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Endoscopic resection of early gastric cancer
신현필,박수비,서혜란,전정원 한국운동재활학회 2023 JER Vol.19 No.5
Endoscopic resection (ER) is an effective treatment for early gastric cancer (EGC) without metastases. Existing endoscopic mucosal resection (EMR) is easy to perform, has few complications, and can be applied when the lesion size is small. However, en bloc and complete resection rates vary depending on the size and severity of the lesion. EMR using the cap-mounted panendoscopic method and EMR after circumferential preamputation of the lesion are useful in the treatment of EGC. However, completely oversized lesions (≥ 2 cm) and lesions associated with ulcers or submucosal fibrosis are more likely to fail resection. Endoscopic submucosal dissection has been widely used to resect tumors larger than 2 cm in diameter and has a higher acceptable complication rate and en bloc and complete resection rates than EMR. ER for EGC is superior to surgical resection in terms of improving patient quality of life. Additionally, compared to surgery, emergency rooms have a lower rate of treatment-related complications, shorter hospital stays, and lower costs. Accordingly, the indications for ER are expanding in the field of therapeutic endoscopy. Long-term outcomes regarding recurrence are excellent in both absolute and extended criteria for ER in EGC. Close surveillance should be performed after ER to detect early metachronous gastric cancer and precancerous lesions that can be treated with ER. Follow-up gastroscopy and abdominopelvic computed tomography scans every 6 to 12 months are recommended for patients who undergo curative ER for EGC on absolute or extended criteria.
A case of leukemoid reaction in a patient with sarcomatous hepatocellular carcinoma
신현필,전정원,박재준,차재명,주광로,이정일,강소영,김교영 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3
A leukemoid reaction is defined as reactive leukocytosis exceeding 50,000/mm^3, with a significant increase in early neutrophil precursors, and can be a paraneoplastic manifestation of various malignant tumors. A 71-year-old male patient complained of decreased appetite, fatigue, and abdominal fullness. He had a palpable, firm liver, and laboratory investigations suggested leukemoid reaction. Liver dynamic computed tomography revealed a hypervascular mass, and an ultrasound-guided fine-needle aspiration of the mass confirmed hepatocellular carcinoma (HCC) with a sarcomatoid component. The leukocyte count of the patient had increased to 147,800/mm^3, and he died 10 days after admission. This is a rare case of leukemoid reaction in a patient with sarcomatous HCC.
신현필,동석호,김장하,한요셉,이병욱,정용희,김효종,김병호,장영운,이정일,장린 대한소화기내시경학회 2003 Clinical Endoscopy Vol.26 No.4
대장 내시경검사는 출혈, 천공 등의 합병증이 드물게 발생하고 천공이 발생하면 응급 상황으로 제한된 경우 외에는 수술적 절제술과 문합술을 시행한다. 그러나 대장 천공이 발생한 환자 중 일부는 비수술적인 치료를 시도하는데 이 중 클립을 이용한 내시경적 치료는 1997년 국외문헌에서 처음 보고되었다. 저자 등은 대장 내시경검사 중 직장천공에 의해 장내 물질이 유출되어 응급 수술을 시행해야 했던 환자에서, 기저질환으로 전신 마취 및 수술을 시행할 수 없어 내시경적 클립술을 이용한 비수술적 치료만으로 치유한 1예를 경험하였기에 문헌고찰과 더불어 보고한다. Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications. (Korean J Gastrointest Endosc 2003;26:232-235)
신현필,박지애,Blaire Burman,Richard A. Kozarek,Asma Siddique 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.4
Background/Aims: Treatment of chronic hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) is essential. The availability of sofosbuvir (SOF) has dramatically improved overall HCV cure rates, however there is insufficient data regarding its use in patients with CKD. We evaluated SOF in patients with hepatitis C genotype 1 (G1) and moderately impaired renal function. Methods: We retrospectively reviewed all patients treated with a SOF-based regimen from December 2013 through September 2015 at Virginia Mason Medical Center. Data was then collected for HCV G1 patients with stage 3 CKD. Results: A total of 28 patients with HCV G1 and stage 3 CKD were treated with a SOF-based regimen. Twenty-one patients had stage 3A CKD (estimated glomerular filtration rate [eGFR] 45–60 mL/min/1.73m2) and 7 patients had stage 3B CKD (eGFR 30–45 mL/min/1.73m2). The overall rate of sustained virologic response (SVR) 12 weeks after completion of therapy (SVR12) was 85.7% (24/28). SVR12 in stage 3A CKD patients was 81.0% (17/21) and in stage 3B CKD patients, SVR12 was 100% (7/7). Based on the treatment regimen used, the SVR12 was 81.8% (9/11), 92.3% (12/13), and 75.0% (3/4) for SOF/ledipasvir (LDV), SOF/simeprevir (SIM), and SOF/pegylated interferon (PEG)/ribavirin (RBV), respectively. Greater than 30% reduction eGFR was observed in 4 out of 28 patients. Conclusions: SOF-based regimens resulted in high SVR12 rates in patients with moderately impaired renal function. During therapy, HCV patients with CKD should be carefully monitored for worsening renal function.
