조기위암의 형태학적인 분류에 따른 임파절 전이 양상

최은서,강길,박정희,장정환,김권천,김경종,민영돈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Currently, in the limited cases of early gastric cancer (EGC), endoscopic mucosal resection (EMR) is used for curative treatment. However, its completeness is still controversial. The purpose of this study was to review the suggested indications of EMR. We retrospectively analyzed 234 patients with EGC who underwent curative (RO) gastrectomy. The enrolled cases were further classified into mucosal and submucosal types, and mucosal EGC were further classified according to the size, gross type and histologic pattern. 133 patients had mucosal cancers and 101 patients submucosal. The overall incidence of positive lymph node was 14.1% (33/234), the incidence of mucosal cancer was 8. 3% (11/133), which was significantly lower than that of submucosal, 22% (22/101). Of 133 patients with mucosal EGC, 90 were smaller than 2㎝ in size and the incidence of lymph node metastasis was 5.6% (5/90), compared to 43 of larger than 2㎝ with the incidence of 14% (6/43). According to the gross type classification of mucosal cancer, incidence of lymph node metastasis in protruded type (EGC type Ⅰ, Ⅱa, Ⅰ+Ⅱa) was 15.4% (4/26), nat type(EGC type Ⅱb) 2. 9% (1/35), depressed type (EGC type Ⅱc, Ⅲ) 8.3% (6/72). Lymph node metastasis in differentiated type of mucosal cancer was 6.9% (5/72) and undifferentiatcd type 9.8% (6/61). In this study, there was no single indication free from lymph node metastasis, It is thought that the selection of EMR for the curative treatment of EGC should be considered carefully and more clinical studies with long-term follow up are necessary for EMR to be generally acceptable.

고주파 전극도자 절제술로 치료한 부자간에 발생한 Wolff-Parkinson-White 증후군

강보현,김현중,남궁준,김준수,홍경표,박정의,서정돈 대한순환기학회 2002 Korean Circulation Journal Vol.32 No.8

대퇴동맥을 통한 경피적 관동맥 중재시술 환자의 천자부위 지혈을 위한 Angioseal^(�) 사용과 고식적 용수 압박법의 비교 : 전향적 연구

김용훈,권현철,김필호,안석진,유철웅,최진호,이상철,김준수,김덕경,전은석,이상훈,홍경표,박정의,서정돈 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 경피적 관동맥 중재술은 최근 양적 및 질적으로 급격한 발전을 보였지만 시술 시 천자부위의 혈관 합병증은 아직 해결해야 할 문제점이다. 저자들은 대퇴동맥을 통한 경피적 관동맥 중재술을 환자에게 천자부위 지혈을 위한 혈관폐쇄기구인 안지오실의 안전성과 유용성을 고식적인 용수 압박법과 비교 연구하고자 하였다. 방법 : 2002년 4월부터 2003년 5월 사이에 삼성서울병원 심장혈관센터에서 대퇴동맥을 통한 경피적 관동맥 중재술을 성공적으로 시행한 200명의 환자(안지오실 사용군: A군, 100명, 고식적 용수압박법 사용군 B군, 100명)를 대상으로 시술 후 주요 합병증 및 경한 합병증, 지혈 후 환자가 자리에 앉기까지의 시간, 보행개시 가능시간, 총 재원 기간과 시술 1주 후의 합병증을 전향적으로 조사하여 비교 연구하였다. 결론 : 두 군에서 연령, 성별, 기저질환, 심혈관 질환의 위험요소, 시술의 종류, 시술 중 사용한 헤파린의 양, clopidogrel의 양, ticlopidine의 양, 지혈 시 수축기와 확장기혈압, ACT (activated clotting time)는 차이가 없었다. A군이 B군에 비해 시술 후 자리에 앉기까지의 시간 (A군: 4.3±0.3시간, B군: 13.7±0.8시간, p=0.004) 및 보행개시까지의 시간(A군: 6.8±0.5시간, B군: 18.8±2.1시간, p=0.013)이 유의하게 짧았다. 시술 후 주요 합병증은 두군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 A군에서 유의하게 적었다(A군: 28명, B군: 19명, p=0.003). 반상출혈의 경우는 A군에서 유의하게 낮았지만(A군: 3명, B군: 12명, p=0.01), 혈종, 출혈의 발생은 두군간에 차이가 없었다. 총 재원기간에는 두 군간에 차이가 없었다(p=0.239). 시술 1주 후 경과관찰에서 주요합병증은 역시 두 군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 두 군에서 차이가 없었다(A군: 15명, B군: 13명 p=0.418), 반상출혈의 빈도는 차이가 없었지만 혈종의 발생은 A군에서 더 낮았다(A군: 2명, B군:6명, p=0.004). 두 군 모두에서 출혈은 발생하지 않았다. 결론 : 대퇴동맥을 통한 경피적 관동맥 중재술을 시행한 환자에서 안지오실의 사용은 고식적 용수 압박법에 비해 환자의 침상 안정시간을 줄여 조기 활동개시가 가능하게 하였으며 국소합병증의 위험도를 일부 낮추어, 시술에 따른 환자의 불편을 현저하게 감소시킬 수 있다고 할 수 있을 것으로 기대된다. Background : Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly of newly-developed collagen-based arterial closure device, Angioseal after transfemoral percuatenous coronary intervention. Methods : This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; Angioseal group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after procedure by telephone. Results : The baseline clinical characteriwtics, clinical diagnosis, cardiocascular risk factors, typesof procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3±0.3 hours, group B: 13.7±0.8 hours, p=0.004) and the time to ambulation (group A: 6.8±0.5 hours, group B: 18.8±2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A:12%, group B: 3%, p=0.001) The duration of gospital stay was similar between groups. During 7 days of follow-up period incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. Conclusion : The angioseal may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

외상성 간 손상 환자에서 수술적 치료와 비수술적 치료의 안전성 비교

서거정(Geo Jeong Seo),김권천(Kweon Cheon Kim),박정희(Jung Hee Park),김경종(Kyung Jong Kim),장정환(Jeong Hwan Jang),민영돈(Young Don Min),김성환(Seong Hwan Kim) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.64 No.3

Cigarette smoking elevates oxidative stress and plasma Levels of asymmetrical dimethyl-L-arginine (ADMA) in patients with coronary heart disease

( Euy Myoung Jeong ),( Ul Soon Im ),( Min Kyoung Kang ),( Yoon Ho Choi ),( Jeong Euy Park ),( Jeong Don Seo ),( Won Ro Lee ) 대한내과학회 2001 대한내과학회 추계학술대회 Vol.61 No.-

설탕을 첨가한 Polyethylene Glycol 용액의 장정결 효과 및 복용 순응도

서현웅 ( Hyun Woong Seo ),한군희 ( Koon Hee Han ),김성훈 ( Sung Hun Kim ),박종규 ( Jong Kyu Park ),김영돈 ( Young Don Kim ),정우진 ( Woo Jin Jeong ),이상진 ( Sang Jin Lee ),서현일 ( Hyun Il Seo ),송윤아 ( Yun A Song ),최서현 ( Seo 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2

목적: PEG 용액은 안전하고 정결 효과가 우수하여 현재 임상 에서 대장내시경 전처치제로 가장 널리 사용되고 있지만, 특 유의 짠맛으로 환자의 순응도가 낮다는 제한점이 있다. 이번 연구는 이러한 단점을 보완하기 위해 표준 PEG 용액에 설탕 을 첨가하여 복용하도록 한 후 대장 정결 효과 및 환자 순응도 를 표준 PEG 용액을 복용한 군과 비교 분석하고자 하였다. 대상 및 방법: 2012년 1월부터 6월까지 강릉아산병원 소화기 내과에서 대장내시경을 시행받은 총 100명의 환자들에 대해 무작위 전향적 대조 연구를 진행하였다. 대장 정결은 표준 PEG 용액 4L 또는 설탕을 첨가한 PEG 용액 4 L 중 한 가지 로 무작위 배정하였다. 시술자 설문지를 통해 대장 정결도와 내시경의의 검사만족도를 조사하였고, 환자 설문지를 통해 순 응도를 조사하였다. 결과: 두 군 사이에 대장 정결도(4.2±2.0 vs. 4.1±1.5, p=0.783)와 내시경의의 검사만족도(8.2±1.8 vs. 8.5±1.3, p=0.253)는 유의한 차이가 없었으나 환자의 역겨움의 정도 는 설탕첨가 PEG군이 3.9±2.9로 표준 PEG군 6.4±2.3과 비교하여 볼 때 역겨움의 정도가 낮았으며(p<0.05), 같은 방 법으로 재검사하겠다는 응답도 설탕첨가 PEG군이 2.3±0.7 로 표준 PEG군 2.0±0.6보다 높았다(p<0.05). 전처치제를 복용하면서 느낀 주관적 불편감은 두 군 사이에 유의한 차이 가 없었다. 결론: 설탕을 첨가한 PEG 용액은 효과적인 대장내시경 전처 치 방법이며 표준 PEG 용액을 복용할 때 짠맛으로 인해 복용 의 어려움을 호소하는 환자에게 좋은 대안이 될 수 있을 것으 로 기대된다. Background/Aims: Although polyethylene glycol (PEG) solution is commonly used for colonoscopic bowel preparation because of its safety and effectiveness, its salty taste decreases patient`s compliance. The aim of this study was to compare the sugared PEG solution with the standard PEG solution in regard to the quality of bowel preparation and patient`s compliance. Methods: From January through June in 2012, 100 patients who underwent colonoscopy in Gangneung Asan Hospital were prospectively enrolled. They were randomly assigned to receive either standard PEG solution or sugared PEG solution. The quality of bowel preparation was assessed by a doctor`s questionnaire and the patient`s compliance was assessed by a patient`s questionnaire. Results: There was no significant difference in the quality of bowel preparation (4.2±2.0 vs. 4.1±1.5, p=0.783), and endoscopist`s satisfaction score (8.2±1.8 vs. 8.5±1.3, p=0.253) between two groups. However, The degree of disgust was lower in the sugared PEG group than the standard PEG group (6.4±2.3 vs. 3.9±2.9, p=0.000). The willingness to repeat same regimen was higher in the sugared PEG group than the standard PEG group (2.0±0.6 vs. 2.3±0.7, p=0.004). There was no difference in side effects between two groups. Conclusions: The sugared PEG solution as a bowel preparation method revealed a higher patient`s compliance and was effective as the standard PEG solution. When the patient dislike the taste and saltness of the standard PEG solution, the sugared PEG solution will be good alternative method.

