간장 및 담도 : Ketoconazole 에 의한 독성간염 4예

강진경(Jin Kyung Kang),박찬일(Chan Il Park),김경희(Kyung Hee Kim),민희원(Hee Won Min),오광제(koyang Jae Oh),김형중(Hyung Jung Kim),전재윤(Jae Youn Jun),정재복(Jae Bock Jung),정우희(Woo Hee Jung) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

N/A Ketoconazole is the broad-spectrum antifungal ageht as an imidazole-dioxolane compound which is metabolized chiefly in the liver. It is used in onychomycosis, chronic mucocutaneous candidiasis, systemic fungal infection, and vaginal candidiasis that is chronic or not healed with topical treatment. Side reactions of ketoconazole are seen in 5%~10% of all the patients medicated but most of them are mild and transient. Nausea and vomiting are the most frequent side reactions. In addition, there are abdominal pain, headache, dizziness, itching sensation, fever, photophobia, diarrhea and transient elevation of serum hepatic enzyme level. However, symptoms of hepatitis develop rarely. In 1984, Lewis and co-workers reported 33 cases of ketoconazole- induced hepatitis and this kind of hepatitis has already been reported twice in Korea. In recent time we experienced 4 cases of hepatitis which had seemed as acute or chronic hepatitis clinically, but had confirmed with peritoneoscopic liver biopsy as toxic hepatitis developed after longterm use of ketoconazole.

증례 식도 상부의 이소성 위점막에서 발생한 원발성 선암

이중민 ( Jung Min Lee ),박승우 ( Seung Woo Park ),배상운 ( Sang Woon Bae ),김재학 ( Jae Hak Kim ),감창우 ( Chang Woo Gham ),이세준 ( Se Joon Lee ),송시영 ( Si Young Song ),정재복 ( Jae Bock Chung ),강진경 ( Jin Kyung Kang ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

The incidence of esophageal adenocarcinoma is steadily increasing. Most of them, however, are attributable to adenocarcinoma arising from the lower esophagus, which is quite contrary to rare incidence of upper esophageal adenocarcinoma. The origins of esophageal adenocarcinoma are postulated to be Barrett`s esophagus, ectopic gastric mucosa, and esophageal gland. Barrett`s esophagus is widely accepted as being associated with lower esophageal adenocarcinoma. On the other hand, ectopic gastric mucosa, which is believed to remain due to congenital defect during the developmental stage and which is found as many as 10% of routine esophagogastroscopy, has been rarely proven to be the origin of upper esophageal adenocarcinoma. In Korea, to our knowledge, no case has been reported yet, and we herein report a case of upper esophageal adenocarcinoma originated from ectopic gastric mucosa with a brief review of previous reports. (Korean J Gastroenterol 2003;41:224-228)

Gemcitabine/cisplatin 항암치료 후 완전관해가 보고된 전이성 췌장암 환자 2례

조중현 ( Jung Hyun Jo ),정문재 ( Moon Jae Chung,),박정엽 ( Jeong Youp Park ),방승민 ( Seun Gmin Bang ),박승우 ( Seung Woo Park ),정재복 ( Jae Bock Chung ),송시영 ( Si Young Song ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1

Pancreatic ductal adenocarcinoma has a very poor prognosis. Patients with this type of tumor have a median overall survival of 9 months in locally advanced pancreatic cancer and 3-6 months in metastatic disease. However, there have been rare cases of patients with advanced pancreatic cancer who survived unexpectedly longer without curative surgery. We report two cases of metastatic pancreatic cancer in patients who presented complete remission after receiving gemcitabine/cisplatin chemotherapy and survived for about 10 years. The first case is that of a 51-year-old Korean woman who was diagnosed with pancreatic body cancer with invasion of the celiac artery and supraclavicular lymph node metastasis. The patient received gemcitabine/cisplatin systemic chemotherapy and achieved complete remission after the 12th cycle of chemotherapy. At present, the patient has survived for 10 years and 2 months after diagnosis. The second case is that of a 69-year-old Korean woman who was diagnosed with pancreatic head cancer with liver metastasis. The patient received gemcitabine/cisplatin chemotherapy and achieved complete remission after the 6th cycle of chemotherapy. At present, the patient has survived for 9 years and 2 months after diagnosis. Our study is the first case report of patients who achieved long-term survival with complete remission after receiving chemotherapy alone for metastatic pancreatic cancer.

