암성통증: 제5의 활력징후인 통증의 강도 측정 및 펜타닐 패취(듀로제식$^{(R)}$)의 통증 조절 효과

최윤선,이준영,임연근,김철수,송홍석,김삼용,김수현,김준석,Choi, Youn-Seon,Lee, June-Young,Lim, Yeun-Keun,Kim, Chul-Soo,Song, Hong-Suk,Kim, Sam-Yong,Kim, Su-Hyun,Kim, Jun-Suk 한국호스피스완화의료학회 2004 한국호스피스.완화의료학회지 Vol.7 No.2

Purpose: Pain management is often needlessly suboptimal. Health care professionals are seldom trained in pain management, may not realize the importance of pain management or recognize that a patient is in pain, and may fear prescribing opioid medications. Noting that one of the problems related to health care professionals is poor assessment of pain, we studied a trend of pain severity and satisfaction with pain controls after using TTS-fentanyl in order to determine whether a regular pain assessment was effective for controlling cancer pain. Methods: We assessed the pain as a $5^{th}$ vital sign after using TTS-fentanyl in 471 hospitalized cancer patients during 4 days. The data were collected from September, 2003 to December, 2003. Pain severity was assessed by using a numeric pain intensity scale($0{\sim}10$) by ongoing pain assessment. Results: Pain assessment as a $5^{th}$ vital sign had led to reduce patient's pain scores. High degrees of satisfaction scores in both patients and doctors with TTS-fentanyl were observed. They were also negatively correlated with the pain severity. Conclusion: Regular pain assessment was effective in the management of cancer pain. 목적: 통증조절 실패의 주요 원인 중 하나는 부적절한 통증 평가이다. 규칙적이고 지속적인 암성통증의 평가가 효과적인 통증조절에 도움이 되는지를 검증하고자 하였다. 방법: 2003년 9월에서 12월 사이 전국 25개 병원에 입원하여 듀로제식$^{(R)}$을 처음 사용한 암환자를 대상으로4일간 통증을 제5의 활력징후로 평가하였다. 평가기간 동안의 일 평균 통증 강도 및 진통제 사용량, 돌발성 통증에 사용한 구제 진통제의 용량 및 투여 횟수를 분석하였다. 결과: 최종 분석대상자는 471명이었으며 평균연령은 57.2세, 남자가 59.1%이었다. 연구시작 전 대상자의 평균 통증강도는 6.0점이었고 78.6%가 진통제를 사용하고있었다. 듀로제식$^{(R)}$을 붙인 후 통증을 활력징후로 측정하였는데, 4일째 일 평균 통증강도는 2.9점으로 감소하였다(P<0001). 활력징후 측정 횟수가 많을 수록 4일간의 일 평균 통증강도가 감소하였다(r=-0.143, P=0.0018). 일 평균 듀로제식$^{(R)}$의 사용량은 통계적으로 유의한 차이를 보이지 않았다(P=0.14). 구제 진통제의 사용량과 횟수는 시간에 따라 감소하였다. 의사65.7%, 환자 58.1%가 듀로제식$^{(R)}$ 사용 후 만족한다고 답하였다. 결론: 암성 통증을 제5의 활력징후로 측정하였을 때 보다 효과적으로 통증조절이 이루어졌다. 듀로제식$^{(R)}$ 또한 암성 통증의 조절에 효과적이며, 안전한 약제이나 처음 사용 시에는 신중한 용량적정이 필요하다.

소세포 폐암의 유두부 전이에 의한 폐쇄성 황달

박홍배(Hong Bae Park),임연근(Yeun Keun Lim),여향순(Hyang Soon Yeo),장진형(Jin Hyeong jang),김연종(Yeon Jong Kim),김호동(Hou Dong Kim),윤형신(Heyong Shin Yoon),이윤호(Youn Ho Lee),손장신(Jang Shin Sohn) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

A 56-year-old man was admitted to our hospital because of jaundice. His chest radiography revealed a mass lesion in the left upper lung. Bonchoscopic lung biopsy was performed and the pathological diagnosis was small cell carcinoma of the lung. In his clinical course, obstructive jaundice developed during combination chemotherapy. The findings of abdominal ultrasonography, duodenoscopy with biopsy and percutaneous transhepatic cholangiography suggested that jaundice was developed by extrahepatic biliary obstruction with ampulla of vater metastasis. We experienced one case of obstructive jaundice by ampullary metastasis of small cell carcinoma of the lung cancer in 56-year-old man.

