폐쇄성 황달에서 담도 배액 전후의 Cytokine과 Endotoxin에 대한 연구

강대환 ( Dae Hwan Kang ),허정 ( Jeong Heo ),김광하 ( Gwang Ha Kim ),문재현 ( Jae Hyeon Moon ),권대식 ( Dae Sik Kwon ),김보석 ( Bo Suk Kim ),안진광 ( Jin Kwang An ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ),양웅석 ( Ung Suk Yang 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: Malignant biliary obstruction are associated with high postoperative morbidity and mortality. This study was performed to determine the effect of external and internal biliary drainage on plasma concentrations of cytokines and endotoxin. Methods: Twenly-one patients with malignant biliary obstruction were enrolled in this study. They were devided into two groups, PTBD (percutaneous transhepatic biliary drainage) and ERBD (endoscopic retrograde biliary drainage)groups. Then, plasma concentrations of TNF-α, sTNFr, interleukin 1α (IL-1α), interleukin 6 (IL-6), and endotoxin were measured before and after 1 week in PTBD and ERBD groups. Results: Total bilirubin decreased significantly from 13.3±8.2 to 6.2±4.4 mg/dL after PTBD and 7.0±11.2 to 5.3±4.0 mg/dL after ERBD (p=0.005, 0.007, respectively). Plasma sTNFr in PTBD group was 5.1±1.4 before drainage and remained unchanged 5.5±1.5 ng/mL at one week after drainage (p=0.155). Plasma sTNFr in the ERBD group was 5.9±1.5 and 5.6±1.0 ng/mL before and after biliary drainage, respectivedly (p=0.333). There was no significant difference of sTNFr changes between the PTBD and ERBD groups (p=0.113). Moreover, there was no significant difference in endotoxin changes between the PTBD and ERBD groups (p=0.477). Other cytokines changed insignificantly. Conclusions: Both PTBD and ERBD did not affect significantly plasma concentrations of sTNFr and endotoxin. Although ERBD provides a better quality of life and physiologic benefit, it dose not decrease cytokines and endotoxin associated with high morbidity and mortality in patients with malignant biliary obstruction. (Korean J Gastroenterol 2003;41:493-498)

급성 관상 동맥 증후군으로 오인된 식도 벽내 혈종 1예

유대곤 ( Dae Gon Ryu ),최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),정동일 ( Dong Il Jeong ),김완철 ( Wan Chul Kim ),신재규 ( Jae Gyu Shin ),임태원 ( Tae Won Lim ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.4

Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed. (Korean J Gastroenterol 2017;69:239-242)

고이형성증이 동반된 총담관류 1예

류대곤 ( Dae Gon Ryu ),김은정 ( Eun Jung Kim ),안은영 ( Eun Young Ahn ),송병준 ( Byeong Jun Song ),강대환 ( Dae Hwan Kang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6

이 증례는 특별한 병력이 없던 건강검진 상부위장관 내시경에서 십이지장 종괴가 발견된 환자에서 내시경 역행 췌담관 조영술로 총담관류의 소견을 보여 내시경 유두괄약근 절개술을 시행하였고 조직 검사에서 고이형성증을 동반한 총담 관류를 진단하여 광범위 수술까지 진행한 경우이다. 총담관류는 빈도가 매우 드물고 다른 담관 낭종에 비해 악성화 가능성이 낮아서 내시경 유두괄약근 절개술로 치료를 종결하는 것이 대부분이지만 이번 증례처럼 고이형성증이 동반될 수 있으므로 총담관류를 발견하였을 때 유두괄약근 절개술 후 절개면을 주의 깊게 관찰하고 철저한 조직 검사와 추적관찰이 필요할 것으로 생각한다. A type III choledochal cyst, known as a choledochocele, is rare. It is defined as cystic dilatation of the distal common bile duct, protruding into the duodenal lumen. Surgical treatment of a choledochocele remains controversial because it has a low incidence for malignancy compared with other choledochal cysts. While there have been few reported cases of choledochocele with malignancy, here we report our experience of a choledochocele with high-grade dysplasia and provide a literature review of the field. (Korean J Med 2014;86:728-732)

소화기 ; Churg-Strauss 증후군 환자에서 발생한 무결석 담낭염

박종환 ( Jong Hwan Park ),강대환 ( Dae Hwan Kang ),이진호 ( Jin Ho Lee ),김민대 ( Min Dae Kim ),최철웅 ( Cheol Woong Choi ),김형욱 ( Hyung Wook Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.4

