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위장관 소화성 궤양의 재출혈에서 반복적인 내시경적 지혈술의 유용성과 치료 실패의 예측인자
정재연(Jae Youn Cheong),이용찬(Yong Chan Lee),장혁재(Hyuk Jae Chang),송시영(Si Young Song),김원호(Won Ho Kim),한광협(Kwang Hyub Han),정재복(Jae Bock Chung),전재윤(Jae Yoon Chon),강진경(Jin Kyung Kang),박인서(In Suh Park),문영명(Young 대한소화기학회 2001 대한소화기학회지 Vol.37 No.5
Background/Aims: After endoscopic treatment of peptic ulcer bleeding, rebleeding occurs in 15 to 20 percent of patients. We investigated the factors predicting the failure of initial endoscopic treatment in patients with peptic ulcer bleeding and the usefulness of repeated endoscopic treatment in peptic ulcer patients with rebleeding after initial endoscopic treatment. Methods: Clinical data were retrospectively collected from 376 patients (311 males and 65 females, mean age 53.9 years) with peptic ulcer bleeding between June 1995 and May 1999. Results: Of 376 patients, rebleeding after initial endoscopic treatment occurred in 50 patients (13.3%). Eight patients who failed to initial endoscopic hemostasis underwent operation immediately. The presence of major stigmata on endoscopy (p=0.001) and shock at admission (p=0.001) were two significantly independent factors predictive of rebleeding after initial endoscopic treatment. Among the patients with rebleeding, repeated endoscopic treatment was successful in 26 patients (61.9%), but 16 patients (38.1%0 underwent salvage surgery due to the failure of hemostasis. Patients who did not respond to endoscopic retreatment were more likely to have ulcers ≥2 cm in diameter (p=0.027). Conclusions: Repeated endoscopic treatment can reduce the need for surgery. Ulcer size ≥2cm is an independent factor in predicting the failure of repeated endoscopic treatment in peptic ulcer patients with rebleeding. Therefore, surgery should be considered in the case. (Korean J Gastroenterol 2001;37:319-326)
만성 염증성 장질환 환자에서 항호중구 세포질 항체의 의의
문윤재(Yoon Jae Moon),배희동(Hee Dong Bae),박효진(Hyo Jin Park),김원호(Won Ho Kim),정석훈(Suk Hoon Chung),김현숙(Hyun Sook Kim),전재윤(Chae Yoon Chon),박인서(In Suh Park) 대한내과학회 1997 대한내과학회지 Vol.52 No.5
N/A Objective: Anti-neutrophil cytoplasmic antibody (ANCA), known as a useful diagnostic marker in patients with ulcerative colitis (UC), are specific for granule proteins of granulocytes and monocytes and induce distinct fluorescence patterns. To evaluate the significance of ANCA in chronic inflammatory bowel disease (IHD), the presence of ANCA in chronic IBD was studied using indirect immunofluorescent test (IIF), Methods: Between March, 1994 and September 1995, 51 patients with chronic inflammatory bowel disease were subjected in this study. We had analysed the correlation between duration, disease activity, location by colonoscopy and radiologic examinations, steroid treatment. Results: 1) Among 34 patients with ulcerative colitis (UC), ANCA was demonstrated in 23 patients (67.6%). Among 19 patients with other chronic IBD (4 Crohn's disease, 6 Behcet's colitis, 7 intestinal tuberculosis and 2 radiation colitis) 2 patients (10.5%) had ANCA. The positivity of ANCA in patients with UC was significantly higher than in patients with other chronic IBD. 2) In patients with UC, c-ANCA was positive in 2 (5.9%) patients and p-ANCA was positive in 21 (61.8%) patients. In patients with other chronic IBD, ANCA was positive in one patient with Behcet's colitis or one patient with intestinal tuberculosis but negative in all patients with Crohn's disease or radiation colitis. 3) The mean duration of disease in ANCA positive patients was 42.4±39.4 months and the mean duration of disease in ANCA negative patients was 44.9±36.8 months, but there was no significant difference. 4) The number of patients in clinically mild, moderate and severe group were 23 (37.6%), 6 (83.2%) and 5 (14.7%) respectively. Among these groups the number of ANCA positive patients were 15 (65.2%), 5 (83.2%) and 3 (60%) respectively, but there was no significant difference. 5) The number of patients with proctitis, left side colitis and pancolitis were 9 (26.5%), 14 (41.2%) and 11 (32.4%) respectively, Among these groups the number of ANCA positive patients were 4 (44.4%), 10 (71.4%) and 9 (81.8%) respectively, but there was no significant difference. 6) Among 13 patients with steroid treatment 9 patients (69.2%) were ANCA positive. Among 21 patients without steroid treatment 16 patients (76.2%) were ANCA positive, but there was no significant difference. Conclusion: Although there was no correlation between ANCA and duration, disease activity, location or steroid treatment in UC patients, ANCA could be a diagnostic marker of UC in chronic IBD patients.
