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복막투석 중단없이 성공적으로 치료한 복막투석 치료 중인 당뇨병성 만성신부전 환자에서 발생한 고삼투압성 혼수 2 예
강형주(Hyong Ju Kang),박철휘(Cheol Whee Park),이소연(So Yeon Lee),최현철(Hyun Cheul Choi),이정록(Jeong Rok Lee),손장명(Jang Myung Son),신영신(Young Shin Shin),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.3
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복강경하 저위전방절제술 전 병소위치 표시를 위한 점묵으로 파종된 직장암 1예
강형주 ( Hyong Ju Kang ),이보인 ( Bo In Lee ),김병욱 ( Byung Wook Kim ),최황 ( Hwang Choi ),조세현 ( Se Hyun Cho ),최규용 ( Kyu Yong Choi ),채현석 ( Hiun Suk Chae ),한석원 ( Seok Won Han ),정인식 ( In Sik Chung ),김경미 ( Kyoung 대한장연구학회 2005 Intestinal Research Vol.3 No.2
Endoscopic mucosal resection is accepted standard treatment of early gastrointestinal cancer, defined as cancer with involvement confined to the mucosa without lymph node metastasis. Under the therapeutic endoscopy, submucosal saline injection minimize the risks of transmural burn, perforation, bleeding. As laparoscopic colectomy became popular recently, colonoscopic tattooing of lesions to assist for localization in surgical field is in the spotlight. Four submucosal saline injections around the lesion, performed with an injection needle to test for the possibility of EMR, showed an obvious ‘non-lifting sign’. Therefore we performed endoscopic tattooing, and then experienced tumor cell seeding on tattooing site. Manipulation of cancerous tissue with submucosal saline injection or tattooing can have a risk of tumor cell seeding on injection sites at any time. Furthermore, if bowel wall is perforated, peritoneal metastasis or seeding are possible. In this case, we approached and injected saline carefully for prevention of cancer penetration. (Intestinal Research 2005;3:150-153)
신경베체트병 환자의 양성자(1H) 자기공명분광 영상 2예
강형주 ( Hyong Ju Kang ),태현정 ( Hyon Jung Tae ),김명철 ( Myoung Cheol Kim ),김완욱 ( Wan Uk Kim ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.1
Magnetic resonance imaging (MRI) and computed tomography had been used to detect the neurologic lesions of the Behcet`s disease. However, there are a number of cases which can not be detected by conventional imaging studies in neuro-Behcet`s disease. To overcome this problem, magnetic resonance spectroscopy (MRS) has been introduced in several autoimmune diseases involving central nervous system such as neuropsychiatric lupus, but which was rarely performed in Behcet`s disease. In the present study, we report two cases of neuro-Behcet`s disease that showed normal MRI but abnormal proton MRS (1H MRS) findings. MRS in two cases revealed a reduction of the N-acetyl aspartate (NAA)/creatine (Cr) ratio in the substantia nigra and thalamus, respectively, which were the areas without abnormality on MRI, suggesting a functional defect of neurons in these areas. In a case with thalamic dysfunction, abnormal NAA/Cr ratio was normalized in parallel with clinical improvement after treatment with high-dose steroids and immuno-suppressive agents. These observations suggest that MRS may be useful to early detect the functional abnormality in neuro-Behcet`s disease and to monitor neurologic status after treatment with immuno-suppressive agents.
Sjogren 증후군 환자에서 발생한 재발성 다발성 연골염
이관형 ( Kwan Hyong Lee ),홍연식 ( Yeon Sik Hong ),강형주 ( Hyong Ju Kang ),김세희 ( Se Hee Kim ),김명철 ( Myoung Cheol Kim ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),김기준 ( Ki Jun Kim ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.3
Relapsing polychondritis is a rare multisystem rheumatic disease, characterized by recurrent and potentially destructive inflammatory lesions of cartilaginous structures. All types of cartilage & other proteoglycan-rich structures may be involved, resulting in auricular chondritis, laryngotracheal chondritis, ocular symptoms, vasculitis, cardiac abnormalities, skin lesions and glomerulonephritis. The disease may be associated with another connective tissue and autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sjogren`s syndrome and systemic vasculitis. We experienced a 69-year-old female patient who had been previously diagnosed as Sjogren`s syndrome, presenting respiratory tract involvement, episcleritis, auricular chondritis and vestibular dysfunction.
