소화성궤양 가이드라인 특수한 질환에서 소화성궤양 치료의 가이드라인

김지현 ( Ji Hyun Kim ),문정섭 ( Jeong Seop Moon ),지삼룡 ( Sam Ryong Jee ),신운건 ( Woon Geon Shin ),박수헌 ( Soo Heon Park ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.5

The pathogenesis, incidence, complication rates, response to acid suppression and Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer associated with chronic disease such as liver cirrhosis, chronic renal failure, diabetes mellitus, and critically ill conditions are different from those with general population, so that the management strategies also should be differentiated. The eradication of H. pylori are not so effective for preventing recurrence of peptic ulcer in liver cirrhosis patients as shown in general population, and conservative managements such as preventing deterioration of hepatic function and decrease in portal pressure are mandatory to reduce the risk of ulcer recurrence. The standard triple therapy for H. pylori eradication are as effective in chronic renal failure patients as in normal population, but the frequency of side effects of amoxicillin is higher in the patients not receiving dialysis therapy. Delay in eradication therapy until beginning of dialysis therapy or modification of eradication regimen should be considered in such cases. High prevalence of asymptomatic peptic ulcers and increased mortality in complicated peptic ulcer disease warrant regular endoscopic surveillance in diabetic patients, especially with angiopathy. The prolongation of duration of eradication therapy also should be considered in diabetic patients with angiopathic complication because of lower eradication rate with standard triple regimens as compared to normal population. Prophylactic acid suppressive therapy is highly recommended in critically ill patients with multiple risk factors. Herein, we propose evidence-based treatment guidelines for the management of peptic ulcer disease in special conditions based on literature review and experts opinion. (Korean J Gastroenterol 2009;54:318-327)

위장관 ; 위 점막 연관 림프조직 림프종에서 PET/CT의 유용성

황진원 ( Jin Won Hwang ),지삼룡 ( Sam Ryong Jee ),이상헌 ( Sang Heon Lee ),김지현 ( Ji Hyun Kim ),설상영 ( Sang Yong Seol ),이석모 ( Seok Mo Lee ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

Background/Aims: This study evaluated the diagnostic efficacy of fluorine-18 fluorodeoxyglucose PET/CT (F-18 FDG PET/CT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma and examined the association between FDG avidity and the clinical factors affecting lesions. Methods: Among the patients diagnosed with gastric MALT lymphoma, 16 who underwent a PET/CT for gastric MALT lymphoma were semi-quantitatively and qualitatively tested for FDG avidity of lesions in the stomach. Retrospectively collected data was analyzed to investigate the clinicoradiological factors and endoscopic findings between the patients with positive F-18 FDG PET/CT scans and those with negative scans. Results: Eight of the 16 patients showed FDG avidity. When comparing the size of lesions in the stomach, the patients with FDG avidity had significantly larger lesions than those without (28.8 mm vs. 15.0 mm, p=0.03). The FDG-avid group has a significantly higher rate of positive CT scans than the non-avid group (75% vs. 13%, p=0.03). According to the endoscopic finding of the lesions, FDG avidity was pronounced with 75% of the protruding tumors, and 100% of the erosive-ulcerative types, which are a type of depressed tumors. Conclusions: When gastric MALT lymphoma is large, when lesions are found using abdominal CT scans, and the macroscopic appearance of a lesion is that of a protruding tumor or erosive-ulcerative type of depressed tumor, there is a high probability that such patients may have a positive F-18 FDG PET/CT scan. (Korean J Gastroenterol 2016;67:183-188)

유전자 2형인 만성 C형간염 환자에서 페그인터페론과 리바비린의 단기간 치료 효과

정은욱 ( Eun Uk Jung ),박지훈 ( Ji Hun Park ),배경임 ( Kyung Im Pae ),강석우 ( Suk Woo Kang ),박성재 ( Sung Jae Park ),지삼룡 ( Sam Ryong Jee ),박은택 ( Eun Tak Park ),이연재 ( Youn Jae Lee ),이상혁 ( Sang Hyuk Lee ),설상영 ( Sang 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.3

