최신 연구 소개 : 위 선종에서 헬리코박터 파일로리 제균 치료의 장기적인 효과는 무엇인가?

태정현 ( Chung Hyun Tae ),심기남 ( Ki Nam Shim ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.5

Morphologic and Histologic Changes in Gastric Adenomas after Helicobacter pylori Eradication: A Long-term Prospective Analysis (Helicobacter 2015. doi: 10.1111/hel.12218 [Epub ahead of print])

소세포폐암 환자에서 토포테칸 투약 후 발생한 급성호흡곤란증후군

태정현 ( Jung Hyun Tae ),이진화 ( Jin Hwa Lee ),김윤경 ( Yoon Kyung Kim ),심윤수 ( Yun Su Sim ),이경종 ( Kyung Jong Lee ),노영욱 ( Young Wook Noh ),박재정 ( Jae Jung Park ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),장중현 ( Jun 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

Small cell lung cancer is characterized by an aggressive clinical course and a high tendency for early dissemination in spite of a good chemotherapy response. Topotecan is a topoisomerase I inhibitor, and it is used as second-line treatment for small cell lung cancer. The reported dose-limiting adverse reactions to topotecan are mainly hematologic. Yet pulmonary toxicity associated with topotecan is known to be rare. We report here on a case that showed the development of acute respiratory distress syndrome during the 3rd cycle of topotecan chemotherapy in a patient with small cell lung cancer. He developed dyspnea and respiratory failure, and the chest CT scan revealed diffuse ground-glass opacity that was probably due to chemotherapy-related pulmonary toxicity. He finally died of acute respiratory distress syndrome. (Tuberc Respir Dis 2008;65:142-146)

현금보유가 기업의 투자-현금흐름민감도에 미치는 영향에 대한 연구

태정현(Tae, Jeong-Hyeon) 한국산학기술학회 2011 한국산학기술학회논문지 Vol.12 No.4

본 연구의 목적은 Ӧ.Arslan et al.(2006)의 연구방법론을 적용하여 국내 기업의 현금보유(cash holdings)가 투 자-현금흐름 민감도(investment-cash flow sensitivity)에 어떤 영향을 주는지를 분석하는 데 있다. 1981년부터 2009년 까지 외환위기 이전과 이후 그리고 외환위기 기간으로 분류하여 각 기간별로 현금보유가 투자-현금흐름 민감도에 어 떤 영향을 주는 지를 비교 분석하였다. 연구 결과는 다음과 같다. 첫째, 전체 기업을 재무적 제약(financial constraint) 에 대한 고려 없이 3개의 기간으로 분류해서 살펴본 결과 외환위기 기간을 제외한 외환위기 이전과 이후 기간에서는 현금보유가 많은 기업일수록 투자-현금흐름 민감도는 감소하였다. 둘째, 기업규모나 배당지급 기준에 의해 재무적 제 약하에 있지 않은 기업으로 분류된 경우에는 현금보유가 많을수록 투자-현금흐름 민감도는 오히려 증가하는 것으로 나타났다. 이는 Ӧ.Arslan et al.(2006)의 연구와 일치하지 않는 결과인데 첫째, 기업규모나 배당지급 여부는 국내에서는 기업의 재무적 제약을 나타내는 기준으로 불완전하며 둘째, 본 연구에서 고려하지 못한 투자-현금흐름 민감도에 영향 을 주는 다른 요인들이 존재할 수 있기 때문이다. 하지만 현금보유기준에 의해 재무적 제약하의 기업으로 분류된 경 우에는 투자-현금흐름 민감도는 낮게 나타났다. 이는 Ӧ.Arslan et al.(2006)의 연구결과와 일치한다. 끝으로 전체 기간 동안 현금보유 결정요인은 다음과 같다. 현금흐름(cash flow)과 시장가/장부가비율(market to book ratio)은 증가할수록, 단기부채와 투자지출 그리고 기업규모는 감소할수록, 기업의 현금보유증가에 양(+)의 영향을 주는 것으로 나타났다. This paper investigates how does cash holdings have effect on investment-cash flow sensitivity in korea firms over the period 1981-2009. According to Ӧ.Arslan et al.(2006), I expect that financially constrained firms have more cash holdings. and financially constrained cash-rich firms are likely to have less investment-cash flow sensitivity especially in the financial crisis period. Using financial constraint classification variables(firm size, dividend, cash holdings), we divide whole sample firms into financially constrained firms and financially unconstrained firms, and then I compare investment-cash flow sensitivity in pre-financial crisis(1981-1996), financial crisis(1997-1998) and after-financial crisis(1999-2009) period. This paper's findings are as follows: First, under no financial constraint classification conditions, cash-poor firms exhibit greater investment-cash flow sensitivity than cash-rich firms do during 1981-2009 period except financial crisis period. These findings support the hypothesis that firms have more cash holdings less investment-cash flow sensitivity except in financial crisis period. In financial crisis period, cash holdings have no effect on investment-cash flow sensitivity. Second, this paper findings are somewhat different as Ӧ.Arslan et al.(2006)'s. Under the financial constraint classification conditions, financially unconstrained firms have more investment-cash flow sensitivity rather than constrained firms have. The reason is that both dividend and firm size are not a complete classification criteria variables. And there exists other possible determinants of investment-cash flow sensitivity. Finally, this paper find that there are common determinants of corporate cash holdings in all periods. This paper suggests that cash flow and market to book ratio are positive determinants of corporate cash holdings but short-term debt, investment and firm size are negative determinants of corporate cash holdings.

