• 제목/요약/키워드: gastrointestinal time

검색결과 448건 처리시간 0.024초

내시경초음파 세침흡인술을 통한 전이성 미분화육종의 진단 (Diagnosis of Metastatic Undifferentiated Sarcoma by Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA))

  • 김시영;이희승;정문재;박정엽;방승민;박승우;송시영
    • Journal of Digestive Cancer Research
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    • 제5권2호
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    • pp.120-124
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    • 2017
  • A-49-year-old male patient with no specific medical history was admitted to the clinic because of persistent epigastric pain radiating to back for 4 months. He had multiple parenchymal tumors in body and tail of pancreas, para-spinal muscle, and mediastinum on abdomen CT image. Cytologic examination of the pancreas which was done by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) showed adenocarcinoma, whereas histological examination of the para-spinal mass showed undifferentiated sarcoma. Histologic examination of the pancreatic mass was made through endoscopic ultrasound guided fine needle biopsy (EUS-FNB) for accurate diagnosis, and the histologic examination of both the pancreas and posterior mediastinal mass showed the same undifferentiated sarcoma. Therefore, we reviewed the cytopathic tissue obtained from the pancreas for the first time, and it was confirmed to be similar to histologic findings in the mediastinal mass.

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고식적 항암화학요법 후에 Capecitabine 단독치료에 반응을 보인 전이성 대장암 환자 1례 (Response to Capecitabine Treatment Following Palliative Chemotherapy for Metastatic Colorectal Cancer: A Case Report)

  • 박대화;김주석;강선형;문희석;성재규;정현용
    • Journal of Digestive Cancer Research
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    • 제5권1호
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    • pp.66-69
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    • 2017
  • 대장암의 치료에 여러 약물이 사용되지만, 5-FU는 오랫동안 대장암의 항암치료의 근간이 되고 있다. Capecitabine은 경구 복용하는 5-FU의 전구체로서, 최근 전이성 대장암의 치료에 사용이 증가되고 있는 약물이다. 저자들은 전이성 대장암 환자에서 고식적인 항암화학요법으로 1차 치료로서 FOLFOX에 좋은 반응을 보였으나, 부작용으로 중단 후 2차 치료로서 Capecitabine 단독요법만을 시행하였음에도 지속적으로 좋은 반응을 보이며 추적관찰하고 있는 사례를 문헌고찰과 함께 보고하는 바이다.

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Novel Clean End-to-End Anastomosis Method, Without Opening the Stomach Lumen, in Totally Laparoscopic or Robotic Pylorus-Preserving Gastrectomy

  • Takashi Mitsui;Kazuyuki Saito;Yuhei Hakozaki;Yoshiyuki Miwa;Takuji Noro;Emiko Takeshita;Taizen Urahashi;Yasuyuki Seto;Takashi Okuyama;Hideyuki Yoshitomi
    • Journal of Gastric Cancer
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    • 제23권4호
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    • pp.523-534
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    • 2023
  • Purpose: Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility. Materials and Methods: Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG. Results: NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery. Conclusions: NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.

경증과 중등도 간경화 환자에서 장관 비후의 MR 영상: 임상소견과의 비교 (MR Images of Bowel Wall Thickening in Patients with Minimal to Moderate Cirrhosis: Comparison with Clinical Findings)

