심장이식후 발생한 대장기종 ( Pneumatosis Cystoides Intestinalis )

이천균(Chun Kyun Lee),송시영(Si Young Song),이용찬(Yong Chan Lee),장병철(Byung Chul Chang),문영명(Young Myung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

Pneumatosis cystoides intestinalis(PCl) is a rare disease of undetermined etiology which is characterized by multiple gas-filled cysts in the wall of the small or large intestine or both. It is associated with various medicosurgical conditions including organ transplantation. Fewer than 50 cases of PCI occurring after organ transplantation including 4 cases of cardiac transplantation have been reported in the world literatures. We report a 47-year-old man of PCI who suffered from right lower quadrant abdomina) pain for 1 week. He was taken heart transplantation due to acute myocardiac infarction and ischemic cardiomyopathy 1 year ago. On plain abdominal X-ray revealed the multiple clustered localized collections of gas in the ascending and hepatic flexure of colon. Co]onoscopy showed the typical finding of PCI, which was multiple variable size protruding masses which apperared as round, soft, and somewhat bluish colored cysts. After the puncture of the above cystic mass using endoscopic injection needle, we can observe the deflation of the above ass. This is the first case in Korea. (Korean J Gastroenterol 1995;27: 732 - 737)

다량의 복수로 발현된 사르코이드증 1예

이수진 ( Su Jin Lee ),김은혜 ( Eun Hye Kim ),김영숙 ( Young Sook Kim ),송제은 ( Je Eun Song ),정수진 ( Soo Jin Chung ),이천균 ( Chun Kyun Lee ),장명희 ( Myung Hee Chang ),강중구 ( Jung Gu Kang ),최윤정 ( Yoon Jung Choi ),박수미 ( 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.6

생리 주기에 따라 형태적 변화를 보인 대장의 자궁내막증식증 1예

김승업 ( Seung Up Kim ),김도영 ( Do Young Kim ),원선영 ( Sun Young Won ),조용석 ( Yong Suk Cho ),이천균 ( Chun Kyun Lee ),최윤정 ( Yoon Jung Choi ),강중구 ( Jung Ku Kang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S

식도 운동장애를 동반한 횡격막상부 식도 게실증 3예

박인서(In Suh Park),강진경(Jin Kyung Kain),김충배(Choong Bai Kim),박효진(Hyo Jin Park),문병수(Byung Soo Moon),이천균(Chun Kyun Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

Three patients with epiphrenic diverticula were reviewed with foci on esophageal dysfuntion and its relation to treatment. All cases were identified by bariurn esophagogram and confirmed by endoscopy. Manoetric studies of esophagus documented as diffuse esophageal spasm-like disorder in 1 case, and nonspecific motor disorder in 2 cases. One case was managed surgically, and the other 2 were treated conservatively. We found that epiphrenic diverticulum were associated with esophageal motility disorders. Treatment should be considered to focus on associated motility disorders as well as a diverticulum. (Korean J Gastroenterol 1997;29:687-693)

