Osler-Rendu-Weber 증후군 환자에서 색전요법을 이용한 다발성 폐동정맥루 치험

김재학 ( Jae Hag Kim ),최택희 ( Taek Hee Choi ),남승모 ( Seung Mo Nam ),장재진 ( Jae Jin Chang ),박연희 ( Yeon Hee Park ),허남현 ( Nam Hyun Hur ),최두환 ( Du Hwan Choe ),이병희 ( Byung Hee Lee ),김유철 ( You Cheoul Kim ),이춘택 ( 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.4

우리나라에서의 Crohn 병 - 임상적 , 병리학적 고찰 및 치료에 따른 경과 관찰 -

이종균(Jong Kyun Lee),김유철(You Cheoul Kim),김재준(Jae Jun Kim),이풍렬(Poong Lyul Rhee),최상운(Sang Woon Choi),정현채(Hyun Chae Jung),윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),이승숙(Seu 대한내과학회 1991 대한내과학회지 Vol.41 No.5

N/A Crohn's disease used to be recognized as a rare inflammatory bowel disease in Korea, but current accumula- tion of sporadic case reports suggests a gradual increase of its inridence. Systemic studies, however, with clinical follow-up after treatment have not been fully assessed in the era of advanced colonoscopic approach. This article describes the clinical and pathologic findings of 15 cases of Cron's disease together with their clinical follow-ups with medical therapy, experienced during a period from October, 1978 to July, 1990. The results are summarized as follows: 1) The male-to-female ratio was 3,1, and the mean age was 25.5 years. The duration of symptoms was 2 months to 4 years, and the mean duration was 26 months. Common symptoms and signs included diarrhea, abdominal pain, weight loss, fever, etc., and the extraintestinal manfestations were rather scarce in these study cases. Anemia, increased ESR, throm-bocytosis, and hypoalbuminemia were frequent findings. 2) Colonoscopic and/or radiologic studies showed skipped lesion (80%), cobblestone appearance (67%), and longitudinal ulcer (47%) in order of frequency. The most common involved sites were the small bowel alone (27%), ileocolitis (60%), and the colon alone (13%). 3) Most of the patients (67%) responded well to medical therapy for a short-term period, and there was a good correlation between the subjective symptoms, colonscopic or radiologic findings, and Crohn's disease activity index. 4) Compared with cases from Western countries, the sex ratio in this study showed a male predominance, extraintestinal manifestation was rare, many patients (53%) had a past medical history of failure with anti-tuberculosis medication, and a good correlation existed between the subjective symptoms an6 objective examination. With the above findings, we assume that Crohn's disease is still a rare inflammatory bowel disease in Korea which requires a differential diagnosis with intestinal tuberculosis. It also seems more likely that in patients with clinical features of intestinal tuberculosis but who did not show any evidence of clinical improvement, including objective findings of intestinal ulcer, in spite of prolonged anti-tuberculosis medication lasting for several months, a possibility of Crohn's disease should be considered.

간세포암의 비수술적 치료후 생존율 평가에 의한 UICC 병기의 타당성에 관한 후향적 연구

윤종길(Jong Kil yoon),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),천영국(Young Kug Cheon),김유철(You Cheoul Kim),김창민(Chang Min Kim),홍원선(Weon Seon Hong),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),최수용(Soo Yong Choi) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: The management of hepatocellular carcinoma(HCC) has been frequently complicated due to the variable hepatic dysfunction from underlying chronic liver disease. The validity of UICC staging system based on the anatomical extent of malignant lesion has been questioned because of the poor correlation between stages and clinical outcomes. The purpose of this study is to elucidate the validity of UICC staging system as a prognostic factor and to compare with Child`s classification which represents the functional status of liver. Methods: A total of 831 patients with HCC who received no specific anti-cancer treatment, TACE and/or systemic chemotherapy, between January 1988 and December 1991, were analyzed retrospectively. Factors influencing the prognosis were analyzed by Cox proportional-hazard regression model. Results: Median survival of overall HCC patients was 4 months. There was no significant difference in overall median survival between UICC stage III and IVA; but significant differences between Child A and B, Child B and C were found. UICC staging system for HCC gave less significant clinical value in predicting the survival of HCC patients regardless of the treatment modalities given. In contrast, Child`s classification was better correlated with the survival of HCC patients who received systemic chemotherapy and no specific treatment. In Cox proportional-hazard regression model, Child`s classification was the most influential prognostic factor exceeding the role of UICC system.. Conclusion: UlCC staging system is not a good system for the staging of HCC. We beIieve that the poor correlation between stages and survival originated from the neglect of hepatic dysfunction which is the major prognostic factor in HCC. It is necessary to develop a new staging system which can represent the prognosis better.