Risk Factors for Metachronous Recurrence after Endoscopic Submucosal Dissection of a Gastric Neoplasm

최아름,심기남,Tae Oh Kim,Sang Yoon Kim,Jiyoung Lim,태정현,문창모,김성은,정혜경,정성애 대한상부위장관ㆍ헬리코박터학회 2019 Korean Journal of Helicobacter Upper Gastrointesti Vol.19 No.3

Background/Aims: Although endoscopic submucosal dissection (ESD) is an accepted treatment method for gastric neoplasm worldwide, metachronous recurrence often occurs. Here, we evaluated the risk factors for metachronous recurrence after ESD of gastric dysplasia or adenocarcinoma and also examined the effects of Helicobacter pylori (H. pylori) eradication. Materials and Methods: Among 400 patients who underwent endoscopic resection from February 2005 to December 2014 at Ewha Womans University Hospital, the medical records of 180 patients were retrospectively reviewed. Results: The enrolled patients included 118 men and 62 women, and their median age was 61.7±10.3 years. During a median follow- up period of 34.5 months, metachronous recurrence occurred in 21 (11.7%) patients. Multivariate analyses revealed that H. pylori eradication did not have any preventive effects on metachronous recurrence. A family history of gastric cancer was the only risk factor for metachronous recurrence after ESD of the gastric neoplasm. Conclusions: Metachronous recurrence was found to be related to family history of gastric cancer. However, H. pylori eradication had no preventive effects on metachronous recurrence after ESD of a gastric neoplasm. Therefore, intensive surveillance is required for patients who undergo ESD of a gastric neoplasm and have a family history of gastric cancer.

소화기 내시경 시술 전후 항혈전제 사용 임상진료지침: 2023 IDEN 합의

강승주 ( Seung Joo Kang ),태정현 ( Chung Hyun Tae ),방창석 ( Chang Seok Bang ),신철민 ( Cheol Min Shin ),정영훈 ( Young-hoon Jeong ),최미영 ( Miyoung Choi ),황주하 ( Joo Ha Hwang ),( Yutaka Saito ),( Philip Wai Yan Chiu ) 대한소화기학회 2024 대한소화기학회지 Vol.83 No.6

Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice. (Korean J Gastroenterol 2024;83:217-232)

