단일기관에서의 항혈소판제 복용 환자에서 누두절개술의 경험: 결과, 안정성 및 합병증

백동훈 ( Dong Hoon Baek ),송근암 ( Geun Am Song ),김동욱 ( Dong Uk Kim ),김광하 ( Gwang Ha Kim ),이봉은 ( Bong Eun Lee ),전혜경 ( Hye Kyung Jeon ),지준형 ( Joon Hyung Jhi ),배정호 ( Jung Ho Bae ),이현정 ( Hyun Jeong Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4

Background/Aims: The diagnostic and therapeutic utility of endoscopic retrograde cholangiopancreatography (ERCP) has been well demonstrated for biliary and pancreatic diseases. Biliary access can be allowed by infundibulotomy if failed by using the standard cannulation methods. However, no data are available regarding ERCP-related complications in patients taking antiplatelet agents who are undergoing infundibulotomy. Therefore, we aimed to assess the frequency of ERCP-related complications after infundibulotomy in patients taking antiplatelet agents. Methods: We performed a retrospective study, and enrolled 835 patients who underwent ERCP at Pusan National University Hospital from January 2011 to December 2012. Seventy-two patients had been taking antiplatelet agents prior to the procedure. Patients were classified into two groups according to the utilization of infundibulotomy: 20 patients underwent infundibulotomy (group 1), and 52 patients did not undergo infundibulotomy (group 2). Complications after ERCP were defined as bleeding, post-ERCP pancreatitis, and perforation according to Cotton`s criteria. Results: Between group 1 and 2, there were no significant differences in baseline characteristics. ERCP was successfully performed in all cases. Clinically significant bleeding was observed in one patient in group 1 (5%, 1/20) versus none in group 2. Post-ERCP pancreatitis was observed in 2 patients (10.0%, 2/20) in group 1, and 7 patients (13.5%, 7/52) in group 2 (p=0.691). However, none of these differences were statistically significant. No perforation occurred in both groups. Conclusions: Considering the low incidence of bleeding after infundibulotomy in patients taking antiplatelet agents, infundibulotomy may be safely performed in this group of patients.

창조 이야기 속에 담긴 교육적, 신앙적 의미

백동훈(Dong Hoon BAEK) 창조론오픈포럼 2018 창조론오픈포럼 Vol.12 No.2

The author begins with the premise that "The creation story in the Bible is the starting point of Christian education," which provides the foundation of Christian worldview. He examines the theological implications of the biblical creation story to be heard by our children. In addition, he proposes practical methods how to tell the biblical creation story to our children on the level of faith education. Given the fact that the creation narratives originate from the absolute God, who exists beyond human limits, he suggests that Christian education should start by teaching the creation story in the Bible. The author suggests some important educational methods and elements that should not be missed in education.

EMG와 지자기센서를 이용한 실시간 제어기술 연구

백동훈(Dong Hoon Baek),조예리(Ye Ri Cho),이윤규(Yun Kyu Lee),배동성(Dong Sung Pae),강태구(Tae Koo Kang),임묘택(Myo Taeg Lim) 대한전기학회 2017 대한전기학회 학술대회 논문집 Vol.2017 No.2

유도화학요법 및 국소 치료 후 원격전이를 보인 국소 진행성 두경부암 환자군의 임상 특징 및 위험인자에 관한 연구

이혜원(Hye Won Lee),백동훈(Dong Hoon Baek),이경남(Kyung Nam Lee),조은정(Eun Jung Cho),김효정(Hyo Jeong Kim),설영미(Young Mi Seol),송무곤(Moo Kon Song),최영진(Young Jin Choi),신호진(Ho Jin Shin),정주섭(Joo Seop Chung),조군제(Goon Jae 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.2

