피해자의 애원으로 빚어진 살인극

오탁근 한국사법행정학회 1989 사법행정 Vol.30 No.6

위암의 분자생물학적 치료의 이해

오탁근,이상길,Tak Geun Oh,Sang Kil Lee 대한소화기암연구학회 2013 Journal of digestive cancer reports Vol.1 No.1

The five-year survival for patients with gastric cancer improved only modestly over the last 50 years. So, several studies about molecular target chemotherapy were investigated. We reviewed about molecular target chemotherapy for advanced unresectable and metastatic gastric cancer, which has developed recently. EGFR (Epidermal growth factor receptor), HER (Human epidermal growth factor receptor), VEGF (Vascular endothelial growth factor receptor) can be the target of therapy for gastric cancer. Patients with advanced gastric adenocarcinoma who are potential candidates for trastuzumab should have their tumors assayed for the presence of HER2 overexpression utilizing tumor-specific criteria and/or gene amplification. We suggest the addition of trastuzumab to chemotherapy in patients with HER2-positive tumors (as defined by 3+ immunohistochemical staining or FISH positivity), as long as they do not have a contraindication to trastuzumab. Except for trastuzumab, we summarized several studies for molecular target agents which were not validated yet.

Prognostic Factors and Characteristics of Pancreatic Neuroendocrine Tumors: Single Center Experience

오탁근,송시영,정문재,박정엽,방승민,박승우,정재복 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5

Purpose: Pancreatic neuroendocrine tumors (PNET) are a rare subgroup of tumors. For PNETs, the predictive factors for survival and prognosis are not well known. The purpose of our study was to evaluate the predictive factors for survival and disease progression in PNETs. Materials and Methods: We retrospectively analyzed 37 patients who were diagnosed with PNET at Severance Hospital between November 2005 and March 2010. Prognostic factors for survival and disease progression were evaluated using the Kaplan-Meier method. Results: The mean age of the patients was 50.0±15.0 years. Eight cases (21.6%) were described as functioning tumors and 29 cases (78.4%) as non-functioning tumors. In univariate analysis of clinical factors, patients with liver metastasis (p=0.002), without resection of primary tumors (p=0.002), or American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) stage III/IV (p=0.002) were more likely to demonstrate shorter overall survival (OS). Patients with bile duct or pancreatic duct invasion (p=0.031), sized-lesions larger than 20 mm (p=0.036), liver metastasis (p=0.020), distant metastasis (p=0.005), lymph node metastasis (p=0.009) or without resection of primary tumors (p=0.020) were more likely to demonstrate shorter progression-free survival (PFS). In multivariate analysis of clinical factors, bile duct or pancreatic duct invasion [p=0.010, hazard ratio (HR)=95.046] and tumor location (non-head of pancreas) (p=0.036, HR=7.381) were confirmed as independent factors for predicting shorter PFS. Conclusion: Patients with liver metastasis or without resection of primary tumors were more likely to demonstrate shorter OS. Patients with bile duct or pancreatic duct invasion or tumors located at body or tail of pancreas were more likely to demonstrate shorter PFS.

Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis Caused by Achromobacter xylosoxidans : A Case Report and Comprehensive Literature Review

오탁근,백지현,정수진,채윤태,구남수,진범식,한상훈,김창오,송영구,이호영,김준명,최준용 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.3

Achromobacter xylosoxidans is an uncommon cause of peritonitis in patients on maintenance continuous ambulatory peritoneal dialysis (CAPD). CAPD peritonitis caused by Achromobacter xylosoxidans carries high mortality and recurrence rates because of its virulence and resistance to most antimicrobial agents. We experienced a case of CAPD peritonitis caused by Achromobacter xylosoxidans in a patient with hypertension, diabetes mellitus, and end stage renal disease. The patient was treated with intravenous imipenem/cilastatin, and the CAPD catheter was removed. However, the patient died by aspiration pneumonia on the 34th day of hospitalization.

특집-급성 췌장염의 최신 지견 : 급성 췌장염의 병태생리

오탁근 ( Tak Geun Oh ),방승민 ( Seungmin Bang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2

