만성 경화성 종격동염

고원욱 ( Won Ook Ko ),김광하 ( Gwang Ha Kim ),김윤성 ( Yun Seong Kim ),김사웅 ( Sa Woong Kim ),박승근 ( Seung Keun Park ),이동필 ( Dong Pil Lee ),황성윤 ( Sung Yun Hwang ),하태정 ( Tae Jung Ha ),박순규 ( Soon Kew Park ),신영기 ( Y 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.2

근위부 담도암의 임상적 고찰

주형준(Hyung Jun Joo),고원욱(Won Ook Ko),박승근(Seung Keun Park),하태정(Tae Jung Ha),최성호(Sung Ho choi),송철수(Chul Soo Song),송근암(Guen Am Song),조몽(Mong Jo),양웅석(Ung Suk Yang),문한규(Han Kyu Moon) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: Carcinoma of the proximal bile ducts is a rare condition that occurs more frequently in men than in women. The majority of patients present with obstructive jaundice and the main aim of treatment should be to relieve jaundice while at the same time, if possible, removing the tumor. However, even when surgical resection is contraindicated or technically impossible, it should still be possible to achieve satisfactory palliation of jaundice. Methods: We ana]yzed the 72 patients with carcinoma of proximal bile ducts who were admitted to Pusan National University Hospital from January 1982 to December 1993. Results: The mean age of the patients was 69.1 years old and the ratio of male to female was 1.88:1. The clinical manifestations showed jaundice(97%), right upper quadrant pain(31%), pruritus(22%), epigastric pain(19%) and weight loss(117c). Prevalence rate of proximal cholangiocarcinoma according to the level of lesion in proximal bile duct was 71% in Klatskin tumor(Bismuths type I 16%, type II 0%, type III 6%, type IV 49%), 11% in common hepatic duct, 9% in common bile duct(the area in which cystic duct is communicated with common hepatic duct in this article), and 9% in intrahepatic duct (left 3%, right 6%). The Clonorchis sinensis infestation was associated in 50%, which was the most common associated disease with proximal cholangiocarcinoma. The cholangitis was associated in 5k, the sepsis in 15%, the hepatitis B in 117o, and the liver cirrhosis in 10%. The choledocholithiasis was associated in 5%, which consists of the gallstones in 3%, the common bile duct stones in 1%, and intrahepatic duct stones in 1%. The direct invasion of surrounding structures and metastasis were found in 23 cases. Among 23 cases, direct invasion was found in 18 cases, especially liver invasion in 14 cases, and distant metastasis in 4 cases, among which peritoneal metastasis was 2 cases. Staging could be reviewed in 70 cases. Among them, stage I was found in 46 cases(69%), stage III in 3 cases(3%), stage IV in 21 cases(28%), and stage II was not found. Percutaneous transhe- patic biliary drainage(PTBD) was performed in 43 cases (60%) and T-tube insertion in 7 cases (10%). Nothing was performed in 22 cases(30%). Conclusions: A clinical awareness of the manifestation of proximal cholangiocarcinoma will result in early diagnosis and treatment. Even when surgical resection can not be performed, palliation of jaundice should be required for prolonged survival of patients. (Korean J Gastroenterol 1995;27:700-710)

흡연력과 폐기능에 대한 혈중 호중구 , 호산구 및 호산구성 양이온 단백의 관계에 관한 연구

박병규(Byung Kyu Park),김준홍(Jun Hong Kim),고원욱(Won Ook Ko),이준상(Jun Sang Lee),성낙현(Nak Heon Seoung),박승근(Seung Keun Park),박순규(Soon Kew Park),신영기(Young Kee Shin),이인태(In Tae Lee),박정현(Jung Hyun Park),김치학(Chi Hak 대한내과학회 1997 대한내과학회지 Vol.52 No.2

N/A Objectives: A prospective study was performed to find out the correlation between neutrophil, eosinophil and eosinophilic cationic protein (ECP) the granular protein in eosinophil - and smoking history and pulmonary function change, Methods: In this study there were seventy smokers and seventy lifetime nonsmokers. None of them had the history of atopy, or the evidence of parasitic infestation. Smoking history, spirometric pulmonary function test and blood samples for CBC, serum ECP were analyzed. Results: 1) Eosinophil and neutophil count was elevated in the smokers compared with the nonsmokers. 2) Serum ECP was elevated in smokers and the magnitude of this increase was greater than that of eosinophil count. 3) In the smokers, there was a direct proportional correlation between serum ECP and FEV1, but inverse proportional correlation between neutophil count and FEV. 4) In the smokers, neutrophil count was elevated regardless of FEV value. 5) The level of serum ECP well correlated with the daily tobacco consumption but not with the duration of smoking or pack-year consumption. Conclusion: Incresed neutrophil count, decreased eosinophil count and decreased serum ECP level could be useful in the understanding of pathophysiology of lung parenchymal destruction in smokers.

카포시 육종, 주폐포자층 폐렴 등을 동반한 특발성 CD4+ T 림프구감소증 1 예

김준홍,김병진,정영태,고원욱,김사웅,조군제,정주섭,남태수,서경수,성낙현,김부웅 대한내과학회 1996 대한내과학회지 Vol.51 No.4

The recently recognized immunodeficiency syndrome of idiopathic CD4+ T-lymphocytopenia was defined by the Centers for Disease Control and Prevention (CDC) to include depressed numbers of circulating CD4+ T-lymphocytes ($lt;300 cells/㎣ or $lt;20% of total T cells) on more than one occasion, no laboratory evidence of infection with human immunodeficiency virus type 1(HIV-1) or type 2 (HIV-2), and the absence of any defined immunodeficiency or therapy associated with depressed levels of CD4+ T cells. We had experienced one case of Idiopathic CD4+ T-lymphocytopenia without HIV infection, combined with Kaposi's sarcoma and Pneumocystis carinii pneumonia. She had visited to emergency room due to moderate dyspnea and fever for about three months. On physical examination, multiple purple colored mass lesions were detected on lower back, both upper and lower extremities and right tonsillar area. Skin biopsy on mass of right lower extremity revealed Kaposi's sarcoma. On HRCT of the chest, patch bilateral, symmetric reticulonodular infiltration were founded. So, we performed sputum cytology repeatedly, we identified pneumocystis carinii cysts. Idiopathic CD4+ T-lymphocytopenia is rare and represents various clinical and immunologic states. It is perhaps more important to work harder to track the epidemiologic feature of this syndrome closely, to define the associated immune deficits carefully, and to search broadly for the cause. Further epidemiologic, immunologic, and virologic studies will aid in the characterization of this newly recognized condition.

대장결핵의 내시경적 고찰

김주호,양웅석,송근암,조몽,주형준,고원욱,옥창민,박승근,나산균 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.