경동맥 플라크를 동반한 뒤허혈시신경병증 1예

은준수(Jun Soo Eun),장무환(Moo Hwan Chang),경성은(Sung Eun Kyung) 대한안과학회 2016 대한안과학회지 Vol.57 No.7

목적: 구후성시신경염으로 의심되었던 환자에서 경동맥 플라크를 동반한 뒤허혈시신경병증을 진단하였기에 이를 보고하고자 한다. 증례요약: 48세 남자 환자가 3일 전부터 발생한 두통, 좌안 시력저하 및 하측시야장애를 주소로 내원하였다. 최대교정시력은 우안 1.0, 좌안 0.1이었으며, 전안부 상태 및 안압, 안저, 빛간섭단층촬영 검사는 정상이었다. 좌안 구심성 동공 운동 장애, 색각 이상, 시야 검사상 30°전체 암점 소견이 관찰되었고 혈액검사, 뇌 자기공명검사에서는 특이소견이 관찰되지 않았다. 구후성시신경염 의심하에 3일간 스테로이드 정맥주사를 시행하고 퇴원하였다. 1주 뒤 경과관찰 중 입원 전에 기억소실 및 좌측 상지 무력감이 선행했었다고 하여 형광안저촬영과 경동맥 초음파 검사를 추가적으로 시행하였다. 형광안저촬영에서 시신경유두 주위에 국소적인 혈관 충만지연 소견이 관찰되었고, 경동맥 초음파 검사상 크기 1.4 cm, 두께 1.9 mm의 플라크가 발견되었다. 6개월 후 좌안 교정시력 0.4, 시야 결손은 일부 호전되었다. 결론: 구후성시신경염이 의심되는 경우, 드물지만 뒤허혈시신경병증의 가능성을 고려하여 형광안저촬영을 시행하고, 허혈성이 의심되는 경우 추가적으로 경동맥 초음파 검사를 시행하여 죽상경화증 여부를 확인하는 것이 뇌졸중을 비롯한 심혈관 질환 예방에 도움이 될 것으로 생각된다. <대한안과학회지 2016;57(7):1180-1186> Purpose: To report a case of posterior ischemic optic neuropathy accompanied by carotid artery plaque in a patient with retrobulbar optic neuritis. Case summary: A 48-year-old man visited our clinic complaining of headache, decreasing visual acuity and defect of inferior visual field in his left eye for 3 days. The best corrected visual acuity was 1.0 in the right eye and 0.1 in the left eye. The anterior segment state, intraocular pressure, fundus examination and optical coherence tomography were normal in both eyes. Relative afferent pupillary defect, color vision deficiency and total scotoma were observed in his left eye. The results of the laboratory test and brain magnetic resonance imaging were normal. He was discharged from the hospital after 3 days of systemic steroid treatment on the basis of retrobulbar optic neuritis. A week later, fluorescent angiography and carotid ultrasonography were performed because of his history memory loss and left upper limb weakness before admission. A focal filling defect of the peripapillary area was found on fluorescent angiography. A plaque with a thickness of 1.9 mm and a length of 1.4 cm was found on carotid ultrasonography. After 6 months, the best corrected visual acuity was 0.4 in the left eye and the visual field showed a partially improved defect. Conclusions: Fluorescent angiography is recommended for potential posterior ischemic optic neuropathy in patients with retrobulbar optic neuritis, even though it is rare. Carotid ultrasonography is useful in finding atherosclerosis to prevent stroke or cardiovascular disease if ischemic cause is suspected on fluorescent angiography. J Korean Ophthalmol Soc 2016;57(7):1180-1186

비동맥염성 앞허혈시신경병증 환자에서 스테로이드 치료효과

은준수(Jun Soo Eun),이명원(Myung Won Lee),경성은(Sung Eun Kyung) 대한안과학회 2017 대한안과학회지 Vol.58 No.10

