십이지장에 초점을 맞춘 기능성 소화불량증의 새로운 병태생리와 치료

차라리 ( Ra Ri Cha ),김현진 ( Hyun Jin Kim ) 대한소화기학회 2020 대한소화기학회지 Vol.75 No.2

상부위장관 상피하병변 환자에서 상피하종양과 위장관기질종양의 예측인자

차라리 ( Ra Ri Cha ),오혜원 ( Hye Won Oh ),유현선 ( Hyun Seon Yoo ),홍정우 ( Jeong Woo Hong ),이상수 ( Sang Soo Lee ),김홍준 ( Hong Jun Kim ),하창윤 ( Chang Yoon Ha ),김현진 ( Hyun Jin Kim ),김태효 ( Tae Hyo Kim ),이옥재 ( Ok Jae 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4

목적: 위장관 상피하병변에서 종양성 병변을 비종양성 병변으로부터 감별하는 것은 환자의 적절한 치료에 매우 중요하다. 저자들은 상부위장관 상피하병변 환자에서 종양성 상피하병변을 감별할 수 있는 예측인자를 알아보고자 이 연구를 수행하였다. 대상 및 방법: 2008년 1월부터 2013년 6월까지 경상대학교병원에서 상부위장관 상피하병변에 대해 EUS를 시행한 527예의 의무기록을 후향적으로 검토하여, 내시경적 또는 수술적 절제를 통하여 조직학적 확진이 가능했던 환자 84예를 선정하고, 종양 및 비종양성 상피하병변으로 분류하여 특성을 비교 분석하였다. 결과: 조직학적으로 확인된 84예의 상피하병변 중 상피하종양이 64예(76.2%), 비종양성 상피하병변은 20예(23.8%)였다. 상피하종양은 GIST (42.9%)와 평활근종(19.0%)이 가장 많았다. 성별(p=0.195), 병변의 크기(p=0.266), 에코상(p=0.051)은 상피하종양군과 비종양성병변군 사이에 유의한 차이가 없었다. 비종양성 상피하병변군에 비하여 상피하종양군의 평균연령 (p=0.047), 호발연령대(p=0.047) 및 50세 이상 환자의 비율 (p=0.015)이 높았으며, 고유근층 기원(79.7%)이 많았다. (p=0.001). 상피하종양 중, GIST는 평활근종보다 환자의 평균연령이 높고(57.7세 vs. 47.0세, p=0.049), 50세 이상 (p=0.016), 종양의 위체부 위치(p<0.001), 고유근층 기원 (p=0.003)이 많았다. 다변량분석에서 환자의 연령(≥50세), 종양의 크기(≥30 mm), 고유근층기원이 점막하종양의 독립적인 예측인자였고, 평활근종과 GIST의 감별인자는 찾을 수 없었다. 결론: 상부위장관 상피하병변으로 50세 이상, 30 mm 이상, 고유근층 기원이 상피하종양의 독립적인 예측인자였으며, 평활근종과 감별할 수 있는 GIST의 예측인자는 없으므로 고유근층 기원의 위 상피하종양은 GIST의 가능성을 고려하여 적극적인 치료 및 철저한 추적관찰이 필요하다. Background/Aims: Differentiating subepithelial tumor (SET) from non-neoplastic gastrointestinal subepithelial lesion (SEL) and gastrointestinal stromal tumor (GIST) from leiomyoma are very important for proper management. This study was conducted to analyze factors that could predict the presence of SET and GIST in patients with upper gastrointestinal (UGI) SELs. Methods: A total of 527 patients were diagnosed with UGI SELs endosonographically at Gyeongsang National University Hospital from January 2008 to June 2013. Among these patients, histologic diagnosis was made in 84 patients. Data were collected by retrospectively reviewing the medical records. Variables that could differentiate neoplastic from non-neoplastic SELs and GIST from leiomyoma were analyzed. Results: Among 84 patients with SELs, 64 (76.2%) had SETs including GIST (42.9%) and leiomyoma (19.0%). The patients` mean age (p=0.047), peak age distribution (p=0.047), proportions of patient ≥50 years (p=0.015), and number of proper muscle-originated lesions (p=0.001) were higher in neoplastic than non-neoplastic group. There were no significant differences in gender (p=0.195), size (p=0.266) and echogenicity (p=0.051) of the lesions. Older age (57.7 vs. 47.0 years, p=0.049), age ≥50 years (p=0.016), location in gastric body (p<0.001), and proper muscle origin (p=0.003) were significantly related to the presence of GIST compared to leiomyoma. Multiple regression analysis showed that the patients` age ≥50 years, size ≥30 mm, and proper muscle-origin of lesion were independent predictors of SET; however, there were no predictive factors that could differentiate GIST from leiomyoma. Conclusions: In patients with SEL, the possibility of having SET should be considered for patients ≥50 years with UGI SELs ≥30 mm that arise from the proper muscle. Thorough monitoring and aggressive management is warranted for those with gastric muscular SET since factors predictive of GIST are lacking. (Korean J Gastroenterol 2014;64:189-197)

