폐쇄성 황달로 내원한 담관내 증식을 동반한 간세포암 1예

김승범,김태년,이호찬,박재현,은종렬,장병익,이헌주,윤성수,배영경 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7 -9% The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth A 46-year-o1d woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filhng defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

상부위장관 출혈 원인의 변화 양상

김태년,도병수,김현정,이삼범,정문관 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies were affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by chart and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%)as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), other(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in descending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours for 54.5%, 24 hours for 90.8% and this results were to be like previous results, 57.5% and 90.7 respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seen when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.

급성 출혈성 대장염으로 오인된 궤양성 대장염 1예

문희정,장병익,김승범,이호찬,박재현,은종렬,김태년 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel, Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

Prevalence of clonorchiasis in patients with gastrointestinal disease: a Korean nationwide multicenter survey.

Kim, Ho Gak,Han, Jimin,Kim, Myung-Hwan,Cho, Kyu Hyun,Shin, Im Hee,Kim, Gwang Ha,Kim, Jae Seon,Kim, Jin Bong,Kim, Tae Nyeun,Kim, Tae Hyeon,Kim, Tae Hyo,Kim, Jae Woo,Ryu, Ji Kon,Moon, Young Soo,Moon, Jo WJG Press 2009 World journal of gastroenterology Vol.15 No.1

<P>To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea.</P>

Poster Session : PS 0965 ; The Risk Factors of Gallbladder Polyps in Korean Patients with Chronic Hepatitis B

( Tae Nyeun Kim ),( Jae Hyun Park ),( Kook Hyun Kim ),( Kyeong Ok Kim ),( Si Hyung Lee ),( Byung Ik Jang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Many studies reported a strong association between HBV infection and gallbladder(GB) polyps. This study aimed to identify the prevalence and risk factors associated with the development of GB polyps in patients with chronic hepatitis B(CHB). Methods: Patients (n = 4,168) with CHB diagnosed at Yeungnam University Hospital between January 2010 and December 2013 were analyzed retrospectively. Healthy people (n = 17,526) without CHB who visited at the health promotion center were enrolled as a control group. We compared the clinical, radiological, and laboratory fi ndings between CHB group and the control group. Results: The prevalence of GB polyps was signifi cantly higher in CHB group (11.2% vs. 9.2%, odds ratio [OR], 1.242; 95% confi dence interval [CI], 1.114-1.385; P<0.01). There was no difference in the prevalence of GB polyps according to age, BMI, and total cholesterol level in patients with CHB. The prevalence of GB polyps was higher in male patients with CHB (12.6% vs. 8.9%, p< 0.01). Liver cirrhosis and diabetes increased the risk for GB polyps by 2.718 times (95% CI, 2.187-3.377; P<0.01) and 1.529 times (95% CI, 1.218-1.918; P<0.01), respectively. The severity of the liver function according to the Child-Pugh class carried a signifi cantly greater risk of GB polyps formation [(OR, 4.606 for class C vs. class A, P<0.01) and (2.842 for class B vs. class A, P<0.01), respectively]. Multiple logistic regression analysis showed that diabetes, obesity, and Child-Pugh class were signifi cantly related to the risk of GB polyps formation in patients with CHB. Conclusions: The prevalence of GB polyps in patients with CHB is signifi cantly higher than general population, and the related risk factors in CHB group are diabetes, obesity, and severity of liver function.

Endoscopic Papillary Large Balloon Dilation Combined with Guidewire-Assisted Precut Papillotomy for the Treatment of Choledocholithiasis in Patients with Billroth II Gastrectomy

( Tae Nyeun Kim ),( Si Hyung Lee ) 대한소화기기능성질환·운동학회 2011 Gut and Liver Vol.5 No.2

Background/Aims: Endoscopic extraction of bile duct stones is difficult and often complicated in patients with a Billroth II gastrectomy. We evaluated a simpler technique to achieve an adequate ampullary opening for the removal of choledocholithiasis using endoscopic papillary large balloon dilation (EPLBD) combined with a guidewire-assisted needleknife papillotomy. Methods: Sixteen patients who had a Billroth II gastrectomy were included in this study. Following placement of the guidewire in the bile duct, a precut incision was made over the guidewire with a needle knife sphincterotome inserted alongside the guidewire. Balloon dilation of the ampullary orifice was gradually performed. Results: Needle knife papillotomy over the guidewire with subsequent EPLBD was successful in all patients. Complete stone removal was achieved in 15 (93.7%) patients in 1 session. However, 1 (6.3%) patient required mechanical lithotripsy with an additional procedure for complete ductal clearance, and there was 1 case of minor bleeding following the EPLBD. There were no cases of pancreatitis or perforation. Conclusions: EPLBD followed by guidewire-assisted needle-knife papillotomy appears to be a useful method with few technical diffi culties and a low risk of complications for the removal of bile duct stones in patients with prior Billroth II gastrectomy. (Gut Liver 2011;5:200-203)

