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대한내과학회> The Korean Journal of Internal Medicine

The Korean Journal of Internal Medicine update

  • : 대한내과학회
  • : 의약학분야  >  내과학
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  • : SCI
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  • : 1226-3303
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수록범위 : 1권1호(1986)~34권6호(2019) |수록논문 수 : 2,238
The Korean Journal of Internal Medicine
34권6호(2019년 11월) 수록논문
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KCI등재 SCI

1Achalasia: treatment, current status and future advances

저자 : Lee L. Swanström

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1173-1180 (8 pages)

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Achalasia was first described in the 17th century and its treatment continues to be challenging. Palliative treatment involves disruption of the lower esophageal sphincter, which can be accomplished mechanically (balloon dilation or surgical myotomy) or chemically (Botox). True surgical treatment originated some 100 years ago and remained largely unchanged until the advent of thoracoscopic and then laparoscopic myotomy beginning in the 1980s. Because these procedures provided relatively definitive treatment and were well tolerated by patients, minimal invasive surgery assumed a primary role in the treatment algorithms for achalasia. In 2008, an endoscopic (incision-less) myotomy approach, per-oral endoscopic myotomy, was described. This even less invasive approach has rapidly been adopted in the majority of high-volume achalasia centers. Newer interventions, such as stenting and cell transplant, are under active investigation.

KCI등재 SCI

2Optimal blood pressure target and measurement in patients with chronic kidney disease

저자 : Chang Seong Kim , Hong Sang Choi , Eun Hui Bae , Soo Wan Kim , Seong Kwon Ma

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1181-1187 (7 pages)

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The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called “white coat effect” (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.

KCI등재 SCI

3Evaluating the recent developments in palliative chemotherapy for metastatic colorectal cancer

저자 : Sun Kyung Baek , Kyu Taek Lee , Sang Byung Bae , Sang-cheol Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1188-1196 (9 pages)

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The incidence of colorectal cancer (CRC) has increased. CRC is the third most common cancer and the fourth most common cause of cancer-related deaths in Korea. Palliative chemotherapy can be used to shrink tumors and ease symptoms caused by the cancer when cure is not possible. It is important to identify chemotherapeutic agents that can be used to effectively treat metastatic CRC (mCRC) and thus improve the survival and quality of life of patients with mCRC. This review aimed to evaluate the recent developments in palliative chemotherapy for mCRC and the biological or targeted agents used based on genetic alterations.

KCI등재 SCI

4Rheumatic complications in cancer patients treat-ed with immune checkpoint inhibitors

저자 : Kyung-ann Lee , Hae-rim Kim , So Young Yoon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1197-1209 (13 pages)

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Immune checkpoint inhibitors (ICIs) have revolutionized anticancer therapy due to their long-term clinical benefits and immune boosting mechanisms. However, despite their consistent therapeutic effects, the use of ICIs is associated with a spectrum of adverse events due to their autoimmune and auto-inflammatory actions. These adverse events can affect any organ system, including the endocrine, neurologic, gastrointestinal, cardiac, skin, pulmonary, and musculoskeletal systems. Of the immune-related adverse events (irAEs), rheumatic complications are common and appear to be distinct from irAEs in other organs in terms of variability of onset time, capacity for persistence, and relationship with pre-existing autoimmune rheumatologic diseases. In this article, we review the mechanisms of the anti-cancer effects of ICIs, the irAEs of immuno-oncology drugs, and the general recommendations for managing irAEs. In particular, we focus on rheumatologic irAEs and discuss their prevalence, clinical characteristics, and management.

KCI등재 SCI

5Potential prognostic factors for solitary hepatocellular carcinoma ≤ 5 cm after transarterial chemoembolization

저자 : Soon Young Ko , Won Hyeok Choe

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1210-1211 (2 pages)

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KCI등재 SCI

6Reducing chronic obstructive pulmonary disease mortality in Korea: early diagnosis matters

저자 : Yong Il Hwang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1212-1214 (3 pages)

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KCI등재 SCI

7Quality of information on the Internet for Korean patients with inflammatory bowel disease

저자 : Jun Sik Yoon , Sang Jik Lee , Eun Soo Kim , Sung Kook Kim , Min Kyu Jung , Hyun Seok Lee , Yong Hwan Kwon , Su Youn Nam , Seong Woo Jeon , Sun Jin , Joon Seop Lee , Seong Jae Yeo

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1215-1224 (10 pages)

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Background/Aims: The Internet is the main resource for health-related information. The incidence of inflammatory bowel disease (IBD) is rapidly increasing in Asian countries. However, the quality of websites for IBD available in this region has not been evaluated. We aimed to evaluate the quality of the information on IBD obtained from Korean websites.
Methods: Using the terms “Crohn's disease” or “ulcerative colitis,” websites were selected from those obtained with the three most renowned search engines in Korea; 60 websites from the results of each engine were chosen. The websites were classified into institutional, commercial, charitable, supportive, or alternative medicine types according to the characteristics of each site. The websites were evaluated regarding content quality using the validated DISCERN instrument and the Journal of the American Medical Association benchmarks.
Results: The median score of all the websites according to the DISCERN instrument was 32 (interquartile range, 25 to 47) out of 80, indicating an insufficient overall quality of information. The alternative medicine sites scored the lowest, whereas the institutional sites scored the highest (p < 0.05). The quality of information was significantly different among the search engines (p = 0.028). The rank of appearance in the Google search result did not correlate with the quality level of the information.
Conclusions: The quality of information on the Internet regarding IBD varied according to the website type and search engine. Accreditation and quality assurance systems should be implemented for websites to ensure that the public and patients obtain accurate information on IBD.

