소장 장간막의 낭종성 림프관종에 의한 소장 염전 1예

하창윤 ( Chang Yoon Ha ),심기남 ( Ki Nam Shim ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),나윤주 ( Youn Ju Na ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ),민석기 ( Seog Ki Min ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1

A cystic lymphangioma is a rare benign tumor that arises in an organ with a large number of lymphatics. It arises in patients of all ages and has variable presentations. An abdominal cystic lymphangioma most commonly occurs in the intestinal mesentery, with the retroperitoneum being the second location of choice, and it causes abdominal pain, hematochezia, intussusceptions and protein-losing enteropathy. If the cystic lymphangioma presents with symptoms, surgical excision is required for treatment and diagnosis. We report here a case of cystic lymphangioma of the small bowel mesentery that presented with a small bowel volvulus, along with a brief review of the literature. (Intest Res 2008;6:76-79)

복강 내 결핵성 농양의 CT 소견과 임상경과

하창윤 ( Chang Yoon Ha ),김종열 ( Jong Yeol Kim ),김갑철 ( Gab Chul Kim ),염헌규 ( Hun Kyu Ryeom ),김혜정 ( Hye Jung Kim ),이희중 ( Hui Joong Lee ),강덕식 ( Duk Sik Kang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3

목적: 복강 내 결핵성 농양은 매우 드물지만 다양한 양상으로 발병하기 때문에 암성 복막염과의 감별이 쉽지 않다. 이 연구에서는 복강 내 결핵성 농양의 CT 소견과 임상경과에 대하여 후향적으로 분석해 보고자 하였다. 방법: 수술 혹은 조직 생검을 통해 병리학적으로 복강 내 결핵성 농양으로 확진되고 CT를 시행한 11명의 환자(남자 3명, 여자 8명, 평균 34.8세, 21~66세)를 대상으로 하였으며, 25 CT와 의무기록을 후향적으로 분석하였다. 평균 추적기간은 15개월(12~32개월)이었다. 결과: 11명의 환자에서 16개의 농양이 발견되었고, 이들 중 4개(25%)의 농양은 우측 간주위 공간, 4개(25%)는 좌측 간주위 공간, 3개(19%)는 비장주위 공간, 2개(13%)는 좌측 횡경막하 공간에 있었으며 우측 횡경막하 공간과 우하복부공간, 좌하복부 공간에 각각 1개씩 있었다. 농양의 크기는 1~8 cm(평균, 4 cm)이었으며, 농양의 모양은 12개가 난원형이었고, 4개는 구형이었다. 농양벽의 두께는 1~5 mm(평균, 3 mm)이었다. 16개의 농양 모두에서 농양벽이 얇고, 조영증강되었으며 농양벽 석회화는 보이지 않았으며 12개에서 내부의 격벽이 보였다. 림프절 종대가 2명, 복막의 비후와 대망 혼탁의 소견이 3명에서 있었으며 액체 저류의 소견은 모두 없었다. 복막의 조영증강 소견은 6개의 농양에서 보였다. 동반된 다른 장기의 결핵 이환은 4명에서 발견되었는데, 결핵성 흉막염 2명, 폐결핵과 장염 1명, 폐결핵과 경부 림프절 결핵 1명이었다. 11명 중 5명은 결핵의 병력이 없었으며 농양이 결핵의 일차 병변이었으며 6명은 결핵성 복막염으로 치료 중인 환자로 농양이 역설반응으로 생긴 새로운 병변이었다. 역설반응으로 진단된 6명의 농양 발현 시기는 치료 후 66~116일(평균, 88일)이었다. 모든 환자는 6~12개월동안 항결핵제 치료를 하였으며, 5명은 수술을 하였고, 모두 완치되었다. 추적기간은 12~32개월(평균, 15개월)이었다. 결론: 복강 내 결핵성 농양은 복부 결핵의 일차 병변 또는 결핵성 복막염의 역설반응으로 생길 수 있으며, 상복부 공간에 위치하는 다양한 크기의 조영증강되는 얇은 벽을 가진 낭성 병변의 소견을 보인다. Background/Aims: Intraperitoneal tuberculous abscesses develop infrequently. Because of overlapping features it is difficult to differentiate a tuberculous abscess from carcinomatosis peritonei. The aim of this study was to define the computed tomography (CT) findings and clinical course of the intraperitoneal tuberculous abscess. Methods: The study included 11 patients (3 males, 8 females, mean age 34.8 years) with a pathologically proven intraperitoneal tuberculous abscess. We analyzed the CT findings and reviewed the medical records retrospectively. Results: Sixteen abscesses were found in 11 patients. The locations of the abscesses were in the right subphrenic space (n=1), right perihepatic space (n=4), left perihepatic space (n=4), left subphrenic space (n=2), perisplenic space (n=3), right lower abdominal space (n=1), and left lower abdominal space (n=1). Five patients were proven to have abdominal tuberculosis while six patients had paradoxical responses to antituberculosis therapy for tuberculous peritonitis. The abscess lesions presented on the CT scan as thin walled cystic enhancing lesions without calcification (n=16), a septated mass (n=12), with enlargement of lymph nodes (n=2), and peritoneal and omental haziness (n=3). The mean duration from commencement of treatment to onset of a paradoxical response was 88 days. All patients had antituberculosis therapy for 6 to 12 months and five patients underwent surgery. The mean follow-up was 15 months. Conclusions: The intraperitoneal tuberculous abscess appeared as an ovoid cystic lesion with a slightly enhanced thin wall in the upper abdomen, in the perihepatic space on the CT scan; such as lesion can be the primary lesion of abdominal tuberculosis or associated with the paradoxical response of tuberculous peritonitis. (Korean J Med 74:243-249, 2008)

