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담관 감염을 가진 환자에서 담즙배양의 미생물학 및 항균제 감수성에 대한 연구
배원기 ( Won Ki Bae ),문영수 ( Young Soo Moon ),김종훈 ( Jong Hoon Kim ),이석현 ( Seuk Hyun Lee ),김남훈 ( Nam Hoon Kim ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ),엄태현 ( Tae Hyun Um ),조종래 ( Chong Rae Cho ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4
목적: 담관계에서 발생하는 세균 감염은 패혈증을 유발하거나 치명적일 수 있어 즉각적이고 적절한 치료가 필요한 질환이다. 담즙배액과 적절한 항균제의 사용이 담관계 감염의 치료에 있어 매우 중요하다. 이에 이번 연구는 담관계 감염이 발생한 환자에서 시행한 담즙배양을 통해 최근의 담관감염의 원인균 분포 및 항생제 감수성 결과를 알아보고 이를 바탕으로 임상에서 어떤 항생제가 도움이 되는지를 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2007년 2월까지 인제대학교 일산백병원에서 담관계 감염으로 입원한 환자 중 담관배액술과 함께 담즙배양을 시행한 환자 212명을 대상으로 후향 조사하였다. 담즙의 채취는 환자의 상태와 질병에 따라 내시경 경비 담관배액술, 경피경간 담관배액술이나 경피경간 담낭배액술을 통해 시행하였다. 결과: 담즙배양을 실시한 환자 212명 중 152명에서 배양 양성을 보여 71.7%의 배양률을 보였다. 담관염 환자의 경우 163명 중 119명(73.0%), 담낭염 환자의 경우 49명 중 33명(67.3%)에서 배양 양성을 보였다. 간내 담석을 동반한 경우와 팽대부 주위암의 경우에 모든 환자에서 균배양 양성의 결과를 보였다. 배양된 균주를 보면 E. coli가 54예(25.0%)로 가장 많았으며, 다음으로 Enterococcus spp. 29예(13.4%), Klebsiella spp. 24예(11.1%), Pseudomonas spp. 24예(11.1%) 순이었다. 그람음성균에서는 amoxicillin/clavulanic acid, amikacin, imipenem, piperacillin/tazobactam 등이 높은 감수성을 보였다. 담즙배양을 시행한 환자 212명 중 160명에서 혈액 배양을 동시에 시행하였다. 그 중 50명에서 배양 양성을 보여 혈액 배양의 경우 31.2%의 배양 양성률을 보여 담즙배양의 경우보다 낮았으나 배양된 균주는 담즙배양과 큰 차이를 보이지 않았다. 결론: 담관계 감염을 가진 환자에 있어 초기의 경험적 항균제로는 광범위 penicillin/β-lactamase의 합성제제가 추천된다. 하지만 최근에는 Enterococcus spp나 methicillin-resistant Staphylococcus aureus 등과 같은 그람 양성균에 의한 감염이 늘어나고 있음을 고려하여야 한다. 배양을 통해 원인균이 확인되면 균에 맞는 적절한 항균제로 교체하여야 할 것으로 생각한다. Background/Aims: Bacterial infection of biliary tract may cause severe inflammatory response or sepsis. An immediate bile culture and appropriate antibiotic administration are important to control the biliary tract infection. The objective of the study was to identify organisms in bile and the features of antibiotic susceptibility in patients with biliary tract infection. Methods: We retrospectively reviewed the clinical records of 212 patients whose bile had been cultured for variable biliary tract diseases at Inje University Ilsan Paik Hospital from Jan. 2000 to Feb. 2007. Bile samples were obtained from percutaneous transhepatic biliary drainage (PTBD, n=89), percutaneous transhepatic gallbladder drainage (PTGBD, n=14) or endoscopic naso-biliary drainage (ENBD, n=49). Results: The overall positive rate of bile culture was 71.7% (152 cases). The organisms cultured were Escherichia coli (25.0%), Enterococcus spp. (13.4%), Klebsiella spp. (11.1%), Pseudomonas spp. (11.1%), and coagulase-negative Staphylococcus (9.7%) in decreasing order. Effective antibiotics for Gram-negative organisms were amoxicillin/clavulanic acid, amikacin, imipenem, and piperacillin/tazobactam in order of effectiveness. Of the cultured blood samples from 160 patients, fifty (31.2%) showed positive bacterial growth. The organisms isolated from blood were similar to those found in the bile. Conclusions: A broad spectrum penicillin/β-lactamase inhibitor is a recommendable antimicrobial for empirical treatment for biliary tract infection. However, Gram-positive bacteria such as Enterococcus spp. or methicillin-resistant Staphylococcus aureus are emerging as causative microorganisms. If these organisms are isolated, antimicrobial drugs should be replaced by narrower-spectrum antimicrobials. (Korean J Gastroenterol 2008;51:248-254)
고용량 스테로이드로 치유된 Henoch-Schonlein 자반증의 회장 말단부 궤양 1예
최원호 ( Won Ho Choi ),김남훈 ( Nam Hoon Kim ),정은숙 ( Eun Sook Jung ),윤상구 ( Sang Goo Yoon ),박준섭 ( Jun Sup Park ),배원기 ( Won Ki Bae ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ),문영수 ( Young Soo Moon ),김한성 ( Han 대한소화기학회 2007 대한소화기학회지 Vol.50 No.5
Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions upto 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy. (Korean J Gastroenterol 2007;50:324-327)