  • ;;;김미영
    • Investigative Magnetic Resonance Imaging
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    • 제10권2호
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    • pp.81-88
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    • 2006
  • 목적: 경증과 중등도 간경화 환자에서 장관 비후의 MR 영상 소견을 분석하고, 혈액검사 소견과 비교하여 임상적 의미를 알아보고자 한다. 대상과 방법: 경증과 중등도 간경화 환자 123명을 대상으로 MR영상소견을 분석하고 혈액검사 소견과 비교하였다. MR 영상 소견은 장관벽 비후, 우회혈류의 유무, 복수, 비장의 크기를 분석하였다. 이 소견들과 혈청 단백질, 담즙색소 수치, 혈액응고(프로트롬빈) 시간을 비교하였다. 결과: 위장관벽 비후는 25명 환자에서 37개의 위치에서 있었고, 경증 간경화(17%) 보다 중등도 간경화(20%)에서 더 높게 나타났다. 장관벽 비후의 가장 흔한 위치는 공장과 상행결장이었고 각각 22명과 9 명에서 나타났다. 상행 결장의 비후는 경증 간경화 보다 중등도 간경화에서 더 높게 나타났다. 비후된 장관벽은 대칭적이며 T2강조영상에서 고신호강도를 보였고 T1강조영상에서 동등신호강도와 저신호강도가 섞인 신호강도를 나타냈으며 균질하거나 과녁형 조영증강을 보였다. 혈청 단백질은 장관벽 비후가 있는 환자에서 의미있게 낮은 수치를 보였다($3.3{\pm}0.9$ g/dl vs. $3.9{\pm}0.7$ g/dl; p=0.0024). 혈청 담즙색소는 장관벽 비후가 있는 환자에서 의미있게 높은 수치를 보였다($1.7{\pm}1.0$ mg/dl vs. $1.4{\pm}1.2$ mg/dl; p=0.0160). 장관벽 비후는 우회혈류의 유무, 복수, 비장의 크기, 혈액응고 시간의 지연과 의미있는 관계가 없었다. 결론: 경증과 중등도 간경화에서 MR영상 소견은 간경화의 중증도와 혈액검사 소견을 평가하는데 유용하였다.

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국소적으로 진행된, 절제 불가능한 췌장암에서 정위 방사선 치료 (Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy)

  • 최철원;김미숙;조철구;류성렬;양광모;유형준;이동한;지영훈;한철주;김진;김영한
    • Radiation Oncology Journal
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    • 제24권1호
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    • pp.11-20
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    • 2006
  • 목적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 Cyberknife(CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다 또한 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술(bypass surgery) 여부, 방사선량, CAl9-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다. 결과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 $3{\sim}20$개월, 중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80cc 이하인 경우가 80cc 이상인 경우보다 생존율이 높았으며(p-value < 0.05), 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술, CAl9-9 수치, 주위 장기 및 혈관 침범 여부 등에서는 통계적으로 유의한 차이를 보이지 않았다. 다인자 분석에서는 65세 이하인 경우와 PTV 80 co 이하인 경우에서 생존율이 높았다. 결론: 고식적 방사선 치료, 고선량 입체조형 방사선 치료(high dose conformal radiation therapy), 수술 중 방사선 치료(intraoperative radiation therapy) 또는 세기 조절 방사선 치료(Intensity modulated radiation therapy, IMRT)를 이용한 최근의 결과와 비교하여 CK를 이용한 정위 방사선 치료는 생존율 측면에서 비슷하거나 나은 결과를 보였다. 또한 심각한 부작용은 관찰되지 않았으며 짧은 기간의 치료로 환자에게 편의를 제공할 수 있어 결과적으로 삶의 질을 향상시킬 수 있을 것이다. 따라서, 이 새로운 치료 방법은 국소 진행된, 절제 불가능한 췌장암 환자에서 심각한 부작용 없는 효과적인 치료가 될 것으로 생각된다. 또한 계획용 표적 체적은 CK 치료의 유용한 예후 인자로 사용될 것이다.

구충증(鉤蟲症)에 관(關)한 연구(硏究) 제1편(第1篇) 구충(鉤蟲)의 감염(感染) 및 구충성빈혈(鉤蟲性貧血)에 관(關)한 고찰(考奈) (Studies on Ancylostomiasis I. An Experimental Study on Hookworm Infection and Anemia)

