포스터 전시 : 소화기 ; 마에 의해 유발된 허혈성 대장염 1례

채두근,윤철,김재환,제인수,박성재,지삼룡,이연재,이상혁,설상명,정정명 대한내과학회 2005 대한내과학회 추계학술대회 Vol.69 No.10

전폐세척술을 시행한 폐포단백증 1예

채두근,이영민,염호기,진재용,이혁표,최수전,김주인 인제대학교 2001 仁濟醫學 Vol.22 No.1

Pulmonary alveolar proteinosis(PAP) is a rare disease characterized by the accumulation of strong PAS-positive phospholipids and proteinaceous material in the alveolar space. The etiology of PAP remains unknown, but its pathogenesis is believed to involve excessive secretion and/or disrupted clearance of surfactant. Twelve cases were reported since 1986 in Korea. Whole lung lavage has been done as a effective treatment modality in PAP. We experienced a case of pulmonary alveolar proteinosis treated with whole lung lavage, so we report this case with a review of literature.

저절로 줄기가 절제된 용종양 식도 암육종 1예

강석우,윤철,채두근,김재환,양성연,권수경,최수임 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.6

Carcinosarcomas of the esophagus are rare malignant neoplasms that consist of both carcinomatous and sarcomatous components, which comprise approximately 1∼2% of all esophageal neoplasms. Usually, esophageal carcinosarcomas are the polypoid type, and patients with esophageal carcinosarcoma have progressive dysphagia. The multiplicity in terminology appears to be related to the uncertain histogenesis of these tumors. We report a case of a polypoid esophageal carcinosarcoma with a spontaneous resected stalk in a 45 year-old male patient who presented with progressive dysphagia and weight loss. (Korean J Gastrointest Endosc 2007;35:435-440) 식도의 암육종(carcinosarcoma)은 육종성 성분과 암종성 성분이 동시에 나타나는 악성종양으로 모든 식도 신생물(neoplasm) 중에서 약 1∼2% 정도를 차지하는 매우 드문 질환이다. 대개 용종양이 많으며 진행성 연하곤란이 주로 나타나고 체중감소와 전신쇠약이 동반된다. 이 종양은 육종성분의 기원이 불분명하고 병리학적, 임상적으로 비슷하여 여러 가지 용어로 불리어져 왔다. 그동안 국내에서 식도 암육종에 대한 보고가 몇몇 있었지만 본 증례처럼 용종양 식도 암육종의 줄기가 저절로 절제된 경우는 보고된 적이 없었다. 저자들은 연하곤란과 체중감소를 주소로 내원한 환자에서 심한 흉통 호소 후 줄기가 저절로 절제된 식도의 용종양 암육종 1예를 경험하여 문헌고찰과 함께 보고한다.

4첨 대동맥판막 환자에서 발생한 대동맥판막 폐쇄부전 1례

박경동,김성목,하정수,채두근,조길현,송진호,김두일,김동수 한국심초음파학회 2000 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.8 No.2

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. A case is reported of a 51 year old woman with quadricuspid aortic valv associated with regurgitation. In the past, quadricuspid aortic valve was recognised at surgery or necropsy, but now transthoracic and transesophageal echocardiography play a pivotal role in diagnosing this rare valve malformation. On occasion the transthoracic echocardiogram cannot show the quadricuspid nature of the aortic valve, and transesophageal echocardiography must be performed. 저자들은 평소 자각 증상 없이 지내던 중 신체검사상 우연히 청진된 심잡음으로 인한 심초음파 검사상 4첨대동맥 판막기형을 보이며 그에 따른 대동맥 판막 폐쇄부전 및 중등도의 좌심비대와 폐울혈 소견을 보이는 4첨 대동맥 판막 1례를 경험하였기에 이를 보고하는 바이다.

