협심증 양상의 흉통으로 발현된 식도 아니사키스증 1예

신경덕,안철민,남상우,김상균,김성훈,김인희,김상욱,이승옥,이수택 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.1

Chest pain of a non-cardiac origin is frequently seen in medical practice. This kind of chest pain is often difficult to differentiate from chest pain of a cardiac origin. Esophageal anisakis is a rare finding, but it can cause chest pain. We report here on a patient who had a history of acute myocardial infarction and who also had one stent inserted in his left anterior descending coronary artery two month previously. The patient presented with substernal chest pain that mimicked anginal chest pain. Endoscopic examination revealed a whitish linear worm that had had invaded the esophagogastric junction, and we removed the worm with biopsy forceps. We report here on a patient with an esophageal anisakiasis as a rare cause of noncardiac chest pain that mimicked anginal chest pain. (Korean J Gastrointest Endosc 2007;35:19-22) 흉통은 허혈성 심질환의 중요한 증상 중의 하나이지만 다른 원인에 의해서도 발생할 수 있다. 특히 식도질환에 의한 흉통이 허혈성 심질환에서 발생하는 흉통과 구분하기 어려울 때가 있다. 본 증례는 과거 심근경색으로 경피 관상동맥 중재술을 시행받은 환자에서 협심증과 비슷한 흉통으로 내원하여 시행한 위내시경검사에서 식도위접합부에서 아니사키스가 발견되어 내시경 조직생검 겸자로 제거한 후 증상이 소실된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

기능성 소화불량 및 활동성 십이지장궤양에서 Omeprazole을 포함하는 Helicobacter pylori 박멸제를 이용한 치료효과

신경덕,서재석,이수택,김대곤,안득수 의과학연구소 1999 全北醫大論文集 Vol.23 No.2

Background and objectives : H. pylari has been known important cause of functional dyspepsia and duodenal ulcer. It was reported that duodenal ulcer and functional dyspepsia were improved after eradication of H. phlori. Combination therapy of proton pump inhibitor and two antibiotics(clarithromycin, nitroimidazole or amoxicillin) was recommended. This study was performed to compare the effectiveness of three different regimens in patients with H. pylori. Methods : We performed three tests including endoscopipc biopsy, urea breath test, rapid urease test, before the start of treatment in 15 patients of functional dyspepsia and duodenal ulcer. Drugs of different triple therapy regimen were administered to each pattient randomly for 1 week. The enrolled patients were assigned to one of three treatment schedules. Group Ⅰ : omeprazole 20 ㎎ bid, amosicillin 1,000㎎ bid, clarithromycin 500 ㎎ bid, Group Ⅱ : omeprazole 20 ㎎ bid, clarithromycin 500㎎ bid. And, omeprazole single dose of 20㎎ was administered to all patients for 2 weeks. Urea breath test and rapid urease test were performed to all patients repeatedly through gastrofiberscopy after treatment of two weeks. Results : Fifteen patients with active duodenal ulcer were cured completely by very short term therapy with omeprazole, combination of antibiotics such as tinidazole, clarithromycin, amoxicillin. There were no significant differences in effects and eradication rate of three different treatment regiment including low dose clarithromycin. The eradication rate of three regimens were 80%, 90.9%, 100%, respectively. Symptoms of patients with functional dyspepsia were improved significantly. Adverse effects such as bitter sensation, abdominal discomfort, constipation, diarrhea, dizziness, headache occurred during treatment. But no patient stopped treatment because of any adverse effect. We had done endoscopy as follow-up after 6 months of treatment. No patients have recurred. Conclusions : Active duodenal ulcer could be cured by three weeks regimen completely. Three different triple combinatio therapy containing proton pump inhibitor was effective and safe. But further large scale long term follow-up study is needed to evaluate the reactivation or reinfection of H. pylori.

