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      • SCOPUSKCI등재

        대장암 치료의 복합 요법

        박선자 ( Seun Ja Park ) 대한장연구학회 2007 Intestinal Research Vol.5 No.2

        Polyps that contain carcinomatous changes that are confined to the mucosa (carcinoma-in-situ or severe dysplasia) do not have metastatic potential and are adequately treated with complete polypectomy or endoscopic mucosal resection. If deep invasion into the stalk has occurred or if adverse features (such as lymphatic invasion, or positive margins) are present, then en bloc colectomy is indicated. For lesions in the mid to upper rectum, a low anterior resection is the treatment of choice. To decrease the risk of local recurrence, patients should undergo optimal pelvic dissection with sharp mesorectal excision. Patients with pathologic lymph node-negative T3 or T4 lesions or any lymph node-positive cancer should receive preoperative or postoperative combined modality therapy. A major goal of preoperative therapy is to decrease the volume of the primary tumor and thus enhance sphincter preservation. For resectable colon cancer, the surgical procedure of choice is colectomy with en bloc removal of the regional lymph nodes. Laparoscopic colectomy has been advanced as an approach to the surgical management of colon cancer. Recently, the outcomes of cancer from a randomized trial comparing laparoscopically assisted and open surgery for curable colon cancer was reported. After a median of 4.4 years follow-up, similar cancer recurrence rates were observed in the two groups. The current management of disseminated metastatic colon cancer uses various active drugs, both in combination and as single agents: 5-FU/leucovorin, irinotecan, oxaliplatin, capecitabine, bevacizumab, and cetuximab. The choice of therapy is based on consideration of the type and timing of the prior therapy that has been administered and the differing toxicity profiles of the constituent drugs. As primary therapy for metastatic disease in a patient with good tolerance to intensive therapy, combination therapy consisting of fluoropyrimidines: FOLFOX (oxaliplatin, infusional fluorouracil, and leucovorin) or FOLFIRI (irinotecan, infusional fluorouracil, and leucovorin), with or without bevacizumab; bolus 5-FU/leucovorin/irinotecan with bevacizumab; 5-FU/leucovorin with bevacizumab were recommened. (Intest Res 2007;5:122-130)

      • KCI등재

        기획종설 : 환자와 소통 잘하는 소화기의사가 되기 위하여

        박선자 ( Seun Ja Park ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.3

        There are many reasons why doctors would not to be able to communicate with patients. First, medicine is science or humanity? Although object of medicine is human, modern medicine tends to regard human as broken machine. Second, gastroenterologists are overloaded by treatment of patients, providing education, attending academic conference, and writing papers. Above all things, it is much worse for gastroenterologists because of endoscopic procedures. The other problem is attitude of modern society about human suffering. Sufferings come from not only body but also mind or spirit. Although there are may difficult problems, if doctors listen to patients` history by their side, it will help to restore their faith. In addition, we need humanity education and improvement plans for medical service system. (Korean J Gastroenterol 2012;60:162-165)

      • KCI등재
      • 구연 : 제 1 회의장 (그랜드볼룸 1) ; 위장관 : 인체 소화기암세포(AGS, HT-29)의 증식에 미치는 curcumin의 억제 효과

        김기환 ( Ki Whan Kim ),박현용 ( Hyun Lyoung Park ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),정근옥 ( Kun Oak Jung ),박건영 ( Kun Young Park ),구자영 ( Ja Young Koo ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

        <목적> 음식첨가제에 포함되어 있는 성분인 curcumin이 인체 소화기암세포(AGS, HT-29)의 중식에 미치는 효과를 좀더 자세히 알기 위해, 세포배양실험을 통하여 curcumin의 증식효과를 조사하고, 5-fluorouracil(5-FU)와의 병용효과를 조사하였으며, 증식억제에 따르는 각 세포주기별 변화를 조사하였다. <재료 및 방법> 증식기의 인체 소화기암세포(AGS, HT-29)를 6 well plate에 각 well당 1×10(5)개의 세포

