간접문맥조영상 담 , 췌 병변의 간외 문맥침윤 양성 - 수술소견과의 비교

장재천(Jae Chun Chang),이용우(Yong Woo Lee),김홍진(Hong Jin Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: The aim of this study was to obtain the findings about resectability and curative surgery including portal vein resection in extrahepatic portal vein invasion of invasive pancreaticobiliary lesions. Methods: We analyzed the portographic findings of 64 patients with invasive pancreaticobiliary lesions. All cases underwent indirect portography for evaluation of portal vein invasion and were surgically confirmed(curative resection;40, palliative surgery;24). Pathology of materials were pancreatic neoplasm(n=27, including eleven benign or borderline malignancies), ampulla of Vater cancer(n=15), gallbladder cancer(n=10), bile duct cancer(n 10), duodenal adenocarcinoma(n=l), and leiomyosarcoma(n=l). We classified indirect portographic findings as following 6 types, I: normal, II: simple shift, I1I: unilateral narrowing, IV: bilateral narrowing, V: bilateral narrowing with collateral vein, VI: intraluminal filling defect, and compared pathology, presence of portal vein invasion and possibility of portal vein resection on surgical findings. Results: Portographic type was I;18, II;19, III;11, IV;13, V;2, Vl;1. Benign 1esions were confined to I and II, but malignant lesions were distributed from I to VI. We couldnt find portal vein invasion in all I and II, but could find portal vein invasion in all cases of IV, V, VI, and 55%(6/11) in III. Among 22 cases of portal vein invasion, curative resection including portal resection was possible in 4 cases of type III, 1 case of type IV, 1 case of type VI(6/22;27%). Conclusions: Portal vein invasion can be excluded in type I and II, should be considered in type IV, V, and VI, but in cases of type III, we must consider the site, extension of pathology visible in other images. However, portal vein invasion was not always absolute contraindication of curative resection including portal resection. (Korean 3 Gastroenterol 1995;27:711-718)

동문맥 분리조영 영상으로 관찰한 간암경계병변 및 소간암결절의 혈행성상

장재천(Jae Chun Chang) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

N/A We retrospectively analysed intranodular portal and arterial blood pattern in 50 nodules of borderline lesions and/or small hepatocellular carcinoma below 3cm for estimation of chang- ing flow pattern which was in arterial and portal dominant contrast images with its stepwise development. We found that in all borderline lesions and/or small hepatocellular carcinoma, portal flow began to decrease from very early periods in which we could detect by radiologic methods. The nodules without arterial flow increase were 40% in below 1cm group and 16% in all below 3cm groups. Especially, the nodule with even decreased arterial flow was 27% in below lcm group and 10% in all lesions below 3cm groups. Late contrast CT couldn't demon- strated even the presence of mass in 73% of below 1cm group and in 46% of all below 3cm groups. W e concluded that, in the development of classic HCC from borderline lesion, there was tendency to decrease portal flow from very early periods followed by increase arterial flow later than portal flow decrease. Sometimes arterial flow might be decreased at earliest periods. Therefore arterial and portal dominant contrast images had much more sensitivity to detect and qualify the borderline lesion and/or small HCC than conventional methods because of its high detecting capability for minute intranodular blood flow change. And also we could have some benefits for estimation of degree of pathologic evolution using arterial dorninant contrast CT. (Korean J Gastroenterl 1 994; 26: 282-288)

장의 역회전 1 예

박원규 ( Won Kyu Park ),조재호 ( Jae Ho Cho ),장재천 ( Jay Chun Chang ),김재운 ( Jae Woon Kim ),황미수 ( Mi Soo Hwang ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Diagnosis and treatment of a patient with a congenital anomaly of the midgut with persistent symptom in adult can be difficult because it is particularly in adults. Reversed rotation of the midgut is the rarest of all malrotation anomalies. We report a case of reversed intestinal rotation and review the embryology, clinical presentation, and radiographic findings of this disorder. Although this anomaly is rare, it may be diagnosed by the knowledge of embryology and anatomy.

