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안효석 ( Hyo Suk Ahn ),이상길 ( Sang Kil Lee ),김효종 ( Hyo Jong Kim ),장재영 ( Jae Young Jang ),주광로 ( Kwang Ro Joo ),동석호 ( Seok Ho Dong ),김병호 ( Byung Ho Kim ),이정일 ( Joung Il Lee ),장영운 ( Young Woon Chang ),장린 ( R 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5
목적: 최근 염증성 장질환 치료에 면역억제제와 면역조절제는 주된 역할을 하고 있다. 크론병 환자의 70%, 궤양성 대장염 환자의 32%가 평생 1회 이상 수술 치료를 받는 것으로 알려져 있다. 스테로이드와 6-MP/AZA로 치료 받는 염증성 장질환에서 예정된 장 수술이 시행되는 경우가 많다. 저자들은 스테로이드 또는 6-MP/AZA를 사용하는 환자에서 수술 후 감염 위험성이 높아지는지 여부를 알아보고자 하였다. 대상 및 방법: 1986년 1월에서 2005년 12월까지 경희의대 부속병원에서 예정된 장 수술을 시행 받은 모든 크론병 (n=25)과 궤양성 대장염 환자(n=19)를 대상으로 하였다. 나이, 성별, 유병 기간, 수술 시행 이유, 수술 시간, 수술 종류, 수술 후 감염 유형, 입원 기간, 스테로이드와 6-MP/AZA 사용, 수술 전 검사 결과 등의 의무기록을 후향 조사하였다. 27명은 스테로이드 단독으로 복용 중이었고, 6명은 6-MP/AZA 단독 또는 6-MP/AZA와 스테로이드를 사용 중이었고, 16명은 스테로이드와 6-MP/AZA 모두 사용하지 않았다. 결과: 수술 받은 염증성 장질환 중 17명(38.6%)에서 수술 후 감염이 발생하였고, 수술 부위 감염(76.5%) 빈도가 가장 높았다. 수술 시행 이유로는 약물에 반응을 보이지 않은 경우 (40.9%)가 가장 많았고, 이 경우 수술 후 감염의 빈도 또한 높았다(58.8%, p=0.032). 염증성 장질환 환자 중, 스테로이드 치료군은 약물을 사용하지 않은 군보다 수술 후 감염률이 높았다(p=0.039). 스테로이드에 추가로 6-MP/AZA를 사용한 군은 스테로이드 단독 사용 군 보다 수술 후 감염 발생률이 높지 않았다(p=0.415). 결론: 예정된 장 수술을 시행 받은 염증성 장질환 환자에서 수술 전 스테로이드 치료는 수술 후 감염 합병증의 위험성을 증가시켰다. 스테로이드에 추가로 6-MP/AZA를 사용한 환자들은 수술 후 감염 합병증이 유의하게 증가하지 않았다. Background/Aims: The clinical course of patients with inflammatory bowel disease (IBD) frequently leads to the use of immunosuppressants and immunomodulators. We investigated the risk of postoperative infection in patients with IBD undergoing elective bowel surgery and whether the use of corticosteroid (CS) and/or 6-mercaptopurine/azathioprine (6-MP/AZA) before surgery was associated with the increased risk of postoperative infection. Methods: Patients who were diagnosed as Crohn`s disease (n=25) or ulcerative colitis (n=19) and underwent elective bowel surgery between 1986 and 2005 were identified. Medical records were retrospectively analyzed including age, sex, duration of disease, indication for surgery, duration of surgery, type of surgery, type of postoperative infection, admission period, usage of CS and 6-MP/AZA, and preoperative laboratory values. There were 27 patients receiving CS alone, 6 patients receiving 6-MP/AZA alone or with CS, and 16 patients receiving neither CS nor 6-MP/AZA. Results: There were 17 postoperative infections (38.6%) among IBD patients who had undergone surgery and wound infection was the most common type of infection (76.5%). In IBD patients, patients receiving CS had higher postoperative infection rate than those patients receiving neither CS nor 6-MP/AZA (p=0.039). Patients receiving CS in conjunction with 6-MP/AZA did not have significantly higher postoperative infection rate than those with CS only (p=0.415). Conclusions: Preoperative use of CS in patients with IBD is associated with the increased risk of postoperative infections. Addition of 6-MP/AZA in patients receiving CS does not increase the risk of postoperative infections. (Korean J Gastroenterol 2006;48:306-312)
포스터 전시 : 담도,췌장 ; 장기간 혈액투석을 시행받는 만성 신부전 환자에서 발생한 급성 괴사성 췌장염에 동반된 장 경색 1예
한요셉 ( Yo Seb Han ),동석호 ( Seok Ho Dong ),김한숙 ( Han Suk Kim ),이동근 ( Dong Keun Lee ),김효종 ( Hyo Jong Kim ),김병호 ( Byung Ho Kim ),장영운 ( Young Woon Chang ),이정일 ( Joung Il Lee ),장린 ( Rin Chang ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
만성신부전환자에서 발생하는 급성췌장염은 만성신부전이 없는 환자에서와 달리 원인이 알코올, 담석, 약물에서도 기타의 원인들이 많은 것으로 보고되고 있다. 혈액투석을 시행받는 만성신부전환자에서 급성췌장염의 발생기전은 대부분 전신적인 동맥경화증의 진행으로 인한만성 허혈성 손상에 의한 것이며 그 밖에 이뇨제, 고중성지방혈증, 고칼슘혈증, 저혈압 등이 관여하는 것으로 알려져 있다. 만성신부전환자는 동맥경화성 혈관을 가지고 있고 혈액투석증에 종종 저혈압을 경험하곤