문맥압 항진증의 혈역학적 특성

김태년(Tae Nyeun Kim),서정일(Jeong Ill Suh),장병익(Byeong Ik Jang),정문관(Moon Kwan Chung),이현우(Hyun Woo Lee) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Objectives: Hemodynamic measurements of chronic portal hypertension were done to study the mechanisms that maintain high portal pressure despite well developed collateral circulations. Methods: A prehepatic portal hypertensive rat model was produced by partial portal vein ligation. Cardiac output, organ blood flow and porto-systemic shunt were measured by radioisotope labeled microsphere methods, and vascular resistance was calculated by standard equation. Results: There was a significant reduction in the weight of the liver and increase in the weight of the spleen in the portal stenotic rats. Porto-systemic shunting, representing development of the collateral circulations, was 96.7±0.6% in the portal stenosis group compared with 0.9±0.2% in the control group (p<0.01). Portal pressure was significantly increased in the portal stenosis group compared with the control group(12.8±1.4 vs. 6.5±0.6mmHg; p<0.01). Mean arterial pressure was significantly decreased in portal stenosis group compared with control group(101.4±2.5 vs, 129.9±3.9mmHg; p<0.01). In the portal stenosis group, cardiac output(135.7±8.0 vs. 111.0±4.2ml/min; p<0.01) and splanchnic organ blood flow (28.97±2.03 vs. 17.90±1.27ml/min, p<0.01) were significantly increased, with concomitant decrease in total peripheral vascular resistance(58.0±3.3 vs. 88.2±4.8 dyne sec/cm5×105; p<0.01) and splanchnic vascular resistance(2.54±0.20 vs. 5.47±0.33 dyne sec/cm5×105; p<0.01), However, the portal venous resistance was not significantly different in both groups of rats (3.57±0.31 vs. 3.03±0.38 dyne sec/cm5×105; p>0.05). Conclusion: The hemodynamic results of this study indicate that hyperdynamic status of systemic and splanchnic circulation was present in chronic portal hypertension and that the primary factor contributing to the persistently elevated portal venous pressure was the markedly increased portal venous inflow.

증례 : 문맥염 6예의 임상 양상 및 방사선학적 소견

김태동 ( Tae Dong Kim ),김태년 ( Tae Nyeun Kim ),오희주 ( Hee Ju Oh ),김준환 ( Jun Hwan Kim ),이헌주 ( Hun Ju Lee ),박원규 ( Won Kyu Park ),장재천 ( Jae Chun Jang ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

문맥염은 드문 질환으로 증상이 모호하여 조기진단이 어렵고 치료시기를 놓치면 높은 치사율을 보인다. 원인으로는 충수돌기염, 게실염, 감염성 췌장 괴사 등의 복강내 감염과 간경변이나 간암, 위암, 췌장암 같은 악성종양 및 골수증식성 질환, 혈액응고인자 결핍증과 같은 상태에서 이차적인 감염이 일어나서 생기기도 한다. 예후에 빠른 진단과 치료가 중요하여 저자들은 본원에서 경험한 6예를 통해 화농성 문맥 혈전증의 임상양상과 방사선학적 소견을 고찰해 보고자 하였다. 6예의 환자 모두 남자였으며 평균 추적관찰기간은 11개월(5~24개월), 평균연령은 54.3세(38~60세)였다. 문맥염의 추정 원인으로는 2예에서 담도염, 1예에서 급성 충수돌기염, 3예에서는 원인이 불분명하였다. 임상양상은 전예에서 발열과 오한, 우상복부 통증과 압통을 보였다. 일반혈액검사에서 6예에서 백혈구 증다증과 빈혈이 있었으며 3예에서 혈소판 감소를 보였다. 역동적 복부 전산화 단층 촬영상 전예에서 문맥혈전증이 보였으며 이 중 4예에서 상장간막 혈전증이 동반되어 있었다. 2예에서 간농양이, 2예에서 담즙종이 동반되어 나타났다. 문맥혈전증은 조영되지 않는 간내 문맥, 혈관내 저음영의 혈전소견, 간실질의 불균일한 조영증강, 변연부에 비해 중심부의 저음영 소견으로 나타났다. 치료는 6예 모두에서 광범위 항생제를 투여하였고, 그 중 1예에서 항응고요법을 병행하였다. 6예 모두 증상이 호전되었으며 항응고요법을 시행한 예에서 추적관찰시 혈전이 사라지고 간엽의 위축이 없이 회복되어 항응고요법이 문맥염의 호전에 도움이 될 것으로 생각되나 이에 대해서는 향후 더 많은 연구가 필요할 것으로 생각된다. Pylephlebitis, a suppurative thrombophlebitis of the portal venous system, is a rare complication of intra-abdominal sepsis usually followed by infection either in the region draining the portal system or in the structure contiguous to the portal vein. Early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease, so we retrospectively reviewed 6 cases of pylephlebitis. All patients were males with a mean follow-up of 11 months (range 5~24 months). Clinical symptoms consisted of fever (100%), right upper abdominal pain (100%), jaundice (33.3%), and diarrhea (16.6%). Anemia and leukocytosis were found in 6 patients. Suspected etiology was acute cholangitis in 2 patients, acute appendicitis in 1 patient and idiopathic in 3 patients. All patients were successfully diagnosed with dynamic CT scan which showed the presence of portal vein thrombosis (100%), superior mesenteric vein thrombosis (66.6%), liver abscess (33.3%), and biloma (16.6%). Patients were treated with the systemic administration of a broad spectrum antibiotics and 1 patient was given anticoagulant. Initial symptoms were improved in all patients and some beneficial effects of anticoagulation are expected to achieve the recanalization of thrombosis and prevent atrophic changes in the liver, but further studies on the kind of therapy are needed. (Korean J Med 69:S798-S806, 2005)

