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위막성 장염 환자에서 의식수준과 내시경 소견과의 연관성
정일권 ( Il Kwun Chung ),이석호 ( Suck Ho Lee ),박정훈 ( Jung Hoon Park ),박도현 ( Do Hyun Park ),김홍수 ( Hong Soo Kim ),박상흠 ( Sang Heum Park ),김선주 ( Sun Joo Kim ) 대한장연구학회 2006 Intestinal Research Vol.4 No.2
Background/Aims: Unconsciousness can create problems in diagnosing and treating pseudomembranous colitis (PMC). While early recognition of clostridium difficile infection and immediate medical therapy can lead to a good prognosis, delayed diagnosis can lead to complex, recurrent and even fatal PMC. The relationships between endoscopic clinical features and unconsciousness are not well documented. The aim of this study was to determine the relationships between PMC endoscopic clinical features and the level of consciousness. Methods: Fifty three patients with confirmed PMC during the past 2 years were analyzed retrospectively. Patients were categorized as being in either a conscious state (CS) (i.e. alert) or an unconscious state (US) (i.e. drowsy, stupor, semicoma or coma). Endoscopic patterns of pseudomembranous plaques were classified as grade I=only friability or erosion without plaque, grade II=granular plaque, grade III=nodular plaque, or grade IV=confluent plaque. Clinical features including diagnostic interval (from initial prescription of antibiotic to confirming PMC), endoscopic severity, treatment method, treatment duration and prognosis were compared in between CS and US groups. Results: Mean patient age was 65.7±14.9 (male 47.2%, female 52.8%). The overall diagnostic interval was 9.37±4.35 days. Frequently causative antibiotics were cephalosporin (52.8%, 28/53), clindamycin (13.2%, 7/53) and imipenam (9.4%, 5/53). Of the 53 patients, 60.4% (32/53) were categorized as CS, and 39.6% (21/53) as US. In terms of pseudomembranous plaque endoscopic patterns, 18.9% (10/53) were grade I, 28.3% (15/53) were grade II, 32.1% (17/53) were grade III, and 20.8% (11/53) were grade IV. Treatment involved oral administration only. The overall complete treatment rate was 94.3% (50/53). The overall recurrence rate was 5.7% (3/53), and of these one patient died, and two patients were successfully managed by re-treatment. One recurrent and the fatal case occurred in the US group. The US group was positively correlated with longer diagnostic interval, and showed more severe endoscopic features and longer treatment duration compared to the CS group (p<0.05). Conclusions: Endoscopic and clinical features were more serious in unconscious PMC patients. Compared to conscious patients, unconscious patients being administrated antibiotics must be given greater attention in terms of early diagnosis and successful management of PMC. (Intestinal Research 2006;4:101-105)
소화성궤양 가이드라인 출혈 소화성궤양 치료의 가이드라인
정일권 ( Il Kwun Chung ),이동호 ( Dong Ho Lee ),김흥업 ( Heung Up Kim ),성인경 ( In Kyung Sung ),김진호 ( Jin Ho Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.5
Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pylori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pylori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pylori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer. (Korean J Gastroenterol 2009;54:298-308)
An analysis of Different Methods to Diagnose Helicobacter Infection in Bleeding Peptic Ulcers
정일권 ( Il Kwun Chung ),홍수진 ( Soo Jin Hong ),김은주 ( Eun Joo Kim ),조주영 ( Joo Young Cho ),김홍수 ( Hong Soo Kim ),박상흠 ( Sang Heum Park ),이문호 ( Moon Ho Lee ),김선주 ( Sun Joo Kim ),심찬섭 ( Chan Sup Shim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-
