장출혈을 동반한 회장의 림프종

김성걸(Seong Gul Kim),최지영(Jee Young Choi),임의혁(Euyi Hyeog Im),김진희(Jin Hee Kim),육은주(Eun Ju Yook),김병호(Byeong Ho Kim),성자원(Ja Won Sung),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

Primary small intestinal lymphomas are a hetorogenous group of tumors ortginating from the lymphoid cells of the mucosa and submucosa of the small bowel. The ileum and jejunum are most frequently affected, whereas duodenal involvement is less common. There is a himodal age distribution with peak incidences below the age of 10 and in the fifth and sixth decados, with a slight male prodominance. And it is very difficult to diagnose until the dovelopment of any complications such as obstruction, perforation ancl hemorrahage because of the insidious onset of disense and relative inaccuracy of the diagnostic tools as in all the small bowel tumor. Optimal treatment choices for lymphoma remain controversial. Surgical resection, in many cases, is considered the first line of defense. Primary malignant lymphoma of the small intestine has poorer prognosis due to the delay of the diagnosis than any other extra-intestinal malignancy, but has the better prognosis than any other small intestinal malignancy. The histologic type, the extent of the intestinal disease, and the prosence or absence of extraintestinal involvement are the important factors in prognosis. Patients with resectable disease typically have a 40/r, to 507r, S-year survival. Recently the authers diagnosed the primary small intestinal lymphoma associated with a large amount of bleeding confirmed by intraoperative biopsy. So we report this case with the review ot literatures. (Korean J Gastroenterol 1995;27:251-255)

허혈성 장질환의 임상적 고찰

김진희(Jin Hee Kim),서광식(Kwang Sik Seo),김성걸(Seong Gul Kim),김남재(Nam Jae Kim),정현용(Hyun Young Jeong),이헌영(Heon Young Lee),김영건(Young Kun Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective: Despite increased awareness of the fatality of mesenteric ischemia, the diagnosis seldom is made prior to the onset of gangrene. The multiplicity of etiologic factors, the many varied presentations, and splanchnic vasoconstriction all affect the extent of ischemic injury, adding to the complexity of the clinical problem. Extensive acute processes are still catastrophic illnesses with a high mrotality, but there is a potential for both better diagnisis and therapy with an improved outcome. Discussion of the pathophysiology, diagnosis, and treatment of this entity will be presented. Methods: A Retrospective review of our experience with ischemic bowel disease was made. Ten consecutive clinical cases admitted in ChungNam National University Hospital from October 1990 to April 1994 were observed. Results: 1) We experienced 5 patients with arterial embolic occlusion, 1 patient with venous thrombosis and 4 patients with colonic ischemia. 2) The peak ages were 6th decade and 8th decade. 3) The major clincal symptoms and signs were abdominal pain (100%), abdominal tenderness (70%), melena (70%), nausea (60%), fever (50%), vomiting (40%) and abdominal distension (30%). 4) On laboratory findings, there were leukocytosis (80%) and thrombocytopenia (20%) 5) In plain film, there were ileus (70%), edematous intestinal wall (50%), mucosal edema (30%), thumb printing (10%) and gasless abdomen (10%). Among the 5 cases performed abdominal CT, there were thickening of intestinal wall in 4 cases, narrowing of intestinal lumen in 2 case and ascites in 3 cases. 6) Bowel resections were perfomed in 7 cases and supportive care was performed in 3 cases. 7) The overall mortality rate was 30%, Conclusion: An oggressive approach in patients suspected of having ischemic bowel is indicated if the diagnosis is to be made before necrosis has occurred. A high index of suspicion, early angiography, correction of the underlying cardiac disease, treatment of splanchnic vasoconstriction, surgical revascularization, and resection of gangrenous bowel are necessery if there is to be a significant reduction in the high mortality rates associated with mesenteric ischemia.

고 위험군 급성 담낭염 환자에서 경피적 담낭배액술의 치료 효과

김남재(Nam Jae Kim),이경태(Kyung Tae Lee),이승민(Seung Min Lee),김석현(Seok Hyun Kim),이병석(Byung Seok Lee),서광식(Kwang Sik Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),이헌영(Heon Young Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

N/A Background/Aims: Percutaneous cholecystostomy for decompression and drainage of the gallbladder is indicated when the patient is elderly or suffers from an inflatnmatory process of the gallbladder and is unable to tolerate an operation. To evaluate the role of percutaneous cholecystostomy in the management of acute cholecystitis in the high risk patients, we reviewed our experiences. Methods: Fourteen high risk critically ill patients with acute cholecystitis underwent percutaneous cholecystostomy from January, 1994 to July, 1995 using 8.'7 Fr pigtail catheter under real-time ultrasound and fluoroscopic guidance. Results: The clinical conditions of 14 patients improved after percutaneous cholecystostomy without technical complications. Eight patients subsequently underwent successful elective cholecystectomy after improvement in their medical condition, but one patient who underwent surgery died 10 days after surgery due to gastric varix bleeding which was not related to the gallbladder catheter. The remaining six patients had resolution of acute cholecystitis but did not undergo elective operation because of their poor medical conditions (three in calculous disease) and restoration of gallbladder function(three in acalculous disease). Conclusions: Percutaneous cholecystostomy may be used as an initial life saving procedure for critically I]1 patients with acute cholecystitis, and serves as a definitive procedure for patients considered to be at high operative risk and who have no residual stones. (Korean J Gastroenterol 1997; 29:515-521)

Morgagni`s Hernia 2예

육은주(Eun Ju Yook),전준식(Joon Sik Jeon),김성걸(Seong Gul Kim),김진희(Jin Hee Kim),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),김응중(Eung Jung Kim),이영(Young Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

We report two cases of Morgagnis hernia comprising the protrusion of omentum alone. The treated patients were 65- and 64-year old women. They were referred to our hospital due to epigastric discomfort, or dypnea accompanied by an abnormal shadow in right cardiophrenic angle on chest roentgenogram. Surgery through an abdominal approach was preferred and the post- operative course was benign. (Korean J Gastroenterol 1996;28: 148 150)

위선종과 위암에서 면역조직화학적 염색을 이용한 p53 단백 발현율의 비교

김진희(Jin Hee Kim),서광식(Kwang Sik Seo),김성걸(Seong Gul Kim),임의혁(Euyi Hyeog Im),육은주(Eun Ju Yook),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),이충식(Choong Sik Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

N/A Backgrounds: The mutation of p53 gene and p53 protein accumulation is discovered in dysplasia of stomach and gastric cancer. We compared p53 protein expression rate with gastric adenoma and gastric cancer using the immunohistochemical stain and tried to know the correlation of the malig- nant potential of gastric adenoma with p53 protein expression. Methods: We obtained 52 tissues from 22 gastric cancers and 30 gastric adenomas. Accumulation of p53 protein was detected by immunohistochemistry using Anti-Human p53 monoclonal antibody(Pab 1801; Pharmingen). Results: p53 immunoreactivity was detected in 33.3% of gastric adenomas and in 59.l% of gastric cancers. But, threre was no significant difference between two groups(p=0.065). The rate of p53 expression according to various stages, differentiations, cell types in gastric cancers was not significantly different. Also, p53 expression rate according to cell types, size in gastric adenomas showed no significant difference. Conclusions: We suggest that mutation of the p53 gene is an early event in stomach tumorigenesis. But there is to be required more research about the correlation of the malignant potential of gastric adenoma with p53 protein expression. (Korean J Gastroenterol 1995;27: 509 - 516)

간경변증 환자에서 간신티그램을 이용한 Propranolol 투여 전후의 간혈류 변화

김병호(Byeong Ho Kim),서광석(Kwang Suk Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),육은주(Eun Ju Yook),임의혁(Euyi Hyeog Im),성자원(Ja Won Sung),이강욱(Gang Wook Yi),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Esophageal varix bleeding due to portal hypertension in liver cirrhotics is very emergency state and difficult for management. In spite of many kinds of treatment in esophageal varix bleeding such as medical and surgical methods, but cant be expected of good results. Lebrec report that propranolol is significantly decreased portal venous pressure in 1980. This study analyzed the portal hemodynamics by liver scintigraphy of 38 patients with liver cirrhosis who were proven to have esophageal varices and 10 norrnal subjects. The 19 cirrhotics had taken liver scintigraphy before and after propranolol medication. There were significant difference in HAI(Hepatic Arterial Index) between cirrhotics and normal subjects(64.7k16.5/ vs 31.9+8.3%, p<0.001). There were no significant difference in HAI according to the Childs classification, the type of variceal morphology and the presence of ascites, but the HAI in Child B(68.1%) and C(63.4%) groups were higher than that in Child A group(55.5%). The heart rate decreased significantly after propranolol ( 7.6No./min, p<0.001) and the HAI increased significantly after propranolol (+8.0%, p<0.05). It should be suggested that propranolol is effective in decreasing the portal hypertension by decreasing the portal blood flow. There were no serious complication of propranolol. In conclusion, these results suggest that propranolol could be a potentially useful and safe agent in management and prevention of variceal bleeding by decreasing the portal hypertension and the liver scintigraphy with Tc tin colloid is reasonably a accurate, simple, safe, and rapid method, therefore can be considered suitable for use in the assecement of liver hemodynamics.(Korean J Gastroentero11994; 26: 119-126)

조직학적으로 증명된 위 평활근육종의 임상적 고찰

서광식(Kwang Sik Seo),이병석(Byeng Seok Lee),김석현(Seok Hyun Kim),김성걸(Seong Gul Kim),김진희(Jin Hee Kim),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Objectives : Gastric leiomyosarcomas are uncommon, represent 1 to 3% of primary malignant neoplasms of the stomach and variable in clinical outcomes. This paper is a retrospective study of the clinical behaviour, histopathologic features and prognostic factors. Methods : Between January 1990 and August 1996, the records of nine patients with primary gastric leiomyosarcoma treated at Chung-Nam National University Hospital were reviewed for clinical presentations and histopathologic feature. The statiscal analysis with SAS system was employed for evaluation of prognostic factors. Results: 1) The median age of the patients was 53.4 years with even age distribution from 31 to 76 years. The male and female ratio was 1.25 to 1. 2) The common symptoms were abdominal pain(67%), bleeding(22%) and indigestion(11%). 3) The locations of the tumor was body(56%) and fundus(44%). The growth pattern of the tumor was mostly submucosal(67%). 4) The average size of tumors was 11cm (6-18cm). 5) The central ulcer on the tumor showed 100%. The endoscopically and preoperative diagnosed leiomyosarcoma with endoscopic biopsy was 33%. 6) The low grade tumors were 7 cases and high grade was 1 in eight resected primary gastric leiomyosarcomas. 7) The overall resectability was 89%. The resected cases had no lymph node metastasis. Chemotherapy and radiotherapy was done 5 cases and 1 case, respectively in patients with high mitotic number, large size and distant metastases. 8) The follow-up period was 4 to 49 months and 3 patients were died. Two of 3 died patients were initially diagnosed stage IVA and 1 patient was stage II with very large size (18cm). The average survival time of 3 died patients was 37 months. 9) The two patients from surgically resected eight cases were recurred at liver and peritoneum and died 11 months and 31 months recurrence, respectively. Conclusion : The advanced stage and recurred case has short survival time but the more many cases and longer follow-up periods should be need to identify for prognostic factors and the effective postoperative adjuvant therapy should be studied for high risk patients.