증례 : 소화기 ; 대장내시경 후 발생한 피하기종, 기종격동 및 기복증

허정권 ( Jung Kwon Huh ),노희선 ( Hee Sun No ),임희완 ( Hee Hwan Lim ),김정훈 ( Jung Hoon Kim ),김유철 ( You Cheoul Kim ),김철현 ( Cheol Hyeon Kim ),이재철 ( Jae Cheol Lee ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

Colonoscopy is an essential tool to investigate and to manage intraluminal lesions of the colon and has been considered safe although a perforation as a complication of this procedure is often associated with serious morbidity. A 56-year-old woman had a colonoscopic biopsy for a suspicion of colon cancer. After the procedure, the patient complained of neck swelling and abdominal distension and pain. A chest X-ray and abdominal computed tomography scan showed subcutaneous emphysema, pneumomedistinum and pneumoperitoneum. If the colon perforates into the retroperitoneum, air can travel to the mediastinum and subcutaneous tissue as the fascial planes of the cervical soft tissues are in continuity with those of the mediastinum and through the diaphragmatic hiatus with the retorperitoneal soft tissue space. We report here a rare case of subcutaneous emphysema, pneumomediastinum and pneumoperitoneum that developed after a colonoscopic biopsy. (Korean J Med 77:S1153-S1156, 2009)

전이성 또는 재발성 식도암에 대한 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 복합화학요법의 치료 효과

류백렬(Baek Yeol Ryoo),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),정상훈(Sang Hoon Jeong),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),윤종길(Jong Kil Yoon),천영국(Young Kug Cheon),김서운(Seo Woon Kim),김유철(You Cheoul Kim),김창민(C 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Esophageal cancer is widely disseminated in more than 80% of patients at the time of diagnosis and the prognosis of advanced esophageal cancer is dismal with a median survival of 5 to 8 months. Therefore, systemic chemotherapy has assumed an important role in the treatment of these patients. Among various combination chemotherapy regimens, the combination of cisplatin and 5-fluorouracil has been one of the most effective for esophageal cancer because of their synergism. Etoposide, although reported ineffective as a single agent, has been shown to be synergistic with cisplatin in vitro and in vivo. So, we conducted a phase 2 trial to evaluate the effect of a combination of cisplatin, etoposide and 5- FU (PEF) in patients with metastatic or recurrent esophageal cancer. Thirty-four patients with measurable lesion(s) received cisplatin (20㎎/㎡ i.v. Day 1~5), etoposide (100㎎/㎡ i.v. Day 1, 3 & 5) and 5-FU (800㎎/㎡ continuous i.v. for 12 hours, Day 1~5). Of 30 evaluable patients, 1(3.3%) had a complete response and 11(37%) had partial responses. The median duration of response was 29 weeks. The overall median survival was 34 weeks and the survival time in the responders was longer significantly than that of the non-responders. There was no significant prognostic factor influencing the response rate. Among total 135 cycles of chemotherapy, leukopenia was observed in 36% and thrombocytopenia in 4%. There was no treatment-related death. Main non-hematologic toxicities were neurotoxicity (17%), nephrotoxicity (3%), and stomatitis (10%) and diarrhea (10%). All the toxicities were mild and well tolerated. Conclusion: A combination chemotherapy of cisplatin, etoposide and 5-FU (PEF) was effective and well tolerated in patients with metastatic or recurrent esophageal cancer.

국소적으로 진행된 식도암 환자에서 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 선행화학요법의 효과 ; A Pilot Study

