Morgagni`s Hernia 2예

육은주(Eun Ju Yook),전준식(Joon Sik Jeon),김성걸(Seong Gul Kim),김진희(Jin Hee Kim),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),김응중(Eung Jung Kim),이영(Young Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

We report two cases of Morgagnis hernia comprising the protrusion of omentum alone. The treated patients were 65- and 64-year old women. They were referred to our hospital due to epigastric discomfort, or dypnea accompanied by an abnormal shadow in right cardiophrenic angle on chest roentgenogram. Surgery through an abdominal approach was preferred and the post- operative course was benign. (Korean J Gastroenterol 1996;28: 148 150)

소화성궤양과 위암에서 Helicobacter pylori 의 검출빈도

성자원(Ja Won Sung),육은주(Eun Ju Yook),임의혁(Euyi Hyeog Im),김병호(Byeong Ho Kim),이기천(Ki Cheon Lee),허승식(Seoung Sik Heo),정현용(Hyun Yong Jeong),이헌영(Heun Young Lee),김영건(Young Kun Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.1

N/A Background: It is clear that gastric colonization by H. pylori is extremely common among patients with peptic ulcer, particularly when this involves the duodenal mucosa. The precise frequency of H, pylori in various gastroduodenal conditions varies somehow, but there is unanimity in confirming a strong association among H. pylori, chronic gastritis, and ulceration. Furthermore atrophic gastritis has been reported to be a precursor lesion for gastric cancer. So we estimated the prevalences of H. pylori infection, and serum gastric level in peptic ulcer and gastric cancer. Methods: The specimens were obtained by endoscopic biopsy of the gastric antrum from 40 patients with duodenal ulcer, 38 patients with gastric ulcer and 47 patients with gastric cancer. The urease activity was analyzed for 24 hours on the basis of Campylobacter-like organism test(CLO test). A change in color of the urea broth from yellow-gold to pink-red was interpreted as a positive result. Results: 1) The prevalence of H. pylori infection was significantly higher in duodenal ulcer (75.0%) than in gastric ulcer (52.6%) and in gastric cancer (38.3%, p<0.05). 2) The mean age of positive groups of CLO test among total 125 cases was significantly younger (49 years) than the negative groups (63 years, p<0.05), In each diseases, gastric cancer and duodenal ulcer were also significantly younger in the positive groups than the negative groups(p<0.05). But there was no significant difference between two groups in gastric ulcer. 3) Duodenal ulcer patients with positive CLO test had significantly the lower gastrin level when compared to patients with negative CLO test (p<0.05). In contrst, patients with gastric cancer or gastric ulcer with positive CLO test had trend of higher gastrin level when compared to patients with negative CLO teat. Conclusions: There is a strong association between H, pylori and duodenal ulcer, The influence of H. pylori infection on serum gastrin may be different between gastric disease and duodenal ulcer.

간경변증 환자에서 간신티그램을 이용한 Propranolol 투여 전후의 간혈류 변화

김병호(Byeong Ho Kim),서광석(Kwang Suk Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),육은주(Eun Ju Yook),임의혁(Euyi Hyeog Im),성자원(Ja Won Sung),이강욱(Gang Wook Yi),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Esophageal varix bleeding due to portal hypertension in liver cirrhotics is very emergency state and difficult for management. In spite of many kinds of treatment in esophageal varix bleeding such as medical and surgical methods, but cant be expected of good results. Lebrec report that propranolol is significantly decreased portal venous pressure in 1980. This study analyzed the portal hemodynamics by liver scintigraphy of 38 patients with liver cirrhosis who were proven to have esophageal varices and 10 norrnal subjects. The 19 cirrhotics had taken liver scintigraphy before and after propranolol medication. There were significant difference in HAI(Hepatic Arterial Index) between cirrhotics and normal subjects(64.7k16.5/ vs 31.9+8.3%, p<0.001). There were no significant difference in HAI according to the Childs classification, the type of variceal morphology and the presence of ascites, but the HAI in Child B(68.1%) and C(63.4%) groups were higher than that in Child A group(55.5%). The heart rate decreased significantly after propranolol ( 7.6No./min, p<0.001) and the HAI increased significantly after propranolol (+8.0%, p<0.05). It should be suggested that propranolol is effective in decreasing the portal hypertension by decreasing the portal blood flow. There were no serious complication of propranolol. In conclusion, these results suggest that propranolol could be a potentially useful and safe agent in management and prevention of variceal bleeding by decreasing the portal hypertension and the liver scintigraphy with Tc tin colloid is reasonably a accurate, simple, safe, and rapid method, therefore can be considered suitable for use in the assecement of liver hemodynamics.(Korean J Gastroentero11994; 26: 119-126)

위선종과 위암에서 면역조직화학적 염색을 이용한 p53 단백 발현율의 비교

김진희(Jin Hee Kim),서광식(Kwang Sik Seo),김성걸(Seong Gul Kim),임의혁(Euyi Hyeog Im),육은주(Eun Ju Yook),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),이충식(Choong Sik Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

