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간암 절제술 후 후기 합병증으로 발생한 기관지담관루의 치료 1 예
김영수,이진우,박현신,김인한,이돈행,김범수,김형길,문계혁,김승연,조진경 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2
A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihe-patectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction, BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-hepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.
김영수,최원,김우철,장재남,김인한,김범수,김성기,김형길,이돈행,유종길 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.5
Percutaneous transhepatic biliary catheterization (PTC) has not only been increasingly used in the localization of benign and malignant lesions, but it is also considered rapid, safe and effective method to establish internal and external drainage for decompression of biliary obstructions. Infections and granulomas at the catheter entry site can occasionally develop, but are easily managed. However, such technique, when used both for obtaining malignant cells for diagnosis and for percutaneous decompression of the biliary tract can exposure the patient at risk for dissemination of the tumor along the catheter tract. This rare complication has been observed in a patient who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary tract obstruction. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned.
간외담관암과 이형성 조직에서 p53 , K - ras , Ki - 67 발현의 임상적 의의
김영수,이은상,김영배,이건영,김진영,이진우,신용운,권계숙,이돈행,김범수,김형길,신석환,조현근 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2
Background/Aims: We examined the expression of p53, K-ras, and Ki-67 in extrahepatic bile duct (EHBD) carcinoma, dysplasia, hyperplasia, and normal tissues. Then, their clinical significance was determined. We also investigated if dysplasia and hyperplasia are the precancerous lesion in EHBD carcinoma. Methods: Specimens of 23 patients with surgically resected EHBD carcinoma were classified into normal, hyperplasia, dysplasia, and carcinoma. Then, they were immunostained to examine the expression of p53, K-ras, and Ki-67 antibody. Results: p53 was detected in 46.7% of dysplasia and 66.7% of carcinoma but not in hyperplasia. K-ras was positive in 46.7% of dysplasia and 55.6% of carcinoma but not in hyperplasia. Ki-67 was positive in 18.1% of hyperplasia, 73.3% of dysplasia, and all the carcinoma. None of them was detected in normal tissue. There was no significant correlation between p53 immunoreactivity and gender, histological grade, stage of EHBD carcinoma, and survival. K-ras and Ki-67 immunoreactivity was not associated with gender, age, histological grade, stage of EHBD carcinoma, and survival. Conclusions: These data suggest that p53 and K-ras mutations may have a role in the carcinogenesis of EHBD carcinoma and that dysplasia may be a precancerous lesion of EHBD carcinoma. Ki-67 may be useful in differentiation of carcinoma from dysplasia. There is no prognostic relationship significantly between p53, K-ras, Ki-67 expression, and the clinicopathologic parameters.
김영수,박우상,김인한,김형길,정정환,장재남,유종길,이돈행,김범수 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2
Mucosa-associated lymphoid tissue (MALT) lymphoma of colon usually presents with a solitary lesion of polypoid appearance but may rarely present with multiple polypoid lesions. MALT lymphoma of colon presented as multiple polypoid lesions are not easy to differentiate from multiple lymphomatous polyposis. We experienced a case of MALT lymphoma of colon with a large mass in proximal ascending colon involving ileocecal valve and multiple polypoid lesions in entire colon.
