직장 카르시노이드 종양에서 Ki-67 발현의 예후적 중요성

홍수민 ( Su Min Hong ),김유선 ( You Sun Kim ),문정섭 ( Jung Seop Moon ),김진남 ( Jin Nam Kim ),오명기 ( Myoung Ki Oh ),권선옥 ( Sun Ok Kwon ),정성연 ( Seong Yeon Jeong ),홍성우 ( Seong Woo Hong ),강윤경 ( Yun Kyung Kang ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2

Background/Aims: Rectal carcinoid tumors can be resected with endoscopy, and it is important to assess their prognostic factors. We evaluated the potential of Ki-67 expression as a prognostic factor in rectal carcinoid tumors. Methods: We retrospectively reviewed the medical records of 37 patients with rectal carcinoid tumors who got endoscopic resection from January 2001 to January 2011 at Inje University Seoul Paik Hospital. We analyzed their endoscopic and histologic findings, Ki-67 expression, clinical outcome, and prognosis. Results: The mean age (±SD) of the patients was 56.3±10.7 years, and the male : female ratio was 3.6:1. The mean tumor size was 0.5±0.4 cm, 33 patients showed grade 1 tumors (89.2%) and the average Ki-67 expression was 0.7±1.2%. Thirty five patients underwent endoscopic mucosal resection, and two required endoscopic submucosal dissection. Eight patients had positive margins after resection, but no cases of lymphovascular invasion were identified. The median follow-up duration was 21.4±25.4 months, and no recurrences were observed. Conclusions: In low grade rectal carcinoid tumors which are lack of central depression on colonoscopy, the expression of a molecular marker of malignant potential, Ki-67, was low. Therefore, endoscopic resection seemed to be a safe and effective treatment for these tumors.

보존적 치료로 호전된 종격동 기종을 동반한 벽내성 식도 박리

차인혜 ( In Hye Cha ),김진남 ( Jin Nam Kim ),권선옥 ( Sun Ok Kwon ),김선영 ( Sun Young Kim ),오명기 ( Myoung Ki Oh ),류수형 ( Soo Hyung Ryu ),김유선 ( You Sun Kim ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.

대장 게실증 임상양상에 영향을 미치는 인자에 대한 전향 연구

김선영 ( Sun Young Kim ),김유선 ( You Sun Kim ),김현태 ( Hyun Tae Kim ),권선옥 ( Sun Ok Kwon ),오명기 ( Myoung Ki Oh ),차인혜 ( In Hye Cha ),옥경삼 ( Kyeong Sam Ok ),곽철훈 ( Cheol Hun Kwak ),김진남 ( Jin Nam Kim ),문정섭 ( Jeong 대한소화기학회 2013 대한소화기학회지 Vol.62 No.2

목적: 평균수명의 증가에 따른 사회의 고령화와 식생활의 서구화 및 진단기법의 발전으로 우리나라 소화기관의 게실 빈도는 증가하는 추세이며 이에 따른 대장 게실의 임상양상 또한 후천적 영향에 의해 서구화될 것으로 생각된다. 이에 저자들은 대장 게실증을 진단받은 환자를 대상으로 대장 게실증에 영향을 미치는 후천적 인자를 알아보고자 하였다. 대상 및 방법: 2010년 5월부터 2012년 4월까지 인제대학교 서울백병원에서 시행한 대장내시경검사에서 게실이 관찰되었던 사람을 대상으로 하였으며, 설문을 통해 대상군의 나이, 체질량지수, 복부둘레, 운동량, 지방 섭취 정도, 흡연 및 음주의 정도를 조사하여 대장 게실의 임상양상과의 연관성을 알아 보았다. 결과: 연구 대상은 총 200명으로 나이는 54.9±11.9세(범위17-79세)였고 대장 게실증의 남녀비는 2.2:1이었다. 게실의 위치는 우측 대장이 83%였고 게실의 평균수는 4.07±3.9개였다. 게실 위치와 연관성을 보인 인자는 나이였는데 고령일 수록 좌측에 위치하였고(p=0.001), 게실의 수는 허리둘레와 유의한 연관성을 보였으며(partial correlation coefficient r`=0.143, p=0.047), 대장 게실염은 나이가 적을수록 증가하였다(p=0.002). 결론: 대장 게실의 위치는 고령일수록 좌측에 호발하였으며 게실 수는 복부비만과 연관성을 보였다. Background/Aims: The prevalence of colonic diverticulosis in Korea is increasing in conjunction with the adoption of western dietary pattern, extension of lifespan, and advances in diagnostic modalities. The clinical characteristics of colonic diverticulosis seem to be gradually becoming similar to those of Western societies. Therefore, factors associated with the clinical characteristics of colonic diverticulosis in Korea were investigated. Methods: The data of 200 patients diagnosed with colonic diverticulosis using colonoscopy between May 2010 and April 2012 at Inje University Seoul Paik Hospital (Seoul, Korea) were prospectively collected. Clinical parameters acquired through a questionnaire include age, body mass index, waist circumference, exercise, diet, smoking, drinking habits, etc. Correlation between these factors and the clinical features of diverticulosis were analyzed. Results: Mean age of the patients was 54.9±11.9 (range 17-79) years and male to female ratio was 2.2:1. Most diverticula were located on the right side of the colon (83%) and the mean number of diverticulum was 4.07±3.9. Factor associated with the location of diverticulum on the left side was age (p=0.001). There was a positive correlation between the waist circumference and the number of diverticulum (partial correlation coefficient r`=0.143, p=0.047). Diverticulitis occurred more frequently in younger patients than in older patients (p=0.002). Conclusions: Colonic diverticulosis in older patients is found more frequently on the left colon, and the number of diverticulosis is associated with central obesity. (Korean J Gastroenterol 2013; 62:97-103)