만성 간질환에서 혈청 Type Ⅳ Collagen 측정의 의의

이헌영,김성걸,정현용,구선회,박종우,강대영 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

To evaluate the clinical significance of serum type N collagen levels in patients with various liver diseases, serum type IV collagen levels were measured by one-step sandwich enzyme immunoassay using monoclonal antibodies in 80 patients from December 1993 to December 1994 at Chung Nam National University Hospital. The results were as follows : 1. Mean age of patients was 45 years. Men was 2.1 times more than women. 2. Compared to 15 normal controls(159.9±34.0 ng/ml), serum type IV collagens were significantly elevated in patients with chronic hepatitis (254.5±158.0 ng/ml), liver cirrhosis(281.0±195.7 ng/ml) and hepatocellular carcinoma(420.5±241.4 ng/ml) (p<0.005). 3. Serum type IV collagen levels were increased without significance in patients with alcholic liver cirrhosis(331.6±244.5 ng/ml) compared to non-alcholic cirrhosis(230.4±117.8 ng/ml. p>0.05). 4. The serum levels of type IV collagen were not correlated with the levels of alanine amino-trnasferase(ALT), aspartate aminotransferase(AST) and alkaline phosphatase(ALP). The results suggest that the serum type IV collagen levels correlate well with the degree of progression of chronic liver diseases. Therefore the measurement of serum type IV collagen is relatively simple and useful method to reflect the progression of chronic liver diseases.

만성 간질환에 대한 DDB(Biphenyl Dimethyl Dicaboxylate)의 임상적 효과

이헌영,임의혁,김성걸,김진희,육은주,성자원,김병호,정형용,강대영,김영건 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

To investigate the effects of short-term administration of DDB(Biphenyl Dimethyl Dicarboxylate) for decreasing elevated serum aminotransferase levels in chronic liver diseases, authors applied 3 capsules of DDB per day at each meal time for 35 patients and compared with 35 patients treated with other conservative management. The following results were obtained. 1. Serum alanine aminotransferase (ALT) levels significantly decreased from 247.1± 180.0 IU/L of pretreatment level to 96.6±126.0 IU/L, 61.1±62.7 IU/L and 38.0±26.8 IU/L after 1, 3 and 6 months of treatment(p<0.05) and effective rates were observed in 60.0%, 71.4% and 88.6% of patients after 1, 3 and 6 months of treatment. 2. Serum aspartate aminotransferase (AST) levels decreased also significantly from 167.8±96.9 IU/L of pretreatment levels to 124.4±155.0 IU/L, 77.9±49.6 IU/L, 60.6± 46.9 IU/L after 1, 3 and 6 months of treatment(p<0.05), but decreasing pattern of serum AST was less significant than that of serum ALT. 3. No significant difference were observed in the serum ALT and AST changes according to the cause and duration of hepatitis. 4. No significant adverse effects were observed in whole patients treated with DDB. It is suggested that small dose administration of DDB is effective for decreasing serum aminotrans ferase levels in chronic liver disease in which other conservative management was not effective.

급성 담낭염에 대한 내과적 치료의 역할

강성원,조한래,한설해,박현주,정인성,홍선미,김성걸,이헌영 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

In 58 patients who were admitted to department of internal medicine, ChungNam national university hospital from January 1989 to March, 1993. We evaluated for medical treatments and the following results were obtained. 1) The ratio of male and female was 1 : 1 and mean age of the patients was 57.4 years. 2) At arrival on hospital, the most common clinical symptom was pain in right upper quadrant and epigastrium(93.1%), the remainders were fever and chill(79.3%), nausea(51.7%) and vomiting(36.2 %) in order of frequency. 3) The most common physical findings was tenderness on the right upper quadrant and epaigastrium(98%), the remainders were jaundice(50%) and palpable gall bladder(13.8%) in order of freguency. 4) In laboratory examination, elevated levels of ESR(82.8%), leukocytosis(67.2%), elevated levels of AST(62.0%), ALT(50.0%), serum total bilirubin(51.7%) and alkaline phosphatase (43.1%) were noted. 5) The mean period of NPO was 3.9 days and the mean hospital period was 13.5 days. 6) The rates of combined complications in patients with acute cholecystitis were 17.2%; these are gall bladder empyema(5.2%), hydrops(5.2%), perforation(3.4%), sepsis(3.4%) and intestinal obstruction (1.7%). 7) In 96.6 percent of 58 cases, the symptoms of acute cholecystitis were improved by conservative management. 8) The mean follow-up period was 25.5 months and the recurrence rate was 10% during this period.