위선암과 파골성 거대세포상 십이지장암이 병발한 원발성 중복암 1 예
김영수,박상준,이준희,신용운,권계숙,이돈행,김범수,김경래,조현근,김형길,김준미,김승연,박현신 대한내과학회 2001 대한내과학회지 Vol.61 No.2
Osteoclast like giant cells (OGCs) are infrequently encountered in a number of malignancies in extraosseous sites, such as the breast, pancreas, liver, stomach, thyroid gland, and other organs. Immunohistochemical stains demonstrate that the OGCs are of monocytic or histiocytic origin and probably represent a distinctive host response to the tumor. The OGCs show strong reactivity with CD68, and no reactivity with cytokeratin or polyclonal antibody to carcinoembryonic antigen (CEA). We experienced a 70 year old man who presented with epigastric pain and weight loss, and found synchronous duodenal carcinoma with OGCs and gastric adenocarcinoma. Histological examination showed an undifferentiated carcinoma with evenly scattered OGCs in the duodenum and liver metastases. OGCs were never seen to undergo mitotic division or exhibit atypia. By immunohistochemistry, neoplastic cells were diffusely positive for vimentin and focally positive for CAM 5.2 (low molecular weight cytokeratin), but OGCs were positive for only vimentin. He underwent palliative gastrojejunostomy for intestinal obstruction due to a large duodenal neoplasm. We report a case of synchronous double primary cancer of gastric adenocarcinoma and duodenal carcinoma with OGCs in a 70 year old man which was proved histopathologically.(Korean J Med 61:156-161, 2001)
김미영,김영수,신용운,권계숙,김범수,문희용,조현근,김대혁 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3
Angiodysplasia is probably responsible for 2.6-6.2% of cases involving of lower gastrointestinal bleeding and 1.2-8.0% of cases involving hemorrhages from the upper GI tract. Small bowel neoplasia is rare, accounting for about 5% of gastrointestinal tumors overall and 2-3% of all malignacies. The third most common malignany of the small bowel is the sarcoma, of which the leiomyosarcoma is the most frequent. A 54-year-old male patient was admitted with the chief complaints of dizziness and headache during 2 months. Laboratory findings revealed iron deficiency anemia. A superior mesenteric arteriography found an intensive vascular stained mass in the hepatic flexure. A celiac artery angiography discovered a irregulary vascular stained lesion in the Ll vertebral level. A colonoscopy located a 10 mm sized angiodysplasia in the right colon. According to these findings, we presumed that these lesions are a colonic angiodysplasia and a suspicious duodenal lesion. The operation was perfomed. The final diagnosis was a colonic angiodysplasia combined with leiomyosarcoma of the duodenum. The rarity of this case is emphasized and the literative reviewed.
Kim, Tae-Hoon,Lee, Kwan Yong,Choi, Young,Park, Ha-Wook,Lee, Young Soo,Koh, Yoon Seok,Park, Hun-Jun,Kim, Pum-Joon,Chang, Kiyuk,Chung, Wook Sung,Kim, Dong-Bin,Her, Sung-Ho,Park, Chul Soo,Lee, Jong Min,K Wolters Kluwer Health, Inc. All rights reserved. 2016 Coronary artery disease Vol.27 No.2
<P>Background Mitral regurgitation (MR) is a frequent complication of left-ventricular dysfunction, with an incidence ranging from 13 to 59% after acute myocardial infarction (AMI), which is associated with poor clinical outcome. The aim of this study was to assess the clinical and angiographic characteristics associated with MR, the incidence and predictors of MR, and the outcomes of MR after AMI in those who were successfully treated with primary percutaneous coronary intervention (PCI) using a drug-eluting stent. Methods We analyzed a multicenter all-comer AMI registry and identified 4748 patients between January 2004 and December 2009. Of these, 1894 patients were treated with PCI using a drug-eluting stent and had MR. The association between MR and the composite of major adverse cardiac and cerebrovascular events (MACCE; all-cause death, recurrent nonfatal myocardial infarction, stroke, and any revascularization) was examined. Results Patients with MR after the index PCI showed significantly higher cumulative incidence of MACCE compared with no-MR patients over the 5-year survival period (P=0.002). When the MR groups were compared on the basis of the severity of MR, ranging from mild to severe grades, a higher grade of MR was found to be associated with a higher incidence of MACCE (P<0.001). Multivariate Cox proportional hazard analysis revealed that no reflow, left-ventricular ejection fraction less than 50%, and anemia, in addition to MR, were consistently associated with increased all-cause death during the 5-year period (adjusted hazard ratio 1.408, 95% confidence interval 1.052-1.884, P=0.021). Conclusion MR after AMI in patients successfully treated with primary PCI was associated with poor long-term outcome regardless of ST-segment elevation at diagnosis during the drug-eluting stent era. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.</P>
간동맥색전술로 치료한 고칼슘혈증을 동반한 경화성 간세포암 1예
김영수,최원,이진우,김인한,이돈행,김범수,김형길,이돈,김선후 대한내과학회 2000 대한내과학회지 Vol.59 No.1
The sclerosing hepatocellular carcinoma is a histopathologically unusual subtype of primary hepatocellular carcinoma characterized by intense fibrous stroma in which the tubular neoplastic structures are embedded. It has been reported that hypercalcemia is much more frequently associated up to 69% in this subtype than in other subtypes of primary hepatocellular carcinoma. As we know, uncontrolled hypercalcemia may result in fatal outcome, and it was reported that hypercalcemia associated with hepatocellular carcinoma could be controlled with the resection of the tumor when it was possible. We report a case of sclerosing hepatocellular carcinoma with hypercalcemia in which the hypercalcemia was controlled with transcatheter arterial chemoembolization (TACE).(Korean J Med 59:104-108, 2000)