폴립절제 후 추적대장내시경검사 가이드라인

홍성노 ( Sung Noh Hong ),양동훈 ( Dong Hoon Yang ),김영호 ( Young Ho Kim ),홍성필 ( Sung Pil Hong ),신성재 ( Sung Jae Shin ),김성은 ( Seong Eun Kim ),이보인 ( Bo In Lee ),이석호 ( Suck Ho Lee ),박동일 ( Dong Ii Park ),김현수 ( Hyu 대한소화기학회 2012 대한소화기학회지 Vol.59 No.2

1. 기준대장내시경검사에서 샘종이 3개 이상 발견된 환자는 추적대장내시경검사에서 진행신생물이 발견될 위험이 증가한다. 2. 기준대장내시경검사에서 10 mm 이상 크기의 샘종이 발견된 환자는 추적대장내시경검사에서 진행신생물이 발견될 위험이 증가한다. 3. 기준대장내시경검사에서 관융모 또는 융모샘종이 발견된 환자는 관샘종이 발견된 환자에 비해 추적대장내시경검사에서 진행신생물이 발견될 위험이 증가한다. 4. 기준대장내시경검사에서 제거한 샘종이 고도이형성을 동반한 경우, 저도이형성을 동반한 경우에 비해 추적대장내시 경검사에서 진행신생물이 발견될 위험이 증가한다. 5. 기준대장내시경검사에서 10 mm 이상의 톱니모양폴립이 발견된 환자는 추적대장내시경검사에서 진행신생물의 발생위험이 증가한다. 6. 추적검사에서 진행신생물 발생의 고위험군은 기준대장 내시경검사에서 샘종의 개수가 3개 이상, 가장 큰 샘종의 크기가 10 mm 이상, 관융모 또는 융모샘종, 고도이형성을 동반한 샘종, 또는 크기 10 mm 이상의 톱니모양폴립 중 한 가지 이상의 소견이 진단된 경우이다. 7. 일정한 자격을 갖춘 대장내시경의사가 양호한 대장정결 상태에서 양질의 기준대장내시경검사를 시행하였음을 전제로, 기준대장내시경검사 소견이 폴립절제 후 진행신생물의 발생 고위험군에 해당되지 않는 경우 추적대장내시경검사를 폴립절제 후 5년에 시행할 것을 권고한다. 그러나, 상기의 전제 조건이 만족되지 않거나 기준대장내시경검사 이전의 대장내 시경검사에서 고위험군에 해당하는 소견을 보였던 경우에는 기준대장내시경 소견이 고위험군에 해당되지 않더라도 추적 검사 기간을 단축할 것을 권고한다. 8. 일정한 자격을 갖춘 대장내시경의사가 양호한 대장정결 상태에서 양질의 기준대장내시경검사를 시행하였음을 전제로, 기준대장내시경검사 소견이 폴립절제 후 진행신생물의 발 생 고위험군에 해당하는 경우는 추적대장내시경검사를 폴립 절제 후 3년에 시행할 것을 권고한다. 그러나, 상기의 전제조건이 만족되지 않거나 기준대장내시경검사 소견, 샘종의 절제상태, 환자의 전신 상태, 가족력 및 과거력 등을 고려하여 추적검사 기간을 단축할 수 있다. Post-polypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. However, because the medical resource is limited, and the first screening colonoscopy produces the greatest effect on reducing the incidence and mortality of colorectal cancer, there is a need to increase the efficiency of postpolypectomy surveillance. In the present report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy. Based on the results of review of the evidences, we elucidated the high risk findings of the index colonoscopy as follows: 1) 3 or more adenomas, 2) any adenoma larger than 10 mm, 3) any tubulovillous or villous adenoma, 4) any adenoma with high-grade dysplasia, and 5) any serrated polyps larger than 10 mm. In patients without any high-risk findings at the index colonoscopy, surveillance colonoscopy should be performed five years after index colonoscopy. In patients with one or more high risk findings, surveillance colonoscopy should be performed three years after polypectomy. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polyp removal, the patient`s general condition, and family and medical history. This practical guideline cannot totally take the place of clinical judgments made by practitioners and should be revised and supplemented in the future as new evidence becomes available.

대장폴립절제술 가이드라인

이석호 ( Suck Ho Lee ),신성재 ( Sung Jae Shin ),박동일 ( Dong Ii Park ),김성은 ( Seong Eun Kim ),홍성필 ( Sung Pil Hong ),홍성노 ( Sung Noh Hong ),양동훈 ( Dong Hoon Yang ),이보인 ( Bo In Lee ),김영호 ( Young Ho Kim ),김현수 ( Hyu 대한소화기학회 2012 대한소화기학회지 Vol.59 No.2

