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위장관 ; 미분화 조기위암에서 내시경 점막하박리술의 치료 성적
최문한 ( Moon Han Choi ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),송정엽 ( Jeong Yeop Song ),김대용 ( Dae Yong Kim ),서성우 ( Sung Woo Seo ),하지수 ( Ji Su Ha ),이윤나 ( Yun Nah Lee ),고봉민 ( Bong Min Ko ),이문성 ( Moon Sung 대한소화기학회 2013 대한소화기학회지 Vol.61 No.4
목적: 내시경 점막하박리술은 조기위암의 표준 치료로 받아들여지고 있다. 하지만, 미분화 조기위암에 대한 내시경 점막하박리술의 적응증은 아직 논란이 있다. 이번 연구에서는 확대 적응증에 의한 미분화 조기위암에서 내시경 점막하박리술의 치료 성적에 대해 파악하고자 하였다. 대상 및 방법: 순천향대학교 의과대학 부천병원에서 미분화 조기위암 환자 81명을 대상으로 82병변에 대해 내시경 점막 하박리술을 시행하였다. 치료 성적에 대해 절제 방법(일괄 절제, 분할 절제), 완전 절제율, 합병증, 재발률에 대해 조사하였다. 결과: 일괄 절제율과 완전 절제율은 각각 87.8% (72/82)과 80.5% (66/82)였다. 반지세포암종에서 저분화 선암종과 반지 세포를 동반한 저분화 선암종에 비해 높은 완전 절제율을 보였으나, 통계학적 의미는 없었다(89.3% vs. 75.0%, 76.7%; p=0.347). 저분화 선암종, 반지세포암종, 반지세포를 동반한 저분화 선암종에서 측면절제면 양성이 확인된 경우는 각각 12.5%, 3.6%, 13.3%였다(p=0.395). 기저절제면 양성이 확인된 경우는 각각 12.5%, 3.6%, 10.0%였다(p=0.485). 평균 37.4 개월의 추적기간 동안 재발률은 3.0%였다. 결론: 확대 적응증에 의한 미분화 조기위암에서의 내시경 점막하박리술은 유용한 치료가 될 것으로 생각되나, 장기적이고 대규모의 연구가 필요하겠다. Background/Aims: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment of early gastric cancer (EGC). However, the indication of ESD in undifferentiated-type EGC was controversial. The aim of this study was to evaluate the therapeutic outcomes of ESD in undifferentiated-type EGC according to expanded indication. Methods: At Soonchunhyang University Bucheon Hospital, a total of 82 lesions in 81 patients with undifferentiated-type EGC were treated with ESD. The therapeutic outcomes of ESD were evaluated by resection method (en bloc resection; piecemeal resection), histologic curative resection, complications and recurrence rates after ESD. Results: The rate on en bloc resection and complete resection rate were 87.8% (72/82) and 80.5% (66/82), respectively. In signet ring cell carcinoma, the complete resection rate was higher than those in poorly differentiated adenocarcinoma and poorly differentiated adenocarcinoma with signet ring cell features, but there was no statistical significance (89.3% vs. 75.0%, 76.7%; p=0.347). The lateral margin positivity rate in poorly differentiated adenocarcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma with signet ring cell features were 12.5%, 3.6% and 13.3%, respectively (p=0.395). The vertical margin positivity rate were 12.5%, 3.6% and 10.0%, respectively (p=0.485). The overall recurrence rate was 3.0% during a mean follow-up period of 37.4 months. Conclusions: ESD may be considered as a feasible treatment for undifferentiated-type EGC according to expanded indication. The therapeutic outcome of ESD in undifferentiated-type EGC is likely to be favorable, though further longer follow-up studies are needed. (Korean J Gastroenterol 2013;61:196-202)
전이성 병소에 의해 발생한 급성 충수염의 천공으로 진단된 전신병기 소세포폐암
신동원 ( Dong Won Shin ),최문한 ( Moon Han Choi ),박승식 ( Seung Sik Park ),박성우 ( Sung Woo Park ),김기업 ( Ki Up Kim ),장안수 ( An Soo Jang ),박춘식 ( Choon Sik Park ),임철완 ( Cheol Wan Lim ),고은석 ( Eun Suk Ko ),백상현 ( San 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.3
