개원의 연수강좌 2 : 소화기질환의 증례와 영상진단 ; 상부 위장관 내시경

정문관 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

소화관 선종의 내과적 치료, 견해(내시경소견, 내시경절제)

정문관 대한외과학회 1998 대한외과학회 학술대회 초록집 Vol.1998 No.11

설사의 약물요법

鄭文寬 대한의사협회 1999 대한의사협회지 Vol.42 No.3

상부위장관 출혈 원인의 변화 양상

김태년,도병수,김현정,이삼범,정문관 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies were affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by chart and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%)as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), other(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in descending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours for 54.5%, 24 hours for 90.8% and this results were to be like previous results, 57.5% and 90.7 respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seen when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.

소화성궤양 및 Mallory-Weiss 증후군 출혈에 Hypertonic Saline-Epinephrine 용액의 국소주사에 의한 지혈 효과

정문관,최종화,김태년,현명수,이헌주,이현우 대한내과학회 1992 대한내과학회지 Vol.42 No.2

1986년 11월에서 1989년 10월까지 상부위장관 출혈증세로 내원한 환자중 응급내시경검사상 출혈하고 있거나, 재출혈의 위험성이 많은 소화성궤양과 Mallory-Weiss tear 환자 161명을 대상으로 hypertonic saline-epinephrine 용액을 반복 국소주사하여 지혈효과 및 재출혈 방지효과에 대해 조사하여 다음과 같은 결과를 얻었다. 1) 출혈부위는 위궤양 93예, 십이지장궤양 62예, Mallory-Weiss tear 5예, 변연부궤양 1예였다. 2) 내시경으로 관찰된 출혈 양상은 활동성 출혈이 64예였고, 최근 출혈 흔적이 있는 경우가 97예였으며, 활동성 출혈은 spurting하는 경우가 30예(arterial jet-ting 14예, pulsating 16예), oozing하는 경우가 34예였고, 최근 출혈 흔적이 있는 경우는 궤양 기저부의 혈관노출이 53예이고 혈괴부착은 44예였다. 3) 활동성 출혈이 있는 경우는 전예에서 hypertonic saline-epinephrine 혼합용액 국소주사 후 지혈시킬 수 있었다. 4) 영구 지혈을 위해서 arterial jetting 2.8회, pulsating 2.4회, oozing 1.5회, 궤양 기저부의 혈관노출인 경우 1.9회, 혈괴부착인 경우 2회의 hypertonic saline-epinephrine 혼합용액 국소주사가 요구되었다. 5) 재출혈은 spurting bleeding 30예중 5예(16.7%) oozing 34예중 3예(8.8%), 궤양 기저부에 혈과노출이 되어 있는 53예중 1예(1.9%), 혈관부착되어 있는 44예중 5예(11.4%)에서 발생하였다. 6) 재출혈한 14예중 9예는 반복 hypertonic saline epinephrine 용액 국소주사로 영구 지혈이 되었지만 spurting bleeding 2dP, oozing 1예, 궤양 기저부에 혈괴부탁 2예는 지혈 실패로 수술하였다. 7) 지혈실패한 5예중 1예는 간기능이 심하게 저하된 경우였고 그외 4예는 반복적인 궤양으로 인해 충분한 양의 hypertonic saline epinephrine solution을 국소주사 할 수 없었던 경우였다. 8) Hypertonic saline-epinephrine solution을 국소 주사를 이용한 지혈요법을 시행하지 않았던 1985년 11월부터 1986년 10까지 소화성 궤양과 Mallory-Weiss tear로 인한 출혈로 응급실로 내원한 65예중 25예(38.5%)에서 지혈과 재출혈을 예방하기 위해 수술요법이 요구되었지만 국소주사로 지혈요법을 시행한 후에는 수술요법 빈도를 1.9∼2.4%로 줄일 수 있었다. 이상의 결과로 보아 처치방법이 간단하고 경제적 부담이 많지 않은 hypertonic saline-epinephrine 용액을 이용한 국소주사가 출혈하고 있거나 재출혈의 위험성이 높은 소화성궤양 출혈과 Mallory-Weiss tear 환자에서 출혈을 지혈시키고 재출혈을 예방하는데 효과적인 치료의 한 방법으로 사료된다. We have assessed the efficacy of local kepeated injections with hypertonic saline-epinephrine solution in the clinical management of patients, who have an actively bleeding peptic ulcer Mallory-Weiss tear, exposed vessel or blood clot on ulcer bed. Over 36 months 161 patients, 64 with an actively bleeding ulcer or Mallory-Weiss tear and 97 with blood clot or exposed vessel on ulcer bed were subjected to endoscopic injection therapy with hypertonic saline epinephrine solution. Initial hemostasis was achieved in all patients with actively bleeding peptic ulcer or Mallory-Weiss tear (100%). In 8 of 64 patients with active bleeding and 6 of 97 patients with inactively bleeding pepitc ulcer and Mallory-weiss tear, recurrent episodes of bleeding occurred. Permanent hemostais was achieved in 61 patients (95.3%) with 2 sessions of repeated injections to prevent or control rebleeding and in the group of 97 patients with blood clot or exposed vessel on ulcer bed, permanent hemostasis was acieved in 95 patients (97.9%) with 1.9 sessions of repeated injections to prevent or control bleeding. No significant local or systemic complication was observed. We believe that endoscopic injection therapy with a hypertonic saline-epinephrine solution is a safe simple effective and inexpensive treatment option in control-ling active bleeding or preventing rebleeding peptic ulcer or Mallory-Weiss tear.

