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인후두 역류가 의심되는 환자에서 이중전극 24시간 식도 pH 검사가 유용한가?
윤창옥 ( Chang Ok Yoon ),이오영 ( Oh Young Lee ),노병주 ( Byung Joo Roh ),전대원 ( Dae Won Jun ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
목적: 이비인후과 외래에서 인후두 역류증이 의심되는 환자를 진단할 때에 쉽게 이용할 수 있는 역류 증상 점수와 현재 가장 정확한 방법으로 알려져 있지만 시행이 어려운 이중전극 24시간 식도 pH 검사와의 연관성을 알아보고 이중전극 24시간 식도 pH 검사의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 인후두 역류증이 의심되는 증상을 주소로 본원 이비인후과 외래를 방문한 46명의 환자들을 대상으로 역류증상 설문조사와 후두경검사와 이중전극 24시간 식도 pH검사 및 상부위내시경을 시행하였다. 역류증상 설문조사를 통하여 증상의 중증도를 조사하였다. 이중전극 24시간 식도 pH검사에서 후두 역류 횟수와 증상의 중증도 간의 연관성을 조사하였다. 결과: 대상 환자들의 평균 나이는 49.4세, 남자 20명, 여자 26명이었다. 주증상으로는 인후두 이물감과 애성이 14명씩으로 가장 많았고 기타 인후통과 기침 등을 호소하였다. 이중전극 24시간 식도 pH 검사에서 인후두 역류가 있는 군과 없는 군간에 증상 점수가 통계적으로 의미있는 차이를 보였다(10.0점 vs 7.0점; p=0.04). 그러나 역류 빈도와 점수의 중증도와는 통계적인 유의성이 없었다. 인후두 역류증의 진단기준을 프로톤 펌프 억제제 복용 후 50%의 증상 호전으로 할 경우 이중전극 24시간 식도 pH 검사의 민감도와 특이도는 각각 59.4%와 33.3% 였다. 결론: 이중전극 24시간 식도 pH 검사의 낮은 민감도 및 검사상의 어려움이 있다. 따라서 인후두 역류증의 진단과 치료시 역류증상 점수(8점 이상)와 후두경 검사상 후두염이 관찰되면 이중전극 24시간 식도 pH 검사의 시행보다 먼저 경험적인 프로톤 펌프 억제제를 사용하여 증상의 호전 유무를 관찰하고 호전이 없는 경우 이중전극 24시간 식도 pH 검사 등을 시행하는 것이 좋을 것으로 생각된다. 또한 이중전극 24시간 식도 pH 검사의 민감도를 높이기 위한 다른 진단기준의 마련이 필요할 것으로 사료된다. Background/Aims: Ambulatory 24-hour dual probe pH monitoring, the reflux symptom index (RSI), and the reflux finding score (RFS) have been developed to standardize the diagnosis of laryngopharyngeal reflux (LPR). The aims of this study were to evaluate the relationship between the RSI and the ambulatory 24-hour dual probe pH monitoring, and we also wanted to investigate the sensitivity of pH monitoring in those patients with suspected LPR who were diagnosed by an empirical trial with proton pump inhibitor (PPI). Methods: Forty six patients suffering with LPR symptoms were examined using the RSI, a laryngoscope and ambulatory 24-hour dual probe pH monitoring. Results: LPR on pH monitoring occurred in 30 of the patients (65.2%) among those patients who were suspected of having LPR, based on the RSI or the RFS. There was a significant difference in the RSI between the patients with reflux and patients without reflux on the pH monitoring. The sensitivity and specificity of pH monitoring were 59.4% and 33.3%, respectively, based on 50% symptom improvement as determined by a trial with PPI. Conclusions: Ambulatory 24-hour dual probe pH monitoring is still useful, but it has a low sensitivity. Therefore, other diagnostic LPR criteria are needed to increase sensitivity of ambulatory 24-hour dual probe pH monitoring. (Kor J Neurogastroenterol Motil 2005;11:117-122)
윤창옥 ( Chang Ok Yoon ),김태환 ( Tae Hwan Kim ),강문수 ( Mun Su Kang ),이정익 ( Jeong Ik Lee ),강태영 ( Tae Young Kang ),김기찬 ( Ki Chan Kim ),이인홍 ( In Hong Lee ),전용철 ( Young Cheol Jun ),정성수 ( Sung Soo Jung ),박용욱 ( Y 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.1
Systemic lupus erythematosus (SLE) is a multisystemic disease that can affect most organ system, although gastrointestinal (GI) manifestations are relatively uncommon. Protein losing enteropathy (PLE) is associated with several clinical disorders, but it is an unusual manifestation of SLE. Of over 20 reported cases of PLE associated with SLE, the pathogenesis of lupus associated PLE remains unclear. We describe a patient with edema, diarrhea, abdomianl pain, and hypoalbuminemia who had been diagnosed SLE. PLE was diagnosed by the method of alpha1-antitrypsin clearance in stool.
