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대장암이 동반된 Streptococcus bovis 에 의한 아급성 심내막염 1예
곽경근(Kyeng Kunn Kwack),소순찬(Soon Chan So),박해규(Hae Kyu Park),이덕기(Duck Kee Lee),김종형(Jong Hyeng Kim),유두열(Doo Yel Lyu),신현민(Hyen Min Shin),황동인(Dong In Hwang),임응훈(Eung Hoon Lim),한상국(Sang Kook Han) 대한내과학회 2000 대한내과학회지 Vol.59 No.2
Streptococcus bovis, a group D non-enterococcal organism has recently received increased attention, especially for its role as a cause of infective endocarditis and associated colorectal neoplasm. Infectious endocarditis due to group D streptococci include two non-enterococcal species, S. bovis and S. equinas, which may be mistaken for enterococci in clinical laboratory. However, S. bovis is readily distinguished from the enterococci by screen with bile-esculin hydrolysis and growth in 6.5% NaCl broth. Although endocarditis caused by S. bovis or enterococci share common clinical findings, therapeutically and prognostically, S. bovis endocarditis more resembles infection with viridans group organism. Also the infection of S. bovis significantly increased the prevalence of colorectal cancer in previous report. As discussed above, the patients with S. bovis endocarditis are carried out study of colorectal cancer. We report a case of endocarditis with colon cancer caused by S. bovis in 54 year old female.(Korean J Med 59:198-202, 2000)
장년 대장암 환자와의 비교를 통해 본 노인 대장암 환자의 특성
이형석,이석영,서지현,곽경근,정수진,이광혁,박영수,황진혁,김진욱,정숙향,김나영,이동호,정현채,송인성 대한소화기내시경학회 2007 Clinical Endoscopy Vol.34 No.2
Background/Aims: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. Methods: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. Results: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. Conclusions: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer. (Korean J Gastrointest Endosc 2007;34:76-82) 목적: 국내의 대장암 발생은 지난 10년 동안 빠르게 증가하고 있으며 이러한 추세는 국내 노인 인구의 증가 속도를 고려해 볼 때 앞으로도 계속 이어질 것으로 판단된다. 이에 저자들은 노인과 장년에서 발생한 대장암의 임상, 내시경, 조직 특성의 비교를 통해 국내 노인 대장암의 특성을 분석함으로써 증가되고 있는 노인 대장암에 대한 효율적 진단을 위한 기초 자료를 얻고자 하였다. 대상 및 방법: 2003년 3월부터 2004년 11월까지 분당서울대학교병원에서 대장암으로 진단받은 232명을 대상으로 후향적으로 조사하였다. 환자들을 연령에 따라서 65세 미만의 장년층과 65세 이상의 노년층으로 구분하여 두 군에 대해 성별, 증상, 증상의 기간, 암의 위치 및 형태, 병기, 병리, 검사실 자료, 동반 대장병변 등에 대한 비교 분석을 시행 하였다. 결과: 노인층에서 배변습관의 변화가 유의하게 높게 관찰되었으며(p=0.018) 혈변, 흑색변의 비율도 상대적으로 높게 관찰되었다. 검진에 의한 대장암 발견비율은 장년층에서 유의하게 높았다(p=0.015). 연령대가 증가함에 따라 우측대장암의 비율이 증가하였으며 여자에서 현저하였다. 노인층에서 Duke C 병기의 비율이(p=0.007), 장년층에서는 Duke D 병기의 비율이(p=0.022) 유의하게 높았다. 우측대장암에서 전이의 비율이 높았으며(p=0.009) 성별로는 여자에서 유의하였다(p=0.042). 노인층에서 전이암 중 우측암이 차지하는 비율이 더 높았으며(46.2% vs. 29.6%) 여자의 경우에 현저하였다. 장년층에서 고분화암(p=0.016) 및 저분화암(p=0.031)의 비율이 유의하게 높았으며 인환세포 또는 점액선 형태의 고위험병리암은 여자의 경우에 노인층에서 높은 경향을 보였다(12.8% vs. 4.9%). CEA는 진행된 병기에서 노인층에서 현저하게 낮았다. 동반선종은 노인층에서 평균 2.4±4.0개로 유의하게 많았으며(p=0.004) 동시성 대장암의 경우 노인층에서 많이 발생하는 경향을 보였으며(8.1% vs. 3.4%) 위치는 모두 이웃한 분절 이내에 있었다. 결론: 노인 환자가 배변습관의 변화와 혈변을 호소하는 경우 대장암 가능성을 반드시 고려하여야 한다. 고령일수록 특히 여자의 경우 우측대장에 대한 철저한 검사가 필요하다. 우측대장암의 경우 전이에 대한 평가가 이루어져야 하며 여자의 경우 더욱 주의하여야 한다. 낮은 CEA 값을 보이는 경우에도 진행된 병기 가능성을 고려해야 한다. 동시성 대장암의 유무는 암이 발견된 분절과 인접분절을 중심으로 점검하여야 한다.
