후복막강에 발생한 Castleman병

서정건(Jung Kun Seo),정준근(Jun Keun Jung),정준표(Jun Pyo Chung),박효진(Hyo Jin Park),전재윤(Chae Yoon Chon),지훈(Hoon Ji),김기황(Ki Hwang Kim),지훈상(Hoon Sang Chi),정우희(Woo Hee Jung) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

Castlemans disease is a rare, benign disorder of the lymphoid tissue, and refers ta a distinctive type of giant lymphoid hyperplasia that forms tumor-like masses in lymph nodes and, occasionally, in extranodal sites. Although the mediastinum is its the most common location, it also occurs, albeit rare, in other areas of the body, where lymph nodes are normally found. It is difficult to differentiate between Castlernans disease and other malignant lesions preoperatively. We report a case of a hyaline-vascular variant of Castlemans disease presenting as a solitary retroperitoneal mass in a 39 year old female patient. We also present the MR features, together with conventional radiologic imagings, which made it possible to diagnose Castlemans disease preoperatively, although the mass of the patient was in an unusual location, This report may provide information on differentiation between primary retroperitoneal malignancies and Castlemans disease. (Korean J Gastroenterol 1996; 28:462-468)

원발성 경화성 담관염 ; 증례보고 및 국내문헌 고찰

서정건(Jung Kun Seo),정준표(Jun Pyo Chung),조현근(Hyeon Geun Cho),이귀순(Kwi Soon Lee),이관식(Kwan Sik Lee),전재윤(Chae Yoon Chon),강진경(Jin Kyung Kang),박인서(In Suh Park),김기황(Ki Whang Kim),김호근(Ho Geun Kim),이상인(Sang In Lee 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A We experienced a case of primary sclerosing cholangitis(PSC) in a 40-year-old female who complained of jaundice and pruritus. Marked elevation of serum alkaline phophatase level, typical beaded appearance and pruned-tree appearance on endoscopic retrograde cholangiography, together with a finding of chronic obliterative fibrosing cholangitis on sono-guided gun biopsy specimen of the liver led to a confirmative diagnosis of PSC. The patient responded to ursodeoxycholic acid (UDCA), but was reluctant to treatment and died of hepatic failure 7 months later. PSC is a very rare disease in Korea. So far, only 5 cases including our present case have been reported in the Korean literature. Male-to-female ratio was 2:3 and the median age was 40(27-80 years old). Ulcerative colitis was associated in one case. Four cases involved both intra, and extrahepatic bile ducts and one case was reported to be confined in the intrahepatic bile ducts. Fatality was in 3 cases, 20 days, 36 days, and 7 months after the initial presentaion, respectively. The causes of death were acute cholangitis and sepsis in two, and hepatic failure in one. We herein report a case of PSC and clinical charateristics of the reported cases in Korea, and review the literature with an emphasis on UDCA treatment in PSC.

만성 변비증 환자에서 전기생리학적 검사의 유용성

서정건(Jung Kun Seo),윤상욱(Sang Wook Yoon),조현근(Hyeon Geun Cho),박효진(Hyo Jin Park),오세창(Se Chang Oh),이관식(Kwan Sik Lee),전재윤(Chae Yoon Chon),박인서(In Suh Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: The clinical evaluation of rectal sensation has traditionally relied on the use of balloon distension in the rectum but balloon distension test has been limited because it was seen variably. This study was performed to evaluate usefulness of electrophysiologic test in patients with chronic constipation. Methods: Pudendal nerve terminal motor latency(PNTML), anal and rectal rnucosal electrosensory test, balloon distension test and defecogram were performed in 19 patients with chronic constipation and 1 1 normal controls. Results: There was no significant difference between patients with chronic constipation and normal controls in balloon distension test but balloon distension in the rectum revealed an elevated tendency of sensory threshold in constipated patients. The mean value of right and left PNTML did not differ between tendency in patients with chronic constipation and controls(2.65+0.94 vs. 2.20+0.33 msec, patients vs. controls, p=0.2448). Rectal rnucosal electrosensory threshold revealed an elevated tendency in patient with chronic constipation(50.8>23.6 vs. 40.9+10.1 mamps, patients vs. controls, p=0.0838) but there was no significant difference between patients with chronic constipation and controls in anal threshold. PNTML revealed an elevated tendency in patients with prominent puborectalis on evacuation(2.71 +0.72 vs. 2.03+0.40 msec, p=0.0776), but anal and rectal mucosal sensory threshold did not differ depending on puborectalis dyskinesia. Conclusions: Because rectal mucosal electrosensory threshold revealed an elevated tendency in patient with chronic constipation and PNTML revealed an elevated tendency in constipated patients with prominent puborectalis on evacuation, it is thought that the changes of rectal mucosal sensory threshold and PNTML in patients rnay be related with clinical symptoms and etiology. (Korean J Gastroenterol 1996; 28:751-757)

