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소화성궤양 출혈 환자에서 내시경적 Hemoclip 요법, Hypertonic Saline Epinephrine (HSE) 국소 주입 요법과 병합요법의 치료효과
이태영,이문호,김홍수,장재영,김선주,정일권,박상흠,성재락 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3
Background: Bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding. Various different endoscopic hemostatic methods were introduced to treat bleeding peptic ulcer. Many studies reported the efficacy and comparision of various methods. Endoscopic injection therapy is the most comman method among them because it is inexpensive and easy in use. Complications of injection therapy such as aggravation of bleeding, tissue neerosis and perforation were repoted rarely. Recently endoscopic hemoclipping method is considered to be safe and effective hemostatic method for upper gastrointestinal bleeding, Methods: During the period between January 1993 and August 1996, we have conducted clinical trial and retrospective analysis among 100 patients in whom active bleeding or visible vessel was identified.Results: 1) Three groups was divided, Hemaclip group 26 cases, Hypertonic Saline Epinephrine(HSE) group 59 cases, Combinittion group 15 cases. 2) The sources of bleeding in Hemoclip group were gastric ulcer in 23 cases and duodenal ulcer in 3 cases, end in HSE group, gastric ulcer in 44 cases, duodenal ulcer 14 cases and stomal ulcer in one case, and in combination group, gastric ulcer in 10 cases, duodenal ulcer in 3 caseb and stomal ulcer in two cases. HSE and cot~bination method were performed more than Hemoclip method in duodenal ulcer(23.7% and 20.0% versus 11.5%). 3) As the stigmata of bleeding in Hemoclip and HSE and Combination group, spurting were seen: in 5 cases and 3 cases and 4 cases, and ooang in 10 cases and 17 cases and 3 cases and nonbleeding visible vessel in 11 cases and 39 cases and 8 cases, respectively. Hemeclip method was performed more than HSE method in active bleeding state(57.6% versus 33.9%). 4) Initial hemostasis was achieved in 24 cases(92.3%) in Heanoclip group ad 52 cases(88.1%) in HSE group, 13 cases(86:7%) in Combination group. 5) The rebleeding developed in 1 casae(4.2%) in Hemoclip group and 8 cases(15.4%) in HSE group and I case(7.6%) in Combination group, the emergent operation was undewent 2 cases(7.7%) in Hemoclip group and 10 cases(17.0%) in HSE group and 1 case(6.7%) in Combination group, respectively. 6) The death was noticed in 1 cases(3.9%) in Hemoclip group and 2 cases(3.4%) in HSE gioup and 2 case(13.3%) in Combination group, respectively. 7) Permanent hemostasis by only endoscopic treatment was achieved in 24 cases(92.3 %) in Hemoclip group and 48 cases(81.4%) in HSE group, 12 cases(80.0%) in Combination group. 8) Complication was noticed only in HSE group, aggravation of bleeditlg in one case and hematoma in two cases. Conclusion: Hemoclip method was effective hemostatic method same as HSE injection method, and safe method with low complication in bleeding peptic ulcer. We suggest more detail selectian of endoscopic hemostatic method in variously individualized endoscopic features.
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이태영,이문호,김대중,김홍수,김선주,최우봉,정일권,박상흠,이낙원 대한내과학회 1997 대한내과학회지 Vol.53 No.6
Carcinoma of the gallbladder is relatively rare malignancy usually found in an elderly, predominantly female population. Histologically, adenocarcinoma predominate, with only 10% to 15% being of other varieties(small cell carcinoma and others). Small cell carcinoma of the gallbladder is a rare lesion and predominantly a disease of older women with clinical history of stones. These tumors show an aggressive clinical course and death usually occurs with in a few months of the diagnosis. The diagnosis of small cell carcinoma should be based on cell morphology, histologic pattern and immunohistochemical study. Correct diagnosis is important not only because these tumors give rise to endocrine syndromes, but also because the chemotherapeutic approach to small cell carcinoma differs from that for adenocarcinoma.
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간암을 동반한 윌슨병(Wilson`s disease)1 예
김철,김은주,김대중,김홍수,이문호,김선주,박상흠,정일권,남기룡 대한소화기학회 1999 대한소화기학회지 Vol.33 No.3
Wilson's disease is an autosomal inherited disorder of copper metabolism; impaired copper excretion into the bile leads to copper accumulation in liver, brain and other organ. Hepatocellular carcinoma (HCC) has rarely been reported as a sequele of Wilson' s disease. It has been shown experimentally that copper has an inhibitory effect on the factors responsible for HCC development in rats, and the low prevalance of HCC in case with Wilson' s disease may result from hepatic copper deposition which has been postulated to have a protective effect against hepatic oncogenesis. The clinica features of these cases are characterized by relatively advanced age at diagnosis, the presence of cirrhosis and a male predominance. It is suggested that hepatic copper content in the patient with Wilson' s disease who was treated with penicillamine and subsequently developed HCC may be decreased toward a nonprotective range in response to penicillamine therapy. We report the one case of patient with Wilson' s disease combined with HCC.
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