점액 폭포를 보이는 점막하 종양 형태의 위 점액 선암 1예

장형하,이상현,김광하,최철웅,박찬호,엄재섭,강대환,송근암,김대환,김석,최경운 대한소화기내시경학회 2008 Clinical Endoscopy Vol.36 No.2

위 점액 선암은 전체 위암에서 3∼7%의 빈도를 차지하고 있으며 진단 당시에 림프절 전이, 원격 전이 등이많고 병기가 높아 예후가 불량한 것으로 알려져 있다. 저자들은 고형 음식물을 삼키기 힘들어 내원한 환자에게 시행한 상부 위장관 내시경에서 위 분문부에 점액 폭포를 보이는 점막하 종양 형태의 종괴를 발견하였고, 여러 검사 결과 위 점액 선암에 합당한 소견을 보여 전위절제술 및 비장적출술을 시행하였으며 조직학적 소견에서 위 점액 선암으로 확진할 수 있었기에 문헌 고찰과 함께 보고하는 바이다.

복막암종으로 오진된 IgG4 관련 전신 경화성 질환 1예

장형하,강대환,조몽,김형욱,최철웅,윤기태 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1

달리 분류되지 않는 자가면역성 췌장염에 동반한 심낭삼출액

장형하 ( Hyung Ha Jang ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),최철웅 ( Choel Woong Choi ),박수범 ( Soo Bum Park ),송병준 ( Byung Jun Song ),김수진 ( Su Jin Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6

Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterized by an autoimmune inflammatory process. This is the first case report of AIP, not otherwise specified, accompanied by pericardial effusion. A 52-year-old female visited our hospital due to dyspnea. Echocardiography showed a large amount of pericardial thickening. Abdominal computed tomography revealed diffuse enlargement of the pancreas body and tail with a sausage-shaped appearance, surrounded by a thick hypodense rim. Endoscopic retrograde cholangiopancreatography could not identify the tail portion of the pancreas, despite forceful contrast injection. Serology was positive for antinuclear antibody and IgG4 was normal. Endoscopic ultrasound-guided core biopsy of the pancreas was performed. Histologic examination revealed a fibrous connective tissue with inflammatory infiltration. The patient was treated with steroids. In the follow-up images, abnormal findings of pericardial effusion were improved, although an irregular long stricture of the pancreas tail portion remained. (Korean J Med 2014;86:733-738)

Redox and CD44 Dual-Responsive Nanophotosensitizer Composed of Chlorin e6-Conjugated Hyaluronic Acid via Disulfide Linkage for Targeted Photodynamic Treatment of Cancer Cells

박수범,장형하,이혜림,김정수,나재운,김덕훈,정영일,강대환 대한화학회 2019 Bulletin of the Korean Chemical Society Vol.40 No.5

For redox- and CD44 receptor-sensitive photodynamic treatment of cancer cells, chlorin e6 (Ce6) was conjugated to the end of hyaluronic acid (HA) via disulfide linkages. Ce6-conjuated HA (HAssCe6) nanophosensitizers showed small particle size less than 100?nm and spherical morphology. Ce6 was liberated from HAssCe6 nanophotosensitizer with redox-sensitive manner and Ce6 release rate was faster in the presence of GSH than normal condition. HAssCe6 nanophotosensitizers showed extremely higher Ce6 uptake ratio than Ce6 itself. Pretreatment of HA properly inhibited intracellular uptake of HAssCe6 nanophotosensitizers, indicating that nanophotosensitizers can be entered into cells by CD44 receptor-mediated pathway. HAssCe6 nanophotosensitizer treatment increased reactive oxygen species production and PDT efficacy with negligible dark toxicity against HCT116 cells. Furthoremore, HAssCe6 nanophotosensitizers was efficiently delivered to tumor tissues of HCT116-bearing mice while pretreatment of free HA properly inhibited delivery of nanophotosensitizers against tumor tissues. These results indicated that HAssCe6 nanophotosensitizers have redox- and CD44-senstivity for cancer targeting. We suggested HAssCe6 nanophotosensitizers as a promising candidate for PDT of cancer cells.

금속 스텐트 삽입 후 발생한 스텐트 내재협착의 자연소실

이상현 ( Sang Hyun Lee ),장형하 ( Hyung Ha Jang ),권보란 ( Bo Ran Kwon ),김지량 ( Ji Ryang Kim ),목정하 ( Jeong Ha Mok ),박진현 ( Jin Hyun Park ),이한철 ( Han Cheol Lee ) 대한내과학회 2009 대한내과학회지 Vol.76 No.5

Many interventional cardiologists rely upon percutaneous coronary intervention (PCI) with drug-eluting stents (DES), but DES may provoke serious complications, such as stent thrombosis and delayed restenosis. Previous studies of bare metal stent placement showed regression of neointimal proliferation after 6 months. Here, we report the case of a 50-year-old man demonstrating spontaneous regression of neointimal hyperplasia after undergoing PCI with a bare metal stent to treat a middle left anterior descending (LAD) artery lesion. Coronary angiography showed 90% diffuse restenosis at 6 months after stent placement, but the patient refused PCI due to monetary concerns. After 29 months, follow-up angiography revealed spontaneous regression of restenosis in the middle LAD. (Korean J Med 76:595-599, 2009)

Two Cases of an Implantation of a Permanent Pacemaker Using a Transaxillary Incision

최재훈,김준,박태익,장형하,이태근,이상권,이한철,김준홍,전국진,홍택종,신영우 대한심장학회 2008 Korean Circulation Journal Vol.38 No.9

