만성 췌장염에서 통증, 외분비 및 내분비 기능장애의 치료

전태주 ( Tae Joo Jeon ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.1

만성 췌장염은 점진적인 염증성 질환으로 췌장의 비가역적인 손상 및 섬유화를 유발한다. 이러한 과정은 통증과 외분비장애, 내분비장애와 같은 췌장기능 이상을 일으킨다. 통증은 가장 흔한 증상으로 췌장의 구조적 변화와 신경병적 이상으로 생긴다. 통증 평가는 강도, 지속 시간, 빈도, 삶의 질 등과 연관하여 다각도로 평가해야 한다. 통증의 치료를 위하여 금주, 금연이 필수이다. 진통제 사용은 세계보건기구 지침을 따르며 그 외에 췌장효소, 항산화제, 항우울제, 항경련제 등을 사용할 수 있으나 표준화된 지침은 없고, 상황에 따라 사용할 수 있다. 외분비장애에 췌장효소를 투여할 수 있으며 크기가 2 mm보다 작은 장피복형 최소 미세구이면서 리파아제 함량이 최소 40,000-50,000 USP인 것이 좋다. 식사와 함께 복용하고 치료반응이 없으면 용량을 늘리거나 프로톤펌프억제제나 항생제를 추가해 볼 수 있다. 만성 췌장염과 관련된 당뇨병은 3c형 당뇨병으로 조기 진단 및 매년 추적 검사가 중요하며 1형과 2형 당뇨와의 감별도 중요하다. 적절한 약물 치료에 대한 지침은 현재 없는 상태로 당조절이 잘되고 저혈당이 오지 않도록 생활 개선을 해주는것이 중요하다. 영양실조가 심할 때는 1차적으로 인슐린 사용이 권장된다. Chronic pancreatitis is the progressive and inflammatory disease which will result in the irreversible destruction and fibrosis of the pancreas. These processes cause chronic pain and pancreatic dysfunctions such as exocrine and endocrine insufficiency. Medical treatment for chronic pancreatitis would be reviewed in this article. Abdominal pain should be accessed by using multidimensional approach including pain intensity, pattern, impact on daily function and quality of life. Abstinence from alcohol and smoking should be strong recommendation. The guideline for analgesic therapy follows the principles of the “pain relief ladder” by World Health Organization. The pancreatic enzyme replacement should be considered when exocrine insufficiency is suspected. Enteric-coated microspheres or mini-microspheres of <2 mm in size with a minimum lipase dose of 40,000-50,000 United States Pharmacopeia are the recommended preparations. These preparations should be taken with main meals. Increasing the oral enzyme dose and the addition of a proton pump inhibitor could be considered in cases of unsatisfactory clinical response. Diabetes mellitus secondary to chronic pancreatitis is classified as Type IIIc diabetes mellitus. Optimal pharmacological treatment has not been established yet but should promote life-style changes, which may improve glucose control and avoid hypoglycemia. In patients with severe malnutrition, insulin therapy is recommended as a first choice. Treatment for chronic pancreatitis can include medication, therapeutic endoscopy, interventional radiology, and surgery. Among them, medical treatment is the most important and should be well understood.

Pitfalls in diagnosis of hyperparathyroidism

Tae Joo Jeon(전태주) 대한외과학회 2014 대한외과학회 학술대회 초록집 Vol.2014 No.11

전립선암에서 18F-FDG-PET/CT

전태주 ( Tae Joo Jeon ) 대한핵의학회 2008 핵의학 분자영상 Vol.42 No.-

18F-Fluoride-PET을 이용한 골격계 영상

전태주 ( Tae Joo Jeon ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.4

Bone scintigraphy using 99mTc-labeled phosphate agents has long been the standard evaluation method for whole skeletal system. However, recent shortage of 99mTc supply and advanced positron emission tomography (PET) technology evoked the attention to surrogate radiopharmaceuticals and imaging modalities for bone. Actually, fluorine-18 (18F) was the first bone seeking radiotracer before the introduction of 99mTc-labeled agents even though its clinical application failed to become pervasive anymore after the rapid spread of Anger type gamma camera systems in early 1970s. However, rapidly developed PET technology made us refocus on the usefulness of 18F as a PET tracer. Early study comparing 18F-Na PET scan and planar bone scintigraphy reported that PET has higher sensitivity and specificity in the diagnosis of metastatic bone lesions than planar bone scan. Subsequent reports comparing between PET and both planar and SPECT bone image also revealed better results of PET scan in similar study groups. Rapid clinical application of PET/CT also accumulated considerable amount of experiences in skeletal evaluation and this modality is known to have better diagnostic power than stand alone PET system as well as bone scan. Furthermore 18F-Na PET/CT revealed better or at least equal results in detection of primary and metastatic bone lesions compared with CT and MRI. Therefore, it is obvious that 18F-Na PET/CT has potential to become new imaging modality for practical skeletal evaluation so continuous and careful evaluation of this modality and radiopharmaceutical must be required. (Nucl Med Mol Imaging 2009;43(4):253-258)