      • KCI등재

        증례 : 소화기 ; 위험인자가 없는 환자에게 발생한 대장 내시경에 의한 우측 허혈성 대장염 1예

        이은미 ( Eun Mi Lee ),박선자 ( Seun Ja Park ),송성은 ( Sung Eun Song ),김재현 ( Jae Hyun Kim ),김규종 ( Kyu Jong Kim ),박무인 ( Moo In Park ),박동양 ( Dong Yang Park ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

        저자 등은 평소 특별한 위험인자가 없었던 41세 여자 환자로 대장 내시경 시행 후 갑자기 발생한 혈변 및 우하복부 통증을 주소로 응급실에 내원하여 대장 내시경 및 복부 CT를 통해 대장 내시경에 의해 발생한 우측 대장의 허혈성 대장염으로 진단하고 금식 및 수액 공급 등의 보존적 치료로 회복된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Ischemic colitis is the most common form of intestinal ischemia. Although there are a variety of causes, the most common mechanism is acute, self-limited compromise in intestinal blood flow. Most cases of ischemic colitis are transient and resolve spontaneously, but right colon involvement is associated with poor outcome. Colonoscopy is the gold standard for the identification of colonic ischemia; however, very rarely, colonoscopy itself may induce ischemic colitis in patients with underlying predisposing factors, such as connective tissue disorders. We experienced a case of ischemic colitis of the right colon, following colonoscopy in a patient without risk factors. (Korean J Med 79:285-288, 2010)

      • KCI등재

        크론병 환자에서의 특발성 췌장염 1예

        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)

      • KCI등재

        생리식염수 관장 직후 혈성 설사로 발현한 허혈대장염 1예

        박지은 ( Ji Eun Park ),문원 ( Won Moon ),남지현 ( Ji Hyun Nam ),김낭희 ( Nang Hee Kim ),김성훈 ( Sung Hoon Kim ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),김규종 ( Kyu Jong Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.50 No.2

        Ischemic colitis is a frequent disorder of large bowel in elderly persons or in debilitated patients with a variable underlying medical problems. Ischemic colitis may result from alterations in the systemic circulation or anatomic or functional changes in the local mesenteric vasculature. In most cases, no specific cause for the ischemic colitis is identified. Cases of ischemic colitis after enema for bowel cleansing have been rarely reported, but there has been no case report after normal saline enema. We report a case of ischemic colitis in a 72-year old patient with well-controlled hypertension, presenting as bloody diarrhea which developed after normal saline enema for preoperative bowel cleansing. (Korean J Gastroenterol 2007;50:126-130)

      • 위암 날문부 폐쇄 환자에게 시행한 치료의 비교고찰: 위-공장 우회술과 금속성 자가팽창성 스텐트 삽입술

        조성진,윤기영,최경현,박무인,박선자,고지호,이상호,Jo, Seung-Jin,Yoon, Ki-Young,Choi, Kyung-Hyun,Park, Moo-In,Park, Seun-Ja,Ko, Ji-Ho,Lee, Sang-Ho 대한위암학회 2007 대한위암학회지 Vol.7 No.2

