총담관췌관-십이지장 누공 1예

오흥영,김진배,백일현,백광호,이진헌,김종혁,이진,이명석 대한소화기학회 2004 대한소화기학회 추계학술대회 Vol.2004 No.-

소화성 궤양 출혈에서 내시경적 분말 산포제의 효과

백일현,오흥영,백광호,한태호,김진배,이진,이명석 대한소화기내시경학회 2004 Clinical Endoscopy Vol.29 No.6

Background/Aims: Peptic ulcer bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, techinical difficulties and significant rebleeding rate after such endoscopic hemostasis, offer some beneficial effect of Alto ShooterTM as an adjuvant therapy in active peptic ulcer bleeding. Methods: Twenty-three patients with active peptic ulcer bleeding were randomized to Alto ShooterTM & argon plasma coagulation therapy (ALTO APC) or argon plasma coagulation therapy alone (APC). Forrest classifications were used to compare the effect of bleeding control. Results: The Forrest classifications in two groups before treatment were Ib (6 patients), IIa (11 patients) in "ALTO APC", Ib (2 patients) and IIa (4 patients) in "APC". The Forrest classifications of two groups at follow-up endoscopy were Ia (1 patient), Ib (1 patient), IIc (14 patients), III (1 patient) in "ALTO APC" and IIc (6 patients) in "APC". There was no significant difference in hemostatic effect between "ALTO APC" (p=0.001) and "APC" (p=0.001) groups. Conclusions: Alto ShooterTM offers no advantage over conventional endoscopic argon plasma coagulation therapy in controlling active peptic ulcer bleeding. Therefore routine addition of Alto ShooterTM treatment may not be recommended after initial successful endoscopic argon plasma coagulation therapy in active peptic ulcer bleeding. 목적: 상부위장관 출혈의 가장 흔한 원인인 소화성 궤양 출혈은 대부분 자연 지혈되지만, 지혈되지 않는 경우 내시경적 지혈법을 일차적 치료 방법으로 이용하고 있다. 위장관 출혈의 내시경적 지혈 요법은 국소도포법, 국소주입법, 기계적 지혈법 및 열요법 등이 있으며 내시경적 지혈 치료 후 재출혈의 발생 가능성은 여전히 상존하고 있다. 이에 저자들은 활동성 궤양성 출혈에서 통상적인 아르곤 플라스마 응고소작법에 sodium alginate 분말을 내시경적으로 병변에 직접 산포하여 지혈효과를 내는 Alto ShooterTM (Kaigen Co. Ltd., Osaka, Japan)를 추가적으로 시술하였을 때 아르곤 플라스마 응고소작법의 지혈 효과를 더 높일 수 있는지 알아보았다. 대상 및 방법: 2004년 4월부터 2004년 11월까지 한림대학교 강남성심병원에서 상부소화관 내시경 검사에서 활동성 소화성 궤양 출혈로 진단된 환자 23명을 대상으로 하였다. 치료내시경 시 Alto ShooterTM를 아르곤 플라스마 응고소작법에 추가적으로 사용한 “ALTO+APC군”은 17명, Alto ShooterTM 치료 없이 아르곤 플라스마 응고소작법만을 시행한 “APC군”은 6명이었다. 치료 전후의 효과를 비교하기 위해 출혈 병변의 내시경적 소견을 Forrest 분류법에 따라 분류하였다. 결과: 치료 전 2군의 Forrest 분류는 “ALTO+APC”군은 Ib 6명, IIa 11명, “APC”군은 Ib 2명, IIa 4명이었다. 치료 후 Forrest 분류는 “ALTO+APC”군은 Ia 1명, Ib 1명, IIc 14명, III 1명, “APC”군은 IIc 6명이었다. 치료 전후의 출혈 상태 정도를 비교하였을 때 “ALTO+APC”군에서 p=0.001, “APC”군에서 p=0.001로 Alto ShooterTM를 아르곤 플라스마 응고소작법에 추가적으로 사용하여도 아르곤 플라스마 응고소작법만을 사용한 환자군에 비해 유의한 부가적인 지혈 효과가 없었다. 결론: 활동성 소화성 궤양 출혈에서 Alto ShooterTM의 추가적인 시술은 아르곤 플라스마 응고소작법 단독 치료에 비해 유의한 부가적인 지혈 효과가 없었다.

