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이준욱(Joon Wook Lee),이성수(Seung Su Lee),박영민(Young Min Park),배시현(Si Hyun Bae),신제현(Je Hyun SHin),변병훈(Byung Hun Byun),최종영(Jong Young Choi),윤승규(Seung Kew Yoon),이영석(Young Sok Lee),이창돈(Chang Don Lee),차상복(Sang 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Congenital non-parasitic splenic cysts comprise approximately 10% of all splenic cysts. Clinical manifestations in patients with splenic cyst are often nonspecific and ultrasound or CT is useful for its diagnosis. Total splenectomy has been the major way of treatment. However, currently, spleen-saving procedures are strongly recommended because of the immunological role of the spleen. One of such procedures, the percutaneous treatment with sclerosing agents has already been reported with a good result. In this report, we present a case of a 12×17 cm sized giant congenital splenic cyst treated with percutaneously using ethanol as a sclerosing agent. Seven-times of injections (total 140mL, 20mL/time, every 3 days) into the cystic cavity through the inserted catheter were performed for 3 weeks. After the treatment, the size of cyst decreased markedly in 8 months. On the basis of these results, we may conclude that the percutaneous ethanol ablation therapy is an alternative to surgical treatment for splenic cyst. (Korean J Gastroenterol 2001;38:300-303)
Helicobacter pylori 감염 환자에 있어 삼제요법의 치료효과
정인식,김부성,박두호,변병훈,최종영,이동수,김상우,양영상 대한소화기학회 1998 대한소화기학회지 Vol.32 No.1
Background/Aims: Helicobacter pylori infection is associated with chronic active gastritis, duodenal and gastric ulcers, gastric adenocarcinoma, and gastric lymphoma. Today, eradication of H. pylori represent a generally accepted and beneficial therapeutic strategy for treatment and prevention of peptic ulcer relapse. Major factors that affected on H. pylori eradication are eradication rate of regimen, and compliance of patients. The combination of omeprazole, amoxicillin and clarithromycin has been accepted as one of the most effective treatment for the eradication of H. pylori. The primary aim of this study was to examine the eradication rates of H. pylori infection and side effects of triple therapy in patients with H. pylori infection. Methods: Patients were treated with one of two triple therapies, lansoprazole 30 mg BID, clarithromycin 500 mg BID, placebo (LC group) or lansoprazole 30 mg BID, clarithromyein 500 mg BID, amoxicillin 500 mg QID (LCA group), for 14 days. Results: H. pylori was eradicated in out of 22 patients in LC group (41%) and in 31 out of 38 patients in LCA group (82%). The most frequently observed adverse event was altered taste. Other adverse events included headache and diarrhea. Conclusions: Triple therapy with lansoprazole, claritbromycin and amoxicillin for two weeks is an effective and well tolerated regimen for the treatment of H. pylori infection.
초음파내시경검사로 조기위암의 심달도 판정시 오진의 원인이 된 호산구성 농양 1예
정인식,김부성,박두호,변병훈,최종영,박영민,김상우,양영상,최상욱 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3
Eosinophilic abscess is a rare disease of stomach that consists of many eosinophils in submucosa and muscle layers of stomach. Eosinophilic abscess is usually observed in liver after parasite infestation such as hepatic fascioliasis or in intradermal lesion of pemphigus. A 67-year-old female was admitted due to epigastric pain and indigestion. Endoscopic finding suggested early gastric cancer type IIc with the depth of invasion to mucosal layer at the lesser curvature of lower body. Histologic examination of endoscopic biopsy proved to be signet ring cell type adenocarcinoma. On endoscopic ultrasonography, the tumor was imaged as a slightly elevated mass with 15 mm in diameter. The lesion was localized from the first layer to the fourth layer which correspond to the mucosa and the proper muscle layer, The lesion consisted of low echoic and isoechoic densities. The lower echoic lesion ranging from the third layer to the fourth layer was thought to be necrotic or hemorrhagic portion within the tumor. Subtotal gasterectomy was performed. We compared the endoscopic and endosonographic features with the histologic findings of the resected stomach. Histologic examination showed signet ring cell carcinoma in mucosal layer and eosinophilic abscess in submucosal and proper muscle layer. We concluded that the endosonographic depth of invasion was overestimated because of the eosinophilic abscess.