증례 : 소화기 ; 궤양성 대장염과 동반된 자가면역 간염 1예
이기준 ( Ki Jun Lee ),이준성 ( June Sung Lee ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),김경아 ( Kyung A Kim ),문영수 ( Young Soo Moon ),주미 ( Mee Joo ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
원발경화담관염 환자에서 궤양성 대장염 동반되는 보고는 있으나 자가면역간염 단독으로 궤양성 대장염이 동반되어 발생하는 경우는 국내에서 보고된 바가 없다. 이에 저자들은 자가면역 간염 환자에게서 궤양성 대장염이 동반되어 치료한 경우를 경험하였기에 이를 보고하는 바이다. Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and primary biliary cirrhosis (PBC) are the major immune-mediated chronic liver diseases. They are characterized by circulating autoantibodies, hypergammaglobulinemia, unique clinical features, and associations with other autoimmune diseases, such as inflammatory bowel disease and autoimmune thyroiditis. Primary biliary cirrhosis is known to be associated with inflammatory bowel disease, such as ulcerative colitis. On the other hand, autoimmune hepatitis is rarely associated with ulcerative colitis. Here, we report a case diagnosed as autoimmune hepatitis combined with ulcerative colitis on the basis of histological and endoscopic findings. (Korean J Med 2011;80:S106-S110)
원 저 : 대장내시경 숙련자와 비숙련자 간의 대장회수시간에 따른 선종발견율의 차이
김영두 ( Young Doo Kim ),배원기 ( Won Ki Bae ),최윤호 ( Yun Ho Choi ),좌윤정 ( Yoon Jung Jwa ),정상경 ( Sang Kyung Jung ),이부현 ( Bu Hyun Lee ),백우현 ( Woo Hyun Paik ),김정욱 ( Jong Wook Kim ),김남훈 ( Nam Hoon Kim ),김경아 ( Ky 대한소화기학회 2014 대한소화기학회지 Vol.64 No.5
Background/Aims: Adequate screening colonoscopy in the general population decreases the mortality associated with colorectal cancer through detection and removal of adenomatous polyps. Prolonged colonoscopic withdrawal times (>6 min) are reportedly beneficial for adenoma detection rates (ADRs). However, the quality of the endoscopist compared with colonoscopic withdrawal times is not known. The aims of this study were to investigate the difference in ADRs between trainees and experienced examiners. Methods: A total of 967 consecutive patients who underwent screening colonoscopy in a single University hospital from June 2010 to November 2011 were enrolled in this prospective observational study. Colonoscopy was performed by four experienced staff and seven gastroenterology fellows. Results: Seven gastroenterology fellows performed 633 colonoscopies and four experienced staff performed 334 colonoscopies. The overall detection rates of colorectal adenoma were 31.5% with ADRs of fellows and staff of 29.4% and 35.6%, respectively (p=0.047). Fellows also showed lower advanced ADRs (5.7% vs. 9.9%, p=0.016), and fellows had longer mean withdrawal times than staff (12.4±4.9 min vs. 8.2±4.1 min, p<0.001). Multivariate analysis showed significantly increased ADRs and advanced ADRs for staff compared with fellows (adjusted OR 2.41, 95% CI 1.70-3.43; adjusted OR 2.55, 95% CI 1.47 4.45, respectively). Conclusions: ADRs were significantly lower when colonoscopy was performed by trainees, although withdrawal times were longer than those of staff. Our results demonstrated that the quality of colonoscopy, as measured by ADRs, may be improved by experienced examiners. (Korean J Gastroenterol 2014;64:278-283)
위선종 치료에서 내시경적 점막하 박리술과 비교한 아르곤 플라즈마 응고술의 유용성
이동현 ( Dong Hyun Lee ),배원기 ( Won Ki Bae ),김정욱 ( Jong Wook Kim ),백우현 ( Woo Hyun Paik ),김남훈 ( Nam-hoon Kim ),김경아 ( Kyung-ah Kim ),이준성 ( June Sung Lee ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.5
