만성췌장염의 내시경적 치료

이승옥 ( Seung Ok Lee ),김성훈 ( Seong Hun Kim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1

Chronic pancreatitis is a debilitating disease with complications such as pancreatic duct stricture, duct stones, duct leak or fistulae, pseudocyst contributing to significant morbidity and mortality. Endoscopic intervention in patients with chronic pancreatitis compared to surgery has been known relatively safe and effective. Although there are several limitations, endoscopic intervention plays a specific role in carefully selected patients as primary interventional therapy when medical treatment was failed or patients are not suitable for surgery. In this review, we address the role of endoscopic intervention for chronic pancreatitis.

종설 : 간흡충과 담관암: 발암 기전

이승옥 ( Seung Ok Lee ),김성훈 ( Seong Hun Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3

It has been clarified that chronic infection with viruses such as hepatitis B virus, bacteria such as Helicobacter pylori and parasites contribute to carcinogenesis in human. Three helminth infections have been classified as definitely carcinogenic to humans (group I carcinogens), namely Schistosoma haematobium, which is associated with urinary bladder cancer and liver flukes Clonorchis sinensis and Opisthorchis viverrini associated with cholangiocarcinoma of the liver. Opisthorchis viverrini which has been extensively studied the association with cholangiocarcinoma is endemic in Southeast Asian countries including Thailand, Vietnam and Cambodia. Clonorchis sinensis infection which is common in rural areas of Korea and China has also been reported its definite association with cholangiocarcinoma. Carcinogenesis associated with liver flukes infections is a complex process hard to be studied because of long latency period and numerous other factors can play a role although chronic inflammation has been known as a key feature. Mechanical injury from the activities of migrating and sucking flukes contributes to biliary damage and chronic inflammation. The liver fluke also secretes or excretes metabolic products, some of which are highly immunogenic, toxic and promoting biliary epithelial cell proliferation. Host immune responses and immunopathological processes are also likely associated with chronic inflammation and carcinogenesis. Escape from host anti-tumor immune response and shift to Th2 response of Th1-Th2 balance are related with carcinogenesis. Biliary cell and its DNA damage can be induced by oxygen free radicals such as nitric oxide released from effector cells activated by inflammatory cytokines. Exogenous carcinogen suchas nitrosamine seemed also closely related with cholangiocarcinoma development in liver fluke infected individuals. In this paper, various and stepwise mechanisms of carcinogenesis by liver flukes and its potential targets can be intervene were reviewed. (Korean J Med 2011; 80:273-279)

비전형적인 고형 가유두상 종양

김성훈 ( Seong Hun Kim ),조양동 ( Yang Tong Cho ),권혁진 ( Hyeok Jin Kwon ),안철민 ( Chul Min An ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이수택 ( Soo Teik Lee ),이승옥 ( Seung Ok Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Solid-psudopapillary tumor is an uncommon pancreatic neoplasm of low malignant potential that most frequently affect young woman. Solid-psudopapillary tumor are histologically, clinically, and prognostically quite distinct from the more common ductal adenocarcinoma. Recently, we experienced a 36-year-old male who was suspected to have extrapancreatic tumor based on atypical radiologic imaging study, young age, and male sex, and finally diagnosed as solid-psudopapillary tumor on immunohistochemical stain examination. We report this case with review of the relevant literatures. (Korean J Gastroenterol 2009;54:252-256)

Epidemiological Investigation of Diseases in Korean Native Suckling Calves

권오덕,최경성,이승옥,정환,이주묵,Kwon, Oh-Deog,Choi, Kyoung-Seong,Lee, Seung-Ok,Jang, Hwan,Lee, Joo-Mook The Korean Society of Veterinary Clinics 2000 한국임상수의학회지 Vol.17 No.1

This study was carried out to investigate the epidemiological prevalence of diseases from birth to weaning in 268 Koeran native calves which was delivered from three stock farm in Chonbuk area. We examined body weight gain, incidence rate of diseases and mortality rate in relation to age, season, environmental temperature and rearing management conditions for one year. The results of this experiment were as follows: Birth weight and body weight gain of Korean native calves born of primiparae were lower than those of multiparae. Body weight gain of diseased calves was lower than normal calves. Of 268 delivered calves, 242 calves(90.3%) were affected with gastronistestinal and/or respiratory diseases. The prevalence of the diseases were gastronitestinal disease(54.1%), gastronitestinal and respiratory disease(21.6%), and respiratory disease(14.5%). Of 242 diseased calves, 33 calves(13.6%) were occurred gastronitestinal disease and respiratory disease at different time respectively. Of 268 delivered calves, 126 calves were died(47%). The prevalence of the death were gastronitestinal disease(31.4%), gastronitestinal and respiratory disease(14.5%), and respiratory disease(1.1%). 81% of the diseases and 76.2% of the death were occurred in winter and a change of season(December to May). 59.1% of the diseases and 52.4% of the death were occurred at atmospheric temperatures below 1$0^{\circ}C$. 91.7% of the diseased calves and 96.8% of the dead calves were born of primiparae. 77.2% of the gastronitestinal disease were occurred within 2 weeks old, and the incidence was decreased with increasing age. Whereas the incidence of respiratory disease was incidence with ageing, and 69.2% of the respiratory disease were occurred between 2 weeks and 5 weeks old. And 62% of the gastronitestinal and respiratory disease wre occurred between 1 week and 3 weeks old. 65.1% of the dead calves were died within 2 weeks old. The morbidity and population mortality rate in each farm stock were 56.5%-104.9%, and 14.5%-64.2%, respectively.

