내시경적 점막절제술 이후에 재발하여 수술을 실시한 조기식도암 1예

최정천,김광하,성혁규,김지혜,이용재 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

초대형 MILL HOUSING 주조제작에 관하여

최정천,오중희,손대락 ( J . C . Choi,J . H . Oh,D . R . Son ) 한국주조공학회 1995 한국주조공학회지 Vol.15 No.6

A Submucosal Tumor-Like Recurrence of Early Esophageal Cancer after Endoscopic Submucosal Dissection

최정천,김광하,박도윤,성형규,이영재,김지혜,김태균,이호석 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.2

Early esophageal cancer is defined as a tumor invading the mucosa with or without lymph node or distant organ metastasis. In the current guidelines for early esophageal cancer, absolute indication for endoscopic resection include lesions limited to the epithelium or lamina propria mucosa not exceeding two-thirds of the circumference, and relative indications include lesions limited to the muscularis mucosa or the upper third of the submucosal layer and not accompanied by clinical evidence of lymph node metastasis. After endoscopic submucosal dissection for early esophageal cancer, locally recurrent cancer can occur, especially in the case of incomplete resection. Here, we report a rare case of a submucosal tumor-like recurrence after endoscopic resection of early esophageal cancer.

내시경적 점막절제술 이후에 재발하여 수술을 실시한 조기식도암 1예

최정천,김광하,성혁규,김지혜,이용재 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 조기 식도암은 림프절이나 타장기의 전이여부에 관계없이 종양이 점막에 국한된 경우로 정의된다. 치료법은 수술, 내시경적 절제술, 항암요법, 방사선요법등이 있다. 수술은 조기식도암을 완전히 제거할 수 있지만, 술후 후유증 및 사망가능성이 있다. 만약 종양이 점막에 국 한된 경우라면, 내시경적 절제술이 추천될 수 있다. 현재의 Japan esophageal society 가이드라인에 따르면, 내시경적 절제술의 절대적응증은 병변이 mucosal epithelium에 국한되거나 lamina propria mucosa에 있으면서 직경의 2/3을 넘지 않아야 하며, 상대적응증은 림프절의 전이의 증거가 없이 병변이 muscularis mucosa나 submucosal layer 위 1/3에 국한된 경우이다. 내시경적 절제술은 술후 재발이나 속발성 암과 연관성이 있는 것으로 보고되고 있으며 이러한 단점을 보완한 것이 내시경적 점막절제술이다. 내시경적 점막절제술후에는 출혈, 천공, 협착 및 재발 등의 후유증이 나타날 수 있으며, 그 중에서 재발하는 경우는 현재까지도 거의 보고된 바가 없다. 증례: 환자는 3년 전 식도하부의 조기식도 암(T1N0M0)으로 진단되었고, 내시경적 점막절제술을 시행하였다. 3년간 상부소화관내시경, CT chest등을 시행하였으나 재발소견은 없었다. 내원하기 1개월전부터 연하곤란을 호소하여 입원하였다. 입원당시 혈압 110/70 mmHg, 체온 36.7℃, 맥박수 85회/분, 호흡수 20회였으며, 의식은 명료하였다. 흡연력은 20Pys, 현재도 흡연중이었다. 흉부 청진에서 정상적인 호흡음 및 규칙적인 심음이 들렸다. 복부는 부드럽고 편평했으며, 간이나 비장은 촉지되지 않았으며 말초부종은 관찰되지 않았다. 일반혈액검사, 생화학검사, 전해질검사, 종양표지자검사에서 이상소견은 보이지 않았다. CT chest상 하부식도부위에 1.5 cm정도되는 low density mass가 관찰되고, 상부소화관내시경상 앞니 30 cm부위에 이전 내시경적 점막절제술의 반흔이 보이며, 이 부위는 루골 산포상 염색되지 않았다. 내시경적 초음파상 병변이 muscularis propria까지 침범한 것으로 나타났다. PET CT상 하부식도부위에 FDG uptake가 관찰되었다. 상부소화관내시경을 통한 조직검사상 하부식도부위에 재발로 확인되었고, 흉부외과에 의뢰되어 Ivor Lewis op, pyloroplasty, feeding jejunostomy을 실시하였다. 수술조직에서는 종양이 adventitia (pT3)까지 침범한 것으로 나타났다. 이후에 보조항암치료을 6차례 실시하였고, CT chest및 상부소화관내시경상 재발이 없음을 확인하였으며, 현재 외래에서 경과관찰중이다. 저자들은 조기식도암에서 내시경적 점막절제술을 시행이후에 재발하였고, 이를 수술로 치료한 경우을 경험하였기에 보고하는 바이다.