비공식투자자의 창업기 투자의사결정요소 연구

김태년(Tae-Nyeun Kim),박선영(Sun-Youmg Park),송영화(Yeong-Wha Sawng) 한국콘텐츠학회 2018 한국콘텐츠학회논문지 Vol.18 No.9

창업은 국가 경제성장에 기여하고 고용창출 효과가 크므로 국가는 창업활성화의 다양한 정책들을 추진하고 있다. 그러나 기술창업은 2016년 현재 2013년 대비 오히려 5.0%p 감소하였다. 정부가 추진하는 창업투자활성화는 벤처캐피탈과 엔젤 펀드들을 통해 창업 이후 성장기 또는 주식상장 2~3년 전의 유망한 벤처기업들에 주로 투자되며, 실제적으로 창업기의 투자와는 투자의 시기적 차이가 있고, 이러한 벤처기업에 투자하는 투자의사결정요소에 관한 연구는 많다. 창업활성화는 민간의 창업투자가 활발하도록 환경조성이 필요하며 창업기에 투자하는 민간 투자금의 현금화 가능성과 수익성에 관해 투자자들의 기대에 대한 연구가 필요하다. 창업기에는 창업자, 가족, 친구, 바보들 등의 비공식투자자들에 의해 투자되고 공식투자자들인 벤처캐피탈 및 엔젤펀드 등의 전문투자에 비해 비정형화된 투자의사결정이 이루어지는 것이 일반적이다. 본 연구는 비공식투자자의 특성과 투자의사결정요소, 그리고 투자금의 현금화 가능성 및 투자수익성이 투자의도에 미치는 영향을 분석하는 것으로서, 현금화 가능성은 자영업창업의 투자의도에 매개효과가 있고, 투자수익성은 기업창업의 투자의도에 매개효과가 있는 것으로 분석되었다. The startup, which is a common noun to start a small business, has been recently one of main targets for policymakers due to its important role for job creation and considerable potential for sustainability of an economy. However, technological entrepreneurship decreased by 5.0% p from 2013 to 2016. The revitalization of entrepreneurial investment promoted by the government is mainly supported in fruitable venture companies at grow stage or 2~3 years before IPO through venture capital firms and angel funds. It is far from an investment at start-up. It is therefore necessary to motivate private investment to be active in the private start-up sector. In addition, the start-up investment requires institutional support and government support to meet the expectations of investors about the possibility of payback and profitability of private investment invested in the founding period. As a small entrepreneur at a comparably early stage in the lifecycle of business, investments for the startup are generally made by informal investors such as family, friends and fools, and their decision making processes are relatively non-programmed compared with ones for listed corporales such as venture capital and angel fund agency. This study focuses on analyzing decision making factors in investment, and verifying an impact of such factors, specifically the possibility of investment payback and investment profitability, in a decision-making process for the startup especially at the very early stage.

IMaging and issu : Successful Stone Removal by Endoscopic Retrograde Cholangiopancreatography in Situs Inversus Totalis with Billroth-II Gastrectomy

( Sung Bum Kim ),( Kook Hyun Kim ),( Tae Nyeun Kim ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.1