현장리포트: 첫 육계 사육, '306' 결실을 맺다

한재필,Han, Jae-Pil 한국육계협회 2011 월간 닭고기 Vol.17 No.4

증례 : 바소프레신 의존성 거대결절성 부신피질 증식증 1예

한재필 ( Jae Pil Han ),구현철 ( Hyun Cheol Koo ),김익근 ( Ick Keun Kim ),박인일 ( In Il Park ),최현희 ( Hyun Hee Choi ),이성진 ( Seong Jin Lee ),최문기 ( Moon Gi Choi ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

저자들은 전신쇠약감과 체중 증가를 호소하여 시행 받은 신체검사, 호르몬검사, 호르몬 자극검사 및 방사선검사에서 바소프레신 의존성 거대결절성 부신피질 증식증으로 진단되어 케토코나졸 투여 후 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Macronodular adrernal hyperplasia (MAH) is an extremely rare cause of ACTH-independent Cushing syndrome, in which cortisol secretion is autonomous and plasma ACTH level is persistently suppressed. The pathogenesis of MAH is not clear but recent studies suggest that cortisol secretion may be mediated by expression of ectopic or aberrant receptors for gastric inhibitory polypeptide, vasopressin, β-adrenergic agonist or serotonin. The conventional treatment is bilateral adrenalec-tomy followed by concomittent glucocorticoid and mineralocorticoid replacement therapy. We report a fifty-seven year-old man presenting with generalized weakness, weight gain and hematochezia. The endocrinological and radiological findings revealed ACTH-independent MAH, in which plasma cortisol level was abruptly elevated by administration of vasopressin 10 IU. Because he had severe dilated cardiomyopathy, we only prescribed high dose ketoconazole (1,200 mg/day) which suppresses biosynthesis and secretion of cortisol, and thereafter twenty-four hours urinary free cortisol level was dramatically decreased. In summary, these results strongly suggest that aberrant expression of vasopressin receptor may be associated with the pathophysiology of MAH. (Korean J Med 69:S867-S872, 2005)

신용장거래에서의 ISBP에 관한 연구 - 총론적 접근을 중심으로 -

한재필(Jae-pil Han) 한국국제상학회 2004 國際商學 Vol.19 No.2

This thesis is aiming at digging out the overall problems in the application of ISBP for the examination of documents under documentary credit. Since the ISBP is a practical complement to UCP 500, it is not to amend or revise the UCP. The main purpose of the ISBP is to explain in explicit detail how the rules of UCP are to be applied on day-to-day operation for the examination of documents. The main issues which appear to be presently associated to the UCP from the overall point of view are related to (1) the ambiguity in the instruction to issue or amend the documentary credit, (2) waivers in notice of refusal, (3) non-documentary condition and (4) non-bank issued L/C. And it is anticipated that more practice oriented matters will be added as a result of ISBP operation in relation with UCP. In the application of every provision of ISBP, we have to take into account these issues.

케모포트를 이용한 동맥내 항암화학요법 중 발생한 혈전에 의한 우측 대퇴동맥 폐색

한재필 ( Jae Pil Han ),김영석 ( Young Seok Kim ),이세환 ( Sae Hwan Lee ),정승원 ( Soung Won Jeong ),김상균 ( Sang Gyune Kim ),장재영 ( Jae Young Jang ),김홍수 ( Hong Soo Kim ),이재명 ( Jae Myeong Lee ),김부성 ( Boo Sung Kim ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2

Although chemotherapy may not play a central role in the treatment of hepatocellular carcinoma (HCC), it must be one of the important possibilities of multimodal treatment for advanced HCC. Intra-arterial (IA) chemotherapy which can deliver high concentration of drug to the tumor has been widely used in unresectable or intractable HCC. It seems to reduce the incidence of systemic side effects and improve drug efficacy. For this therapy, catheter implantation is required to infuse anti-tumor drug. Here, we report a case of patient with complication developed during IA chemotherapy for advanced HCC with portal vein thrombosis.