장구균혈증의 임상양상 및 예후인자에 관한 고찰

박형천,이천균,김응,김준명 대한감염학회 1995 감염 Vol.27 No.4

목적:장구균은 일반적으로 발병력이 낮고 그로 인한 위중한 감염의 발생빈도는 비교적 낮은 것으로 고려되어 왔다. 그러나 최근 고령인구, 신생물 질환, 장기이식의 증가에 따라 장구균혈증의 빈도 및 그로 인한 사망률이 증가하는 추세임이 보고되고 있어 이의 임상양상 및 예후인자에 관해 알아보고자 본 연구를 시행하였다. 방법:1986년 1월부터 1992년 12월까지 세브란스 병원에서 장구균혈증으로 진단받은 82예중 기록검토가 가능했던 54예의 임상상 및 치료, 예후와 관련된 요소를 후향적으로 조사하였다. 장구균혈증은 체온이 38.3℃ 이상으로 상승하여 시행한 혈액 배양 검사상 2번이상 장구균이 자란 경우로 하였다. 결과: 1) 전체 연구 대상은 54예로 남녀비는 1.25:1이며 평균연령은 44.3세 (1-77세)였다. 그리고 평균 재원기간은 31.7일(1-164일)이었다. 전체대상중 59.3%인 32예가 병원내 감염이었으며 중환자실 치료를 받은 환자는 38.9%인 21예였다. 2) 혈액 배양에서 동정된 장구균의 종은 Enterococcus faecalis가 50.2%(28예), E.faecium이 27.6%(14예), E.avium은 5.6%(3예)였다. 그리고 다균혈증이 50%인 27예였는데 다균혈증에서 장구균과 병발된 균주는 E.coli가 11예로 가장 많았으며 Enterobacter(5예), Klebsiella(5예), S.epidermidis(5예), S.aureus(2예)등이었다. 3) 대부분의 환자에서 기저질환을 가지고 있었는데 신생물 질환(17예), 심장질환9예), 중추신경계 질환(6예), 그외 당뇨(2예), 만성 신부전과 신장이식(3예), 다발성외상(2예)등이 있었다. 4) 장구균의 원발병소로 28예가 확인되었는데 담도계가 25.9%(14예)가 가장 많았으며 복부 내농양이 14.8%(8예), 비뇨기계가 13.0%(6예), 피부창상이 7.5%(4예)였다. 5) 약제 감수성 검사상 배양된 모든 장구균에 ampicillin 79.1%, vancomycin 85%, teicoplanin 67.0%, ciprobloxacine 41.4%의 약제 감수성을 보였다. 6) 전체 사망률은 23예인 42.6%였으며 그중 장구균혈증 자체에 의한 사망으로 추정되는 경우는 9예인 16.7%였다. 예후인자로서의 성별, 이전 항생제 치료 여부, 다균혈증 여부, 병원내 감염여부는 사망률과 의의있는 상관관계를 관찰할 수 없었으며 기저질환이 위중한 경우에 있어서 약제치료의 적합성과 생존률사이에는 의의있는 관계가 있었다. 결론:이상으로 장구균혈증은 병원내 감염 및 다균혈증을 특징으로 하며 면역력의 약화와 관련된 숙주 방어에 변화가 초래된 환자에게서 많이 발병함을 알 수 있다. 그리고 기저질환의 정도가 심할수록 기저질환의 조절은 물론 감수성 검사에 근거한 적절한 항생제의 조기투여가 예후결정에 중요함을 알 수 있었다. Background:Enterococci belong to Lancefield group D family of Streptococci. Generally, it has bee considered that serious enterococcal infection was not so frequent because its virulence was low. However, as old age, neoplasms and organ transplantations have increased recently, the morbidity and mortality of enterococcal bacteremia have increased. This study was performed to observe the clinical outcome and prognostic factors of enterococcal bactermia. Methods:Fifty-four cases of enterococcal bacteremia diagnosed from January 1986 to December 1992 in Yonsei University College of Medicine were analysed with their clinical records retrospectively. Results: 1) Male to female ratio was 1.25:1 and mean age was 44.3 years old. Mean hospital days were 31.7 days and 32 cases(59.3%) were nosocomial infections. 2) 28 cases(50.2%) were Enterococcus faecalis. 14 cases(27.6%) were E. faecium and 3 cases(5.6%) were E. avium. 27 cases(50%) were polymicrobial infection and the associated organims were E. coli(11), Enterobacter(5), Klebsiella(5), S. epidermidis(5), and S. aureus(2). 3) Most patients had serious underlying diseases including neoplasm(17), heart disease(9), CNS disease(6), DM(2), CRF and renal allograft(3), and multiple trauma(2). 4) Probable portal of entry was identified in 28 patients : 22 cases(40.7%) were of GI origin and 6 cases(13.0%) were of GU origin. 5) In vitro susceptibility tests showed sensitivity rates of 79.1% to ampicillin, 85.0% to vancomycin, 67.0% to teicoplanin, and 41.1% to ciprofloxacine. 6) The overall mortality rate was 42.6% and the mortality rate due to enterococcal bacteremia itself was 16.7%. Gender, polymicrobial infection, nosocomial infection, and previous antibiotics therapy were not related to the mortality. But the appropriate antibiotic therapy was significantly related to the mortality in cases of the fatal underlying disease. Conclusion:Our study suggests that the nature of enterococcal bacteremia is nosocomial and polymicrobial. It is common in patients with altered host defenses secondary to serious underlying disease. Considering its morbidity and mortality, in cases of the fatal underlying disease, correction of the underlying condition and the use of appropriate antibiotic are neccessary to decrease the morbidity and mortality rates.

