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오탁근,이상길,Tak Geun Oh,Sang Kil Lee 대한소화기암연구학회 2013 Journal of digestive cancer reports Vol.1 No.1
The five-year survival for patients with gastric cancer improved only modestly over the last 50 years. So, several studies about molecular target chemotherapy were investigated. We reviewed about molecular target chemotherapy for advanced unresectable and metastatic gastric cancer, which has developed recently. EGFR (Epidermal growth factor receptor), HER (Human epidermal growth factor receptor), VEGF (Vascular endothelial growth factor receptor) can be the target of therapy for gastric cancer. Patients with advanced gastric adenocarcinoma who are potential candidates for trastuzumab should have their tumors assayed for the presence of HER2 overexpression utilizing tumor-specific criteria and/or gene amplification. We suggest the addition of trastuzumab to chemotherapy in patients with HER2-positive tumors (as defined by 3+ immunohistochemical staining or FISH positivity), as long as they do not have a contraindication to trastuzumab. Except for trastuzumab, we summarized several studies for molecular target agents which were not validated yet.
특집-급성 췌장염의 최신 지견 : 급성 췌장염의 병태생리
오탁근 ( Tak Geun Oh ),방승민 ( Seungmin Bang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2
여러 가지 원인이 급성 췌장염을 일으키나 각각의 요인들이 어떤 메커니즘으로 급성 췌장염을 유발하는지에 대한 이해는 급성 췌장염의 원인을 정확히 파악하고 치료하는 데 도움이 될 수 있다. 대표적인 원인 인자로는 만성 알코올 남용과 담석을 꼽을 수 있으며 그 밖에 CFTR mutation과 연관된 가족성 췌장염을 생각해 볼 수 있다. 심한 형태인 괴사성 췌장염에 관해서는 췌장효소의 활성화, 췌장 미세혈관의 손상, 염증인자의 분비가 췌장의 손상과 괴사를 악화시키며 심한 췌장 손상을 받은 일부 환자에서는 전신성 염증반응 증후군까지 진행될 수 있는데 이는 염증소견을 보이는 췌장에서 분비된 활성화된 췌장효소와 사이토카인이 전신으로 순환하면서 발생한다고 볼 수 있다. 일반적으로는 보상화된 항염증 반응이 전신성 염증반응과 균형을 이루면서 회복이 되지만 이와 같은 균형이 깨지면 심한 장기 부전으로 인해 사망으로까지 이를 수 있다. 또한, 급성 췌장염의 경과 중 장내 세균의 전좌(translocation)로 인하여 심한 급성 췌장염 환자의 30%에서 췌장과 췌장주위에 세균감염이 발생할 수 있는데, 이 경우 다발성 장기부전으로 이어질 수 있다. 췌장염의 초기 과정에서는 선방 세포 내의 trypsinogen의 활성화가 중요한 역할을 하나 사망에까지 이르게 하는 전신적 염증 반응의 경우는 독립적인 인자들이 작용하므로 이에 대한 메커니즘 연구 및 그에 맞는 치료법에 대한 연구가 필요한 실정이다. 이와 같이 급성 췌장염은 사망에까지 이르게 할 수 있는 질환으로서 정확한 진단과 치료의 기반이 될 수 있는 급성 췌장염의 병태생리에 대한 이해와 연구가 중요하다. Acute pancreatitis is an inflammatory disease that is caused by various etiologies including gallstone, alcohol or hypertriglyceridemia. Although most cases of acute pancreatitis show self-limiting course, severe cases are still associated with significant morbidity and mortality. The pathogenic mechanisms of acute pancreatitis are not fully understood. However, it is a central dogma that premature intracellular activation of trypsinogen is the earliest pathologic event. Even though it remains unknown how intracellular trypsinogen activation can be caused by such diverse etiologies, this initial insult in pancreatic acinar cells lead to local inflammatory complications and a systemic response or death. Pathophysiologic mechanisms related to the progression of acute pancreatitis include microcirculatory injury, chemoattraction of inflammatory cells, release of pro-inflammatory cytokines, and bacterial translocation to pancreas and systemic circulation. Recently, several interesting transgenic mice model experiments shed a light in trypsin independent mechanism of local and systemic inflammation for progression of acute pancreatitis.(Korean J Med 2013;85:111-115)
증례 : 소화기 ; 광역학 치료 후 간 좌엽절제술이 가능하였던 담관 내 유두상 점액 종양 1예
이희승 ( Hee Seung Lee ),오탁근 ( Tak Geun Oh ),정문재 ( Moon Jae Chung ),박정엽 ( Jeong Youp Park ),방승민 ( Seung Min Bang ),송시영 ( Si Young Song ),박승우 ( Seung Woo Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1
IPMN은 매우 드문 질환으로 내시경상 IPMN이 의심될 경우 조직학적 진단을 통해 악성 종양의 가능성을 항상 고려해야 하고 정확한 감별 진단이 필요하다. 또한 IPMN이 담관계 내 수술 범위가 넓은 경우에는 치료 방침이 명확하지 않은 실정이다. 이에 저자들은 수술적 절제가 어려운 광범위한IPMN에 대해 PDT 후 간 좌엽절제술을 시행한 증례를 보고한다. Mucin-hypersecreting bile duct tumors, which closely resemble intraductal papillary mucinous neoplasms of the pancreas, arerare, and both the clinical features and management thereof are poorly understood. As the biliary tract and the pancreas share a commonorigin, the two diseases may exhibit homologous histopathological features. Certain intraductal papillary tumors of the bileduct are associated with production of large amounts of mucin that disturb bile flow and cause severe biliary dilatation, obstructivejaundice, and cholangitis. Herein, we report on a patient with an extensive intraductal papillary mucinous neoplasm of the bile duct,involving both the right and left intrahepatic ducts. The ducts were subjected to photodynamic therapy, followed by lefthepatectomy. The surgical specimen revealed an adenocarcinoma with a negative resection margin. Photodynamic therapy of theintrahepatic ducts was well-tolerated in the present case, and may serve as a useful therapeutic option for selected patients with intraductalpapillary mucinous neoplasms of the bile duct.
