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중심성 폐암환자에서 악성 기도폐쇄에서 전기 탐침과 투열올가미를 사용한 전기 소작술의 효과
유홍준 ( Hong Jun You ),최평락 ( Pyoung Rak Choi ),박은호 ( Eun Ho Park ),양재홍 ( Jae Hong Yang ),( In Su Choi ),김형준 ( Hyoung Jun Kim ),김주훈 ( Joo Hoon Kim ),옥철호 ( Chul Ho Oak ),조현명 ( Hyun Myung Cho ),장태원 ( Tae W 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.59 No.5
전이성 대장암에서 1차 치료로 FOLFOX-4 또는 FOLFIRI 복합화학약물 치료 후의 예후 인자 분석
김재현 ( Jae Hyun Kim ),최평락 ( Pyoung Rak Choi ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),문원 ( Won Moon ),김성은 ( Sung Eun Kim ),이규원 ( Gyu Won Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4
Background/Aims: Information on prognostic factors for metastatic colorectal cancer is an important basis for planning the treatment and predicting the outcomes of the patients; however, it has not been well established. The aim of this study was to identify factors that predict results of chemotherapy and to establish a plan for treatment of patients whose tumors are inoperable due to metastatic colorectal cancer. Methods: We conducted a retrospective review of records from 75 patients treated for colorectal cancer in Kosin University Gospel Hospital, from October 2004 to September 2008. Patients with inoperable tumors due to metastasis at the time of diagnosis who were treated with oxaliplatin or irinotecan as the first-line treatment were included in this study. We investigated the factors that might have an effect on overall survival. Results: A total of 75 patients were included in this study. Results of univariate analysis showed that hemoglobin (Hb) ≥10 g/dL at the time of diagnosis, no increase in CEA on the follow-up examination after chemotherapy, chemotherapy plus surgery, and better response to chemotherapy were significant prognostic factors. Results of multivariate analysis showed that Hb ≥10 g/dL at the time of diagnosis (p<0.001), surgery after chemotherapy (p=0.001), and better response to chemotherapy (p=0.014) were significant prognostic factors. Conclusions: In this study, Hb ≥10 g/dL at the time of diagnosis, surgery after chemotherapy, and better response to chemotherapy were significant prognostic factors for metastatic colorectal cancer.
박찬복 ( Chan Bok Park ),문원 ( Won Moon ),최평락 ( Pyoung Rak Choi ),임동한 ( Dong Han Im ),신은경 ( Eun Kyung Shin ),김규종 ( Kyu Jong Kim ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.4
Pancreatitis has been occasionally associated with Crohn`s disease (CD). A definite etiology of pancreatitis can be identified in most patients, but a very small proportion remain idiopathic. We report a case of idiopathic pancreatitis resolved along with the clinical improvement of CD in a 25-year-old man. He presented with abdominal pain and diarrhea for 8 years. Ileocolonoscopy and enteroclysis showed multiple, longitudinal ulcers and strictures at the ileojejunum. The laboratory findings showed elevated serum amylase (951 IU/L) and lipase (326 IU/L) without positive autoantibodies. Esophagogastroduodenoscopy, enhanced pancreatic CT, and MRCP showed no abnormalities at ampulla of Vater, pancrease, and pancreaticobiliary duct. With the treatment with antibiotics, 5-aminosalicylic acid, steroid, and azathioprine, as a whole, decreasing pattern and intermittent fine coordinated fluctuation of the levels of amylase and lipase along with the decrease of Crohn`s disease activity index (CDAI) and the CRP levels were observed. Then, three months after the start of the treatment, normalization of the pancreatic enzymes was observed, and there was recurrent elevation of pancreatic engyme during 12 months maintenance therapy. This report supports the concept of an association between idiopathic pancreatitis and CD, based on a significant and close relation between the levels of serum amylase and lipase, and CDAI. (Korean J Gastroenterol 2009;53:251-256)
증례 : 소화기 ; 간 좌외하구역 형성부전을 동반한 좌측담낭 1예
이재남 ( Jae Nam Lee ),한병훈 ( Byung Hoon Han ),이지숙 ( Jee Suk Lee ),신은경 ( Eun Kyung Shin ),최평락 ( Pyoung Rak Choi ),윤병철 ( Byung Cheol Yun ),이상욱 ( Sang Uk Lee ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3