각종 만성 간질환들에서 B형간염 바이러스의 잠재성 감염에 대한 관찰

정정명,강석우,윤철,채두근,김성목,설상훈,조환진,조경임,박영홍,모혜경 인제대학교 백병원 2001 仁濟醫學 Vol.22 No.2

Objectives: Occult Hepatitis B virus infection is defined as HBV DNA positivity without HBsAg by serologic test. It has been thought to be caused by the escape mutant which do not express HBsAg or prouduce S protein with altered antigenicity. But the precise mechanism and pathophysiology of this phenomenon is still unclear despite of numerous previous reports. We investigated occult hepatitis B infection and their clinical characteristics in the patients with various chronic liver diseases. Methods and Materials: Thirty eight patients with chronic liver diseases with positive HBsAb or negative HBsAg were included. After confirmation of HBV DNA, we performed entire base pair sequence analysis on the C region of HBV genome. Results: 1. HBV DNA was detected 29 cases among 38 patients(76.3%) they had 12 chronic toxic hepatitis(41.4%), 7 liver cirrhosis(24.1%), 7 cases of simultaneous hepatocellular carcinoma with liver cirrhosis(24.1%), 1 chronic C hepatitis(3.4%), 1 alcoholic liver disease(3.4%), and 1 uncertified cause(3.4%). 2. The mutation at core promoter region were found in 24 patients(83.1%), of which 15 showed simultaneous mutations in both nucleotide 1762 and 1764, and 1 patients in 1764 single mutation. 3. Twenty four of 29 patients(83.1%) have mutations at precore region, of which the nucleotide 1896(codon 28) was the most frequent site(9 patients- 37.5%). 4. The mutations were found at whole length of core gene, but were the most frequent at epitope regions. For cytotoxic T cell epitope region, the mutation in codon 27 and 31 were from 9(31.0%) and 19(65.5%) patients, respectively. For CD4 epitope region, the mutations in codon 49, 60 and 76 were from 12(41.4%), 9(31.0%) and 16 patients(55.2%), respectively. And for B cell epitope region, those in codon 130 and 143 were from 19(65.5%) and 15 patients(52.0%), respectively. 5. S gene mutations were observed in only 3 patients, 2 liver cirrhosis and 1 hepatocellular carcinoma patients. Point mutation was frequently observed in codon 51, 67, 68, 91 of pre-S1, codon 38, 39, 40, 46 of pre-S2, and codon 3, 27, 82, 92 of S gene. In the case of hepatocellular carcinoma, the 120bp deletion from pre-S1 to pre-S2 was observed. Conclusion: From the above results, we may conclude that the occult hepatitis B virus infection is highly prevalent in epidemic area of HBV infection, and may be related with severe liver diseases. Escape mutant may be an important mechanism of this phenomenon.

포스터 전시 : 소화기 ; 간세포암에서 고주파 열치료 후 천자침 경로를 통한 전이에서의 고주파 열치료 및 방사선 치료 1례

윤철,제인수,김재환,채두근,박성재,지삼룡,이연재,이상혁,설상영,정정명 대한내과학회 2005 대한내과학회 추계학술대회 Vol.69 No.10

클립으로 지혈된 십이지장 제3부의 거대 게실 내 Dieulafoy 병변

김모세,양성연,김재환,권수경,김태희,설상훈,노은지,채두근,고정해 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.6

A duodenal diverticulum is common in the second portion of the duodenum and can occur at any age. An obstruction, bleeding, perforation, diverticulitis are not an uncommon complicationa of duodenal diverticulum. As a rare complication, bleeding in the duodenal diverticulum may be massive, and duodenal diverticulum is resected primarily as a result of the difficulty in determining the site of bleeding. However, there has been a recent increase in endoscopic diagnosis and the treatment of diverticular bleeding. Band ligation increases the risk of duodenal diverticular perforation because of the thin diverticular wall. An endoscopic hemoclip is a preferable method for endoscopic sclerotherapy. We report a 48- year-old man with a giant duodenal diverticulum that was treated with a hemoclip. The duodenal diverticular perforation was treated effectively with supportive care. (Korean J Gastrointest Endosc 2007;35:441-444) 십이지장 게실은 주로 제2부에 발생하고 폐색, 출혈, 천공, 게실염 등을 유발할 수 있다. 십이지장 게실 내의 출혈은 드문 합병증으로 가끔 대량 출혈을 초래할 수 있다. 십이지장 게실 출혈은 상부 위장관 내시경검사로 출혈 장소를 확인하기 어려워 수술적 절제술로 치료된 경우가 많았다. 그러나 최근에는 내시경 접근을 통해 게실 출혈의 진단과 치료가 증가하고 있다. 그러나 내시경 경화 요법이나 밴드 결찰술 등은 게실의 벽이 얇기 때문에 천공의 위험이 높아 지혈 클립이 가장 선호되는 내시경 치료로 인정받고 있다. 저자들은 남자 48세 환자에서 발생한 거대 십이지장 게실 내의 Dieulafoy 출혈을 지혈 클립을 사용한 치료 후 십이지장 천공이 발생하였고 이를 보존적 치료 후 효과적으로 치유한 증례를 보고하고자 한다.

