췌장에서 발생한 파골세포양 거대세포를 가지는 미분화 암종

장한원 ( Han Won Jang ),박원규 ( Won Kyu Park ),장재천 ( Jay Chun Chang ),김재운 ( Jae Woon Kim ),배영경 ( Young Kyung Bae ),최준혁 ( Jun Hyuk Choi ),윤성수 ( Sung Su Yun ),이동식 ( Dong Shik Lee ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of exocrine pancreas. Till recently, some cases have been reported, however histogenesis of the tumors are controversial and their characteristic findings have not been described yet. Thirty five-year-old men and 75-year-old men were presented with upper abdominal pain and a palpable mass. On computed tomography, one case showed a well enhancing solid tumor with low density and the other was showed a mainly cystic tumor with peripheral enhancement in the body and tail of the pancreas. One case accompanied multiple metastatic liver masses with subhepatic lymph node enlargement. Tumor staining was seen on angiography. Biopsy and pancreatectomy were performed. Pathological findings revealed tumors composed of neoplastic spindle shaped or pleomorphic large cells with scattered non-neoplastic osteoclast-like giant cells. In one case, there were small foci of adenocarcinoma components in the periphery of the tumor. On immunohistochemical stain, neoplastic cells showed focal positivity for epithelial membrane antigen and vimentin. Tumors were diagnosed as undifferented carcinoma with osteoclast-like giant cells. We report these rare cases with a review of literature. (Korean J Gastroenterol 2006;48:355-359)

증례 : 대장에서 발생한 혈관주위 상피모양세포 종양 1예

김국현 ( Kook Hyun Kim ),장병익 ( Byung Ik Jang ),김태년 ( Tae Nyeun Kim ),장재천 ( Jae Chun Jang ),심민철 ( Min Chul Shim ),심영란 ( Young Ran Shim ),최준혁 ( Joon Hyuk Choi ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5

혈관주위 상피모양세포 종양(PEComa)은 여러 장기의 중간엽에서 발생하며 조직학적으로 상피모양세포를 가지는 종양을 총칭하는 드문 질환이다. 저자들은 1개월 간의 좌상복부 불편감과 발열을 주소로 내원한 환자를 대장에서 유래하는 악성 GIST로 의심하고 수술을 시행한 후, 절제된 조직의 면역조직화학염색검사에서 멜라닌세포 표지자인 HMB-45에 강한 양성 염색을 보여 GIST가 아닌 PEComa로 확진한 1예를 경험하였기에 문헌고찰과 함께 보고한다. Perivascular epithelioid cell tumor (PEComa) is a rare family of related mesenchymal neoplasms that include angiomyolipoma, lymphangiomyomatosis and clear cell `sugar` tumor of the lung. Although this type of tumor has been described in the literature in organs such as kidney, lung, uterus and urinary bladder, there are few reports of gastrointestinal tract-related tumor. We report here on a case of PEComa arising in the transverse colon. This occurred in a 41-year-old male who had no history of tuberous sclerosis complex. Histopathologically, the tumor consisted of nests or sheets of epithelioid cells with eosinophilic cytoplasm. The tumor cells were positive for HMB-45, vimentin and caldesmon, but they were negative for S-100 protein, cytokeratin and CD117, according to immunohistochemical staining. Careful follow up is warranted because the biological behavior of PEComa has not yet been documented. We present here a case of colonic PEComa that was confirmed by immunohistochemical staining and the histopathologic findings, and we include a review of the literature. (Korean J Med 72:540-545, 2007)

증례 : 문맥염 6예의 임상 양상 및 방사선학적 소견

김태동 ( Tae Dong Kim ),김태년 ( Tae Nyeun Kim ),오희주 ( Hee Ju Oh ),김준환 ( Jun Hwan Kim ),이헌주 ( Hun Ju Lee ),박원규 ( Won Kyu Park ),장재천 ( Jae Chun Jang ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