Backgrounds:Head and neck cancer is one of the most prevalent cancers in the world. It tends to remain lo-calized at the primary site and regional lymph nodes, but if distant metastasis occurs, it has a poor prognosis. This study was performed to evaluate the prevalence of distant metastasis and to determine the risk factor in local-ly advanced head and neck cancer after induction chemotherapy followed locoregional control therapy. Meth-ods:A retrospective review was performed in 420 patients with locally advanced head and neck cancer who treated with induction chemotherapy followed locoregional control therapy from January 2001 to December 2010. Among them, 31 patients who had distant metastasis as first relapse within 2 years after termination of therapy were analyzed for clinical features and the risk factors of distant metastasis. Results : The overall incidence of distant metastasis was 7.3%. The bone, lung, and liver were the most frequent metastatic organs. In univariate analysis, nodal stage, nasopharyngeal cancer, laryngeal cancer, G3/G4 neutropenia during induction chemother-apy, and concurrent chemoradiotherapy were the influencing factors for distant metastasis. In multivariate analy-sis, advanced N stage and nasopharynx were the risk factors of distant metastasis, and grade 3/4 neutropenia during induction chemotherapy was considered to decrease distant metastasis. Conclusion:This study sug-gests that the advanced N stage is the risk factor of distant metastasis and Grade 3/4 neutropenia during induction chemotherapy can be beneficial against distant metastasis in locally advanced head and neck cancer patients treat-ed with induction chemotherapy followed locoregional control therapy.

원발성 하부위장관 B세포 림프종의 임상 특징 및 예후

차라리 ( Ra Ri Cha ),백동훈 ( Dong Hoon Baek ),이경원 ( Gyeong Won Lee ),박선자 ( Seun Ja Park ),이종훈 ( Jong Hoon Lee ),박종하 ( Jong Ha Park ),김태오 ( Tae Oh Kim ),이상훈 ( Sang Heon Lee ),김형욱 ( Hyung Wook Kim ),김현진 ( Hy 대한소화기학회 2021 대한소화기학회지 Vol.78 No.6

Background/Aims: This multicenter study reviewed the clinical features and prognosis according to the primary site of involvement and the treatment modality in patients with B-cell primary intestinal lymphoma (PIL). Methods: Among 125 consecutive patients diagnosed with PIL, 100 patients were analyzed. Results: The median age was 59 years, and the male to female ratio was 1.86:1. Diffuse large B-cell lymphoma (66/100, 66.0%) was the most common histological subtype. The estimated 5-year survival rate (5-YSR) was 48.5%. The 5-YSR was similar regardless of the type of primary treatment (chemotherapy alone vs. surgery/chemotherapy, 50.7 vs. 45.3%, p=0.582). A comparison of the survival according to the primary site of involvement revealed a 5-YSR of 32.5% (p=0.027), 64.3% (reference), 46.5% (p=0.113), and 49.8% (p=0.024) for the small intestine, ileocecal region, large intestine, and multiple sites, respectively. Multivariate analysis, however, revealed a low hemoglobin level, advanced Ann Arbor stage, and aggressive histological type to be independent prognostic factors for shorter survival but not ileocecal region involvement. Conclusions: The Ann Arbor stage, hemoglobin level, and histological type were independent prognostic factors for survival, while the primary site of involvement and treatment modality did not affect the prognosis in patients with B-cell PIL. (Korean J Gastroenterol 2021;78:320-327)

골반환 손상에서 발생하는 신경 손상

김지완 ( Ji Wan Kim ),백동훈 ( Dong Hoon Baek ),김재현 ( Jae Hyun Kim ),김영창 ( Young Chang Kim ) 대한골절학회 2014 대한골절학회지 Vol.27 No.1

목적: 골반환 손상에서 발생한 신경적 손상 정도를 파악하고 신경 손상에 영향을 주는 위험 인자를 알아보고자 한다. 대상 및 방법: 2010년 3월부터 2013년 5월까지 골반환 손상 62예를 대상으로 하였으며 신경적 손상이 의심되는 경우 근전도 검사를 시행하여 확인하였다. 동반 손상, 골절 분류, 후방환 전위 정도에 대한 조사를 하여 신경적 손상에 영향을 미치는 인자를 분석하였다. 결과: 전체 62예 중 AO/OTA 분류상 A형이 7예, B형이 37예, C형이 18예였다. 척추 골절이 동반된 경우가 25예(40%)였고, 골절의 전위 정도는 평균 7 mm (1-50 mm)였다. 신경적 손상이 있는 경우는 20예였으며 이 중 골반환 손상과 관련된 신경적 이상은 13예(21%)였다. 요천골 신경총 병변 5예, 제5요추 및 제1천추 신경 근병증 5예, 폐쇄 신경 손상 2예, 외측 대퇴 피부 신경 손상 1예였다. 골절 분류별 신경 손상의 빈도는 통계적으로 차이가 없었다. 신경 손상에 영향을 미치는 요인은 후방환의 전위 정도 및 동반한 척추 골절로 나타났다(p=0.006, p=0.048). 결론: 골반환 손상 시 이와 관련된 신경 손상은 21%에서 발생하였으며, 후방환의 전위 정도와 동반된 척추 골절이 신경 손상에 영향을 미치는 것으로 나타났다. Purpose: To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures. Materials and Methods: Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury. Results: There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048). Conclusion: The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

