췌장암에서의 선행보조항암요법

안동원,Dong-Won Ahn 대한소화기암연구학회 2015 Journal of digestive cancer reports Vol.3 No.1

Pancreatic cancer is an aggressive tumor and only 10-20% patients are considered candidates for curative resection at diagnosis. While surgery remains the only chance for cure, prognosis is poor even after surgery due to high rate of recurrence. A complementary chemotherapy and radiotherapy in a multimodal approach has been attempted to improved prognosis after surgery. Since adjuvant chemotherapy has yielded an only modest outcome improvement, various neoadjuvant approaches with chemotherapy, chemoradiation, or chemotherapy followed by chemoradiation have been attempted. In this article, current knowledge of the various neoadjuvant approaches for pancreatic cancer will be reviewed and the role of the neoadjuvant strategies will be discussed.

원발성 경화성 담관염과 원발성 담즙성 담관염의 최신 지견

안동원 ( Dong-won Ahn ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.2

원발성 경화성 담관염과 원발성 담즙성 담관염은 모두 면역 반응을 매개로 하는 만성 간질환이다. 원발성 경화성 담관염은 담관의 염증과 섬유화로 인한 다발성 담관 협착을 특징으로 하는 질환으로 대부분의 경우, 비대상성 간경변증으로의 진행으로 인해 간이식을 필요로 하는 질환이다. 대부분의 원발성 경화성 담관염의 진단에서 영상학적 소견을 통한 특징적인 담관 협착 소견이 중요하다. 원발성 경화성 담관염의 경우, 대부분 염증성 장질환이 동반되어 있고 담관암과 대장암의 발생 위험이 크게 증가하는 것으로 알려져 있다. 원발성 경화성 담관염에서 질병의 진행을 늦출 수 있는 것으로 입증된 약물 치료는 아직 없는 것으로 알려져 있고, 담관 협착으로 인한 급성 담관염이 발생하거나 임상적으로 담관암이 의심될 경우, 내시경 시술을 통한 조직 진단과 담관 배액이 필수적이다. 원발성 담즙성 담관염은 자가면역 기전의 담즙 정체성 만성 질환으로 적절한 치료를 하지 않으면 비대상성 간경변증으로의 진행으로 간이식을 필요로 하는 질환이다. 원발성 담즙성 담관염의 진단은 담즙 정체성 간염 소견과 특징적인 자가면역항체의 양성 소견으로 이루어진다. 원발성 담즙성 담관염의 임상 경과는 환자들에 따라 매우 다양하므로 적절한 치료가 시행되기 위해서는 약물 치료 전과 후의 위험도 평가가 필수적이다. 우르소데옥시콜산과 오베티콜릭산과 같은 약물 치료는 원발성 담즙성 담관염에서 간경변증으로의 진행을 늦추어 예후를 개선시키는 데 중요한 역할을 하는 것으로 알려져 있다. Primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are immunemediated chronic liver diseases. PSC is a rare disorder characterized by multi-focal bile duct strictures and progressive liver diseases, in which liver transplantation is required ultimately in most patients. Imaging studies such as magnetic resonance cholangiopancreatography have important role in diagnosis in most cases of PSC. PSC is usually accompanied by inflammatory bowel disease and there is a high risk of cholangiocarcinoma and colorectal cancer in PSC. No medical therapies have been proven to delay progression of PSC. Endoscopic intervention for tissue diagnosis or biliary drainage is frequently required in cases of PSC with dominant stricture, acute cholangitis, or clinically suspected cholangiocarcinoma. PBC is a chronic inflammatory autoimmune cholestatic liver disease, which when untreated will culminate in endstage biliary cirrhosis requiring liver transplantation. Diagnosis is usually based on the presence of serum liver tests indicative of a cholestatic hepatitis in association with circulating antimitochondrial antibodies. Patient presentation and course can be diverse in PBC and risk stratification is important to ensure all patients receive a personalised approach to their care. Medical therapy using ursodeoxycholic acid (UDCA) or obeticholic acid (OCA) has an important role to reduce the progression to end-stage liver disease in PBC.