소화관 혈액순환에 Nitric oxide의 역할과 bacterial translocation의 의의

정문관 영남대학교 의과대학 1995 Yeungnam University Journal of Medicine Vol.12 No.1

외과의가 접하는 타과적 문제: 내과

정문관 대한외과학회 2002 대한외과학회 학술대회 초록집 Vol.2002 No.5

산화 질소 억제제가 문맥 고혈압 쥐의 혈역학 변화에 미치는 영향

장병익,김태년,김필영,정문관 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2

Background: Nitric oxide, a vasodilator synthesized from L-arginine by vascular endothelial cells, accounts for the biological activity of endothelium derived relaxing factor Previous studies demonstrated that nitric oxide inhibitor, N"-Nitro-L-Arginine(NNA) diminished the hyperdynamic splanchnic and systemic circulation in portal hypertensive rats. The present study was done to determine the role of nitric oxide in the development of hyperdynamic circulations in the prehepatic portal hypertensive rat model produced by partial portal vein ligation. Methods: The portal hypertensive rats were divided into water ingestion group and NNA ingestion group. After partial portal vein ligation. NNA ingestion group and water ingestion group received NNA, 1me/kg/day and plain water through the mouth for 14 days, respectively. Cardiac output, mean arterial pressure, organ blood flow and porto-systemic shunting were measured by radioisotope labeled microsphere methods. Vascular resistances were calculated by standard equation. Results: There were significant decreases in mean arterial pressure, increases in cardiac output and cardiac index, and decreases in total systemic and splanchnic vascular resistance in portal hypertensive rats compared to normal control group(p<0.01). Compared to the water ingestion group, significantly increased mean arterial pressure with decreased cardiac output and cardiac index were developed in the NNA ingestion group. Total systemic and splanchnic vascular resistance were significantly increased in the MNA ingestion group compared to water ingestion group(p<0.05). But, there was no significant difference in portal pressure between the two groups. Conclusion: The hemodynamic results of this study indicate that hyperdynamic circulation in prehepatic portal hypertensive rat model was attenuated by ingestion of NNA. Nitric oxide may play an important role in the development of hyperdynamic circulation with splanchnic vaodilation in chronic portal hypertension.

소화성궤양 출혈의 내과적 치료

정문관 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.1

내시경적 식도 정맥류 경화술 후의 균혈증에 대한 연구

정문관,이현우,이형우,최종화,권경순,현명수 대한소화기내시경학회 1990 Clinical Endoscopy Vol.10 No.1

The incidence of transient bacteremia following esophageal variceal sclerotherapy (EVS) was evaluated in 29 patients. These 29 patients underwent a total of 83 sclerotherapy sessions.Prior to EVS, all instruments were sterilized. Blood cultures were drawn pre-EVS and post-EVS.All pre-EVS and post-EVS blood cultures were negative. In conclusion, it was found bacteremia following sclerotherapy is not easily developed, if a vigorous approach of using well cleaned equipment is used. Unless there is a cardiac prothesis or valvular heart disease, antibiotic prophylaxis is not warranted.