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내시경을 이용한 담석제거술을 통해 치료된 I형 Mirizzi 증후군 2예
전창균,박도현,류지원,심윤숙,박정훈,이석호,김홍수,박상흠,김선주 대한소화기내시경학회 2007 Clinical Endoscopy Vol.34 No.1
Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature. (Korean J Gastrointest Endosc 2007;34:60-64) Mirizzi 증후군은 담낭관 내의 담석이나 이에 동반된 염증으로 담낭관이 확장되어 총간관의 기계적인 압박이나 염증에 의한 가역적인 폐쇄성 황달을 일으키는 드문 질환이다. 본 질환은 수술 전 진단이 어려운 질환으로 알려져 있으며, 또한 수술 시의 소견이 담관 주위의 종양과 매우 유사한 경우가 많아 담낭 주위 종양과 감별을 요하는 질환이다. Mirizzi 증후군의 치료는 과거 외과적 수술에 의존해 왔으며, 감입된 담낭관 결석에의 접근이나 제거가 쉽지 않아 고식적인 내시경을 이용한 결석제거술로는 치료가 어렵다. 그러나 최근 경구 및 경피 내시경 수기의 발전에 힘입어 외과 수술 치료를 대신할 수 있는 여러 방법들이 소개되고 있다. 저자들은 I형의 Mirizzi 증후군 환자들 중 수술을 거부하였거나 수술의 고위험군이었던 환자 2명을 내시경을 이용한 담석제거술로 치료하였기에 문헌고찰과 함께 보고하는 바이다.
양성 담관협착 진단 3개월 후 간문부 담관암으로 확진된 1예
전창균,장희윤,차상우,조영덕 대한췌담도학회 2012 대한췌담도학회지 Vol.17 No.1
Klatskin tumors are difficult to diagnosis in the early stages. Therefore early detection is important for curative treatment and prognosis of these tumors. We report a case of a 70-year-old female who was diagnosed with a benign stricture of the common bile duct during a routine health examination at an outside hospital. She underwent dilation of the stricture but of follow up examination the stricture worsened and she was referred to our center. On admission no malignance was suspected on initial abdominal ultrasound, CT, MRCP, ERCP and brush cytology. On follow up CT and MRI at our center, Klatskin tumor was suspected and adenocarcinoma was confirmed on ERCP and IDUS with brush cytology and forcep biopsy. Even if malignancy is not suspected on radiologic and histologic examination it is prudent to perform close follow up of benign biliary strictures.
국내 임상에서의 대장내시경의 질 척도 인자 분석: 대장내시경 시행 후 3차 병원에전원된 환자의 코호트 연구
전창균,김현건,전성란,고봉민,이병후,김진오 대한장연구학회 2013 Intestinal Research Vol.11 No.3
목적: 대장내시경의 질은 대장암 선별검사로서 대장내시경의 유용성을 향상시키는 중요한 인자임에 분명하지만, 실제 국내 임상 현장에서 대장내시경의 질에 대한 보고는 매우 제한적이라 할 수 있다. 저자들은 임상 일선에서 시행되는 대장내시경의 질 척도 인자들을 분석하고자 하였다. 방법: 2012년 1월부터 10월까지 1, 2차 의료기관에서 대장내시경을 시행한 후 3차 대학병원으로 전원된 환자들 중 컴퓨터 분석이 가능하였던대장내시경 소견들을 분석하였다. 맹장 삽관율과 대장내시경 후퇴시간, 장정결도와 대장내시경 결과 기록지를 분석하였다. 장정결도는 우수,양호, 보통, 불량의 4단계로 분석하였다. 결과: 총 198예(남자 126명, 여자 72명)가 분석 가능하였다. 이들의 맹장 삽관율은 91.4% (181/198)였으며 맹장입구 사진 획득률과 회맹판사진 획득률은 각각 84.3% (167/198)와 71.7% (142/198)였다. 장정결도의 경우 83.3%의 예에서 ‘우수’ 52%, ‘양호’ 31.3%로 적절한 장정결도를 보였다. 대장내시경 후퇴시간은 전체의 94.4% (187/198)에서 측정이 가능하였으며, 측정 가능하였던 진단대장내시경(165명)의 평균후퇴시간은 8.6분이었다. 그러나 이들 중 6분 이상의 내시경 후퇴시간을 보인 경우는 69.7% (115/165)였다. 전체 30개 기관의 대장내시경결과 기록지가 분석 가능하였는데 이들 중 46.6% (14/30)는 결과 기록지에 환자 정보와 내시경 진단명만을 기재하고 있었다. 결론: 임상 일선에서 시행되고 있는 대장내시경의 상당 부분은 질 관리 인자들이 제대로 지켜지지 않고 있았다. 