제48차 대한내과학회 추계학술대회초록집 : 임상강좌 ; 담석의 진단과 치료

강진경 대한내과학회 1996 대한내과학회지 Vol.51 No.-

내시경적 역행성 담췌관 조영술후 발생하는 고아밀라제혈증의 병인에 산소유리기의 역할

강진경,서창희,박인서,문영명,함기백,정재복,이동기,문희용 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.1

There is growing evidence that oxygen-derived free radicals(OFR's) play a role in the pathogenesis of pancreatic diseases, especially of acute paetcreatitis. Many types of experimental ex vivo and in vitro pancreatitis can be inhibited by superoxide dismutase and catalse. Allopurinol also ameliorates the injury response. While these experiments strongly suggest the involvement of OFR's in some forms of experimental acute pancreatitis, their clinical significance is still unknown. Clinical trials with free radical scavengers or allopurinol are clearly needed to answer the question of free radical initiation of acute or chronic pancreatitis. The aim of this study was to know the role of OFR's on the ERCP-induced hyperamylasemia. Total forty-two patients who underwent ERCP for diagnostic purposes were included and randomly divided into two group6, non-pretreatment group(NP group 19 patients) and pretreatment group(P group, 23 patients pretreated with vitamin E 1000 I.U. and allpurinol 300 mg for 5 days before ERCP orally). 15 ml of venous bloods were drawn in EDTA treated tubes. Serial changes of serum amylase levels(U/ml), washed RBC malonyDdialdehyde levels(MDA, nmol/ml RBC), buffy coats myeloperoxidase activites(MPO, U/ml buffy coats), and plasma superoxide dismutase levels(SOD, U/ml) were measured before, 2 and 24 hours after ERCP, respectively. Serum amylase levels in P group were decreased than NP group, but without statistical significance. The mean RBC MDA levels of P group measuted 2 hr after FRCP were 3.43±1.13, which were significantly decreased than those of NP group(5.27±1.53)(p$lt;0.05). The plasma SOD levels of P group were 17.71 1.8, 20.41±1.3, 19.4±2.2 at before, 2 and 24 hr after FRCP, respectively, which were all significantly decreased than those of NP group(p$lt;0.05). The huffy coats MPO activities were not changed at all in spite of pretreatment. In conclusion, OFR's might be in volved in the pathogenesis of ERCP-induced hyperamylasemia, but do not play a major role. A protective effect of allopurinol and vitamin E could be expected.

간외담관암의 진단에 있어서 자기공명담췌관촬영술 : ERCP와의 비교 Comparison with EBCP

강진경,박인서,문영명,정재복,김명진,서정훈 대한소화기학회 1998 대한소화기학회지 Vol.32 No.1

Background/Aims: Although the gold standard for evaluating the extrahepatic bile duct cancer is endoscopic retrograde cholangiopancreatography (ERCP), the procedure is associated with complications such as cholangitis and pancreatitis. In contrast, magnetic resonance cholangiopancreatography (MRCP) is a noninvasive diagnostic modality capable of producing bigh-quality images of the pancreato-biliary tree. The purpose of this study was to examine the diagnostic accuracy of MRCP and the difference hetween the images of MRCP and ERCP, Methods: We retrospectively analyzed 17 patients who were diagnosed as extrahepatic bile duct cancer between July 1995 and June 1997. All patients underwent ERCP and MRCP. In MRCP, fast spin echo was used in 10 cases and single shot fast spin echo was used in 7 cases. Malignant obstruction was confirmed in 12 patients by surgical findings and in 5 patients by clinical follow-ups and imaging findings. Results: The ERCP and the MRCP showed sensitivities of 100% and 94% for correct level of obstruction, 100% and 88% for causes of obstruction, 47% and 82% for recognition of the upper margin of lesion, 100% and 82% for recognition of the lower margin of lesion, 47% and 100% for visualization of the bile duct proximal to obstruction, and 100% and 93% for visualization of the bile duct distal to obstruction, respectively. Conclusions: The MRCP has a diagnostic accuracy similar to ERCP and shows excellent images in recognition of upper margin of lesion and visulaization of the duct proximal to obstruction in extrahepatic bile duct cancer. Therefore, it can be used as a primary diagnostic tool before ERCP or in cases that ERCP is incomplete or cannulation of the duct is not possible.