간내 비구역성 관류이상: 동맥강조영상에서 보이는 일시적 간 변연부 관류증가

박원규 ( Won Kyu Park ),장재천 ( Jay Chun Chang ),김재운 ( Jae Woon Kim ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Purpose:This study was done to arrange the cases showing temporally hyperperfusion in the periphery of the liver, to check the etiology and mechanism, and to find out the new radiologic role on diffuse liver disease. Materials and Methods:We reviewed 12 cases of showing transient arterial hyperperfusion in the just peripheral portion of the liver on the arterial dominant phase on dynamic CT and the absence of abnormal perfusion between central and peripheral portion on tissue equilibrium phase. We retrospectively analyzed final diagnosis and the presence of main portal vein thrombi, and cavernous transformation. 1) Results:Final diagnosis in 12 cases was as follows: diffuse liver disease was in seven cases, pancreatitis in three and pyogenic portal thrombosis in two. Main portal vein thrombosis were detected all cases of pancreatitis and pyogenic portal thrombosis. In seven diffuse liver disease, two cases shown thrombosed, two cases shown normal and the other cases are collapsed. Cavernous transformation was in three cases of pancreatitis and two of diffuse liver disease. Conclusion:We think that the causes of this phenomenon maybe as follows: the difference of the hemodynamic compensation mechanism between central and peripheral zone of the liver, presence of microscopic thrombi in peripheral portal branch which cannot be detected by imaging technique, hypercoagulability in portal area, the systematic destruction of terminal portal branch and the development of ectopic portal pathway.

대장게실의 발병양상에 관한 방사선학적 분석

손미영(Mi Young Son),장재천(Jae Chun Chang),황미수(Mi Soo Hwang),김선용(Sun Yong Kim),박복환(Bok Hwan Park),심민철(Min Chul Sim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1

Recently, colonic diverticulosis in Korea is one of the rapidly increasing diseases but it is different from that of western countries in its incidence or developing pattern. So, the authors reviewed 3589 cases of double contrast study of the colon performed for 32 months, from Jan 1st, 1987 to Aug 30th, 1989 at the Department of Diagnostic Radiology, Yeungnam University Hospital to analyze current disease pattern of the colonic diverticulosis. The results were as follows: l) The prevalence was 8.5% (304/3589)and predominant in male(1.9:1). 2) The mean age of patients was 48.4 years and older in female, but their prevalence was not increased with advancing age over 6th decade. 3) The mean number of diverticula was 6.3. 4) Diverticulosis involved several anatomic locations more commonly than one location. 5) Left sided colonic diverticulosis was found in relatively older age group and more frequently involved descending colon than sigmoid colon most commonly seen in western people. 6) Recently, the prevalence of colonic diverticulosis is increasing in both the right and left colon, which is thought to be due to various factors and partly to the routine use of double contrast study of the colon.

간전이 위암환자의 치료 결과 및 예후

김은미,김세원,김상운,이경희,현명수,박원규,장재천,송선교,Kim, Eun-Mi,Kim, Se-Won,Kim, Sang-Woon,Lee, Kyung-Hee,Hyun, Myung-Soo,Park, Won-Kyu,Chang, Jae-Chun,Song, Sun-Kyo 대한위암학회 2006 대한위암학회지 Vol.6 No.4