급성 ST 분절 상승 심근경색증의 표준진료지침 설계

권선옥,김우식,오명기,나종천,이홍기,조욱현,최석구 인제대학교 2006 仁濟醫學 Vol.27 No.-

The use of critical pathways for a variety of clinical conditions has grown rapidly in recent years, particularly pathways for patients with acute myocardial infarction. We intend to determine the impact of a clinical pathway on ST-elevation myocardial infarction (STEMI) and to evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI) compared with primary PCI. Low risk STEMI patients (ST elevation >0.1mV in more than 2 limb leads or ST elevation >0.2mV in contiguous precordial lead, chest pain lasting more than 30 min without response to nitroglycerin) will be included. All patients will be also treated medically according to critical pathway. STEMI is one of the common diseases in emergency medicine and so it is necessary to establish realistic treatment guidelines. The use of critical pathways will improve the quality of care.

지주막하출혈에 의해 발생한 Takotsubo 심근병증의 1예

김선영,김우식,박종혁,오명기,권선옥,나종천,조욱현,최석구 인제대학교 2007 仁濟醫學 Vol.28 No.-

A 64-years-old man was admitted to emergency department with symptom of chest pain. The characteristic of symptom was squeezing pain at substernal area. The patient had a history of hypertension and diabetes mellitus. His electrocardiogram(ECG) showed ST elevation in lead Ⅰ, Ⅱ, V3-6 and his laboratory results revealed mild increase in cardiac enzymes. And his echocardiogram showed apical hypokinesis. Based on the suspicious symptoms and results for acute anterior myocardial infarction, we decided to take a coronary angiogram for further evaluation. However, coronary angiogram revealed normal epicardial coronary arteries. He was admitted at Intensive Care Unit for monitoring and treatment of heart failure. After 3 days of hospitalization, his mental status was changed. His brain computed tomography revealed subarachnoid hemorrhage. After 5 days, hypokinesis of apex was improved to nearly normal on echocardiogram. This is a case of transient left ventricular apical ballooning or takotsubo cardiomyopathy associated with subarachnoid hemorrhage.

고용량의 염산복용 후 다발성 장기부전으로 사망한 증례 1예

나현희,김상민,김선영,권선옥,박종혁,오명기,고행일 인제대학교 2007 仁濟醫學 Vol.28 No.-

Currently, the corrosive agent ingestion for suicidal purpose caused not only gastrointestinal problems but also death. The corrosive injury caused by alkali or acid agent. The alkali ingestion injures mainly esophagus, and acid ingestion damages mainly the stomach. Then, the acid agent damages the esophagus and stomach simultaneously in spite of quickly passage in esophagus. So, the acid agent caused esophageal ulcer, stricture and necrosis. As well as, in case of large amount acid ingestion, the acid causes fatal course as disseminated intravascular coagulation, myocardial infarction. We report a case of death that large amount acid ingestion cause metabolic acidosis and multiple organ failure.