식도정맥류 치료의 경화요법과 내시경적 결찰요법의 비교

문귀애,조홍집,신원창,최원충,이진호,김관엽 인제대학교 1998 仁濟醫學 Vol.19 No.1

내시경적 경화요법(Endoscopic Injection Sclerotherapy: 이하 EIS라 함) 및 내시경적 결찰요법(Endoscopic Variceal Ligation: 이하 EVL라 함)은 응급 지혈과 재출혈 예방에 효과적인 방법으로. 심각한 합병증이 없이 시행할 수 있다. 본 연구는 내시경적으로 확인된 식도정맥류 출혈에 대하여 EIS 및 EVL을 시행한 후, 추적 관찰이 가능하였던 44예에서 그 각각에 대해 응급 지혈 효과, 정맥류 근절율, 재발율, 재출혈의 빈도 및 생존율을 조사하여 각 방법의 치료 효과를 비교하였고, 합병증의 종류 및 빈도를 조사하여 각 방법의 안정성을 비교하였다. 시술 당시의 활동성 출혈에 대한 응급 지혈율은 EIS 군이 83.5%, EVL 군이 85.7%로, EVL 군이 EIS 군보다 높았으나, 두 방법간에 차이가 없었다. 정맥류의 근절율은 EIS 군은 62.5%, EVL 군은 67.8%로 다른 보고와 유사하였다. 식도정맥류의 재발율은 EIS군은 37.5%, EVL 군은 32.1%에서 재발하였으나, 두 군간에 유의한 차이는 없었다. 재출혈율은 EIS 군은 25.0%, EVL 군은 17.8%로, 두 군간에 통계적인 차이는 관찰되지 않았다. 추적 기간 중 사망한 환자는 EIS 군에서 2명(11%)과 EVL 군에서 2명(7%)이 식도정맥류의 재출혈로 사망하였다. 즉 EIS와 EVL은 식도정맥류 출혈 환자에 있어서, 단기적 및 장기적 치료 효과가 우수한 방법으로 사료된다. 한편, 내시경적 치료의 합병증으로는, EVL 군에서 식도 궤양이 7%에서 발생하여 EIS 군의 31.2%보다 훨씬 드물게 발생하였으나, overtube의 사용으로 인한 식도 천공이 1례 발생하여 치명적일 수 있다. 즉 EIS와 EVL은 식도정맥류 출혈을 치료하는데 효과적이며, 비교적 안전한 방법으로 사료된다. 그러나, 각각의 장단점을 고려하여 치료 초기에는 EVL을 시행하고, 후기에는 EIS를 시행하는 것이 합당할 것으로 사료된다. The endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been widely used in the treatment and eradication of acute bleeding esophageal varix, and in prevention of rebleeding without severe complications. To compare the effectiveness of EIS with that of EVL in patients with bleeding of esophageal varix, we evaluated the bleeding control rate, the eradication rate of varix, the recurrance rate of varix, the rebleeding rate in 44 patients with liver cirrhosis and the bleeding of esophageal varices. Also, we evaluated the complication of each method to compare the safety of the procedure between them. Active bleeding was controlled with EVL(85.7%) as efficiently as with EIS(83.5%). Esophageal varices were eradicated or improved by more grade I in 62.5% of 16 patients managed with EIS and in 67.3% of 28 patients managed with EVL, and these results were as efficient as other studies. Recurrence rates of varices were founded as 37.5% in EIS and 32.1% in EVL, and there was no difference in recurrence rate between each method. Rebleeding rate were 25.0% in EIS, and 17.8% in EVL respectively. The uncontrolled bleeding of varix resulted in death in 2 patients(11%) in EIS. and in 2 patients(7%) in EVL. Then, EIS and RVL might be efficient modality to manage bleeding esophageal varices Also, the safely of endoscopic treatment was assesed by the frequency of complication. The esophageal ulcerations were founded in 7% of EVL, and in 31.2% of EIS. But, In 1 case of EVL, there was esophageal perforation by the insertion of overture, which may be life-threathening. EIS and EVL might be efficient and relatively safe method to manage esophageal varices. But it might be recommended that EVL be employed in early period and followed by EIS to obtain the complete eradication.

이달의 X-선 : 위치에 따라 이동하는 종괴를 포함한 공동으로 진행된 비소세포폐암에 동반된 폐렴

엄태찬 ( Tae Chan Um ),문귀애 ( Kwie Ae Moon ),김필호 ( Phil Ho Kim ),김상현 ( Sang Hyun Kim ),정병오 ( Byung Oh Jeoung ),이혁표 ( Hyuk Pyo Lee ),김주인 ( Joo In Kim ),염호기 ( Ho Kee Yum ),최수전 ( Soo Jeon Choi ),김성준 ( Sung J 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.4

