the patients recovered but with some sequelae.
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Streptococcus anginosus 균혈증에 동반된 상완 골수염 및 주변부 연조직 농양 1예
한우진,조문숙,이정현,안홍대,윤규현,서종구,김진용,김수연,박윤수,서일혜,조용균 대한감염학회 2008 감염과 화학요법 Vol.40 No.5
Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group, It has often been associated with pyogenic infection, such as periodontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-o1d man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed, Streptococcus anginosus grew in blood culture, He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.
KCI
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