위내시경으로 (胃內視鏡) 진단된 위암의 (胃癌) 임상적 (臨床的) 고찰

이상호(Sang Ho Lee),김경식(Kyung Sik Kim),박홍배(Hong Bae Park),초상기(Sang Ki Cho),임연근(Yeun Keun Lim) 대한소화기학회 1982 대한소화기학회지 Vol.14 No.2

N/A This report is an analysis of 273 cases of stomach cancer diagnosed by gastrofiberscopy, among whom 105 patients were operated upon at the Kwangju Christian Hospital from May, 1975 to August, 1980. The results obtained were as follows: 1) Of 3282 gastrofiberscopies, gastric cancer was found in 273 (8.32%). The most frequent type of advanced gastric cancer was Borrmanns type III (78.75%). And early gastric cancer was seen in 16 patients(5. 87%). 2) In 273 cases of gastric cancer, male to female ratio was 2.1:1. The peak age incidence was the 6th decade with 35. 5%, the 7th decade with 23. 8%, and the 5th decade with 22. 4% of the patients in that order. 3) The most frequent symptoms were epigastric pain, fullness and indigestion, and epigastric hunger pain. The duration of symptoms were less than 1 year in 66, 6% of patients. 4) Blood group A was the most common(42. 9%). 5) Of those patients also having an upper G-I series 63. 9% were diagnosed as gastric cancer. In patients having liver scans, metastasis of gastic cancer was seen in 81 cases(56.3%) and normal liver scan was seen in 47 cases(32. 6). 6) The most frequent site of gastric cancer was the antrum(49.9%), followed by the body, cardia, and angle of stomach in that order. 7) Positive diagnosis for stomach cancer by gastroscopic biopsy was 63.4%. On touch cytologic examination, Class lV and V were seen in 50. 2%, of the patients. 8) Among the 105 patients with stomach cancer who had surgical intervention, the early gastric cancer patients received radical gastrectomy and advanced gastric cancer patients received palliative surgery. The most common postoperative histological finding was adenocarcinoma (80%).

패쇄성 황달을 동반한 간흡충 감염증에 있어서 내시경적 유두절개술의 의의

윤형신(Hyeong Shin Yoon),김연종(Yeon Jong Kim),김호동(Hou Dong Kim),장진형(JIn Hyeong Jang),임연근(Yeun Keun Lim),여향순(Hyang Soon Yeo),박홍배(Hong Bae Park) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Clonorchiasis is very common in the Far East, especially southern China, Taiwan, Hong Kong, Japan, and Korea, where raw or undercooked fish has long been considered a delicacy. In Korea, people who live in the vicinity of the major four rivers are most frequently infected. 3ome percentage of infected individuals will develop the symptoms of chronic clonorchiasis, which include inflammation, infection, stones, obstruction, and neoplastic changes in the biliary tree. Methods: To evaluate the effects of EST in clonorchiasis patients with obstructive jaundice, 73 patients underwent EST as a method of biliary drainage after praziquantel therapy between August 1989 and July 1991. All of the patients were diagnosed as having clonorchiasis by the stool examination and ERCP and as having obstructive jaundice according to their blood chemistry findings. Results: (pt.; patient) 1) 73 patients, 54 male (74%) and 19 female (26%), underwent EST 1.14 times in average (from 1 to 3 times). 2) The associated diseases of the patients at presentation were biliary stones (22 pt., 30%), pancreatitis (16 pt., 22%), biliary tumors (8 pt., 11%) and liver cirrhosis (5 pt., 7%). 3) AST, ALT, alkaline phosphatase and direct and total serum bilirubin were significantly improved in 32 patients (44%) within 1 week after EST and 63 patients (86%) within 4 weeks after EST (p<.0.01). 4) 10 patients (14%) with biliary tumors (5 pt., 7%), liver cirrhosis (4 pt., 5%) and CBD stone (1 pt., 1%) were not improved in their blood chemistry. 5) Complications (9 pt., 12%) were acute pancreatitis (6 pt., 8%), major bleeding (2 pt., 3%) and acute cholangitis (1 pt., 1%). Conclusion: EST is the very effective, convenient, safe and non-surgical method of biliary drainage in clonorchiasis patients with obstructive jaundice. But it is of little value in most of the patients with biliary tumors and liver cirrhosis.