신 이식 후 Parvovirus B19 감염에 의한 적혈구무형성증 1 예
이정익(Jeong Ik Lee),강태영(Tae Young Kang),조한표(Han Pyo Cho),윤창옥(Chang Ok Yoon),정청일(Chung Il Jung),이숙진(Sook Jin Lee),강문수(Mun Su Kang),이창화(Chang Hwa Lee),강경원(Kyoung Won Kahng),박찬현(Chan Hyun Park),강종명(Chong M 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts, including organ transplant recipients. We report a case of pure red cell aplasia caused by parvovirus B19 in renal transplants. The patient was 16-year-old male who was diagnosed as chronic renal failure 7 years ago and had been on hemodialysis twice a week. He got renal transplantation in June 1999. But anemia was not improved in first postoperative period. On admission hemoglobin was 43.0 g/L, hematocrit was 12.7%. The bone marrow biopsy revealed severe erythroid hypoplasia with giant pronormoblasts. The pronormoblasts showed prominent intranuclear inclusions, characteristic of parvovirus B19 infection. The parvovirus H19 PCR and anti-parvovirus B19 IgM were positive. The patient was treated with intravenous immunoglobulin and then reticulocyte count was in- creased 5 days later. Hemoglobin level restored to 104 g/L two months later.
변재원(Jai Won Byun),강문수(Mun Su Kang),윤창옥(Chang Ok Yoon),박근태(Geun Tae Park),이오영(Oh Young Lee),윤병철(Byung Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.4
Background: Malnutrition frequently occurs in patients with liver cirrhosis independently for its etiology and can modify prognosis of the disease. Since malnutrition was observed at all clinical stages, but more frequently seen at advanced stages, early and detailed nutritional assessment in all patients with liver cirrhosis is important. The aims of this study are to define the nutritional status and the difference of nutritional index according to etiology and Child classification in patients with liver cirrhosis in Korea. Methods: A total 138 cirrhotic patients (41 alcoholic cirrhosis, 97 virus-related cirrhosis) were studied. The diagnosis of cirrhosis was based on clinical, laboratory and ultrasonographic criteria and liver biopsy. The patients were divided into three groups according to the severity of their liver disease as assessed by the Child-Pugh classification. Nutritional parameter of protein (serum albumin, serum transferrin, total lymphocyte count) were measured. Results: The patients with protein malnutrition are as follows: albumin 55, transferrin 68, total lymphocyte count 8. The frequency of moderate to severe protein malnutrition was high in alcoholic cirrhosis: albumin (<2.9 g/dL) (26.8% vs 17.5%), transferrin (<180 mg/dL) (48.5% vs 24.8%), total lymphocyte count (<1200 number/L) (2.4% vs 2.0%). The mean value of nutritional index correlated with the degree of liver function impairment . (Child C showed the lowest value). Conclusion: In spite of limitation of nutritional index in this study, our study showed that severe protein-energy malnutrition was rare in Korea, and protein-energy malnutrition was not only more common in alcoholic cirrhosis but related to the severity of liver disease. Therefore, our data suggests that clinician should understand the importance of not imposing unnecessary restrictions and supplementation on protein intake for fear of imbalance of nutrition.(Korean J Med 61:384-390, 2001)
하부식도 근육층 비후를 동반한 호두까기 식도 환자에서 발생한 Steakhouse 증후군
양선영 ( Sun Young Yang ),이오영 ( Oh Young Lee ),한성희 ( Sung Hee Han ),전대원 ( Dae Won Jun ),노병주 ( Byoung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
