국내 대장 폴립 절제 후 추적검사 현황

홍성노 ( Sung Noh Hong ),양동훈 ( Dong Hoon Yang ),김영호 ( Young Ho Kim ),김성은 ( Seong Eun Kim ),신성재 ( Sung Jae Shin ),홍성필 ( Sung Pil Hong ),이보인 ( Bo In Lee ),이석호 ( Suck Ho Lee ),박동일 ( Dong Il Park ),김현수 ( Hyu 대한장연구학회 2011 Intestinal Research Vol.9 No.2

Background/Aims: There is a paucity of information on postpolypectomy surveillance currently practiced in Korea. Thus, we investigated the present state of postpolypectomy surveillance in Korea using a web-based survey. Methods:A multiple choice questionnaire was used to determine the preferred surveillance modality, the colonoscopic surveillance interval used in 11 case scenarios, and clinical factors influencing surveillance intervals. The form was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians involved in a colonoscopy surveillance program. Of 425 colonoscopists contacted, 263 replied (response rate, 62%). Of the respondents, 94% were internists and 54% practiced in tertiary referral hospitals. Results: All respondents chose colonoscopy as a preferred surveillance modality following polyp removal. Colonoscopy at 3 years was the most frequent answer after removal of 1 or 2 tubular adenoma(s) <1 cm in size, while 1 year was the most frequent answer after removal of an advanced adenoma or ≥3 adenomas, and 6 months was the most frequent choice after removal of adenoma with high-grade dysplasia or a sessile polyp ≥2 cm. The agreement rate for the time of first surveillance between preferred guideline recommendations and respondent answers was in the low range at 14-43%. Conclusions: A significant disagreement exists between current postpolypectomy surveillance practices of Korean colonoscopists and preferred guideline recommendations. This discrepancy may be due to the fact that the guidelines do not reflect recent studies and the specific medical environment in Korea. Thus, there is a need to develop new evidence-based Korean guidelines for postpolypectomy surveillance. (Intest Res 2011;9:118-128)

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.

해외학회지에 게재된 국내연구소개 : 이 환자가 식도운동이상 또는 비정상 위산식도역류를 가지고 있을까?

홍성노 ( Sung Noh Hong ),이풍렬 ( Poong Lyul Rhee ) 대한소화관운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2

과민성 장 증후군환자에서 장외 증상은 매우 흔한 환자가 호소하는 식도증상은 식도운동이상(esophageal motility abnormality)과 비정상 위산식도역류(pathologic acid exposure)의 중요한 진단 단서이지만 예측적 정확도(predictive accuracy)에 대한 정보는 충분하지 않다. 본 연구는 식도증상을 호소하지만 기질적인 병변이 발견되지 않아 표준 식도내압검사와 보행성 24시간식도산도검사를 시행한 462명의 환자들을 대상으로 주요호소증상에 따라 환자들을 분류하고 식도운동이상 및 비정상 위산식도역류에 대한 식도증상의 진단적 유용성을 평가하기 위해 민감도, 양성예측치, 우도비(likelihood ratio)를 계산하였다. 462명의 환자 중 202명(44%)에서 식도운동이상 소견을 보였다. 연하곤란을 호소하는 환자군에서는 전형적인 아칼라지아(classic achalasia)와 미만성식도경련(diffuse esophageal spasm)의 우도비가 각각 6.24(95% CI, 3.32-8.78)와 3.58(95% CI, 1.03-7.12)로 높았다. 흥미로운 것은 연하곤란을 호소하는 환자군을 중증도에 따라 나누어 보면, 심한 연하곤란군에서 경한 연하곤란군보다 전형적인 아칼라지아의 발생이 유의하게 높았다(p=0.016). 한편, 비정상 위산식도역류는 위식도역류연관증상을 보인 환자군에서 그렇지 않은 환자군보다 발생 빈도가 유의하게 높았다(p=0.011). 소수의 식도증상만이 식도운동이상 및 비정상 위산식도역류의 예측에 도움이 되며, 이중에서 심한 연하곤란은 전형적인 아칼라지아의 강력한 예측인자로 생각된다.