간문부 담관암(Klatskin Tumor)으로 오인된 원발 담관 림프종

강현구 ( Hyoun Gu Kang ),최정식 ( Jung Sik Choi ),서정아 ( Jeong Ah Seo ),문성수 ( Sung Soo Moon ),김지현 ( Ji Hyun Kim ),지삼룡 ( Sam Ryong Jee ),이연재 ( Youn Jae Lee ),설상영 ( Sang Yeong Seol ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

Primary non-Hodgkin`s lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is extremely rare. A 60-year-old man was admitted due to suddenly developed jaundice. Computerized tomography and endoscopic retrograde cholangiopancreatography showed a tumor at the proximal common hepatic duct. These clinical and radiologic findings resembled those of Klatskin tumor. The resection of the common hepatic duct tumor, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. There was no regional lymph node metastasis and no residual tumor at the resection margins. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell malignant lymphoma involving the common hepatic duct. The patient is scheduled to receive adjuvant chemotherapy. In summary, primary non-Hodgkin`s lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes for obstructive jaundice. An accurate histopathologic diagnosis and surgical resection combined with chemotherapy may be the approach to offer a chance for cure. (Korean J Gastroenterol 2009;54:191-195)

내시경역행담췌관조영술에서 조영제 주입 전 담즙 흡인의 임상적 효과

최정식 ( Jung Sik Choi ),강대환 ( Dae Hwan Kang ),김현대 ( Hyun Dae Kim ),엄상화 ( Sang Hwa Urm ),이상헌 ( Sang Heun Lee ),김지현 ( Ji Hyun Kim ),지삼룡 ( Sam Ryong Jae ),정은욱 ( Eun Uk Jung ),박성재 ( Sung Jae Park ),이연재 ( Yo 대한소화기학회 2012 대한소화기학회지 Vol.60 No.6

목적: 내시경역행담췌관조영술 후 담관염, 간기능의 악화, 담낭염, 췌장염 등의 합병증을 경험하게 된다. 이를 예방하기 위한 방법으로 조영제 주입 전 담즙을 일부 흡인함으로써 폐쇄 담관의 감압을 통한 이들 합병증의 빈도가 감소하는지를 알아보기 위하여 이번 연구를 시행하였다. 대상 및 방법: 2008년 12월 1일부터 2010년 6월 30일까지 3차 의료기관에서 내시경역행담췌관조영술을 시행한 988명의 환자 중 담관 조영술 전에 일정량의 담즙 흡인 후 조영제를 주입한 환자 102명과 통상적인 방법인 담즙 흡인 없이 조영제를 주입하여 담관 조영술을 시행한 대조군 115명을 대상으로 하여 시술 후 담관염, 간기능의 악화, 담낭염, 췌장염 등을 전향적으로 비교하였다. 결과: 조영제 주입전 담즙 흡입을 먼저 시행한 102명 중 담관염은 3명(2.9%), 시술 후 간기능 악화 4명(3.9%), 담낭염과 췌장염은 1명도 발생하지 않았다. 시술 후 복통 없이 혈청 아밀라제 증가만 보인 경우가 6명(5.8%)이었다. 대조군 115명 중에서 담관염은 1명(0.4%), 시술 후 간기능 악화소견을 보인 환자는 9명(7.8%), 췌장염은 3명(2.6%), 시술 후 복통 없이 혈청 아밀라제 증가만 보인 경우가 10명(8.6%)이었으며, 담낭염은 1명도 발생하지 않았다. 조영제 주입 전 담즙 흡입군과 대조군에서 시술 후 합병증의 유의한 차이를 보이지 않았다 (p>0.05). 결론: 담관 폐쇄 환자에서 내시경역행담췌관조영술을 시행할때 선택적 담관 삽관 후 일정량의 담즙을 흡인한 후에 조영제를 주입하여 담관조영술을 하는 경우에 시술 후 합병증 예방에 미치는 영향은 미미하였다. Background/Aims: This study was designed to determine whether bile aspiration before contrast injection cholangiogram prevent of post-ERCP cholangitis, liver function worsening, cholecystitis and pancreatitis. Methods: One hundred and two patients in the bile aspiration group before contrast injection from December 1, 2008 to December 30, 2009 and 115 patients in the conventional control group from January 1, 2010 to June 30, 2010 were analyzed. The incidence of post-ERCP cholangitis, liver function worsening, cholecystitis, pancreatitis, and hyperamylasemia only were compared between these two groups. Results: In the 102 patients with the bile aspiration group, post-ERCP cholangitis in 3 patients (2.9%), liver function worsening in 4 patients (3.9%), cholecystitis and pancreatitis in none, and hyperamylasemia only in 6 patients (5.8%) occurred. In the 115 patients with control group, post-ERCP cholangitis in 1 patient (0.4%), liver function worsening in 9 patients (7.8%), cholecystitis in none, pancreatitis in 3 patients (2.6%), hyperamylasemia only in 10 patients (8.6%) developed, The two groups did not significantly differ in terms of the incidence of post-ERCP cholangitis, liver function worsening, pancreatitis, and hyperamylasemia only (p>0.05). Conclusions: Initially bile juice aspiration just before contrast injection into the bile duct rarely prevented post-ERCP cholangitis, liver function worsening, and pancreatitis in patients with the extrahepatic bile duct obstruction.