A Proposal for the treatment of locally advanced proximal bile duct cancer

Myung-Wook Kim(김명욱),Jae-Bock Chung(정재복),Wook-Hwan Kim(김욱환),Mison Chun(전미선),Kyung-Po Lee(이경포),Hee-Jung Wang(왕희정) 한국간담췌외과학회 1997 한국간담췌외과학회지 Vol.1 No.1

췌장암에서 p53 단백발현의 임상적 의의

박인서(In Suh Park),정재복(Jae Bock Chung),박찬일(Chan Il Park),송시영(Si Young Song),이돈행(Don Haeng Lee),이우정(Woo Jung Lee),박영년(Young Nyun Park) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: Alteration in the p53 tumor suppressor gene are involved in the pathogenesis of diverse human cancer. Immunohistochemical detection of the p53 protein has been strongly correlated with rnutations in the p53 gene. Although p53 overexpression or mutation have been elucidated in a variety of cancers, there has been no study in pancreatic cancer in Korea. The purpose of this study is to evaluate the expression rate of p53 protein in pancreatic cancer. In addition, we attempted to clarify the association between expression of p53 and clinicopathologic features including survival. Methods: Using immunohistochemistry with monoclonal antibody to p53(Zymed Lab. Clone No. BP53-12), we exained 47 formalin-fixed paraffin-embedded tissues of pancreatic cancer(39 intraductal adenocarcinoma, 8 rnucinous adenocarcinoma) for overexpres- sion of p53 gene product. Results: Positive nuclear p53 immunoreativity was detected in 44.6% of pancreatic cancer. No clear correlation was found between p53-positive immunostaining and clinicopathologic features such as age, sex, tumor size, location, histologic type, differentiation of tumor cells and stage of tumnor, etc. The mean duration of survival was 8.6 months in the group of p53 positive and 9.6 months in the group of p53 negative and no difference was noted between two groups. Conclusions: These results suggest that mutation of p53 tumor suppressor gene may play a role in the pathogenesis of pancreatic cancer. However there was no correlation between the presence of p53 overexpression and clinicopathologic features or survival. (Korean J Gastroenterol 1997; 30:98 - 102)

증례 : 복강경으로 성공적으로 절제한 후복막 점액성 낭선종 1예

문성진 ( Sung Jin Moon ),윤영훈 ( Young Hoon Yoon ),전태주 ( Tae Joo Jeon ),정재복 ( Jae Bock Chung ),이우정 ( Woo Jung Lee ),신은아 ( Eun Ah Shin ),김호근 ( Ho Geun Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

저자 등은 28세 여자 환자에서 발생한 후복막 점액성 낭선종 1예를 복강경을 이용하여 성공적으로 치료한 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Primary retroperitoneal mucinous cystadenoma is a extremely rare tumor, reported exclusively in women. There have been about 30 cases of reports in worldwide literature, and only 3 reported cases in Korea to date. Because this tumor is histologically heterogenous and may have metastatic potential, a careful surgical excision with a thorough histopathological examination is needed, and close follow-up is mandatory. While transabdominal laparotomy and complete surgical excision is a standard of treatment, there had been a case-report of laparoscopic resection in 1998. Herein we report a case of primary retroperitoneal mucinous cystadenoma, which was successfully resected by laparoscopy, in 28-year-old woman. (Korean J Med 69:S741-S745, 2005)

조기췌장암 상태에서 발견된 미세선암

강진경(Jin Kyung Kang),박인서(In Suh Park),정재복(Jae Bock Chung),박찬일(Chan Il Park),송시영(Si Young Song),이기명(Kee Myeong Lee),최윤정(Yoon Jung Choi),이우정(Woo Jung Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