The incidence of appendiceal metastatic cancer is quite low. In particular, in small cell lung cancer, there is a very low incidence of a metastasis to the appendix. A 75-years old man with right lower quadrant pain, cough and sputum was transferred to our hospital. Abdominal CT revealed acute appendicitis with a perforation. The patient underwent surgery. The frozen sections of the tissue obtained during surgery, indicated a malignancy, but a right hemicolectomy was not performed due to the patient`s poor general condition. The histology findings of the appendix were identified as a small cell carcinoma. The abdominal CT scan and chest x-ray at admission day showed a mass in the right lower lobe, and a further evaluation of the lesion was performed including positron emission tomography and flexible bronchoscopy with a biopsy. The pathology findings of the lung mass were also small cell lung cancer. The specimens from both sites stained positive for cytokeratin, cluster designation 56, synaptophysin, chromogranin-A and thyroid transcription factor 1. It was concluded that the appendiceal small cell cancer originated from the lung. (Tuberc Respir Dis 2008;65:230-234)
10년간 크기가 서서히 증가한 고립성 폐결절이 선암으로 진단된 1예
권기두 ( Ki Du Kwon ),김지형 ( Ji Hyeong Kim ),김대용 ( Dae Yong Kim ),최문한 ( Moon Han Choi ),최재혁 ( Jae Huk Choi ),신동원 ( Dong Won Shin ),최종효 ( Jong Hyo Choi ),이설희 ( Sul Hee Yi ),윤진아 ( Jin A Yun ),최재성 ( Jae Sung 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.4
임상 연구 : 간경변 환자의 신기능 평가에서 Cystatin C의 유용성에 대한 연구
김지형 ( Ji Hyeong Kim ),신동원 ( Dong Won Shin ),이설희 ( Sul Hee Yi ),최문한 ( Moon Han Choi ),최종효 ( Jong Hyo Choi ),김대용 ( Dae Yong Kim ),박무용 ( Moo Yong Park ),최수정 ( Soo Jeong Choi ),김상균 ( Sang Gyune Kim ),김진국 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6
목적: Cystatin C는 사구체 기저막을 자유로이 통과하여 세뇨관에서 재흡수 완전 분해되어 사구체 여과율 (glomerular filtration rate; GFR)을 노인, 간경변 환자처럼 근육 위축을 동반한 환자에서 creatinine 보다 정확하고 민감하게 반영하는 것으로 알려져 있다. 이에 저자들은 간경변증 환자에서 cystatin C를 근거로 하는 신기능 평가의 유용성을 연구하였다. 방법: 2007년 2월부터 9월까지 순천향대학교 부천병원에 입원한 안정된 간경변 환자를 대상으로 혈청 creatinine (MDRD와 Cockroft & Gault 공식), 24시간 소변 검사, 혈청 cystatin C (Hoek와 Larsson 공식)로 측정한 GFR 값을 크롬-EDTA로 측정한 GFR를 기준으로 비교하고, 신기능을 조사하였다. 결과: 총 46명의 환자 중 Child classification A가 10명, B가 17명, C가 19명이고, 평균 creatinine 1.1±0.56 mg/dL이며, 평균 cystatin C는 1.2±0.5 mg/L이었다. 평균 GFR은 크롬-EDTA로 67.8±29.4 mL/min/1.73m2이었다. MDRD 공식으로 81.6±29.6 mL/min/1.73m2, C&G로 79.9±29.3 mL/min/1.73m2, 24시간 소변의 Cr 배설율로 62.7±29.8 mL/min/1.73m2, Hoek 공식으로 77.0±28.6 mL/min/1.73m2, Larsson 공식으로 80.0±35.2 mL/min/1.73m2 이었다. Cystatin C는 당뇨, 연령, 성별에 따라 차이가 없었다. Cystatin C는 BUN (r=0.422), MDRD 공식 (r=-0.715), C&G 공식 (r=-0.659), 24시간 소변의 Cr 청소율 (r=-0.536), 크롬-EDTA 결과 (r=-0.617)의 GFR과 의미있는 상관 관계를 보였으며, MELD score, 혈청 albumin, Creatinine, PT, bilirubin과는 관련이 없었다. Cystatin C을 이용한 Hoek 공식 (r=0.657)과 Larsson 공식 (r=0.647)의 GFR은 MDRD (r=0.550)와 C&G 공식 (r=0.458)에 비해 크롬-EDTA와 높은 상관 관계를 보였다. Cystatin C의 크롬-EDTA GFR에 대한 회귀방정식은 -33.7×cystatin C+106.4 mL/min 이었다. 신기능의 차이는 없으나, cystatin C는 모든 간경병증 환자에게서 상관관계가 높았다. 