혈청 HBsAg 양성 IgA 신병증 환자의 임상상

한경근(Kyung Geun Han),배성진(Sung Jin Bae),김성은(Seong Eun Kim),김기현(Ki Hyun Kim),박정하(Jeong Ha Park),지삼룡(Sam Ryong Ji),임정현(Jeong Hyun Lim),장광열(Goang Yul Jang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A There are some clinical evidences that hepatitis B virus(HBV) infection may cause IgA nephropathy. To evaluate clinical significances and pathogenetic roles of HBV infection in patients with IgA ne-phropathy, we studied that varius clinical and lab- oratory findings in 172 patients with IgA nephrop-athy as serum hepatitis B surface antigen(HBsAg) positive(19 cases) and negative group(153 cases). The result was as following: 1) The incidence of positive serum HRsAg was 11.0%(19/172 cases) in patients with IgA nephrop- athy and it was higher than that of the randomized age-sex matched general population(4.1%) but has no significance statistically. 2) There was no significant differences in incidence of hypertension, serum levels of IgA, C3, SGOT, SGFf between HBsAg postive and negative group. 3) The cases of nephrotic range proteinuria(3.5g/ day) was more prevalent in HBsAg positive group (31.6%) than that in negative group(7.2%). significantly(p<0.05). 4) The cases of impaired renal function(serum creatinine more than 1.4mg/dL) were more frequent in HBsAg positive group(42.19%) than that in neg-ative group(13.1%) significantly(p<0.05).

크론병과 장결핵의 감별에 있어 특징적인 대장내시경 소견

제인수 ( In Soo Je ),이상혁 ( Sang Hyuk Lee ),정은욱 ( Eun Uk Jung ),강명주 ( Myoung Joo Kang ),박상원 ( Sang Won Park ),최바울 ( Pa Ul Choi ),김지현 ( Ji Hyun Kim ),박성재 ( Sung Jae Park ),지삼룡 ( Sam Ryong Jee ),박은택 ( Eun T 대한장연구학회 2007 Intestinal Research Vol.5 No.2

Background/Aims: The incidence of Crohn``s disease (CD) is on the increase in Korea. The differentiation of Crohn``s disease from intestinal tuberculosis (IT) is difficult. The aim of this study is to determine the characteristics of colonoscopic findings and factors that differentiate CD from IT. Methods: A total of 136 patients who were diagnosed with CD or IT at the Busan Paik Hospital from January 1995 to May 2005 were included in this study. We analyzed endoscopic findings, clinical characteristics and histological findings of 75 patients with CD and 61 patients with IT retrospectively. Results: For patients with IT, 18 (58.1%) of the patients had circular ulcers. For patients with CD, 27 (42.1%) of the patients had transverse ulcers, 18 (28.1%) of the patients had longitudinal ulcer, and 19 (29.6%) of the patients had both types of ulcers. The involvement of the ileocecal valve was noted in 18 (58.0%) of the patients with CD and in 37 (57.8%) of the patients with IT. The involvement of the rectum or anus was noted in 24 (51.5%) of the patients with CD and one (3.2%) patient with IT. Conclusions: According to previous studies, the presence of an ulcer was important to differentiate CD from IT. However, the presence of an ulcer was not a significant differentiating factor in our study. On colonoscopic findings, involved segments, an aphthous ulcer, cobblestone appearance, involvement of the rectum or anus and mucosal bridge should be observed carefully. (Intest Res 2007;5:158-164)

Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction

Se Hui Oh(오세휘),Nak Jun Choi(최낙준),Sang Hyuk Seo(서상혁),Min Sung An(안민성),Kwang Hee Kim(김광희),Ki Beom Bae(배기범),Jin Won Hwang(황진원),Sang Heon Lee(이상헌),Ji Hyun Kim(김지현),Sam Ryong Jee(지삼룡),Mi Seon Kang(강미선),Kwa 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.1

Purpose: Colorectal obstruction develops most frequently by carcinoma, and 7%–30% of these colorectal carcinomas are acute cases. The oncologic safety of self-expanding metal stent (SEMS) insertion as a bridge to surgery has not yet been established. Thus, we investigated the oncologic safety of SEMS insertion as a bridge to surgery in patients with obstructive colorectal cancer. Methods: This retrospective had 56 patients enrolled requiring emergency management for obstructive colorectal cancer at stage II or III, who had undergone curative surgery between July 2008 and June 2011. These subjects were divided into two groups: patients who had undergone emergency surgery without SEMS insertion (non-stent group) and those who had undergone elective surgery after preoperative decompression with SEMS insertion (stent group). The two groups were compared for clinicopathologic characteristics, postoperative complications, and survival rate. Results: Enterostomy was performed in 25 patients (100.0%) in the non-stent group and 1 patient (3.2%) in the stent group; laparoscopic surgery was carried out in 7 patients (28.0%) in the non-stent group and 19 patients (61.29%) in the stent group, each showing statistically significant differences. There was no statistically significant difference in postoperative complications and 5-year disease-free survival rate (72% vs. 74.19%, P=0.87, respectively). Conclusion: In treatment of malignant colorectal obstruction, elective operation after stent insertion had similar oncologic outcomes compared with emergency operation. Preoperative stent insertion not only lowers the incidence of enterostomy but also makes laparoscopic surgery possible, thereby enhancing patients’ quality of life. Therefore, preoperative stent insertion is a useful method that may replace emergency surgery in treatment of malignant colorectal obstruction.

수입각증후군에 의한 급성 복증 1례

정은욱,지삼룡,이영태,박지훈,김동기,제인수,채두근,박성재,박은택,이연재,이상혁,설상영,정정명 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Afferent loop syndrome is an uncommon complication of a gastrectomy and Billroth Ⅱ reconstruction. It may cause symtoms at any time from the first postoperative day to many years after the gastrectomy. Afferent loop syndrome is characterized by abdominal pain, vomiting and elevation of serum amylase. Thus, it is difficult to differentiate afferent loop syndrome from other cause of acute pancreatitis. However, the history of gastrectomy can be an important clue for diagnosing afferent loop syndrome. We experienced one case of chronic afferent loop syndrome with acute pancreatitis. After appropriate management, the abdominal pain disappeared and serum amylase level decreased. We report this case with a review of relevant literatures.

건강한 성인에서 발병한 칸디다와 연관된 위궤양 1례

박지훈,이상혁,김희,이재호,박성재,지삼룡,양성연,박은택,이연재,설상영,정정명,강미선 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Fungus such as Candida albicans is a normal flora that is frequently found in the oral cavity, gastrointestinal tract, genitourinary tract, vaginal mucosa in a normal person. However, candida can cause opportunistic infection in an immune compromised host. Candidiasis has broad spectrum of disease from mucocutaneous infection to invasive or disseminated infection. But, it is rarely reported that candida is associaed with gastrointestinal tract disease in a healthy adult. The case of gastric ulcer associated with candida particularly in a health adult is reported with relevant literature.