식도 암육종 환자에서 이시적으로 발생한 식도 편평상피세포암

차라리 ( Ra Ri Cha ),정운태 ( Woon Tae Jung ),오혜원 ( Hye Won Oh ),김희진 ( Hee Jin Kim ),하창윤 ( Chang Yoon Ha ),김홍준 ( Hong Jun Kim ),김태효 ( Tae Hyo Kim ),고경혁 ( Gyung Hyuck Ko ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.6

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogastroduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma. (Korean J Gastroenterol 2014;64:364-369)

위염전

차라리 ( Ra Ri Cha ),김현진 ( Hyun Jin Kim ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.1

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)

호산구성 장염

차라리 ( Ra Ri Cha ),안효정 ( Hyo Jung An ),김현진 ( Hyun Jin Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.2

로마 기준 IV 이해하기: 과민성 장증후군과 기능성 설사

김현정 ( Hyun Jung Kim ),차라리 ( Ra Ri Cha ),김현진 ( Hyun Jin Kim ) 대한내과학회 2017 대한내과학회지 Vol.92 No.4

Irritable bowel syndrome (IBS) is a common, chronic functional gastrointestinal disorder affecting the large intestine, and pres-ents as abdominal pain and/or discomfort, bloating, gas retention, diarrhea, and constipation. IBS impairs quality-of-life and re-quires long-term management. In 2016, the Rome Foundation introduced new IBS diagnostic criteria (the Rome IV criteria), and al-so revised the diagnostic algorithms for, and the multidimensional clinical profile (MDCP) of, functional gastrointestinal disorders. The IBS MDCP includes clinical data, the extent to which normal daily activities are affected, and psychosocial and physiological measures. The criteria seek to aid physicians in choosing appropriate treatment for IBS patients. Herein, we seek to provide evi-dence-based practical information on IBS and functional diarrhea. We review the new Rome diagnostic IV criteria, the MDCP, and the various IBS treatment options. We suggest that, in clinical practice, combination therapies may be useful to treat patients with IBS of various grades. (Korean J Med 2017;92:366-371)

다발성 전이를 동반한 후복막강 악성 혈관주위상피모양세포종양

오혜원 ( Hye Won Oh ),김태효 ( Tae Hyo Kim ),차라리 ( Ra Ri Cha ),김나영 ( Na Young Kim ),김현진 ( Hyun Jin Kim ),정운태 ( Woon Tae Jung ),이옥재 ( Ok Jae Lee ),이정희 ( Jeong Hee Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.5