N/A Backgrounds: The mutation of p53 gene and p53 protein accumulation is discovered in dysplasia of stomach and gastric cancer. We compared p53 protein expression rate with gastric adenoma and gastric cancer using the immunohistochemical stain and tried to know the correlation of the malig- nant potential of gastric adenoma with p53 protein expression. Methods: We obtained 52 tissues from 22 gastric cancers and 30 gastric adenomas. Accumulation of p53 protein was detected by immunohistochemistry using Anti-Human p53 monoclonal antibody(Pab 1801; Pharmingen). Results: p53 immunoreactivity was detected in 33.3% of gastric adenomas and in 59.l% of gastric cancers. But, threre was no significant difference between two groups(p=0.065). The rate of p53 expression according to various stages, differentiations, cell types in gastric cancers was not significantly different. Also, p53 expression rate according to cell types, size in gastric adenomas showed no significant difference. Conclusions: We suggest that mutation of the p53 gene is an early event in stomach tumorigenesis. But there is to be required more research about the correlation of the malignant potential of gastric adenoma with p53 protein expression. (Korean J Gastroenterol 1995;27: 509 - 516)

장출혈을 동반한 회장의 림프종

김성걸(Seong Gul Kim),최지영(Jee Young Choi),임의혁(Euyi Hyeog Im),김진희(Jin Hee Kim),육은주(Eun Ju Yook),김병호(Byeong Ho Kim),성자원(Ja Won Sung),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

Primary small intestinal lymphomas are a hetorogenous group of tumors ortginating from the lymphoid cells of the mucosa and submucosa of the small bowel. The ileum and jejunum are most frequently affected, whereas duodenal involvement is less common. There is a himodal age distribution with peak incidences below the age of 10 and in the fifth and sixth decados, with a slight male prodominance. And it is very difficult to diagnose until the dovelopment of any complications such as obstruction, perforation ancl hemorrahage because of the insidious onset of disense and relative inaccuracy of the diagnostic tools as in all the small bowel tumor. Optimal treatment choices for lymphoma remain controversial. Surgical resection, in many cases, is considered the first line of defense. Primary malignant lymphoma of the small intestine has poorer prognosis due to the delay of the diagnosis than any other extra-intestinal malignancy, but has the better prognosis than any other small intestinal malignancy. The histologic type, the extent of the intestinal disease, and the prosence or absence of extraintestinal involvement are the important factors in prognosis. Patients with resectable disease typically have a 40/r, to 507r, S-year survival. Recently the authers diagnosed the primary small intestinal lymphoma associated with a large amount of bleeding confirmed by intraoperative biopsy. So we report this case with the review ot literatures. (Korean J Gastroenterol 1995;27:251-255)

내시경으로 진단된 소화성 궤양의 임상적 고찰

김영건,육은주,김성걸,임의혁,성자원,김병호,허승식,이기천,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

A clinical analysis was performed of 3055 pateints with peptic ulcer who were diagnosed with gastroduodenoscopy, in Hospital of Chungnam National University College of Medicine from July 1988 to May 1993. 1) During the period 1988-1993, The proportion of gastric ulcer among peptic ulcer decreased from 47.8% to 42.8%, but that of duodenal ulcer increased from 36.8% to 39.6%. 2) Of the 3055 cases, the number of patients with esophageal ulcer was 98(3.2%), with gastric ulcer 1407(41.6%), with. duodenal ulcer 1104(36.1%), with channel ulcer 149(4.9%), and with combind ulcer 297(9.7%). 3) We observed a peak incidence of peptic ulcer in the 50-69age group, gastric ulcer in the 5069age, duodenal ulcer in the 40-59age group. The ratio of male to female was 3.6 : 1 in peptic ulcer, 4.4 : 1 in gastric ulcer, 3.0 : 1 in duodenal ulcer. 4) The common site was angle in gastric ulcer, and bulb in duodenal ulcer. 5) The active stage was 39.4% of gastric ulcer, and 37.4% of duodenal ulcer, the healing stage was 34.2% of gastric ulcer, and 17.9% of duodenal ulcer, and the scar stage of gastric ulcer was 26.4%, and duodenal ulcer was 44.7%. 6) The size of ulcer was less than 1Cm in 66.7% of gastric ulcer, and in 75.5% of duodenal ulcer, the size of ulcer was greater than 2Cm in 13.2% of gastric ulcer, and in 6.5% of duodenal ulcer. 7) The frequency of multiple ulcer was 29.9% in gastric ulcer, and 16.5% in duodenal ulcer.