목적: 비동맥염성 앞허혈시신경병증 환자에서 스테로이드 치료(정맥 내 주사, 경구) 효과를 알아보고자 하였다. 대상과 방법: 2005년 1월부터 2016년 12월까지 본원에서 비동맥염성 앞허혈시신경병증으로 진단 받은 환자에게 스테로이드 치료의 장단점을 설명하여 치료 방법을 선택하게 한 뒤 후향적으로 의무기록을 통해 치료효과를 비교하였다. 6개월 이상 경과관찰이 가능했던 환자는 41명으로 정맥 내 스테로이드 주사, 경구 스테로이드 투여, 스테로이드 치료 없이 경과관찰만 시행한 3군으로 나누어 초기시력과 마지막 내원 시 시력, 시야결손 정도 및 형태, 형광안저촬영, 시유발전위검사, 뇌자기공명영상 결과를 분석하였다. 결과: 전체 비동맥염성 앞허혈시신경병증 환자 41명의 첫 내원 시 주 증상은 시력저하(24명), 시야장애(10명), 증상없음(4명), 복시(2명), 비문증(1명) 순이었다. 스테로이드 투여 방법에 따른 환자 분포는 정맥 내 주사치료 15명, 경구 투여 14명이었고, 스테로이드 치료를 시행하지 않은 경과관찰군은 12명이었다. 초기 시력 및 마지막 내원 시 시력 변화는 정맥 내 주사(87%), 경구 투여(43%), 치료 없음(33%) 순의 비율로 시력 호전을 보였다. 결론: 비동맥염성 앞허혈성시신경병증 환자에서 치료방법을 선택하게 한 뒤 후향적으로 조사한 치료효과 비교에 있어서 정맥 내 스테로이드 주사 방법으로 치료를 시행한 환자군이 87%의 시력호전과 교차비 5.5배(95% 신뢰구간 1.05-28.88, 유의확률 0.04), 경구 투여환자군이 43%의 시력호전과 교차비 1.5배(95% 신뢰구간 0.30-7.43, 유의확률 0.62)를 보여, 스테로이드 치료 없이 경과관찰(33%)만을 시행한 환자군에 비해 높은 비율의 시력호전 결과를 보였고, 특히 정맥 내 스테로이드 주사군은 경과관찰군에 비해 상대적으로 5.5배의 시력호전 효과를 보였다. Purpose: To investigate the effect of steroid treatment (intravenous injection, oral) in patients with non-arteritic anterior ischemic optic neuropathy (NAION). Methods: From January, 2005 to December, 2016, 41 patients who were diagnosed with NAION and observed for more than 6 months were included in this study. The treatment was decided based on patient’s choice after explaining the advantages and disadvantages of steroid therapy. The patients were divided into three groups (intravenous steroid injection, oral steroid, no treatment). Initial visual acuity, final visual acuity, degree of visual field defect, fluorescein angiography, visual evoked potential and brain magnetic resonance imaging were analyzed by chart review. Results: The chief complaints of the 41 NAION patients at the first visit were decreased visual acuity (n = 24), visual field defect (n = 10), no symptoms (n = 4), diplopia (n = 2), and floaters (n = 1). The distribution of the patients according to steroid administration method was 15 patients with intravenous steroid injection, 14 patients with oral steroid and 12 patients with no treatment. The improvement in visual acuity was greatest in intravenous steroid injection (87%), oral steroid (43%) and no treatment (33%) in that order. Conclusions: In a retrospective comparison of treatment effects after explaining the advantages and disadvantages of steroid therapy in patients with NAION, the intravenous steroid injection group showed 87% improvement in visual acuity and an odds ratio of 5.5 (95% confidence interval [CI] 1.05-28.88, p-value 0.04), while the oral steroid group showed 43% improvement and an odds ratio of 1.5 (95% CI 0.30-7.43, p-value 0.62). The steroid treatment group showed better visual acuity improvement than the no treatment group, and the intravenous steroid injection group showed 5.5 times greater improvement in visual acuity compared to the no treatment group.

류마치스 관절염과 담석증의 상관성에 관한 연구

백상현 ( Sang Hyun Baik ),함준수 ( Jun Soo Hahm ),전용철 ( Young Chul Jeoun ),이오영 ( O Young Lee ),이민호 ( Min Ho Lee ),기춘석 ( Chun Suk Ki ),박준용 ( Jun Yong Park ),은창수 ( Chang Soo Eun ),한동수 ( Dong Su Han ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

〈배경〉 현재까지 담석의 증가와 연관성을 가진 병적인 상태를 찾고자하는 연구가 진행되어 왔다. 대개의 류마치스 관절염환자는 NSAID를 복용하고 있는 자가 많고, 동물 실험을 NSAID가 담석 생성과 관련이 있음이 발표되기도 하였다. 본 연구에서는 류마치수 관절염환자에서의 담석의 빈도를 제시하고 matched control과의 여러 다른 기준척도등의 비교를 통해 이들간의 유의성을 비교하였다. 〈연구대상 및 방법〉 한양대 류마치스 병원에 입원하였던 선별검

십이지장벽 내에 발생한 췌장 가성낭종 1예

박은주,박경남,이용욱,이민호,조윤주,최호순,이동후,손주현,함준수,손영우,은창수,전용철,기춘석,윤병철,유정수 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.1

Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum.