식도 운동장애를 동반한 횡격막상부 식도 게실증 3예

문병수,박효진,김충배,이천균,강진경,박인서 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.5

내시경적 유두괄약근절개술의 조기합병증 및 위험인자에 관한 연구

김원호,강진경,박인서,문영명,송시영,이천균,정재복,이루다 대한소화기학회 1998 대한소화기학회지 Vol.30 No.6

Background/Aims: Although initially endoscopic sphincterotomy(EST) has been performed for the removal of bile duct stone and drainage of the biliary tree, recently its spectrum has been widely extended for the management of various pancreaticobiliary diseases, Despite its relative safety, various complications - bleeding, acute pancreatitis, perforation, cholarigitis and sepsis - could be developed in about 5-10%. Even though the incidence of these complications has been well known, the studies focused on the risk factors of complication are lacking and ramain to be solved. The purpose of this study is to assess the various early complications of EST and elucidate the risk factors. Methods: The clinical records of 643 patients who performed EST between Jan. 1985 and Aug. 1995 were analysed. Analysis for tbe complications and risk factors were focused on 552 cases whose clinical records could be completely reviewed. Results: Arnong 643 patients, 368 were male and 280 were fernale and their mean age 59.3(25-88) years. Tjnderlying disease on where EST is performed were gallstone(373 cases), bile duct cancer(116 cases), gall bladder cancer(16 cases), benign bile duct stricture(20 cases), postoperative bile duct injury (8 cases), malignant bile duct obstruction(14 cases), pancreatic cancer(42 cases), pancreatic stone(12 cases), pancreatic leak(1 case), ampullary cancer(22 cases) and sphincter of Oddi dysfunction(14 cases). Overall success rate of EST was 94.9%(610/643 cases). Indications of EST were removal of bile duct stone(338 cases), drainage of bile duct(246 cases), peroral choledochoscopy(24 cases), peroral pancreatoscopy(3 cases), management of benign biliary stricture(8 cases), treatment of sphincter of Oddi dysfunction(14 cases), removal of pancreatic stone(9 cases), drainage of pancreatic duct(6 cases), obtaining cholangiogram(29 cases), transpapillary biopsy of pancreatic or biliary duct(23 cases). Early complications were developed in 7.6%(42 cases). Bleeding was the most common(16 cases). Others were acute pancreatitis(12 cases), sepsis(14 cases), and duodenal perforation(2 cases). Statistically significant risk factors for the developrnent of early complicrtions were failure of EST, larger bile duct stone($gt; 2cm), failure of stone removal or biliary drainage(p=0.044, 0.009, 0.023, 0.047, respectively). The presence of juxtapapillary diverticulum and its location, common bile duct dilation, number of stone, type of papillotome were not influenced the development of complications. The significant risk factors for the bleeding were failure of EST, removal of stone and biliary drainage(p$lt;0.0001, 0.004, 0.0004, respectively) and for the acute pancreatitis size of bile duct stone and ampullary buldging(p=0.037, 0.0001, respectively). Conclusions: These fin- dings suggest that the development of early complications of EST is mainly deJ$gt;end on the failure of procedures undergone after EST, such as biliary drainage and stone remov;il rather than EST itse]f or other procedure not related conditions. Therefore the procedures after EST should be done carefully with full review to prevent the EST related early complications.