Early pancreatic cancer is defined as the tumor size equal to or less than 2 cm, no histologic evidence of capsular invasion, abscence of lymph node, and distant metastasis. Even though there has been remarkable improvement in the diagnostic modalities for panmeatic cancer, the detection in early stages is still very difficult. Pancreatie microadenocarcinoma, which was first described in 1975 by Cubilla, is a very rare form of pancreatic adenocarcinoma. Usually the tumor is relatively large, whieh is composed of small glands, that are smaller than usual duetal adenocarcinoma in sheets or nests of relatively unifrom small cells. It resernbles a carcinoid tumor but special stainings for granules of islet or carcinoid were negative. Most cases of pancreatic mictoadenocarcinoma are diagnosed in the far advanced stage. Their mean survival rate is only 2 months, and it is seldom diagnosed in an early stage. We report a 40-year-old woman of early pancreatic microadenocarcinoma who suffered from right upper quadrant and epigastric aMominal discomfort for 1 year. AMorninal ultrasonography, computed tomography, and magnetic resononce imaging, and endoscopic ultrasonography revealed the pancreatic head mass which satisfied the criteria,for early pancreatic cancer. Pancreaticoduo- denectomy was done and immunohistochemical staining and electromnicroscopic examination of the resected specimen showed fmdings typical of the microadenocarcinoma. (Korean J Gastroen- terol 1997 ; 29: 554-560)

조기간외담관암의 정의에 관한 검토

한기준(Key Joon Han),강진경(Jin Kyung Kang),송시영(Si Young Song),정재복(Jae Bock Chung),박인서(In Suh Park),이우정(Woo Jung Lee),김병로(Byong Ro Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: The early gastric cancer has been defined as that in which the depth of invasion is limited to the submucosa regardless of the lymph node(LN) metastasis. However, in the carcinoma of extrahepatic bile duct, the definition of early cancer may be different, because of the differences of histologic features such as lacking of muscularis mucosa and submucosal layer. Recently, Mizumoto et al. Proposed the definition of extrahepatic bile duct cancer, in which invasion limited to mucosa and fibromuscular layer, however there have been no data in Korea. The purpose of this study is to clarify the concept of early carcinoma of extrahepatic bile duct in Korea. Methods: We evaluated the 60 cases underwent radical operation due to extrahepatic bile duct carcinoma at Severance Hospital, Yonsei University from January l980 to December 1993. Results: The invasion limited to the mucosa(Tla) was noted in 2 cases(3.3%), fibromuscular layer(Tlb) in 11 cases(18.4%), adventitia of fibromuscular layer and serosa(T2) in 22 cases(36.77c) and invasion of adjacent organ(T3) in 25 cases(41.6%). The LN metastasis was found in 16 cases(26.7%). No LN metastasis was noted in Tl, however in T2 the LN metastasis was found in 27.3%(all Nl) and 40.0%(N1: 4 cases, N2: 6 cases) in T3. All cases of Tl but one who recurred at 16 months after surgery survived without recurrence. Disease-free survival according to the T stages were: in Tl, 100%, 90.9%, 90.9% at l, 3, and 5 year, respectively; in T2, 80%, 56% and 37%, respectively; in T3, 83%, 58%, 58%, respectively. The survival rate of Tl was significantly higher than that of T2 and T3(p=0.03). The mean survival in patients of T2 without LN metastasis was 50.5 months, which was longer than that of 38.7 months in cases of T2 with LN metastasis. Multivariate analysis revealed that the depth of invasion was the only significant prognostic factor. The polypoid type and papillary adenocarcinoma were frequently encountered in early cancer comparing advanced cancer. Conclusions: Early cancer of the extrahepatic bile duct could be defined as the tumor invaion restricted to the mucosa and fibromuscular layer. (Korean J Gastroenterol 1995;27:690 - 699)

간외담관의 폐쇄소견을 보인 원발성 간세포암 - 담관조영술 소견을 중심으로 -

박승우(Seung Woo Park),송시영(Si Young Song),정재복(Jae Bock Chung),강진경(Jin Kyung Kang),박인서(In Suh Park),이우정(Woo Jung Lee),김병로(Byong Ro Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.1