한국인 가족성 염증성 장질환에서 유전학적예기(Genetic Anticipation)에 대한 연구
이병욱 ( Byoung Wook Lee ),김효종 ( Hyo Jong Kim ),양석균 ( Suk Kyun Yang ),박종범 ( Jong Beom Park ),정용희 ( Yong Hee Jeong ),한요셉 ( Yo Seb Han ),박원갑 ( Won Gab Park ),동석호 ( Seok Ho Dong ),김병호 ( Byung Ho Kim ),장영운 ( 대한장연구학회 2003 Intestinal Research Vol.1 No.1
Background/Aims: Several recent epidemiologic studies in familial inflammatory bowel disease (IBD) reported preliminary evidences for genetic anticipation in IBD. However, presence of genetic anticipation in IBD has been questioned. We studied pairs of two-generation first-degree relatives with IBD to identify evidence for genetic anticipation in Korean patients with familial IBD and to know the influence of gender of transmitting parent on anticipation in IBD. Methods: Through retrospective review of the records of 11 parent-child pairs with IBD, we compared age at diagnosis (AAD) and severity of disease between generations and investigate difference in the degree of anticipation with respect to gender of transmitting parent. Results: At the time of study enrollment, the mean age of parents was 56.2 years and 29.1 years in children. Diagnostic intervals (time from first symptoms to diagnosis) between generations were similar (p=0.307). The mean AAD was 21.7 years younger in children than in parents (p<0.001). But, the degree of anticipation was not different according to gender of transmitting parents (p=0.369). Also, severities of disease were not significantly different between generations. Conclusions: Genetic anticipation may exist in Korean patients with familial IBD but, further studies with larger cohorts and sufficient observation time is warranted to rule out the effect of short follow-up time bias. (Intestinal Research 2003;1:31-38)
조직학적 으로 확인된 Dieulafoy`s Vascular Malformation 2예
정진우(Jin Woo Jeong),김효종(Hyo Jong Kim),동석호(Suk Ho Dong),김병호(Byoung Ho Kim),이정일(Jung Il Lee),장영운(Young Woon Chang),장린(Rin Chang) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3
Dieulafoys vascular malformation is an uncommonly reported cause of massive upper gastrointestinal hemorrhage. It is charact.erized by the followings .' a negative past medical his tory, independence from peptic ulcer disease, sudden onset, increasing bouts of hematemesis, subcardial location, a tiny mucosal lesion, an open submucous artery of seemingly large cali- ber, failure of conservative treatment, and high mortality. The diagnosis is usually made by gastroscopy or laparotorny. We experienced 2 cases of Dieulafoys vascular malformation of the stomach, which werv. Proved by histology.(Korean J Gastroenterol 1994; 26: 568 572)
장린(Rin Chang),장영운(Young Woon Chang),이정일(Jung Il Lee),김병호(Byoung Ho Kim),김효종(Hyo Jong Kim),김영관(Young Kwan Kim),김정희(Jeong Hee Kim),동석호(Suk Ho Dong) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1
Adenoid cystic carcinoma(ACC) is well known in the salivary gland, but ACC of the esophagus is a relatively rare lesion which characteristically exibit more aggressive clinical behavior and intensive widespread metastasis. Although many authors think that this tumor arises from the submucosal esophageal gland, its histogenesis is still in dispute. We have recently experienced a 66-year-old man who had ACC of the esophagus with chief complaint of hematemesis. The tumor was discovered incidentally together with gastric ulcer by esophagogastroscopy. The tumor exhibited a large lobulated fungating appearance, morphologically similar to ACC in the salivary glands and localized in th submucosal layer. The patient is still alive and well 12 months after surgery.