강성호,이상헌,박성환,전희경,변병훈,김호연,이원영,조철수,위성헌,문윤기,정재열 대한내과학회 1996 대한내과학회지 Vol.50 No.1
Rheumatic manifestations in myelodysplastic syndroms(MDS) are divided into different categories' inflammatory arthritis, cutaneous vasculitis, neuropathy, and patients with both rheumatic disease and MDS. The followings are the characteristics of inflammatory arthritis in MDS: Serologic studies are repeatedly negative. Radiologic studies show no bony erosion. The arthritis responses to oral prednisolone with hematologic improvement. We report a case of 25-year-old female with seronegative inflammatory polyarthritis in MDS. She showed prompt response to oral prednisolone therapy with resolution of the arthritis and hematologic abnormalities.
이상헌,박성환,박동준,변병훈,김호연,문성대,조철수 대한내과학회 1995 대한내과학회지 Vol.48 No.4
Ankylosing spondylitis(AS) is a chronic inflammatory joint disease of axial joints and both sacroiliac joints. In addition AS is characterized by a number of extra-articular manifestations, such as enthesopathy and anterior uveitis, and is closely linked to HLA-B27. The disease-related mortality is relevant to amyloidosis, cardiovascular complications, and cervical spine subluxation. A further cause of premature death is the occurrence of malignancies, especially seondary to radiotherapy. The case of 65 year-old farmer, who has AS and Hodgkin's disease is described, and malignancy in AS is reviewed.
위정맥류출혈에서 Histoacryl 주입으로유발된 폐색전증 1 예
박태욱,정인식,김탁용,김부성,박두호,변병훈,최종영,송치원,이동수,김상우,양영상 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1
N-Butyl-2-cyanoacrylate (Histoacryl) has been used successfully to control bleeding from esophagogastric varices since the first report in 1986 by Soehendra. Complications of Histoacryl injection include local sloughing with ulcer formation, rebleeding, sepsis, mediastinitis, esophageal strictures and fever. Systemic embolization, including pulmonary and cerebral embolization, has been reported. We describe here the presentation of an un-usual complication of Histoacryl injection. A 42-year-old woman presented with an attack of massive hematemesis. Endoscopy revealed bleeding evidence of gastric varices. Sclero-therapy was carried out using Histoacryl mixed with Lipiodol (ratio 1 :1), with complete solidification of the varix. Next morning she complained of dyspnea and tachycardia. The chest x-ray showed multiple metallic densities, consistent with cyanoacrylate mixed with lipoidol, located at central portion. She was diagnosed as having pulmonary embolism by convential precontrast chest CT. She was treated onservatively using oxygen and analge-sics. She recovered soon and was discharged without significant problems.
만성 B형 간염과 간경변 환자에서 Lamivudine 저항성 B형 간염 바이러스의 출현양상 및 YMDD motif 돌연변이 검출
강성호,박태욱,박영민,정규원,안병민,배시현,김부성,박두호,이창돈,변병훈,최종영,신제현,차상복,선희석 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.1
Background/Aims: Lamivudine is an antiviral nucleoside analogue effective for the treatment of hepatitis B virus (HBV) infection via the inhibition of DNA polymerase activity. The mutations, however, in YMDD motif, such as YVDD and YIDD, have been found to interfere with the therapeutic efficacy of lamivudine. This study was performed to identify the role of such mutant-type HBV among Korean hepatitis B patients with chronic hepatitis or cirrhosis receiving lamivudine treatment. Methods: Serum samples were collected from four groups of patients; patients with breakthrough (group I, n = 8); patients who showed no response after the treatment (group II, n = 6); patients who showed good response (group III, n = 6); patients with chronic hepatitis B without any treatment (group IV, n = 4). Mutations were detected by PCR-cloning and automated sequencing. Results: Mutations in YMDD were found in only 4 (50%) in group I and were negative in group II. No mutations could be identified in the serum samples collected before treatment and from groups III and IV. YVDD mutation was found to be associated with two additional mutations, 'L-to-M' in 528th amino acid and 'L-to-V' in 577th amino acid. Conclusions: Lamivudine resistance appeared in three different patterns: (1) breakthrough related to the mutations in YMDD motif; (2) breakthrough not related to the YMDD mutations; and (3) primary non-responder not related to the YMDD mutations.(Korean J Hepatol 2001;7:15-33)
Pneumobilia 가 동반된 간세포암종에서 간동맥 화학색전술 후 비암성 간 내에 발생한 간농양 1 예
김영철,이성구,박영민,이소영,김용균,정규원,배시현,김부성,정연주,선희식,유수은,박두호,변병훈,최종영,신제현,홍창균 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2
Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from O% to 3.3%. Moreover, liver abscess formation in non - tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo - enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non - tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia(Korean J Hepatol 2001;7:189-194)