여러 가지 원인이 급성 췌장염을 일으키나 각각의 요인들이 어떤 메커니즘으로 급성 췌장염을 유발하는지에 대한 이해는 급성 췌장염의 원인을 정확히 파악하고 치료하는 데 도움이 될 수 있다. 대표적인 원인 인자로는 만성 알코올 남용과 담석을 꼽을 수 있으며 그 밖에 CFTR mutation과 연관된 가족성 췌장염을 생각해 볼 수 있다. 심한 형태인 괴사성 췌장염에 관해서는 췌장효소의 활성화, 췌장 미세혈관의 손상, 염증인자의 분비가 췌장의 손상과 괴사를 악화시키며 심한 췌장 손상을 받은 일부 환자에서는 전신성 염증반응 증후군까지 진행될 수 있는데 이는 염증소견을 보이는 췌장에서 분비된 활성화된 췌장효소와 사이토카인이 전신으로 순환하면서 발생한다고 볼 수 있다. 일반적으로는 보상화된 항염증 반응이 전신성 염증반응과 균형을 이루면서 회복이 되지만 이와 같은 균형이 깨지면 심한 장기 부전으로 인해 사망으로까지 이를 수 있다. 또한, 급성 췌장염의 경과 중 장내 세균의 전좌(translocation)로 인하여 심한 급성 췌장염 환자의 30%에서 췌장과 췌장주위에 세균감염이 발생할 수 있는데, 이 경우 다발성 장기부전으로 이어질 수 있다. 췌장염의 초기 과정에서는 선방 세포 내의 trypsinogen의 활성화가 중요한 역할을 하나 사망에까지 이르게 하는 전신적 염증 반응의 경우는 독립적인 인자들이 작용하므로 이에 대한 메커니즘 연구 및 그에 맞는 치료법에 대한 연구가 필요한 실정이다. 이와 같이 급성 췌장염은 사망에까지 이르게 할 수 있는 질환으로서 정확한 진단과 치료의 기반이 될 수 있는 급성 췌장염의 병태생리에 대한 이해와 연구가 중요하다. Acute pancreatitis is an inflammatory disease that is caused by various etiologies including gallstone, alcohol or hypertriglyceridemia. Although most cases of acute pancreatitis show self-limiting course, severe cases are still associated with significant morbidity and mortality. The pathogenic mechanisms of acute pancreatitis are not fully understood. However, it is a central dogma that premature intracellular activation of trypsinogen is the earliest pathologic event. Even though it remains unknown how intracellular trypsinogen activation can be caused by such diverse etiologies, this initial insult in pancreatic acinar cells lead to local inflammatory complications and a systemic response or death. Pathophysiologic mechanisms related to the progression of acute pancreatitis include microcirculatory injury, chemoattraction of inflammatory cells, release of pro-inflammatory cytokines, and bacterial translocation to pancreas and systemic circulation. Recently, several interesting transgenic mice model experiments shed a light in trypsin independent mechanism of local and systemic inflammation for progression of acute pancreatitis.(Korean J Med 2013;85:111-115)

다낭성 난소증후군 치험 1례

오탁근 ( Tak Geun Oh ),김송백 ( Song Baeg Kim ),이수정 ( Su Jeong Lee ),유성원 ( Sung Won Ryu ),김지양 ( Ji Ryang Kim ),강정아 ( Jung Ah Kang ) 대한한방부인과학회 2008 大韓韓方婦人科學會誌 Vol.21 No.2

알레르기성 자반증 환자에서 캡슐내시경으로 공장궤양을 진단한 1예

이용강,오탁근,최아라,이지훈,김미나,홍성필 고신대학교의과대학 2012 고신대학교 의과대학 학술지 Vol.27 No.1

Henoch-Schönlein purpura (HSP) is the most common form of systemic vasculitis in children. Palpable purpura, arthralgia, arthritis, abdominal pain and renal involvement are the major clinical manifestations. Gastrointestinal involvement is related with abdominal pain and bleeding. We described a 71 year-old female experienced acute exacerbation of HSP presented with gastrointestinal bleeding. She was hospitalized for hematemesis and diagnosed duodenitis by esophagogastroduonenoscopy (EGD). Duodenitis was improved at EGD checked in 7 days. She still complained of melena and abdominal pain. There were no abnormal findings at sigmoidoscopy. Jejunal ulcer and purpura were diagnosed by capsule endoscopy. Symptoms were relieved after administration of systemic steroid. But she needed renal replacement therapy for 3 months. Small bowel ulcer diagnosed by capsule endoscopy in patients with HSP was rarely described in Korean literature. This case suggests that capsule endoscopy have a role in diagnosis of small bowel ulcer and its severity in HSP with gastrointestinal symptom.

Cholecystectomy for Prevention of Recurrence after Endoscopic Clearance of Bile Duct Stones in Korea

정문재,송명은,이동준,오탁근,박정엽,방승민,박승우,송시영,정재복 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1

Purpose: Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. Materials and Methods: A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. Results: The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). Conclusion: A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.

증례 : 소화기 ; 광역학 치료 후 간 좌엽절제술이 가능하였던 담관 내 유두상 점액 종양 1예

이희승 ( Hee Seung Lee ),오탁근 ( Tak Geun Oh ),정문재 ( Moon Jae Chung ),박정엽 ( Jeong Youp Park ),방승민 ( Seung Min Bang ),송시영 ( Si Young Song ),박승우 ( Seung Woo Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1

IPMN은 매우 드문 질환으로 내시경상 IPMN이 의심될 경우 조직학적 진단을 통해 악성 종양의 가능성을 항상 고려해야 하고 정확한 감별 진단이 필요하다. 또한 IPMN이 담관계 내 수술 범위가 넓은 경우에는 치료 방침이 명확하지 않은 실정이다. 이에 저자들은 수술적 절제가 어려운 광범위한IPMN에 대해 PDT 후 간 좌엽절제술을 시행한 증례를 보고한다. Mucin-hypersecreting bile duct tumors, which closely resemble intraductal papillary mucinous neoplasms of the pancreas, arerare, and both the clinical features and management thereof are poorly understood. As the biliary tract and the pancreas share a commonorigin, the two diseases may exhibit homologous histopathological features. Certain intraductal papillary tumors of the bileduct are associated with production of large amounts of mucin that disturb bile flow and cause severe biliary dilatation, obstructivejaundice, and cholangitis. Herein, we report on a patient with an extensive intraductal papillary mucinous neoplasm of the bile duct,involving both the right and left intrahepatic ducts. The ducts were subjected to photodynamic therapy, followed by lefthepatectomy. The surgical specimen revealed an adenocarcinoma with a negative resection margin. Photodynamic therapy of theintrahepatic ducts was well-tolerated in the present case, and may serve as a useful therapeutic option for selected patients with intraductalpapillary mucinous neoplasms of the bile duct.

호흡기 알레르기질환에서 기도과민반응의 임상적 특징

이재현,윤일선,박희진,조중현,오탁근,박중원,홍천수 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-