보툴리눔 독소 주입 후 증상 호전을 보인 미만성 식도 경련

한재필 ( Jae Pil Han ),홍수진 ( Su Jin Hong ),김훈일 ( Hoon Il Kim ),변진명 ( Jin Myung Byun ),김화종 ( Hwa Jong Kim ),고봉민 ( Bong Min Ko ),이준성 ( Joon Seong Lee ),이문성 ( Moon Sung Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up. (Korean J Gastroenterol 2012;60:109-112)

위장관 ; 미분화 조기위암에서 내시경 점막하박리술의 치료 성적

최문한 ( Moon Han Choi ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),송정엽 ( Jeong Yeop Song ),김대용 ( Dae Yong Kim ),서성우 ( Sung Woo Seo ),하지수 ( Ji Su Ha ),이윤나 ( Yun Nah Lee ),고봉민 ( Bong Min Ko ),이문성 ( Moon Sung 대한소화기학회 2013 대한소화기학회지 Vol.61 No.4

목적: 내시경 점막하박리술은 조기위암의 표준 치료로 받아들여지고 있다. 하지만, 미분화 조기위암에 대한 내시경 점막하박리술의 적응증은 아직 논란이 있다. 이번 연구에서는 확대 적응증에 의한 미분화 조기위암에서 내시경 점막하박리술의 치료 성적에 대해 파악하고자 하였다. 대상 및 방법: 순천향대학교 의과대학 부천병원에서 미분화 조기위암 환자 81명을 대상으로 82병변에 대해 내시경 점막 하박리술을 시행하였다. 치료 성적에 대해 절제 방법(일괄 절제, 분할 절제), 완전 절제율, 합병증, 재발률에 대해 조사하였다. 결과: 일괄 절제율과 완전 절제율은 각각 87.8% (72/82)과 80.5% (66/82)였다. 반지세포암종에서 저분화 선암종과 반지 세포를 동반한 저분화 선암종에 비해 높은 완전 절제율을 보였으나, 통계학적 의미는 없었다(89.3% vs. 75.0%, 76.7%; p=0.347). 저분화 선암종, 반지세포암종, 반지세포를 동반한 저분화 선암종에서 측면절제면 양성이 확인된 경우는 각각 12.5%, 3.6%, 13.3%였다(p=0.395). 기저절제면 양성이 확인된 경우는 각각 12.5%, 3.6%, 10.0%였다(p=0.485). 평균 37.4 개월의 추적기간 동안 재발률은 3.0%였다. 결론: 확대 적응증에 의한 미분화 조기위암에서의 내시경 점막하박리술은 유용한 치료가 될 것으로 생각되나, 장기적이고 대규모의 연구가 필요하겠다. Background/Aims: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication. Methods: At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD. Results: The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months. Conclusions: ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed. (Korean J Gastroenterol 2013;61:196-202)

내시경 점막하 박리술로 제거한 상부 식도의 고유근층 기원 근종

강명수 ( Myung Soo Kang ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),서정연 ( Jung Yeon Seo ),윤라영 ( La Young Yoon ),최문한 ( Moon Han Choi ),김희경 ( Hee Kyung Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.4

The technique of endoscopic submucosal dissection is occasionally used for resection of myogenic tumors originating from muscularis mucosa or muscularis propria of stomach and esophagus. However, endoscopic treatments for esophageal myogenic tumors >2 cm have rarely been reported. Herein, we report a case of large leiomyoma originating from muscularis propria in the upper esophagus. A 59-year-old woman presented with dysphagia. Esophagoscopy and endoscopic ultrasonography revealed an esophageal subepithelial tumor which measured 25×20 mm in size, originated from muscularis propria, and was located at 20 cm from the central incisors. The tumor was successfully removed by endoscopic submucosal dissection and there were no complications after en bloc resection. Pathologic examination was compatible with leiomyoma. (Korean J Gastroenterol 2013;62:234-237)

증 례 : 내시경 점막하 터널 절제술로 제거한 위 분문의 고유근층 기원 근종

정은수 ( Eun Soo Jeong ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),곽정자 ( Jeong Ja Kwak ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.6

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.(Korean J Gastroenterol 2015;66:340-344)