말기 신질환과 혈액투석 환자의 담석증 유병률에 대한 고찰

한동수,이민호,이정익,김호중,최호순,윤병철,이오영,기춘석,함준수,은창수,전용철,이향락,손병관,정청일 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Background/Aims: Gallstone disease is one of the major cause of morbidity in adults. Hemodialysis (HD) has been found to increase risk of gallstone formation following increase in bile cholesterol and biliary saturation index. There are very few data about the prevalence of gallstone in hemodialysis patients and so, we performed this study. Methods: We compared the prevalence of gallstone disease in patients with end-stage renal disease (ESRD) treated with HD with that in 208 age- and sex-matched controls (non-uremic control group). Patients who had chronic liver disease, renal disease, and diabetes were excluded from the control group. Results: In our study, we found a prevalence of gallstone of 18.3% in patients with ESRD treated with HD, which was significantly higher than 5.3% in the non-uremic control group. In most of our HD patients, cholecystolithiasis was asymptomatic. HD patients with cholecystolithiasis were statistically significantly older than patients without gallstones. We did not find a difference in sex, duration of HD treatment between patients with and without gallstones. Conclusions: Our results suggest that the prevalence of gallstone disease is higher in patient with ESRD treated with HD than in non-uremic population in Korea.

담도 배액관 교체 후 발생한 혈담증

박경남,한동수,이민호,최호순,손주현,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Hemobilia is defined as hemorrhage into the biliary tract and occurs when injury or disease cause communication between the biliary tract and blood vessels. The causes of hemobilia are trauma (accidental, iatrogenic), inflammation, gallstone, neoplasm, and vascular lesions. Currently, the mos common cause of hemobilia is trauma. Specially, iatrogenic causes are considered as the mos important. Iatrogenic cause of hemobilia has increased now because invasive procedures such as liver biopsy, biliary drainage (PTBD, ERBD) were popular. We experienced 2 cases of iatrogenic hemo bilia developed after exchange of ERBD stent.

점막하 종양양상의 위 과오종 1예

박경남,한동수,이민호,박용욱,조윤주,장우영,최호순,이동후,이오영,기춘석,함준수,윤병철,은창수,전용철,고동희 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.3

Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3×2×1.5 cm and was characterized by cystic dilation of glandular structures, The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures.

담낭절제술과 대장암과의 상관관계

김기찬,박경남,한동수,이민호,최호순,이동후,손주현,이오영,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: It has been suggested that cholecystectomy can be related with the developmen of colon cancer and altered bile acid metabolism after cholecystectomy may be an important facto in the carcinogenesis. Thus, we have conducted a retrospective case-control study to clarify the relationship between cholecystectomy and subsequent development of colon cancer. Methods: We compared the incidence of previous cholecystectomy in 424 patients with colon cancer who had treated in our clinic during the period of 1983 to 1997 and in 424 age- and sex-matched controls Results: There was no significant difference in a prevalence of cholecystectomy and gallstones between colon cancer patients and controls (Cholecystectomy: odds ratio=1.17, 95% confidence interval=0.39-3.51; Gallstone: odds ratio=1.27, 95% confidence interval=0.73-2.21). The prevalence of cholecystectomy and gallstones was a little high in right-sided colon cancer group, but there was no statistically significant difference between right and left colon. Conclusions: The present study showed that there was no statistically significant association between cholecystectomy and colon cancer. To clarify whether colon cancer is associated with cholecystectomy or gallstones, further study with large sample size and a prospective study of the incidence of colon cancer afte cholecystectomy are proposed.

간내담관암에 동반된 종양 색전에 의한 폐쇄성 황달

박준용,박경남,한동수,이광수,이민호,조윤주,최호순,이동후,손주현,손영우,기춘석,은창수,전용철,임현철,고병희,함준수,윤병철 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1

Tumor emboli of intrahepatic cholangiocarcinoma in bile duct rarely cause obstructive jaundice. Intraductal tumor embolus is associated with advanced stage of tumor within the liver, and shows poor prognosis and brief survival. However, jaundice by tumor embolus from intrahepatic cholangiocarcinoma must be distinguished from jaundice by common cause, which can be palliated safely and effectively. A patient presented with 1-month history of jaundice and epigastric pain. On cholangiography, polypoid filling defect was observed in the common hepatic duct, which had dilated proximal intrahepatic bile duct and mass shadow on the left lobe of liver. Tumor resection, embolectomy, and bile duct decompression were performed and the obstructive jaundice was relieved. Tumor embolus from intrahepatic cholangiocarcinoma was confirmed intraoperatively and pathologically as the cause of bile duct obstruction. In this report, we describe the rare case of obstructive jaundice by tumor emboli from intrahepatic cholangiocarcinoma with a review of literatures.