총담관 결석 제거에서 풍선을 이용한 내시경적 유두부 성형술

강진경,박인서,문영명,정재복,이세준,이돈행,송시영,이천균 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3

Background: The complications associated with endoscopic stone removal arise from the sphincterotomy that is performed to facilitate stone extraction. Early complications such as bleeding, perforation, pancreatitis and sepsis occur in about 10% of all patients. Moreover late complications may emerge due to the loss of the sphincter function. So the endoscopic removal of the bile duct stones without a sphincterotomy seems preferable in order to avoid the early complications related to the sphincterotomy, and may also help to preserve the function of the sphincter of Cddi. Aim: To evaluate the efficacy and safety of endoscopic balloon sphinteroplasty(EBS), we attempted to remove common bile duct stones, less than 12 mm, without sphincterotomy in 11 patients. We also investigated the effects of sphincteroplasy on the motility of sphincter of Oddi before and after EBS. Results: All patients were treated succesefully, with two patients administered sublingual nitroglycerine for the medical sphincter dilatation. Only one patient had mild abdominal pain, while the others experienced no complications. Follow-up manometric examinations showed the papillary function to be well preserved. Conclusion: This results suggested that the endoscopic balloon sphincteroplasy without sphincterotomy for the removal of small-sized stones is a useful and safe method, and its major advantage may lie in the preservation of the sphincter function. We recommend that prospective studies, preferably randomized, with clear objectives, are needed to clarify the success and safety of this technique compared to the standard sphincterotomy.

임상강좌 : 생활습관병 ; 생활습관병의 개요

강진경 대한내과학회 2004 대한내과학회 춘계학술대회 Vol.2004 No.-

지상발표 : 췌장질환의 내시경적 역행성 췌담관조영술

강진경,최흥재,문영명 대한소화기학회 1979 대한소화기학회 추계학술대회 Vol.1979 No.-

췌장질환진단(膵臟疾患診斷)에 있어서 내시경적(內視鏡的) 역행성 담(膽), 췌관조영술(膵管造影術)

강진경 대한소화기학회 1981 대한소화기학회지 Vol.13 No.1

원발성 점막연관 림프조직형 위 림프종에서 초음파 내시경의 역할

강진경,박인서,문영명,정재복,정재연,이용찬,전재윤,이충렬,조용석 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.6

Background/Aims: Endoscopic ultrasonography (EUS) is a useful diagnostic method for diagnosing local invasion and lymph node metastasis of primary gastric lymphoma including mucosa-associated lymphoid tissue (MALT) lymphoma, but the role of follow-up EUS after histologic regression of MALT lymphoma has not been well established until now. Therefore the usefulness of EUS in initial and follow up studies after Helicobacter pylori eradication therapy was investigated. Methods: From January 1995 to October 1998, nineteen MALT lymphoma patients were investigated. All but four patients underwent EUS exam at diagnosis and 3∼23 months thereafter. 17 patients recieved H. pylori eradication therapy and 2 patients recieved operations without medical treatment. Results: 16 of the 17 patients (94%) were cured of H. pylori infection after antimicrobial therapy. but on the histologic criteria, 13 of the 16 cases (81%) who were cured of H. pylori infection showed complete regression of MALT lymphoma. Histologic regression o MALT lymphoma was observed 6 weeks to 23 months after H. pylori eradication. In follow up EUS exam, gastric wall abnormalities returned to normal in 9 cases (69%) and remained abnormal in 4 cases (31%) among the completely regressed 13 cases. Conclusions: Considerable portion (31%) of follow up EUS exam showed persistent abnormalities of gastric wall such as thickening of mucosa and/or submucosa after histologic regression of MALT lymphoma. To evaluate the usefulness of EUS, follow up EUS exam with regular interval for longer periods after histologic regression is needed.

위암의 심달도 판정에 있어서 내시경초음파검사상 오진된 예들의 병리조직학적소견의 검토

강진경,한지영,박인서,문영명,정재복,박찬일,김명욱,송시영,천상배 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.3

Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. However, there are pathologic findings coexisting cancers which are unable to be detected by EUS resulting in mis-staging preoperatively. To find out the causes of mis-staging in determining the depth of cancer invasion we analysed the pathologic findings of mis-staged cases of gastric cancer by EUS. Ninety one cases who were operated for gastric cancer were evaluated by EUS prior to operation. EUS was performed with a 7.5 ㎒ Olympus-endoscopic ultrasonography(EU-M3) The results were compared with the depth of cancer invasion of the resected specimen and analysed the pathologic findings in mis-staged cases. The degree of vertical invasion of gastric cancer was classified into 4 stages: mucosa, submuosa, muscularis propria and deeper than subserosa. Overall accuracy of EUS in determining the depth of cancer invasion was 68.1%(62 of 91 cases). Among the 29 cases of mis-staging, the local extent of cancer infiltration was overstaged in 22 cases and understaged in 7 cases. The main pathologic findings of overstaging were fibrosis coexisting ulcexative cancer(10 of 22 cases) and compression of adjacent layer by the tumor(5 of 22 cases The main pathologic finding of understaging was microinvasion of cancer(6 of 7 cases). In conclusion, to improve the diagnostic accuracy of EUS in determining the depth of cancer invastion, further studies are needed to differentiate cancer and fibrosis, and to find out the method to detect microinvasion of cancer.

급성 췌장염의 병태생리

강진경 대한소화기학회 1982 대한소화기학회지 Vol.14 No.2