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( Sung Bum Cho ),( Jong Sun Rew ),( Sung Young Park ),( Hyeng Chen Park ),( Kyeong Won Yoon ),( Seok Cho ),( Wan Sik Lee ),( Chang Hwan Park ),( Hyen Soo Kim ),( Sung Kyu Choi ) 대한소화기학회 2007 SIDDS Vol.9 No.-
Background Aims: Rectal carcinoid has been increasingly detected due to the recent wide use of colonoscopy for routine health examination. Although endoscopic resection should be considered as the treatment for rectal carcinoid, the scar formation after colonoscopic biopsy can lead to unpredicted difficulty in this procedure. This study evaluates the per-procedure findings and treatment results in an attempt to elucidate the effect of scar formation after colonoscopic biopsy in endoscopic resection for rectal carcinoid. Methods: Twelve cases of rectal careinoid with scar formation were compared with 18 non-scar cases, which were treated using the endoscopic resection from January 2002 to August 2007, in terms of the endoscopic findings, resection methods and treatment results. Results: The differences in the clinical findings and tumor size between the scar group and the non-scar group were nonspecific. The average waiting-time between biopsy and resection was shorter (13±16 vs 42±26 ds; p=0.11) in the scar group. During endoscopic resection, small active ulcer was found in 4 scar cases with lesser than 7 days of waiting-time. The risk of limited elevation after submucosal injection was higher (83% vs 44%, p=0.03) in the scar group. In resection methods, ESD was frequently adopted in the scar group (4 cases vs 1 case). The difference in the result of pathologic complete resection between two group were nonspecific. Four patients in the scar group should be admitted (vs 1 case in the non-scar group). Conclusions: ESD technique should be considered in selected cases, because of the postbiopsic scar can block the submucosal elevation in endoscopic resection for rectal carcinoid.
류성윤 ( Sung Yoon Rew ),고영일 ( Young Il Koh ),신희영 ( Hee Young Shin ),박승환 ( Seong Hwan Park ),류시현 ( Shi Hyun Ryu ),김하나 ( Ha Na Kim ),김민석 ( Min Suk Kim ),천승우 ( Seong Woo Chun ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.3
Background: Since introduction of regional pharmacovigilance centers in Korea, the number of domestic adverse drug reactions (ADRs) reported is rapidly increasing. However, there have been only a few reports on reporting and clinical features of ADRs in Korea. This study was designed to investigate the reporting and clinical features of ADRs reported from a single university hospital. Methods: We included the patients with ADRs reported from a regional pharmacovigilance center of Chonnam National University Hospital between June 2009 and December 2009. ADRs were identified by both voluntary and automated computerized surveillance systems. Additional information was retrospectively collected from electronic medical records and then reporting and clinical features of ADRs were analyzed. Results: Six hundred eighty four ADRs were reported in 446 patients based on both Naranjo`s scale and WHO-UMC criteria. Voluntary reporting consisted of 61.0% of ADRs. Most of ADRs (85.5%) were reported by doctors. Females consisted of 60.4% of patients. The most common clinical manifestations of ADRs were skin symptoms (47.7%), followed by neuropsychiatric (15.5%) and gastrointestinal symptoms (11.5%). The most common offending drugs were anti-infective drugs (30.0%), followed by non-steroidal anti-inflammatory drug (18.1%) and central nervous system agent (12.0%). Conclusion: Doctors can easily report ADRs in our computerized surveillance system. Although it is well known that skin is frequently involved in ADRs and anti-infective drugs and non-steroidal anti-inflammatory drugs induce ADRs, neuropsychiatric symptoms and central nervous system agents should be considered as common manifestations and causative drugs of ADRs, respectively. (Korean J Asthma Allergy Clin Immunol 2011;31:184-191)
( Seon Young Park ),( Kyoung Won Yoon ),( Chang Hwan Park ),( Tae Jin Seo ),( Hae Kyung Chung ),( Ho Sung Rew ),( Sung Beom Cho ),( Wan Sik Lee ),( Hyeun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Gut and Liver Vol.5 No.3
Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection. (Gut Liver 2011;5:391-394)
Vibrio vulnificus 감염증으로 확진된 92예의 임상적 고찰
유종선,문범,지미선,최성규,백강우,김기태,박창환,윤종만 대한감염학회 1995 감염 Vol.27 No.4
