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회장말단의 결핵 반흔에 의한 가성 게실의 급성출혈 1예
배서은,정성애,송현주,정지민,김성은,심기남,유권,강민정 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.6
Acquired ileal diverticuli are an uncommon condition and the diagnosis is often difficult when bleeding occurs from this source. Tuberculosis mainly involves the terminal ileum and has associated complications such as obstruction, perforation, stricture and bleeding, but rarely presents with pseudodiverticuli with a fistula. A 42-year-old man presented with massive hematochezia for three days. The patient had a history of pulmonary tuberculosis with complete recovery two times. Emergency sigmoidoscopy, esophagoduodenoscopy and computed tomography of the abdomen could not detect the bleeding focus. The next day, colonoscopy was performed, which demonstrated the opening of pseudodiverticuli at the terminal ileum. There was an exposed vessel in one of the pseudodiverticuli. The patient was treated successfully with epinephrine and ethanol sclerotherapy. A subsequent colonoscopy showed that the exposed vessel was completely healed seven days later. We report a case of acute pseudodiverticular bleeding from a tuberculous scar of the terminal ileum with a review of the relevant literature. 후천성 회장 게실의 출혈은 흔하지 않은 질병으로, 장염, 결핵, 크론병, 궤양성 대장염, 림프종, 거대세포바이러스 감염 등에 의해 드물게 회장 말단에 가성 게실과 누공을 형성할 수 있다. 42세 남자가 다량의 혈변을 주소로 내원하였다. 과거력에서 30년 전과 10년 전에 폐결핵으로 치료 받았고, 20년간 매일 소주 1병을 마시는 음주력이 있었다. 내원 당일 위내시경, S상결장경, 복부전산화 단층촬영을 시행했으나 출혈부위를 찾지 못하였고 다량 혈변이 지속되어 대장정결 후 대장내시경을 다시 시행하였고, 회장 말단에 결핵 반흔으로 보이는 가성 게실이 관찰되었다. 게실 내부에 노출된 혈관에서 활동성 출혈이 있었고 에피네프린과 에탄올로 경화술을 시행하였다. 저자들은 대장내시경을 통해 회장 말단부위에 결핵 반흔에 의한 가성 게실을 확인하고, 게실 내에 활동성 출혈을 보이는 혈관의 노출을 발견하여 내시경적으로 치료한 1예를 문헌고찰과 함께 보고한다.
항혈소판제 단독 혹은 병합요법이 상부위장관 출혈에 미치는 영향
배서은 ( Suh Eun Bae ),김성은 ( Seong Eun Kim ),정성애 ( Sung Ae Jung ),윤소윤 ( So Yoon Yoon ),심기남 ( Ki Nam Shim ),정혜경 ( Hye Kyung Jung ),김태헌 ( Tae Hun Kim ),유권 ( Kwon Yoo ),문일환 ( Il Hwan Moon ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
Background/Aims: The increasing incidence of cardiovascular disease has led to an increase in the frequency of upper gastrointestinal (GI) hemorrhage due to the use of antiplatelet agents. This study examined the clinical characteristics of patients with upper GI hemorrhage who were administered aspirin alone or a combination treatment of antiplatelet agents. Methods: A 656 patients who underwent drug-eluting coronary stenting at Ewha Mokdong Hospital in 2008 were divided into three groups according to the antiplatetlet agents used after the intervention; groups of aspirin alone, aspirin plus clopidogrel, and aspirin, and clopidogrel plus another antiplatelet agent, respectively. Patients admitted with GI hemorrhage in the same period without a medication history of antiplatelet or nonsteroidal anti-inflammatory drugs were used as the control hemorrhage group. The medical records were reviewed. Results: Significant GI symptoms were observed in 21.1% of total patients, of whom 48.2% had ulcers. The upper GI hemorrhage rate was 3.8%. There was no significant difference in the hemorrhage rate between three groups. Compared to the control hemorrhage group, the endoscopic variables of the antiplatelet-related hemorrhage group were not significantly different. However, the Helicobacter pylori infection rate was lower, the admission period was longer, and the mortality rate was higher in the antiplatelet-related hemorrhage group (p<0.05, respectively). There was no direct association between restarting or discontinuance of antiplatelets after the hemorrhage event and mortality. Conclusions: Adding other antiplatelet agents to aspirin did not increase the hemorrhage rate. However, active diagnostic and therapeutic efforts are recommended in patients with GI symptoms during antiplatelet therapy. (Korean J Gastroenterol 2011;57:213-220)
간으로 전이된 소세포암의 면역조직화학적 및 전자현미경 관찰
노선희,정규원,박재정,문일환,배서은,유 권,조민선 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.1
Small cell lung cancer accounts for about 20% of all lung cancers. At the time of diagnosis, the majority of patients already have metastasis. The liver is one of the most common sites of distant metastasis of lung cancer. Small cell lung cancer arises from neuroendocrine cells which produce hormone, hormone producing granules can be seen under electron microscope . A 65-year-old male was admitted to hospital because of jaundice and right upper quadrant pain. The chest roentgenogram and chest computed tomography(CT) scan showed a 3 cm mass in right upper lobe with bilateral mediastinal lymphadenopathy and right pleural effusion. The abdomen CT scan revealed multiple masses in the liver with heterogenous pattern suggesting metastatic orgin. Though the immunohistochemistry and electron miscroscopy, he was diagnosed as metastatic small cell lung cancer of liver. We report a case of the Immunohistochemical and Electron Microscopic Observation of Metastatic Small Cell Lung Cancer of Liver.
