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증례 : 혈액종양 ; 동측 신장에서 발생한 동시성 집합관세포암종과 이행세포암종 1예
형건덕 ( Chien Ter Hsing ),목지영 ( Ji Young Mok ),한지선 ( Ji Sun Han ),김태효 ( Tae Hyo Kim ),박종혁 ( Jong Hyeok Park ),나서희 ( Seo Hee Rha ),김효진 ( Hyo Jin Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
동측신장에서 발생한 신세포암종과 이행세포암종은 드문 경우이다. 본 증례는 49세 남자가 좌측 옆구리 통증을 주소로 내원하여 복부단층촬영사진상 좌측신장에 조영이 되는 종괴가 보여 좌측신장 적출술을 시행하였으며 병리학 소견에서 집합관세포암종과 이행세포암종이 동시에 발견되었다. 이 증례에서 동시성 동측신장에서 발생한 집합관세포암종과 이행세포암종이 집합관세포암종 단일존재 했을 때보다 더욱 불량한 경과를 관찰하였기에 문헌고찰과 함께 보고하는 바이다. The coexistence of synchronous ipsilateral primary cancer in the genitourinary system has only rarely been described in the literature. We present the case of a 49-year-old man with left flank pain as an initial presentation. An abdominal CT study showed a mildly enhancing lesion at the left renal mid-pole posterior aspect. A left radical nephrectomy was performed. The pathological diagnosis was a collecting duct carcinoma (CDC) and a papillary transitional cell carcinoma (TCC). This is a rare case of combined renal malignancies. (Korean J Med 77:S1293-S1297, 2009)
형건덕 ( Chien Ter Hsing ),김하연 ( Ha Yeon Kim ),이정현 ( Jung Hyun Lee ),한지선 ( Ji Sun Han ),이종훈 ( Jong Hun Lee ),장진석 ( Jin Seok Chang ),최석렬 ( Seok Reyol Choi ),정진숙 ( Jin Sook Jeong ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis. (Korean J Gastroenterol 2012;59:382-385)
급성췌장염의 중증도 예측에 대한 혈청 Procalcitonin의 효용성 및 절단값
우수미 ( Su Mi Woo ),노명환 ( Myung Hwan Noh ),김병근 ( Byung Geun Kim ),형건덕 ( Chien Ter Hsing ),한지선 ( Ji Sun Han ),유승희 ( Seung Hee Ryu ),서정민 ( Jeong Min Seo ),윤현아 ( Hyun Ah Yoon ),장진석 ( Jin Seok Jang ),최석렬 ( 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1
Background/Aims: The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers. Methods: Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission. Results: Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021). Conclusions: Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis. (Korean J Gastroenterol 2011;58:31-37)
혈중 CA 125 수치가 지속적으로 상승되었던 기관지확장증
신봉철 ( Bong Chul Shin ),구태형 ( Tae Hyoung Koo ),김상옥 ( Sang Ock Kim ),형건덕 ( Hsing Chien Ter ),엄수정 ( Soo Jung Um ),이수걸 ( Soo Keol Lee ),손춘희 ( Choon Hee Son ),김기남 ( Ki Nam Kim ),이기남 ( Ki Nam Lee ),노미숙 ( Me 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.6
Serum CA 125 is the most useful marker for monitoring patients with epithelial ovarian cancer. However, it can be elevated above normal level in a variety of conditions other than ovarian cancer such as endometriosis, pelvic inflammation disease, and other malignant or nonmalignant disorders, including pulmonary diseases. Recently, we experienced a case of bronchiectasis in which the serum CA 125 level was elevated, changing with the patient`s condition. There was no evidence of underlying malignant disease on positron emission tomography or on gynecologic examination, including transvaginal ultrasonography. During follow-up for 14 months, we could not find any clue of malignant disease that could have been the cause of the elevated levels of serum CA 125. Elevated serum CA 125 level should be interpreted carefully according to the patient`s clinical condition. In addition, our case suggests that CA 125 may be used as a surrogate marker for acute inflammatory status for chronic pulmonary diseases.
오유정 ( You Jeong Oh ),한지선 ( Ji Sun Han ),김도경 ( Do Kyong Kim ),정석희 ( Seuk Hee Chung ),김상옥 ( Sang Ock Kim ),형건덕 ( Chien Ter Hsing ),목지영 ( Ji Young Mok ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1
Purpose: Recently the incidence of severe hyponatremia is increasing in old patients but there is no report about clinical findings of old patients with hyponatremia. We evaluated the cause and clinical manifestations of severe hyponatremia in old patients who had been admitted via emergency room. Methods: We retrospectively reviewed clinical records of the hyponatremic patients who had been admitted from 2000 to 2007. We enrolled 53 patients (Age>60 years, Na<125mEq/L) without severe liver cirrhosis, heart failure or chronic kidney disease. We analyzed data to evaluate the differences of clinical manifestations according to the presence of symptoms, taking diuretics, urine sodium concentrations and the degree of hyponatremia. Results: Mean serum sodium concentration was 111.4±6.9mEq/L and urine sodium concentration was 68.7±43.8mEq/L. There was no difference in serum sodium concentration according to age. Twenty-nine (54.7%) patients had nausea and vomiting and 19 patients (35.8%) had neurologic symptoms. Patients with neurologic symptoms showed lower serum and urine sodium concentration than patients without neurologic symptoms. The main causes of severe hyponatremia were poor oral intake (79.2%), diuretics use (37.7%) and recent operation (15.1%). The mean sodium concentration of the fluid administered to achieve 125mEq/L of serum sodium level was 336.5±160.6mEq/L. Conclusion: The urinary sodium loss, e.g., diuretics abuse, may be the main cause of severe hyponatremia in elderly patients over 60 years. In elderly patients, diuretics should be carefully administered with frequent electrolyte monitoring.
복합 항암요법으로 성공적으로 치료한 동시성 식도암과 위선암
한지선 ( Ji Sun Han ),최석렬 ( Seok Reyol Choi ),장진석 ( Jin Seok Jang ),노명환 ( Myung Hwan Roh ),김대철 ( Dae Cheol Kim ),유승희 ( Seung Hee Ryu ),우수미 ( Su Mi Woo ),형건덕 ( Chien Ter Hsing ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2
Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m2) and CDDP (60 mg/m2). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option. (Korean J Gastroenterol 2012;60:113-118)