목적: V. vulnificus 감염증은 전남지방에서 매년 발생하고 있고 지속적인 계몽과 집중적인 치료에도 불구하고 아직도 높은 치사율을 나타내고 있어 1983년부터 1994년까지의 전남지방의 V. vulnificus 감염증의 임상상과 역학적인 특성을 분석 검토해보았다. 방법:1983년부터 1994년 9월 까지 전남대학병원에 내원한 환자중 균 배양검사로 V. vulnificus 감염증으로 확진된 92예를 대상으로 세균학적 검사소견, 역학적 특성, 임상소견을 분석 검토하였다. 혈액배양은 BACTEC blood culture system(Bekton Dickinson)을 이용하였고, 피부병변 조직배양은 혈액한천배지, MacConkey agar, Thioglycolate broth에 접종 배양한 후 배양된 세균을 ATB 32GN(biome-rieux. France)과 API 20E(biomerieux. France)로 동정하였다. 항생제 감수성은 Kirby-Bauer 디스크(BBL Sensi disc)확산법으로 검사하였다. 결과: 1) V. vulnificus는 혈액배양에서 20예(22%), 조직배양에서 43예(47%), 혈액과 조직에서 27예(29%), 혈액과 복수에서 1예(1%), 혈액과 뇌척수액에서 1예(1%)가 배양되었다. 원판 확산법에 의한 균 감수성검사에서는 tetracycline, chloramphenicol, ampicillin, gentamicin, piperacillin, cefoperazone, cefotaxime, ciprofloxacin등은 100%의 감수성을 나타냈고 amikacin, kanamycin, carbenicillin등은 약 85%, cephalothin은 77%의 감수성을 나타냈으며 colistin은 전 균주에서 내성을 나타냈다. 2) 연도별 발생빈도는 85년에 21예로 가장 많았고, 94년 12예, 89년 10예, 87년 9예, 91년 8예, 93년 8예의 순이었다. 월별로는 5월에서 10월 사이에 발생하였으며 특히 7월에서 9월 사이에 78예(85%)로 집중적으로 발생하였다. 지역별로는 해안지방과 인접 내륙지방에 주로 발생하는 경향을 보였다. 3) 간질환이나 중등도 이상의 음주력이 있는 40-50대의 남자에서 어패류를 생식 또는 불충분하게 조리하여 섭취했을때 많이 발생하였다. 환자 발생시기의 남서해안 근해 평균수온은 16.3℃-28.7℃였으며 특히 22.0℃-23.9℃시기의 발생이 전체의 54%를 차지하였고 해수온도가 상승함에 따라 발생빈도가 증가하는 경향을 보였다(r=0.43 p=0.006). 4) 대부분이 원발성 패혈증 증세를 보였고 하지의 부종과 수포등 피부병변만 나타나고 패혈증 증세가 없었던 창상감염증 1예와 뇌막염 증세를 동반한 패혈증이 1예 관찰되었다. 임상증상으로는 주로 피부병변(96%), 사지통(56%), 저혈압(52%), 발열(47%), 오한(43%), 설사(33%), 복통(26%), 구토(25%)등이 나타났고, 심한 경우에는 핍뇨(9%), 호흡곤란(7%), 혈변(2%)도 나타났다. 피부병변으로는 수포(56%), 부종(52%), 홍반(51%), 괴사(18%), 자반(11%), 구진(7%), 농포(2%), 등이 관찰되었고 주로 하지(73%)에 많이 발생하였다. 5) 사망률은 전체적으로는 57.6%이였고, 점차 감소화 하는 추세를 보였다. 사망군과 생존군간에는 생명징후, 잠복기에 따른 차이는 없었으나 백혈구수와 혈소판수가 감소할수록, AST가 높을수록 사망률이 높았다 결론:V. vulnificus 감염증은 일단 패혈증이 발생하면 병의 진행이 빠르고 감수성 있는 항생제로 집중적인 치료를 해주어도 사망률이 높기때문에 발병후 치료보다 예방이 훨씬 중요하리라 사료된다. Background:V. vulnificus infection is a highly fatal disease prevailing in Chonnam area. To increase understanding of V. vulnificus infection, we investigated clinical and epidemiological characteristics of V. vulnificus infection in Chonnam area. Methods:We retrospectively reviewed the clinical recores of 92 cases with V. vulnificus infection which admitted to Chonnam University Hospital from 1983 to 1994 and bacteriologically were confirmed. Results: 1) V. vulnificus was isolated from blood in 22%, tissue in 47%, blood and tissue in 29%, blood and peritoneal fluid in 1%, and blood and cerebrospinal fluid in 1% of the cases. All the isolates were susceptible to tetracycline, chloramphenicol, ampicillin, gentamicin, piperacillin, cefoperazone and cefotaxime. About eighty-five pervent of the isolates were susceptible to amikacin, kanamycin and carbenicillin and seventy-seven percent to cephalothin. All the isolates were resistant to colistin. 2) The yearly distribution was 21 cases in 1985, followed by 12 in 1994, 10 in 1989, 9 in 1987 in decreasing. The monthly distribution was each 27 cases in July and August, followed by 24 in September, 8 in June, 5 in October, 1 in May. The majority of cases occurred in coastal areas and nearly inlands of Chonnam province. 3) All of V. vulnificus infections occurred in association with ingestion of raw seafoods. The age and sex distribution ranged from the thirties to the eighties and occurred mainly in adult males in the fifties(48%) and the forties(24%). Of ninety-two cases, 73 cases had underlying liver diseases and 67 cases were heavy alcohol consumers. 4) Almost all cases showed primary septicemia except one which had wound infection without septicemia. One case showed septicemia with meningeal symptoms. Clinical manifestations included skin lesion(96%), pain in the extremities or myalgia (56%), hypotension(52%), fever(47%), chills(43%), diarrhea(33%), abdominal pain(26%), oliguria(9%), dyspnea(7%) and melena(2%). Skin lesions included vesicles or bullae(56%), edema(52%), erythema(51%), necrosis(18%), purpura(11%), macules(7%) and pustules(2%). Most of the skin lesions developed in the lower extremities. 5) The average sea water temperature ranged from 16.3℃ to 28.7℃ which was provided by National Fisheries Research & Developement Agency from 1983 to 1994, when V. vulnificus infection occurred. As sea water temperature rose, the incidence of V. vulnificus infection tended to be increased(r=0.43 p=0.006) 6) The overall case fatality rate was 57.6%. There were no significant differences between survivors and non-survivors in vital signs, incubation period, arrival time, and liver function test except aspartate aminotransferase. However, leukocyte and platelet counts were significanty lower in non-survivors (p<0.05). Conclusion:In spite of the susceptible antibiotics therapy and intensive care, V. vulnificus infection was highly fatal. Therefore, we stress that prevention is more important rather than treatment of the disease.