췌장암에 의해 발생한 총담도와 십이지장 폐쇄 부위에 각각 적용된 이중 스텐트 삽입 1 예

신용주(Yong Ju Shin),오동현(Dong Hyun Oh),기영우(Young Woo Kee),박민호(Min Ho Park),정순일(Sun Il Jeong),강성진(Sung Jin Kang),서강석(Kang Seok Seo),임연근(Yeun Keun Lim) 대한소화기학회 2002 대한소화기학회지 Vol.40 No.4

Pancreatic cancer is not amenable to curative resection generally and therapeutic efforts are directed at palliation of symptoms. Endoscopic palliation of malignant biliary and/or gastrointestinal tract obstruction is available and contributes to improving quality of life. We describe a patient, with unresectable pancreatic cancer who initially presented with malignant biliary obstruction and subsequently complicated by duodenal obstruction. The patient had previously undergone biliary stenting with uncovered metal stent and six weeks later, percutaneous biliary drainage was performed due to stent obstruction by tumor ingrowth. Insertion of an uncovered duodenal stent effectively relieved obstructive symptoms for 6 weeks until restenosis by tumor ingrowth occured. Subsequent insertion of a covered duodenal stent resulted in symptomatic improvement again. Insertion of an another covered biliary stent effectively decompressed biliary obstruction. We report our experience of placement of two double metal stents for simultaneous decompression of malignant biliary and duodenal obstruction. (Korean J Gastroenterol 2002; 40: 278-281)

식도 궤양을 동반한 Behcet 병 1예

김경수,여향순,임연근,조철현,김원영,이승욱,윤봉한,김광현,강명원 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.2

Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature.

내시경적 결찰요법에 의한 상부위장관출혈 치유 3예

윤봉한,이승욱,김광현,조철현,김원영,여향순,임연근,강명원 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3

Upper gastrointestinal bleeding occurs so rapidly that emergency measures are required to avoid exsanguination. Many diseases cause bleeding from the gastrointestinal tract. Patients with upper gastrointestinal bleeding must be quickly assessed and resuscitated. An endoscopy is the diagnostic procedure of choice because of its high rate of accuracy and immediate therapeutic potential. An endoscopy however, must be performed only following adequate resuscitation and clinical assessment of the patient. Recently, reports have described the usefulness of endoscopic O-ring band ligation in the management of upper gastrointestinal bleeding. Endoscopic O-ring band ligation is mucosal ligation using intraluminal negative pressure with an elastic O-ring. We performed an emergency endoscopy in 3 patients who had massive or recurrent episodes of upper gastrointestinal bleeding, identified as having resulted from Dieulafoy lesion and Anisakiasis. We tried to perform an endoscopic ligation using an O-ring band, and were successful in achieving hemostasis. Our conclusion is that endoscopic ligation using an O-ring band can be used effectively to control active upper gastrointestinal bleeding resulting from Anisakiasis and a Dieulafoy lesion.

다발성 골수종과 동반된 만성호중구성 백혈병 1례

김광현,김원영,조철현,이승욱,윤봉한,강명원,임연근,여향순,이명희 大韓血液學會 1998 大韓血液學會誌 Vol.33 No.3

소아에서 출혈을 동반한 단일 연소성 용종의 내시경적 절제술

김준기,조상욱,신성하,고영춘,최정영,서강석,강명원,임연근,여향순,김경수 全南大醫大 2001 전남의대학술지 Vol.37 No.3

화농성 간농양 환자에서 내시경적 역행성 담도 조영술의 유용성에 관한 연구

박종서,박홍배,유성식,강명원,여향순,강성진,우용안,임연근,홍건영 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.2

Background/Aims : This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. Methods: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69:1, and the peak incidence was in the sixth decade. Results : The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage i 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. Conclusions : The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess.