한국인에 있어서 상부식도의 이소성 위점막의 빈도 및 임상적 양상

이동욱(Dong Wook Lee),김은영(Eun Young Kim),박정모(Jung Mo Park),이원석(Won Suk Lee),곽동협(Dong Hyup Kwak),김정희(Jung Hee Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. Methods: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. Results: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 eases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. Conclusion: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus, The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.

영도대교 보수ㆍ복원 공사

박경호(Kyung-Ho Park),곽동협(Dong-Hyup Kwak),전성용(Sung-Yong Jeon),김선용(sun-Yong Kim),김재근(Jae-Geun Kim) 대한토목학회 2014 대한토목학회지 Vol.62 No.4

원위부 총담관 결석으로 오인된 결석을 동반한 총담관류 치료

곽태영 ( Tae Young Kwak ),박창환 ( Chang Hwan Park ),엄석현 ( Seok Hyeon Eom ),황홍석 ( Hong Suk Hwang ),정덕원 ( Duk Won Chung ),서지영 ( Ji Young Seo ),김영성 ( Yeong Sung Kim ),곽동협 ( Dong Hyup Kwak ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors’ hospital due to cholangitis and pancreatitis. The patient``s condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.

Helicobacter pylori의 초기 박멸요법 후 궤양치유를 위한 추가적인 산억제제가 필요한가 ?

정재진(Jae Jin Jung),이동욱(Dong Wook Lee),이동수(Dong Su Lee),정강욱(Kang Wook Chung),김영성(Young Sung Kim),김은영(Eun Young Kim),손수호(Soo Ho Son),여준기(Jun Ki Yeo),곽동협(Dong Hyup Kwak) 대한내과학회 2001 대한내과학회지 Vol.60 No.5

N/A Background : Helicobacter pylori (H. pylori) can now be eradicated in the majority of patients with 7 days of treatment with OAC ( omeprazole + amoxicillin + clarithromycin ) regimen. It is unclear if additional acid-suppressing treatment should be continued beyond 7 days in patients with active gastric or duodenal ulcers. Methods : Ninety two patients with endoscopically proven active peptic ulcers who were H. pylori positive were randomized to receive either omeprazole 20 mg plus amoxicillin 1.0g plus clarithromycin 500mg ; twice daily for 1 week alone (OAC group) or same regimen followed by 3 weeks of omeprazole (OACP group). Endoscopy and UBT (urea breath test) were performed 8 weeks after the initiation of treatment. Results: Forty four of forty five (97.8%) of OAC group and forty four of forty seven (93.6%) of OACP group were noted to have healed ulcer at week 8. Conclusion: In patients with H. pylori infection and peptic ulcers, one week of OAC therapy without further need for PPI may heal the ulcers. Following an l week course of H. pylori eradication therapy by OAC for peptic ulcers, further 3 weeks of acid-suppressing therapy with PPI was not proven to promote ulcer healing rate.(Korean J Med 60:439-443, 2001)

증례 : 스테로이드로 치료한 특발성 호산구성 담낭염 1예

강현준 ( Hyun Jun Kang ),최민호 ( Min Ho Choi ),김호태 ( Ho Tae Kim ),곽태영 ( Tae Yeong Kwak ),이현철 ( Hyun Chaol Lee ),김영성 ( Yeong Sung Kim ),곽동협 ( Dong Hyup Kwak ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3

호산구성 담낭염은 일반적인 담낭염과 증상 및 검사 소견에서 명확히 구분되지 않아 대부분 담낭 절제술로 진단과 치료가 동시에 이루어진다. 하지만 본 증례처럼 특별한 호산구 증가증의 원인이 없는 호산구성 담낭염이 의심되면 담낭천공, 패혈증 등의 응급 수술을 요하는 경우를 제외하고 담낭 절제술에 앞서 스테로이드 사용을 신중히 고려해 볼 수 있겠다. Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.

정상 위 분문부 점막에서 발견된 이소성 골 형성

엄석현 ( Seok Hyeon Eom ),박창환 ( Chang Hwan Park ),정덕원 ( Duk Won Chung ),이상혁 ( Sang Hyeok Lee ),서지영 ( Ji Young Seo ),김영성 ( Yeong Sung Kim ),곽동협 ( Dong Hyup Kwak ),김정희 ( Jung Hee Kim ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.2

Heterotopic bone formation in the gastrointestinal tract is a rare phenomenon. Most reported cases were associated with benign and malignant neoplasms, except for a case in which heterotopic bone formation was found in a patient with Barrett`s esophagus. The exact pathogenesis of the disease has not yet been established. However, most heterotopic bones found in the gastrointestinal tract were associated with mucinproducing tumors of the appendix, colon, and rectum. Inflammation may also play a role in osseous metaplasia in a case with bone formation at the base of an ulcer in Barrett`s esophagus. Here, we report on a patient with heterotopic bone formation in normal gastric cardiac mucosa. A 50-year-old female visited our hospital for a routine health examination. She had no gastrointestinal symptoms, and her physical examination, blood test, X-ray, urine, and stool examination results were normal. A 0.3 cm sized polypoid lesion located just below the squamocolumnar junction was observed on upper gastrointestinal endoscopy. A piece of biopsy was taken. Histologically, a lamella bone trabecula and chronic inflammatory cells were observed in the gastric cardiac mucosa. The follow-up endoscopy performed one month later showed no residual lesion.

