안정형 및 불안정형 협심증 환자에서 관동맥 조영술상 병변형태와 관동맥내 혈전에 대한 비교

이록윤(Rok Yun Lee),한윤창(Yun Chang Han),지재환(Jae Hwan Jee),조병동(Byung Dong Cho),채경수(Gyeoung Soo Chae),장명국(Myoung Kuk Jang),서유미(Yu Mi Seo),김재삼(Jai Sam Kim),경태영(Tae Young Kyong),임종윤(Chong Yun Rim),고영박(Young B 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: Unlike stable angina, unstable angina is a common syndrome associated with significant morbidity and frequent progression to acute myocardial infarction. Several investigators have suggested that corronary artery thrombus formation, most likely secondary to plaque rupture in complex morphology of stenotic coronary artery, may preci- pitate unstable angina. But the frequency of coronary artery thrombus by coronary angiography is diverse. Methods: In 108 patients with either stable(27 patients) or unstable angina(81 patients), the morphology of coronary artery lesions was qualitatively assessed by angiography. Each obstruction reducing the luminal diameter of the vessel by 50% or greater was categorized into one of Ambrose morphologic classification. Results: Type II eccentric lesion was more frequent in patients with unstable angina pectoris (38.9%) than in patients with stable angina pectoris (6.1%) (p<0.01). Frequency of intraluminal ulcer was 31.9% in unstable angina, and 8.6% in stable angina(p<0.05). Intraluminal thrombus was observed more frequently in unstable angina pectoris(18.6%) than in stable angina pectoris(6.1%)(p<0,05). Conclusions: The high prevalence of type II eccentric lesion morphology, ulcer, and intraluminal thrombus observed in patients with unstable angina emphasizes the important role of intimal disruption and of subsequent thrombogenesis in the pathogenesis of myocardial ischemic in those unstable syndromes of ischemic heart disease.

Helicobacter pylori 감염이 있는 환자의 배우자에서의 감염빈도와 임상적 의의

김학양,유재영,박충기,김종혁,김용범,장웅기,김재삼,박수종 대한소화기학회 1998 대한소화기학회지 Vol.31 No.6

Background/Aims; The transmission mode of Helicobaeter pylori infection has not been definded. We investigated the seroprevalence of H. pylori infection in spouses of infected patients to clarify the transmission mode of H. pylori infection, Methods: Sera were collected from 26 spouses of infected patients and examined for H. pylori infection by serology. We compared the antibody responses to H. pylori proteins (CagA, VacA and urease subunits) in 5 couples. Results: H. pylori infection was observed in 20 out of 26 spouses (77%). The infection rate was increased from 50% in less than 10 years of cohabitation to 100% in more than 31 years of cohabitation. The gastroscopic exarnination for the infected patients revealed chronic gastritis in 6, gastric ulcer in 9, duodenal ulcer in 8, concurrent gastric and duodenal ulcer in 2, and gastric cancer in 1. In spouses, the gastroscopy showed chronic gastritis in 10 and pyloric canal ulcer with H. pylori infection in 1. The couple with pyloric canal ulcer showed similar antibody responses to CagA, VacA and urease subunits. Conclusions: This study suggested that H. pylori might be transmitted via oral to oral route. Further study about the risk of gastroduodenal lesion in spouses is needed.

Propofol 지속정주를 이용한 상부소화관 내시경

김경호,이기성,김학양,유재영,박충기,김용범,김재삼,엄광석,노병연 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.5

Background/Aims: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. Methods: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6∼10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. esults: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7±2.1, 20.9± 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. Conclusions: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy.

Helicobacter pylori 감염의 박멸후 발생한 역류성 식도염

이준호,김학양,유재영,박충기,김종혁,이종민,김용범,서지영,김재삼,유희승 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.5

Helicobacter pylori infection causes chronic gastritis and its well documented con- sequences are peptic ulcer disease and gastric neoplasia. As duodenal ulcer is often associated with gastroesophageal reflux disease and antral gastritis is a frequent finding in patients with reflux disease, H. pylori infection may be a common cause of both conditions. Recent studies reveal that H. pylori has no role in the pathogenesis of reflux esophagitis. Furthermore, there are some arguments on whether H. pylori infection may have a protective role in reflux esophagitis. We have experienced two cases of reflux esophagitis after cure of H. pylori infection. H. pylori eradication therapy was performed in two patients who have gastric and/or duodenal ulcer with omeprazole and two anti-biotics (clarithromycin and amoxicillin). After cure of H. pylori infection, reflux esophagitis was demonstrated in these patients by endoscopy.

담낭에 발생한 전장낭 1예

이진헌,김학양,유재영,김주섭,김용범,김재삼,허관석,송홍석 대한소화기학회 2000 대한소화기학회지 Vol.36 No.2

During the early embryonal stage of foregut development, malformations may be encountered. Foregut duplications are considered to be developed due to abnormal cannulization of the gastrointestinal tract. It may be communicating or non-communicating, and cystic or tubular. They are lined by mucosal membrane and subdivided into bronchogenic, esophageal, gastroenteric or ciliated hepatic cysts. We encountered a case of foregut cyst of gallbladder in pulmonary tuberculosis patient incidentally. The patient was a 37-year-old female complaining of nausea. Physical examination revealed no abnormal findings, but abdominal ultrasonography demonstrated small cystic mass in gallbladder. On endoscopic retrograde cholangiopancreatography, we found a filling defect of gallbladder which looked compressed externally. Abdominal computed tomography scan revealed 1 cm sized intramural cystic mass on the fundus of gallbladder. At laparotomy, 5×4×0.5 cm sized gallbladder was excised and it had greenish colored and soft surface.t also revealed 1.5×1.5 cm sized cyst. Pathology showed a cystic mass containing bronchial mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers.

Helicobacter pylori 감염이 소화성 궤양 출혈에 미치는 영향

유재영,이준호,이자영,김성균,박충기,김학양,김용범,서지영,김재삼,장명국,노병연,최종형,김종혁 대한소화기학회 1998 대한소화기학회지 Vol.31 No.4

Background/Aims: The aim of the present study was to determine whether Helicobacter pylori infections are related to the risk of bleeding complications of peptic ulcer disease. Methods: We have examined 267 patients with symptoms and endoscopic stigmata of recent ulcer bleeding. The severity of ulcer bleeding was categorized by Forrest classification and H. pylori infection was evaluated by CLOtest. The H. pylori infection rates of the patients group were cornpared with those having uncomplicated peptic ulcer. Results: The positive rate of H. pylori infection in total patients with bleeding ulcer was 65.2% (174 of 267), which was significantly lower than that of patients with non-bleeding ulcer 72.6% (748 of 1031)(p$lt;0.05, OR;0.708, 95%, CI;0.532-0.943). However, in subgroup analysis, the positive rates of CLOtest in patients with bleeding gastric ulcer (GU) and duodenal ulcer (DU) were 59.0% (98/166) and 76.1% (70/92), respectively. These data are similar to the rates obtained from those with uncomplicated ulcers, 66.1% (302/457) in GU, and 79.3% (367/463) in DU, respectively (p=0.105, p=0.496). In the subgroups of Forrest Ia and Ib, 20 out of 21 patients (95.2%) were infected by H. pylori, and their infection rate was significantly higher than that of total patients (p$lt;0.05). Conclusions: Our results suggested that H. pylori infection was not a risk factor of bleeding complications of peptic ulcer. However, the subgroup of active ulcer bleeding, Forrest Ia and Ib could be associated with H. pylori infection.