        목적: 위암에 의한 위출구 폐쇄는 다양한 소화기 증상과 영양 실조를 야기하며, 따라서 삶의 질을 떨어뜨리고 생명을 단축시킨다. 이처럼 위날문부 폐쇄 환자에게 시행하는 스텐트삽입 시술은 위 공장 우회술에 비교하여 덜 침습적이고 효과적인 시술로 알려져 있다. 그러나, 위암에서의 스텐트 시술의 효과와 위공장 우회술의 효과에 대한 비교연구는 찾아볼 수 없다. 대상 및 방법: 2000년 1월부터 2006년 8월까지 고신대학교 복음병원에서 내시경 및 위장관 조영술을 이용하여 위암으로 인한 위 날문부 폐쇄를 진단 받고, 위 날문부 스텐트 삽입시술을 받은 환자군과 위공장 우회술을 받은 환자군 간의 데이터 통계를 1개월에서 46개월까지 추적 관찰한 외래 차트를 바탕으로 후향적으로 비교하였다. 이 중 위암의 재발로 인해 시술을 받은 환자와 이중암(double cancer)으로 진단을 받은 환자는 제외하였다. 결과: 100명의 환자가 스텐트 삽입을 시행받았고, 31명의 환자가 위 공장 우회술을 시행받았다. 두 그룹 간 남녀 성별 비는 통계적인 의미가 없었으나(스텐트 M : F 2 : 1, 우회술 M : F 2 : 1, P=0.637) 연령은 스텐트군은 $67{\pm}10$, 우회술군은 $57{\pm}10$ (P<0.001)으로 통계적인 의미가 있었다. 스텐트 삽입군에서 수술을 못한 이유는 60%의 경우 암진행, 34%의 경우는 고령, 6%의 경우는 동반질환의 중중도에 의하였고, 스텐트 시술 후 가장 gms한 합병증은 스텐트내 종양성장, 다음으로 스텐트 이동이었고 시술의 실패는 3%였다. 두 군 간 시술 후 유동식까지 걸린 시간은 스텐트군 $3{\pm}2$ (일), 우회술군은 $6{\pm}2$ (일)(P=0.003) 그리고 시술 후 입원기간은 스텐트군 $5{\pm}2$ (일), 우회술군 $15{\pm}6$ (일)(P<0.001)로 모두 통계적으로 유의한 결과가 나왔다. 결론: 위암의 날문부 폐쇄 환자에게 시행한 자가팽창 금속성 스텐트 시술은 위장 우회술에 비하여 빠른 식 사진행과 짧은 입원기간으로 효과적인 시술일 수 있지만, 스텐트가 움직이거나 종양의 재성장으로 인해 스텐트를 다시 시술해야하근 불편함이 있는 등 스텐트로 인한 환자의 불편함이 많아서 향후 더욱 많은 연구가 필요할 것이다. Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.

      • KCI등재

        증례 : 소화기 ; 항암 치료 중인 위암 환자에서 피부 전이로 오인된 스파르가눔증

        이지숙 ( Jee Suk Lee ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),김규종 ( Kyu Jong Kim ),문원 ( Won Moon ),신은경 ( Eun Kyung Shin ),박동양 ( Dong Yang Park ) 대한내과학회 2009 대한내과학회지 Vol.77 No.6

        저자들은 전이성 위암 환자에서 항암 치료 중에 발생한 좌측 장딴지 종물을 피부 전이 의심하에 생검 적출술을 시행하였고, 스파르가눔증으로 진단된 예를 경험하였기에 문헌고찰과 함께 보고하였다. Sparganosis is a rare parasitic disease caused by the migrating plerocercoid larva of tapeworms in the genus Spirometra. The most frequent clinical manifestation of human sparganosis is a subcutaneous nodule resembling neoplastic disease. Since the disease is relatively uncommon, even in endemic areas, sparganosis is rarely considered in the differential diagnosis of skin lesions. We experienced a case of sparganosis mimicking a skin metastasis in a patient with metastatic stomach cancer and made the diagnosis after an excisional tissue biopsy. (Korean J Med 77:755-758, 2009)

      • SCOPUSKCI등재

        점막하 종양의 양상을 보인 조기 점액성 위암 1예

        유찬희 ( Chan Hui Yoo ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),문원 ( Won Moon ),김형훈 ( Hyung Hun Kim ),이준식 ( Jun Sik Lee ),송준영 ( Jun Young Song ),장희경 ( Hee Kyung Jang ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.2

        Mucinous gastric carcinoma (MGC) is an unusual histologic subtype, and early detection of MGC is very rare. Early stage MGC appears as an elevated lesion resembling a submucosal tumor (SMT) due to abundant mucin pools in the submucosa or mucosa. We report a rare case of SMT-like early-stage MGC. Tumor type was predicted preoperatively based on characteristic endoscopic findings, in which an SMT-like mass was observed at the gastric fundus. The tumor was covered by nearly normal mucosa, but with an opening allowing for the passage of copious mucus discharge. A total gastrectomy with Roux-en Y esophagojejunostomy was subsequently performed. Histopathology of the tumor revealed early-stage (lamina propria) mucinous adenocarcinoma. (Korean J Gastroenterol 2013; 62:122-125)

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