민사사건 처리에 대한 소고

채철병 한국사법행정학회 1962 사법행정 Vol.3 No.2

우연히 발견되어 치료 목적의 위점막하 박리술을 시행받은 국소적 위 아밀로이드증 1례

채철병 대한내과학회 2019 대한내과학회 추계학술대회 Vol.2019 No.1

S-83 특발성 급성 상장간막 동맥 혈전증 환자에서 발생한 소장의 허혈성 장염 1례

채철병,박호준,이동욱 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

급성 장간막 허혈은 급성 복증을 유발하는 위장관 질환의 약 2%정도를 차지하며 응급실을 통해 내원한 환자의 약 1,000명당 1명에서 발생하는 것으로 보고될 정도로 매우 드문 질환이나 연령 증가에 따라 빈도가 늘어나는 양상을 보인다. 또한 사망률은 전반적으로 불량하며 통상적으로 59~93% 정도로 보고되고 있다. 이중 급성 상장간막 동맥 혈전증의 경우 전체 급성 장간막 허혈 중 25% 정도의 빈도를 보이며 기저 동맥경화증의 병력이 있는 경우가 많으며 폐색이 상장간막 동맥의 근위부에 발생할 가능성이 높아 보다 광범위한 장경색을 유발하는 경우가 많다고 보고되고 있다. 본 증례의 경우 특이 약물 복용력이나 과거력이 없는 49세의 젊은 나이의 환자가 급성 복통으로 응급실 내원하였으며, 당시 단순 복부 영상에서는 비특이적인 장마비 소견외에 특이소견이 없었고(Fig. A) 혈액검사에서도 특이소견은 없었으며, 복부 CT 검사에서 장염소견 보여 입원 치료하던 중 반복적으로 심화되는 양상의 복통있어 다음날 복부 삼상 조영증강 CT 검사 실시하였으며 근위부 상장간막 동맥에 새로 발생한 혈전이 확인되었다(Fig. B). 이후 헤파린 투여하였으며 다음날 중재시술을 시행하였고 말초 혈관으로 이동한 다발성 폐색소견 확인되어(Fig. C) 유로키나제 투여하였다. 이후 증상 호전 보이다가 반복되는 복통있어 상급 의료기관 전원하였으나, 원인을 발견하지 못한 상황에서 최종적으로 복강경하 소장절제술을 시행받았고 조직검사 상 허혈성 장염소견이 확인되었다. 이러한 증례를 통해 알 수 있듯이 급성 복통의 증상으로 환자가 내원하였을 경우 젊은 연령에 뚜렷한 기저질환이 없으며 검사상 특이소견이 없는 경우에도 증상이 지속되는 경우, 드물지만 복부 장혈관의 폐색성 질환에 대해 높은 수준의 의심을 가져야하며 진단이 될 경우 즉각적인 처치를 시행하야 한다.

십이지장 내 벽외성 압박의 위치에 따른 임상적 의미

채철병,김광하,박상규,이문원,이봉은 대한상부위장관ㆍ헬리코박터학회 2019 Korean Journal of Helicobacter Upper Gastrointesti Vol.19 No.1

Background/Aims: Differentiating extraluminal compressions from true subepithelial tumors in the duodenum by endoscopy alone is difficult. Endoscopic ultrasonography (EUS) is one of the most useful diagnostic modalities for this purpose. Extraluminal compression in the duodenum is occasionally observed, but its clinical significance has not been reported. Therefore, the aim of this study was to evaluate the clinical significance of extraluminal compression in the duodenum according to lesion location. Materials and Methods: We retrospectively evaluated 22 patients diagnosed as having extraluminal compression in the duodenum based on EUS findings between January 2006 and December 2017. Some patients underwent abdominal computed tomography for accurate diagnosis. Results: The location of the extraluminal compression was the duodenal bulb in 10 cases, the superior duodenal angle in 10 cases, and the second portion of the duodenum in 2 cases. Of the 22 cases, 12 were caused by normal structures, including vessels, the right kidney, the gallbladder, and the pancreas, and 10 were caused by pathological lesions, including the hepatic cyst, remnant cystic duct and dilated common bile duct after cholecystectomy; gallstones, gallbladder polyps, remnant cystic duct cancer, and pseudomyxoma peritoneii. The anterior wall of the duodenum was the most frequent location of extraluminal compression. However, the lesions in the anterior wall of the duodenal bulb and superior duodenal angle showed a high frequency of pathologic lesions, including malignancy. Conclusions: If the extraluminal compression is found in the anterior wall of the duodenum, EUS is needed because of the high frequency of pathological lesions. (Korean J Helicobacter Up Gastrointest Res 2019;19:56-60)

The association between T wave inversion and apical hypertrophic cardiomyopathy

채철병,최정현,하주희,김준호,이재준,최한일,박기범,김진희 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.3