기능성 장질환과 기질적 장질환의 감별에 있어서 대변 Calprotectin의 유용성 소아 변비 환자에서의 적용

홍성노 ( Sung Noh Hong ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.5

Laxatives 제대로 알기 ; 차세대 완하제

홍성노 ( Sung Noh Hong ),신정은 ( Jeong Eun Shin ),홍경섭 ( Kyoung Sup Hong ),정기욱 ( Kee Wook Jung ),이태희 ( Tae Hee Lee ),이봉은 ( Bong Eun Lee ),박선영 ( Sun Young Park ),김성은 ( Seong Eun Kim ),박경식 ( Kyung Sik Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1

A significant proportion of chronic constipation patients are dissatisfied with their treatment. Recently, a number of new medicationshave been introduced for patients refractory to conventional laxatives, such as prucalopride, lubiprostone, linaclotide, andelobixibat. Prucalopride is a novel gastrointestinal prokinetic agent that acts as a 5-hydroxytryptamine type 4 (5-HT4) agonist. Compared with older nonselective 5-HT4 agonists, the higher selectivity of prucalopride for 5-HT4 receptors can reduce the risk ofsignificant adverse cardiovascular events. Prucalopride improves stool frequency and consistency, and reduces the need for rescuemedications. Lubiprostone, a chloride channel activator, increases the secretion of intestinal fluid, improves the stool frequency andconsistency, and reduces straining. Linaclotide, a guanylate cyclase-C agonist, is effective in treating patients with chronic constipationand its effect on visceral sensitivity, as shown mainly in animal studies, provides an attractive pharmaceutical option for patients with irritable bowel syndrome with constipation. Elobixibat is an ileal sodium-dependent bile acid transporter inhibitor thatblocks the enterohepatic circulation of bile acids, increasing the bile acid concentration in the intestine, which accelerates colonictransit and softens the stool. A phase III trial of the treatment of chronic constipation and irritable bowel syndrome with constipationis underway. The clinical application of new-generation laxatives will contribute to the management of chronic constipation refractoryto conventional laxatives.

PUS 부재의 휨 강도에 관한 실험적 연구

홍성진(Hong Sung-Jin),김승훈(Kim Seung-Hun),노삼영(Noh Sam-Young),천성철(Chun Sung-Chul),한범석(Han Byum-Seok),김갑수(Kim Kap-Soo) 대한건축학회 2011 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.31 No.2(구조계)

Recently the Permanent Uni-wall System (PUS) has been developed which improved the disadvantage of the CIP and could be used as permanent retaining wall. In the general design of PUS, deformed casing section consists of reinforced concrete, and circle casing section consists of various structural types which are steel, reinforced concrete, and steel reinforced concrete. In this study, two types of PUS section were tested to investigate the flexural strength and behaviors. Test results showed that the flexural strength wasn’t much affected by reinforcing bars in circle casing section, and that the stirrups, which confined the steel in circle casing section, had an effect on stable behavior after ultimate strength.

PUS와 지하 바닥구조 접합부 전단 성능평가

홍성진(Hong Seong-Jin),천성철(Chun Sung-Chul),김승훈(Kim Seung-Hun),노삼영(Noh Sam-Young),김갑수(Kim Kap-Soo),권대홍(Kwon Dae-Hong) 대한건축학회 2011 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.31 No.2(구조계)

Recently the Permanent Uni-wall System (PUS) has been developed which improved the disadvantage of the CIP and could be used as permanent retaining wall. From analyses of the characteristics of design and construction of PUS, shear friction reinforcements with couplers were adopted for shear design of the joints. Twelve types of joints were developed which were classified according to the types of floor structures, wale, and piles of PUS. Two typical joints were tested and the joints showed satisfactory behaviors on the points of shear strength, stiffness, and serviceability. Especially the shear strengths were much higher than the design strengths due to the shear keys which were by-products in splicing shear reinforcements.

