급성 복통: 급성 췌장염 치료의 실제

방성조 대한내과학회 2019 대한내과학회 춘계학술대회 Vol.2019 No.-

척수에 뒤집힌 V징후를 가진 시신경척수염: 항아쿠아포린-4항체와 비타 민 B12 기능적 결핍

방성조,김소현,정영석,이서현,석흥열 제주대학교 의과학연구소 2022 The Journal of Medicine and Life Science Vol.19 No.3

Several studies have reported a possible link between antiaquaporin- 4 antibody and vitamin B12 deficiency in neuromyelitis optica spectrum disorder (NMOSD). Bilaterally symmetric hyperintense signals on magnetic resonance imaging (MRI) of the posterior columns, called the inverted V sign, are a characteristic feature of subacute combined degeneration associated with vitamin B12 deficiency. We report a patient with anti-aquaporin-4 antibodypositive NMOSD and an inverted V sign on MRI of the spinal cord and address the association between anti-aquaporin-4 antibody and functional vitamin B12 deficiency.

간흡충증(Clonorchis Sinensis Infestation)과 담도암(Cholangiocellular Carcinoma) : Etiologic Relationship

방성조 대한췌담도학회 2009 대한췌담도학회지 Vol.14 No.2

위수술 후 수술 문합부에 발생한 장중첩증 2예

방성조,김도하,이진혁,변정식,김순주,김현준,정훈용,명승재,양석균,홍원선,김진호,민영일,정순재,김아영 대한소화기내시경학회 2004 Clinical Endoscopy Vol.28 No.4

Intussusception is a rare but potentially serious complication of gastric surgery, and 6 cases have been reported in Korea. Diagnosis can be made by endoscopy, upper gastrointestinal series or computed tomography, but it needs a high index of suspicion for diagnosis. Early diagnosis and prompt surgical intervention is mandatory to avoid mortality. We report two cases of intussusception occurring through the stoma after gastric surgery. A 58-year-old woman presented with epigastric pain and vomiting followed by hematemesis, 30 years after gastrojejunostomy for pyloric obstruction caused by duodenal ulcer. Endoscopy showed jejunogastric intussusception and CT scan was compatible with the diagnosis. She was managed by segmental resection and anastomosis of the jejunum. Another 60-year-old man presented with epigastric pain and hematemesis, 7 years after total gastrectomy with a Roux-en-Y anastomosis for advanced gastric cancer. He was diagnosed as having chronic type jejunal intussusception by endoscopy and CT scan, and intussusception was resolved spontaneously. 위절제수술 후에 수술문합부위에서 발생하는 장중첩증은 위절제수술의 드문 합병증으로 국내에는 6예가 보고되어 있으며, 진단이 지연될 경우 사망률이 높아지므로 신속한 진단이 필요하다. 저자들은 내원 30년 전 궤양에 의한 협착으로 위공장문합술을 시행받았던 58세 여자 환자가 복통과 토혈을 주소로 내원하여 내시경검사와 전산화단층촬영검사에서 공장위장중첩증으로 진단을 받고 수술로 정복한 1예와, 내원 7년 전 위암으로 위전절제술을 시행받았던 60세 남자 환자가 복통과 토혈을 주소로 내원하여 내시경검사와 전산화단층촬영검사에서 만성 장중첩증으로 진단을 받고 자연 정복된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

췌장의 낭종성 질환-수술 혹은 경과관찰

방성조 ( Sung Jo Bang ),김명환 ( Myung Hwan Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient. (Korean J Med 78:295-300, 2010)

이종코로나바이러스감염증-19 추가 백신 접종 이후 발생한 새로운 중추신경계 골수세포과산화효소관련혈관염

정영석,방성조,김근영,전재호,오기령,정종혁,박형종 대한신경과학회 2023 대한신경과학회지 Vol.41 No.2

The coronavirus disease-19 (COVID-19) pandemic leaded to inevitable expeditious vaccine rollout without sufficient safety profile. Especially, severe acute respiratory syndrome coronavirus 2 infection has known to induce overreacted immune responses such as releasing of proteinase-3 and myeloperoxidase (MPO) by neutrophil. This overreacted immune response leads to the concern of the development of autoimmune diseases after COVID-19 vaccination. We report the case of de novo MPO-associated systemic vasculitis involving central nervous system following heterogeneous mRNA1273 COVID-19 booster vaccination.