Objectives: Electrocardiograhy (ECG) is the first step in hypertrophic cardiomyopathy (HCMP) diagnosis. For various reasons, the T wave inversion (TWI) and ECG change with time and HCMP is not easy to diagnosis. The aim of this retrospective study was to investigate the association between TWI on ECG and apical HCMP. Methods: A total of 4,730 ECGs presenting TWI from January 2011 to March 2013 in Pusan National University Hospital were enrolled. 133 patients who were examined by both echocardiography and coronary angiogram were analyzed. Patients were divided into two groups: Group A (TWI ≥ 10 mm) and Group B (5 mm ≤ TWI < 10 mm). HCMP is defined by a wall thickness ≥ 15mm in one or more LV myocardial segments. Apical HCMP is defined to be hypertrophy that is confined to LV apex. The patients who had ECGs with at least one month interval were divided 3 groups: Normal T wave, Abnormal T wave, and Persistent TWI. The prevalence of Apical HCMP and coronary artery disease (CAD) was reviewed among the three groups. Results: In this study there were a total 133 patients, with patients divided into Group A which had 15 patients and Group B which had 118 patients. Among the 23 patients with apical HCMP, three patients were Group A and twenty patients were Group B (P = 0.769). Regarding constancy of TWI, persistent TWI group was higher in apical HCMP than in other groups (P = 0.038). CAD had no difference between groups (P = 0.889). Conclusions: T wave negativity was not associated with incidence of apical HCMP. However, apical HCMP was diagnosed more frequently in patients with persistent TWI. Further follow up echocardiographic study is needed to evaluate the progression of apical HCMP in patients with TWI.

상피하 종양으로 발견된 십이지장 신경절신경종 1예

주동찬,김광하,채철병,이소정,박도윤 대한상부위장관ㆍ헬리코박터학회 2018 Korean Journal of Helicobacter Upper Gastrointesti Vol.18 No.4

Ganglioneuroma of the gastrointestinal tract is a rare tumor that consists of ganglion cells, nerve fibers, and supporting cells of the enteric nervous system. Ganglioneuromas are usually associated with genetic disorders such as the multiple endocrine neoplasia syndrome or neurofibromatosis. Ganglioneuromas of the gastrointestinal tract predominantly involve the colon and rectum, and reports about duodenal ganglioneuromas are few. Herein, we report a case of duodenal ganglioneuroma treated with endoscopic resection. A 56-year-old female patient visited our hospital because of a subepithelial tumor in the second portion of the duodenum. She had no remarkable medical or family history and revealed no history of genetic disorders. Endoscopic ultrasonography and abdominal computed tomography revealed a tumor located mainly in the submucosal layer, without any regional lymph node involvement. Endoscopic resection of the lesion was performed, and the pathological examination confirmed a duodenal ganglioneuroma. (Korean J Helicobacter Up Gastrointest Res 2018;18:271-274)

당뇨성케톤산증 환자에서 괴사성 위궤양을 유발한 위 털곰팡이증 1예

김준호,이현정,하주희,채철병,이동욱,박호준,이재준,박기범 대한상부위장관ㆍ헬리코박터학회 2016 Korean Journal of Helicobacter Upper Gastrointesti Vol.16 No.4

Mucormycosis is a rare invasive disease with high mortality rates caused by fungi of the zygomycetes class and Mucorales order. Mucormycosis is manifested by a variety of clinical presentations according to the involved site and occurs in immunocompromised conditions such as diabetes mellitus and other conditions. Rhino-orbital-cerebral and pulmonary infection is known as commonly involved areas. Primary gastrointestinal mucormycosis is a very rare and life-threatening invasive fungal infection. Gastrointestinal mucormycosis may occur in any alimentary tract, with the stomach being most involved part. The early diagnosis and appropriate treatment including surgical debridement of involved tissues and antifungal agents is needed to improve survival rates. We report a case of gastric mucormycosis successfully treated with radical debridement and antifungal agents in a 45-year-old man with diabetic ketoacidosis.

고령의 복통 환자에서 발견된 소장의 위장관 간질 종양 천공 1례

오공진,황종호,편성익,신재규,박호준,채철병 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Acute abdominal pain is a common presenting complaint in elderly patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. In elderly patients, the diagnostic accuracy is lower and the mortality far higher than the younger patients. In the geriatric population, biliary tract disease is the most common cause of abdominal pain, followed by malignancy, bowel obstruction, complicated peptic ulcer disease, incarcerated hernia, non-specific pain. Early and correct diagnosis for the elderly patients with acute abdomen is critical and significantly influences the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor (GIST) who presented emergency department with presentation of acute abdomen. Laparotomy was performed, since perforation of a tumor in the jejunum found by computed tomography. Diagnosis is confirmed on histopathology and immunohistochemistry. We recommend to consider small bowel disease when exploring the cause of acute abdominal pain in elderly patients.

고령의 복통 환자에서 발견된 소장의 위장관 간질 종양 천공 1예

오공진,황종호,이호영,편성익,신재규,박호준,채철병 대한노인병학회 2014 Annals of geriatric medicine and research Vol.18 No.4

Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.