스테로이드-의존성 궤양성대장염 환자에서 원심분리 백혈구제거요법의 임상적 유용성: 장기간 추적관찰 결과
최황 ( Hwang Choi ),최규용 ( Kyu Yong Choi ),이보인 ( Bo In Lee ),강형주 ( Hyong Ju Kang ),박수정 ( Soo Jeong Park ),김병욱 ( Byung Wook Kim ),한치화 ( Chi Wha Han ),정인식 ( In Sik Chung ) 대한장연구학회 2005 Intestinal Research Vol.3 No.2
목적: 궤양성 대장염의 병인은 아직 명확하지 않으나 활성화 백혈구가 중요한 역할을 하고 있다. 활동기의 스테로이드-의존성 궤양성 대장염 환자에서 백혈구제거요법의 효과와 부작용에 대하여 알아보고자 하였다. 대상 및 방법: 궤양성대장염 환자 가운데 스테로이드에 의존성을 보여 백혈구제거요법을 받고 2년 이상 추적 관찰이 가능하였던 8명(남자 3명)을 후향적으로 조사하였다. 대상 환자의 병변범위는 광범위 대장염 4예, 좌측 대장염 4예였다. 백혈구제거요법은 원심분리 방법(Cobe Spectra 2 Arm, Gambro BCT, Inc, USA)의 백혈구성분채집술을 사용하였다. 상완 말초정맥에 삽관하여 6시간 동안 실시하였다. 일주일 간격으로 5회를 시행한 후 한달 간격으로 시행하였다(평균 총 시행횟수 9.5회, 범위 6-17회). 백혈구제거요법 전후 임상적 효과를 단순 임상 장염 활성지표를 사용하여 평가하였으며, 말초혈액검사를 실시하고, 부작용을 관찰하였다. 결과: 단순 임상 장염 활성지표는 백혈구제거요법 전 평균 8.75(표준편차 1.83, 범위 6-12)에서 0.5로 감소하였다(p<0.001). 백혈구제거요법 후 평균 44개월의 추적 관찰 기간 동안, 4명은 재발하여 스테로이드와 6-MP를 다시 투여하였으며, 이 중 한 명은 백혈구제거요법을 재차 시행하였다. 재발은 백혈구제거요법 후 평균 18.5개월에 발생하였다. 백혈구제거요법 전후 ESR과 CRP의 유의한 변화는 없었다. 백혈구제거요법 후 백혈구 수는 일시적으로 감소하였으며, 혈색소는 감소하였다. 혈소판의 유의한 감소가 있었으나 임상적으로는 문제가 없었으며 일주일 이내에 회복되었다. 두 명에서 백혈구제거요법 도중 입술과 눈 주위, 손 등에 감각이상을 호소하였으나 칼슘 정주 후 곧 회복되었다. 결론: 원심분리방법의 백혈구제거요법은 스테로이드-의존성 궤양성대장염 환자에서 유용한 치료방법이며, 스테로이드 장기 사용에 따른 부작용을 줄일 수 있을 것이다. 향후 전향적인 대조연구가 필요할 것으로 생각한다. Background/Aims: Although the etiologies of ulcerative colitis have not been proven yet, activated leukocytes have a great role in the pathogenesis of ulcerative colitis. We studied to evaluate the long-term clinical usefulness and adverse effect of the leukocyte removal technique (leukapheresis) for the patients with steroid-dependent ulcerative colitis. Methods: Eight patients who had performed leukapheresis for management of steroid-dependent active ulcerative colitis were analyzed retrospectively. We used a centrifugal method (Cobe Spectra, Gambro BCT, Inc, USA) for the leukapheresis. The schedule was one session weekly for 5 weeks of intensive therapy and one session monthly of maintenance therapy. The number of leukapheresis performed was average of 9.5 cycles. The simple clinical colitis activity index (SCCI) and complete blood counts were checked before and after each sessions of leukapheresis. We observed the side effects of leukapheresis and clinical outcomes of the patients over 2 years. Results: After 5 sessions of leukapheresis, the average SCCI decreased from 8.75 to 0.5 (p<0.001). All patients could easily taper the steroid dose during leukapheresis and 7 patients stopped the use of steroid after leukapheresis. During mean follow-up of 44 months, 4 patients relapsed and started steroid and 6-mercaptopurine. Two patients complained of numbness and parasthesia on the face and fingers during leukapheresis and theses symptoms were relieved after the injection of calcium. Conclusions: Centrifugal leukapheresis was an effective and safe method for the treatment of the patients with steroid-dependent active ulcerative colitis. We expect further prospective controlled studies. (Intestinal Research 2005;3:110-116)
생선회를 먹은후 십이지장 벽에 박힌 쇠바늘의 내시경적 제거
한혜원,박선희,최규용,김진일,정인식,김성수,이강문,김명철,선희식,이창돈,채현석,장정원,방춘상,강형주 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.3
Foreign bodies in the stomach and duodenum are usually accidentally swallowed by children, mentally ill patients, alcoholics, or persons with dentures. Swallowed foreign bodies are usually asymptomatic, and moved down the alimentary tract to be passed spontaneously without discomfort. There had been reported many kinds of foreign bodies, for example, metal fragments, fish bones and so on. A metal thread, which looks like a fishing hook in gastrointestinal tract as a foreign body, has never been reported in humans. A 62-year-old male patient was admitted due to abdominal discomfort for five days after eating raw fish. We performed gastroduodenoscopy and could find a thread penetrating to the anterior wall of duodenal bulb. It was removed by biopsy forcep. Herein, we report a case of a metal thread in duodenal bulb, which looked like a fishing hook.