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장동기,Dong Kee Jang 대한소화기암연구학회 2023 Journal of digestive cancer reports Vol.11 No.1
One of the most common side effects of chemotherapeutic agents is chemotherapy-induced peripheral neuropathy (CIPN). The occurrence of CIPN is increasing as the survival rate of patients with cancer improves and the cumulative dose or duration of neurotoxic drugs increases. Approximately 30-40% of patients receiving neurologically toxic drugs experience CIPN, which eventually increases the burden of medical expenses. However, preventive measures against CIPN have not yet been established. Clinical trials have tested various drugs for the management of neuropathic pain, but only duloxetine has shown any significant effect. Further studies should evaluate nonpharmaceutical treatments, such as exercise.
이정현,조혜기,장동기,강현우,김재학,임윤정,이준규,Jung Hyeon Lee,Hye ki Cho,Dong Kee Jang,Hyoun Woo Kang,Jae Hak Kim,Yun Jeong Lim,Jun Kyu Lee 대한소화기암연구학회 2018 Journal of digestive cancer reports Vol.6 No.1
Multiple primary cancer is defined as two or more malignant neoplasms in a single individual. The incidence of multiple primary cancer is likely to increase due to earlier and accurate diagnosis and prolonged life span. Above all, the incidence of quintuple primary malignant tumors is reportedly extremely rare. Herein, we present a case of 65-year-old who had quintuple primary cancers of the liver, rectum, nasopharynx, oropharynx and hypopharynx.
수술적 절제술 후 간에 재발한 췌장암에서 항암화학요법과 종양절제술로 완전 관해를 보인 증례
손준혁,이재우,장동기,이상협,류지곤,김용태,Jun Hyuk Son,Jae Woo Lee,Dong Kee Jang,Sang Hyub Lee,Ji Kon Ryu,Yong-Tae Kim 대한소화기암연구학회 2015 Journal of digestive cancer reports Vol.3 No.2
Pancreatic cancer is commonly presented with distant metastasis. However metastasis to central nervous system (CNS) of pancreatic cancer was rarely reported. 79-years-old man was hospitalized with sudden onset right arm dysesthesia and weakness. In brain magnetic resonance imaging, multifocal high signal intensity lesions in cerebral and cerebellar cortices were observed. Leptomeningeal and parenchymal enhanced lesions were also noted in contrast-enhanced T1 images suggesting a metastasis from the pancreatic cancer. Stroke like manifestation of CNS metastasis of pancreatic cancer is extremely rare. Careful history taking and evaluation should be performed to find the origin of the sudden neurologic deficit.
진정내시경시 비마취과의사에 의한 프로포폴 투여의 안전성
이준규 ( Jun Kyu Lee ),장동기 ( Dong Kee Jang ),김원희 ( Won Hee Kim ),김정욱 ( Jung-wook Kim ),장병익 ( Byung Ik Jang ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.1
Propofol (2,6-diisopropylphenol) is a hypnotic drug with a very rapid onset and offset of action. It has increasingly been used in gastrointestinal endoscopy. Administration of propofol by nurses or endoscopists is commonly referred to as non-anesthesiologist-administered propofol (NAAP). There have been a lot of studies on the safety of NAAP compared with those by anesthesiologists. Safety results of those studies are summarized in this review. (Korean J Gastroenterol 2017;69:55-58)
백우현 ( Woo Hyun Paik ),장동기 ( Dong Kee Jang ),이준규 ( Jun Kyu Lee ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.2
췌장염 환자의 10-30%는 그 원인을 찾지 못하여 특발성 췌장염으로 분류되며, 그중 일부는 유전적 변이가 원인일 것으로 생각된다. 유전성 췌장염은 소아 때부터 췌장염 관련 증상이 발생하여 대부분 30대 전후로 만성 췌장염으로 진행하기 때문에 췌장암의 발생에 대해 각별한 주의가 필요하다. 췌장염 관련 유전자는 현재까지 30종류 이상 발견되었으며, 대표적으로 PRSS1, SPINK1, CFTR, CTRC 변이가 있으며, 이는 인종 및 지역에 따라 다양성을 보이고 있다. 따라서, 국내특발성 췌장염 환자를 대상으로 한 유전자 연구를 통하여 한국인에서의 췌장염 관련 유전자 변이의 양상 및 특징을 파악하는 것이 중요하겠다. 본고에서는 특발성 췌장염의 병태생리에서 유전적 변이의 역할에 대해 중점적으로 고찰해보고, 국내 문헌을 토대로 특발성 혹은 유전성 췌장염의 국내 연구결과를 살펴보고자 한다. 10-30% of patients with pancreatitis can be categorized as idiopathic pancreatitis, and some of them may be due to genetic alterations. Since hereditary pancreatitis develops from pediatric patients with symptoms related to pancreatitis, which usually progresses to chronic pancreatitis around 30 years of age, special attention should be paid to the development of pancreatic cancer in such patients. Up to now, there have been more than 30 genetic alterations associated with pancreatitis. Alterations in protease serine 1 (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR) and chymotrypsin C (CTRC) are common, which show diversity according to race and region. It is important to understand the characteristics of Korean patients with idiopathic pancreatitis through genetic studies. The purpose of this article is to review the role of genetic variations in the pathophysiology of idiopathic pancreatitis and to survey the results of Korean studies of idiopathic pancreatitis.
