다발성 골수종에서 저용량 thalidomide, cyclophosphamide, dexamethasone (TCD) 요법의 효과

류충헌,정재현,고정해,장제혁,박영진,최규남,박봉수,이상민,주영돈 인제대학교 2008 仁濟醫學 Vol.29 No.-

Background and Objectives : The immunomodulatory drug thalidomide can inhibit angiogenesis and induce apoptosis in experimental models. It can also induce marked and durable response in newly diagnosed myeloma patients. Thalidomide has been used at doses ranging from 200 to 800 mg with significant toxicity. No data are available on the impact of low-dose thalidomide, cyclophosphamide and dexamethasone as initial therapy for myeloma patients. Design and Methods : To address this issue, newly diagnosed myeloma patients were treated with 50 mg/day thalidomide continuously and cyclophosphamide 150 mg/m², days 1-4 and dexamethasone 20 mg/m², days 1-5 and day 15-19, every month. Between October 2005 and October 2006, 14 patients (median age 54.5 years) were treated with low-dose thalidomide, cyclophosphamide and dexamethasone. Results : After a minimum of two cycles of treatment, 5 patients (55.5%) showed a partial remission. After four cycles of treatment, 10 patients (83.3%) showed a partial remission (n=6) and complete remission (n=4). After a median follow-up of 15.4 months, 1 year overall survival rate was 82.0%. Thalidomide was well tolerated without serious toxic effects. Conclusions : The combination of low-dose thalidomide, cyclophosphamide and dexamethasone demonstrates favorable response rate and 1 year overall survival rate in newly diagnosed myeloma. Severe toxicities were not seen with this combination.

알코올성 췌장염 vs. 자가면역 췌장염 (PPT)

류충헌,김홍준,박도현,이상수,서동완,이성구,김명환 대한췌담도학회 2010 대한췌담도학회지 Vol.15 No.3

내시경 삽입 중 발생한 십이지장 천공의 성공적인 치료 3예

류충헌,박도현,김명환,서동완,이상수,이성구,김홍준 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.1

Endoscopic retrograde cholangiopancreatography has become a standard procedure for the diagnosis and treatment of pancreatobiliary disease. Like any invasive procedure, it carries a small, but significant rate of serious complications such as duodenal perforation. Primary surgical closure is the treatment of choice for the cases of duodenal perforation. However, there have been some case reports in which endoscopic metal clip closure of an iatrogenic duodenal perforation was successful. We experienced three cases of successful treatment of the iatrogenic duodenal perforation using endoscopic clipping and fibrin glue injections during a duodenoscope insertion. 내시경 역행성 췌담관 조영술은 췌담도 질환의 진단과 치료에 있어 필수적인 검사이고, 최근 내시경 술기 및 기구의 발전으로 시술의 기회가 많아짐에 따라 천공 등의 합병증이 발생할 가능성이 높아지고 있다. 의인성 십이지장 천공의 치료원칙은 현재까지 수술적 봉합이지만, 최근 내시경을 이용한 금속클립을 사용하여 성공적인 봉합술을 시도한 여러 예가 보고되었다. 이에 저자들은 내시경 역행성 췌담관 조영술 시행을 위해 십이지장 진입 중 발생한 천공을 내시경 금속 클립 및 fibrin glue를 이용하여 성공적인 치료를 경험하였기에 보고하는 바이다.

44개월간의 경과관찰 중에 악성으로 변화한 위 간질종양 1예

류충헌,김지현,박관식,서효림,최윤정,하승인,김윤정,설상영 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.1