Acute esophageal obstruction caused by the impaction of a large bolus of food has been called the `steakhouse syndrome`. Esophageal stenosis is usually found in adults suffering with steakhouse syndrome, but occasionally the syndrome occurs in the absence of any underlying organic abnormality. A 71-year-old male patient had complained of swallowing difficulty after ingesting meat two days previously. We performed endoscopy and found a meat bolus at 30 cm from the incisors, and we so removed the meat with a basket. No pathologic findings were observed endoscopically after the removal of the esophageal meat bolus. The esophageal manometry showed segmental, high amplitude esophageal pressure at the lower esophagus with normal peristalsis. We performed endoscopic ultrasonography with a high frequency catheter and we found thickening of the lower esophageal muscle layer. This case shows that nutcracker esophagus may be the cause of esophageal foreign body impaction and thickening of muscle layer may be associated with the symptom. (Kor J Neurogastroenterol Motil 2005;11:166-169)
과민성 장 증후군 아형에 따른 구불창자 수용성 적응도의 차이
전대원 ( Dae Won Jun ),이오영 ( Oh Young Lee ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),노병주 ( Byung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
목적: 과민성 장 증후군의 병태 생리에 대해 많은 연구가 이루어져 왔으나 아직도 명확히 규명되어 있지 않다. 최근에는 과민성 장 증후군 환자에서 구불창자의 수용성 적응도(accommodation)에 대한 연구보고가 있지만 아직 연구가 미흡하며, 특히 아형에 따른 수용성 적응도의 차이는 알려져 있지 않다. 방법: 위장 증상이 없는 7명의 건강한 대조군(평균연령 36.7세, 남자 4명, 여자 3명)과 로마 II 기준에 의한 15명의 과민성 장 증후군 환자(평균연령 36.8세, 남자 8명, 여자 7명)를 대상으로 하였다. 구불창자에 풍선을 삽입하고 바로스타트(barostat) 를 이용하여 구불창자의 수용성 적응도를 측정 하였다. 시각상사척도를 이용하여 지난 3개월 동안 증상 정도와 주당 평균 배변 횟수를 측정였다. 결과: 15명의 과민성 장 증후군 환자 중 변비형이 8명(남자 2명, 여자6명), 설사형이 7명(남자 6명, 여자 1명)이었다. 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았다(정상 대조군 1.3 ml/s, 과민성 장 증후군 1.0 ml/s, p=0.024). 구불창자 수용성 조절능은 설사형 과민성 장 증후군 환자에서 보다 낮은 경향을 보였다(정상 대조군 1.3 ml/s, 설사형 과민성 장 증후군 0.9 ml/s, p=0.051). 변비형 과민성 장 증후군 환자의 경우 정상대조군(정상 대조군 1.3 ml/s, 변비형 과민성 장 증후군 1.1 ml/s, p=0.081)에 비해 통계적으로 유의한 차이를 보이지 않았다. 구불창자 수용성 조절능은 환자가 호소하는 소화기 증상과 배변횟수와 직접적인 연관성을 보이지 않았으나, 변비형 과민성 장 증후군 환자에서는 배변 횟수와 연관성을 보이는 경향이 있었다(r=0.7, p=0.052). 결론: 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았으며 특히 설사형 과민성 장 증후군 환자에서 구불창자의 수용성 적응도가 낮았다. Background/Aims: A contentious issue in medicine is whether or not patients with irritable bowel syndrome (IBS) have abnormal motor physiology, and also whether the sensory and motor physiologies are different between the patients suffering with the various subtypes of IBS. Our aim was to investigate if IBS patients have different sigmoid accommodation compared with the normal controls or if the differences exist in sigmoid accommodation according to the IBS subtype. Methods: Fifteen Rome II positive IBS patients and 7 normal controls were recruited for the study. A sigmoid bag catheter was endoscopically placed, and then bag inflation was performed via a barostat. Sigmoid accommodation was measured by using the rapid phasic distention method. Results: In the IBS patients, sigmoid accommodation (1.0 ml/s) was significantly lower than that of the controls (1.3 ml/s). There were no statistically significant differences in sigmoid accommodation according to the IBS subtype, but the IBS patients with predominate symptoms of diarrhea had a tendency for lower sigmoid accommodation (p=0.051). Gastrointestinal symptoms and stool frequency did not seem to have any correlation with sigmoid accommodation. However, for the IBS patients with predominate symptoms of constipation, the stool frequency tended to be associated with the sigmoid accommodation (p=0.052). Conclusions: Sigmoid accommodation was significantly lower in the IBS patients. The results are generally consistent with the finding that the IBS patients with predominate symptoms of diarrhea exhibit a tendency for lower sigmoid accommodation. (Kor J Neurogastroenterol Motil 2005;11:129-134)