포스트 코로나 시대 준비를 위한 임상실습 교육 고찰

정소미(So-Mi Jeong),고아라(Ara Ko),편욱범(Wook Bum Pyun),태정현(Chung Hyun Tae) 학습자중심교과교육학회 2023 학습자중심교과교육연구 Vol.23 No.20

목적 본 연구는 COVID-19 시대 임상실습교육 점검하고 포스트 코로나 시대 임상실습교육의 방향 설정을 위한 기초 정보 마련을 목적으로 하였다. 방법 본 연구는 서울 소재 E-대학교 의과대학에서 2022년 12월 임상실습 교육 개선을 위하여 임상실습 과별로 진행한 ‘임상실습 선진화 회의’의 회의록과 각 임상 실습과에서 제출한 ‘2023학년도 임상실습 개선 계획서’를 대상으로 하였다. 포커스 그룹 인터뷰 분석방법을 차용하여 분석하였다. 결과 첫째, COVID-19 시기, 임상실습 교육에 영향을 미친 요소를 살펴본 결과, 임상실습 교육의 긍정적 요소와 임상실습 교육의 부정적 요소 2개 영역에서 8개 범주, 17개 하위범주가 도출되었다. 둘째, 포스트 코로나 시대 준비를 위한 임상실습 개선 계획을 살펴본 결과, 임상실습 교육 실시 전 교육 개선 노력과 임상실습 중 교육 운영 개선 노력, 장기적 개선의 3개 영역에서 6개 범주, 23개 하위범주가 도출되었다. 셋째, 포스트 코로나 시대 임상실습을 위해 필요한 사항을 살펴본 결과, 포스트 코로나 시대 임상실습 교육을 위한 제언, 포스트 코로나 시대 임상실습 교육을 위해 필요한 지원의 2개 영역에서 6개 범주, 11개 하위범주가 도출되었다. 결론 본 연구를 통해 COVID-19 시기 이루어진 임상실습 교육을 점검하고 포스트 코로나 시대 임상실습 개선을 위한 시사점을 도출하였다. 본 연구의 결과는 향후 임상실습 교육 개선에 기초자료가 될 것이며, 궁극적으로 임상실습 교육의 질 향상에 기여할 수 있을 것이다. Objectives This study aimed to examine clinical clerkship education in the COVID-19 era and gather fundamental information for setting the direction of clinical clerkship education in the post-COVID era. Methods This study focused on the minutes of the ‘Clinical clerkship Advancement Conference’ held in December 2022 and the ‘2023 Clinical clerkship Improvement Plans’ submitted by each clinical clerkship department at E-Medical School in Seoul. The study employed the Focused Group Interview analysis method. Results First, when examining the factors that influenced clinical clerkship education during the COVID-19 peri-od, a total of 8 categories and 17 subcategories were identified in two domains: positive factors of clinical clerkship education and negative factors of clinical clerkship education. Second, when examining the improvement plans for clinical clerkship education in preparation for the post-COVID era, a total of 6 categories and 23 subcategories were derived from three domains: efforts for pre-implementation education improvement, efforts for operational improvement of clinical clerkship education, and long-term improvement. Third, when exploring the requirements for clinical clerkship in the post-COVID era, a total of 6 categories and 11 subcategories were identified in two do-mains: recommendations for clinical clerkship education in the post-COVID era and necessary support for clinical clerkship education in the post-COVID era. Conclusions This study examined the clinical clerkship education conducted during the COVID-19 period and de-rived implications for improving clinical clerkship in the post-COVID era. The findings of this study will serve as foundational data for future improvements in clinical clerkship education and ultimately contribute to enhancing the quality of clinical clerkship education.