헬리코박터 파이로리 치료 실패 후 레보플록사신을 이용한 3차 구제요법의 기간에 따른 제균율

노형민 ( Hyung Min Noh ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),박경우 ( Kyung Woo Park ),이윤나 ( Yun Nah Lee ),이태희 ( Tae Hee Lee ),고봉민 ( Bong Min Ko ),이준성 ( Joon Seong Lee ),이문성 ( Moon Sung Lee ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.5

Background/Aims: This study evaluated the eradication rate of levofloxacin-containing rescue therapy by treatment duration in patients in whom previous first- and second-line treatment failed. Methods: Fifty-five patients with persistent Helicobacter pylori infection after first-line therapy and second-line therapy were studied in a single referral academic center. We compared the eradication rates by the treatment duration of third-line therapy. Results: Of 55 patients, 12 (21.8%) received rescue therapy for seven days, 24 (43.6%) received rescue therapy for 10 days, and 19 (34.5%) received rescue therapy for 14 days. The eradication rates of therapy with levofloxacin were 65.5% in the 55 enrolled patients and 73.5% in the 49 patients who underwent follow-up testing. In cases where follow-up testing was performed, the eradication rate of 7-day therapy was 58.3%, of 10-day 68.2%, and of 14-day therapy 93.3%. Eradication rate of 14-day therapy was higher than 7-day (p=0.06) and 10-day (p=0.108), but chance could not be ruled out in the difference among groups. Conclusions: This study showed somewhat increasing of H. pylori eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days. (Korean J Gastroenterol 2016;68:260-264)

Acinetobacter 병원내 폐렴에서 다제 내성군과 약제 감수성군 간의 임상적 특징과 예후

박인일 ( In Il Park ),김익근 ( Ick Keun Kim ),구현철 ( Hyun Cheol Koo ),한재필 ( Jae Pil Han ),김영묵 ( Young Mook Kim ),이명구 ( Myung Goo Lee ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.1

연구 배경: A. baumannii는 전 세계적으로 중요한 병원 내 병원균으로 부각되고 있고 이들 균에 의한 감염 또한 빠르게 증가하고 있다. 이들 감염에 연관된 사망률(균혈증:52%, 폐렴:23-73%)은 매우 높고 다제 내성은 비교적 흔하게 발생하고 있는 실정이다. 그러므로 다제 내성 A. baumannii 감염에 대한 효과적인 치료를 위해서 이들의 임상 특징과 결과를 분석하고 이해하는 것이 필요하다. 이에 본 연구는 A. baumannii 병원내 폐렴 중 다제 내성군과 약제 감수성군간의 임상적 특징, 사망률, 이환율을 비교하였다. 방법: 2002년 1월 1일부터 2004년 11월 1일까지 춘천성심병원에 입원했던 환자 중 Acinetobacter 병원 내 폐렴으로 판단되는 47명의 환자를 연구 대상으로 하였고 이들의 의무기록을 후향적으로 분석하였다. 본 연구에서는 다제 내성 A. baumannii를 실험 환경에서 A. baumannii에 효과적이며 상업적으로 이용할 수 있는 모든 항생제에 내성을 보이는 것으로 정의하였다. 결과: 47명의 A. baumannii 병원내 폐렴 환자 중 17명이 다제 내성군, 30명이 약제 감수성군으로 분류되었다. 이들의 평균 연령은 다제 내성군은 69±11세, 약제 감수성군 70±13세이었고 APACHE II 점수, 중환자실 입원기간, 사망률에 있어서 두 군간에 유의한 차이는 없었다(16.1±5.4 vs 14.9±4.8, P=0.43, 25.1±13.6 vs 39.1±31.0, P=0.2, 58.8% vs 40%, P=0.21). 결론: Acinetobacter baumannii 다제 내성군과 약제 감수성군 간의 사망률과 임상적 특징 사이에서 유의한 차이는 보이지 않았다. 그러나 양군 모두 사망률과 이환율은 높게 나타나 A. baumannii 감염의 효과적인 감시 및 조절이 지속적으로 필요하겠다. Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was 69±11 years old and the latter was 70±13 years old. The mean APCHE II score, ICU days and mortality were not different between the two groups(16.1±5.4 vs. 14.9±4.8, P=0.43, 25.1±13.6 vs. 39.1±31.0, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential. (Tuberc Respir Dis 2006; 61: 13-19)