이형석,이석영,서지현,곽경근,김주성,정현채,송인성 대한대장항문학회 2006 Annals of Coloproctolgy Vol.22 No.2
Purpose: Endoscopic mucosal resection (EMR) for early colorectal cancer (ECC) is increasing, but in Korea, little is known about long-term results of this treatment, especially in cases of incomplete resection. In this study, we reviewed the records of patients with ECC who underwent EMR, and we analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of EMR. Methods: From May 1995 to December 2003, 45 patients underwent EMR for ECC at Seoul National University Hospital and followed for over 10 months. Their medical records were reviewed retrospectively. Results: 45 patients with average age of 62 accounted for 47 ECCs out of 164 colon mucosal lesions. En-bloc resection rate was 78.7%. Submucosal invasion was found in 10 cases (21.3%). De novo cancer rate was 12.8% and relatively high in submucosal cancer (40%). The complete resection rate was 70.2%. During the mean follow-up period of 25 months, residual tumor growth occurred in 3 out of 14 incompletely resected cases, and that was related to piecemeal resection. One of those 3 patients underwent surgical resection due to submucosal invasion, and the other two were treated endoscopically with no additional abnormal findings. No tumor recurred in completely resected cases. Conclusions: A complete en-bloc resection was a prerequisite for prevention of tumor recurrence. In cases of incomplete resection, especially those performed using piecemeal method, within 3 months after the resection and within 1 year thereafter, follow-ups are essential for the early detection of tumor regrowth, and additional endoscopic treatment can achieve complete removal of residual tumor, despite initial incomplete resection.
이소성 점막을 동반하지 않은 Meckel 게실 환자에서 발현된 대량 하부 장관 출혈 1예
박석준,김종형,신현민,이덕기,김석은,소순찬,곽경근,박해규 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.2
Meckel's diverticulum, which is a persistence of a remnant of the omphalomesenteric duct, is the most common developmental anomaly of the gastrointestinal tract, with an incidence of about 2% in the general population. Typically, Meckel's diverticulum is a true diverticulum because it arises from the antimesenteric border of the small bowel and all layers of the intestinal wall are present. Complications of Meckel's diverticulum include bleeding, perforation, diverticulitis, intestinal obstruction, stones, intussusception, hernia, and neoplasm. Bleeding in particular is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic gastric mucosa in a Meckel's diverticulum. A case was recently experienced involving massive hematochezia from Meckel's diverticulum without ectopic gastric mucosa in a 27 year-old woman, and in herein reported.
김화영,박석준,이창후,김석은,한성민,소순찬,강정협,곽경근,박해규,박영희 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.4
Primary carcinoid tumor of duodenum are rare, Usually, small duodenal carcinoid tumors are often discovered endoscopically. Most of these tumors are asymptomatic, but in rare cases, jaundice, hemorrhage, duodenal obstruction, or carcinoid syndrome were apparent. Uaually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of carcinoid tumor of duodenu in 53 year-old women. A 53-year-old female patient was admitted to our hospital because of epigastric discomfort and indigestion. On the gastrofiberscopic examination, 0.9 cm sized polypoid mass with central umblication was noted on the duodenall bulb. The biopsy specimen showed carcinoid cells. She was treated with endoscopic polypectomy.
박영희,한성민,김화영,박석준,이창후,김석은,강정협,곽경근,박해규,소순찬 대한소화기학회 2000 대한소화기학회지 Vol.35 No.4
Hepatocellular carcinoma (HCC) usually spreads to the lung and regional lymph nodes by direct extention, lymphatic route, and vascular dissemination. Rarely, it happens to metastasize to the bones. Metastases to other organs such as bones seem to occur by erosions of pulmonary veins into the systemic circulation or retrogradely, into vertebral venous plexuses via portal vein. Treatment results were poor with a median survival of 5 months. We experienced multiple bone metastases in a 61-year-old male patient with small HCC. In conclusion, this report is valuable in presenting unusual multiple bone metastases in small HCC.