위장관 ; 부식제로 인한 상부위장관 손상: 단일 3차 기관의 20년간의 후향적 분석

송혜경 ( Hye Kyung Song ),심기남 ( Ki Nam Shim ),윤혜원 ( Hye Won Yun ),태정현 ( Chung Hyun Tae ),김성은 ( Seong Eun Kim ),정혜경 ( Hye Kyung Jung ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1

목적: 부식제는 상부위장관에 심각한 손상을 초래하며 드물게는 사망까지 이르게 한다. 그러나 국내에서 부식제 음독에 관한 임상 양상 및 치료에 대한 연구가 많지 않다. 이번 연구의 목적은 단일 기관의 20년간 부식제 음독 환자를 분석하여 상부위장관의 내시경적 점막손상 정도를 포함한 임상 양상 및 치료의 변화를 관찰하고자 하였다. 대상 및 방법: 1993년 9월부터 2012년 12월까지 부식제 음독으로 이대목동병원을 방문한 140명의 의무기록을 후향적으로 분석하였다. 1993년부터 2002년까지 병원을 방문한 환자를 조기군으로, 2003년부터 2012년까지 병원을 방문한 환자를 후기군으로 정의하여 두 군 간의 상부위장관 내시경상 점막손상을 포함한 임상 양상 및 치료를 비교하였다. 결과: 부식제 음독환자의 평균 연령은 43.7±17.4세(범위18-88세)이며, 남성이 40.7%였다. 부식제 음독의 연도별 발생건수는 줄지 않았다(연간 발생 건수 범위, 2-22건). 조기군은 50명, 후기군은 90명으로 후기군에서 염기성 부식제 음독이 통계적으로 의미 있게 많았고(20% vs. 65.6%, p<0.001), grade 2b 이상 식도 점막손상의 빈도가 낮았다(41.3% vs. 20.7%, p=0.012). 두 군 간에 연령, 성별, 음독 동기(자살 또는 우발사고) 및 급성 합병증이나 협착의 발생은 차이가 없었다. 치료에 있어 후기군에서 위 세척(p<0.01), grade 2b 이하 점막손상 환자에서 광범위 항생제 사용(p=0.03)이 통계적으로 유의하게 줄었으나, 스테로이드 사용은 두 군 간에 차이를 보이지 않았다. 결론: 국내에서 부식제 음독 발생은 지난 20년간 줄지 않았고 염기성 부식제 음독 비율이 증가하였다. 내시경적 식도 점막손상 정도는 감소하였으나 급성 합병증이나 협착은 줄지 않았다. 위 세척, 광범위 항생제 사용은 감소되었으나 스테로이드 사용은 차이가 없었다. 따라서 부식제의 엄격한 안전 관리가 필요하며 효과적인 치료에 관한 숙지가 필요하다. Background/Aims: Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. Methods: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). Results: A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. Conclusions: In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.

기능성 소화불량증의 임상 진료 지침 개정안 2020

오정환 ( Jung Hwan Oh ),권중구 ( Joong Goo Kwon ),정혜경 ( Hye-kyung Jung ),태정현 ( Chung Hyun Tae ),송경호 ( Kyung Ho Song ),강승주 ( Seung Joo Kang ),김성은 ( Sung Eun Kim ),정경원 ( Kyoungwon Jung ),김준성 ( Joon Sung Kim ) 대한내과학회 2021 대한내과학회지 Vol.96 No.2

Background/Aims: Functional dyspepsia (FD) is a chronic upper gastrointestinal symptom complex that routine diagnostic work-up, such as endoscopy, blood laboratory analysis, or radiological examination, fails to identify a cause for. It is highly prevalent in the Korean population, and its response to the various available therapeutic strategies is only modest because of the heterogeneous nature of its pathogenesis. We constituted a guidelines development committee to review the existing guidelines on the management of FD. Methods: This committee drafted statements and conducted a systematic review and meta-analysis of various studies, guidelines, and randomized control trials. External review was also conducted by selected experts. These clinical practice guidelines for FD were developed based on evidence recently accumulated with the revised version of FD guidelines released in 2011 by the Korean Society of Neurogastroenterology and Motility. Results: These guidelines apply to adults with chronic symptoms of FD and include the diagnostic role of endoscopy, Helicobacter pylori screening, and systematic review and meta-analyses of the various treatment options for FD (proton pump inhibitors, Helicobacter pylori eradication, and tricyclic antidepressants), especially according to the FD subtype. Conclusions: The purpose of these new guidelines is to aid understanding, diagnosis, and treatment of FD, and the targets of the guidelines are clinicians, healthcare workers at the forefront of patient care, patients, and medical students. The guidelines will continue to be revised and updated periodically. (Korean J Med 2021;96:116-138)