Gastrointestinal stromal tumor is a common type of gastrointestinal mesenchymal tumor. Depending on the patient’s age, compliance and health status, and the level of suspicion of malignancy, tumors ≤3 cm in size are typically monitored annually by endoscopic ultrasonography. The examination interval can be extended if no size change is noted on consecutive examinations. We report here on a 44-year-old female who presented with abdominal discomfort and displayed no size change of her gastrointestinal stromal tumor on three consecutive endoscopies over a 44- month interval. The patient was diagnosed with malignant gastrointestinal stromal tumor on the basis of the evident ulceration seen on esophagogastroduodenoscopy and the inhomogenous echo noted on the endoscopic ultrasonography and the pathologic findings by gastric wedge resection. 위장관 간질종양은 간엽조직 기원의 종양 중 가장 흔한 종양이다. 위장관 간질 종양은 3 cm 이하의 크기인 경우 환자의 나이, 순응도, 건강상태, 검사자의 악성 의심 정도에 따라 추적검사를 해야 한다고 알려져 있고, 약 2년마다 내시경초음파 추적 검사를 하여, 2번의 내시경초음파에서 크기의 변화가 없다면, 추적검사기간을 늘릴 수 있다고 하였다. 하지만 저자들은 양성의 내시경초음파 소견 및 3 cm 이하의 위장관 간질종양으로 내원한 45세 여자에서 약 44개월간 3번의 추적 내시경 검사에서 크기 변화가 없다가, 마지막 추적 내시경 검사 6개월 후 복부 불편감으로 내원하여 시행한 내시경초음파 검사에서 크기의 변화는 없으나, 표면에 궤양 형성을 보이고, 내부의 비 균질 에코를 보여 시행한 쐐기 절제술에서 악성 위장관 간질종양으로 확진한 증례를 경험하여 고찰과 함께 보고한다.

양성 담도협착에서 완전 피막형

류충헌 ( Choong Heon Ryu ),김명환 ( Myung Hwan Kim ),이상수 ( Sang Soo Lee ),박도현 ( Do Hyun Park ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.1

Background/Aims: Benign biliary strictures (BBSs) have been endoscopically managed with plastic stent placement. However, data regarding fully covered self-expandable metal stents (FCSEMSs) in BBS patients remain scarce in Korea. Methods: Forty-one patients (21 men, 65.9%) with BBSs underwent FCSEMS placement between February 2007 and July 2010 in Asan Medical Center. Efficacy and safety were evaluated retrospectively. Patients were considered to have resolution if they showed evidence of stricture resolution on cholangiography and if an inflated retrieval balloon easily passed through the strictures at FCSEMS removal. Results: The mean FCSEMS placement time was 3.2 (1.9-6.2) months. Patients were followed for a mean of 10.2 (1.0 32.0) months after FCSEMS removal. The BBS resolution rate was confirmed in 38 of 41 (92.7%) patients who underwent FCSEMS removal. After FCSEMS removal, 6 of 38 (15.8%) patients experienced symptomatic recurrent stricture and repeat stenting was performed. When a breakdown by etiology of stricture was performed, 14 of 15 (93.3%) patients with chronic pancreatitis, 17 of 19 (89.5%) with gall stone-related disease, 4 of 4 (100%) with surgical procedures, and 2 of 2 (100%) with BBSs of other etiology had resolution at FCSEMS removal. Complications related to stent therapy occurred in 12 (29%) patients, including post-ERCP pancreatitis (n=4), proximal migration (n=3), distal migration (n=3), and occlusion (n=2). Conclusions: Temporary FCSEMS placement in BBS patients offers a potential alternative to plastic stenting. However, because of the significant complications and modest resolution rates, the potential benefits and risks should be evaluated in further investigations. (Korean J Gastroenterol 2013; 62:49-54)

A Case of intraductal papillary neoplasm of the bile duct combined with IPMN

이상준,류충헌 대한내과학회 2021 대한내과학회 추계학술대회 Vol.2021 No.1

캡슐 내시경에서 발견되지 않은 궤양에 의한 소장 폐쇄와 캡슐 저류

박관식,김지현,류충헌,서효림,최윤정,하승인,이상헌,설상영 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.1