상부소환관협착에 대한 Savary-Gilliard Dilatation의 치료효과와 안전성에 관한 관찰

정현용,육은주,임의혁,김병호,성자원,이기천,허승식,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

For the patient with stenosis of upper digestive tract caused by either benign or malignant process, esophageal dilatation is an important therapeutic modality. We reviewed retrospectively 39 cases treated by Savary-Gilliard dilatation for upper digestive tract stenosis, and results were follows : (1) Dysphagia was improved in 95% of the patients. (2) Eight patients(20%) sufferd perforation, five of them were managed with conservative medical measures, others were managed operatively. (3) In the cases with benign stenosis dysphagia was not noticed for 8.8 months, but with malignant stenosis dysphagia was reappeared after 2.8 months despite concomitant chemoradiotherapy. In conclusion, Savary-Gilliard dilatation was an effective measure for symptome due to upper digestive tract stenosis, but more careful attention for perforation should be necessitated. Also another therapeutic modality for treatment of malignant stenosis was inevitable.

당뇨병의 급성 대사성 합병증에 대한 임상적 고찰(Ⅱ)

김영건,육은주,성자원,허승식,송민호 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

We observed clinical features in 43 patients with acute metabolic complications of diabetes mellitus, diabetic ketoacidosis 36 cases and hyperosmolar nonketotic coma 7 cases who were diagnosed and treated in Chunangnam National University Hospital from Jan. 1988 to Dec. 1992. The range of age of the patients with diabetic ketoacidosis was from 2nd decade to 9th decade. The diabetic ketocacidosis was most frequent in the 4th decade(22.2%). But the range of patients with hyperosmolar nonketotic coma was from 6th decade to 9th decade and that compications was most frequent in 6th decade. There were no significant sex difference in the groups of acute metabolic complications. The altered consciousness was the most common complaints both groups of diabetic ketoacidosis and hyperosmolar nonketotic coma. Omission of insulin therapy, infection, and fasting were the most common precipitating factors for the development of diabetic ketoacidosis and hyperosmolar nonketotic coma. Only 3(8.3%) out of 36 patients with diabetic ketoacidosis were presented as the initial manifestations of diabetes mellitus. The mortality rates of the patients with diabetic ketoacidosis and hyperosmolar nonketotic coma 5.6% and 28.6%, respectively.

만성 간질환에 대한 DDB(Biphenyl Dimethyl Dicaboxylate)의 임상적 효과

이헌영,임의혁,김성걸,김진희,육은주,성자원,김병호,정형용,강대영,김영건 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

To investigate the effects of short-term administration of DDB(Biphenyl Dimethyl Dicarboxylate) for decreasing elevated serum aminotransferase levels in chronic liver diseases, authors applied 3 capsules of DDB per day at each meal time for 35 patients and compared with 35 patients treated with other conservative management. The following results were obtained. 1. Serum alanine aminotransferase (ALT) levels significantly decreased from 247.1± 180.0 IU/L of pretreatment level to 96.6±126.0 IU/L, 61.1±62.7 IU/L and 38.0±26.8 IU/L after 1, 3 and 6 months of treatment(p<0.05) and effective rates were observed in 60.0%, 71.4% and 88.6% of patients after 1, 3 and 6 months of treatment. 2. Serum aspartate aminotransferase (AST) levels decreased also significantly from 167.8±96.9 IU/L of pretreatment levels to 124.4±155.0 IU/L, 77.9±49.6 IU/L, 60.6± 46.9 IU/L after 1, 3 and 6 months of treatment(p<0.05), but decreasing pattern of serum AST was less significant than that of serum ALT. 3. No significant difference were observed in the serum ALT and AST changes according to the cause and duration of hepatitis. 4. No significant adverse effects were observed in whole patients treated with DDB. It is suggested that small dose administration of DDB is effective for decreasing serum aminotrans ferase levels in chronic liver disease in which other conservative management was not effective.

출혈성 식도정맥류의 내시경적 경화요법 및 결찰요법시행후 위정맥류의 발생양상

김남재,김진희,서광식,김석현,이병석,이헌영,김성걸,육은주,정현용,임의혁 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.1

Background: Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated, and the fate of coexisting gastric varices after eradication of esophageal varices is not clearly known. Methods: EIS or EVL was preformed in 174 patients with variceal hemorrhage in CHUNG-NAM NATIONAL UNIVERSITY HOSPITAL from September 1990 to December 1993. Among the total 174 patients, 50 patients were followed for at least 1 year. Forty four patients were treated with EIS, and 6 witb EVL. We assesed the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in 50 patients. Results: 1) Primary(present at initial examination) gastric varices were seen I 40(23.0%) of 174 patients. 2) In 6(17.1%) of the 35 patients after sclerotherapy, secondary gastric varices developed. 3) In 2(22.2%) of 9 patients who diagnosed as coexisting gastric varices in early evaluation, gastric varices were reduced or disappered after EIS. 4) Six patients with ligation therapy were followed over 1 year, and the development of Secondary gastric varices were observed in 3(50%) patients. Coneluslon: These results show that the development and reduction of gastric varices after EIS or EVL in portal hypertension patients, however we think that further clinical studies with a large number of cases including control group should be undertaken to achieve statistical significance.