Sn-58Bi 솔더 페이스트와 ENIG 표면 처리된 기판 접합부의 계면 반응 및 접합강도
신현필,안병욱,안지혁,이종근,김광석,김덕현,정승부,Shin, Hyun-Pil,Ahn, Byung-Wook,Ahn, Jee-Hyuk,Lee, Jong-Gun,Kim, Kwang-Seok,Kim, Duk-Hyun,Jung, Seung-Boo 대한용접접합학회 2012 대한용접·접합학회지 Vol.30 No.5
Sn-Bi eutectic alloy has been widely used as one of the key solder materials for step soldering at low temperature. The Sn-58Bi solder paste containing chloride flux was adopted to compare with that using the chloride-free flux. The paste was applied on the electroless nickel-immersion gold (ENIG) surface finish by stencil printing, and the reflow process was then performed at $170^{\circ}C$ for 10 min. After reflow, the solder joints were aged at $125^{\circ}C$ for 100, 200, 300, 500 and 1000 h in an oven. The interfacial microstructures were obtained by using scanning electron microscopy (SEM), and the composition of intermetallic compounds (IMCs) was analyzed using energy dispersive spectrometer (EDS). Two different IMC layers, consisting of $Ni_3Sn_4$ and relatively very thin Sn-Bi-Ni-Au were formed at the solder/surface finish interface, and their thickness increased with increasing aging time. The wettability of solder joints was investigated by wetting balance test. The mechanical property of each aging solder joint was evaluated by the ball shear test in accordance with JEDEC standard (JESD22-B117A). The results show that the highest shear force was measured when the aging time was 100 h, and the fracture mode changed from ductile fracture to brittle fracture with increasing aging time. On the other hand, the chloride flux in the solder paste did not affect the shear force and fracture mode of the solder joints.
특발성 막성 신병증 환자의 치료 결과 및 예후인자 분석
신현필 ( Sin Hyeon Pil ),이상호 ( Lee Sang Ho ),이태원 ( Lee Tae Won ),김명재 ( Kim Myeong Jae ),임천규 ( Im Cheon Gyu ) 대한내과학회 2004 대한내과학회지 Vol.66 No.3
목적 : 논란이 있어왔던 특발성 막성 신병증의 치료에서 cyclophosphamide 병합요법의 치료효과를 알아보기 위해 치료방법에 따른 결과를 보고, 각 치료법이 단백뇨의 관해와 만성 신부전 진행에 미치는 예후인자를 알아서 적절한 치료군을 설정하고 그 치료방법의 결정에 도움을 얻고자 후향적 연구를 시행하였다. 방법 : 경피적 신생검 후, 막성 신병증을 진단받은 환자 중 이차적 원인에 의한 경우를 제외한 66명(남자 51명, 여자 15명)의 환자를 관찰대상으로 하여 환자의 임상 및 검사 결과와 순응도에 따라 보존적 치료군과 경구 스테로이드 단독 요법군 그리고 경구 스테로이드-cyclophophamide 병합 요법군으로 나누어 경구 스테로이드 단독 요법시는 0.5∼1 ㎎/㎏/day로 병합하여 6∼12개월 동안 사용하여 전체 및 각군의 치료성적을 알아보고 단백뇨의 관해와 만성 신부전으로의 진행에 관계되는 예후인자를 다변량 분석을 통하여 검정하였다. 결과 : 치료 방법에 따라 스테로이드 치료군은 전체 12예 중에 완전관해 4예(33.3%), 부분관해 4예(33.3%), 무반응 4예(33.3%)를 보였고, cyclophosphamide와 스테로이드 병합 요법군은 완전관해 18예(38.3%), 부분관해 11예(23.4%), 무반응 18예(38.3%)를 보여 치료방법에 따른 관해율의 차이는 나타나지 않았다. 평균 53,4개월의 추적관찰하였고, 예후인자를 다변량 분석한 결과 완전관해 유지는 1년 이내의 최초 치료에 반응이 있고, 비흡연군에서 높았으며 해당 환자수가 적었으나 만성 신부전으로의 진행은 내원시 혈청 creatinine 1.2 ㎎/dL 이상인 경우와 60세 이상의 고령군에서 많이 증가하는 것으로 나타났다. 결론 : 특발성 막성 신병증 환자에 있어 기존의 스테로이드 요법에 cyclophosphamide의 병용 여부에 따른 치료의 결과가 병합요법군에서 스테로이드 단독 요법과 대등한 완전 관해율을 보여 향후 cyclophosphamide와 스테로이드 병합요법이 특발성 막성 신병증, 특히 고위험군환자에서 적극적 치료 요법의 하나로 고려되어야 할 것이다. Background : Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults but the treatment regimen and the prognosis of IMN are controversial issue. Immunosuppresive treatment was preferably used in patients with high risk factors related to renal failure. We studied biopsy-proven idiopathic membranous nephropathy to evaluate clinical predictors for risk statification and treatment outcomes according to regimens. Methods : 66 patients (51 male, 15 female) with biopsy-proven IMN at our hospital during the period of 1991 to 2001 were studied retrospectively. Clinical information and data were obtained at the time of presentation and followed up regularly. We used several different treatment regimen according to patients compliance, clinical and laboratory data. Seven patients were treated with conservative management, 12 with oral steroid alone, 47 with oral steroids and combination with oral cyclophosphamide (1∼2 ㎎/㎏/day for 6∼12 months). The mean follow-up period was 53.4±34.2 month. Treatment oucomes and predictors were idetified. Results : At presentation, mean age was 45.5±14.7 years old and patients with nephrotic syndrome was 77.8%. Pathologic stages Ⅱ (Ehrenreich and Churg classification) was most common (68.2%). After each treatment, 33.3% of the group treated with oral steroid alone showed partial remission (PR) and 33.3% showed complete remission (CR), in combination thrapy group (cyclophosphamide with steroids) 23.4% PR and 38.3% CR. During follow-up period, four patients (6.1%) developed into chronic renal insufficiency. We used multivariate analysis of prognostic factor associated with persistent CR and progression to chronic renal insufficiency (CRI). Initial response within one year after therapy and non smoking were predictior of persistnet CR and increased initial serum creatinine and old age was related to progression to CRI. Conclusion : At the end of follow-up, immunosuppresive therapy including oral cyclophosphamide and steroids induced favorable effect and can be used for high risk patients.