만성 C형 간염 환자에서 인터페론치료 중 병발한 편평태선 1예

이상혁,김성목,정정명,설상영,이연재,박은택,채두근,박경동,하정수 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Lichen planus (LP) is a chronic inflammatory disease of unknown cause with variable clinical presentations on skin and mucosa. LP is frequently observed in patient with hepatitis C virus infection and can occur or exacerbate during interferon treatment. We report a case of LP which developed and was aggravated during interferon treatment on chronic hepatitis C. The patient was a 44-year-old man who was diagnosed as chronic hepatitis C on liver biopsy. We started interferon alpha treatment in a dose of 3 million units subcutaneously 3 times weekly. Five months later of interferon treatment, erythematous erosive skin lesion on lower lip was found and it was aggravated progressively. Skin biopsy showed LP. The condition of the patient was improved with local treatment after discontinuation of interferon injection.

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.

부산시 기장지역 주민에서 혈청 요산치와 인슐린저항성 증후군

임경호,김성목,조문숙,박정현,김동준,이병두,강창일,윤보영,채두근 대한당뇨병학회 2001 Diabetes and Metabolism Journal Vol.25 No.4

Background: Insulin resistance syndrome is defined as the constellation of central obesity, hypertension, glucose abnormality and dyslipidemia. Other constituents of insulin resistance syndrome have recently been reported including serum uric acid. Causative correlation between serum uric acid and insulin resistance syndrome is still not clear. We pertormed epidemiologic study to clarify its correlation with insulin resistance syndrome in the people living at Kijang district of Busan City. Methods: We pertormed volunteer study of the people living at Kijang district of Busan City from 16th to 19th day of November in 1998 (n=232). Height, body weight, abdominal and hip circumference, and blood pressure were measured. We also measured fasting blood glucose, fasting serum insulin (Linco^(R) RIA), HDL-cholesterol, triglyceride, total cholesterol and serum uric acid. Insulin resistance was calculated by HOMA (homeostasis model assessment) method. Results: Total number of subjects were 232 (male 61, female 171), and their mean age was 5.1±13.4 (years), BMI (body mass index) 23.4±3.2 kg/㎡, and WHR (waist to hip ratio) 0.82±0.07. Mean HOMA-IR value derived from fasting blood glucose and insulin was 2.5±2.4, mean serum uric acid was 270±72 μmol/L. The serum uric acid level showed positive correlation with BMI (r=.324), WHR (r=.403), log transformed triglyceride value (r=.135), systolic blood pressure(r=.181), diastolic blood pressure (r=.185) and negative correlation with HDL-cholesterol (r=-.185,p$lt;0.01). Stepwise linear regression revealed that only serum creatinine, WHR and natural logarithmic value of triglyceride showed statistically independent correlation with serum uric acid level. Conclusion: Serum uric acid level in the people living at Kijang district of Busan City showed statistically significant correlation with other well-known constituents of insulin resistance syndrome. Thus, we may conclude that the level of serum uric acid can be regarded as the component of insulin resistance syndrome in the people living at Kijang district. However, its relationship with insulin resistance syndrome may be indirect.