배변기능이 정상인 성인에서 발생한 융기형 고립성 직장궤양 증후군

한서룡,김규종,문원,박무인,박선자 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

포스터 전시 발표 순서 : 소화기 ; 배변기능이 정상인 성인에서 발생한 융기형 고립성 직장궤양 증후군 1예 (초)

한서룡,김규종,문원,박무인,박선자 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

염증성 장질환 환자에서 결핵균의 검출

한서룡,정민정,장희경 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2

Background and Purpose: It is difficult to make a precise diagnosis of idiopathic inflammatory bowel disease (IBD) and to differentiate it from intestinal tuberculosis(TB). However, early diagnosis of TB is important for correct medical intervention and prevention of spread of the bacteria. The author explored the feasibility of PCR for detection of atypical and typical mycobacterium in formalin-fixed, paraffin-embedded tissues where a definite differentiatial diagnosis ofIBD from TB cannot be made. Material and Methods: DNA was extracted from the paraffin sections of 27 cases of ulcerative colitis, 4 of crohns disease, and 20 of non-specific granulomatous inflammatory lesion(NSGIL). Samples were amplified by duplex PCR with Panmycobacterial primers, ITS-F (5-TGGATCCGACGAAGTCGTAACAAGG-3) and Mycom-2(5-ATGCTCHCAACCACTATCCA-3) andMycobacterium tuberculosis (M.tb)-specific primers, TBF(5-TGGTGGGGCGTAGGCCGTGA-3) and mycom- 2(5- TGGATAGTGGTTGCGAGCAT-3). Results : Mycobacterium tuberculosis were detected in 18 of 27(66.6%) ulcerative colitis, 2 of 4 (50.0%) crohns disease, and 13 of 20 (65.0%) NSGIL. Atypical mycobacterium was not detected in all cases. Conclusion: These data indicate that PCR is reliable for differential diagnosis of IBD from intestinal TB and can be used to increase diagnostic accuracy in patients who had perplexing diagnostic problems associated with IBD.

두 차례 풍선 확장술로 치료하면서 장기간 추적 관찰한 식도 아칼라지아

한서룡 ( Seo Ryong Han ),박무인 ( Moo In Park ),문원 ( Won Moon ),박선자 ( Seon Ja Park ),김규종 ( Gyu Jong Kim ),정규식 ( Gyoo Sik Jung ),김낭희 ( Nang Hee Kim ),김성훈 ( Seong Hun Kim ),남지현 ( Ji Hyeon Nam ),박지은 ( Ji Eun P 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

Achalasia is a motility disorder of the esophagus that`s characterized by the loss of inhibitory neurons in the lower esophagus and lower esophageal sphincter. The primary motility disorders of the esophagus are usually considered to include two disease entities: achalasia and diffuse esophageal spasm. These two conditions are part of a spectrum of related motor disorders. Achalasia can change to diffuse esophageal spasm and show the return of peristalsis after balloon dilatation. We experienced a 64-year-old female patient who complained of dysphagia. Achalasia was diagnosed by performing barium esophagography and esophagogastroduodenoscopy, and by the typical esophageal manometric findings. After performing two sessions of balloon dilatation, the basal lower esophageal sphincter pressure decreased and peristalsis of lower esophagus returned. When the patient again complained of dysphagia, the basal lower esophageal sphincter pressure was increased and peristalsis was not seen. Consequently, we could observe the spectrum and natural course of this disease before and after treatment for achalasia. (Kor J Neuro-gastroenterol Motil 2006;12:177-180)

내시경 지혈 클립술로 치료한 십이지장 게실의 출혈성 Dieulafoy 병변 1예

김낭희,김규종,한서룡,박지은,남지현,김성훈,신은경,김도현,송준영,김성은,문원,박무인,박선자 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.4

A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping. (Korean J Gastrointest Endosc 2007;35:258-261) 십이지장 게실은 제 2부에서 흔하며, 대부분은 무증상이고 일부에서 폐쇄, 출혈, 천공, 황달, 췌장염과 같은 합병증이 발생할 수 있다. 이 중 십이지장 게실에서의 출혈은 드물며, 특히 Dieulafoy 병변이 원인인 경우는 매우 드물어 지금까지 소수의 증례만 보고되고 있다. 최근 내시경과 지혈술의 발달로 내시경적 치료의 성공률이 높으며 지혈 클립술은 게실 내 Dieulafoy 병변의 치료에 있어 타 지혈법에 비해 보다 효과적이며 안전하다고 보고되고 있다. 저자들은 토혈과 흑색변을 주소로 내원한 84세 여자에서 십이지장 게실 내 출혈성 Dieulafoy 병변을 확인한 후 1회의 지혈 클립술로 합병증없이 치료하였음을 보고한다.

위에 발생한 사구종야 1예

박희승,이준호,김우성,이동석,최성호,오영하,최소진,한서룡,이창렬 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.1

It is very important to be aware of occurrence and distinctive histologic features of gastric glomus tumor because its clinical presentation and endoscopic ficdings are indistinguishable from other gastric tumors. A 58-year-old man was admitted because of intermittent epigastric pain and indigestion for 2 months. Physical examination and laboratory findings revealed within normal limits. Upper gastroendoscopy demonstrated a submucosal mass near the antrum with central mucosal depressionand peripheral multiple erosions. Endoscopic ultrasonography revealed a circumscribed mass that continued to the third and fourth layers which demonstrated a heterogeneous low echo pattern mixed with internal high echo spots. Histologically, the tumor cells have uniform small nuclei with inconspicuous nucleoli. Immunochemical analysis on the tumor cells expressed alpha 1 smooth muscle actin and the tumor cells are enveloped by reticulin fiber, individually or grouped. A case of glomus tumor of the stomach is herein reported with a review of literature.

