복강경을 이용하여 치료한 상장간막 동맥 증후군 1예

천지성,정우철,황성수,조현민,이강문,이보인,이수연,안지원,장우임,양진모,최규용,정인식 대한소화기내시경학회 2006 Clinical Endoscopy Vol.32 No.3

Superior mesenteric artery (SMA) syndrome is a symptom complex resulting from compression of third portion of duodenum by the root of the small bowel mesentery at the level of the SMA. This syndrome can occur as an acute illness but more commonly it appears as chronic condition. Identification of this syndrome can be a diagnostic dilemma and it is frequently made by exclusion. In our patient, rapid weight loss, nausea and bile stained vomiting were present. Ultrasound and MR-angiography were performed for measuring the angle and the distance between the SMA and the aorta. We confirmed the diagnosis via the reduced aorto-mesenteric angle and distance and the patient was then treated by laparoscopic surgery. After lysis of the ligament of Treitz, the patient's symptom were improved. This syndrome must be considered as one of the causes of upper gastrointestinal obstruction. (Korean J Gastrointest Endosc 2006;32:215-220) 상장간막 동맥 증후군(superior mesenteric artery syndrome)은 십이지장의 제3부위가 상장간막 동맥의 기시부에서 장간막에 의해 압박되면서 나타나는 질환이다. 임상적으로 급성인 형태로 나타나기도 하지만 대부분은 만성적으로 나타나기도 한다. 진단은 비교적 쉽지 않아 대부분 다른 질환들을 배제함으로써 확인하게 된다. 저자 등은 최근에 심한 체중 감소와 함께 식후 복부 팽만감과 구역, 담즙이 섞인 구토를 주소로 내원한 환자에서 복부 초음파와 MR-angiography를 실시하여 aorto-mesenteric angle과 aorto-mesenteric distance를 측정함으로써 상장간막 동맥 증후군으로 진단하였고, 복강경을 이용하여 Treitz 인대를 분할하고 십이지장을 하방 전이시켰다. 이후 환자는 증상이 호전되었다. 상부위장관 폐쇄가 있을 경우에 상장간막 동맥 증후군도 하나의 원인으로 고려해야 할 것이고, 이에 문헌 고찰과 함께 보고하는 바이다.

Chemoport 감염에 의한 Mycobacterium abscessus 패혈증 1예

김태호,천지성,장우임,정호윤,김상일,박연준,김양리,이근화,국윤호,강문원 대한감염학회 2000 감염 Vol.32 No.6

크루켄버그 종양 12예에 대한 분석

윤인재,천지성,박순민,이종민,정정조,문건웅,이상준,서백종,윤종구 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.5

투석중인 말기신부전 환자에서 부갑상선 호르놈 형성에 관여하는 임상인자

송호철,최의진,김선화,천지성,박주현,신영신,김영옥,김석영,장윤식,방병기 대한신장학회 1998 춘계학술대회 초록집 Vol.1998 No.-

전형적인 내시경 소견을 보인 악성 십이지장-대장 누공 1예

박진민,정우철,이강문,이보인,천지성,우영식,장우임,양진모,최규용,정인식 대한소화기내시경학회 2005 Clinical Endoscopy Vol.31 No.6

Malignant duodeno-colic fistula is a rare complication of advanced colon cancer. The right colon cancer adjacent to the hepatic flexure can occasionally invade into the pancreas or duodenum, but the formation of fistula between the duodenum and colon is very rare. The patients usually complain chronic diarrhea, vomiting and belching of foul smelling gas. This results in physiologic complications such as weight loss, malnutrition, and electrolyte imbalance. It is well known that the barium enema is the most useful diagnostic procedure. We experienced the case of duodeno- colic fistula that arose from the right colon cancer, and the fistula was directly confirmed by an endoscopic examination 십이지장-대장 누공은 악성 대장암에서 보기 드문 합병증이다. 우측 대장 특히 간만곡 부위에 발생한 대장암은 해부학적으로 십이지장이나 췌장에 근접해 있어 침습하는 경우가 가끔 있지만, 십이지장-대장 누공이 형성되는 경우는 매우 드물다. 주 증상으로 만성적인 수양성 설사와 악취를 동반한 구토와 트림을 호소하고, 이로 인해 체중 감소, 영양 결핍 및 전해질 불균형을 초래한다. 진단은 바리움 대장 조영술이 가장 유용한 것으로 되어 있다. 본 증례에서 저자는 상부 위장관 내시경 검사를 실시하였고, 십이지장의 후구부에서 악성 궤양성 병변으로 인한 누공을 통하여 내시경이 바로 우측 대장으로 진입된 경우를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