증례 : 대장내시경으로 제거된 S상 결장에 감입된 이쑤시개 1예

박진일 ( Jin Il Park ),엄성현 ( Sung Hyeon Eum ),김철연 ( Cheul Yeon Kim ),윤지환 ( Ji Hwan Yoon ),황홍석 ( Hong Seok Hwang ),김영성 ( Yeong Sung Kim ),곽동협 ( Dong Hyup Kwak ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6

저자들은 급성 복증으로 오인되어 충수돌기제거술을 받고 난 후 재발된 하복부 동통을 호소한 환자에서 대장 내시경상 S상 결장 내에 감입되어 국소 농양을 형성하고 있는 이쑤시개를 발견하여 내시경적으로 제거하였던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Most ingested foreign bodies spontaneously pass through the upper and lower intestinal tract. The impaction of an ingested foreign body in the colon is rare. Foreign bodies swallowed inadvertently often cause serious complications, such as perforation, obstruction, abscess formation, enterocolic fistula, or hemorrhage. Physicians should proceed with routine medical care while considering the possibility of the ingestion of a foreign body In cases where abdominal pain of an unknown origin is observed, particularly in elderly patients who wear dentures, alcoholics, mentally disturbed, or rapid eating, and presenting with altered bowel habits. We report a case of a colonoscopically-removed wooden toothpick that impacted the sigmoid colon and was complicated by the formation of a local abscess with a review of the literature. (Korean J Med 71:668-672, 2006)

복수를 동반한 호산구성 위장염 1례

한승묵,신원승,김민수,김정희,김성종,정재진,이동욱,이동욱,곽동협 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.3

호산구성 위자염은 툭발성으로 위장관 벽의 호산구 침윤과 말초 혈액내 호산구증다증을 동반하고 다양한 위장관 증상을 나타내는 질환으로 복수가 동반된 경우는 매우 드문 것으로 알려져 있다. 이에 저자들은 최근에 말초 혈액에 호산구증다증과 장점막의 호산구 침윤뿐만 아니라 소산구성 복수가 동반되고 스테로이드 요법으로 잘 치료된 호산구성 위장염 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Eosinophilic gastroenteritis is an uncommon disease of uncertain etiology characterized by eosinophilia in the peripheral blood and eosinophilic infiltrates in the bowel wall. Clinical features vary depending on which layers or regions of the gastrointestinal tract are mainly affected. Mucosal involvement causes malabsorption. protein-losing enteropathy and diarrhea. Infiltration of the muscle layer manifests gastric outlet or small bowel obstruction. Serosal involvement causes an exudative ascites rich in eosinophils. Eosinophilic gastroenteritis with ascites is a rare from of eosinophilic gastroenteritis. In this paper, we present a case of eosinophilic gastroenteritis with ascites demonstrating eosinophilia in the peripheral blood and eosinophilic infiltrates in the mucosal wall. The patient was successfully treated with steroid therapy. In addition to this case report, the several literatures on eosinophilic gastroentritis are reviewed.

고립성 직장결핵 3예

이동수,정강욱,황도연,이형화,김대현,김영성,곽동협 대한내과학회 2003 대한내과학회지 Vol.64 No.1

저자들은 장결핵 중 발생 부위상 드문 곳으로 알려진 직장에 발생한 고림성 결핵을 3예 경험하였기에 문헌고찰과 함께 보고하는 바이다. Isolated rectal tuberculosis commonly involves sigmoid, ascending, or transverse colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. Isolated rectal tuberculosis was defined as focal lesions of rectum in the abscence of demonstrable lesions in the small and large bowel. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic feature of tuberculosis in biopsy material and response to antitubercular therapy. Three patients with isolated rectal tuberculosis were seen at Kwak's hospital. The lesions observed was classified according to macroscopic morphology as follows: ulcerative, hypertrophic and ulcero-hypertrophic. Clinical manifestations were non-specific and consists of rectal bleeding, fever, weight loss, constipation and abdominal pain. One of the three patients had coexisting tuberculous pleurisy. Response to antitubercular chemotherapy was good. (Koeran J Med 64:96-100, 2003)

Cryptococcus 뇌막염 4례

기세길,박근용,곽동협,강영우,윤덕구,박승국 啓明大學校 醫科大學 1987 계명의대학술지 Vol.6 No.1

Four cases of cryptococcal meningitis were experienced in Keimyung University Hospital during 11 years periods. These patients were one pregnant woman, one man who had liver cirrosis and diabetes mellitus and two healthy men. After admission, all four patients were treated with antituberculous agent under the impression of tuberculous meningitis, but no clinical improvement was achieved. Later, Crytococcus neoformans was identified in CSF by India ink preparation or Sabouraud media culture, after then one patient was treated with combination of amphotericin B and 5-fluorocytosine and achieved much clinical and laboratory improvement. Unfortunately other three patients were not followed. The authors experienced four cases of crytococcal meningitis and herein presenting our experience and literature were reviewed.