특집-급성 췌장염의 최신 지견 : 급성 췌장염의 영양요법

박은택 ( Eun Taek Park ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2

중증 급성 췌장염 환자에서 영양 공급은 치료의 중요한 부분을 차지함에도 불구하고 오랜 기간 동안 소홀히 다룬 측면이 있다. 경증인 경우 현재까지 새롭게 제시된 보존적 치료법은 없지만 영양 공급 면에서 조기 저지방 유동식(lowerfat soft diet)의 시도가 병의 재발이나 복통의 재발 없이 입원 기간 단축을 유도한다. 중증인 경우, 내원 48-72시간 이후 발생하는 영양 부족 및 면역 저하 등으로 인해 발생하는 국소 합병증의 이차 감염증 예방에 영양 공급은 필수적이며 투여 방법에서 경장 영양법이 정맥 주입법보다 우위에 있으나 필요한 만큼의 영양 공급이 이루어지지 않는 경우 정맥 주입법을 보조적으로 사용하는 것이 바람직하다. 경장 영양시 경공장관 영양공급이 유용한 것으로 보고되어 왔으나 최근 비위관 영양공급의 편리성이 부각되어 적극적으로 시도하는 경향이다. Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Acute pancreatitis is a hypercatabolic state resulting in rapid loss of body weight, fat and protein. Nutritional support is an integral part of patient care and is started early in the course of disease. Patients with mild to moderate disease (80% of patients) do not require enteral nutrition (EN) or parenteral nutrition (PN), as they will begin oral feeding within 4 days of presentation. Nutritional support is needed for severe disease, EN is preferred over PN, and use PN when EN is contraindicated or not feasible. Most groups have used nasojejunal feeding, which has difficulties in maintenance of the tube position and patency. Nasogastric feeding in severe acute pancreatitis has shown little difference in terms of clinical outcome from nasojejunal feeding. In this review, we review the role, methods, and clinical implications of nutritional supports in acute pancreatitis and also present recently recommended standard guidelines. (Korean J Med 2013;85:130-134)

급성췌장염의 약물, 수액 및 영양요법

박은택 ( Eun Taek Park ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.4

Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Acute pancreatitis is a hypercatabolic state resulting in rapid loss of body weight, fat and protein. Nutritional support is an integral part of patient care and is started early in the course of disease. Patients with mild to moderate disease (80% of patients) do not require enteral nutrition (EN) or parenteral nutrition(PN), as they will begin oral feeding within 4 days of presentation. Nutritional support is needed for severe disease, EN is preferred over PN, and use PN when EN is contraindicated or not feasible. Most groups have used nasojejunal feeding, which has difficulties in maintenance of the tube position and patency. Nasogastric feeding in severe AP has shown little difference in terms of clinical outcome from nasojejunal feeding. In this review, we review the role, methods, and clinical implications of nutritional supports in acute pancreatitis and also present recently recommended standard guidelines. Korean J Pancreatobiliary 2014;19(4):170-175

종 설 : 담낭벽 종대 발견시 적절한 대처

박은택 ( Eun Taek Park ) 대한내과학회 2016 대한내과학회지 Vol.90 No.1

Thickening of the gallbladder wall is a relatively frequent finding on diagnostic imaging. Such thickening is also a common but nonspecific finding in many patients with intrinsic gallbladder disease and extracholecystic conditions. Wall thickening may be diagnostically problematic, occurring (as it does) in both symptomatic and asymptomatic patients and in those with and without indications for cholecystectomy. An important first step is to distinguish between the diffuse and focal forms of thickening. Subsequently, identification of ancillary imaging findings and the directed use of additional imaging modalities allow accurate diagnosis. This is of clinical importance. Misinterpretation of the cause of thickening can trigger unnecessary cholecystectomies in patients without intrinsic gallbladder disease. Also, misdiagnosis of patients who do in fact require cholecystectomy may delay treatment, thus increasing morbidity. Although a definitive imaging diagnosis may not be possible, the cause of gallbladder wall thickening can be determined in most instances by correlating the clinical presentation with associated imaging findings. (Korean J Med 2016;90:15-19)