Role of Nuclear Medicine in Evaluation of Hyperparathyroidism

전태주(Tae Joo Jeon) 대한갑상선-내분비외과학회 2016 대한갑상선-내분비외과학회 학술대회 논문집 Vol.- No.-

직장-S상 결장에서 발생한 기저양 편평세포암

하태환 ( Tae Hwan Ha ),전태주 ( Tae Joo Jeon ),박지영 ( Ji Young Park ),장용호 ( Yong Ho Jang ),김덕희 ( Deok Hee Kim ),류미진 ( Mi Jin Ryu ),신동현 ( Dong Hyun Sinn ),오태훈 ( Tae Hoon Oh ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.6

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma, which mostly occurs in the upper aerodigestive tracts. Basaloid squamous cell carcinoma also typically arises in the anal canal, but is extremely rare in the lower gastrointestinal tract. A 70-year-old man presented with loose stool and intermittent hematochezia 2 months ago. Colonoscopy showed an ulceroinfiltrative mass on the rectosigmoid colon from 16 cm to 18 cm above the anal verge. Conventional colonoscope could not pass through the lesion but it was possible with pediatric colonoscope. Abdominal CT scan showed 1.6 cm sized wall thickening with circumferential luminal narrowing in the rectosigmoid colon and multiple ill-defined low density masses in both lobes of the liver. Therefore, colon cancer with liver metastasis was suspected. However, basaloid cells were noted on histologic examination, and they were weakly positive for synaptophysin on immunohistochemical study. After palliative lower anterior resection, histologic examination of the resected specimen revealed basaloid differentiation with keratin pearls, and tumor cells were positively stained with high molecular weighted cytokeratin (34BE12) and CK 5/6. Thus, the patient was finally diagnosed with basaloid squamous cell carcinoma of rectosigmoid colon with distant metastases. (Korean J Gastroenterol 2013;62:375-378)

결핵균 중합효소연쇄반응 양성으로 진단된 담낭 결핵

류미진 ( Mi Jin Ryu ),전태주 ( Tae Joo Jeon ),박지영 ( Ji Young Park ),최예나 ( Ye Na Choi ),백승석 ( Seung Suk Baek ),신동현 ( Dong Hyun Sinn ),오태훈 ( Tae Hoon Oh ),김정연 ( Jung Yeon Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1

Gallbladder tuberculosis is an extremely rare disease that is rarely reported in the literature. Arriving at the correct diagnosis of gallbladder tuberculosis is difficult, and it is usually made by histopathologic examination after cholecystectomy. However, due to the low sensitivity of acid-fast stain and culture result, diagnosing gallbladder tuberculosis is still demanding even after tissue acquisition. To overcome this problem, tuberculosis-polymerase chain reaction (TB-PCR) is performed on the resected specimen, which has high sensitivity and specificity. A 70-year-old female who had previously undergone total gastrectomy for advanced gastric cancer was admitted with right upper quadrant pain. Abdominal ultrasonography and computed tomography revealed acute cholecystitis without gallstones or sludge. She underwent cholecystectomy and the histopathologic finding of the specimen showed chronic active cholecystitis without gallstones or sludge. Because she was suspected to have pulmonary tuberculosis, TB-PCR was also performed on the resected gallbladder. TB-PCR showed positive reaction for Mycobacterium tuberculosis and we could diagnose it as gallbladder tuberculosis. Herein, we present a case of gallbladder tuberculosis diagnosed by TB-PCR from resected gallbladder. (Korean J Gastroenterol 2014;63:51-55)

장출혈로 진단된 혈관종에 의한 성인 소장 장중첩증

김선영 ( Sun Young Kim ),전태주 ( Tae Joo Jeon ),홍진희 ( Jin Hee Hong ),김광실 ( Gwang Sil Kim ),오태훈 ( Tae Hoon Oh ),서동대 ( Dong Dae Seo ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.3