Safety and Efficacy of an Aortic Arch Stent Graft with Window-Shaped Fenestration for Supra-Aortic Arch Vessels: an Experimental Study in Swine

박종하,이한철,최정천,김상필,박태식,안진희,박진섭,오준혁,이혜원,최정현,차광수 대한심장학회 2017 Korean Circulation Journal Vol.47 No.2

Background and Objectives: Thoracic endovascular aortic repair exhibits limitations in cases where the aortic pathology involves the aortic arch. We had already developed a fenestrated aortic stent graft (FASG) with a preloaded catheter for aortic pathology involving the aortic arch. FASG was suitable for elective cases. Materials and Methods: An aortic arch stent graft with a window-shaped fenestration (FASG-W) for supra-aortic arch vessels is suitable for emergent cases. This study aims to test a FASG-W for supra-aortic arch vessels and to perform a preclinical study in swine to evaluate the safety and efficacy of this device. Six FASG-Ws with 1 preloaded catheter were advanced through the iliac artery in 6 swine. The presence of endoleak and the patency and deformity of the grafts were examined with computed tomography (CT) at 4 weeks postoperatively. A postmortem examination was performed at 8 weeks. The mean procedure time for FASG-W was 27.15±4.02 minutes. The mean time for the selection of the right carotid artery was 5.72±0.72 minutes. Results: Major adverse events were not observed in any of the 6 pigs who survived for 8 weeks. For the FASG-W, no endoleaks, no disconnection, and no occlusion of the stent grafts were observed in the CT findings or the postmortem gross findings. Conclusion: The procedure with the FASG-W was able to be performed safely in a relatively short procedure time and involved an easy technique. The FASG-W was found to be safe and convenient for use in this preclinical study of swine.

산주 유형별 산림투자 요인 비교분석

서영완(Yeong Wan Seo),최정천(Jong Cheon Choi) 한국산림과학회 2001 한국산림과학회지 Vol.90 No.5

The case study of the Cooperatives` members and Sincere Forest Managers/Forest Successors was carried out to find the determinants affecting the forest investment of private forest owners and analyze their effects on it. For this the landowners` forest investment probability function was estimated using the logistical regression model. The results showed that the forest investment of the Cooperatives` members was the function of forest area, stand age, forest income, and technical assistance. Three of the variables (forest income, forest area, and technical assistance) exhibited a positive effect on the forest investment as expected, while stand age showed a negative effect unlike the expectation of the study. In case of Sincere Forest Managers and Forest Successors forest area, distance(1)(distance from forest to road accessible by vehicle), knowledge of financing program, and forest income were significant indicators for the forest investment. All these variables showed the expected signs; forest area, knowledge of financing, and forest income had a positive effect on the forest investment, and distance(1) showed a negative effect.

Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults

오준혁,송승환,이하린,이선학,김두엽,최정천,안진희,박진섭,신명준,전윤경,이혜원,최정현,이한철,차광수 대한의학회 2019 Journal of Korean medical science Vol.34 No.30

Background: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non- invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. Methods: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. Results: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. Conclusion: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups

Esophageal Pyogenic Granuloma: Endosonographic Findings and Endoscopic Treatments

성형규,김광하,송근암,김지혜,오민영,최정천,고정희,박창준 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.1

Pyogenic granuloma is a benign inflammatory vascular lesion, mainly found in the skin and oral mucosa. A few cases of pyogenic granuloma in the gastrointestinal tract have been reported, and the esophagus was the main site in these cases. These patients were diagnosed with pyogenic granuloma after they underwent upper endoscopy and biopsy. Endoscopic resection is a favorable treatment option for esophageal pyogenic granuloma. Recently, we observed characteristic endosonographic findings in two cases with esophageal pyogenic granuloma, which were then treated successfully by endoscopic resection.

증례 : 순환기 ; 고위험군 대동맥궁 동맥류에 대동맥 상부 혈관 우회술과 스텐트 그라프트 치료 2예

장세원 ( Se Won Jang ),고우석 ( Woo Seok Ko ),김민정 ( Min Jeong Kim ),최정천 ( Jung Cheon Choi ),안진희 ( Jin Hee Ahn ),송승환 ( Seung Hwan Song ),이한철 ( Han Cheol Lee ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2

연령이 높고 수술 고위험군인 대동맥궁의 대동맥류에 대해 대동맥궁 상부동맥 우회술과 스텐트 이식편(stent-graft) 삽입을 같이 시행하는 Hybrid 수술을 시행하여 좋은 결과를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A large aortic aneurysm invading the aortic arch can be catastrophic if rupture occurs. In the past, the standard treatment was an open thoracotomy followed by total aortic arch replacement. However, open surgery is difficult in patients at high operative risk. Consequently, thoracic endovascular aortic repair (TEVAR) is preferred in high-risk patients. In patients with a short proximal landing whose aortic aneurysm invades the aortic arch, TEVAR is not available because of innominate, left carotid, and left subclavian artery occlusion. We report two cases in which aortic aneurysms invaded the aortic arch, and who were treated with TEVAR after a supra-aortic artery bypass operation. (Korean J Med 2014;86:218-223)

Trend and Long-term outcome of cardiogenic shock with mechanical circulatory support in Korea

최혜나,이혜원,차광수,이한철,최정현,오준혁,박진섭,안진희,최정천,이선학,김라은 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2