위장관 ; 노인 위암 환자의 임상적 및 병리적 특징과 수술 시행에 따른 생존율 차이

최주영 ( Ju Young Choi ),심기남 ( Ki Nam Shim ),노선희 ( Sun Hee Roh ),태정현 ( Chung Hyun Tae ),김성은 ( Seong Eun Kim ),정혜경 ( Hye Kyung Jung ),김태헌 ( Tae Hun Kim ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ),문일환 ( Il Whan 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1

목적: 노인 위암 환자는 장년 환자에 비해 전신상태가 좋지 않고 동반질환의 비율이 높아 수술 시행률이 낮고 수술 후 예후가 좋지 않다고 알려져 있다. 이번 연구에서 노인 위암 환자에서 암의 특징을 알아보고 수술 시행에 따른 생존기간의 연장여부를 조사하였다. 대상 및 방법: 2000년부터 2004년까지 이화여자대학교 부속목동병원에서 위암을 진단받은 환자를 대상으로 하였고 연령에 따라 65세 미만의 장년층과 65세 이상의 노년층으로 구분하였다. 대상 환자들의 의무기록을 검토하여 두 군의 임상적 및 병리적 특징을 비교하였고 수술 시행에 따른 합병증 발생 여부와 생존기간의 차이를 분석하였다. 결과: 선정기준에 합당한 370명 중 노년층이 44.6%, 장년층이 55.4%였다. 노년층은 장년층에 비하여 어지러움, 구역, 피로, 체중감소의 비전형적인 증상으로 위암을 진단받는 경우가 많았다. 기저 질환은 노년층에서 심장질환의 빈도가 높았으며 수술 시행률은 장년층에 비해 낮았다. 고분화암은 노년층에서 높은 빈도로 나타났다. 수술을 하는 경우 노년층과 장년층 간에 수술시간, 수술 후 입원기간, 합병증 발생률에서 차이가 없었다. 수술받은 위암환자에서 생존기간에 영향을 주는 인자는 tumor-node-metastasis (TNM) 병기였는데, 노년층과 장년층 간에 병기의 차이는 없었다. 노년층 환자에서 생존기간과 관련된 인자는 TNM 병기와 수술시행 여부였으며, 수술을 받으면 보존 치료를 받은 군에 비해 생존기간이 연장되었다. 결론: 노년층의 위암 환자에서 동반 질환의 비율은 장년층에 비해 높지만 수술 합병증 발생은 장년층과 차이가 없고, 수술을 시행한 군의 생존율은 보존 치료를 한 군보다 높다. 따라서 고령의 환자에서도 더 적극적으로 수술적 치료를 고려해야 한다. Background/Aims: It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment. Methods: Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged ≥65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed. Results: Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6±70.7 vs. 257.3±83.8 min, p=0.115), postoperative hospital stays (15.8±10.6 vs. 14.7±9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient`s survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26; p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26; p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively. Conclusions: In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer. (Korean J Gastroenterol 2011;58:9-19)

폐색전증을 동반한 원발성 항인지질증후군

이재범 ( Jae Beom Lee ),심윤수 ( Yun Su Sim ),노영욱 ( Young Wook Noh ),박혜성 ( Hye Sung Park ),태정현 ( Chung Hyun Tae ),임소연 ( So Yeon Lim ),전윤희 ( Yoon Hee Jun ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),이진화 ( Jin Hw 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures. (Tuberc Respir Dis 2007; 63: 72-77)