관동맥내 스텐트 삽입 후 사용한 Ticlopidine과 저분자헤파린 효과에 대한 전향적 무작위 비교연구

신경덕,채제건,문성기,김원호,고재기 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.3

전혈을 이용한 Biocard^TM Helicobacter pylori IgG One-step Immunochromatographic Test의 유용성

신경덕,채제건,이홍범,이수택,안득수 大韓消化器病學會 1999 大韓消化器病學會誌 Vol.34 No.3

두가지 형태의 스테인레스 스틸 풍선확장형 관동맥 튜브스텐트를 경험한 단일 병원에서의 임상결과 비교 연구

채제건,신경덕,김현철,이병현,이수택,김원호,고재기 의과학연구소 2000 全北醫大論文集 Vol.24 No.1

Background and Objectives : Since the introduction of Palmaz-Schatz stent, various second generation stainless steel ballon-expandable tube stents such as MultiLink or NIR stents have been developed and used in the field of coronary intervention. The initial results of these stents were comparable to or even better than those of Palmaz-Schatz stent. However, the clinical and angiographic results comparing with these second generation stents have not been known yet. The purpose of this study was to evaluate the initial and late outcomes of these second-generation tube stents in the experiences of the single institution. Materials and Method : We retrospectively analyzed the efficacy of MultiLink or NIR stents which had been implanted for elective stenting in 140 patients with 155 de novo lesions. Patients with the multiple stents in a single lesion were excluded. There was no limitation of the clinical presentations. Group 1 included the patients who underwent the implantation of short MultiLink 15mm, Group 2 included also the similar length of NIR stent 9mm/16mm. The patients who underwent the implantation of intermediate length of MultiLink 25mm/35mm were group 3, NIR 25(26)mm/32mm was underwent the implantation of intermediate length of MultiLink 25mm/35mm were group3, NIR 25(26)mm/32mm was group 4. Repeat coronary angiography was performed at 187±59 days after stenting with quantitative coronary angiographic analysis (QCA). Results : There were no sgnificant differences in any baseline clinical and angiographic variables between each groups. The mean procedural success rates were 85% and similar in all groups. During the follow-up periods, there were no subacute stent thrombosis, re-infarcrion and death in all groups. Each restenosis rate was 26%, 23%, 14% and 27% and each target lesion revascularization (TLR) rate was 15.0%, 4.7%, 6.7% and 9.5% in group 1, 2, 3 and 4, respectively. These results exhibited that short MultiLink group showed higher TLP rate than short NIR group (p<0.05). Conclusion : There were no sgnificant differences in immediate or midterm clinical and angiographic outcomes after the implantation of MultiLink or NIR stents, which have different designs of stainless-steel ballon expandable tube type except higher TLR rate in short MultiLink than short NIR stents. The midterm outcomes of intermediate length of two tubular stents were similar with those of short stents. However, more experiences and futher evaluations should be warranted.

경피적 알코올 중격절제술로 치료한 비후성 폐쇄성 심근병증 1예

고재기,신경덕,채제건 의과학연구소 1999 全北醫大論文集 Vol.23 No.1

특발성 비후성 심근병증은 좌심실 유출로의 역동적 폐쇄와 대동맥판막하 심실중격의 비대칭성비후를 특징으로 하는 질환이며 지금까지 베타차단제나 칼슘길항제를 이용한 약물요법과 영구형 심박동기를 설치하는 방법, 수술적인 방법이 이용되어 왔다. 저자들은 100% 알코올을 이용하여 비수술적 방법인 경피적 알코올 중격절제술을 시행함으로써 좌심실 유출로의 폐쇄와 압력차를 효과적으로 감소시킨 비후성 폐쇄성 심근병증 환자 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

폐에 발생한 가성 림프종 1예

오상미,이길홍,신경덕,이용철,이양근 대한결핵 및 호흡기학회 1996 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.83 No.0

전혈을 이용한 BiocardTM Helicobacter pylori IgG One-step Immunochromatographic Test 의 유용성