반복적인 위장관 출혈을 야기한 공장 정맥류

안동원 ( Dong Won Ahn ),정지봉 ( Ji Bong Jeong ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.3

담석성 췌장염의 재발 예방을 위한 유두괄약근절개술과 담낭절제술의 유용성

안동원 ( Dong Won Ahn ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.5

Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis? (Korean J Gastroenterol 2015;65:297-305)

총담관 결석이 의심되는 환자에서 담낭절제술의 조기 시행은 이상적인 치료 방법인가?

안동원 ( Dong Won Ahn ),정지봉 ( Ji Bong Jeong ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.3

담낭 결석으로 담낭절제술을 앞두고 있는 환자에서 간 수치 상승과 같은 총담관 결석이 의심되는 경우, 수술 전에 내시경초음파(EUS), 자기공명담췌관조영술(MRCP)이나 내시 경역행담췌관조영술(ERCP)을 먼저 시행하는 경우가 많지만, 총담관 결석이 십이지장으로 저절로 이동하는 경우도 많아, 총담관 결석이 의심되는 경우의 이상적인 치료 방침에 대해서는 아직 정립되지 않은 상태이다. 이에 Iranmanesh 등1은 전향적 무작위 임상연구를 통해 총담관 결석이 의심되는 경우의 이상적인 치료 방침에 대해 규명하고자 하였다. 담낭 결석으로 인한 증상이나 합병증으로 담낭절제술을 계획하는 환자들중 총담관 결석의 동반 위험이 중등도인 100명의 환자들을 대상으로 무작위로 두 그룹으로 구분하여 치료를 시행하였다. 한 그룹에서는 담낭절제술을 먼저 시행하고 수술 중 담관 투시 영상(intraoperative cholangiography, IOC)을 얻어 총담관 결석이 있으면 수술 중 또는 수술 후에 ERCP를 시행하였고, 다른 한 그룹에서는 담낭절제술 전에 EUS를 먼저 시행해서 총담관 결석이 확인되면 ERCP로 제거한 후에 담낭절제술을 시행하였다. 연구 결과 일차 평가 지표(primary outcome)인 재원 기간은 담낭절제술을 먼저 시행한 군에서 유의하게 낮았고(5일 vs. 8일, p<0.001), EUS, ERCP, MRCP와 같은 총담관에 대한 검사 건수도 담낭절제술을 먼저 시행한 군에서 유의하게 낮았다(25건 vs. 71건, p<0.001). 또한, 합병증과 추적 관찰 중의 삶의 질에서는 양 군 사이에 유의한 차이가 없었다. 결론으로 총담관 결석의 동반 가능성이 중등도일 경우에는 담낭절제술을 먼저 시행하는 치료 전략이 재원 기간과 불필요한 시술을 줄일 수 있다는 점에서 더 우월할 수 있음을 제시하였다는 데 의의가 있다고 하겠다. Initial Cholecystectomy vs Sequential Common Duct Endoscopic Assessment and Subsequent Cholecystectomy for Suspected Gallstone Migration: A Randomized Clinical Trial (JAMA 2014;312:137-144)

내시경유두괄약근절개술 후 출혈의 내시경 치료

안동원 ( Dong-won Ahn ),박선미 ( Seon Mee Park ),한정호 ( Joung-ho Han ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.1

내시경역행담췌관조영술(ERCP)은 췌담도 질환의 진단과 치료에 필수적인 시술이며, 내시경유두괄약근절개술(EST)은 ERCP를 성공하기 위한 관문이다. EST를 시행하기 위한 장비 의 발전에도 불구하고, EST 후 발생한 출혈은 여전히 치명적 인 합병증으로 남아있다. EST 직후에 발생한 출혈은 내시경 시야를 방해하여 성공적인 ERCP를 마칠 수 없게 하며, EST 후 지연형 출혈의 경우에는 혈담즙과 이에 의한 담도염, 심지어 혈역학적 쇼크까지 유발할 수 있으므로 주의가 필요하다. 다행히도 대부분의 출혈은 자발적으로 멈추지만, 임상적으로 의미 있는 출혈량이 있거나, 지속적인 출혈에서는 1차적으로 내시경 지혈술이 필요하다. 에피네프린을 혼합한 식염수의 주 사, 전기응고법, 클립이나 밴드를 이용한 기계적 지혈법까지 다양한 내시경적 지혈법이 있으며, 이러한 방법은 대부분 위 장관 출혈의 지혈술에서 사용되는 방법을 가져온 것이다. ERCP를 시행하는 의사는 다양한 내시경적 지혈술을 모두 숙 지하고 있어야, 한가지 지혈술로 실패한 경우에 다른 방법의 지혈술로 전환을 할 수 있어야한다. 또한 내시경적 지혈술에 실패한 경우에는 혈관조영술이나 수술로 출혈을 치료할 수 있 는 결정을 할 수 있어야만 한다. Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a side-viewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.