상부 위장관 출혈로 발현한 바터 팽대부 유암종 1예

박재석,방성조,정석원,권성호,김병철,한동하,김현수,김영민,남창우,김도하 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.6

A Carcinoid tumor of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastrointestinal carcinoids. Most reported cases have arisen from the gallbladder. An ampullary carcinoid most commonly presents with jaundice or upper abdominal discomfort, and bleeding from the tumor is exceedingly rare. A diagnosis is most frequently made postoperatively due to submucosal spread of the tumor. As the metastatic potential cannot be predicted by tumor size, a Whipple pancreaticoduodenectomy rather than local excision is considered the treatment of choice. We herein report a case of a primary carcinoid tumor located at the ampulla of Vater that presented as gastrointestinal bleeding; the tumor was diagnosed by an endoscopic biopsy after a papillary sphinterotomy. (Korean J Gastrointest Endosc 2007;35:420-423) 바터 팽대부의 유암종은 소화관에서 발생하는 전체 유암종 중 0.3% 미만의 발현을 보이는 매우 드문 질환으로, 흔한 증상은 종괴의 총담관 압박에 의한 황달이 반수에서 보고되며, 토혈이나 흑색변을 동반한 경우는 매우 드물다. 저자들은 실신을 동반한 흑색변을 주소로 내원한 44세 남자에서 상부 위장관 내시경 검사로 궤양을 동반한 바터 팽대부의 종괴에서 출혈을 확인하였고, 내시경하 조직검사로 유암종을 확진하였다. 바터 팽대부에 발생한 유암종은 국내에서는 수 차례 보고된 적이 있으나, 저자들이 경험한 경우처럼 내시경으로 급성 상부 위장관 출혈을 확인한 경우는 아직 보고된 바가 없는 첫 증례이다.

Santorinicele Containing a Pancreatic Duct Stone in a Patient with Incomplete Pancreas Divisum

주광로,방성조,신정우,김도하,박능화 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.5

Santorinicele, a focal cystic dilatation of the distal duct of Santorini, has been suggested as a possible cause of the relative stenosis of the accessory papilla, is associated with complete pancreas divisum, which results in acute episodes of pancreatitis or pain. This report describes a case of a santorinicele, which was initially detected by upper gastrointestinal endoscopy as a polypoid mass, in a patient with recurrent abdominal pain. The mass was subsequently proved to be a santorinicele containing a pancreatic duct stone associated with incomplete pancreas divisum on endoscopic retrograde pancreatography. To the best of our knowledge this is believed to be the first description of a santorinicele associated with these characteristic findings.

가족성 선종성 용종증 수술 후 발생한 복강 내 유건종 1예

정인두,방성조,신정우,박능화,최대화,차희정,김도하 대한소화기내시경학회 2006 Clinical Endoscopy Vol.33 No.1

Familial adenomatous polyposis (FAP) arises from germline mutations of the adenomatous polyposis coli (APC) gene. FAP is characterized by the occurrence of hundreds to thousands of adenomas throughout the colorectum, and there is nearly a 100% risk of colorectal cancer. In addition to polyposis coli, patients with FAP can develop a variety of extracolonic manifestations. Recent advances in screening and surgery have reduced the colon cancer occurrence and death in FAP patients, leaving desmoid tumors as a leading cause of their morbidity and mortality. Treatment of desmoid tumors is generally considered to be challenging for both the doctor and the patient. We report here on an 18 year old man with resectable intra-abdominal desmoid tumor that developed after total colectomy due to FAP and we include a review of the relevant literature. (Korean J Gastrointest Endosc 2006;33:50-53) 가족성 선종성 용종증의 치료로 전대장 절제술이 시행되지만 절제술 이후에도 여러 가지 장외 병변이 나타난다. 이러한 것으로는 문합부의 대장암 발생이나 췌장, 십이지장의 암 발생 같은 악성 종양의 발생이나 장간막, 후복막 등에 유건종의 발생 등이 있다. 이 중 유건종의 발생은 전대장 절제술을 시행한 가족성 선종성 용종증 환자의 예후를 결정하는 중요한 인자가 된다. 국내에서 가족성 선종성 용종증으로 전대장 절제술을 시행 후 복강 내 유건종의 발생에 대한 보고는 있었으나, 모두 완전 절제가 불가능하였던 예였다. 저자 등은 완전 절제가 가능하였던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

A Bile Based Study of Clonorchis sinensis Infections in Patients with Biliary Tract Diseases in Ulsan, Korea

주광로,방성조 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.6

Stool examination is believed to be the most reliable method for detecting Clonorchis sinensis (CS) eggs. However, it has limited value for diagnosing clonorchiasis when the biliary tract is obstructed or when there is a light infection. We evaluated the infection states of CS in patients with biliary tract diseases using a bile sample. From January 2001 to August 2003, 238 patients who had undergone endoscopic biliary drainage were prospectively included in the study. The patients' bile samples were obtained directly from the nasobiliary drainage tube and then analyzed to detect CS eggs. The overall CS egg positive rate was 28.2% (35.4% in males, 19.4% in females). The egg positive rate was similar in all age groups examined: 26.7% in 30-39 years, 25.0% in 40-49 years, 24.4% in 50-59 years, 30.2% in 60-69 years, 35.3% in 70-79 years, and 25.0% in 80 years of age and over. There were no significant differences in the egg positive rate between the disease groups: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, and 26.4% in gallstone diseases. Our results show that the CS infection rate was very high, regardless of the age, gender, and type of diseases of the patients. Although the study population was limited to patients with biliary tract diseases, it is assumed that clonorchiasis is still an endemic disease in Ulsan, Korea.