1. 대장폴립절제술 전 혈전색전증 발생 고위험군에서는 아스피린 복용을 계속해야 하고, 혈전색전증 발생 저위험군에서는 환자 및 폴립의 특성에 따라 중단 여부를 결정해야 하며, 혈전 발생위험이 없는 군에서는 가능하면 아스피린을 중단하는 것이 권고된다. 2. 미소폴립의 제거에서는 완전 제거율, 안정성, 회수조직의 조직학적 적정성 여부를 고려할 때 고온 생검법은 권고되지 않는다. 3. 폴립절제술 시점막하 주사는 조기 출혈 예방에 도움이 되지만 지연 출혈 예방효과는 분명치 않다. 4. 크기가 큰(>1 cm) 목 있는 폴립의 절제에서 절제 전예방적 시술(루프 혹은 클립 유치)은 조기 출혈의 예방에 도움이 되지만 지연 출혈의 예방효과는 분명치 않다. 5. 폴립 절제 후 생성된 인공궤양에 대한 예방적 시술(아르곤플라스마 응고술 혹은 클립 유치술)은 지연 출혈 예방에 도움이 되지 않는다. 6. 폴립절제술 후 조직검사에서 점막하 침범이 있으면서 완전절제(절제면 음성)된 선암으로 판정된 경우 림프관 혹은 정맥 침범이 있거나, 분화도가 나쁜 경우, 침범 깊이가 깊을 경우에는 림프절 전이의 위험이 증가하므로 추가적인 수술적 절제를 고려해야 한다. There are indirect evidences to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary, secondary and tertiary and medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, Pubmed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient`s condition and the available courses of action.

Ro 5-4200 의 임상적 연구

김완식,박동호,김영석,윤주식,한두호,문준일 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.2

Benzodiazepine derivatives, chlordiazepoxide(Librium), diazepam(Valium), nitrazepam(Mogadon) and oxazepam(Serenid-D) are mainly used as hypnotics at present. Diazepam has been used mainly for premedication in anesthesia and as an intravenous anesthetic agent. The pharmacological actions of these drugs are tranquilizing effects for central nervous system, slight depression on the cardiovascular and respiratory system, anticonvulsant, anxiolytic and antidepressant effects. A new benzodiazepine derivative, Flunitrazepam(Ro 5-4200) has strong hypnotic action, is anticonvulsant and antidepressant in spite of slight depression of the cardiovascular and respiratory systems. Furthermore the onset and duration of this drug are shorter than the others. In our clinical study, flunitrazepam in the dosage of 0.005mg/kg was administered intravenously, as an intravenous anesthetic induction agent, for 22 surgical adult patients. In each patient, the blood pressure, pulse rate, respiratory rate, minutes volume and arterial gas study were done, before and after administration of the Ro 5-4200. The results are as follows; 1. Dosage of this flunitrazepam is not constant as other benzodiazepines. 2. The effects of flunitrazepam on the cardiovascular system showed slight depression but no effect by one hour post-operation. 3. In respiratory system, the minute volume was depressed slightly and the respiratory rate was increased but negligibly. 4. Undesirable side effects attributed to this drug were not found, except the developing of cough (one case).

집중치료실관리

김완식,박동호,윤주식,김영석,한두호,문준일 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.2

Sine 1961, Dr. Safar postulated the new form of patient, so called $quot;progressive patient care$quot;, the hospital service in all countries are fashioned with intensive therapy unit. Particulary the- World Federation Society of Anesthesiologists who have discu sincerly at several International congress. we were interested from the literature and visited England, Denmark, United States. and Japan. Of course in Korea, the intensive therapy unit developed from the recovery room and is thus intimately oonnected with anesthesiologists. Here we reviewed with literature and introduced the activities af the iatensive therapy unit of Hanyang University Hospital from May 1972 to October 1973, fram the point view of the definition, building design, location, capacity, equipment, staff organization and charge of patient, several problems and regulations. Furthermore we recommended with the following new ideas for establishment in hospital of an intensive therapy. unit. a. The design should be arranged on the same floor (OR-RR-Anes.-1TU) and in central part of building. b. Several isalation rooms should be made in 1-T-U. c. One central monitoring system will serve each units. d. The 1-T-U equipment should be used with wall trolly system. e. The regulations of 1-T-U should be nated and advocated by all hospital members. f. The beds in 1-T-U should be arranged with open system.

八物湯이 알레르기반응에 미치는 효과

허만규,홍현우,감철우,박동일 대한동의생리학회,대한동의병리학회 2003 동의생리병리학회지 Vol.17 No.4

This experimental research has been done to study the effects of Palmul-tang on the anti-allergic reaction. We found the several important results from the research which has been performed by two experiments toward immediately type and delayed type in order to study the effects of Palmul-tang on hypersensitivity response to mice. The results obtained from our research are as following: The survival rate of one group to which we injected only the compound 48/80 is almost 0% according to its density and timing test. In the other hand, the survival rates of the other group to which we injected both of the compound 48/80 and Palmul-tang are 20%, 0%, 40%, 10%, 20% and 50% according to 0.025, 0.05, 0.1, 0.25 0.5 and 1 (mg/g) of compound 48/80. Time dependency test also shows the 30% and 20% survival rates in 5 and 1 O minutes. Palmul-tang revealed the significantly inhibitory effect on Compound 48/80 induced Mast cell degranulation. Palmul-tang showed the significantly inhibitory effect in the delayed type hypersensitivity response to picry1 chbride. Palmul-tang showed the significantly inhibitory effect in the delayed type hypersensitivity response to sheep red blood cell. Our research provides the important evidence that Palmul-tang is benificial to the prevention and treatment of allergy related oiseases.