개정된 대한췌장담도학회 급성췌장염 임상진료지침: 중증도 평가
조중현 ( Jung Hyun Jo ),장동기 ( Dong Kee Jang ),이상협 ( Sang Hyub Lee ),정민규 ( Min Kyu Jung ),이동호 ( Dong Ho Lee ) 대한췌장담도학회 2022 대한췌담도학회지 Vol.27 No.1
급성췌장염의 중증도는 장기부전 여부 및 지속 시간, 국소합병증 여부를 고려하여 경증, 중등 중증, 중증으로 분류한다. 급성췌장염은 중증도에 따라 사망률과 합병증 이환율에 큰 차이를 보이므로 초기 급성췌장염 환자의 중증도 평가는 예후 예측, 중환자실 입실, 전원 등의 치료 방침 결정을 위해 중요하다. 급성췌장염 초기 중증도 평가를 위해 생체 징후를 통한 장기부전의 동반 여부 확인 및 영상/임상 검사를 통한 객관적 평가가 필요하며, BISAP, SIRS, APACHE-II 지표 등 여러 중증도 판정 기준을 이용한 평가를 고려할 것을 본 권고안을 통하여 권고한다. The severity of acute pancreatitis (AP) is classified into mild, moderately severe, and severe, considering the presence and duration of organ failure and local complications. Since patients with AP show a large difference in mortality and morbidity according to AP severity, evaluation of the severity of patients with AP in the early stage is important for predicting the prognosis and determining treatment plans including transfer to the intensive care unit or advanced facilities. In order to evaluate the initial severity of AP, it is necessary to confirm the presence of organ failure and objective evaluation using imaging or clinical examinations. In this guideline, it is recommended that evaluation using various severity indices such as bedside index for severity in acute pancreatitis (BISAP), systemic inflammatory response syndrome (SIRS), and acute physiology and chronic health evaluation (APACHE)-II scores be considered. Korean J Pancreas Biliary Tract 2022;27(1):12-21
내시경역행담췌관조영술의 경향 및 특징: 한국의 전국 데이터베이스 연구
윤승배 ( Seung Bae Yoon ),김정미 ( Jungmee Kim ),백창렬 ( Chang Nyol Paik ),이준규 ( Jun Kyu Lee ),장동기 ( Dong Kee Jang ),윤원재 ( Won Jae Yoon ),김정욱 ( Jung-Wook Kim ),손병관 ( Byoung Kwan Son ),이태희 ( Tae Hee Lee ),장재영 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.3
배경/목적: 내시경역행담췌관조영술(endoscopic retrograde cholangiopancreatography, ERCP)은 췌장담도 질환의 진단 및 치료에 효과적인 시술법으로 알려져 있다. 한국에서는 40년 이상 ERCP 시술에 대한 범국가적 데이터가 축적되어 있으나 시술에 대한 경향과 특성에 정보는 미미하다. 본고는 ERCP 건수 및 현황에 대한 전국 데이터를 조사하였다. 방 법 : 2012년부터 2015년 사이에 ERCP와 관련된 국민건강보험심사평가원 청구 데이터를 분석하였다. ERCP 시술건수와 시술과 관련된 특성, 시술을 시행 받은 환자의 건수 및 인구역동학적 특징 등을 조사하였다. 결과: 조사에 해당하는 기간에 158,038건의 ERCP 시술이 114,757명의 환자에게 시행되었다. ERCP 전체 수는 매년 증가하였으며, 특히 치료 ERCP의 비율이 증가 추세를 보였다. 시술의 약 2/3 (63.3%)가 종합병원 이상의 규모 큰 기관에서 시행되었다. 2015년에는 시술은 받은 80세 이상의 고령 환자비율이 2011년 14.3%에서 2015년은 17.2%로 증가하였다. 결론: 한국에서 매년 시행되는 ERCP의 시술 건수는 증가 추세에 있다. 특히 치료 목적 또는 고령 환자의 시술이 뚜렷한 증가 추세를 보여 시술과 관련된 환자의 안전에 더 많은 주의가 요구된다. Background/Aim: Endoscopic retrograde choangiopancreatography (ERCP) has been established as an effective tool for the diagnosis and treatment of pancreatobiliary diseases. However, after the evolution for more than 4 decades, nationwide data on current trends and characteristic is not well known. Therefore, we conducted an analysis of nationwide database to determine the number and status of ERCP performed in Korea. Methods: We used the nationwide claims database, Korean Health Insurance Review and Assessment between 2012 and 2015. We investigated the frequencies and characteristics of ERCP procedure performed as well as demographics of the patients. Results: A total of 158,038 ERCP procedures were performed in 114,757 patients during study period. The number of total ERCPs increased every year, and especially the rate of therapeutic ERCPs is on the increased trend. About two-thirds of ERCPs (63.3%) were performed in high-scaled hospitals. In 2015, the proportion of elderly patients over 80 years old increased compared to that in 2011, from 14.3% to 17.2%. Conclusions: The annual number of ERCPs performed is increasing in Korea. With increasing ERCP for therapeutic purposes or for older patients, more attention should be paid to safety for patients. Korean J Pancreas Biliary Tract 2021;26(3):186-194