국내 대장폴립절제 시 치료 행태에 대한 설문조사

신성재 ( Sung Jae Shin ),이석호 ( Suck Ho Lee ),박동일 ( Dong Il Park ),홍성노 ( Sung Noh Hong ),김성은 ( Seong Eun Kim ),양동훈 ( Dong Hoon Yang ),홍성필 ( Sung Pil Hong ),이보인 ( Bo In Lee ),김현수 ( Hyun Soo Kim ),김영호 ( You 대한장연구학회 2011 Intestinal Research Vol.9 No.3

Background/Aims: There are no evidence-based, procedural guidelines to appropriately perform a colon polypectomy. Thus, we investigated the treatment modality for colon polypectomy in Korea, using a web-based e-mail survey. Methods: A questionnaire of preferred treatment modality for colon polypectomy was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who performed colonoscopies as a screening or surveillance program nationwide. Among 425 colonoscopists who were sent the e-mail, 263 replied. We analysed data from 252 colonoscopists who had performed colon polypectomies. Results: The stopping time for antiplatelet and anticoagulation therapy before a colon polypectomy had a tendency to increase and the restarting time for these drugs was delayed as polyp size increased. Colonoscopists preferred cold biopsy removal for polyps <5 mm in size and a hot snare polypectomy after injecting normal saline and epinephrine mixture for polyps ≥5 mm in size. More than half of colonoscopists preferred observation rather than additional procedures for adenomas with incomplete resection. In contrast, most colonoscopists recommended additional procedures, such as endoscopic mucosal resection, endoscopic submucosal dissection or surgery for an advanced adenoma with incomplete resection. The most preferred prophylactic treatment for immediate postpolypectomy bleeding was hemoclipping. Conclusions: Various treatment modalities were used for a colon polypectomy because there are few guidelines for performing a colon polypectomy based on a critical review of the available data. Further well-designed, prospective studies are needed to develop evidence-based guidelines for colon polypectomy. (Intest Res 2011;9:196-205)

임상실습을 경험한 물리치료 전공 학생의 전문직업성 연구

유재호,배영현,노수현,김윤태,홍성화,Yu, Jae-Ho,Bae, Young-Hyeon,Noh, Su-Hyun,Kim, Yun-Tae,Hong, Sung-Hwa 대한물리치료과학회 2021 대한물리치료과학회지 Vol.28 No.2

Purpose: The purpose of this study is to find the perceived level of professionalism of physical therapy student who experienced clinical practice. Design: Cross-sectional study. Methods: The subjects of the study were conducted for 3 months from March to June, 2017, and randomly selected physical therapy student who experienced clinical practice in Chungnam-Do. The 138 students in cross-sectional survey were done via Korean of Professionalism In Physical Therapy: Core Values (PPTCV). The questionnaire data analyzed by SPSS 19.0 version. Results: The mean scores of PPTCV were accountability 41.34±0.83, altruism: 19.67+0.90, compassion/caring 43.82±0.81, excellence 45.57±0.80, integrity 43.69±6.16, professional duty 28.67±4.70, and social responsibility 45.84±7.64. Conclusion: Physical therapy students who experienced clinical practice had overall high scores.

초고온가스로 모사 실험회로 설계를 위한 전산유체역학 해석

윤철(Churl Yoon),홍성덕(Sung Deok Hong),노재만(Jae Man Noh),김용완(Yong Wan Kim),장종화(Jong Hwa Chang) 대한기계학회 2009 대한기계학회 춘추학술대회 Vol.2009 No.11

A medium scale Helium loop that can simulate a VHTR(Very High Temperature Reactor) is now under construction in Korea Atomic Energy Research Institute. The heater of the test Helium loop electrically heats up the Helium fluid up to 950℃ at the pressure of 1 ~ 9㎫. To optimize design specification of the experimental Helium loop, conjugate heat transfer in the high-temperature Helium heater was analyzed by CFD simulation. From the analysis results, the maximum temperature does not exceed the allowable limit. It is confirmed that thermal characteristics of the given geometry well meet the design requirements.