의학강좌-개원의를 위한 모범처방 : 담낭용종의 치료 전략

박은택 ( Eun Taek Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5

마산만의 수질 개선을 위한 우선순위 하천 선정

배은택 ( Eun-taek Bae ),박종관 ( Jong-kwan Park ),문병현 ( Byung-hyun Moon ) 한국환경기술학회 2022 한국환경기술학회지 Vol.23 No.6

This study aimed to select the priority streams requiring improvement in water quality among the 17 streams flowing into the Masan Bay. Several methods were employed to select the priority streams, including calculation of discharge load and discharge load per unit area, analyses of the impervious rate and road ratio using land cover characteristics, grouping of branch streams, and the calculation of load duration curve excess rate. Watershed data, including flow and water quality data, were collected and monitoring was conducted in the Masan Bay watershed from 2005 to 2021 at the endpoints of the streams. 1) Five and six streams were identified as the subjects of priority management, according to the highest load rates by subwatershed and per unit area, respectively. 2) Two streams appeared to be the subjects of priority management, according to land cover characteristics that indicated an impervious ratio >50 % and a road ratio >10 %. 3) Stream grouping was carried out to identify group A water quality streams with high load and flow rates; six and eight streams were found to be the subjects of priority management, respectively. 4) As a result of selecting streams with an average excess flow >50 % using a flow duration curve, six streams were found to be the subjects of priority management. 5) The analysis of the five indicators revealed that Shinicheon and Samhocheon streams require priority management to improve water quality in the Masan Bay area, particularly management of point-source pollution. Continuous management is also required for Cheoksan, Naedong, and Changwon streams, which were identified as the subjects of priority management based on four indicators.

전임의를 위한 내시경역행담췌관조영술 교육 가이드라인

김재환 ( Jaihwan Kim ),박은택 ( Eun Taek Park ),손병관 ( Byoung Kwan Son ),최은광 ( Eun Kwang Choi ),김국현 ( Kook Hyun Kim ),김효정 ( Hyo Jung Kim ),박상욱 ( Sang Wook Park ),송태준 ( Tae Jun Song ),안동원 ( Dong-won Ahn ),윤재훈 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.1

내시경역행담췌관조영술(ERCP)은 췌담도계 질환의 진단 및 치료에 필수적인 내시경 술기이다. 비록 자기 공명 담췌관 조영술이나 초음파 내시경과 같은 비침습적인 검사들로 인해 서 ERCP의 진단적인 역할은 감소하고 있으나 여전히 ERCP 는 췌담도계 질환의 치료에서 매우 중요하다. 그러나 한국에 서는 시술이 많은 일부 병원으로의 ERCP 집중, 시술 후 합병증의 높은 위험 그리고 긴 수련과정과 같은 이유로 전임의들 이 ERCP를 배우고자 하는데 주저함이 있다. 이와 같은 배경 에서 대한췌담도학회 교육위원회는 한국에서 수련받고 있는 전임의들을 위해 ERCP 교육 가이드라인을 준비해왔다. 대한 췌담도학회 교육위원회는 가이드라인이 현재 수련 중인 전임 의들에게 도움이 될 것을 기대한다. Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential endoscopic technique in diagnosis and treatment of pancreatobiliary diseases. Although its diagnostic role is decreasing because of less invasive modalities such as magnetic resonance cholangiopancreatography or endoscopic ultrasound, it is still very important in treatment of pancreatobiliary diseases. However, there is a trend of hesitation to learn ERCP by the fellows in Korea because of following reasons; concentration of ERCP in a few high volume centers, high risk of post-procedural complications, and long training courses. In this background, the education committee of Korean Pancreatobiliary Association has prepared for ERCP educational guidelines for fellows in Korea. This guideline should be helpful to fellows who are currently under the training.