  • 이문호;김동집;이장규;서병설;이순형
    • 대한핵의학회지
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    • 제1권1호
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    • pp.55-66
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    • 1967
  • In view of its prevalence in the Far East area, a more detailed knowledge on the hookworm infection is one of the very important medical problems. The present study was aimed to; determine the infectivity of the artificially hatched ancylostoma duodenale larvae in man after its oral administration, evaluate the clinical symptomatology of such infection, determine the date of first appearance of the ova in the stool, calculate the blood loss per worm per day, assess the relation-ships between the ova count, infectivity(worm load), blood loss and severity of anemia. An erythrokinetic study was also done to analyse the characteristics of hookworm anemia by means of $^{59}Fe\;and\;^{51}Cr$. Materials and Methods Ten healthy male volunteers(doctors, medical students and laboratory technicians) with the ages ranging from 21 to 40 years were selected as the experimental materials. They had no history of hookworm infection for preceding several years, and care was taken not to be exposed to reinfection. A baseline study including a through physical examinations and laboratory investigations such as complete blood counts, stool examination and estimation of the serum iron levels was done, and a vermifuge, bephenium hydroxynaphoate, was given 10 days prior to the main experiment. The ancylostoma duodenale filariform larvae were obtained in the following manner; The pure ancylostoma duodenale ova were obtained from the hookworm anemia patients and a modified filter paper method was adopted to harvest larger number of infective larvae, which were washed several times with saline. The actively moving mature larvae were put into the gelatine capsules, 150 in each, and were given to the volunteers in the fasting state with 300ml. of water. The volunteers were previously treated with intramuscular injection of 15mg. of chlorpromazine in order to prevent the eventual nausea and vomiting after the larvae intake. The clinical symptoms and signs mainly of the respiratory and gastrointestinal tracts, appearance of the ova and occult blood in the stool etc. were checked every day for the first 20 days and then twice weekly until the end of the experiment, which usually lasted for about 3 months. Roentgenological survey of the lungs was also done. The hematological changes such as the red blood cell, white blood cell and eosinophil cell counts, hemoglobin content and serum iron levels were studied. The appearance of the ova in the stool was examined by the formalin ether method and the ova were counted in triplicate on two successive days using the Stoll's dilution method. The ferrokinetic data were calculated by the modified Huff's method and the apparent half survival time of the red blood cells by the modified Gray's method. The isotopes were simultaneously tagged and injected intravenously, and then the stool and blood samples were collected as was described by Roche et al., namely, three separate 4-day stool samples with the blood sample drawing before each 4-day stool collection. The radio-activities of the stools ashfied and the blood were separately measured by the pulse-height analyser. The daily blood loss was calculated with the following formula; daily blood loss in $ml.=\frac{cpm/g\;stool{\times}weight\;in\;g\;of\;4-day\;stool}{cpm/ml\;blood{\times}4}$ The average of these three 4-day periods was given as the daily blood loss in each patient. The blood loss per day per worm was calculated by simply dividing the daily blood loss by the number of the hookworm recovered after the vermifuge given twice a week at the termination of the experiment. The iron loss in mg. through the gastrointestinal tract was estimated with the daily iron loss in $mg=\frac{g\;Hgb/100ml{\times}ml\;daily\;blood\;loss{\times}3.40}{100}$ 3.40=mg of iron per g Hgb following formula; Results 1. The respiratory symptoms such as cough and sputum were noted in almost all cases within a week after the infection, which lasted about 2 weeks. The roentgenological findings of the chest were essentially normal. A moderate degree of febril reaction appeared within 2 weeks with a duration of 3 or 4 days. 2. The gastrointestinal symptoms such as nausea, epigastric fullness, abdominal pain and loose bowel appeared in all cases immediately after the larvae intake. 3. The reduction of the red blood cell count was not remarkable, however, the hemoglobin content and especially the serum iron level showed the steady decreases until the end of the experiment. 4. The white blood cells and eosinophil cells, on the contrary, showed increases in parallel and reached peaks in 20 to 30 days after the infection. A small secondary rise was noted in 2 months. 5. The ova first appeared in the stool in 40. 1 days after the infection, ranging from 29 to 51 days, during which the occult blood reaction of the stool became also positive in almost cases. 6. The number of ova recovered per day was 164, 320 on the average, ranging from 89,500 to 253,800. The number of the worm evacuated by vermifuge was in rough correlation with the number of ova recovered. 7. The infectivity of ancylostoma duodenale was 14% on the average, ranging from 7.3 to 20.0%, which is relatively lower than those reported by other workers. 8. The mean fecal blood loss was 5.78ml. per day, with a range of from 2.6 to 11.7ml., and the mean blood loss per worm per day was 0.30ml., with a range of from 0.13 to 0.73ml., which is in rough coincidence with those reported by other authors. There appeared to exist, however, no correlation between the blood loss and the number of ova recovered. 9. The mean fecal iron loss was 2.02mg. per day, with a range of from 1.20 to 3.89mg., which is less than those appeared in the literature. 10. The mean plasma iron disappearance rate was 0.80hr., with a range of from 0.62 to 0.95hr., namely, a slight accerelation. 11. The hookworm anemia appeared to be iron deficiency in origin caused by continuous intestinal blood loss.

