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항산화제 투여 후 총 항산화지수 및 사이토카인 변화와 스텐트 재협착에 미치는 영향
윤형근 ( Hyung Geun Yoon ),방덕원 ( Duk Won Bang ),박승훈 ( Seung Hoon Park ),안지훈 ( Ji Hoon Ahn ),서존 ( John Seo ),윤여준 ( Yeo Joon Yoon ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Joo Kwon ) 대한내과학회 2006 대한내과학회지 Vol.71 No.2
Background: Oxidative stress might be a role in atherosclerosis and increased intake of antioxidant appear to be protective and modify neointimal formation. An antioxidant and probucol prevents endothelial dysfunction and low density lipoprotein oxidation and also inhibits the secretion of cytokine by macrophages. We aimed 1) to study the effects of antioxidant (Vitamin C, E and probucol) supplementation on serum level of antioxidant status (TAS), P-selectin, MCP-1, IL-6 and IL-10 and 2) to investigate the effects of antioxidant intake on in-stent restenosis. Methods: Total 90 patients were assigned to control or antioxidant group (probucol; 500 mg, vitamin C; 1,000 mg, vitamin E; 400 mg). We performed follow up coronary angiography in 35 patients of antioxidant group and 36 patients of control group after 6 months of coronary bare metal stent implantation. We counted the stenotic lesions more than 50% of implanted stent lumen as a restenosis by quantitative coronary angiography. The serum levels of total antioxidant status, P-selectin, MCP-1, IL-6 and IL-10 were measured. Results: The serum levels of total antioxidant status was not elevated in antioxidant group. Antioxidant supplementation did not change the serum levels of P-selectin, MCP-1, IL-6 and IL-10. The 6-month angiographic in-stent restenosis rate was 27% versus 30% (p=NS) with an associated late loss of 0.76±1.01 mm versus 0.91±1.00 mm (p=NS) for antioxidant group and control group. The serum levels of total antioxidant status did not correlate with the restenosis or late loss after stent implantation. Conclusions: Vitamin C, E and probucol did not elevate the serum level of antioxidant status and could not prevent in-stent restenosis after bare metal stent implantation.(Korean J Med 71:158-165, 2006)
간외담관암 환자의 금속배액관 선택에서 관강내세경초음파 검사의 역할
윤형근 ( Hyung Geun Yoon ),강지헌 ( Jee Heon Kang ),이은정 ( Eun Jeung Lee ),문종호 ( Jong Ho Moon ),김상균 ( Sang Gyun Kim ),천영국 ( Young Koog Cheon ),김영석 ( Young Seok Kim ),조영덕 ( Young Deok Cho ),이준성 ( Joon Seong L 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6
목적: 수술이 불가능한 간외담관암 환자의 내시경배액술로 이용하는 막부착금속배액관은 종양 내증식은 방지할 수 있으나 과증식이 문제로 남아 있다. 과증식을 방지하기 위해서는 담관암 종축으로의 침범 부위를 정확하게 결정해야 하나 담관조영술은 정확성이 떨어진다. 이에 관강내세경초음파 검사(intraductal US, IDUS)를 시행하여 내시경역행담관 조영술(ERC)과 비교하여 배액술을 위한 금속배액관 선택에 영향을 미치는지 알아보기 위하여 이번 연구를 시행하였다. 대상 및 방법: 조직 생검 또는 세포진 검사로 확진된 수술이 불가능한 간외담관암 환자 17예 (평균 연령: 67.4세, 남자: 12예)를 대상으로 하였으며, 간문부를 침범한 경우는 제외하였다. ERC를 시행하여 담관암 침범 부위를 간측과 십이지장 측으로 나누어서 결정하였으며 동시에 IDUS를 시행하여 ERC의 결과와 비교하였다. 금속배액관은 일차적으로 막부착형 금속배액관을 고려하였으나 ERC 또는 IDUS상 담관암 침범 부위가 간문부에서 2㎝ 이내인 경우에는 막미부착형 금속배액관을 시술하였다. 배액관 길이는 담관협착 부위보다 1㎝ 긴 것을 선택하였다. 결과: 담관암의 간 쪽 침범 부위 결정에서 17예 중 7예(41.2%)에서 ERC가 IDUS에 비해 저평가하였고, 저평가된 길이는 평균 10.6 ㎜였으며, 1예에서는 ERC가 과평가하였다. 담관암의 십이지장 침범부위 결정에서 평가가 가능하였던 16예 중 7예(43.8%)에서 ERC가 IDUS에 비해 저평가하였고 길이는 평균 9.0㎜였다. 막부착금속배액관을 선택하였던 환자 중 3예는 IDUS 시행 후 막미부착금속배액관으로 시술하였다. IDUS 시행으로 17예 중 5예(29.4%)에서 IDUS 시행 후 종류와 길이가 다른 금속배액관을 삽입하였다. 결론: IDUS는 간외담관암의 침범 길이를 결정하는 데 유용하며, 금속배액관 선택에도 영향을 줄 수 있을 것으로 생각한다. Background/Aims: Endoscopic stent insertion with self expandable metal stent (SEMS) is one of the standard palliative treatments for the patients with unresectable bile duct carcinoma. The aim of this study was to determine whether detection of longitudinal spread of extrahepatic bile duct carcinoma by intraductal US (IDUS) would be helpful in the selection of metal stent for the palliative drainage in bile duct carcinoma. Methods: Seventeen patients with histologically proven unresectable extrahepatic bile duct carcinoma who underwent endoscopic retrograde cholangiography with IDUS were included. Longitudinal cancer extension along the bile duct was determined and, then, compared with the cholangiographic image. The type and length of SEMS was selected based on IDUS findings. Results: IDUS demonstrated more extensive tumor spread than ERC in 7 of 17 (41.2%) patients with the hepatic side of strictures and in 7 of 16 (43.8%) patients with the duodenal side of strictures. Five of 17 (29.4%) patients have changed the plan of endoscopic biliary drainage with SEMS after IDUS. There was no early dysfunction associated with endoscopic biliary drainage. Conclusions: IDUS prior to biliary drainage would be useful in demonstrating longitudinal extension of extrahepatic bile duct carcinoma. It has a potential role in helping stent selection and identifying factors which predict early stent dysfunction. (Korean J Gastroenterol 2006;48:415-420)
내시경 시술이 어려운 췌장 가성낭종 환자의 선행 경피배액술 치료 경험 3예
강지헌 ( Jee Heon Kang ),박도현 ( Do Hyun Park ),박상흠 ( Sang Heum Park ),윤형근 ( Hyung Geun Yoon ),이석호 ( Suck Ho Lee ),정일권 ( Il Kwun Chung ),김홍수 ( Hong Soo Kim ),김선주 ( Sun Joo Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.2
Previously reported series suggested that the morbidity rate of internal surgical drainage procedure alone was about 15% and the mortality rate was less than 5% in patients with pancreatic pseudocysts. Recently, ultrasonography or CT-guided percutaneous drainage and endoscopic drainage techniques have created a new dimension of invasive, non-surgical treatment options for these patients. In the absence of prospective, randomized, controlled studies comparing outcomes of different pseudocysts drainage techniques, the decision as to which method should be employed often lies with local expertise and enthusiasm. In our experience, radiologic percutaneous drainage with subsequent transpapillary endosopic drainage had a high success rate and was relatively less difficult which resulted in rapid clinical improvement. We report three cases of pancreatic pseudocysts treated with percutaneous drainage as a first-line treatment followed by endoscopic treatment. (Korean J Gastroenterol 2007;49:100-105)
김민 ( Min Kim ),이혁 ( Hyuk Lee ),허태길 ( Tae Gil Heo ),장선희 ( Sun Hee Chang ),윤형근 ( Hyung Geun Yun ),윤성민 ( Seong Min Yoon ),이혜란 ( Hye Ran Lee ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5
Extramedullary plasmacytomas are uncommon malignant neoplasms that can occur in any organ. They arise most frequently from the upper aerodigestive tract. Lymph nodes are exceedingly rare sites of extramedullary plasmacytomas. Most extramedullary plasmacytomas of the lymph node arise in the cervical lymph nodes. Here, we report a case of an extramedullary plasmacytoma of the lymph node arising from a cervical lymph node. A 43-year-old male patient was admitted to our hospital and presented with a non-tender mass on the left side of his neck, which had been growing slowly for 1 month. The mass was excised. The pathology showed diffuse infiltration of immature plasma cells that were encapsulated by a layer of lymphoid cells, indicating an extramedullary plasmacytoma. He was treated with local radiation of the left cervical area. As of March 2009, he is doing well and shows no further evidence of the disease. (Korean J Med 2013; 84:751-754)
이민우 ( Min Woo Lee ),김태형 ( Tae Hyong Kim ),추은주 ( Eun Joo Choo ),강지헌 ( Jee Heon Kang ),김도환 ( Do Whan Kim ),김동균 ( Dong Kyun Kim ),박상욱 ( Sang Wook Park ),안지훈 ( Ji Hoon An ),윤형근 ( Hyung Geun Yoon ),어성준 ( S 대한내과학회 2006 대한내과학회지 Vol.70 No.6
Background: Necrotizing fasciitis is a life threatening severe soft tissue infection primarily involving the fascia and the subcutaneous tissue with thrombosis of the cutaneous microcirculation. The purpose of the study was to analyze the microbiological and clinical characteristics of necrotizing fasciitis in Korea and to suggest adequate antibiotic therapy. Methods: We retrospectively reviewed medical records of three Soonchunhyang University Hospitals in Seoul, Bucheon and Cheonan. Patients admitted for skin graft or secondary treatment were excluded. Blood cultures were obtained at the time of admission and pus cultures were obtained at the time of first operative debridement. Results: Twenty two patients (16 males, 6 females, 16~82 years old, median age: 59 years old) were enrolled for this study. Fourteen pateints underwent surgical treatment and 2 of them died of necrotizing fasciitis. Gram positive organisms were isolated in 13 cases and gram negative organisms were isolated in 11 cases. Third generation cephalosporin resistant gram negative organisms were isolated in 3 cases. Conclusions: This study suggest that characteristics of necrotizing fascitis in Korea were; high proportion of aged person, predominance of type 2 necrotizing fascitis and increasing tendency of third generation cephalosporin resistant gram negative bacterial infections. Consequently, initial choice of empirical antibiotics for necrotizing fasciitis should consider 3rd generation cephalosporin resistant gram negative organisms. Prompt surgical debridement and adequate antimicrobial therapy are mandatory for improved survival.(Korean J Med 70:681-687, 2006)