정상훈(Sang Hoon Jeong),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),손태용(Tae Yong Son),곽영임(Young Im Kwak),천영국(Young Kug Cheon),김현각(Hyun Kag Kim),류백렬(Baek Yeol Ryoo),김유철(You Cheoul Kim),이춘택(Choon Taek Lee),김창민( 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A The prognosis of esophageal cancer is very poor. Even for those with localized disease who are potentially curable, 5-year survival rates are under 20% in almost all series. We conducted a pilot study to evaluate the safety and possibility of efficacy of neoadjuvant chemotherapy followed by surgery in patients with locally advanced esophageal cancer. Two or three cycles of neoadjuvant combination chemotherapy with cisplatin (20㎎/㎡/day i.v., D1-5), etoposide (100㎎/㎡/day i.v., D1,3,5), and 5-fluorouracil (800㎎/㎡/day continuous i.v., D1-5) were planned to be given before surgery. Total 21 patients entered this trial. Three patients were lost to follow-up after 1 cycle of chemotherapy to make eighteen patients evaluable. Thirteen out of eighteen patients (72%) had objective improvement after neoadjuvant chemotherapy and four (22%) had no change and one (6%) had progression. Among 18 evaluable patients, surgery was performed in 11 patients. Surgery could not be done in 7 patients because of patient's refusal (5), progression of disease (1), and development of lung abscess (1). In 13 patients who were candidates for surgery, curative resection was done in 10 patients to make curative resection rate 10/13 (77%). One of eleven patients having surgical resection had no pathologic evidence of tumor (pathologic complete remission 9%). Postoperative complications of wound dehiscence and anastomotic site fistula developed in 2 patients. Three courses of postoperative adjuvant chemotherapy with PEF regimen were administered to 9 patients. The median survival time for all 18 patients was 60 weeks. Toxicities of PEF neoadjuvant chemotherapy were leukopenia, nausea/vomiting and alopecia, but they were mild and reversible. There was no treatment-related deaths. In conclusion, neoadjuvant chemotherapy with PEF regimen were tolerable, safe and possibly effective in locally advanced esophageal cancer. Based on this study, we will perform phase 2 or 3 study to assess the efficacy of PEF neoadjuvant chemotherapy for locally advanced esophageal cancer.

위암세포주에서 Recombinant Human Interferon-r와 Adriamycin의 투여순서가 항암효과에 미치는 영향

홍원선,손영숙,김창민,강윤구,이춘택,김유철,임영혁,남현석,이진오,강태웅 大韓免疫學會 1993 大韓免疫學會誌 Vol.15 No.-

Numerous previous studies, both in vitro and in vivo, have demonstrated that the cytotoxicity can be enhanced by the combination of chemotherapeutic agent and interferons(IFNs) in various types of cancer cells. We have previously reported that combined treatment of MKN-45, human gastric adenocarcinoma cells, with adriamycin(ADM) and recombinant human interferon-r(rh-IFN-r) increased in the cytotoxicity. In this study, the effects of combination timing of rh-IFN-r and ADM on the cytotoxicity against MKN-45 were investigated using MTT assay. MKN-45 was treated with rh-IFN-r and ADM in vitro on three schedules : Treat A ; rh-IFN-r and ADM were treated simultaneously, Treat B ; rh-IFN-r was treated 24 hours after the treatment with ADM, Treat C ; rh-IFN-r was treated for 72 hours and followed by the treatment with ADM. The survival of MKN -45 was inhibited by ADM dose-dependently. 102 and 103U/ml of rh-IFN-r significantly inhibited the survival of MKN-45(% survival : 35.1 ±-1.2% and 34.4 ±1.1% in Treat A and 42.5 ± 2.1% and 45.9-±2.5% in Treat C, respectively). However no difference in the survival was observed between 102 and 103U/ml of rh-IFN-r. Combined treatment with rh-IFN-r and ADM significantly augmented the cytotoxicity at low concentrations of ADM. Combined effects of rh-IFN-r and ADM were evaluated using IC30(,ag/ml) to ADM. IC30s of MKN-45 in Treat A, B and C at 102 U/ml of rh -IFN-r _ were 0.019 -?- 0.003, 0.045 :I:0.001 and 0.054 ± 0.012, respectively, while IC30 of MKN-45 treated with ADM alone was 0.052±0.004. IC30s of MKN-45 in ADM alone group, Treat A, Treat B and Treat C at 103U/ml of rh-IFN-r were 0.047 ±0.003, 0.004 -±0.001, 0.031 ±0.004 and 0.056 0.008, respectively. These results indicate IC30s of Treat A and B were significantly lower than those of ADM alone(p<0.05) and IC30s of Treat A was significantly lower than those of Treat B(p <0.01). IC30s of Treat C, however, were not different from those of ADM alone. From these results demonstrating that cytotoxic effects were increased by the combination of rh-IFN-r and ADM in the order, Treat A > Treat B> Treat C, it can be concluded that the simultaneous administration of rh-IFN-r and ADM may be the most effective method to combine these two therapeutic modalties.