좌측 담낭이 내장역위증과 무관하게 발생하는 경우는 매우 드물며, 더욱이 좌측 담낭이 간의 부분적 형성부전을 동반하는 경우는 더욱 드물 것으로 생각된다. 저자들은 오랜 기간 동안 만성 B형 간염으로 치료받는 것 이외에는 어떤 췌장담도계 질환도 나타나지 않았던 환자에서 간 3분절 형성부전을 동반한 좌측담낭 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A left-sided gallbladder occurring in the absence of situs inversus is a rare anomaly. This anomaly was found in a 50-year-old man without any evidence of pancreatobiliary disease. Epigastric transverse ultrasonography showed a normal gallbladder with its
측정 자세에 따른 식도 내압의 변화 - High resolution manometry를 이용한 연구
이지숙 ( Jee Suk Lee ),박무인 ( Moo In Park ),문원 ( Won Moon ),김경미 ( Gyung Mi Kim ),박선자 ( Seun Ja Park ),김규종 ( Kyu Jong Kim ),박은호 ( Eun Ho Park ),신은경 ( Eun Kyoung Shin ),임동한 ( Dong Han Yim ),최평락 ( Pyoung Rak 대한소화기기능성질환·운동학회 2009 Journal of Neurogastroenterology and Motility (JNM Vol.15 No.1
목적: 식도운동질환을 진단하는데 기본 검사로 시행되어온 표준 식도내압검사는 검사실에서 누운 자세로 제한된 시간동안 10회 정도의 물을 연하시켜 발생하는 식도 수축파를 분석 평가하므로 실제 생활 중에 일어나는 식도 운동성변화를 반영하는 데는 한계가 있다. 이에 반해 High resolution manometry (HRM)는 자세에 관계없이 측정이 가능하며, 측정 자세의 변화에 따라 식도 내 압력의 측정치가 달라지는지에 대한 연구는 부족한 실정이다. 이에 저자는 HRM을 시행하여 검사 위치에 따른 식도 내압 측정치의 변화 여부를 평가하고자 하였다. 대상 및 방법: 29명의 지원자와 삼킴 곤란을 호소하는 환자를 대상으로(남자 15명, 여자 14명, 나이 27-72세) 1 cm 간격으로 센서가 부착된 36 channel의 high resolution manometry (Sierra Scientific Instruments Inc., Los Angeles, CA)를 시행하였다. 6시간 금식 후 5mL의 물을 10회 삼키게 한 후에 앉은 자세에서 먼저 측정하였고 15분 후에 누운 자세에서 측정하였다. 하부 식도 조임근과 상부 식도 조임근에서의 평균 안정 식도압, 평균 연동 진폭(mean wave amplitude), 평균 속도, 연동성 식도-위경계부의 이완압(deglutitive EGJ relaxation)은 ManoView(TM)(Sierra Scientific Instruments Inc., Los Angeles, CA)으로 자동분석하였고, PFV (Pressurization front velocity)와 DCI (distal contractile integral)는 ManoView(TM)의 Smart Mouse tool을 이용하여 측정하였다. 진단은 pressure topography criteria에 근거한 식도 운동 분류 기준을 사용하였다. 결과: 앉은 자세와 누운 자세에서의 측정값은 평균 기저 하부식도조임근의 압력(20.9±7.0 mmHg vs 22.4±8.3 mmHg, p=0.28), 평균 기저 상부식도조임근의 압력(51.0±30.2 mmHg vs 49.7±17.2 mmHg, p=0.11), 평균수축파의 진폭(64.7±29.0 mmHg vs 73.9±41.0mmHg, p=0.19), 연동속도(5.4±4.5 cm/s vs 5.8±5.3 cm/s, p=0.91), PFV (4.2±1.2 cm/sec vs 4.3±0.9, p=0.70), 연동성 식도-위경계부의 이완압(9.2±4.6 mmHg vs 11.2±4.3, p=0.23)로 유의한 차이가 없었다. 원위부 수축 적분값(DCI) 만이 누운 자세에서 유의한 증가소견을 보였다(2625.6±1265.9 mmHg.s.cm vs 3426.4±1542.6 mmHg.s.cm, p < 0.01). 22명(75.9%)은 측정자세에 따른 결과가 일치하였으나 7명(24.1%)은 서로 불일치하였다. 앉은 자세에서는 모두 정상 식도 기능으로 진단된 반면 누운 자세에서 3명은 호두까기 식도, 3명은 경한 기능적 폐쇄, 나머지 1명은 비정상적으로 하부식도조임근의 압력의 감소로 진단되었다. 결론: 앉은 자세와 누운 자세에서의 HRM의 측정 변수 중 DCI 이외에는 유의한 차이는 없었다. 그러나 측정 자세가 최종 진단에 영향을 미칠 수 있음을 확인하였다. 따라서 측정 자세 변화에 따른 High resolution manometry의 정상치와 새로운 진단 기준에 대한 연구가 필요하리라 생각한다. Background/Aims: High-resolution manometry (HRM) is a new methodology that can be done at any position. The aim of this study was to determine whether the body position affects the esophageal manometric parameters. Methods: Twenty nine subjects (15 males and 14 females, age: 53.1±13.2) were studied with a 36-channel HRM assembly. The subjects performed ten 5-mL water-swallows in the sitting position. At 15 minutes, the same study was done in the supine position. The basal mean LES pressure and the UES pressure, the mean wave amplitude, the velocity and the deglutitive relaxation were analyzed automatically using ManoView(TM). The Pressurization front velocity (PFV) and distal contractile integral (DCI) were manually calculated using the Smart Mouse tool in ManoView(TM). We used the Chicago classification1 for the diagnosis. Results: The mean manometric parameters in the sitting and supine positions were the basal LES pressure (20.9±7.0 mmHg vs 22.4±8.3 mmHg, respectively, p=0.28), the basal UES pressure (51.0±30.2 mmHg vs 49.7±17.2 mmHg, respectively, p=0.11), the wave amplitude (64.7±29.0 mmHg vs 73.9±41.0 mmHg, respectively, p = 0.19), velocity (5.4±4.5 cm/s vs 5.8±5.3 cm/s, respectively, p=0.91), the PFV (4.2±1.2 cm/sec vs 4.3±0.9, respectively, p=0.70), and the deglutitive relaxation (9.2±4.6 mmHg vs 11.2±4.3, respectively p=0.23). Only the DCI was significantly increased in the supine position (2625.6±1265.9 mmHg.s.cm vs 3426.4±1542.6 mmHg.s.cm, respectively, p<0.01). A different final diagnosis was noted in 7 subjects (24.1%) at each position. Conclusions: The patient position during HRM study may affect the esophageal motor parameters and the final diagnosis. (Kor J Neurogastroenterol Motil 2009;15:31-37)