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기능성 소화불량증 환자에서 증상과 위의 전기적 활동에 대한 식이 성분의 영향
명보현 ( Bo Heon Meong ),이광재 ( Kwang Jae Lee ),심성준 ( Sung Jun Shim ),김진홍 ( Jin Hong Kim ),함기백 ( Ki Baik Hahm ),조성원 ( Sung Won Cho ) 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
목적: 고지방식이 기능성 소화불량증에서 소화불량의 증상을 유발하거나 악화시킨다고 알려져 있지만 칼로리 농도와 탄수화물과 단백질의 구성과 같은 식이 요소들이 소화불량 증상 및 위의 운동이상에 미치는 영향에 대해서는 아직도 정보가 부족한 실정이다. 이에 저자들은 기능성 소화불량증 환자군과 건강한 지원자군에서 비영양 유동식(물)과 영양 유동식, 그리고 탄수화물과 단백질의 구성비가 다른 두 영양 유동식 간에 소화불량 증상과 위의 전기적 활동에 대한 효과를 비교하고자 하였다. 대상 및 방법: 첫 번째 연구에서는 27명의 기능성 소화불량 환자와 10명의 건강 지원자를 대상으로 비영양식인 물과 칼로리 영양 유동식의 효과를 비교하였고, 두 번째 연구에서는 21명의 기능성 소화불량증 환자와 10명의 건강 지원자를 대상으로 고탄수화물 유동식과 고단백 유동식의 효과를 비교하였다. 위전도(electrogastrography; EGG)와 증상의 정도를 처음 15분동안 기록하고, 음식을 섭취한 후에 30분 동안 측정을 계속하였다. 결과: 2-4 cpm 범위에서 식사전후의 power ratio는 환자군과 건강 대조군 모두에서 물과 칼로리 유동식간에, 또한 고탄수화물과 고단백 유동식간에 유의한 차이를 보이지 않았다. 식후에 2-4 cpm 서파의 평균비율은 물과 칼로리 유동식 간에, 그리고 고탄수화물과 고단백질 유동식 간에 유의한 차이를 보이지 않았다. 건강 대조군과 달리 소화불량 환자들은 물보다 칼로리 유동식 섭취 후에 증상의 정도가 더 심하였으나 고탄수화물과 고단백질 유동식 후의 증상의 정도에는 유의한 차이가 없었다. 결론: 기능성 소화불량증 환자에서는 칼로리 영양식이 비영양식보다 더 증상유발과 관련되어 있지만 탄수화물과 단백질 구성의 변화가 기능성 소화불량증 환자에서 소화불량 증상과 비정상적인 위의 전기적 활동의 발생에 중요한 영향을 주는 것 같지는 않다. Background/Aims: Only Limited information has been provided on the effects of dietary factors in functional dyspepsia (FD). The aim of the present study was to compare the effects of different liquid meals on the symptoms and gastric electrical activities in FD patients. Methods: In the first study, comparisons between water and a caloric nutrient drink were performed in twenty-seven FD patients and ten healthy volunteers. In the second study, a high carbohydrate liquid meal was compared with a high protein meal with the same calories, volume and fat component for the twenty-one FD patients and the ten healthy volunteers. Recording of the electrogastrography with symptom assessment was performed. Results: The power ratio, the postprandial dominant frequency instability coefficient and the postprandial percentage of time with normogastric slow waves did not differ between the water and a caloric nutrient drink, and also between the high carbohydrate and high protein meals. Unlike the healthy controls, the FD patients had more severe symptoms after a caloric nutrient drink as compared to water. No difference in the symptom scores was observed between the high carbohydrate and high protein meals. Conclusions: The caloric nutrient drink is more associated with symptoms than is a non-nutrient meal for FD patients. Variations in the carbohydrate and protein composition are of no importance in the genesis of dyspeptic symptoms and gastric electrical abnormalities. (Kor J Neurogastroenterol Motil 2005;11:123-128)
명보현(Bo Hyun Myoung),최인선(In Seon Choi),박석채(Seog Chea Park),임호(Ho Lim) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.4
N/A Background: It has been shown that severe asthmatic attacks are related to airway hyperresponsiveness(AHR). However, there has been no study on AHR measured just after control of acute severe asthma. Objective : To determine the degree of AHR following acute severe asthma and to evaluate the safety of AHR measurement in patients just recovering from a severe attack. Method: In 23 consecutive asthma patients just recovering from a severe attack (10 severe, 13 near-fatal). All medications except inhaled or systemic steroids were withdrawn temporarily for more than each action time. Then a methacholine bronchoprovocation test was performed in patients with FEV1≥75% of predicted or personal best value. Results : Mean duration required to control asthma was 5.6±3.6 days, and methacholine provocation test was performed at 12.6+5.2 hospital days. The patients showed significantly lower methacholine-PC20(geometric mean 0.54 vs 1.64 mg/ml, p<0.05) and steeper slope of dose-response curve(p<0.01) compared to 62 outpatients. Initial FEV1(r=0.470. p<0.05) and the duration required to control asthma(r =-0.623. p<0.01) were significantly related to methacholine-PC20. However, only 9 patients(39.1%) showed severe AHR. which was not significantly different from outpatients(25.8%). Conclusion : These results suggest that AHR is a risk factor of severe asthmatic attack and methacholine challenge just after control of acute asthma is relatively safe. (J Asthma Allergy Clin Immunol 20: 641-649, 2000)
S-16 : A case of cerebral air embolism during endoscopic variceal ligation
안용수,명보현,박혁,김도현,김호동 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Introduction: Air embolism as a complication of medical procedure is very rare. The complication has been observed during various types of endoscopic procedures. This case was presented of cerebral air embolism that occurred immediately after EVL. Case report: A 73-year old man developed hematemesis and was brought to our hospital. The medical history included cirrhosis of the liver from alcolism and no episode of variceal bleeding. On arrival, the patient was conscious. His blood pressure was 100/50 mmHg. The results of laboratory test were WBC 9,790/μ L, Hgb 6.9 g/dL, platlet count 101×103/μL, total protain 3.8 g/dL, albumin 2.2 g/dL, total bilirubin 0.95 mg/dL, prothrombin time 52%. Emergency endoscopy was performed and spurting bleeding was observed at esophagogastric junction. After insertion of a flexible overtube, the endoscope was removed and the reinserted with an EVL device attached to the tip. Ligation was successfully performed after suction of esophageal mucosa. Immediately after ligation, The patient was became unconscious & had convulsion. CT image of brain (Fig. 1) revealed intracranial air that was distributed in the area supplied by the right middle cerebral artery. The patient discharged one month later and remained left hemiparesis weekly. Conclusion: There is always the risk that a stroke or another unexpected complication may occur in patients undergoing EVL. When symptoms referable to the central nervous system developed in these situations, air embolism, although rare, should be considered.
안용수,정홍명,문장식,명보현,김호동,박혁,황영준,김도현 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.3
Dieulafoy's lesion is an uncommon cause of gastrointestinal (GI) bleeding, but can be associated with massive, life-threatening GI bleeding. This lesion is an isolated protruding vessel of the submucosal artery associated with a small mucosal defect and normal surrounding mucosa. Although this lesion can occur throughout the GI tract (esophagus, stomach, duodenum, colon, rectum, etc), it has been rarely reported elsewhere than the stomach. Especially, there have been no reports of Dieulafoy lesion coexistent with early gastric cancer in Korea. We report the successful application of endoscopic hemoclipping for the treatment of a very rare Dieulafoy lesion coexistent with early gastric cancer. Dieulafoy 병변은 위장관 출혈의 드문 원인질환이지만 치명적인 대량출혈을 일으킬 수 있으므로 주의를 요한다. 이 병변은 궤양의 동반 없이 작은 점막 결손부위를 통해 점막하층의 동맥이 주행하여 소화관 내로 혈관이 돌출 되는 것을 특징으로 한다. 최근 위를 제외한 식도, 십이지장 등 상부위장관과 대장, 직장 등 하부위장관에서도 Dieulafoy 병변이 드물게 보고되며, 특히 조기위암에 동반한 Dieulafoy 병변의 국내 보고는 없다. 저자들은 hemoclip을 이용하여 조기위암에 동반된 Dieulafoy 병변을 지혈한 드문 1예를 경험하여 문헌 고찰과 함께 보고한다.