오지(五肢) 송아지 둔부(臀部) 부착된 과잉후지(過剩後肢)와 과잉미(過剩尾)를 가진 이둔체(二臀體)

김종섭,안동원,정순희,Kim, Chong-sup,Ahn, Dong-won,Jung, Soon-hee 대한수의학회 1990 大韓獸醫學會誌 Vol.30 No.4

A female Holstein calf with five legs and two tails was examined macroscopically and radiographically. The external feature included two normal forelimbs, two normal hindlimbs, a normal tail and each of underdeveloped extra hindlimb and tail, which was attached to the pelvic region. The extra hindlimb consisted of an underdeveloped femur, crural meromelia, duplicated calcaneous, partially duplicated metatarsal bone, three rows of digits with hoofs. This extra hindlimb was connected to an extra os coxa. The cervical and thoracic vertebrae were fused partially. The lumbar, sacral and coccygeal vertebrae were duplicated. This calf is a dipygus associated with pygopagus parasiticus.

닭의 정자선(精子腺) 기능(機能) 향상(向上)을 위한 연구(硏究) 2. 정자(精子) 저장(貯藏) 상태에 대하여

곽수동,안동원,Kwak, Soo-Dong,Ahn, Dong-Won 대한수의학회 1991 大韓獸醫學會誌 Vol.31 No.1

The purpose of this study was designed to investigate the methods for the functional elevations of sperm-host (utero-vaginal, U-V) glands in domestic hens. The laying hens were assigned to five groups of low-, medium-, high- fecundity, gonadotrophin-, and caffeinetreated hen groups, these group hens were sacrified at interval after last artificial inseminations (AI). Number of U-V gland observed in tissue preparation of each hen U-V region were investigated, and also the appearance rates of spermatozoa-contained U-V glands were calculated. 1. In low-fecundity hen groups, the appearance rates of spermatozoa-contained U-V glands were found to be 13.5, 15.6, 11.8, 13.6, 2.3, 0, and 0% respectively at the hens of 1, 3, 7, 10, 13, 16, and 19 days after AI. 2. In medium-fecunditiy hen groups, the appearance rates of spermatozoa-contained U-V glands were found to be 21.7, 22.7, 13.4, 10.4, 10.0, 7.7 and 0% respectively at the hens of 1, 3, 7, 10, 13, 16, and 19 days after AI. 3. In high-fecundity hen groups, the appearance rates of spermatozoa-contained U-V glands were found to be 30.8, 31.8, 28.9, 13.0, 10.3, 10.8, and 0.9 respectively at the hen of 1, 3, 7, 10, 13, 16, and 19 days after AI. 4. In gonadotrophin-treated hen groups, the appearance rates of spermatozoa-contained U-V glands were found to be 31.8, 33.7, 32.3, 17.3, 12.0, 5.0, and 1.0% respectively at hens of 1, 3, 7, 10, 13, 16, and 19 days after AI. 5. In caffeine-treated hen groups, the appearance rates of spermatozoa-contained U-V glands were found to be 33.2, 29.2, 22.4, 17.8, 12.7, 0, and 1.1% respectively at hens of 1, 3, 7, 10, 13, 16, and 19 days after AI. 6. The appearance rates of completely filled U-V glands and partially filled U-V glands of spermatozoa-contained U-V glands were found to be 3.8:1. So we suggested as follows: The appearance rates of spermatozoa-contained glands tend to be high from 1 day after AI to 7 days and tend to declined rapidly from 10 days. Also higher fecundity hen groups tend to be higher in the appearance rates and longer in spermatozoa-contained duration in U-V glands than in lower fecundity hen groups. Gonadotrophin hormone tend to increase the appearance rates of spermatozoa-contained U-V glands than those in control group, whereas caffeine tend to increase those rates at 1 day and to declined more rapidly from 3 day than in control group.