실제 임상에서 대장내시경의적절한 질 관리를 위해서는 질 관리에 대한 필요성 인식과 지속적인 관심이 필요할 것으로 생각된다. Background/Aims: Although the quality of colonoscopy is considered important to improve screening efficacy, there is little evidence and few statistical reports which properly reflects the colonoscopy quality of clinical practices in Korea. We aimed to investigate the quality indicators of colonoscopy performing in clinical practice. Methods: We analyzed the computerized photo-documentation files of patients who were transferred to tertiary academic hospital from private clinics or primary and secondary hospitals from January 2012 to October 2012. Quality indicators including cecal intubation rate, withdrawal time, bowel preparation status, colonoscopy report form were analyzed. Bowel preparation was assessed by 4 steps on the preparation scale (excellent, good, fair, poor). Results: A total of 198 patients (134 male, 64 female) were enrolled and analyzed. Cecal intubation rate was 91.4% (181/198) and photo-documentation of appendiceal orifice and ileocecal valve was achieved as 84.3% (167/198) and 71.7% (142/198), relatively. Overall, 83.3% of cases were adequate bowel preparation state (excellent 52%, good 31.3%). Withdrawal time could be estimated at 94.4% (187/198) of cases and mean withdrawal time of diagonostic colonoscopy (n=165) was 8.6 minutes. However, the rate of cases which withdrawal time was more than 6 minutes was 69.7% (115/165). Total of 30 institution’s colonoscopy report forms were analyzed and among nearly half enrolled institutions (46.6%, 14/30) were just recording patient’s information and colonoscopic diagnosis. Conclusions: Considerable portion of colonoscopy examination in the primary clinical practice has been performed with low procedure quality. We thus need careful attention to maintain the quality of colonoscopy in daily practice routines. (Intest Res 2013;11:198-203)
관상동맥 성형술에서 일반 스텐트와 약물방출 스텐트 사용에 따른 혈청 sCD40L 및 neopterin의 농도변화
윤진아,박승훈,류지원,전창균,홍중락,방덕원,현민수,김성구,권영주 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.1
Drug-eluting stents(DES) had decreased the frequency of coronary restenosis. We therefore hypothesized that DES would be associated with reductions in serum levels of soluble CD40L and neopterin after percutaneous coronary intervention(PCI). We studied 40 patients who underwent PCI and who had repeated angiograms at 6-month follow-up. Plasma sCD40L and neopterin were measured before and 6-munth after PCI. Patients treated with DESs(n=20) did not differ in baseline characteristics, sex, age and risk factors. Both DES and BMS(bare metal stents) groups did not show difference between before and after PCI in serum levels of sCD40L and neopterm (mean 2.72±4.32ng/mL vs 1.26±1.45ng/mL, p = 0.141 in BMS and 4.05±5.22ng/mL vs 2.73±4.34ng/mL, p = 0.411 in DES for sCD40L, mean 6.69±5.66nmol/L vs 5.38±4.52nmol/L, p = 0.079 in BMS and 6.84±6.93nmol/L vs 7.41±6.41nmol/L, p = 0.715 in DES for neopterin). Patients treated with DES did not show diffrence in changes of sCD40L and neopterin (mean -1.31±7.00ng/mL vs -1.451±4.23ng/mL, p = 0.940 for sCD40L, 0.578±6.99 nmol/L vs -1.31±3.16nmol/L, p = 0.278 for neopterin). Serum levels of sCD40L and neopterin were not associated with late restenosis after PCI. Also both of sCD40L and neoptehn did not differ by DES use.