내시경 점막절제술로 치료한 바렛식도에서 발생한 고도 이형성증

하창윤 ( Chang Yoon Ha ),심기남 ( Ki Nam Shim ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),나윤주 ( Youn Ju Na ),정해선 ( Hae Sun Jung ),백수정 ( Su Jung Baik ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ),조민선 ( Min Sun Cho 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1

Esophageal adenocarcinoma develop in 0.5~0.8% of Barrett`s esophagus. Although the incidence of adenocarcinoma is low, annual endoscopic surveillance is needed because of poor outcome. Recently endoscopic mucosal resection is increasingly being used in the management of early esophageal cancer because of low morbidity and mortality rates. Herein, we report a case of high grade dysplasia arising from Barrett`s esophagus treated with endoscopic mucosal resection and brief review of literatures.

증례 : 중심정맥도관 사용과 관련된 Mycobacterium fortuitum에 의한 혈류 감염 1예

하창윤 ( Chang Yoon Ha ),남승현 ( Seung Hyun Nam ),임석아 ( Seok Ah Im ),최희정 ( Hee Jung Choi ),이미애 ( Mi Ae Lee ),윤여준 ( Yeo Jun Yun ),국윤호 ( Yoon Hoh Kook ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

Atypical mycobacterial infections are increasing, especially such as skin and soft tissue abscess, wound infection, pneumonia, lymphadenitis, and disseminated disease. Atypical mycobacteria could infect immunocompromised patients with more severe bacteremia by central venous catheter. Catheter-related infection often develops due to catheter colonization, hematogenous infection, skin and exit site infection, and infusion-fluid contamination. We experienced a case of catheter-related blood stream infection by Mycobacterium fortuitum. He was 15-year old man with non-Hodgkin`s lymphoma, stage IVb. After 13 days of chemotherapy, he visited our hospital due to fever. M. fortuitum was identified on blood culture, and we used cefoxitin and amikacin for 4 weeks and then change to trimethoprime/sulfamethoxazole. (Korean J Med 69:S994-S998, 2005)

Mobile SMS와 상담을 기반으로 한 노인용 대장내시경 교육프로그램의 효과

이영순(Lee Yeong Sun),이봉조(Lee Bong Jo),하창윤(Ha Chang Yoon),전미양(Jeon Mi Yang) 한국기초간호학회 2021 Journal of korean biological nursing science Vol.23 No.1