사염화탄소에 의해 활성화된 간성상세포에서 G1 Cyclin 및 Rb-E2F 의 발현과 비타민 E 의 효과
이광재(Kwang Jae Lee),이관식(Kwan Sik Lee),한광협(Kwang Hyub Hahn),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),오상환(Sang Hwan Oh),김호근(Ho Keun Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Background/Aims: It is obscure when the activation of hepatic stellate cells and the expression of its related factors occur in acute liver injury. Vitamin E is expected to prevent hepatic fibrosis. The aims of this study were to establish the model of hepatic stellate cell activation in acute liver injury and to confirm the effect of vitamin E for preventing hepatic fibrosis. Methods: Male Sprague-Dawley rats were classified into two groups. The one group received a single injection of CCl4 and the other group received injection of vitamin E daily and a single injection of CCl4. The serial changes of serum ALT, and [3H]thymidine uptake, α-SMA, cyclin D1, CDK4, cyclin E, CDK2, Rb, E2F-1 and NF-κB of stellate cells were measured. Results: The serial changes of serum ALT levels, [3H]thymidine uptake, and α-SMA positive cells showed maximum increase at 32 hours after CCl4 injection. However, they were significantly decreased with injection of vitamin E. CDK4, cyclin E and CDK2 showed definite band at 16, 32, 48 hours after CCl4 injection, which diminished or disappeared with injection of vitamin E. Cyclin D1, Rb, E2F-1 and NF-κB showed definite band at 32 hours after CCl4 injection, which also diminished or disappeared with injection of vitamin E. Conclusions: We established an in vivo model of hepatic stellate cell activation in acute liver injury and confirmed the effect of vitamin E in preventing hepatic fibrosis. (Korean J Gastroenterol 2001;38:262-269)
경정맥 간내문맥 - 간정맥 단락술로 십이지장정맥류 대량 출혈을 성공적으로 치료한 1 예
윤영준(Young Joon Yoon),한광협(Kwang Hyub Hahn),이도연(So Yun Lee),백용한(Yong Han Paik),정재연(Jae Yeon Chung),김철(Chul Kim),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Duodenal varices can be resulted from either liver cirrhosis or extrahepatic portal hypertension. Bleeding from duodenal varices is rare but often severe and life threatening. Bleeding of duodenal varices can be treated with non-surgical or surgical treatment. Non-surgical treatments include endoscopic variceal ligation, endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Surgical treatments include shunt surgery, variceal ligation, variceal resection, and duodenectomy. However, endoscopic treatments are not so effective and surgical interventions have many limitations. A 68-year-old man with liver cirrhosis was admitted to our department and presented with mental change and melena. He received a large amount of transfusion and it was not possible to perform gastrointestinal endoscopy. Emergency angiography revealed marked dilatation of mesenteric veins, which was treated by TIPS. After TIPS, transfusion requirement was markedly reduced and gastrointestinal endoscopy demonstrated duodenal varices without bleeding. We conclude that TIPS may be an effective therapeutic option for control of hemorrhage from duodenal varices. (Korean J Gastroenterol 2001;38:292-295)
원발성 세균성 복막염 진단에 있어서 혈액 배양 배지를 이용한 복수 배양법의 유용성
이명래(Myung Rae Lee),전재윤(Jae Yoon Chon),문영명(Young Myoung Moon),박인서(In Suh Park),이경원(Kyung Won Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6