문맥염은 드문 질환으로 증상이 모호하여 조기진단이 어렵고 치료시기를 놓치면 높은 치사율을 보인다. 원인으로는 충수돌기염, 게실염, 감염성 췌장 괴사 등의 복강내 감염과 간경변이나 간암, 위암, 췌장암 같은 악성종양 및 골수증식성 질환, 혈액응고인자 결핍증과 같은 상태에서 이차적인 감염이 일어나서 생기기도 한다. 예후에 빠른 진단과 치료가 중요하여 저자들은 본원에서 경험한 6예를 통해 화농성 문맥 혈전증의 임상양상과 방사선학적 소견을 고찰해 보고자 하였다. 6예의 환자 모두 남자였으며 평균 추적관찰기간은 11개월(5~24개월), 평균연령은 54.3세(38~60세)였다. 문맥염의 추정 원인으로는 2예에서 담도염, 1예에서 급성 충수돌기염, 3예에서는 원인이 불분명하였다. 임상양상은 전예에서 발열과 오한, 우상복부 통증과 압통을 보였다. 일반혈액검사에서 6예에서 백혈구 증다증과 빈혈이 있었으며 3예에서 혈소판 감소를 보였다. 역동적 복부 전산화 단층 촬영상 전예에서 문맥혈전증이 보였으며 이 중 4예에서 상장간막 혈전증이 동반되어 있었다. 2예에서 간농양이, 2예에서 담즙종이 동반되어 나타났다. 문맥혈전증은 조영되지 않는 간내 문맥, 혈관내 저음영의 혈전소견, 간실질의 불균일한 조영증강, 변연부에 비해 중심부의 저음영 소견으로 나타났다. 치료는 6예 모두에서 광범위 항생제를 투여하였고, 그 중 1예에서 항응고요법을 병행하였다. 6예 모두 증상이 호전되었으며 항응고요법을 시행한 예에서 추적관찰시 혈전이 사라지고 간엽의 위축이 없이 회복되어 항응고요법이 문맥염의 호전에 도움이 될 것으로 생각되나 이에 대해서는 향후 더 많은 연구가 필요할 것으로 생각된다. Pylephlebitis, a suppurative thrombophlebitis of the portal venous system, is a rare complication of intra-abdominal sepsis usually followed by infection either in the region draining the portal system or in the structure contiguous to the portal vein. Early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease, so we retrospectively reviewed 6 cases of pylephlebitis. All patients were males with a mean follow-up of 11 months (range 5~24 months). Clinical symptoms consisted of fever (100%), right upper abdominal pain (100%), jaundice (33.3%), and diarrhea (16.6%). Anemia and leukocytosis were found in 6 patients. Suspected etiology was acute cholangitis in 2 patients, acute appendicitis in 1 patient and idiopathic in 3 patients. All patients were successfully diagnosed with dynamic CT scan which showed the presence of portal vein thrombosis (100%), superior mesenteric vein thrombosis (66.6%), liver abscess (33.3%), and biloma (16.6%). Patients were treated with the systemic administration of a broad spectrum antibiotics and 1 patient was given anticoagulant. Initial symptoms were improved in all patients and some beneficial effects of anticoagulation are expected to achieve the recanalization of thrombosis and prevent atrophic changes in the liver, but further studies on the kind of therapy are needed. (Korean J Med 69:S798-S806, 2005)

조선시대 향교의 사회교육 연구

장재천 한국교육학회 2000 敎育學硏究 Vol.38 No.3

조선시대의 향교교육은 '인재의 양성'(학교 교육적 측면)과 '풍속의 교화'(사회 교육적 측면) 라고 하는 두 가지의 목표를 양대 축으로 설정하여 대동(大同) 세계를 실현하려는 유교의 궁극적 이념 하에 이루어졌다고 할 수 있다. 그 '유교'라고 하는 지배이념의 유지를 위해, 지방행정의 사회교육 차원으로는 석전제례(釋奠祭禮), 향음주례(鄕飮酒禮), 향사례(鄕射禮), 양로례(養老禮), 향악(鄕約), 특별강습(特別講習), 기타 등의 방법을 향교에서 활용하였다. 그와 같은 사회 교화적 행사들은 거의 모두가 예(禮)·효(孝)·제(悌)의 실천을 통해 공동선(公同善)의 사회를 구축하는 데 있었다고 하겠다. The purpose of this study was to investigate the characteristics and the forms of the aspects of social education in the Hyang-Gyo of the Chosun Dynasty through a literature research. The Hyang-Gyo in the Chosun Dynasty could be seen that it had been carried out two aims called 'the fosterage of capable men' and 'the indoctrination of customs', in order to realization a utopia of 'Dae-Dong Society(大同社會)' under the ruling ideology of confucianism. However, the social education on the indoctrination of customs in the Chosun Dynasty could be seen that it had been accomplished in the main with the national universities as the central figure. For that reason, I think that the ruling class of the Chosun Dynasty at that time regard looked upon very much importantly as the maintenance of ruling ideology what we called 'Confucianism'. Therefore, the social education in the Sung-Kyun-Kwan(成均館) had been executed to the programs of Suk-Jeon-Je(釋奠祭), Dae-Sa-Rye(大射禮), Yang-Ro-Ryes(養老禮), and in the Hyang-Gyo utilized to the programs of Suk-Jeon-Je, Special Lecture(特別講習),Hyang-Eum-Rye(鄕飮禮),Hyang-Sa-Rye(鄕射禮), Yang-Ro-Rye, Hyang-Yaks(鄕樂), for the maintenance of confucianism ideology. Finally, the such educational all contents and methods were to construct a Utopia of Dae-Dong Society which confucianism pursued to put through practice of Ye-Ak(禮樂) and Hyo-Je(孝悌).

간문부 담관암 환자에서 경피경관 양측성 금속 배액관의 효과

김금래,김주형,박원규,장재천,조재호,김태년,김준화,장병익 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.2

Background: The purpose of this study was to determine the effectiveness of percutaneously place self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. Materials and Methods: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral self-expanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. Results: There were 4 cased of Bismuth type Ⅱ,21 cases of Bismuth typeⅢa 8 cases of Bismuth type Ⅲb and 15 cases of Bismuth type Ⅳ. Stent placement was technically successful in all patients All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage of 91.9% There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and median survival time were 303 days (range, 60~815) and 338 days (range, 60 ~1175), respectively. Conclusion: Placement of a percutaneous metallic stent is an effective and safe method of palliation of patients with hilar cholangiocarcinoma.