Inhibitory Effect of Roasted Astragalus membranaceus with UVB induced Oxidative Stress in HDF cells

Jeong Yong Park(박정용),Ji Yeon Lee(이지연),Hyung Don Kim(김형돈),Gwi Yeong Jang(장귀영),Je Hun Choi(최재훈),Seung Eun Lee(이승은),Kyung Hye Seo(서경혜) 한국약용작물학회 2018 한국약용작물학회 학술대회논문집 Vol.2018 No.2

Is Follow-Up Endoscopy Necessary in Upper Gastrointestinal Cytomegalovirus Disease?

Seo, Myeongsook,Kim, Do Hoon,Gong, Eun Jeong,Ahn, Ji Yong,Lee, Jeong Hoon,Jung, Kee Wook,Choi, Kee Don,Song, Ho June,Lee, Gin Hyug,Jung, Hwoon-Yong,Kim, Jin-Ho,Lee, Sang-Oh,Choi, Sang-Ho,Kim, Yang Soo Wolters Kluwer Health 2016 Medicine Vol.95 No.19

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Gastrointestinal (GI) cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. Diagnosis of GI CMV disease mostly relies on endoscopy examination and histopathologic findings. There are limited data on the need for follow-up endoscopy with histopathologic examination in patients with upper gastrointestinal (UGI) CMV disease. All adult patients with confirmed and probable UGI CMV disease at a tertiary hospital over a 16-year period whose follow-up endoscopy was available were enrolled. The patients were classified as endoscopic responders if they showed complete or partial improvement on follow-up endoscopy, and as endoscopic nonresponders if there was no improvement or worsening. CMV tissue clearance was defined as absence of any visible CMV inclusion bodies, negative CMV immunohistochemistry and negative CMV polymerase chain reaction in follow-up biopsy tissues. During the study period, 77 patients with UGI CMV disease were analyzed. The median time to follow-up endoscopy was 19 days (interquartile range, 14–27). Of these 77 patients, 52 (68%) were classified as responders, and the remaining 25 (32%) as nonresponders. GI bleeding was more common in the nonresponders than the responders (36% vs 12%, respectively; <I>P</I> = 0.02). There was no significant difference in CMV tissue clearance between the responders and nonresponders (56% vs 69%, respectively; <I>P</I> = 0.38), median durations of treatment (20 days vs 21 days, respectively; <I>P</I> = 0.48), and relapse rates (10% vs 8%, respectively; <I>P</I> > 0.99). Multivariate analysis showed that the only independent predictive factor for relapse of CMV antigenemia or CMV GI disease was multiorgan CMV disease (odds ratio = 12.4, 95% confidence interval 1.6–97.9; <I>P</I> = 0.02). Endoscopic responses were obtained in about two-thirds of patients with UGI CMV disease 2 or 3 weeks after antiviral therapy. However, these follow-up endoscopic findings neither reflected CMV tissue clearance nor predicted disease relapse. These findings suggest that the routine follow-up endoscopy may not be warranted in patients with UGI CMV disease.</P></▼2>

SDS-3000 체외충격파쇄석기를 이용한 요석 치료경험 440례

서정빈,서영준,이상돈,정문기 大韓泌尿器科學會 2001 Korean Journal of Urology Vol.42 No.5

심근조명 심초음파를 이용한 심내막하 경색 진단을 위한 심전도 검사의 신뢰도 평가

서정기,박금수,권준,권미영,이돈,양성식,홍의수,이효정,김대혁,조성욱,이우형 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8