Analysis of Mutant Line Derived from T-DNA Insertion in Chinese Cabbage

Mi-kyung Lee(이미경),Eun-Taek Woo(우은택),Jae-kyung Yu(유재경),Suk-man Park(박석만),Young-Doo Park(박영두) 한국원예학회 2005 한국원예학회 학술발표요지 Vol.2005 No.10

원발성 유두 장액성 복막암종으로 오인된 급성 췌장염의 합병증

이진욱 ( Jin Wook Lee ),박은택 ( Eun Taek Park ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.2

급성 췌장염은 췌장의 염증성 질환으로 췌장성 복수 및 가성 낭종과 같은 합병증을 일으킬 수 있다. 이러한 합병증은 심할 경우 결장, 복막 및 장간막의 이차성 변화를 일으켜 복막암종과 구별하기 어려울 수 있다. 본 증례의 환자는 타 병원에서 급성 췌장염 및 합병증으로 발생한 가성 낭종을 치료하는 도중 복막암의 가능성이 있어 추가 평가를 위하여 본원으로 전원되었다. 복막암의 가능성을 배제하기 위한 복막 조직검사 없이 순차적인 시술적 접근을 통하여 췌관의 손상으로 발생한 췌장성 복수와 가성 낭종으로 진단할 수 있었다. Acute pancreatitis is an inflammatory disease of pancreas which could lead to a number of complications including pancreatic ascites and pseudocysts. When these complications are severe, the secondary changes in colon, peritoneum or mesentery can make it difficult to distinguish from peritoneal carcinomas. Herein, we report a case of acute pancreatitis that was difficult to differentiate from peritoneal carcinoma. We performed a sequential procedure without peritoneal biopsy to exclude the possibility of peritoneal cancer, and we could diagnose pancreatic ascites and pseudocyst resulting from pancreatic injuries.

우리나라 만성 C형간염 환자에서 페그인터페론과 리바비린의 병합치료에 대한 효과

강명주 ( Myoung Joo Kang ),정은욱 ( Eun Uk Jung ),박상원 ( Sang Won Park ),최바울 ( Pa Ul Choi ),김지현 ( Ji Hyun Kim ),박성재 ( Sung Jae Park ),박은택 ( Eun Taek Park ),이연재 ( Youn Jae Lee ),이상혁 ( Sang Hyuk Lee ),설상영 ( Sa 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.3

비확대 협대역 대장내시경을 이용한 대장용종의 감별진단

김봉진 ( Bong Jin Kim ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),문원 ( Won Moon ),박은택 ( Eun Taek Park ),김성은 ( Sung Eun Kim ),임창섭 ( Chang Sup Lim ),유재훈 ( Jae Hoon Yoo ),강성주 ( Seong Joo Kang ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.5

Background/Aims: Narrow band imaging (NBI) endoscopy can be used for gross differentiation between the types of colonic polyps. This study was conducted as a retrospective study for estimation of the interobserver and intra-observer agreement of the pit pattern of the mucosal surface and the accuracy of histology prediction. Methods: A total of 159 patients underwent complete colonoscopy and 219 polyps examined by NBI endoscopy without magnification were assessed. Interobserver and intra-observer agreement were calculated by investigators in each group for determination of the surface pattern and prediction of histology based on the modified Kudo’s classification using intraclass correlation coefficient. Results: Interobserver agreement for the surface pit pattern and prediction of polyp type was 0.84 and 0.73 in experienced endoscopists, and 0.86 and 0.62 in trainees, respectively. Intra-observer agreement for the surface pit patterns and prediction of polyp type was 0.81, 0.83, 0.85, 0.83, 0.56, 0.84, 0.51, 0.83, and 0.71; and 0.71, 0.70, 0.82, 0.54, 0.72, 0.37, 0.51, 0.34, and 0.30, respectively. The diagnostic accuracy for prediction of polyp type was 69.4% for experienced endoscopists and 72.9% for trainees. Conclusions: NBI endoscopy without magnification showed fairly good inter and intra-observer agreement for the pit pattern of the mucosal surface and the accuracy of histology prediction; however, it had some limitation for differentiation of colon polyp histologic type. Training and experience with NBI is needed for improvement of accuracy.