원발성 담즙성 경변증 16예의 임상상 : 단일 센터 경험

박동일(Dong Il Park),고광철(Kwang Cheol Koh),이준혁(Jun Hyek Lee),최문석(Moon Seok Choi),강태욱(Tae Wook Kang),문원(Won Moon),류민규(Min Kyoo Ryu),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),장재권(Jae Kwon Jang) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown etiology. The disease is relatively common in western countries, but so far, only about 20 cases have been reported in Korea. Thus, the purpose of our prospective study was to evaluate the clinical characteristics of PBC in Korea. Methods : Between October 1994 and February 1999, 16 patients diagnosed as PBC at our department were enrolled in this study. We analyzed these patients for the distribution of age and sex, initial symptoms and signs, associated disorders, laboratory, endoscopic, and radiologic and histologic findings. Results : Of the 16 patients, the ratio of male to female was 1:7 and the average age was 57.5 years. Pruritus (37.5%) was the most frequent presenting symptom followed by xerostomia and xerophthalmia (12.5%), jaundice (6.3%), chronic fatigue (6.3%), melena (6.3%). Associated disorders were Sj gren's syndrome (25%), arthropathy (12.5%), Raynaud's phenomenon (6.3%) and diabetes (6.3%). Abnormalities of liver function were found frequently. Antimitochondrial antibody (100%), antinuclear antibody (31.25%) and rheumatoid factor (31.25%) were found. Long-term administration of UDCA improved both clinical and biochemical signs in most patients, however, 2 patients experienced exacerbation during UDCA therapy. Conclusions : We experienced 16 cases of PBC within a short period. It is expected that we can find these patients more frequently if we suspect this disease in patients with pruritus and unexplained obstructive pattern of liver function abnormality.(Korean. J. Med 59:634-640, 2000)

식도 정맥류 출혈을 동반한 간경변 환자에서 Ciprofloxacin의 예방적 투여는 세균성 감염 예방에 효과적인가?

홍성노,김범진,이선영,이춘영,류민규,최문석,이준혁,이풍렬,고광철,김재준,백승운,이종철,최규완 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3