자기 면역성 담관염 2예

박용범,문영명,박영년,최병현,박찬일,이수곤,이천균,한광협,황영웅 대한소화기학회 1998 대한소화기학회지 Vol.31 No.6

We describe two patients showing features of primary biliary cirrhosis but negative antimitochondrial antibody. Botn were females. Serum biochemical study showed increase in alkaline phosphatase and gamma glutamyl transpeptidase levels. Markers of hepatitis B and C virus were absent. In both patients, serum anti-mitochondrial antibodies were not detected on immunofluorescence study. Both had high titers of serum antinuclear antibodies. Liver biopsy specimen showed histological features of primary biliary cirrhosis with marked cellular infiiltration of the portal areas and bile duct damage. Intralabular intlammation and piecemeal necrosis were mild. These patients were treated with prednisolone or UDCA and then, showed decrease in serum alkaline phosphatase level. We thought these patients were cornpatible with autoimmune cholangiopathy.

위 및 전 소장을 침범하고 말단 회장 천공을 동반한 Behcet 병 1예

김원호,김범수,강진경,박인서,정재복,최병현,이천균,윤용석,배종엽 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.4

Behcet's syndrome is a multisystemic, chronic inflammatory disease with triad of oral ulcer, genital ulcer and inflammatory ocular lesion. Intestinal Behcet's disease accounts for 1-2% of Behc'ets disease and most commonly affects the ileocecal region as ulcerations. A 70-year-old male patient was admitted to this hospital because of melena for 5 days. There was a history of recurrent aphthous stomatitis and genital ulcer. Colonoscopy showed multiple, irregularly, rnarginated, ellipsoid ulcers surrounded by hyperemic mucosa with vessel exposure on terminal ileum. Esophagogastroduodenoscopy showed multiple, round punched out ulcers on antrum and duodenal bulb. He was taken the near total small bowel resection, right hemicolectomy and ileotransverse colostomy because of hemorrhage and terminal ileal perforation. Three days after operation, melena reappeared and esopbagogastoduodenascopy revealed bleeding from duodenal ulcers and impending perforation of antral ulcer. He was reoperated with antrectomy, truncal vagotomy and gastroduodenostomy. Resected small bowel was 510 cm in length and there were multiple small round transverse ulcers surrounded by hyperemic edematous elevated rnucosa. Three 'punch-out ulcers' were also found on resected gastric antrum. So, we report a case of gastrointestinal Behcet's disease involving stomach, duodenum, jejunum and ileum with terminal ileum perforation.

인터페론 단독 투여에 지속적 치료 효과가 없었던 만성 C 형 간염 환자에서의 인터페론과 리바비린의 병용 치료

김영아,최원,김현숙,전재윤,한광협,문영명,정정일,최병현,이관식,이천균,김부일 대한소화기학회 1999 대한소화기학회지 Vol.33 No.2

Background/Aims: Interferon-alpha has been effective in 10-20% of treated patients with chronic hepatitis C (CH-C) on a long term basis. We conducted this study to evaluate the biochemical and virological outcomes of combined treatment with interferon alpha and ribavirin for the patients who had CH-C but showed non-response or relapse to interferon alpha alone. Methods: Twenty five patients with CH-C who had not responded or relapsed to interferon alpha alone treatment were enrolled. Eighteen patients were given by the combined treatment of interferon alpha and ribavirin and 7 patients were not given any specific treatment as control. Interferon alpha-2a was given subcutaneously, at a dose of 4.5 MU thrice weekly. Ribavirin was also given orally, at a dose of 900 mg/day for 24 weeks. We quantified serum HCV-RNA levels at the end of treatment. Results: The normalization rate of serum ALT at the end of treatment was 47.1% (8/17) in treated group and 14.3% (1/7) in control group and negative conversion of HCV-RNA was noted in all patients. In the treated group, 75% (6/8) of responders at the end of treatment sustained serum ALT level normally during 24 weeks follow-up, but none has responded persistently in the control group. Conclusions The combined treatment with interferon alpha and ribavirin is effective and safe for treating chronic hepatitis C in patients who showed non-response or relapse to interferon alone. (Kor J Gastroenterol 1999;33:232 - 239)