증예(症例) : 경피경간 담배액관 통로를 통해 파종성 피하 전이를 보인 담낭암 1예

이상연 ( Sang Youn Lee ),김성훈 ( Seong Hun Kim ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이승옥 ( Seung Ok Lee ) 전북대학교 의과학연구소 2005 全北醫大論文集 Vol.29 No.1

경피경간 담도배액술은 수술이 불가능한 악성 담도폐쇄 질환이나 수술적 처치가 어려운 양성 담도폐쇄 질환 모두에서 그 효과가 입증되었으며 비교적 안전하다고 알려져 있는 외적 담도배액술이다. PTBD의 합병증으로는 균혈증과 출혈, 복막염 등이 흔하며 드물게 배액관 통로를 통한 파종성 전이가 있을 수 있으나 국내에는 보고된 예가 없다. 저자들은 담낭암으로 인한 악성 담도폐쇄로 PTBD 시행 후 피하에 종양의 파종성 전이를 전형적으로 보인 1예를 경험하였기에 문헌고찰과 함께 보고한다. Percutaneous transhepatic biliary drainage (PTBD) is a well established method in the treatment of malignant obstructive jaundice and in surgically incurable benign diseases causing obstructive jaundice. Although PTBD is considered safe, it has a potential risk of tumor seeding along the catheter tract. Metastatic tumor seeding is very rare and there have been only a few reported cases. We report a case of subcutaneous implantation metastasis in a 69-year-old woman who underwent PTBD due to obstructive jaundice caused by gallbladder cancer.

증례 : 소화기 ; 고립 상장간막동맥박리로 스텐트 삽입 후 발생한 상장간막 동맥증후군

이승룡 ( Seung Ryong Lee ),김성훈 ( Seong Hun Kim ),남상우 ( Sang Woo Nam ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이승옥 ( Seung Ok Lee ),이수택 ( Soo Teik Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

상장간막동맥증후군은 대동맥과 상장간막동맥이 이루는 각이 줄어들면서 십이지장의 폐쇄를 유발하는 매우 드문 질환이다. 여러 의학적 혹은 정신적 질환에 의해 급격한 체중감소가 발생하면 십이지장 제3부가 통과하는 대동맥과 상장간막동맥 간의 공간에 지방조직이 줄어서 발생하게 된다. 고립 상장간막동맥박리는 급성 장간막 허혈의 매우 드문 원인 중 하나인데, 장경색을 유발하거나 상장간막동맥의 파열의 위험이 높은 박리증의 치료는 응급수술이 우선이고, 생체활력징후가 정상이고, 증상이 심하지 않은 경우엔 보존적인 치료를 시행할 수 있다고 알려져 있다. 최근 몇몇 문헌에서 고립 상장간막동맥박리 때 경피 혈관 스텐트삽입술로 장경색으로의 진행을 막고 단기 예후가 좋다고 보고하고 있으나, 장기 예후에 관한 보고가 없고, 스텐트 관련 합병증이 보고된 것이 적어서, 혈관 스텐트삽입술의 안정성이 명확하게 밝혀지지 않은 상황이다. 본 저자들은 고립 상장간막동맥박리로 인한 급성 장간막 허혈로 경피 혈관 삽입술을 시행 후 발생한 상장간막동맥증후군 합병증을 치료한 증례를 최초로 경험하여 보고하는 바이다. Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. Various medical and psychiatric conditions may result in the initial rapid weight loss that causes narrowing of the aortomesenteric angle. Isolated dissection of the superior mesenteric artery (DSMA) is an uncommon cause of acute mesenteric ischemia. Several literature reports suggest that medical treatment in combination with close observation is reasonable in uncomplicated dissection with stable hemodynamic status. Recently, as several reports describe, rapid revascularization by percutaneous angioplasty and endovascular stent insertion can prevent bowel ischemia that progresses to irreversible bowel necrosis. However, the stability of endovascular stents at the DSMA has not been confirmed, because its use is reasonably infrequent. Here, we report a case of SMA syndrome, as a complication of endovascular stent placement at the DSMA. (Korean J Med 2011;80:S67-S72)