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태음조위탕(太陰調胃湯)의 유탕억제효능(遺瘍抑制效能)에 관(關)한 연구(硏究) (A study on the ulcerous inhibitory effects of Taeumchowetang)

  • 박동언;김달래
    • 사상체질의학회지
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    • 제9권2호
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    • pp.227-243
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    • 1997
  • The experimental study used in this paper was done to examine the clinical effects of Taeumchowetang for the gastric ulcer and the function of gastrointestinal tract using rats and mice which were administered orally the water extraction from Taeumchowetang. Then, the counter-action of the water extraction on the isolated ileum and gastric fundus, the inhibitory effects of pylorus-ligated ulcer and indomethacin-induced ulcer, the associations with gastric juice secretion, total acidity, pepsin output, the transportability in the small and large intestine, were studied with administering acetylcholine chloride and barium chloride. In addition, it was investigated whether the central nervous system related to pain control and sleeping time was influenced by Taeumchowetang. The following results have been obtained; 1. As resulting from injection of acetylcholine chloride and barium chloride into the isolated ileum of rats and mice, Taeumchowetang led to have an inhibitory effect on the muscle contraction of the ileum. Then, acetylcholine chloride was measured as lower effect than barium chloride 2. For the inhibitory effect on contraction for the gastric fundus strip in rats by either acetylcholine chloride or barium chloride, the one showed low inhibitory effect, on the other hand the other showed density-dependent effect. 3. The water extraction was given on the pylorus ligated ulcer with using two different administration groups of 1,300mg/kg and 2,600mg/kg, each result was measured as 22.9% and 36.5% for an ulcerous inhibitory effect (p<0.05). 4. According to the two administration groups, the preventive effect was tabulated 18.1% and 29.3% for indomethacin-induced ulcer (p<0.05, P<0.01). 5. For associations with gastric juice secretion, total acidity, pepsin output in the administration group 2,600mg/kg, Taeumchowetang was recognized as having an inhibitory effects related to suppressive actions involving gastric juice secretion(p<0.05), and free acidity(p<0.01), but there was no significant association with total acidity and pepsin output. 6. To know the transportability in the intestine, BaSO4 solution was used. The transportability of the small intestine in the administration group 2,600mg/kg was 22.2% which was statistically significant compared with the large intestine's transportability(P<0.01). 7. In the administration group 1,300mg/kg and 2,600mg/kg, analgesic effect with against acetic acid was measured as being 16.8% and 24.4% which was shown as statistically siginificant(p<0.01). 8. No statistically significant association between Taeumchowetang and sleeping time was found in both 1,300mg/kg and 2,600mg/kg by administering phenobarbital-Na. According to the results of this study, Taeumchowetang has agreed with the effects of literature review. Further more in this study, Taeumchowetang also has preventive effects on pylorus-ligated ulcer. Hence, Teaumchowetang can be significant effect such as both anti ulcer agent and increasing gastric activity for the patients who suffer from gastric ulcer.

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종합검진 수검자의 스트레스 수준과 생활습관, 자각증상 및 임상적 진단의 관련성 (Relationship of Level of Stress, Life Style, Subjective Symptoms and Clinical Diagnosis in Clients taken Multiphasic Screening Program)

  • 박준한;전진호;강장미;손병철;김대환;이창희;정귀원;엄상화
    • Journal of Preventive Medicine and Public Health
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    • 제31권4호
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    • pp.728-739
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    • 1998
  • To improve wellness and quality of life by recognizing the health efforts of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests; electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase$(\gamma-GTP)$, fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was $46.5{\pm}11.2$ years and the mean of body mass index was $24.0{\pm}3.7kg/m^2$. The mean vol of stress was $18.5{\pm}6.0$ expressed as the score out of 40. By general characteristics and lift style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skip-ping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lowe. socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system (p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom$(\gamma=0.476)$ and cardio-vascular symptom$(\gamma=0.361)$ in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom$(\gamma=0.371)$. The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life it would be of value that periodic stress evaluation program and stress management including apropriate control of smoking and drinking, regular exercise and meal.