간세포암 환자에서 경동맥 Lipiodol-항암제 투여술 후 합병증에 대한 전향적 연구

김경현,김창민,김성배,김성환,최두환,정숙향,이진오,한철주,김유철,강태웅,이병희,양정훈,송은정,최병국 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: Transarterial chemolipiodolization (TAC) is a therapeutic option for unresectable hepatocellular carcinoma (HCC). The aims of this study were to analyze types and frequencies of post-TAC complications, to evaluate the necessity of prophylactic antibiotics, and to identify risk factors associated with complications. Methods: One hundred thirty five patients treated with TAC were analyzed prospectively. The patients' status was evaluated daily during the admission period Patients were followed up for 4 weeks by weekly phone interview. Results: Complications were fever in 38%, epigastric pain in 33%, right upper quadrant (RUQ) pain in 24%, nausea and vomiting in 13%, abdominal fullness in 11%, acute cholecystitis in 1.5%, liver abscess in 0.7% and hepatic failure in 0.7% of the 135 patients. Statistically significant risk factors were the amount of infused lipiodol and the number of treatment for fever and the location and the number of tumors for RUQ pain. Conclusions: Various post-TAC complications were observed in 70.4% of the patients. However , infectious complications were rare, and thus prophylactic antibiotic treatment is not necessary. Careful clinical observation and early symptomatic management for fever and abdomina pain are desirable.

만성 간질환과 간세포암종 환자에서 Basic Fibroblast Growth Factor와 Vascular Endothelial Growth Factor의 혈청 농도

김창민,홍석일,이진옥,유성재,정성문,정숙향,이진오,한철주,김종광,송용환,홍영준,김유철 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.1

Background/Aims: Angiogenesis occurs in response to tissue damage, and is of vital importance for tumor growth and metastasis. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are potent angiogenic factors, and have been suggested to be useful diagnostic markers in certain hypervascular tumors. However, little is known of serum bFGF and VEGF in patients with hepatocellular carcinoma (HCC). We attempted to measure serum bFGF and VEGF in patients with chronic liver diseases (CLD) and HCC to assess their pathogenetic role and usability as tumor markers. Methods: Serum bFGF and VEGF were measured in 8 patients with chronic hepatitis (CH), 15 patients with liver cirrhosis (LC), and 49 patients with HCC. bFGF was measured in 33, and VEGF was measured in 50, healthy blood donors. Results: Serum bFGF was 3.8±1.9, 2.0±1.4, 4.2±6.0, 17.4±30.0 pg/mL in normal control, CH, LC, HCC, respectively. The serum bFGF level was significantly increased in patients with HCC when compared withmal control or patients with CLD. No difference, however, was observed in serum VEGF levels among the four groups. The serum levels of bFGF and VEGF were not significantly different in patients with HCC according to tumor type, size and stage. Serum bFGF showed good sensitivity (90%), specificity (87%), and positive predictive value (94%) in differentiating patients with HCC from those with CLD at the cut-off value of 4.6 pg/mL. Conclusions: bFGF might play a role in the growth of HCC and its serum level might be used as a tumor marker. On the other hand, serum VEGF does not seem to be an adequate tumor marker.(Korean J Hepatol 2001;7:47-54)

간경변증 환자에서 간의 조직 괴사로 인해 공간점유병변을 보였던 중례 2예

김창민,김성배,정숙향,이진오,김유철,강태웅,남승모,김재학 대한소화기학회 1998 대한소화기학회지 Vol.32 No.1

Ischemic necrosis of the cirrhotic liver is rare because the liver has dual blood supply and an extensive collateral system. However, it may occur in the condition of sudden reduction of hepatic arterial flow such as acute blood loss or shock Recently, we experienced two cases of ischemic necrosis of the liver assoicated with cirrhosis. Those were presented as space-occupying lesions on the radiological study. In contrast with hepatocellular carcinoma, these lesions showed neither hypervascularity nor deposition of injected lipiodol. Repeated percutaneous fine needle cytology revealed no evidence of malignant cells, Furthermore, short-term follow-up examination showed decrease in size and/or extent of the lesions, It is important to differentiate these lesions from tumorous condition because interventional trial such as transarterial chemoembolization may further aggravate the ischemic lesion and unnecessary surgery under false impression of hepatocellular carcinoma in cirrhotic patients should be avoided.