약물 방출 스텐트 삽입 후 반복적으로 발생한 아급성 스텐트 혈전증 1예
심윤숙,최은숙,노미오,전창균,정철호,이승환,조윤행,이내희 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2
Drug-eluting stents (DES) have been proved to reduce the restenosis rates and the need for repeated revascularization. But the concerns about stent thrombosis (ST) have been raised because ST is a serious complication of DES implantation. Repeated ST is rare. We report a case of recurrent ST after DES implantation. 경피적 관상 동맥 중재술 후 반복적으로 발생한 아급성 스텐트 혈전증의 환자애서 관상 동맥 우회로술로 회복된증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이 다.
심광연,차상우,엄욱현,전창균,정승원,장재영,조영덕 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2
Gallbladder (GB) cancer occurs predominately as a biliary tract malignant tumor. It generally has a very poor prognosis, and early detection is often difficult. A variety of carcinogens have been implicated as an important cause for GB cancer. Benzene is a well-known carcinogen for hematologic malignancy, and its casual relationship with GB cancer has been suggested. We report a case of two patients who had operated a laundry cleaning facility together and later simultaneously got GB cancer after prolonged benzene exposure.
세탁소를 운영하는 부부에서 동시에 발생한 담낭암 담낭암과 벤젠과의 연관성
심광연 ( Kwang Yeun Shim ),차상우 ( Sang Woo Cha ),엄욱현 ( Wook Hyun Um ),전창균 ( Chang Gyun Chun ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),조영덕 ( Young Deok Cho ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2
Gallbladder (GB) cancer occurs predominately as a biliary tract malignant tumor. It generally has a very poor prognosis, and early detection is often difficult. A variety of carcinogens have been implicated as an important cause for GB cancer. Benzene is a well-known carcinogen for hematologic malignancy, and its casual relationship with GB cancer has been suggested. We report a case of two patients who had operated a laundry cleaning facility together and later simultaneously got GB cancer after prolonged benzene exposure.
급성 췌장염 후 악화된 산역류 연관성 미만성 식도 경련
은수훈 ( Soo Hoon Eun ),이준성 ( Joon Seong Lee ),전창균 ( Chang Gyun Chun ),김연수 ( Yeon Soo Kim ),주현수 ( Hyun Soo Joo ),정현구 ( Hyun Ku Jung ),김경민 ( Kyung Min Kim ),정인섭 ( In Seop Jung ),고봉민 ( Bong Min Ko ),홍수진 ( 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1
Diffuse esophageal spasm (DES) is a typical motility disorder of the esophagus thats manifested by episodic chest pain and dysphagia. Visceral hypersensitivity is considered to be an important pathophysiological mechanism in the development of noncardiac chest pain, the same as for functional gastrointestinal disorders. Recent studies have revealed that descending facilitation from the rostral ventromedial medulla maintains visceral pain in a model of experimental pancreatitis. We report here on a 24-year old male who suffered from retrosternal chest pain and dysphagia, and this was aggravated after acute pancreatitis. The initial endoscopic examination revealed reflux esophagitis. After 11 months, esophageal manometry showed the typical findings of diffuse esophageal spasm, while the endoscopic examination and 24 hr pH metry failed to reveal acid reflux. We performed endoscopic botulinum toxin injection that resulted in relieving his symptoms along with improved results on the balloon provocation test. We present here a case of aggravated reflux-associated DES after acute pancreatitis, along with a review of the literature. (Kor J Neurogastroenterol Motil 2007;13:76-80)