N/A Rackground/Aims: Mechanisms of hepatomo-in(luced biliary obstruction include pedunculated tumor extension, obturating bemorrhagic clot and tumor debris, direct invasion of the biliary system by a tumor nodule, and metastatic lymph node compression of the major ducts in the porta hepatis. Usually, the diagnosis has been an unexpected finding at surgery or postmortem and preoperative diagnosis is seldom made, it is very meaning to find out thc characteristics to predict the hepatoma-induced biliary obstruction. This study I, conducted to elucidnte the findings in patients with hepatoma-induced obstructive jaundice. Methods: We reviewed clinical, radiological and surgical findings in six cases of hepatocellular carcinoma who showed jaundice due to obstruction of the extrahepatic bile duct and confirmed histologically from 1990 to 1993, and analyznl the cholangiographic fingdings. Results: The mean age of the patients was 54.2 years and 4 were males, 2 females. The common cholan-giographic tmdings of a11 case. Wvre bulky intraluminal tilling defects, which expand the biliary trce by tumor itself. Thesc defects somewhat resemble a wine- g1ass appearance. The margins of defects were slightly lobulated and somewhat irregular. Defects occurred at various level from the intrahepatic raclicle to the <lista1 common hile duct, however most frequently located in the common hepotic duct. Total obstruction was demonstrated in 2 cases, however stenosis wa.I not noticed in all of our ca.ies. Tissue diagnosis was madc preoperatively by cytologic examination of hile ohtained during ERCP in 2 cases and remaining 4 cases diagnosed by operatively. Conclusions: We may suspect this disease on the findings of bulky filling defects expanding the extrahepatic bile duct especially in common hepatic duct level resembling wine-gIass, and which has lobulated and somewhat irregular surface on cholangiogram. Additionally even though the preoperative histologic diagnosis is difficult, patho1ogic examination of the extracted materials or bile, transpapillary biopsy during ERCP or peroral choledochoscopic examinations are mandatory for the confirmative diagnosis. (Korean J Gastroenterol 1994; 27: 83-95)

내시경적 역행성담관배액법 ( ERBD ) 을 이용한 악성폐쇄성황달의 치료

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),김원호(Won Ho Kim),정재복(Jae Bock Jung),송시영(Si Young Song),이동기(dong Gi Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

N/A To evaluate the clinical usefulness of endoscopic retrograde biliary drainage (ERBD) in the treatment of malignant obstructive jaundice, we analysed 10 patients (common bile duct cancer; 8 patients, pancreas cancer; 1 patient and metastatic cancer; 1 patient) who underwent 14 procedures of ERBD from April 1988 to February 1989 at Yonsei Medical Center. The results were as follows. 1) The success rate for insertion of endoprosthesis was 78.6% (11 of 14 ERBD procedures). The causes of failure were failure of the endoscopic sphincterotomy due to a tumor of the ampulla of Vater in one patient and failure of introducing the guidewire beyond the stenosis in 2 patients. 2) The complications were hemorrhage (1 patient), fever (7 patients), increased serum amylase level (4 patients), cholangitis (5 patients), and sepsis (2 patients). Endoprosthetic complications included obstruction (4 patients) and migration (1 patient). 3) Average interval between the introduction of the endoprosthesis and obstruction was 64.8 days (21,59,82 and 97 days in each patient). 4) The total bilirubin was decreased at 7-14 days after ERBD, and then maintained at low level. 5) Of the 10 patients who received ERBD, 2 patients were lost to follow up, and 3 patients died due to sepsis. It was impossible to make conclusions about the survival time because of the short period of follow-up, however the survival time was longer in the patient treated by chemotherapy and radiotherapy (185 days) than in the patients treated by chemotherapy (range; 24-255 days, mean; 137 days) and by conservative measures (range; 10-81 days, mean 55 days). In conclusion, we thought that ERBD is a useful method of palliative treatment in malignant obstructive jaundice. However, the problem of obstruction of the endoprosthesis must be solved in the future.