간세포암환자에서 간동맥 화학 색전술 후 발생한 리피오돌에 의한 폐렴 1예
김소이,김유리,허현미,배서은,이명원,최윤정,김고흔,김태헌,유 권,문일환 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.2
Hepatocellular carcinoma(HCC)is one of common causes of cancer-related death in Korea where the majority of HCC patients were Hepaitc B virus(HBV)carriers and have cirrhosis. Transarterial chemoembolization(TACE)is commonly applied to the treatment of multinodular HCC in Korea and careful selection of candidate is important for the risk of various side effects. Besides common side effects as fever, nausea, abdominal pain and elevation of liver enzyme, TACE may predispose to hepatic failure, ischemic cholecystitis, pulmonary embolism, cerebral embolism and pneumonitis. In previous studies, some cases of pulmonary and cerebral embolism cases were reported but lipiodol pneumonitis after TACE was rarely reported. A 65-year-old woman with a multinodular HCC associated with HBV infection, was treated with TACE. Seven days after the procedure, nonspecific respiratory symptoms such as dyspnea and dry cough developed. Chest X-ray and chest computed tomography showed diffuse ground glass opacities in whole lung fields, suggestive of lipiodol pneumonitis. After several days of supportive care with steroid administration, radiologic abnormalities and subjective symptoms were much improved, considered that the disease was compatible with lipiodol pneumonitis.
Associations of Serum Lipid Level with Gastric Cancer Risk, Pathology, and Prognosis
피규영,공은정,최지영,김민주,안지용,최재원,배서은,장혜숙,나희경,이정훈,정기욱,김도훈,최기돈,송호준,이진혁,정훈용 대한암학회 2021 Cancer Research and Treatment Vol.53 No.2
Purpose The association of serum lipids with gastric cancer is controversial. We clarified the role of serum lipids in the development, progression, and prognosis of gastric cancer.Materials and Methods In total, 412 patients diagnosed with gastric cancer were prospectively recruited, and 2,934 control subjects who underwent screening endoscopy were enrolled from December 2013 to March 2017 to conduct a case-control study in a tertiary center. Serum lipid profiles, including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), apolipoprotein A-I (apoA-I), and apolipoprotein B, and clinicopathologic characteristics were analyzed.Results The gastric cancer group showed significantly lower HDL-C, higher LDL-C, and lower apoA-I level than the control group. In multivariate analysis, old age (odds ratio [OR], 1.051; p < 0.001), smoking (OR, 1.337; p < 0.001), a family history of gastric cancer (OR, 2.038; p < 0.001), Helicobacter pylori seropositivity (OR, 4.240; p < 0.001), lower HDL-C (OR, 0.712; p=0.020), and higher LDL-C (p=0.002) were significant risk factors for gastric cancer. Lower HDL-C and higher LDL-C remained significant after adjustments for covariates, including age and sex. In a subgroup analysis of the gastric cancer group, lower TG levels were associated with undifferentiated histology. No serum lipids were associated with overall survival.Conclusion Lower HDL-C and higher LDL-C were associated with the risk of gastric cancer, even after adjusting for age, sex, and other factors. In the gastric cancer group, undifferentiated histology was associated with lower TG levels.
박재정 ( Jae Jung Park ),정성애 ( Sung Ae Jung ),노영욱 ( Young Wook Noh ),김고흔 ( Go Heun Kim ),허현미 ( Hyun Mi Heo ),배서은 ( Suh Eun Bae ),최윤정 ( Yun Jung Choi ),김소이 ( So I Kim ),이명원 ( Myung Won Lee ),강민정 ( Min Jun 대한장연구학회 2009 Intestinal Research Vol.7 No.1
Background/Aims: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. Methods: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. Results: Twenty-three patients (7 females and 16 males; average age, 42±14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. Conclusions: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan. (Intest Res 2009;7:47-51)