항결핵 치료과정에서 호전되었다가 악화된 뇌 결핵종 1예 보고

이대훈,유진홍,강미자,김홍기,김선화,고동훈,천지성,유원종 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.3

In spite of nationmide tuberculosis control program, tuberculosis is still prevalent in Korea. Accordingly, tuberculous meningitis also poses one of the main trouble some problems. Recently, We experienced a perplexing case of tuberculous menin-gitis and tubercdoma in a 24-year old female patient. She was admitted to our hospital owing to meningeal irritation sign, aphasia, VI nerve palsy, and ,fever. CSF analysis showed a finding consistent with that of presumptive tuberculous meningitis.. Initial MRI of the brain revealed a large mass(tuhercu1oma) on left parieto-temporal area. Antitubeculous regimen(1soniazid (INH), rifampin(RMP), ethambutol(EMB), pyrazinamide(PZA)} of meningeal dose was given immediately, and her symptoms and signs were dramatically disappeared with a few days after treatment. She was discharged with improved condition and under maintenance treatment of tuberculosis. Follow-up one year after treatment. revealed that the previous lesion was nearly diminished. She showed no symptom at all until she recognized a total blindness of sudden onset on her left eye a t the 18th month of treatment. Brain MRI checked at that time showed multiple masses of tuberculoma scattered over the brain base and one of them invaded left optic nerve. In our opinion, the cause of relapse in this patient might he explained by the selection and ultimate replication of a minor population of resistant strain. Although such relapse is an extremely rare event, we think that we should always pay attention to this possible resistance problem every time we meet patients with tuberculous meningitis.

크루켄버그 종양 12예에 대한 분석

이상준,박순민,이영석,한남익,윤종구,이종민,한석원,문건웅,윤인재,천지성,정정조,서백종 대한소화기학회 1998 대한소화기학회지 Vol.30 No.5

Background/Aims: The Krukenberg tumor is a metastatic or primary ovarian tumor of the signet-ring cell type. The incidence of this tumor are high in Korea, especially among relatively young age group, and the prognosis is poor. Therefore we tried to understand the relationship between the many factors and survival periods. Methods: We have observ d 12 cases of Krukenberg tumors from January 1984 to February 1997 in Holy Family Hospi:al and analyzed them. Results: The Krukenberg tumor accounts for 14.1% among the 85 malignat ovarian tumor and 3.5% among the 342 female gastric cancers found in our hospital during this period. The age distribution of the patients ranged from 25 to 50 years of age and the majority were under 40 years of age. The mean age was 34.2 years. Initial chief complaints were epiga.tric pain, lower abdominal pain, and lower abdominal mass. The sizes of Krukenberg tumors range from 7.2cm to 18.0cm and the tumors were usually bilateral. From diagnosis to death, the mean duration of survival was 6.7 months. But it was 9.0 months in cases where an operation on the ovaries and the primary site, were performed. In the group of ascites(8 cases), it was 2.6 months contrary to 14.8 months of ascites-free group. Conclusions: The prognosis of the Krukenberp tumor depends on early diagnosis and aggressive treatrnent.