목적: 식도 정맥류 출혈을 동반한 간경변증 환자 에서 세균성 감염은 비교적 흔한 합병증으로 불량한 예후와 연관되어 있다. 이러한 환자에서 경구용 항생제를 예방적으로 투여하면 세균성 감염의 위험을 낮출 수 있는 것으로 보고 되어 왔으나, 세균성 감염이 흔히 발생하는 출혈 초기에는 경구로 항생제를 투여하는 것이 상당수에서 비효율적이며, 투여 자체가 어려운 경우가 많다. 저자 등은 식도 정맥류 출혈을 동반한 간경변증 환자에서 ciprofloxacin의 정맥 투여가 세균성 감염 예방에 효과적인지 알아보고자 연구를 시행하였다. 방법: 식도 정맥류 출 혈로 내시경적 식도 정맥류 결찰술을 시행 받은 Child-Pugh 분류 B군 이상의 간경변증 환자 40명 (남:여=33:7, 연령:30∼78세)을 일련적으로 등록하여 치료군(20명)과 대조군(20명)으로 무작위 배정하였다. 치료군에게는 ciprofloxacin 200mg을 12시간 간격으로 72시간 동안 정맥 주사하였고, 대조군에게는 항생제를 투여하지 않았다. 이들을 7일간 추적 관찰 하며 혈액 배양 검사, 소변 검사, 흉부 방사선 촬영 과 복수 천자 등의 검사를 시행하여 세균성 감염 여부를 양군간에 비교하였고, 각 군의 임상 경과와 병 원 재원 일수 및 의료비를 비교하였다. 결과: 20명 의 대조군 중 9명(45%)에서 세균성 감염이 발생하였으나, 20명의 치료군 중에서는 2명(10%)에서만 세균성 감염이 발생하여 치료군에서 대조군보다 세균성 감염의 발생이 유의하게 적었다(p<0.05). 임상 경과와 사망률은 양군간에 차이가 없었으나, 재원 기간은 치료군에서는 13.4± 9.6일, 대조군에서는 20.4± 23.7일로 대조군에서 더 긴 재원 기간을 보였고(p<0.001), 의료비도 치료군보다 대조군에서 의료비가 더 많았다(p<0.001). 결론: 식도 정맥류 출혈을 동반한 Child-Pugh 분류 B군 이상의 간경변증 환자에서 출혈 초기 정맥 주사용 ciprofloxacin을 사용하는 것은 세균성 감염의 발생 빈도를 낮추며, 병원 재원 일수 및 의료비를 감소시키는 효과가 있다. Background/Aims: In cirrhotic patients with esophageal variceal bleeding, bacterial infections are a frequent complication. Oral antibiotic prophylaxis decreases the incidence of bacterial infections. The administration of oral antibiotics, however, may be difficult in some cirrhotic patients with active bleeding.The purpose of this study was to assess the efficacy of prophylactic intravenous antibiotics for the prevention of bacterial infections in cirrhotic patients with esophageal variceal bleeding. Methods: From December 1998 to September 2001, a total of 40 consecutive cirrhotic patients with Child-Pugh class B or C were enrolled after emergent endoscopic esophageal variceal ligation (EVL) was taken because of esophageal variceal bleeding. Enrolled patients were randomized into a treatment group and a control group. The treatment group (n=20) received the intravenous ciprofloxacin 200mg IV q 12 hours for 3 days while the control group(n=20) didn,t. Results: Bacterial infection developed in nine patients (45%) of the control group and only two patients (10%) in the treatment group. The incidence of bacterial infections was significantly lower in the treatment group than the control group (p<0.005). The hospital cost and length of hospital stay decreased in the treatment group compared with the control group (p<0.001). There were no differences in the hospital course and mortality within 30 days between the two groups. Conclusions: In cirrhotic patients with variceal bleeding and with Child-Pugh class B or C, the use of intravenous ciprofloxacin for 3 days after EVL was not only effective in the prevention of bacterial infections but also cost-effective. (Korean J Hepatol 2002;8:288-296)

항결핵 화학요법과 외과적 절제로 치료한 간내 일차성 단발성 결핵종 1 예

이경수,이상수,문원,조재원,강태욱,최규완,백승운,최문석,이준혁,이종철,박철근,류민규,홍종락,배문희 대한내과학회 2001 대한내과학회지 Vol.61 No.1

The solitary form of primary hepatic tuberculosis is a rare disease. We report an unusual case of primary solitary hepatic tuberculosis treated with surgical resection and second-line antituberculosis chemotherapy due to the recurrence after first-line antituberculosis chemotherapy alone. A 36-year-old man was presented with right upper abdominal discomfort, chills and weight loss for 2 months. Computerized tomography demonstrated the solitary space occupying lesion on the left lobe of liver suggesting a malignant disease. The open biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis. The patient was treated with antituberculosis chemotherapy for nine months and eighteen months respectively with the interval of eighteen months. But the hepatic lesion had become larger and symptoms were aggravated after the discontinuation of therapy. He underwent surgical excision of the lesioin. With second-line antituberculosis chemotherapy, the symptoms improved in postoperative days. Twenty four months later, no evidence of recurrence was noted in symptoms, laboratory findings and imaging studies. (Korean J Med 61:77-81, 2001)

활동성 크론병에서 초기 스테로이드 치료 반응에 따른 임상적, 생화학적, 병리학적 인자들에 관한 연구

김영호,장재권,김지은,최규완,박동일,도재혁,백승운,고광철,이풍렬,이종철,현재근,안병훈,김재준,류민규 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.6

Background/Aims: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory faetor of the response to initial steroid therapy in active Crohn`s disease patients, Methods: The medical records of 32 patients with active Crohn`s disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. Results: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68.8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. Conclusions: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group.