KCI등재 SCI

8Clinical outcomes of patients with a single hepatocellular carcinoma less than 5 cm treated with transarterial chemoembolization

저자 : Min Young Baek , Jeong-ju Yoo , Soung Won Jeong , Jae Young Jang , Yong Kwon Kim , Shin Ok Jeong , Sae Hwan Lee , Sang Gyune Kim , Sang-woo Cha , Young Seok Kim , Young Deok Cho , Hong Soo Kim , Boo Sung Ki

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1223-1232 (10 pages)

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Background/Aims: Transarterial chemoembolization (TACE) is performed for single hepatocellular carcinoma (HCC) that are not eligible for surgery or ablation therapy. We investigated the clinical outcomes of patients with a single HCC ≤ 5 cm treated with TACE.
Methods: This study analyzed 175 consecutive patients who underwent TACE as an initial treatment for single HCC ≤ 5 cm. Predictive factors for complete response (CR), recurrence after CR, and overall survival (OS) were evaluated.
Results: Total 119 patients (68%) achieved CR after TACE. Tumor size < 3 cm and hepatitis B virus infection were significant predictors of CR (p < 0.05). Recurrent HCC was detected in 73 patients (61.3%) after CR. Age > 65 years and absence of liver cirrhosis were predictive factors for non-recurrence after CR (p < 0.05). The OS for all patients was 80.7 ± 5.6 months, and the 1-, 3-, and 5-year OS rates were 88.1%, 64.8%, and 49.9%, respectively. In multivariate analysis for OS, CR (hazard ratio [HR], 0.467; 95% confidence interval [CI], 0.292 to 0.747) and Child class A (HR, 0.390; 95% CI, 0.243 to 0.626) were significant factors. The OS for the CR and Child class A group were 92 and 93.6 months, respectively, and that of the non-CR and Child B, C group were 53.3 and 50.7 months, respectively (p < 0.001).
Conclusions: TACE can be a valid treatment in patients with a single HCC ≤ 5 cm not suitable for curative treatment, especially in patients with Child class A and CR after TACE.

KCI등재 SCI

9Liver volume index predicts the risk of esophageal variceal hemorrhage in cirrhotic patients on propranolol prophylaxis

저자 : Beom Hee Kim , Jung Wha Chung , Chung Seop Lee , Eun Sun Jang , Sook-hyang Jeong , Nayoung Kim , Jin-wook Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1233-1243 (11 pages)

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Background/Aims: Non-selective β-blockers (NSBBs) are used for primary prevention of esophageal variceal hemorrhage (VH) in patients with portal hypertension, but a significant number of patients develop VH while on NSBB therapy. In this study, we sought to determine whether liver volume can predict the risk of primary prophylaxis failure in cirrhotic patients on NSBB therapy.
Methods: A retrospective cohort of 309 patients on prophylactic propranolol was analyzed. Liver volume was measured in portal venous phase images of multidetector computed tomography. Predictors of VH were assessed using a Cox proportional hazards model with competing-risks analysis. A nomogram was developed for estimation of the risk of primary prophylaxis failure.
Results: During a median follow-up of 36 months, 37 patients on propranolol developed VH. Liver volume index, the ratio of measured-to-expected liver volume, was an independent predictor of VH (adjusted hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.37 to 5.33; p = 0.004) as were the presence of large varices and the absence of ascites. A nomogram-based volume score of > 0.6 was predictive of prophylaxis failure (HR, 7.54; 95% CI, 2.88 to 19.73; p < 0.001). Time-dependent receiver operating characteristic curve analysis revealed that a nomogram-based risk score had significantly better discriminatory power than the North Italian Endoscopy Club index in predicting prophylaxis failure at 6 and 8 years.
Conclusions: Liver volume index is an independent predictor of first VH and a nomogram-based volume score stratifies the VH risk in cirrhotic patients on propranolol prophylaxis.

KCI등재 SCI

10Development of an acute pancreatitis porcine model based on endoscopic retrograde infusion of contrast medium or sodium taurocholate

저자 : Jin-seok Park , Seok Jeong , Joon Mee Kim , Bum Hei Lee , Jae Min Kim , Don Haeng Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 34권 6호 발행 연도 : 2019 페이지 : pp. 1244-1251 (8 pages)

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Background/Aims: A reproducible, endoscope-based, large animal model, of acute pancreatitis was developed to meet the need for a suitable means of preclinically testing treatments. The aim of this study was to develop an endoscope-based animal model of acute pancreatitis.
Methods: This experimental study was conducted on six mini-pigs. The pancreatitis model was induced by infusing contrast medium (CM) or sodium taurocholate (TCA) under high pressure (100 mmHg) into the main pancreatic duct by endoscopic retrograde pancreatography. Animals were randomly allocated to three groups: a CM group, a 10% TCA group, and a 20% TCA group. Pancreatic injuries were evaluated histologically, and serum amylase and lipase levels were measured.
Results: Acute pancreatitis was observed in all animals during hematologic and histologic examinations. Serum amylase and lipase levels were significantly higher (> 10 times baseline), and pancreatic edema, vacuolization of acinar cells, and hemorrhagic necrosis were observed. Severity of pancreatitis tended to be greater in the TCA groups than in the CM group as assessed using histologic scores, and degrees of pancreatitis were found to be dose-dependently related to TCA concentration.
Conclusions: The two endoscopic procedures described are effective and safe for creating a swine model of acute pancreatitis. The authors hope the described endoscopic methods will assist in the development of a suitable treatment strategy.

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