저자들은 급성 무결석성 담낭염으로 발현한 Churg-Strauss 증후군 환자를 조직 소견을 포함한 ACR 기준에 따라 진단하여 치료하였고, 증상 호전 후 담낭절제술을 시행하였는데 담낭조직에서는 호산구 침윤이나 혈관염을 찾을 수 없었던 증례를 경험하여 관련 문헌 및 최근 문헌보고와 함께 보고하는 바이다. Churg-Strauss syndrome is an uncommon disorder characterized by asthma, hypereosinophilia, and systemic vasculitis. Gastrointestinal involvement is commonly encountered in Churg-Strauss syndrome; however, acute cholecystitis is rare, and few cases have been documented in the literature. A 22-year-old female with a history of asthma was admitted with a complaint of steady pain in the right upper abdominal quadrant. Laboratory test results showed leukocytosis with hypereosinophilia. Abdominal ultrasonography and computed tomography revealed acute cholecystitis. Her symptoms did not improve with conservative treatment, so she underwent percutaneous transhepatic gallbladder drainage. Subsequently, peripheral neuropathy, erythematous papules on the skin, and dyspnea developed. A chest computed tomography scan showed bilateral pulmonary infiltrates. A pathological examination of the skin lesion indicated necrotizing vasculitis with eosinophilic infiltrates. She was diagnosed with Churg-Strauss syndrome. She was treated with corticosteroids, and her condition improved dramatically. After the drainage catheter was removed, complications including a bile leak occurred. Consequently, a cholecystectomy was performed. (Korean J Med 79:412-416, 2010)

단분절 바렛식도에서 발생한 식도선암

강진 ( Jin Kang ),안성규 ( Sung Gyu An ),김표준 ( Pyo Jun Kim ),박태익 ( Tae Ik Park ),김일두 ( Il Du Kim ),김도훈 ( Do Hoon Kim ),김태오 ( Tae Oh Kim ),김광하 ( Gwang Ha Kim ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),김익두 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

Barrett`s esophagus is characterized by a change in the esophageal epithelium, of any length of the esophagus, and this can be recognized via endoscopy and confirmed by the presence of intestinal metaplasia and goblet cells on biopsy from the lower esophagus. It is a premalignant lesion of adenocarcinoma of the esophagus. Barrett`s esophagus is classified as long when it presents as a segment of columnar epithelium longer than 3 cm, and as short when it is shorter than 3 cm. The prevalence of Barrett`s esophagus is low and its malignant change is rare. We report here on a case of esophageal adenocarcinoma that developed from a short segment Barrett`s esophagus, and this was treated by proximal gastrectomy. (Kor J Neuro-gastroenterol Motil 2007;13:68-71)

제5차 대한간학회 춘계학술대회 초록집 : 특발성 문맥압 항진증의 임상 양상

이준홍 ( Lee Jun Hong ),강대환 ( Kang Dae Hwan ),이창훈 ( Lee Chang Hun ),송근암 ( Song Geun Am ),조몽 ( Jo Mong ),양웅석 ( Yang Ung Seog ) 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.1(S)

양성 식도 수술 문합부 협착에 대한 확장 치료의 임상 결과

최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),박수범 ( Su Bum Park ),김수진 ( Su Jin Kim ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.2

목적: 식도 절제술 후 발생하는 양성 식도 협착은 드물지 않은 합병증이다. 양성 식도 문합부 협착은 여러 번의 확장 치료가 필요하다고 알려져 있다. 본 연구에서는, 수술 후 발행한 식도 문합부 협착 환자에서 확장 치료(내시경 풍선 확장 또는 부우지 확장)의 임상 결과를 분석하고, 불응성 협착과 관련된 위험인자를 알아보고자 하였다. 대상과 방법: 2009년 1월부터 2016년 5월까지, 식도 수술 문합부 협착으로 진단되어 확장 치료를 시행 받은 환자의 의무기록을 후향적으로 분석하였다. 결과: 연구 기간 동안에 21명의 양성 식도 문합부 협착 환자에 대해서 확장시술을 시행하였다. 환자의 성별은 남자가 17명(80.1%), 환자의 평균나이는 68.2±7.2세였다. 첫 진단 때, 협착의 직경은 협착 정도가 5 mm 미만인 경우가 10명(47.6%), 6-10 mm가 8명(38.1%), 11 mm 이상인 경우가 3명(14.3%)이었다. 협착의 길이는 평균 6.4 mm(표준편차 8.1mm)였다. 확장 치료 후 발생하는 중요 합병증은 없었다. 불응성 식도 협착은 7명(33.3%)이었고, 관련된 인자는 협착의 길이(>10 mm)와 당뇨였다. 결론: 양성 식도 수술 문합부 협착 환자에서 확장 치료는 안전한 치료법이며, 협착의 길이가 10 mm보다 작은 경우에 효과적이었다. Background/Aims: Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture. Methods: Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed. Results: During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients. Conclusions: Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length. (Korean J Gastroenterol 2017;69:102-108)