십이지장 용종으로 발견된 발달형 이소성 위 점막의 내시경 절제술 1예

김성훈,박선자,김낭희,남지현,박지은,한서룡,문원,김규종,박무인,정민정 대한소화기내시경학회 2007 Clinical Endoscopy Vol.34 No.3

Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5 1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2007;34:146-150) 이소성 위 점막은 전 장관에서 발생할 수 있다. 십이지장에 발생하는 이소성 위 점막은 선천적인 발달형 이소성 위 점막(heterotopic gastric mucosa)과 후천적인 획득형 이소성 위점막(gastric metaplasia)으로 나누어진다. 이소성 위 점막은 대부분 획득형이며 발달형은 0.5~2.0%에서 발견되는 드문 질환이다. 발달형 이소성 위 점막은 무증상에서부터 자각증상이 있기도 하고 천공, 출혈, 장폐색 등을 유발하기도 하여 내시경적 추적 관찰이 권고되기도 한다. 발달형의 내시경 소견은 대부분 다수의 작은 결절로 관찰되는 융기성 병변으로 보이나 저자들은 무증상의 31세 남자에게서 십이지장에 1.5×1.2 cm의 한 개의 용종성 병변을 발견하여 내시경 절제술 후 발달형 이소성 위 점막으로 진단한 1예를 문헌 고찰과 함께 보고하는 바이다.

점막하종양 형태의 위선암 2예

남지현,박선자,박지은,김낭희,김성훈,한서룡,문원,김규종,박무인,장희경 대한소화기내시경학회 2007 Clinical Endoscopy Vol.34 No.2

위암은 잘 분화된 융기성 종양에서부터 미만성의 침윤성 종양까지 아주 다양한 형태를 보이나 병리학적 진단은 일반적인 내시경 조직 생검을 통해 쉽게 이루어진다. 하지만 정상 점막으로 덮여 있으면서 점막하종양과 유사한 형태를 보이는 경우가 있다. 이런 형태의 위암은 일본에서 모든 절제된 위암의 0.1~0.63% 정도로 아주 드물게 보고된다. 점막하종양 형태 위암의 병리학적 진단은 암세포의 대부분이 정상 점막으로 덮여 있어 반복적인 내시경 조직검사로도 어렵다. 상부소화관내시경검사에서 이런 병변을 보게 된다면 점막하의 암이 노출되는 부분 즉 종양 중앙부에서 한쪽으로 치우쳐 존재하는 함몰, 발적, 백태부착에 주의해야 한다. 저자 등은 통상적 내시경 조직 생검을 통해 진단하고 수술로 치료한 2예의 점막하종양 형태의 위선암을 문헌고찰과 함께 보고하고자 한다. The gastric carcinoma displays various macroscopic appearances ranging from well defined protuberant to diffuse infiltrating tumors but its histological diagnosis is usually simple when performing an endoscopic biopsy. A few gastric cancinomas resemble submucosal tumors (SMT). A gastric carcinoma with a SMT-like appearance is extremely rare, and reportedly accounts for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A histological diagnosis of a SMT-like gastric carcinoma by repeated endoscopic biopsies is often difficult as the tumors are almost entirely covered with normal mucosa. When one sees the lesions in an upper gastrointestinal endoscopy, one should be careful about the location of depression, redness and coating that deviates from the top of the tumor. Here we report two cases of SMT-like gastric carcinomas, diagnosed by the usual endoscopic biopsy method and treated with surgery, with an accompanying review of the recent literature. (Korean J Gastrointest Endosc 2007;34:94-98)

면역기능이 정상인 환자에서의 십이지장 모균증 1예

박희승,이혜진,김우석,최성호,김무영,권태헌,한서룡,이중길 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.4

Mucormycosis is a rare and fulminating opportunistic fungal infection that occurs almost in immunocom-promised patients. It is also a highly virulent and rapidly progressive disease with poor prognosis. Its incidence has been increasing in recent years. We have experienced a case of solitary duodenal mucormycosis in a 45 year-old male patient. Mucormycosis was diagnosed by pathology & culture and he was treated with amphotericin B and discharged with clinical improvement. We report this case with a literature review.

궤양을 동반한 급성 봉소염성 식도염 1예

이준호,박희승,김우성,이동석,최성호,이창렬,최소진,한서룡,정노원 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.2

Phlegmonous esophagitis is an uncommon disease characterized by purulent infection of the esophageal wall, sparing the mucosa. Bacterial infection of the eosphagus is usually presented as a superimposed infection upon a preexisting viral or fungal esophagitis and most victims are immunocompromised hosts. A case was experienced involving an acute phlegmonous esophagitis in an 21-year-old man who was immunologically normal and whose main symptoms were epigastric pain and fever for one day. Esophagographic examination revealed a large ulceration of the eosphagus with exudation, and submucosal lesions. Due to its rarity, this case is herein reported with a review of the corresponding literature.