수술과 항암치료 후 종양표지자 검사의 상승으로 복막 가성점액종의 재발을 확인한 1례

한인섭,송근암,김광하,이봉은,백동훈,이성준,이문원,한성용,In Sub Han,Geun Am Song,Kwang Ha Kim,Bong Eun Lee,Dong Hoon Baek,Seong Jun Lee,Moon Won Lee,Sung Yong Han 대한소화기암연구학회 2016 Journal of digestive cancer reports Vol.4 No.1

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by profuse jelatinous materials in the abdominal cavity and pelvis with mucinous implants on the peritoneal surface. There are some studies for serum tumor markers, including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125), to assess the risk of recurrence following cytoreductive surgery and intraperitoneal chemotherapy. However, rare cases were reported about recurrence with increasing serum CEA levels. Herein, we report a case of recurrence of PMP according to serially elevated serum CEA.

증례 : 새롭게 진단된 HIV 감염 환자에서 보고된 자가면역성 저혈당 1예

이혜원 ( Hye Won Lee ),백동훈 ( Dong Hoon Baek ),이경남 ( Kyung Nam Lee ),조은정 ( Eun Jung Cho ),김상수 ( Sang Soo Kim ),김보현 ( Bo Hyun Kim ),김인주 ( In Joo Kim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1

인슐린 항체에 의한 자가면역성 저혈당의 기전에 대해서는 뚜렷한 결론은 없지만, 항인슐린 항체와 인슐린의 결합과 분리의 부조화로 나타난다고 보고되고 있으며, 여러 약제 및 자가면역 질환들과 동반되는 경우가 많다. HAART의 개발로 HIV 환자군의 생존률이 크게 향상되면서 HIV 감염 및 후 천성 면역 결핍 증후군과 자가면역질환의 발생이 관련이 있다는 보고가 증가하고 있으며, protease inhibitor를 복용한 환자군에서 당 불내성 등의 대사 장애가 나타나는 것으로 알려져 있다. 저자들은 내인성 고인슐린혈증을 동반한 저혈당 환자의 평가과정에서 후천성 면역 결핍증후군에 병발한 자가면역성 저혈당을 진단하였고, 후천성 면역 결핍증후군의 치료 과정 중 자가면역성 저혈당의 임상적 소견이 호전됨을 보였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hypoglycemia is a rare cause of hypoglycemia, characterized by insulin autoantibodies, hyperinsulinemia, and fasting hypoglycemia without previous insulin immunization. This paper reports autoimmune hypoglycemia in a patient with a newly diagnosed HIV infection. A 63-year-old female visited the emergency room because of decreased mentality with a low blood glucose and high plasma insulin concentration. There was no evidence of insulinoma and the anti-insulin antibody was positive at 92.42%, so she was diagnosed with autoimmune hypoglycemia. She also had positive human immunodeficiency virus (HIV) antibody tests, and the CD4-positive T cell count was 28/uL. Therefore, a diagnosis of acquired immunodeficiency syndrome (AIDS) was confirmed and she was started on highly active antiretroviral therapy (HAART). The prednisolone therapy for the autoimmune hypoglycemia was held. Subsequently, she has maintained a stable plasma glucose level without dextrose. The recovery from hypoglycemia may reflect the disease course of the autoimmune hypoglycemia, or be the effect of a protease inhibitor.

강직성 고관절의 인공 고관절 전치환술로의 전환에서 임상적 결과에 영향을 미치는 예후 인자들

이수호 ( Soo Ho Lee ),백동훈 ( Dong Hoon Baek ),강석중 ( Seok Joong Kang ),조수현 ( Su Hyun Cho ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