Background/Aims: To date, the best therapeutic modality for gastric adenoma, especially low-grade adenoma, has not been established. The aim of this study was to assess the usefulness of argon plasma coagulation (APC) in treating gastric adenoma compared with endoscopic submucosal dissection (ESD). Methods: We included 210 patients with gastric adenoma, who underwent treatment with either APC (97 patients) or ESD (113 patients). The clinical and pathologic characteristics, mean duration of hospital stay, complications, and recurrence rates between the two groups were compared. Results: The mean adenoma size was 0.9 cm and 1.1 cm in the APC group and ESD group, respectively (p<0.001). The mean duration of hospital stay was significantly shorter in the APC group than in the ESD group (1.6 days vs. 5.8 days, p<0.001). Complications did not occur in the APC group. However, one case of perforation (0.9%) and 6 cases of bleeding (5.3%) occurred in the ESD group. The recurrence rates were 15.3% (15/97 patients) in the APC group and 3.5% (4/113 patients) in the ESD group (p=0.003). The proportion of hospitalization was less in the APC group (43.3%, 42/97) than in the ESD group (100.0%, 113/113) (p<0.001). Medical expense was less in the APC group (377,172 won) than in the ESD group (1,430,610 won) (p<0.001). Conclusions: The findings of this study suggest that APC is a safe treatment method for gastric adenoma without serious complications. However, regular endoscopic follow-up is necessary to detect any residual or recurrent lesions due to the relatively high rate of local recurrence after APC. (Korean J Gastroenterol 2017;69:283-290)
내시경 역행 췌담관조영술 중 경췌중격절개술 후 발생한 벽내 십이지장 혈종 및 문헌고찰
김정곤 ( Jung Gon Kim ),백우현 ( Woo Hyun Paik ),김재형 ( Jae Hyung Kim ),김정욱 ( Jong Wook Kim ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1
Transpancreatic septotomy is known to improve the success rate of selective bile duct cannulation in endoscopic retrograde cholangiopancreatography. Recent retrospective study reported that transpancreatic septotomy is more effective and safer than needle knife sphincterotomy. Herein, we report a case of patient with gallstone pancreatitis who suffered from intramural duodenal hematoma after transpancreatic septotomy that caused obstruction of the duodenum and hypovolemic shock. The intramural hematoma improved after conservative management. The rare adverse event such as intramural duodenal hematoma seems to be considered after transpancreatic septotomy, especially when acute pancreatitis is accompanied.
C형 간염에 의한 간경변 환자에서 간암 표지자로서 혈청 알파태아단백의 유용성: 간암 발생 이외에 알파태아단백 상승에 영향을 미치는 인자 분석
김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ),정은숙 ( Eun Sook Jung ),김종연 ( Jong Yeon Kim ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),문영수 ( Young Soo Moon ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5
Background/Aims: Serum α-fetoprotein (AFP) is frequently used for the diagnosis of hepatocellular carcinoma (HCC). Most available data concerning AFP came from studies of patients with chronic hepatitis B or mixed etiologies. Studies concerning the diagnostic value of AFP for HCV-related liver cirrhosis (LC) are limited. We evaluated the factors influencing AFP elevation in the absence of HCC and analyzed the diagnostic value of serum AFP in HCC surveillance of HCV-related LC patients. Methods: We enrolled 55 patients of HCV-related LC with HCC and 62 patients without HCC as a case-control study were analyzed. The sensitivity and specificity were calculated and the clinical and biochemical factors influencing serum AFP levels. Results: The sensitivities and specificities of serum AFP for the detection of HCC in HCV-related LC were 72.7% and 59.7% for AFP≥20 ng/㎖, and 47.3% and 92.5% for AFP≥100ng/㎖, respectively. Elevated serum AST was independently associated with elevated serum AFP level in HCV-related LC. In cases of AST≤2×upper limit of normal (ULN), the specificity of AFP≥100 ng/㎖ for the diagnosis of HCC was 100%. However, in case of AST>2×ULN, the specificity was 85.0% for AFP≥100 ng/㎖ and 95.0% for AFP≥200 ng/㎖. Conclusions: Serum AST levels influence serum AFP level in HCV-related LC. In cases of AST≤2×ULN, AFP greater than 100 ng/㎖ highly indicates HCC in HCV-related LC, but not in case of AST>2×ULN. (Korean J Gastroenterol2006;48:321-326)