다운증후군과 동반된 부갑상선 기능저하증 1예

김필호,박연호,남궁준,문귀애,김상현,엄태찬,김성준,고경수,이병두,박미정 인제대학교 1998 仁濟醫學 Vol.19 No.2

다운증후군은 특이한 외모, 지능 발달 저하 등의 임상상으로 나타나는 가장 흔한 상염색체 수 이상 증후군이다. 저자들은 전신 경련을 주소로 내원한 환자에서 염색체 검사를 실시하여 Robertsonian translocation에 의한 부분 삼체성의 다운증후군 및 특발성 부갑상선 기능저하증이 동반된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Down syndrome is perhaps the oldest condition associated with mental retardation and the most common genetic cause of developmental disability. It is presumed that the additional gene products of the triplicated chromosome 21 cause alterations in the normal processes regulating embryogenesis. Ninety-five percent of cases are caused by trisomy 21, whereas the remainder are translocations. Mainly, the chromosomal translocation is made of Robertsonian translocation. Clinically it consists of cranio-facial abnormality, such as microcephaly, with flattening both of the occiput and face, an upward slant to the eyes with epicanthal folds, and the ears are small. Congenital heart disease, musculoskeletal abnormalities, gastrointestinal disorders, hematologic abnormalities and associated developmental disabilities. And thyroid dysfunction and infertility are the most significant endocrinologic disorders in individuals with Down syndrome. But we could not find any reported case of hypoparathyroidism associated with Down syndrome in worldwide search of literatures. Even though some cases of hereditary hypoparathyroidism, which is not associated with Down syndrome were reported. We experienced a rare case of 15-year-old male diagnosed as hypoparathyroidism associated with Down syndrome, which is diagnosed by cytogenetic chromosomal study and by radioimmunoassay for PTH wish symptoms of seizure disorder due to hypocalcemid and typical cranio-facial abnormalities.

중추성 요봉증과 단독성 성선자극 호르몬 결핍증을 동반한 공허안증후군 1예

김성준,조남국,엄태찬,문귀애,김필호,김상현,고경수,이병두,박재홍 인제대학교 1998 仁濟醫學 Vol.19 No.2

공허안증후군은 뇌하수체와 내로 거미막하 공간이 내려와 뇌하수체가 편평해지는 질환이다. 공허안증후군 환자의 대부분은 뇌하수체 기능 장애 없이 우연히 발견되는 경우가 많다. 저자들은 이차 성징 발현 소실을 주소로 내원한 30세 남자에서 원발성 공허안증후군과 중추성 요붕증, 단독성 성선자극호르몬 결핍증이 동반되었음을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Primary empty sella syndrome(PESS) associated wish trophic hormone deficiency is rare. Furthermore, PESS with central type of diabetes insipidus(DI) and isolated anterior pituitary hormone deficiency is extremely rare. We experienced a case of PESS associated with central type of DI and isolated gonadotropin deficiency in a 30-year-old man who had complained of sexual infantilism and polyuria. MRI of pituitary gland showed posteriorly displaced pituitary stalk and CSF-like signal intensity in the sella turcica. We report this case wish review of the relevant literatures.

소화성 궤양의 재출혈 위험인자 및 에탄올 주입치료의 효과에 관한 연구

김상현,이진호,김성준,신원창,김관엽,문귀애,김필호,엄태찬 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.4

Background/Aims: Acute peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, and needs urgent management in cases including large amounts of blood loss. Ernergency endoscopy was performed and evaluation was made on the risk factors of rebleeding in peptic ulcer patients and the efficacy of ethanol injection therapy. Methods: The clinical and endoscopic variables were evaluated according to the rebleeding rates and the efficacy of ethanol injection therapy for hemostasis and prevention of rebleeding in 161 cases including gastric ulcers (GU) with bleeding (M: F 134: 27, mean age 56.5 years) and 136 cases including duodenal ulcers (DU) with bleeding (M: F 111: 25, mean age 40.7 years). Background/Aims: Acute peptic ulcer bleeding is the mast common cause of upper gastrointestinal bleeding, and needs urgent managment in cases including large amounts of blood loss. Emergency endoscopy was perform~;d and evaluation was made on the risk factors of rebleeding in peptic ulcer patients and to efficacy of ethanol injection therapy. Methods: The clinical and endascopic variables were evaluated according to the rebleeding rates and the efficacy of ethanol injection therapy for hemostasis and prevention of rebleeding in 161 cases including gastric ulcers (Gj.J) with bleeding (M : F 134 : 27, mean age 56.5 years) and 136 cases including duodenal ulcers (DU) with bleeding (M : F 111 : 25, mean age 40.7 years). Results: 1. There wad no difference in age or gender ratio according to the incidence of rebleeding and shock between GU and DU. In GU, rebleeding was mast common in gastric bodies, failowed by angle and antrum. Posterior wall was the most common rebleeding direction, followed by anterior wall, greater curvature, and lesser curvature. In DU, rebleeding was more common in the bulbar portion than postbulbar portion. Posterior wall was the ghost common rebleeding direction, followed by greater curvature, anterior wall, and lesier curvature. The average size of ulcers with rebleeding was smaller than those without rebleeding. 2. In GU, rebleeding was more common in ulcers with active bleeding and visibly vessels, but without red spots or stigmata. In DU, rebleeding was common in ulcers only with active bleeding, but not with visible vessels, red spots, or stigmata. 3. Ethanol injection therapy (EIT) was successful in controlling bleeding in 91 out of 98 cases in the first trial. The second EIT was performed in 20 rebleeding cases resulting in 15 hemostasis with 92% efficacy. 4. The EIT could not decrease the rebleedng incidence in patiends with active bleeding, visible vessels nor red spots. In the EIT group, the shock incidence transfusion amount and the hospital stay were all noted to be higher than the untreated group. Conclusions: The rebleeding risk should be carefully evaluated and managed diffeently according to clinical and endoscopic findings. The EIT was effective in controlling bleeding peptic ulcers but not in the prevention of rebleeding. The application of the ETT in for prevention of rebleeding should be stratified according to the severity of the first bleeding.