Perivascular epithelioid cell tumors (PEComas) are unusual mesenchymal neoplasms composed of histologically and immunohistochemically distinct perivascular epithelioid cells (PECs). Although PEComas have the potential to behave in a malignant fashion, malignant PEComas arising from the retroperitoneum are extremely rare. A 68-year-old woman presented with a painful palpable mass in her left upper abdomen. Computed tomography of the abdomen showed a 9 cm sized heterogeneous mass in left para-aortic space and multiple hypervascular nodules in the liver. 18F-fludeoxyglucose-PET/CT showed multifocal hypermetabolic lesions in retroperitoneum, liver, and skeletal bones. Percutaneous needle biopsies were done on the retroperitoneal and hepatic mass. Both specimens were positive for human melanoma black-45 (HMB-45) on histological and immunohistochemical staining which was compatible with PEComas. Herein, we report a rare case of retroperitoneal PEComa with multiple metastases involving liver and bone at initial diagnosis that exhibited aggressive behavior and resulted in a devastating prognosis. (Korean J Gastroenterol 2014,64:302-306)

증례 : 소화기; 알코올 간경변 환자에서 발생한 자발성 근육 내 혈종 3예

유동훈 ( Dong Hoon Lew ),최자윤 ( Ja Yoon Choi ),차라리 ( Ra Ri Cha ),오혜원 ( Hye Won Oh ),조윤원 ( Yun Won Jo ),민현주 ( Hyun Ju Min ),이옥재 ( Ok Jae Lee ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4

자발성 근육 내 혈종은 간경변 환자에서 드물지만 치명적인 합병증이다. 저자들은 알코올 간경변 환자에서 자발적으로 발생한 근육 내 혈종 3예를 경험하여 보고하는 바이다. 출혈 혈관에 대하여 반복적인 경동맥 색전술을 시행하였음에도 불구하고 지속되는 출혈과 간부전으로 모두 사망하였다. 현재까지 보고된 간경변 환자에서 발생한 자발성 근육내 혈종 14증례에서 알코올 간경변 환자에서 가장 많이 발생하였으며 빠른 진단과 치료에도 불구하고 사망률이 높았다. 따라서 간경변 환자에서 발생하는 자발성 근육 내 혈종은 드물지만 예후가 매우 불량하여 이의 발생과 치료에 주의를 요한다. Liver cirrhosis is commonly associated with bleeding complications due to portal hypertension or coagulopathy. Spontaneous muscle hematoma is a rare but potentially lethal complication of liver cirrhosis. Here we report three cases of spontaneous muscle hematoma diagnosed in patients with alcoholic liver cirrhosis. All three patients died due to recurrent bleeding and liver failure although they had undergone repeated transcatheter arterial embolization of the actively bleeding vessels. We reviewed 14 cases of spontaneous muscle hematoma that were associated with liver cirrhosis, including our cases, and found that the mortality rate was86%, despite early diagnosis and treatment. Cirrhosis-associated spontaneous muscle hematoma occurred more frequently in patients with alcoholic liver cirrhosis, who accounted for -93% of cases. Thus, spontaneous muscle hematoma should be considered a life-threatening complication in patients with alcoholic liver cirrhosis, and abstinence from alcohol may help to prevent the occurrence of this deadly condition. (Korean J Med 2014;86:472-477)

간세포암종에 대한 간동맥 화학색전술 후 발생한 급성호흡곤란증후군

조윤원,이정미,최자윤,유동훈,차라리,오혜원,김홍준,민현주,김현진,정운태,이옥재,하창윤,이선영 이화여자대학교 의과학연구소 2013 EMJ (Ewha medical journal) Vol.36 No.1

Transcatheter arterial chemoembolization (TACE) has become an effective alternative treatment strategy for patients with inoperable hepatocellular carcinoma (HCC). Although TACE is relatively safe, acute respiratory distress syndrome associated with pulmonary lipiodol embolism is a rare and potentially fatal complication. We report a rare case of acute respiratory distress syndrome after TACE for inoperable HCC. A 75-year-old man, with huge HCC in right lobe, was treated by TACE for the first time. Seven hours after uneventful TACE procedure, he felt dyspneic and his oxygen saturation recorded by pulse oximetry (SpO2) fell to 80% despite of applying non-rebreathing mask. He underwent mechanical ventilation with a protective ventilatory strategy. We experienced a case of acute respiratory distress syndrome after TACE for HCC.