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일개 종합병원 복강경 위절제술 환자의 표준진료지침 적용효과 (Effects of a Standardized Critical Pathway for Laparoscopic Gastrectomy Patients in a General Hospital)

  • 박효진;박종;류소연;최성우
    • 한국콘텐츠학회논문지
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    • 제16권9호
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    • pp.649-657
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    • 2016
  • 본 연구는 새롭게 개발된 복강경 위절제술의 표준진료지침(Critical pathway, CP) 적용효과를 분석하기 위해 수행되었다. 연구대상은 전라남도에 소재한 C병원 위장관클리닉에서 위암으로 진단받고 복강경 위아전절제술을 시행하고 퇴원한 20세 이상의 성인 환자로, 실험군은 2008년 10월부터 2009년 9월까지 CP를 적용하여 복강경 위아전절제술을 시행한 환자 102명으로 하였고, 대조군은 2007년 9월부터 2008년 9월까지 CP를 적용하지 않고 복강경 위아전절제술을 시행한 환자 63명으로 하였다. 본 연구결과 퇴원시 통증에서는 CP적용군이 비적용군보다 퇴원 당일 통증이 있는 경우가 0.07배 낮았다(Odds ratio [OR], 0.07; 95% Confidence interval [CI], 0.03-0.21). 총 재원일수는 CP적용군에서는 평균(표준오차)은 8.95(1.33)일, 비적용군에서는 평균 10.69(4.04)일로 유의한 차이를 보였고(p<0.001), 수술 후 재원일수 또한 CP적용군이 평균 7.16(0.94)일, 비적용군이 평균 8.79(3.90)일로 통계적으로 유의한 차이(p<0.001)를 보였다. 본 연구 결과 복강경 위절제술에 대한 CP의 적용은 퇴원시 통증감소, 총 재원일수 및 수술 후 재원일수를 단축시키는 효과를 보였다.

인공위액조건과 예열처리에 따른 GM 콩 도입단백질(CP4EPSPS)의 소화성 평가 (In vitro Digestibility Assessment of CP4EPSPS in GM Soybean under Different Conditions of Simulated Gastric Fluid and Preheating)

  • 최미희;김건희
    • 한국식품영양과학회지
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    • 제41권9호
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    • pp.1310-1314
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    • 2012
  • 본 실험은 제초제 내성을 가지는 CP4EPSPS를 도입시킨 유전자재조합 콩을 이용하여 인공위액의 비율에 따른 도입 단백질의 소화특성을 평가하고, 열처리가 유전자재조합 콩의 도입단백질의 소화성에 미치는 영향을 살펴보았다. 유전자재조합 콩과 펩신의 비율에 따른 도입단백질 CP4EPSPS의 소화성은 인공위액 즉 펩신의 양에 따라 차이를 나타내 유전자재조합 식품의 도입단백질에 대한 소화성 평가에서 펩신의 양이 중요한 요인이 됨을 알 수 있었다. 또한 유전자 재조합 콩에 대한 예열처리가 도입단백질 CP4EPSPS의 펩신에 대한 내성을 많이 감소시켜 소화성을 높이는 것으로 나타났다. 따라서 앞으로 유전자재조합식품의 안전성을 평가하는 in vitro 소화평가 시험에서 생리학적 측면에 근거한 인공위액의 비율을 반영함으로써 보다 정확한 도입단백질의 소화성에 대한 평가가 필요하리라 사료되며, 또한 콩의 주요 섭취방법인 열처리에 따른 도입단백질의 소화특성을 평가함으로써 유전자재조합 콩의 안전성에 대한 신뢰도 제고를 위한 기초자료가 될 것으로 기대된다.