증례 : 류마티스 ; 장병증성 관절염에서 발생한 Candida Parapsilosis에 의한 감염성 관절염 1예
박희진 ( Hee Jin Park ),정세진 ( Se Jin Jung ),오탁근 ( Tak Geun Oh ),석한나 ( Han Nah Seok ),이상원 ( Sang Won Lee ),박용범 ( Yong Beom Park ),이수곤 ( Soo Kon Lee ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6
장병증성 관절염으로 면역 억제제 치료를 받은 환자에서 반복적인 활액 천자 및 스테로이드 주사를 받은 후, C.parapsilosis에 의한 진균 감염성 관절염을 처음으로 경험하였기에, 이에 대해 문헌고찰과 함께 보고하는 바이다. Infectious arthritis is an important medical emergency with high morbidity. The most frequent causative organism of infectious arthritis is Staphylococcus aureus, and Candida is an uncommon pathogen. Candida arthritis has been reported to occur in seriously ill or immunocompromised patients and neonates. We report the first case of C. parapsilosis arthritis in a patient with ulcerative colitis. A 52-year-old woman was diagnosed with ulcerative colitis 1 year previously and took balsalazide. Pain and swelling in the right knee joint developed 6 months after diagnosis. She was diagnosed with enteropathic arthritis associated with ulcerative colitis and took methotrexate, sulfasalazine, and prednisolone for 3 months, but the symptoms did not improve. We finally diagnosed her with infectious C. parapsilosis arthritis by culturing the synovial fluid. The patient received amphotericin B for 6 weeks and underwent arthroscopic synovectomy. She finally experienced improvement of inflammation in the right knee joint. (Korean J Med 2011;81:797-801)
염증성 장질환에서 5-aminosalicylate에 의해 발생한 재발성 급성 심낭염
최아라 ( A Ra Choi ),김미나 ( Mi Na Kim ),이지훈 ( Ji Hoon Lee ),이용강 ( Yong Kang Lee ),박윤혜 ( Yoon Hea Park ),신혜선 ( Hye Sun Shin ),오탁근 ( Tak Geun Oh ),박희진 ( Hee Jin Park ),박민석 ( Min Suk Park ),임승택 ( Seungtaek L 대한장연구학회 2012 Intestinal Research Vol.10 No.3
Inflammatory bowel disease (IBD) is an idiopathic chronic inflammation of the intestines. IBD treatment may require anti-inflammatory agents such as sulfasalazine or 5-aminosalicylate (5-ASA) and immunomodulators to control the symptoms. However, these agents have a variety of common adverse effects such as nausea, vomiting, skin rash, leukopenia, thrombocytopenia, and infections. Moreover, rare side effects such as nephrotic syndrome, pneumonitis, and pericarditis can occur. A 21-year-old male was admitted to the hospital due to acute chest pain, fever, and sweating. The patient had a history of Crohn`s disease and had been taking mesalazine for 3 weeks. Chest x-ray, echocardiography, and clinical manifestations revealed that the patient had acute pericarditis. However, we did not recognize the relationship between these findings and 5-ASA at that time. Two years later, the patient took 5-ASA again, and similar symptoms occurred, which led us to confirm that he suffered from pericarditis induced by this drug. We report a case of acute recurrent pericarditis that developed after taking 5-ASA for IBD treatment with a review of the literature. (Intest Res 2012;10:289-294)