국소형 선근종증에서 발생한 담낭내유두모양종양 1례

남형석 ( Hyeong Seok Nam ),강대환 ( Dae Hwan Kang ),최병현 ( Byung Hyun Choi ),김소영 ( So Young Kim ),이정희 ( Jung Hee Lee ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.4

만성담낭염에 흔히 동반되는 담낭의 선근종증은 육안적 형태에 따라 분절형, 국소형, 미만형의 세가지로 분류할 수 있다. 선근종증에서 드물게 담낭암의 전구성병변이나 담낭암이 발생하기도 하는데, 대부분 분절형 선근종증에서 기원하는 것으로 알려져 있다. 담낭암의 전구성병변 중 하나인 담낭내유두모양종양은 담낭의 점막 상피에서 기원하여 내강 내로 자라면서 용종이나 유두종을 형성하는 것이 일반적이다. 이번 증례에서 담낭 점막의 용종이나 유두종을 형성하지 않고 근육층에 국한되어 있으면서 국소형 선근종증에서 유래한 담낭내유두모양종양 1예를 보고하고자 한다. Adenomyomatous hyperplasia (AMH) of the gallbladder commonly accompanies chronic cholecystitis and may be classified into three types according to the gross features: segmental, localized (fundal), and diffuse types. In situ or invasive carcinomas arising from and confined to AMH are rarely observed, especially of the segmental type. Intracystic papillary neoplasm (IPN) is one of the precancerous lesions of the gallbladder. IPN usually grows into the lumen and produces a polypoid or papillary mass. Here, we report an extremely rare case of IPN arising from and limited to a localized AMH incidentally detected in a brain-dead 68-year-old female patient during organ harvesting. Korean J Pancreas Biliary Tract 2018;23(4):182-189

췌장 Simple Mucinous Cyst 내 Hemosuccus Pancreaticus 1예

조일억 ( IL Eok Jo ),강대환 ( Dae Hwan Kang ),최철웅 ( Cheol Woong Choi ),김형욱 ( Hyung Wook Kim ),김수진 ( Su Jin Kim ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.6

Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a sus-pected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms. (Korean J Gastroenterol 2017;70:301-303)

착륙장치 복합재 토크링크 피로내구성 평가에 대한 연구

권정호(Jung-Ho Kwon),강대환(Dae-Hwan Kang) 한국항공우주학회 2010 韓國航空宇宙學會誌 Vol.38 No.6

본 연구는 최근 금속재를 대체하기 위하여 RTM법으로 개발된 헬리콥터 복합재 토크링크 구조에 대하여 피로 내구성 평가 절차와 기법에 대하여 고찰하였다. 피로내구성 평가에 필요한 운용수명 중 예상되는 피로하중스펙트럼을 산출하는데 보다 신뢰성이 높은 진보된 기법으로 확률적 랜덤처리 기법을 도입하였다. 그리고 불균질성이 큰 복합재에 대하여 재료의 피로특성치를 기반으로 하는 강도저하 접근법을 통하여 잔여강도와 피로파손 확률 거동을 분석함으로써 보다 신뢰성 있는 내구성 평가를 수행하였다. 이때 강도저하 파라미터 는 일련의 재료시편 피로시험 결과를 최대근사법을 사용하여 Weibull 파라미터를 해석함으로써 결정하였다. 또한 복합재 토크링크 실물시제에 대하여 피로내구성 시험을 수행하고 해석결과와 비교 검토하였다. This research work contributed to a study for the procedure and methodology to assess the fatigue durability for a composite torque link of helicopter landing gear, which was newly developed and fabricated by the resin transfer moulding technique to interchange with metal component. The simulated load spectrum anticipated to be applied to the torque link during its operation life was generated using an advanced method of probabilistic random process, and the fatigue durability was evaluated by the strength degradation approach on the basis of material test data. The full scale fatigue test was also performed and compared with the analysis results.