목적: 고관절 자체의 동통 뿐만 아니라 인접 관절의 동통, 강직에 의한 고도의 기능적 제약 등도 적응증이 되는 강직성 고관절의 전치환술로의 전환에 있어 술후 임상적 결과에 영향을 미치는 예후인자들을 분석하여 수술 여부의 결정 등에 도움을 주고자 하였다. 대상 및 방법: 46명, 53고관절을 대상으로 하였으며 추시 기간은 평균 3년 4개월이었다. 예후 인자로 강직의 종류, 강직 시기 및 강직 기간, 외전근의 발달 정도, 선행 질환, 하지 부동의 정도, 삽입물의 종류, 대전자 절골술의 시행 여부 등을 분석 대상으로 하였다. 이에 따른 임상적 결과로 수술 전후의 Harris 고관절 점수(동통, 보행, 활동도), 고관절 운동범위 및 인접 관절의 동통 완화도 등을 후향적으로 조사하여 예후 인자로서 의미 있는 변수가 무엇인지를 통계학적으로 분석하였다. 결과: 골성 강직보다 고도의 섬유성 강직이, 외과적 강직보다 자발적 강직이, 15세 이전보다 이후에 발생한 강직이 Harris 고관절 점수와 인접 관절 동통 완화도에서 보다 의미 있는 호전을 보였으며, 외전근의 강한 수축력이 Harris 고관절 점수 중 특히 보행에 중요한 예후인자로 나타났다. 결론: 강직성 고관절에 관절 가동성을 부여하는 전치환술로의 전환에서는 예후 인자를 미리 파악하여 환자의 요구에 응하는 것이 중요하다고 사료된다. Purpose: To analyze the prognostic factors influencing clinical outcomes and to aid the surgeon`s decision making concerning conversion of ankylosed hip to total hip arthroplasty (THA). Materials & Methods: Forty-six patients (53 hips) with a mean follow-up duration of 3 years 4 months were studied. Prognostic factors including type of ankylosis, age at fusion, abductor development, fusion duration, preceding diseases, leg length discrepancy, implant type, and trochanteric osteotomy were analyzed. Clinical results were evaluated retrospectively using Harris hip score (HHS; pain, gait, activity), pain scale of adjacent joints, and range of motion. Results: Favorable prognosis factors were severe fibrous ankylosis, spontaneous ankylosis, and age at fusion over 15 years. Unfavorable factors were bony ankylosis, surgical ankylosis, and age at fusion under 15 years in HHS and pain scale of adjacent joints. Strong contraction of the abductor muscle was also an important prognosis factor in HHS, especially in gait. Conclusion: In conversion of ankylosed hip to THA, it is important to recognize the possible prognostic factors and to meet the patient`s various demands and needs.

아르곤 플라스마 응고소작술로 치료한 담관내 유두상 점액 종양

박상규 ( Sang Gyu Park ),백동훈 ( Dong Hoon Baek ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),송근암 ( Geun Am Song ),안상정 ( Sang Jeong Ahn ),김동욱 ( Dong Uk Kim ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.1

담관내 유두상 점액 종양은 담관내에서 흔히 발견되며, 최근에는 전암성병변으로 인식되어 왔다. 담관내 상피세포의 유듀상 성장과 점액생성 및 그로 인한 간내담관의 확장을 특징으로 한다. 수술적 절제가 악성 변화를 막기 위한 최선의 방법이다. 담관내 유두상 점액 종양에 대한 연구가 증가하고 있지만 수술이외의 치료에 대한 보고는 많지 않다. 우리는 75세 여자 환자가 우연히 담관내 유두상 점액 종양으로 진단 받고 아르곤 플라즈마 응고소작술로 성공적 치료를 받은 경 우를 보고한다. 환자의 나이와 동반질환 등을 고려하여 수술 적 절제보다는 아르곤 플라즈마 응고소작술을 시행하였고, 치료 4주 후 시행한 경피 경간 담도내시경에서 잔여종양의 증거는 없었다. Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is frequently found and has recently been recognized as a precancerous lesion leading to invasive carcinoma characterized by papillary growth of the ductal epithelium with rich mucin production and cystic dilatation of the hepatic duct. Surgical resection is the treatment of choice to avoid malignant transformation. Despite a growing number of studies on IPMN-B, there are few reports of its treatment aside from surgery. A 75-year-old woman was incidentally diagnosed as IPMN-B. Considering the patient`s age, comorbidity, and preference, we recommended an argon plasma coagulation (APC) as local ablation therapy rather than surgical resection. There was no evidence of remnant tumor on percutaneous transhepatic cholangioscopy 4 weeks after the ablation of tumor mass by using APC. We report a rare case of IPMN-B successfully treated with APC.