Capsule endoscopy (CE) is a valuable modality for directly examining the small bowel in a relatively noninvasive and safe manner. CE is being increasingly used for obscure gastrointestinal bleeding, Crohn’s disease, drug induced ulcer and small bowel tumor. Although capsule retention is a relatively infrequent complication, small bowel obstruction and strictures have been considered contraindications to CE. But some authors have reported that capsule endoscopy can be safely used to help identify the etiology and site of small bowel obstruction, and the retention of the capsule indicates the presence of a lesion requiring surgery. We report here on a case of small bowel obstruction and capsule retention by a small bowel ulcer, and the small bowel ulcer was not found when performing capsule endoscopy. 캡슐 내시경은 소장 질환 진단에 매우 중요한 검사법으로 비교적 간편하고 안전한 검사법이다. 캡슐 내시경은 원인 불명의 위장관 출혈, 소장 크론병, 약제 유발성 궤양, 소장 종양 등을 진단하기 위해 사용되고 있으며 점차 적응증이 확대되어 가고 있다. 캡슐 저류는 가장 중요한 부작용중의 하나이고 이러한 이유로 소장 폐쇄나 협착이 의심되는 경우 캡슐 내시경 검사의 금기로 알려져 있다. 그러나 최근 캡슐 내시경이 소장 폐쇄나 협착의 유발 인자와 폐쇄 부위 진단에 도움이 될 수 있고 캡슐 저류가 수술 절제가 필요한 병변의 존재와 확진을 가능하게 할 수도 있다는 보고가 있다. 이에 저자들은 소장 출혈이 의심되어 캡슐 내시경을 시행한 환자에서 폐쇄 병변은 발견되지 않았으나 캡슐 저류가 발생하여 폐쇄 병변의 존재를 간접적으로 알 수 있었고 수술 절제를 통해 궤양과 주위 유착으로 인한 소장 폐쇄가 발생한 1예를 경험하여 문헌 고찰과 함께 보고한다.

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

김병근,노명환,류충헌,남화성,우수미,유승희,장진석,이종훈,최석렬,박병호 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.3

Background/Aims: The bedside index of severity in acute pancreatitis (BISAP)is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously. Methods: Fifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson’s score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC). Results: The accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (≥ 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT. Conclusions: BISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage

김홍준,이성구,류충헌,박도현,이상수,서동완,김명환 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.6

Background/Aims: To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD) as a new method of draining multiple bile duct obstructions. Methods: A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course. Results: Of the 38 patients who underwent double ENBD, 20 (52.6%) had Klatskin tumors, 12 (31.6%) had hepatocellular carcinoma, 3 (7.9%) had strictures at the anastomotic site following liver transplantation, and 3 (7.9%) had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%), drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%), obtain cholangiography in 4 (10.5%), drain hemobilia in 3 (7.9%), relieve Mirizzi syndrome with cholangitis in 3 (7.9%), and relieve jaundice in 3 (7.9%). Conclusions: Double ENBD may be useful in patients with multiple biliary obstructions.

십이지장 유두부에 발생한 선편평 상피암종 1예

김홍준,이성구,장지웅,류충헌,박도현,이상수,서동완,김명환 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.6

Primary adenosquamous carcinoma arising from the papilla of Vater is an extremely rare tumor. Here we report a case of adenosquamous carcinoma of the duodenal major papilla. The patient was a 56-year-old man presenting with abdominal discomfort and anorexia. A computed tomography (CT) scan showed dilatation of the common bile duct (CBD) and both intrahepatic ducts with a suspicious mass in the distal CBD. Duodenoscopy revealed a mass with an irregular surface at the papilla. The patient underwent Whipple's operation. He was diagnosed as having adenosquamous carcinoma of the papilla of Vater. Eighteen months after pancreaticoduodenectomy, metastatic lymph nodes were noted in a follow-up CT scan. 56세 남자가 복부 불편감과 식욕저하를 주소로 내원하였다. 전산화 단층촬영에서 원위담도 부위에 종괴를 의심하였고 십이지장내시경에서 십이지장 유두부의 종괴를 관찰하였다. 수술 후 선편평 상피암종으로 진단하였고 경과 관찰 중 18개월 후 시행한 복부 전산화 단층촬영에서 전이성 림프절을 관찰하였다. 십이지장 유두부에 발생하는 선편평 상피암종은 매우 드문 질환으로 저자들은 1예를 경험하여 문헌고찰과 함께 보고한다.