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권형주,문석배,박귀원,정성은,Kwon, Hyung-Joo,Moon, Suk-Bae,Park, Kwi-Won,Jung, Sung-Eun 대한소아외과학회 2008 소아외과 Vol.14 No.2
Infantile hepatic hemangioendothelioma (IHHE) is the most common benign vascular hepatic tumor in children. We analyzed the 17-year experience of IHHE. The medical records of 16 patients (M:F=8:8) treated at the Department of Pediatric Surgery and the Department of Pediatrics Seoul National University Children's Hospital between January 1991 and January 2008 were reviewed retrospectively. Mean age at presentation was 87 days (1 day - 551 days). Seventy five percent of patients were diagnosed with imaging study and 25 % with biopsy. Major symptoms were hepatomegaly (N=5), palpable abdominal mass (N=4) and congestive heart failure (N=3). Six patients had no symptoms. Kasabach-Merritt syndrome was combined in one patient. Nine patients (56.3 %) underwent operation and 2 patients (12.5 %) underwent only medical treatment. Clinical observation was tried on 5 patients (31.3 %) without any treatment. Operation was performed on the patient with clinical symptoms or on patients where the differentiation between begin and malignant could not be determined. Patients who had clinical symptoms but tumor was unreresectabile were treated medically. Among the 5 patients who had been observed for their clinical course, 2 patients showed complete regression and the tumors of the remaining 3 patients were regressing. Clinical symptoms, the age at presentation, the size of tumor and ${\alpha}$-FP, all had no significant statistical relationship with the time required for complete tumor regression. There was no relationship between the size change of the tumor and the change of ${\alpha}$-FP level. Only the size of tumor was related with clinical symptoms. One patient died of post-operatvie bleeding. Treatment plan was determined by the extent of the tumor and the presence of clinical symptoms. Observation was enough for the patients without clinical symptoms and complete resection was curative for patients with clinical symptoms. Medical treatment is an alternative for the patient whose tumor is unresectable.
김미영,이철호,김영묵,박영우,이동윤,이준상,김진관,이무열,권형주,황인석,유흥선 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6
Behcet's disease is a multisystemic, chronie inflammatory disease with a triad of symptoms including oral ulcers, genital ulcers, and inflammatory ocular lesions. While intestinal Behcet's disease commonly affects the ileocecal region, esophageal ulceration with odynophagia is very uncommon. A 38-year-old male patient was admitted due to odynophagia, a postprandial epigastric burning sensation, and right lower quadrant abdominal pain. He had a history of recurrent oral and genital ulcerations, An esophagogastroduodenoscopy revealed relatively well demarcated ulcerative lesions with mucosal nodiularities on the mid to distal esophagus which was suspected to be esophageal cancer. But repeated biopsies showed lymphocytic and plasma cell infiltrations on the lamina propria. A colonoscopy revealed a well demarcated, deep ulcerative lesion with stenotic narrowing in the ileocecal valve. The diagnosis of intestinal Behcct's disease with an esophageal ulcer was made on the basis of clinical and pathological findings. The patient was treated with steroids and sulfasalazine and the response was favorable.
원발성 십이지장 유암종 (Carcinoid tumor) 1 예
이철호,박영우,유종훈,이정석,이동윤,이준상,이무열,최의혁,홍수희,권형주,김영묵,황순철 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2
Carcinoid tumors are slow growing, rare neoplasms that arise from enterochromaffin cells, with malignant potential. Primary duodenal carcinoid tumors are rare, the reported incidence being 2.0 ∼8.9% of all gastrointestinal carcinoid tumors. Unless the carcinoid syndrome has developed, the non-specificity of the symptoms and physical findings, makes the clinical diagnosis of these tumors difficult. However, with the introduction of large and deep endoscopic biopsies, it is possible to diagnose duodenal carcinoid tumors at an early stage. Usually, local resection is the therapy of choice because of the very slow growth of the lesion and the low incidence of metastasis. Radical surgery is mandatory only in lesions more than 2 cm in diameter, or in the presence of muscular invasion. A 69-year-old female visited our medical department, having had symptoms of upper ab-dominal pain and intermittent melena for 1 week. Endoscopic examination showed 2.5 2.5 cm sized elevated mass lesion with central ulceration in the nterior wall side of the duodenal bulb. Immunohistochemical stains of the biopsy specimen showed that the tumor cells are positive reactivity for NSE (neuron-specific-enolase), chromogranin A, and cyto-keratin.
내장동맥(좌우동맥) 동맥류 파열에 의한 복강내 출혈 1 예
이철호,박영우,유종훈,이정석,이동윤,이준상,이무열,최의혁,홍수희,권형주,김영묵 대한내과학회 1998 대한내과학회지 Vol.55 No.3
Splanchnic artery aneurysms, previously thought to be rare, are being diagnosed with incresed frequency be- cause of development of noninvasive imaging techniques. The pathogenesis of visceral aneurysms is varied and may be secondary to arteriosclerosis(30%), trauma(25%), inflammation(11%), gestational alteration, surgery, infection, medial necrosis, collagen vascular disease, arteritis, and congenital anomalies. Clinical manifestation of visceral artery aneurysms is vague and not specific. The diagnosis and treatmet for them are difficult. Preoperative arteriography may be helpful in emergency situation to detect the aneurysm and visualize multiple aneurysms. Surgical ligation, resection and/or reconstructive surgery are first choice of treatment for them. Otherwise, transarterial embolization has also been reported for them recently. We report a case of hemoperitoneum due to left gastric artery aneurysmal rupture and a rare complication of splanchnic artery aneurysm "Double rupture". The patient was treated successfully with simple ligation of the ruptured vessel.