Marshmallow를 이용한 식도조영술의 의의

서정건(Jung Kun Seo),박효진(Hyo Jin Park),김경철(Kyung Chul Kim),이귀순(Kwi Soon Lee),윤상욱(Sang Wook Yoon),전재윤(Chae Yoon Chon),김기황(Ki Whang Kim),박인서(In Suh Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: In the evaluation of esophageal symptoms, the endoscopy, conventional esophagography using liquid barium and esophageal manometry have been used for the detection of organic and functional esophageal diseases. But some questions were raised that these studies were not capable of reproducing the esophageal symptoms and the manometry was often not a confirmative test in all functional esophageal diseases. So, we performed an esophagography using the semisolid material, marshmallow, and evaluated its clinical usefulness in patients with func- tional esophageal diseases. Methods: We perfonned the endoscopy, conventional esophagography and marshmallow esophagography in 54 consecutive patients with esophageal symptoms(dysphagia, globus symptom and non-cardiac chest pain) and esophageal manometry in 21 patients among them, and compared with asymptomatic, healthy volunteers(n=9). Results: The marshmallow esophagography revealed abnormal hesitation and impaction in 15 patients(45%) with normal conventional esophagography(n=33) and in 4 patients(57%) with normal esophageal manometry studies(n=7). In contrast with these result, all of the conventional esophagography were normal in patients with normal marshmallow esophagography(n=17). In the reproducibility of symptoms, the dysphagia group was greater than another groups(p(0.05) and there was a trend towards a high reproducibility of symptoms in patients who showed the severe grade(p (0.05). The abnormal marshmallow esophagography was correlated with the abnormal peristalsis of conventional esopha- gography and nonspecific esophageal motility disorder of manometry(p(0.05). Conclusions: We found the marshmallow esophagography was rnore sensitive and capable of reproducing the sypmtoms than conventional liquid barium esophagography in the evaluation of the esophageal symptoms, and the marshmallow esophagography is thought to be valuable as one of diagnostic tools for esophageal motility disorders. (Korean J Gastroenterol 1996; 28:303-310)

만성신부전환자에서 혈장 단백 C 및 S 의 임상적 의의

이귀순(Kwi Soon Lee),하성규(Sung Kyu Ha),박종훈(Chong Hoon Park),서정건(Jung Kun Seo),이호영(Ho Yung Lee),한대석(Dae Suk Han),송경순(Kyung Soon Song) 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: Patients with chronic renal failure have increased hemorrhagic tendency due to an uremic platelet dysfunction and complications from anticoagulants used in hemodialysis. They are also prone to have thrombotic complications in the cerebral vessels, coronary arteries and A-V fistula, due to hypercoagulability from changes in various factors. Recently, deficiencies in plasma protein C and S, which are physiological anticoagulants, have been reported to cause thrombosis. In chronic renal failure, plasma protein C and S activities are known to be decreased. Methods: In the present study, activities and antigen concentrations of plasma protein C and S, as well as AT-III activities were investigated in three groups; the normal control group, the predialysis group of chronic renal failure patients treated conservatively, and the hemodialysis group. The findings were analyzed for their relationship to hypercoagulability. Results: 1) The activities of plasma protein C, S and antithrombin-III were significantly lower in the predialysis chronic renal failure group as compared to the control. Antithrombin-III concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly lower than those of the control group. But, protein C antigen concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly higher than those of the control group. There was no significant difference between these groups in plasma protein C activities, and plasma protein S activities and antigen concentrations. 2) In the hemodialysis group, antithrombin-III activities, antigen concentration and activities of plasma protein C were significantly higher than after dialysis as compared to those before the dialysis. 3) There were no significant difference in plasma protein C, S and antithrombin-III activities and plasma protein C and S antigen concentrations in hemodialysis patients between with and without thrombosis at arterio-venous fistula site. However, plasma protein C and antithrombin-III activities were significantly lower in those with thrombosis as compared to those of the normal control group. There were no significant difference in plasma protein C and S activities and antigen concentrations in those without thrombosis as compared to those of the normal control group. 4) There were no significant diffrences in plasma protein C, protein S and antithrombin-III activities and antigen concentrations in dialysis patients with and without recombinant erythropoietin treatment. 5) There were no significant correlations between serum creatinine and creatinine clearance, and plasma antithrombin-III, protein C and protein S activities and antigen concentrations in predialysis group. Conclusion : These results suggest that the decrease in plasma antithrombin-III, protein C and S could be the factors causing hypercoagulability in chronic renal failure patients, and the decreased activities of these factors may return to normal by dialysis. In the hemodialysis group, there were no significant diffrences in plasma protein C and S and antithrombin-III activities and antigen concentrations between the group which showed clinical thrombosis and the group which did not. However, in those who had thrombosis, plasma protein C and antithrombin-III activities are significantly lower than the control group. Administration of recombinant human erythropoietin does not appear to affect the activities of plasma protein C and S and antithrombin-III. In predialysis chronic renal failure patients, there was no significant relationship between renal function and plasma protein C and S and antithrombin-III.

제2형 당뇨병 환자에서 알부민뇨와 심혈관계 질환의 유병율에 대한 연구

강태수,최소래,김영아,박흥수,서정건,황학진,윤세정,신석균,강신욱,최규헌,이호영,한대석,허애정,하성규 대한신장학회 2000 대한신장학회잡지 Vol.19 No.5

간우협 형성부전 2예

정준표,박인서,이관식,김웅,김기황,전재윤,서정건,조현근 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

신장주위 거대혈종을 보였던 신중후성 출혈열 1예

박운형,김영아,정재한,최소래,강태수,서정건,박흥수,하성규 대한신장학회 2000 대한신장학회잡지 Vol.19 No.6

상부위장관 출혈을 동반한 위 기생충성 호산구성 육아종 1예

박효진,손승국,박인서,전재윤,정준표,이관식,김기황,김호근,서정건,조현근 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.1

The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.