증례 : 다발성근염과 만성 B형 간염에 병발한 혼합 간세포-담관상피암종 1예

정혜진 ( Hey Jin Jeong ),김성훈 ( Seong Hun Kim ),김세인 ( Se In Kim ),김인희 ( In Hee Kim ),문우성 ( Woo Sung Moon ),이승옥 ( Seung Ok Lee ),김대곤 ( Dae Ghon Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1

다발성근염은 림프구가 골격근에 침윤하여 비화농성 염증반응을 일으켜 골격근의 손상을 초래하는 원인불명의 자가면역 질환으로, 근위부근육의 대칭적인 근무력이 서서히 진행되는 임상적인 특징을 갖는다. 아직까지 뚜렷한 발병 원인이 규명되지 않은 질환으로 최근 자가면역설과 바이러스 감염설이 가장 유력한 가설로 생각되어지고 있다. 그러나 아직까지 만성간질환과 동반된 경우는 발병률이 매우 낮으며 국내에서 원발성 간암이 함께 병발한 사례는 보고된 바가 없었다. 저자는 최근 만성 B형 간염과 다발성근염으로 치료중인 환자에서 혼합 간세포-담도상피암종이 동시에 병발한 환자 1예를 경험하였기에 보고하는 바이다. Polymyositis is characterized by symmetrical proximal muscle weakness, nonsuppurative inflammation of striated skeletal muscle, an elevation of muscle enzymes, and abnormality of electromyographical changes, but its pathogenesis is not clear. In recent years, there has been an increased awareness of the association of malignant tumors with this disorder. Still, the relationship between polymyositis and a malignant tumor remain obscure. Some researchers have suggested that the cause of polymyositis may be due to an autoimmune response induced by aviral infection. However, a chronic hepatitis B virus infection associated with polymyositis is very rare. We present in this report a rare case of combined hepatocellular-cholangiocarcinoma associated with polymyositis and chronic hepatitis B virus infection. (Korean J Med 72:79-84, 2007)

바터 팽대부에 비외상성 십이지장 벽내 혈종으로 인한 폐쇄성 황달과 급성 담낭염

안대선 ( Dae Seon Ahn ),김성훈 ( Seong Hun Kim ),윤지영 ( Ji Young Yoon ),장진원 ( Jin Won Jang ),전형구 ( Hyung Ku Chon ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이승옥 ( Seung Ok Lee ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Nontraumatic spontaneous intramural hematoma is an infrequent complication of the use of oral anticoagulants. The most commonly affected site is the jejunum followed by ileum and duodenum. The symptoms can vary depending on the location and size of hematoma. Patients with intramural hematoma usually present with abdominal pain, nausea and vomiting, but rarely present with hematuria, pancreatitis, cholangitis. An obstructive jaundice and acute cholecystitis has not been reported as a secondary cause of duodenal intramural hematoma in Korea so far. Here, we report spontaneous duodenal intramural hematoma caused by anticoagulant therapy that associated with transient obstructive jaundice and acute cholecystitis in a 79-year-old man, which was successfully managed conservative management. In addition, we reviewed reports of intramural hematoma with literature review.

증례 : 활동성 크론병 환자에서 발생한 감염성 심내막염 1예

안철민 ( Chul Min An ),김성훈 ( Seong Hun Kim ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이승옥 ( Seung Ok Lee ),이수택 ( Soo Teik Lee ),김대곤 ( Dae Ghon Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

저자들은 활동성 크론병으로 치료 중인 22세 남자 환자로서 발열 기침을 주소로 내원하여 경험적 항결핵제와 항생제 치료 중 발생한 감염성 심내막염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Crohn`s disease is a condition of chronic inflammation potentially involving any location of the alimentary tract, from the mouth to the anus. Numerous extraintestinal manifestations also may be present. Inflammatory bowel disease may be considered an independent risk factor for infective endocarditis. Reasons for endocarditis may be more frequent bacteremia because of the higher incidence of diagnostic and therapeutic interventions, as well as an increased permeability of the damaged mucosa for bacteremia and therapeutic immunosuppression in patients with active inflammatory bowel disease. We report here a case of a 22-year old male who was diagnosed with infective endocarditis in active Crohn`s disease. This is the first case report in Korea of this diagonsis. (Korean J Med 72:420-425, 2007)

라미부딘 내성이 발생한 만성 B형간염에서 아데포비어에 대한 초기 치료 반응이 아데포비어 내성 발생에 미치는 영향

김인희 ( In Hee Kim ),김성훈 ( Seong Hun Kim ),김현철 ( Hyun Chul Kim ),신경덕 ( Kyoung Deok Shin ),김상욱 ( Sang Wook Kim ),이승옥 ( Seong Ok Lee ),이수택 ( Soo Teik Lee ),김대곤 ( Dae Ghon Kim ) 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.3