목적: 간전이 위암환자들을 대상으로 치료 결과를 알아보고 생존 분석을 통해 예후를 확인하고자 하였다. 대상 및 방법: 1990년 3월부터 2006년 3월까지 영남대학교 영남의료원 내과 및 외과에 내원한 위암환자 중 간전이가 발견된 85예(동시성 62예, 이시성 23예)를 대상으로 후향적 연구를 시행하였다. 임상병리학적 인자와 위절제술, 간전이병소 절제술 및 항암화학요법 등 치료 관련 인자들에 대해 생존분석을 실시하였다. 결과: 간전이 위암환자들의 중앙생존기간은 11개월(동시성 11개월, 이시성 17개월)이었다. 동시성 간전이군의 경우 위절제율은 24.1%, 간전이병소 절제율은 16.1%였다. 간외 전이 동반율은 23.5%였고 생존기간에 차이가 있었다(P<0.05). 간전이 병소 절제 및 위절제군, 위절제군, 비절제군의 중앙생존기간은 각각 60개월 이상, 10개월 및 9개월이었다(Fig. 1, P<0.05). 이시성 간전이군의 경우 위암절제 후 무병생존기간의 중앙치는 8개월이었으며 초기병기와 간전이 빈도 사이에는 차이가 없었다. 동시성 간전이군에서는 단변량 분석 결과 간외 전이, 위절제술, 간전이 병소 절제술, 외과적 절제 형태 및 항암화학요법에 대한 반응이 유의하였고 다변량 분석 결과 간전이병소 절제술, 항암화학요법에 대한 반응 및 간외 전이가 독립적 예후인자였고, 이시성 간전이군에서는 간외 전이, 항암화학요법에 대한 반응 및 원발암 세포의 분화도가 유의하였고 간외 전이가 독립적 예후인자였다. 결론: 간전이 위암환자에서 예후는 간전이 병소의 절제, 원발 병소의 절제, 간외 전이 유무 및 항암화학요법에 대한 반응여부에 의해 결정되므로 치료에 있어 간외 전이가 없는 경우 보다 적극적인 절제 노력과 항암화학요법이 생존율 향상에 기여할 것으로 판단된다. Purpose: This study was conducted to evaluate the treatment outcomes and the prognosis for gastric cancer patients with hepatic metastasis. Materials and Methods: This retrospective study was based on the medical records of 85 gastric cancer patients with hepatic metastasis (62 synchronous and, 23 metachronous) who received chemotherapy with or without resectional therapy from March 1990 to March 2006. The survival rate was analyzed according to clinicopathologic factors and therapeutic factors, such as whether or not a gastrectomy, a hepatic resection, and/or chemotherapy had been performed. Results: The median survival of gastric cancer patients with hepatic metastasis was 11 months (synchronous: 11 months and metachronous: 17 months). The rates of gastrectomies and hepatic resections in the synchronous group were 24.1% and 16.1%, respectively A 23.5% prevalence of extra-hepatic metastasis was observed. The median survivals of patients who underwent a gastrectomy with a hepatic resection, a gastrectomy alone, and non-surgical treatment were 60, 18, and 9 months, respectively (P<0.05). The disease-free median survival of the metachronous group was 8 ($3{\sim}39$) months. There was no difference in initial pathologic stage and frequency of hepatic metastasis after the gastrectomy in the metachronous group. In the synchronous group, extra-hepatic metastasis, a gastrectomy as the operative procedure, a hepatic resection as the operative procedure and the response to chemotherapy were statistically significant in the univariate analysis, and a hepatic resection as the operative procedure, the response to chemotherapy, and extra-hepatic metastasis were independant prognostic factors identified by the multivariate analysis. In the metachronous group, extra-hepatic metastasis, the response to chemotherapy and differentiation were statistically significant in the univariate analysis, and extra-hepatic metastasis was an independent prognostic factor identified by the multivariate analysis. Conclusion: An aggressive surgical therapy and effective chemotherapy are necessary in the treatment of gastric cancer patients with hepatic metastasis. (J Korean Gastric Cancer Assoc 2006;6:237-243)

간동맥항암제주입요법으로 병기하향 후 근치절제를 시행한 진행 간세포암종

은종렬 ( Jong Ryul Eun ),이헌주 ( Heon Ju Lee ),김재운 ( Jae Woon Kim ),장재천 ( Jay Chun Chang ),윤성수 ( Sung Su Yun ),최준혁 ( Joon Hyuk Choi ) 대한간암학회 2011 대한간암학회지 Vol.11 No.1