이태훈 ( Tae Hun Lee ),정일권 ( Il Kwun Chung ),길효욱 ( Hyo Wook Gil ),박현준 ( Hyun Jun Park ),김영훈 ( Young Hoon Kim ),박상흠 ( Sang Heum Park ),김홍수 ( Hong Soo Kim ),이문호 ( Moon Ho Lee ),김선주 ( Sun Joo Kim ),조현득 ( Hy 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5
The incidence of small cell carcinomas of the pancreas is approximately 1% of malignant pancreatic diseases. About 10% of metastatic small cell carcinomas of the pancreas are originated from the lung. Diagnosis of primary small cell carcinomas of the pancreas should be done after exclusion of any extraabdominal presence of small cell carcinomas. Metastasis-induced acute pancreatitis is unusual and the case manifested by primary pancreatic cancer is also unusual. We experienced a rare case of metastatic small cell carcinoma of the pancreas, which was suspected to be originated from the lung. He presented with clinical features of acute pancreatitis and was diagonsed having small cell carcinoma of the pancreas by histologic examination. The radiographic finding on his chest was normal, but small cell lung cancer was detected by more active evaluation of the lung. (Korean J Gastroenterol 2003;41:417-420)
Infliximab으로 호전된 장관 증상없이 발생한 구강-안면 크론병
정보용 ( Bo Yong Jung ),이석호 ( Suck Ho Lee ),정승규 ( Seung Kyu Chung ),이창균 ( Chang Kyun Lee1 ),이태훈 ( Tae Hoon Lee ),정일권 ( Il Kwun Chung ),김선주 ( Sun Joo Kim ),조현득 ( Hyun Deuk Cho ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.6
Crohn`s disease is a chronic inflammatory bowel disease that can involve the whole gastrointestinal tract. The orofacial manifestation of Crohn`s disease, which is rare, can develop irrespective of intestinal involvement. These orofacial lesions are often misdiagnosed as simple oral ulcers. Corticosteroids are the mainstay of therapy for orofacial Crohn`s disease. However, infliximab, the chimeric monoclonal antibody to tumor necrosis factor-α, is now considered as a primary treatment because of the disease`s relatively high rate of steroid resistance. We present a case of deep oral ulcer and periorbital swelling in a 65-year-old woman. She was diagnosed with intestinal Crohn`s disease 7 years ago, which was in remission after treatment with an immunosuppressive agent (azathioprine). The patient was given the diagnosed with orofacial Crohn`s disease and successfully treated with infliximab. (Korean J Gastroenterol 2012;59:437-440)
김인호(In Ho Kim),김영훈(Young Hoon Kim),정일권(Il Kwun Chung),조현득(Hyun Deuk Cho),김홍수(Hong Soo Kim),박상흠(Sang Heum Park),이문호(Moon Ho Lee),김선주(Sun Joo Kim) 대한내과학회 2002 대한내과학회지 Vol.62 No.6
목적 : 대장 림프양 증식증에 대한 내시경적 연구는 매우 드물다. 따라서 저자들은 대장내시경 조직검사를 통해 확인된 림프양 증식증의 내시경 소견을 분류하고, 이와 연관된 임상 양상 및 병리학적인 의미를 알아보고자 하였다. 대상 및 방법 : 35예의 대장 림프양 증식증에 대하여 내시경 사진을 통한 병변의 육안적 분류와 병리조직검사 및 의무기록을 통한 임상병리학적 분석을 시행하였다. 병리조직학적으로는 분류 1등급은 정상 림프 여포 1개와 소수의 림프구의 간질조직 침윤을 보인 경우, 2등급은 정상 림프 여포 1개와 다수의 림프구의 간질 조직 침윤이거나, 정상 림프 여포가 2개 보이는 경우, 3등급은 정상 림프 여포가 3개 이상, 다발성 또는 림프구 간질조직 침윤이 매우 심한 상태인 경우로 분류되었다. 결과 : 환자의 성별은 남자 20예, 여자 15예, 평균 나이는 45.2±5세이고, 주증상은 하복부 복통과 불쾌감 18예 (51.4%), 설사 8예 (22.9%), 혈변 및 기타 (25.7%) 등의 순이었다. 내시경 소견으로서 모양은 용종 18예 (52%), 표적 병변 7예 (20%), 사마귀상 병변 5예 (14%), 미란 5예 (14%), 종괴로 관찰되는 경우는 없었다. 크기는 5 mm 이하가 10예 (29%), 5∼10 mm가 11예 (31%), 10 mm 이상이 14예 (40%)였고, 갯수는 3개 이하가 22예 (63%), 3∼5개가 10예 (29%), 5개 이상이 3예 (8%)였다. 발생 부위별 빈도는 말단 회장 2예 (6%), 회맹부와 맹장 6예 (17%), 상행결장 3예 (8%), 횡행결장 3예 (8%), 하행결장 0예, S상 결장 5예 (14%), 직장 1예 (46%)가 관찰되었다. 이상의 결과로 대장 림프양 증식증은 용종의 모양이 가장 많았으나, 표적 병변의 경우도 다수 관찰되었다. 호발 부위는 맹장 및 직장이 많았고, 내시경적 모양에 따른 발생 부위에서 용종 및 표적 병변이 맹장 및 직장 부위에서 다수 관찰되었다. 병리조직학적으로는 분류 1등급은 19예 (54.3%), 2등급은 13예 (37.1%), 3등급은 3예 (8.6%)로 분류되었다. 조직학적 중등도는 연령, 병변의 크기, 발생부위, 병변의 개수 등과 관련이 없었다. 사마귀양 및 미란 형태의 소견을 보이는 경우에는 조직학적 중등도가 높은 경향이 있었으나, (p=0.105) 추적 검사상 기질적 질환으로 변환 및 악성화한 경우는 없었다. 