최진호 ( Jin Ho Choi ),이상협 ( Sang Hyub Lee ),김주성 ( Joo Seong Kim ),김정 ( Jung Kim ),신방섭 ( Bang Sup Shin ),장동기 ( Dong Kee Jang ),류지곤 ( Ji Kon Ryu ),김용태 ( Yong Tae Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.6
Adenomyomatous hyperplasia is a reactive malformation or non-neoplastic tumor-like lesion frequently observed in the gallbladder, stomach, duodenum and jejunum, but rare in the extrahepatic bile duct. A 42-year-old man with epigastric discomfort had a stricture in the common bile duct on initial CT scans. Initially, it was regarded as a malignant lesion with some evidence, but histopathologic examinations of multiple biopsies obtained by multiple sessions of endoscopic retrograde cholangiopancreatography showed no evidence of malignancy. The patient had undergone the pylorus preserving pancreaticoduodenectomy because of the possibility of malignancy; however, the final diagnosis was adenomyomatous hyperplasia. It is important to distinguish a malignancy from benign biliary stricture with endoscopic biopsies. Surgery for suspected biliary malignancy often reveals benign lesions. Therefore, a correct diagnosis is important before deciding upon treatment of bile duct stricture. In conclusion, in younger patients with bile duct stricture where there is no evidence of histologic malignancy despite multiple biopsies, the possibility of benign disease such as adenomyomatous hyperplasia should be considered, to avoid unnecessary radical surgery. (Korean J Gastroenterol 2016;67:332-336)
증 례 : 급성췌장염으로 발현한 췌관내유두상점액종양 연관 침습암 1예
김주성 ( Joo Seong Kim ),이상협 ( Sang Hyub Lee ),한승준 ( Seung Jun Han ),최진호 ( Jin Ho Choi ),강진우 ( Jin Woo Kang ),장동기 ( Dong Kee Jang ),류지곤 ( Ji Kon Ryu ),김용태 ( Yong Tae Kim ) 대한췌담도학회 2015 대한췌담도학회지 Vol.20 No.4
급성 췌장염 중에 1차 검사에서 원인이 불명확한 경우 급성 특발성 췌장염이라고 하며 그 중 종양에 의한 것은 비교적 드물지만 진단이 늦어질 경우 예후가 좋지 않아 먼저 의심하는 것이 매우 중요하다. 본 증례는 급성 특발성 췌장염 환자에서 악성종양을 의심하고 적극적으로 추적관찰하던 과정에서 초음파내시경상 이상소견이 확인되었고, 적절한 시기에 수술을 결정하여 췌관내유두상점액종양 관련 침습암을 진단한 경우이다. 따라서 원인이 불분명한 췌장염에 대해 악성종양을 의심하는 것이 필요함을 강조함과 동시에 초음파내시경의 추적관찰이 진단에 도움이 된 실제 사례를 보고함으로써 앞으로의 진료 및 의사결정에 유익할 것으로 보여 문헌과 함께 보고하는 바이다. Idiopathic acute pancreatitis (IAP) is defined as acute pancreatitis for which the standard initial evaluation has failed to reveal the etiology. Although a tumor is a rare cause of IAP, it is important to consider it in advance, because prognosis is poor if diagnosis is delayed. We describe a case of presumed IAP at the index presentation that was finally diagnosed as intraductal papillary mucinous neoplasm with an associated invasive carcinoma in a 70-year-old woman after surgery to remove a mass identified during follow-up endoscopic ultrasonography. Therefore, this is a case in which suspicion of malignancy and follow-up endoscopic ultrasonography helped to appropriately diagnose and treat the tumor.