Cure by single modality for advanced hepatocellular carcinoma (HCC) is difficult. Therefore, multidisciplinary approaches are needed to get a better outcome for advanced HCC. In this paper, we report a case of advanced HCC treated with curative surgical resection after downstaging by hepatic arterial infusion chemotherapy (HAIC). A 50-year-old male patient had a maximum 16.0 cm sized HCC in the right lobe. He achieved a partial response after 2 cycles of HAIC with 5-FU (750 mg/m2) and cisplatin (25 mg/m2). After completion of 6 cycles, he received a curative right hepatectomy and the histopathology revealed 95% of tumor necrosis. He is under follow-up without recurrence at 14 months of surgery. This case suggests that surgery after downstaging by HAIC may provide good clinical outcome in advanced HCC.

췌장에서 발생한 파골세포양 거대세포를 가지는 미분화 암종

장한원 ( Han Won Jang ),박원규 ( Won Kyu Park ),장재천 ( Jay Chun Chang ),김재운 ( Jae Woon Kim ),배영경 ( Young Kyung Bae ),최준혁 ( Jun Hyuk Choi ),윤성수 ( Sung Su Yun ),이동식 ( Dong Shik Lee ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of exocrine pancreas. Till recently, some cases have been reported, however histogenesis of the tumors are controversial and their characteristic findings have not been described yet. Thirty five-year-old men and 75-year-old men were presented with upper abdominal pain and a palpable mass. On computed tomography, one case showed a well enhancing solid tumor with low density and the other was showed a mainly cystic tumor with peripheral enhancement in the body and tail of the pancreas. One case accompanied multiple metastatic liver masses with subhepatic lymph node enlargement. Tumor staining was seen on angiography. Biopsy and pancreatectomy were performed. Pathological findings revealed tumors composed of neoplastic spindle shaped or pleomorphic large cells with scattered non-neoplastic osteoclast-like giant cells. In one case, there were small foci of adenocarcinoma components in the periphery of the tumor. On immunohistochemical stain, neoplastic cells showed focal positivity for epithelial membrane antigen and vimentin. Tumors were diagnosed as undifferented carcinoma with osteoclast-like giant cells. We report these rare cases with a review of literature. (Korean J Gastroenterol 2006;48:355-359)

간세포암에서 경동맥문맥조영중 전산화단층촬영 100예의 의의

이헌주(Heon Ju Lee),김홍진(Hong Jin Kim),장재천(Jae Chun Chang),박복환(Bok Hwan Park),조재호(Jae Ho Cho),한건수(Kon Soo Han),심민철(Min Cheol Shim),권굉보(Kyung Bo Kwun),김태년(Tae Nyon Kim),정문관(Mun Kwan Jung) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

N/A We retrogradely analized the meannings of computed tomography during arterial portography (CTAP) compared with conventionally contrast enhanced computed tomography (conventional contrast CT) taken in 100 cases of hepatocellular carcinoma. We could find 57.8% additional borderline. lesions with CTAP in number of patients and 92.5% in numbers of masses. Portal vein invasion which was not demonstrated by conventional contrast CT could be detected by CTAP in 10 cases. In diagnosis of unilatral or bilateral lobe involvement for determinantion of treatment planning, CTAP could prevent 35.5% of mis-underdiagnosis of unilateral lobe involvement by demonstrating the nodule and/or portal vein invasion cf controlateral lobe. In conclusion, CTAP is very usefuI in detection of hidden borderline lesion, portal vein invasion, and recognition of portal venous flow nature in preserved portion of liver. Therefore CTAP is considered essential in pretreatment evaluation of hepatocellular carcinoma for determination of proper treatment principles.

간의 원발성 평활근육종

김홍진(Hong Jin Kim),이동식(Dong Shik Lee),임명국(Myeung Kook Lim),권굉보(Koing Bo Kwun),장재천(Jae Chun Chang),최준혁(Jun Hyeuk Choi) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.57 No.1