단일 기관에서 경험한 크론병에서 Infliximab의 치료 효과
김연주 ( Yeon Ju Kim ),김정욱 ( Jung Wook Kim ),이창균 ( Chang Kyun Lee ),박현진 ( Hyun Jin Park ),심재준 ( Jae Jun Shim ),장재영 ( Jae Young Jang ),동석호 ( Suk Ho Dong ),김효종 ( Hyo Jong Kim ),김병호 ( Byung Ho Kim ),장영운 ( Y 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5
Background/Aims: Our aim was to assess the long-term data regarding efficacy and safety of infliximab (IFX) treatment for refractory Crohn`s disease (CD) patients in our tertiary teaching hospital. Methods: We have retrospectively analyzed the medical records of 89 CD patients who underwent IFX treatment between March 2003 and February 2011 at Kyung Hee University Hospital (Seoul, Korea). The primary outcome measurements were the rates of initial clinical response (CR) at 10 weeks after the 1st IFX infusion and sustained CR at the end of the follow-up. Overall adverse events related to IFX treatment were also evaluated. Results: The mean (SD) follow-up period of eligible 80 patients was 33.7 (21.9) months. A total of 77 patients (96%) showed initial clinical response, but 8 patients showed loss of response to IFX during the follow-up. Finally, 59 patients (59/77, 76.6%) showed sustained CR at the end of the study. Logistic regression analyses showed that an initial CR at 10 weeks was the independent predictor associated with sustained CR (OR 22.286, 95% CI 2.742-132.717, p=0.001). Overall adverse events reported in 18 patients (18/80, 23.3%), including 3 serious infection (pulmonary tuberculosis and herpes zoster). Conclusions: Treatment with IFX was efficacious and relatively safe for refractory CD patients in Korea. An initial CR at 10 weeks was significantly associated with sustained CR.
이상호,김원호,백일현,이정일,김병호,김효종,김영관,장린,동석호,장영운,양석균 대한소화기학회 2000 대한소화기학회지 Vol.35 No.4
Background/Aims: The decrease of bone mineral density (BMD) has been reported in Western patients with inflammatory bowel disease (IBD). However, its prevalence and pathophysiology in Asian population have never been studied. The aim of this study was to investigate the prevalence and mechanism of osteopenia in Korean patients with newly diagnosed IBD. Methods: We studied 14 patients with Crohn's disease (CD) and 25 patients with ulcerative colitis (UC), all of whom had never used corticosteroids. BMD was measured in the lumbar spines and the femur by dual-energy X-ray absorptiometry. Biochemical parameters of bone metabolism, such as osteocalcine, iPTH, active and inactive vitamin D, were measured. Results: Reduced BMD (Z score$lt;-1) at the spine was observed in 36% of the patients and there was no significant difference in lumbar Z scores in the patients with CD and the patients with UC. There was no significant difference in nutritional status or biochemical parameters of bone metabolism between the patients with normal BMD and those with decreased BMD. There was a significant correlation between the lumbar BMD and femoral neck BMD. Conclusions: Decreased trabecular bone density is a common feature in Korean patients with newly diagnosed IBD as well as in Western patients. The mechanism causing low bone mass is not related to ethnic difference. Malnutrition such as calcium or vitamin deficiency could possibly play a certain role in the pathogenesis of bone loss in patients with newly diagnosed IBD.