N/A Background/Aims: Spontaneous bacterial peritonitis(SBP) is a serious and frequently fata1 compli- cation in cirrhotics, therefore earlier detection and earlier institution of appropriate treatment is crucial for good result. However, the conventional method of ascitic tluid culture has a low sensitivity in detecting causative organism of SBP. Methods: We have compared the sensitivity of the conventional method to the bedside inoculation of ascites into blood culture media. Two kinds of ascites culture methods were compared in cirrhotic patients with spontaneous bacterial peritoni- tis: 1) conventional(on blood agar, MacConkey agar, thioglycolate broth, and phenylethanol blood agar) and 2) blood culture media method(inoculation of each S mL of ascites into one 30-mL tryptic soy broth bottle and one30-mL thioglycolate broth bottle at the patients bedside. Results: In a 55-month period, 67 episodes of SBP in 61 cirrhotic patients were examined using simultane- ous both culture methods. The conventional method grew bacteria in 22 episodes(32.8%), whereas the blood culture media method grew in 55 episodes(82.1%), which showed a significantly higher sensitivity(p0.005). The organisms most frequently isolated in ascitic fluids in this study were aerobic gram-negative bacteria(88.37o), among them E. coli was the most most common pathogen comprising 55.0% of total isolates. The conventional method grew five species of organism whereas the b]ood culture media did eleven species. Most of E. coli were susceptible to amino- glycosides, third generation cephalosporins, aztreonam, and ofloxacin, but resistant to ampicil]in. Conclusions: It is suggested that the inoculation of ascitic fluid to a blood culture media is more sensitive than the conventional method and shou]d be routinely used for ascitic fluid culture in cirrhotic patients. (Korean J Gastroenterol 1995;27: 659 - 672)
이차성 비기능항진증에서 부분적 비장동맥색전술의 장기 치료 효과
이중민 ( Jung Min Lee ),전재윤 ( Chae Yoon Chon ),한재용 ( Jae Yong Han ),윤기태 ( Ki Tae Yoon ),문창모 ( Chang Mo Moon ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),이종태 ( Jong Tae Lee ),문영명 ( Young Myoung Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
목적: 간경변증 환자에서 이차성 비기능항진증이 동반되어 범혈구감소증이 생기면서, 그 중에서 특히 혈소판감소증이 임상적으로 문제가 되는 경우가 많다. 치료를 위해서는 과거에 비장적출술(splenectomy; SPL)을 시행하였는데 간기능 저하가 동반되어 있어서 수술 자체의 위험성이 많아 적응증이 안 되는 경우가 있다. 따라서 수술에 비하여 비침습적인 부분적 비장동맥색전술(partial splenic embolization; PSE)이 소개되고 있으며 결과가 양호한 것으로 알려져 있다. 간경변증으로 진단된 환자에서 PSE의 치료 효과에 대해서 고찰하고 SPL과의 치료 효과를 비교하였다. 방법: 1999년 1월부터 2003년 12월까지 간경변증 환자 중 PSE 또는 SPL을 시행한 환자를 대상으로 후향적 연구를 수행하였다. 이차성 비기능항진증에 의한 혈소판 감소증으로 출혈 증상이 있거나 혈소판감소증을 교정해야 할 목적으로 시행하였으며, 치료 전후의 혈액검사를 비교하였고 합병증의 유무를 확인하였다. 결과: PSE 군이 총 40명, SPL 군이 35명이었고, 남녀 비가 각각 27:13, 23:12로 남자가 더 많았으며, 평균 연령은 각각 50.8, 49.2세였다. 백혈구는 PSE 및 SPL 군에서 2년째에 4,450 및 5,560/μL로서 치료 전에 비해 유의한 증가를 보였고 혈소판도 양 군에서 2년째에 각각 144, 174 k/μL를 보여 유의한 증가를 보였으며 혈색소도 마찬가지로 2년째에 각각 13.7, 12.8 g/dL로서 치료 전에 비해서 유의한 증가를 보였다. Child-Pugh score를 계산하면 PSE 군은 치료 전 6.5에서 치료 후 5.5로 유의한 감소를 보였으며(p=0.04), SPL 군은 6.4에서 5.9로서 통계적인 차이가 없었다. 합병증은 양 군에서 경미하였고 사망, 출혈, 감염증의 심각한 합병증은 7.5% 이하에서 나타났으며 통계적 차이가 없었다. 결론: 이상의 결과로 PSE는 간기능이 비교적 양호한 환자에서 이차성 비기능항진증으로 의한 혈구감소증에 좋은 치료 방법으로 생각되며, 심각한 합병증의 발생은 적고 일부 간기능의 호전을 기대할 수 있어서 간경변증 환자에서 시행해 볼 수 있는 비교적 안전하고 효과적인 방법으로 생각된다. Background: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. Methods: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. Results: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. Conclusions: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism. (Korean J Med 72:470-479, 2007)