Intussusception is primarily a disease of children, and is relatively rare in adults. Unlike childhood intussusception, adult intussusception has an identifiable leading lesion such as malignant or benign neoplasm. However, intussusception caused by hemangioma is very rare. There were few cases of small bowel intussusception caused by hemangioma in adults, but those reports were presented with abdominal pain. This report describes a 65-year-old female who suffered from small bowel intussusception caused by hemangioma presenting with intestinal bleeding. Upper gastrointestinal endoscopy and colonoscopy were performed, but bleeding focus was not found. Abdominal computed tomography showed the target sign of small bowel with a leading point of mass. This mass turned out to be a hemangioma after the small bowel resection. Therefore, small bowel intussusception by hemangioma should be also considered as a bleeding focus when an adult patient presented intestinal bleeding without bleeding focus in the stomach and colon. Herein we report a case of small bowel intussusception caused by hemangioma presenting with intestinal bleeding. (Korean J Gastroenterol 2008;52:183-187)

복부 둔상 3개월 후에 발생한 회장 협착

강건희 ( Gun Hi Kang ),전태주 ( Tae Joo Jeon ),서동대 ( Dong Dae Seo ),오태훈 ( Tae Hoon Oh ),김수현 ( Sooh Yun Kim ),조현선 ( Hyun Sun Cho ),배병노 ( Byung Noe Bae ),김정연 ( Jung Yeon Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.6

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction. (Korean J Gastroenterol 2011;57:370-373)

자궁내막암의 치료 후 루틴 추적검사 방법으로서 FDG-PET/CT의 유용성

이신재 ( Shin Jae Lee ),전태주 ( Tae Joo Jeon ),김승조 ( Seung Jo Kim ),김희진 ( Hee Jin Kim ),안희정 ( Hee Jung An ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.4

목적: 자궁내막암의 치료 후 루틴 추적관찰로써의 FDG-PET/CT의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 자궁내막암으로 치료 받은 환자 중 2004년 1월 1일부터 2008년 1월 31일 사이에 FDG-PET/CT를 시행한 101명의 환자(25-79세, 평균 50.6세)를 대상으로 하였다. 모든 환자에서 종양표지자와 다른 영상의학적 검사(CT, MR)에 대해서도 함께 검토하였다. FDG-PET/CT상 국소 FDG 섭취를 보인 병변을 benign, equivocal, malignant로 분류하였고, equivocal과 maliganat 병변에 대하여 조직학적 혹은 임상적으로 재발유무를 판정하였다. 결과: FDG-PET/CT상 강한 섭취를 보인 경우는 19명의 30개의 병변이었다. Malignant 섭취를 보인 환자는14명이었고, 이중 11예가 재발로 확인되었다. Equivocal 병변을 보인 환자는 5명이었고, 이중 1예가 재발로 확인되었다. 위음성을 보인 경우는 2예가 있었고, 모두 복강내 암종증 환자로 진단되었다. 이상의 결과를 종합하였을 때, 자궁내막암의 치료 후 재발의 평가에 대한 전반적인 결과는 예민도 86 %, 특이도 92 %, 양성예측도 63 %, 음성예측도 98 %, 그리고 정확도는 91 %였다. 결론: 자궁내막암의 치료 후 루틴 추적관찰로써 FDG-PET/CT를 시행할 경우 높은 예민도, 특이도로 재발의 진단에 도움이 될 뿐만 아니라 높은 음성 예측도로 인하여 FDG-PET/CT상 음성인 경우 불필요한 추가 검사를 피할 수 있을 것으로 기대된다. Purpose: The aim of this study was to evaluate the usefulness of FDG-PET/CT as follow up imaging tool in patients with endometrial cancer after therapy. Material and Methods: One hundred one patients with endometrial cancer who underwent FDG PET/CT after the treatment of this disease were included in this study population (25-79 yr old, Mean age 50.6 yr old) and all these patients also performed various laboratory and imaging studies such as serum tumor marker, CT or MRI. The lesions having increased focal FDG uptake were classified into benign, equivocal, and malignant one according to their pattern and activity. Tumor recurrence was confirmed by histopathological results and other clinical and imaging data. Results: Among the 19 patients with 30 malignant or equivocal hot uptakes, 11 of 14 patients supposed to be malignant finding in PET/CT were proved to be tumor recurrence, while one of 5 patients with equivocal lesions were recurred malignancy. Two false negative cases were turned out to be peritoneal carcinomatosis. Estimated sensitivity, specificity and accuracy of PET/CT for diagnosis of recurrence in endometrial carcinoma after treatment were 86 %, 92 % and 91%, respectively. Positive and negative predictive values in the same issue were 63% and 98%, respectively. Conclusion: FDG-PET/CT is useful for regular work up of endometrial carcinoma after the treatment because of its high negative predictive value as well as high sensitivity and specificity. (Nucl Med Mol Imaging 2009;43(4):301-308)