대장암으로 오인된 허혈성 대장염 1예

최치훈,백일현,오흥영,백광호,김진배,이명석 대한소화기내시경학회 2004 Clinical Endoscopy Vol.29 No.1

Ischemic colitis is the most common vascular disorder of intestines, and usually affects older patients. Many predisposing conditions have been implicated in the pathogenesis of colonic ischemia, although many occurrences are spontaneous in nature. Ischemic colitis can induce a wide spectrum of radiological or endoscopic features, depending on the site, extend, and timing of its onset. The coexistence of colonic ischemia with carcinoma of large bowel is well documented. However It is less well recognized that a localized segment of ischemic colon can mimic a carcinoma. Here, we report a case of ischemic colitis mimicking colon cancer in a 66 year-old man. 허혈성 대장염은 주로 고령층에서 호발하며 대개 복부 통증과 혈변을 주소로 내원한다. 허혈성 대장염의 진단은 임상증상과 더불어 방사선학 소견과 내시경 소견 등을 토대로 한다. 그러나 내시경 소견 및 병리조직학적 양상이 허혈성 손상의 정도와 기간에 따라 다양하기 때문에 정확한 진단을 하기 어려운 경우가 있다. 대장암을 동반한 허혈성 대장염에 대한 증례는 간헐적으로 보고되고 있으나 대장을 거의 폐쇄할 정도의 종괴처럼 보이는 허혈성 대장염은 그 증례가 드문 것으로 되어 있다. 저자들은 66세 고령환자의 대장내시경 검사에서 하행결장을 거의 폐쇄할 정도의 궤양성 종괴처럼 보여 추적 내시경 검사 및 조직 검사를 시행한 결과 허혈성 대장염으로 진단된 1예를 경험하였기에 보고한다.

결핵성 간문맥부 림프절염에 의한 폐쇄성 황달 1예

김우중,이명석,김형건,오흥영,곽성재,권성희,여미애,이경원 대한소화기학회 2000 대한소화기학회지 Vol.35 No.6

Tuberculosis of the liver is uncommon. Subsequent development of jaundice during antituberculous chemotherapy is usually caused by the side effects of drugs. The case of obstruction of the extrahepatic biliary system by tuberculous lymphadenopathy causing obstructive jaundice is extremely rare. A 18- year-old man was admitted to the hospital due to jaundice. He had the medical history of tuberculous pleurisy treated by antituberculous chemotherapy for about 4 months. Abdominal ultrasonography and computed tomography revealed a 3.4 cm-sized soft tissue masses at periportal area. Endoscopic retrograde cholangiography showed nearly complete luminal obstruction of the distal common bile duct. Ultrasound-guided fine needle aspiration and biopsies showed epithelioid histiocytes and necrotic materials. Endoscopic nasobiliary drainage and successive antituberculous chemotherapy resolved obstructive jaundice and lymphadenopathy without surgical management. We report a case of obstructive jaundice due to tuberculous portal lymphadenitis.

특발성 문맥압항진증 환자에게 병발된 간문맥 및 상장간막정맥 혈전증 1 예

김지수,박수현,김형건,여미애,오흥영,곽성재,육청미,김삼 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Idiopathic portal hypertension (IPH) presents with splenomegaly, pancytopenia, and variceal bleeding, but shows no hepatic dysfunction. Although the absence of extrahepatic portal vein obstruction is required for diagnosis of IPH, cases associated with extrahepatic portal vein thrombosis have been repeatedly reported. We recently experienced a case of IPH, which developed portal and superior mesenteric vein thrombosis (PMVT). A 27-year-old woman, who had presented with dizziness and received splenectomy after diagnosis of IPH at age 22, was admitted for melena. Esophageal and fundic varices were observed. Spiral abdominal computed tomography (CT) showed long segmental PMVT. After endoscopic variceal ligation, anticoagulation therapy was performed for PMVT. Follow-up CT showed almost complete resolution of PMVT. We report a case of IPH associated with extrahepatic portal vein thrombosis for the first time in Korea.

Fluoxetine에 의한 급성 독성 간염

박수현,이준상,김형건,여미애,김지수,이중서,오흥영,곽성재 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.2

Fluoxetine (Prozac ) is a antidepressant that inhibits the reuptake of serotonin in central nervous system, and has lesser adverse effects than the tricyclic antidepressants. The adverse effects of this drug are various, and the most common side effects are headache and nausea. The hepatic injury caused by fluoxetine is reported but very rare and not well known. Literature review has shown only 3 cases of hepatotoxicity from fluoxetine. We regard our case as the first of the hepatotoxicity from fluoxetine in Korea. The patient that we experienced showed normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values before fluoxetine administration. 15 days after she took fluoxetine, AST and ALT values were increased and gradually increased as she took fluoxetine daily. We studied about viral hepatitis, metabolic liver disease, and autoimmune liver disease, but the cause of hepatic injury was not established. After the patient stopped to take fluoxetine, AST and ALT values decreased. A liver biopsy showed a moderate infiltration within the portal tracts with lymphocytes and ballooning degeneration of hepatocytes. We concluded fluoxetine-induced acute toxic hepatitis had occured. We must keep in mind that fluoxetine may cause hepatitis without cholestasis and suggest taking liver function tests regularly.(Korean J Hepatol 2000;6:236-240)

조기위암에 병발한 미세변화 신증후군양 IgA 신병증 1 예 : 국내외 보고 예 고찰

김진철,이상무,구자룡,정성원,김우중,이현순,조성태,윤종우,오흥영,채동완,김근호,노정우,김형직,전로원,육청미 대한내과학회 2001 대한내과학회지 Vol.61 No.3

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgA level and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.(Korean J Med 61:286-292, 2001)

서울시청사 본관동 구조형식 및 콘크리트 내구성 고찰

강승호(Seung-Ho Kang),조영열(Young-Youl Jeo),박동순(Dongsoon Park),오흥영(Houng-Young Oh) 한국콘크리트학회 2010 콘크리트학회지 Vol.22 No.5