결론: Cystatin C는 간경변증 환자에게서 혈청 Creatinine보다 정확하게 신기능을 반영하고, 간경변증 정도에 관계없이 상관관계가 높았다. Purpose: Cystatin C is known to predict the glomerular filtration rate (GFR) more precisely in patients with substantial muscle atrophy, such as liver cirrhosis, compared to creatinine. We evaluated the usefulness of cystatin C for prediction of renal function in liver cirrhosis patients. Methods: From February 2007 to September 2007, we evaluated the renal function in patients with liver cirrhosis who were admitted to Soonchunhyang University Bucheon Hospital. We compared renal function with GFR as estimated by creatinine (Modification of diet in renal diseases; MDRD, the Cockroft&Gault equation; C&G, Creatinine clearance; CCr) and cystatin C (the Hoek and Larsson equations) with that of the GFR as calculated by Cr-EDTA. Results: A total of 46 patients were enrolled. The mean GFR was 67.8±29.4, 81.6±29.6, 79.9±29.3, 62.7±29.8, 77.0±28.6, 81.0±35.2 mL/min/1.73m2 according to Cr-EDTA, MDRD, C&G, CCr, Hoek and Larsson equations, respectively. Cystatin C showed a correlation to MDRD (r=-0.715), C&G (r=-0.659), CCr (r=-0.536) and Cr-EDTA GFR (r=-0.617). GFR by the Hoek (r=0.657) and the Larsson (r=0.647) equation using cystatin C showed a higher correlation with Cr-EDTA GFR than GFR by MDRD (r=0.550) and C&G equation (r=0.458). Conclusion: Cystatin C is a more accurate predictor of renal function than creatinine in patients with liver cirrhosis.
내시경 점막하 박리술로 제거한 상부 식도의 고유근층 기원 근종
강명수 ( Myung Soo Kang ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),서정연 ( Jung Yeon Seo ),윤라영 ( La Young Yoon ),최문한 ( Moon Han Choi ),김희경 ( Hee Kyung Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.4
The technique of endoscopic submucosal dissection is occasionally used for resection of myogenic tumors originating from muscularis mucosa or muscularis propria of stomach and esophagus. However, endoscopic treatments for esophageal myogenic tumors >2 cm have rarely been reported. Herein, we report a case of large leiomyoma originating from muscularis propria in the upper esophagus. A 59-year-old woman presented with dysphagia. Esophagoscopy and endoscopic ultrasonography revealed an esophageal subepithelial tumor which measured 25×20 mm in size, originated from muscularis propria, and was located at 20 cm from the central incisors. The tumor was successfully removed by endoscopic submucosal dissection and there were no complications after en bloc resection. Pathologic examination was compatible with leiomyoma. (Korean J Gastroenterol 2013;62:234-237)
일개 대학 병원에서 경험한 뎅기열-뎅기출혈열 4예와 국내 문헌 고찰
최문한,추은주,김태형,전민혁,박의주,신동원,이설희,최종효 대한감염학회 2008 감염과 화학요법 Vol.40 No.6
Dengue virus infection is an emerging imported disease in Korea. A total of 4 cases of dengue fever or dengue hemorrhagic fever diagnosed at Soonchunhyang University Hospital in Bucheon between January 2001 and December 2007 were retrospectively reviewed, In addition, relevant domestic literatures from Korean bibliographic databases, which matched 'dengue fever', 'dengue hemorrhagic fever' or 'dengue shock syndrome' as key words, have been reviewed. Ten articles (13 patients) met the inclusion criteria and were included in this review. All the patients except for one who was infected in Africa, were infected in Asian countries: Philippines (4), Indonesia (3), India (2), Cambodia (2), Sri Lanka (1), Thailand (1), Bangladesh (1), Myanmar (1), and Malaysia (1). Clinical manifestations after returning from abroad were as follows: fever (100%), chills (82%), headache (65%), myalgia (53%), nausea (41%), neutropenia (82%), thrombocytopenia (82%) and elevation of AST (82%) and ALT (53%). Most of the patients improved with conservative care except for one who died of dengue shock syndrome.