결론 : 대장 림프양 증식증의 내시경적 소견은 용종, 표적 병변이 대부분이지만 미란이나 사마귀양 병변 등의 다양한 소견을 보였다. 그러나 사마귀양 병변이나 미란 소견에서 조직학적 중등도가 높은 경향을 보여 (p=0.105) 대장 내시경을 통한 추적 검사시 더 많은 관심과 주의가 필요하리라 생각된다. 이러한 대장 림프양 증식증의 내시경 소견 및 임상 양상과의 정확한 임상적 의의를 찾기 위해서는 더 많은 환자를 대상으로 한 연구 및 장기적 추적 관찰이 필요하리라 사료된다. Background : There have been known a few endoscopic studies of colonic lymphoid hyperplasia. The various findings of colonic lymphoid nodules may nevertheless cause confusion with other endoscopic diagnosis and their clinicopathologic significance have not been well known until now. The aims of this study were to classify the colonic lymphoid hyperplasia accordings to the colonoscopic findings and to reveal the clinicopathological relationship. Methods : From January 1998 to December 2000, 35 cases of colon lymphoid hyperplasia were selected in this study, the patients who had any other colon diseases were excluded in initial study group. We evaluated the endoscopic features of colonic lymphoid hyperplasia and analyzed their clinicopathologic relationships. Results : Colonic lymphoid hyperplasia was endoscopically classified as follows: 18 Polyps, 7 Target lesions, 5 Verrucous lesions, 5 Erosions. The rectum and cecum were most frequently involved. The histological grades of colonic lymphoid hyperplasia were divided into grade I (19 cases), grade II (13 cases), graded III (3 cases) according to degree of lymphatic follicle and lymphocyte infiltration to interstitial tissue. The severity of histologic grades had a tendency to increment in verrucous or erosive lesion comparing with polyp or target lesion, but they had no significant relation with other endoscopic or clinical features. Conclusion : Colonic lymphoid hyperplasia can be classified endoscopically into four types. Verrucous or erosive lesion might be considered as more severe colonic lymphoid hyperplasia. Further prospective and long-term studies are needed to confirm clinicopathologic significance of various endoscopic features.(Korean J Med 62:625-632, 2002)
담석성 췌장염 치료에서 내시경적 유두부 괄약근절개술의 임상적 유용성
박상흠(Sang Heum Park),권광안(Kwang An Kwon),김인호(In Ho Kim),김은주(Eun Joo Kim),정일권(Il Kwun Chung),김홍수(Hong Soo Kim),이문호(Moon Ho Lee),김선주(Sun Joo Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Background/Aims : Gallstone pancreatitis has been classically treated by cholecystectomy to prevent recurrence of pancreatitis. However, for patients whose condition is not suitable to operation, endoscopic sphincterotomy (EST) without cholecystectomy was recently performed. Thus, we analyzed the result of EST without cholecystectomy in patients with gallstone pancreatitis and evaluated its clinical usefulness. Methods: Seventeen patients who were diagnosed as gallstone pancreatitis from January 1997 to January 2000 and treated by EST without cholecystectomy because of difficulties in operation were enrolled in this study. The patients were followed up by visiting outpatient department or interview by telephone. Results: The mean age was 64.4 years and the mean duration of follow-up was 15.5 months. According to modified Glasgow criteria, the disease status of 14 patients were mild and the other 3 patients were severe. The site of gallstones were gallbladder in 6 patients, common bile duct (CBD) in 2, and both in 6. Success rate of stone removal in CBD was 100%(11/11) and EST-related complication rate was 6%(1/11). During the follow-up period, there were no pancreatobiliary diseases. Conclusions: EST without cholecystectomy is a safe and useful therapeutic modality in patients with gallstone pancreatitis who had diffculties in operation. (Kor J Gastroenterol 2000;36:383 - 389)