In surgeries that require the implantation of a pacemaker, the endocardial pacemaker leads are introduced into the cardiac chambers through subclavian or axillary venous catheterization or cephalic vein cutdown. The drawback of this type of surgery is scarring of the pectoral area, which can be a serious cosmetic problem especially for young women. In this study, we report on 2 cases where a permanent pacemaker in two young women with symptomatic bradycardia was implanted using a transaxillary incision. Both patients successfully recovered with no complications and were asymptomatic for more than 17 months after the procedure. Therefore, we found that implantation of a pacemaker via transaxillary incision provided excellent cosmetic results and should be considered in young women that require this type of surgery. In surgeries that require the implantation of a pacemaker, the endocardial pacemaker leads are introduced into the cardiac chambers through subclavian or axillary venous catheterization or cephalic vein cutdown. The drawback of this type of surgery is scarring of the pectoral area, which can be a serious cosmetic problem especially for young women. In this study, we report on 2 cases where a permanent pacemaker in two young women with symptomatic bradycardia was implanted using a transaxillary incision. Both patients successfully recovered with no complications and were asymptomatic for more than 17 months after the procedure. Therefore, we found that implantation of a pacemaker via transaxillary incision provided excellent cosmetic results and should be considered in young women that require this type of surgery.

ST절 비상승 급성 심근경색증에서 관상동맥 중재술의 시기에 따른 예후

안성규,박태익,이상현,장형하,이동원,하재경,이한철,김준,김준홍,전국진,홍택종,신영우 대한심장학회 2008 Korean Circulation Journal Vol.38 No.1

Background and Objectives: An early invasive strategy with coronary angiography and revascularization is currently the recommended treatment for patients at high risk with an acute non-ST-segment elevation myocardial infarction (NSTEMI). In this early invasive strategy, percutaneous coronary intervention (PCI) is generally recommended within 48 hours, but there is little data on earlier intervention in intermediate risk patients. Subjects and Methods: We studied retrospectively the past medical records of 118 patients at intermediate risk that were admitted at Pusan National University Hospital and were stratified by the time interval from chest pain onset to PCI (Group I: <24 hr; Group II: 24-48 h; Group III: >48 h). Clinical outcomes were evaluated in terms of in-hospital and 12 months follow-up of a major adverse cardiac event (MACE). Results: Baseline characteristics were not different statistically among the three groups, except for the use of tirofiban. There were no in-hospital deaths or myocardial infarctions (MI) in Group I and Group II patients, but there were three cases of in-hospital deaths in Group III patients. The incidence of a 12-month MACE was 0% in Group I patients, 6.7% (one revascularization) in Group II patients and 17.1% (3 deaths, 3 MIs, 7 revascularizations) in Group III patients (p=0.043). Conclusion: In acute NSTEMI, the incidence of a 12-month MACE was lower in the intermediate risk group when PCI was performed in the early period. Early PCI could be recommended in acute NSTEMI on the basis of the status of individual patients. (Korean Circ J 2008;38:23-28) 배경 및 목적 급성 ST절 비상승 심근 경색증 환자의 고위험군에서 관상동맥 중재술을 통한 조기 침습적 치료 전략이 현재 널리 이용되고 있다. 이러한 조기 침습적 치료의 경우 48시간 이내에 관상동맥 중재술 시행을 추천하고 있으나 24시간 이내의 자료는 부족한 실정이며 중등도 위험군의 환자를 대상으로 한 연구도 드물다.방 법부산대학교병원의 외래 혹은 응급실을 통해 입원한 ST절 비상승 심근경색증 환자 중 TIMI score 3~4점의 중등도 위험군 118명을 대상으로 후향적으로 조사하여 흉통 발생 시점으로부터 관상동맥 중재술을 시행한 시간에 따라 24시간 이내 군 (Group Ⅰ), 24시간에서 48시간 사이 군 (Group II), 48시간 이후 군 (Group III)으로 나누어 임상적 특징 및 관상동맥 위험요소들을 평가하고 12개월 추적 주요 심장 사건을 조사하였다. 결 과 임상적 특징은 tirofiban의 사용을 제외하고 세 군 사이에 통계학적으로 유의한 차이가 없었다. 병원내 사망, 심근경색은 Group Ⅰ과 Group II에서 한 건도 없었으며, Group III에서는 1.3%로 사망 1건이 있었으나 통계적 의의는 없었다 (p=0.757). Group Ⅰ에서 12개월 추적 관찰 주요 심장 사건의 비율은 0%였고 Group II에서는 6.7%로 목표혈관 재관류요법 1건이었고, Group III에서는 17.1%로 사망 3건, 심근경색 3건, 목표혈관 재관류요법이 7건으로 높았으며 통계적 유의한 차이를 보였다 (p=0.049). 결 론 급성 ST절 비상승 심근경색증의 중등도 위험군에서 12개월 추적 관찰 주요 심장 사건의 발생이 중재술의 시기가 빠를수록 유의하게 낮았으며 더 좋은 예후를 반영하였다. 또한 중재술을 24시간이내 시행한 군에서 12개월 추적 관찰 주요 심장 사건의 발생은 한 건도 없어 가장 좋은 예후를 보여주었다. 본 연구를 통해 개별환자의 상황을 고려해서 조기에 관상동맥 중재술 시행을 추천한다.

비정맥류 상부위장관 출혈에서 내시경적 클립 지혈술과 내시경적 응고술의 비교

하종건,최철웅,김형욱,강대환,박수범,김수진,박진현,장형하,김태경 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1

측방 발육형 종양에서 원주 절개 후 점막절제술(EMR-CI)과 점막하박리술(ESD)의 치료성적 분석

박진현,김형욱,최철웅,강대환,박수범,김수진,장형하 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1

장 정결에 있어 PEG 복용 후 최적의 시간 간격

김태경,최철웅,김형욱,강대환,박수범,김수진,박진현,하종건,장형하,홍영미 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1