혈액투석중인 말기신부전 환자에서 부갑상선 호르몬에 관여하는 임상인자

송호철(Ho Cheol Song),최의진(Euy Jin Choi),김선화(Seon Hwa Kim),천지성(Ji Seong Chun),박주현(Joo Hyun Park),신영신(Shin Young Shin),김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),김석영(Suk Young Kim),장윤식(Yoon Sik Chang),방병기(Byung Ke 대한내과학회 1998 대한내과학회지 Vol.55 No.5

N/A Objectives: Renal osteodystrophy has been recognized as one of the major complications in long-term hemodialysis patients. Bone histomorphology is the definite method for diagnosis but plasma intact PTH level has predictive value for diagnosis of renal osteodystrophy. We performed this study to evaluate the prevalence and correlating factors of secondary hyperparathyroidism in ESRD patients Methods: we analyzed the intact PTH level(normal value: 12-72 pg/ml) and clinical parameters in 309 maintance hemodialysis patients retrospectively. Results: The causes of ESRD were chronic glomerulonephritis(32%) diabetic nephropathy(25%) and hypertensive nephropathy(13%). In hemodialysis patients, the mean duration were 48±43 months, the serum phosphorus levels were 5.0±1.8 mg/dl, and the serum albumin levels were 3.9±0.6 gm/dl. The intact PTH levels were 175±266 pg/ml. The incidence of hypercalcemia (>10.5 mg/dl) in patients was 4.6% and the incidence of hypocalcemia (<8.5mg/dl) was 26.4%. Twenty-five percent of the patients had iPTH level more than three times normal. Another 42% had a less than normal iPTH level. In multiple regression, serum calcium(r=-0.24), age(r=-0.17) and duration of dialysis (r=0.15) correlated significantly with iPTH level, The iPTH levels between diabetic(82±139 pg/ml) and nondiabetic(229±320 pg/dl) patients were significantly different(P<0.01). But there are no significant correlation between sugar control and iPTH level. Conclusion: We conclude that the iPTH levels were significantly correlated with the age, durations of hemodialysis and the serum calcium levels, Level of intact iPTH in diabetic group were significantly lower than nondiabetes in hemodialysis.

반복성 늑막삼출로 발현된 Boerhaave 증후군 1 예

김선화,최명규,방춘상,윤종구,이동수,김성수,김상우,강미자,한석원,채현석,추교영,천지성,이대훈 대한소화기학회 2000 대한소화기학회지 Vol.36 No.6

Spontaneous rupture of the esophagus is an uncommon disease which was firstly reported by Boerhaave in 1724. It can cause fatal results unless diagnosed and treated early. Delayed diagnosis is mostly caused by lack of knowledge and atypical clinical symptom. Its mortality increases proportionally to the time between esophageal perforation and treatment. We experienced a case of spontaneous esophageal perforation. The patient was a 40-year-old alcoholic, who complained of epigastric, shoulder, and back pain following forceful hematemesis. The results of chest X-ray was normal on admission. Alcoholic delirium tremens developed 12 hours after admission. On the 3rd hospital day, massive preural effusion developed. Pleural effusion was drained completely and recurred on the 4th hospital day. Under the suspicion of esophageal rupture, we performed chest computed tomography, which revealed airs, fluids, and tiny soft tissue densities in the mediastinum. Operation was performed on the 4th hospital day. There was a 7-8 cm sized longitudinal tearing in lower esophagus. He died 5 days after operation.

대량의 위궤양 출혈을 일으킨 정상 신생아

박영실 ( Young Sil Park ),정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),이보인 ( Bo In Lee ),천지성 ( Ji Sung Chun ),장우임 ( U Im Chang ),양진모 ( Jin Mo Yang ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.3

Gastric ulcer bleeding in neonatal period, mainly in preterm newborn babies or in neonates treated in intensive care units, is relatively frequent, However the occurrence of significant gastric ulcer bleeding in healthy full term infants is unusual. We experienced a case of massive upper gastrointestinal (GI) bleeding in a 3-day-old healthy full term infant. Endoscopic examination confirmed the presence of gastric ulcerations. Treatment was initiated with transfusion and histamine 2 receptor antagonist, and the clinical signs resolved. Mother`s serum antibody to Helicobacter pylori (H. pylori) was positive. We collected stool of the patient including other 17 infants in the intensive care unit. A highly sensitive semi-nested PCR for H. pylori DNA was performed, but all infants including the patient revealed negative. H. pylori infection is not related with upper GI bleeding in healthy full term infants. In conclusion, the diagnosis of upper GI bleeding in infant can be easily made by means of pediatric endoscopy, which is a simple and a well tolerated examination. (Korean J Gastroenterol 2006;48:210-214)