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총담관 확장 원인의 감별진단에서 내시경초음파의 진단적 유용성
염주진,최창수,심미령,조은영,오효정,최석채,김태현,김학철,나용호 대한소화기내시경학회 2005 Clinical Endoscopy Vol.30 No.6
Backgound/Aims: The aim of this study was to assess the diagnostic use of endoscopic ultrasonograpy (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom abdominal ultrasonography or abdominal CT scan could not identify the cause of dilatation. Methods: Thirty-seven patients (23 men, 14 women, mean age 62.2 years) with uncertain causes of CBD dilatation on abdominal sonogram and CT scan between October 1999 and November 2003 were enrolled. All patients were evaluated by EUS and endoscopic retrograde cholangiopancreatography (ERCP). Final diagnosis were determined by ERCP, surgical exploration and clinical follow-up. Results: The following diagnosis were made by EUS: choledocholithiasis in 11 patients, CBD dilatation only in 12, benign stricture of distal CBD in 8, periampullary tumor in 6. The definitive diagnosis of choledocholithiasis (n=11), benign stricture of distal CBD (n=10), ampullary tumor (n= 5) were determined by ERCP with or without sphincterotomy and surgical exploration. EUS provided the accurate explanation for CBD dilatation in 32 of the 37 patients (86%). Conclusions: When the diagnosis of biliary obstruction remains obscure on abdominal sonography or CT scan, EUS may be useful. 목적: 복부초음파나 전산화단층촬영(CT)으로 원인을 밝힐 수 없는 총담관 확장이 있는 환자에서 총담관 확장의 원인 규명에 있어 내시경초음파(EUS)의 진단적 유용성에 대해 알아보고자 하였다. 대상 및 방법: 1999년 10월에서 2003년 12월까지 본원을 방문한 환자 중 복부초음파나 CT에서 원인을 밝힐 수 없는 총담관 확장 소견이 있었던 37명의 환자를 대상으로 하였다. 모든 환자들은 EUS를 시행 받은 후 최종 진단을 위해 내시경역행성 췌담관조영술(ERCP)과 수술 혹은 임상 추적검사를 시행하였다. 결과: 대상 환자는 남자 23명, 여자 14명이었고, 평균 연령은 62.2±16.5세였다. EUS에서 총담관 결석으로 의심된 11예 중 10예는 ERCP에서 총담관 결석이 확인되었고 1명의 환자는 원위부 총담관 양성협착 소견만 보였다. EUS에서 단순 담도 확장만 보였던 12예 중 11예는 단순한 총담관 확장으로, 1예는 총담관 결석으로 확인되었다. EUS에서 원위부 총담관 양성협착 소견을 보였던 8예 중 7예는 ERCP에서도 양성협착 소견만 보였고, 1예는 팽대부 선종이 관찰되었다. EUS에서 팽대부주위 종양소견을 보였던 6명의 환자의 최종 진단은 원위부 총담관 양성협착 2명, 팽대부암 1명, 팽대부 선종 3명이었다. 총담관 확장의 원인 규명에 있어 EUS의 정확도는 86%였다. 결론: EUS는 복부초음파나 복부 CT에서 담도 확장의 원인이 불확실한 경우에 팽대부 주위 질환을 진단하는 데 있어 유용한 검사법으로 생각한다.
풍선 확장술을 시행받았던 식도 이완불능증 환자에서 발생한 식도암
염주진 ( Joo Jin Yeom ),심미령 ( Mi Ryeong Sim ),조은영 ( Eun Young Jo ),최창수 ( Chang Soo Choi ),서검석 ( Geom Seog Seo ),김상욱 ( Sang Wook Kim ),김태현 ( Tae Hyeon Kim ),최석채 ( Suck Chei Choi ),나용호 ( Yong Ho Nah ) 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1
Achalasia is believed to be a predisposing factor for the development of esophageal cancer in achalasia. Esophageal cancer has been reported as a late complication in 3~7% of patients with achalasia. The presumed mechanism responsible for the development of cancer are food stasis and gastroesophageal reflux. We experienced a case of esophageal carcinoma in a 61-year-old woman, who had been diagnosed as achalasia fourteen years ago, and who had undergone pneumatic balloon dilatation. Esophagogram, esophagoscopy with biopsy, esophageal manometry, and chest computerized tomography scanning revealed achalasia and esophageal carcinoma. (Kor J Neurogastr oenter ol Motil 2004;10:72-75)
비마약성 진통제 복용 후 간질성 신염없이 발생된 미세변화 신증후군 1예
이재훈,심혁,염주진,이명수,박병현,오석규,김남호,박무림,안선호,송주흥 대한내과학회 2002 대한내과학회지 Vol.63 No.2
The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin^ for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin^ administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.
심미령,조은영,염주진,김용성,김희식,윤기중,유교상,김태현,최석채,나용호 대한소화기내시경학회 2003 Clinical Endoscopy Vol.27 No.1
Primary gastrointestinal lymphomas originating from the mucosa-associated lymphoid tissue (MALT) have been reported with increasing frequency. The stomach is the most frequent site of MALT lymphoma, and a relationship with Helicobacter pylori infection has been studied. However, primary MALT lymphoma arising from the ampulla of Vater is extremely rare, and its relationship with Helicobacter pylori infection is still obscure. We report here a case of a 71-year-old man with marginal zone B cell lymphoma of MALT with large B cell lymphoma of the ampulla of Vater that was not associated with Helicobacter pylori. A pancreaticoduodenectomy was performed, and the pathologic examination of the resected specimen confirmed the diagnosis. The patient tolerated just one course of systemic chemotherapy, but has been doing well for 18 months after surgery. (Korean J Gastrointest Endosc 2003;27:51-55) 점막연관림프조직 림프종은 주로 위에서 발생하며 Helicobacter pylori (H. pylori) 감염과 연관이 있는 것으로 알려져 있다. 바터 팽대부의 점막연관림프조직 림프종은 국내에서 발생된 보고는 없으며, H. pylori와의 연관성도 불분명하다. 저자들은 황달을 주소로 내원한 71세 남자 환자에서 바터 팽대부에 발생한 종괴를 수술 후 조직 검사와 면역 화학염색을 통해 진단된 대세포 림프종을 포함한 점막연관림프조직 변연대 B세포 림프종(marginal zone B cell lymphoma of MALT with large B cell lymphoma) 1예를 경험하였기에 보고하는 바이다.