안득수,이수택,이흥범,신경덕,채제건 대한소화기학회 1999 대한소화기학회지 Vol.34 No.3

Background/Aims: The aim of this study was to evaluate usefulness of whole blood serologic test (BiocardTM H. pylori IgG one-step immunochromatographic test) in detecting IgG antibodies to Helicobacter pylori (H. pylori). Methods: For patients with dyspepsia and abdominal discomfort, gastroduodenoscopy was performed. We excluded patients who received treatments for H. pylori infection within a year or who took drugs such bismuth compounds, proton pump inhibitors, or antibiotics (metronidazole, amoxicilline, tetracycline) within 2 weeks. During gastroduodenoscopy, specimens were obtained from the antrum for rapid urease test and histologic examination (Hematoxyline-eosin stain, Giemsa stain). Biocard H. pylori test was performed using whole blood. Characteristics of the Biocard test were evaluated using Giemsa stain and rapid urease test as the $quot;gold standard.$quot; Results: Biocard test was carried out immediately after the endoscopic examination, and the result was available within 10 min in all cases. When the Biocard H. pylori test was compared with histology or rapid urease test, the sensitivity and specificity were 92.8% and 71.3%, respectively. Moreover, its positive predictive value was 92.8% and the negative predictive value was 71.3%. Conclusions: The Biocard H. pylori test using whole blood sample was an easy and rapid method and yielded relatively good performance. This test can be an accurate screening method for H. pylori infection in the office setting and primary care units.

악성 폐쇄성 황달에서 경피적인 십이지장 유두부 통과 스텐트의 안정성 평가: 췌장염 발생 위험도와 선행적 유두부 괄약근 절개술의 의미를 중심으로

정영욱 ( Young Wook Jeong ),신경덕 ( Kyong Deok Shin ),김성훈 ( Seong Hun Kim ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이경애 ( Kyong Ae Lee ),전병준 ( Byung Jun Jeon ),이승옥 ( Seung Ok Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.6

목적: 악성 폐쇄성 황달 환자에서 PTBD를 통한 스텐트 삽입술 시 췌장염의 발생 위험성에 대해 알아보고, 특히 십이지장 유두부 통과 여부와 PTBD 시술 전 EST가 되어 있는 경우가 췌장염 발생에 영향을 미치는지 알아보았다. 대상 및 방법: 2002년 1월부터 2007년 12월까지 본원에서 PTBD를 통해 스텐트 시술을 하였던 90명을 대상으로 스텐트의 십이지장 유두부 통과 여부에 따른 췌장염의 발생빈도와 PTBD 시술 전 선행적 EST의 시술 여부에 따른 췌장염의 발생 빈도를 비교하여 관련된 췌장염 발생의 위험도를 알아보았다. 췌장염은 PTBD 시술 전과 비교하여 amylase 농도가 정상범위의 3배 이상 상승하며 24시간 이상 복통이 지속되는 경우로 정의하였다. 결과: PTBD를 통한 스텐트 삽입술 시 십이지장 유두부의 통과는 췌장염 발생을 증가시키는 경향을 보였으나 통계학적인 유의성은 없었다(Odd ratio 1.867, 95% CI 0.515-6.761, p=0.562). 선행적인 EST가 되어있는 경우에는 췌장염 발생이 감소하는 경향을 보였으나 통계학적인 유의성은 없었다(Odd ratio 0.914, 95% CI 0.656-1.273, p=0.614). 결론: PTBD를 통한 스텐트 삽입술 시 스텐트의 십이지장 유두부 통과는 췌장염 발생의 위험인자 가능성이 있으며, 선행적인 EST가 PTBD 시술과 관련된 췌장염 발생의 위험을 감소시킬 수 있음을 추정할 수 있다. 향후 좀 더 많은 환자를 대상으로 이에 대한 전향 연구가 필요할 것으로 생각한다. Background/Aims: Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. Methods: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. Results: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). Conclusions: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention. (Korean J Gastroenterol 2009;54:390-394)

제2형 당뇨병 환자의 경동맥 플라크와 Apo E 지단백 유전형 다형성과의 관계

이승현,박태선,김달식,최정기,신경덕,류완희,김현각,백홍선,문치영 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.5