계분의 사료가치에 관한 연구 1 . 육성돈에 대한 계분의 사료가치시험

안병홍,김윤환,안동원 ( Byung Hong Ahn,Yoon Hwan Kim,Dong Won Ahn ) 한국축산학회 1977 한국축산학회지 Vol.19 No.4

To investigate the nutritive value of dried poultry waste (DPW) in the growing pig ration, this experiment was carried out for 5 months from May 14, 1975 to October 13, 1975 employing 24 male pigs of Landrace × Birkshire crossbreed weighing an average of 16.7㎏. The level of dried poultry waste added to the growing pig rations was divided into 0, 10, 20, and 30%. The results obtained were as follow; 1. Average daily gain (ADG) of growing pig fed the rations added 0, 10, 20, and 30% of DPW was 597, 556, 553 and 491gm, respectively. Average daily gain of growing pig fed the rations supplemented 30% of DPM was significantly (P$lt;0.05) decreased compared with ADG of growing pig fed with the rations supplemented with 0, 10, and 20% of DPW. 2. Average daily feed intake (ADFI) of growing pig fed with the rations Containg 0, 10, 20, and 30% of DPW was 2290, 2295, 2366 and 2369gm, respectively. ADFI of growing pig fed with the rations Cotaining 20 and 30% of DPW was significantly (P$lt;0.05) higher than that of growing pigs fed with the rations containing, and 10% of DPW. Feed efficiency was progressively decreased as the level of DPW in the growing pig ration was increased. Feed efficiency of growing pig, fed with the ration containing 30% of DPW was significantly (P$lt;0.05) decreased in comparison with that of growing pigs fed with the rations containing, 0, 10, 20% of DPW. 3. In the economical analysis, feed cost required per ㎏ of body weight gain of pig fed with the rations containing 0, 10, 20 and 30% of DPW was 294, 291, 270, and 302 Won, respectively. Feed cost was decreased as the level of DPW was increased till the level of 20%. On the contrary feed cost was increased in the lot fed with 30% of DPW. 4. Date required 90㎏ of body weight after birth was progressively extended as the level of DPW was increased. The average date ranged from 180 to 190. Therefore, according to the results of this experiment, it was concluded that dried poultry waste was able to add till 20% in the growing pig ration.

악성 대장 폐쇄 환자에서 자가팽창성 금속 스텐트의 임상적 효과: 내시경적 및 방사선적 삽입법 비교

김지원 ( Ji Won Kim ),정지봉 ( Ji Bong Jeong ),이국래 ( Kook Lae Lee ),김병관 ( Byeong Gwan Kim ),정용진 ( Yong Jin Jung ),김원 ( Won Kim ),김휘영 ( Hwi Young Kim ),안동원 ( Dong Won Ahn ),고성준 ( Seong Joon Koh ),이재경 ( Jae K 대한소화기학회 2013 대한소화기학회지 Vol.61 No.1

Background/Aims: This study compared the clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent (SEMS) in patients with malignant colorectal obstruction. Methods: In total, 111 patients were retrospectively enrolled in this study between January 2003 and June 2011 at Seoul National University Boramae Hospital. Technical and clinical success rates, complication rates, and stent patency were compared between using an endoscopic (n=73) or radiologic (n=38) method during the SEMS placement procedure. Results: The technical success rate was higher in the endoscopic method than in the radiologic method (100% [73/73] vs. 92.1% [35/38], respectively; p=0.038). In addition, in 3 of the remaining 35 patients in the radiologic-method group, adjuvant endoscopic assistance was required. In the six patients (including the three aforementioned patients), the causes of technical failure were the inability to pass the guidewire into an obstructive lesion due to a tortuous, curved angulation of the sigmoid or descending colon (n=4), and a difficult approach to a lesion located at the descending or transverse colon (n=2). The clinical success rate, complication rate, and stent patency did not differ significantly between the two methods (p=0.424, 0.303, and 0.423, respectively). Conclusions: When the colorectal obstruction had a tortuous, curved angulation of the colon or was located at or proximal to the descending colon, the endoscopic method of SEMS placement appears to be more useful than the radiologic method. However, once SEMS placement was technically successful, the clinical success rate, complication rate, and stent patency did not differ with the method of insertion. (Korean J Gastroenterol 2013;61:22-29)