Purpose: This study was conducted to examine the effects of an educational program based on mobile SMS and counseling for colonoscopy in elderly people. Methods: The study utilized a non-equivalent control group with a non-synchronized design as a quasi-experimental research. The study subjects consisted of 72 elderly people (36 elderly people in the experimental group and 36 in the control group). Among the subjects, 49 were male (68.1%) and 23 were female (31.9%), and the age was 69.04±6.14 years. Forty-five subjects (62.5%) answered that they had underlying diseases, eight subjects (11.1%) had a family history of colon disease, and 61 subjects (84.7%) had undergone a colonoscopy. The experimental group was provided with an educational program based on mobile SMS and counseling when three days and one day before the test. The control group received verbal explanations using information sheet. The data were analyzed using descriptive statistics, the Chi-squares test, and the independent t-test with SPSS/WIN 21.0. Results: Significant differences were found in bowel cleanliness scores (t=3.60, p=.003) between the groups. No significant differences were seen between the groups in the sedation drug dosage (propofol (t=1.02, p=.730), midazolam (t=0.66, p=.380)) and time for colonoscopy (t=1.08, p=.235). Conclusion: Based on the results of this study, an educational program based on mobile SMS and counseling for colonoscopy was proposed as an educational program before colonoscopy.

위장관 ; 임상에서 비정맥류 상부위장관 출혈의 지혈클립 단독치료와 복합치료의 지혈술 비교: 관찰연구는 무작위 연구의 성적과 다른가?

이수현 ( Su Hyun Lee ),정진태 ( Jin Tae Jung ),이동욱 ( Dong Wook Lee ),하창윤 ( Chang Yoon Ha ),박경식 ( Kyung Sik Park ),이시형 ( Si Hyung Lee ),양창헌 ( Chang Heon Yang ),박윤선 ( Youn Sun Park ),전성우(교신저자) ( Seong Woo Jeo 대한소화기학회 2015 대한소화기학회지 Vol.66 No.2

목적: 내시경클립지혈술은 비정맥류 상부위장관 출혈에서 효과적이며 안전한 방법으로 사용되고 있으며, 복합지혈술과의 비교에서도 동등한 효과를 가지는 것으로 알려져 왔다. 이 연구는 전향적 코호트데이터를 기반으로 복합지혈술과 클립단독지혈술의 효과를 비교하기 위한 것이다. 대상 및 방법: 2011년 2월부터 2013년 12월까지 전향적으로 비정맥류 상부위장관 출혈 환자를 등록하였으며, 이들 1,584명의 환자 중 지혈클립을 사용하여 치료한 186명에 대해서 분석하였다. 환자군은 각각 1군: 지혈클립만 단독 적용(n=62),2군: 지혈클립과 에피네프린 국소주입요법을 병합(n=88), 3군: 지혈클립과 에피네프린 국소주입요법의 병합과 함께 다른내시경 지혈술을 적용한 군(n=36)으로 나누었다. 일차유효성평가는 재출혈, 내시경 외 다른 지혈술 시행, 입원기간, 금식기간 및 사망률로 하였으며, 이차유효성평가는 출혈연관성 사망률과 전체사망률로 하였다. 결과: 1군에서 3군으로 갈수록 궤양으로 인한 상부위장관 출혈 및 활동성 출혈이 많았다(p<0.001). 지혈클립을 포함한 내시경 복합지혈술을 시행한 3군과 지혈클립 단독요법을 시행한 1군 및 2군과 비교 시 치료성적에서 차이를 보이지 않았으며, 세 군 간의 일차 및 이차유효성평가 변수들은 차이를 보이지 않았다. 결론: 이 연구는 활동성 출혈을 보이는 위장관 병소에서 내시경 의사들은 지혈클립을 포함한 내시경 복합지혈술을 선호한다는 것을 보여주고 있으며, 3가지 이상의 내시경 지혈술의 병합요법이 무작위 대조군 연구와는 다르게 임상에서는 좀 더강력한 지혈술임을 반영한다. Background/Aims: Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Methods: Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n=62), hemoclipping only; group 2 (n=88), hemoclipping plus epinephrine injection; and group 3 (n=36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Results: Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p<0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups. Conclusions: Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice. (Korean J Gastroenterol 2015;66:85-91)

성인 환자에서 위와 결장에 동시 침범한 랑게르한스 세포 조직구증: 증례 보고

김성제 ( Seong Je Kim ),하세인 ( Se In Hah ),곽지윤 ( Ji Yoon Kwak ),최정우 ( Jung Woo Choi ),조현진 ( Hyun Chin Cho ),하창윤 ( Chang Yoon Ha ),정운태 ( Woon Tae Jung ),이옥재 ( Ok Jae Lee ),이창민 ( Chang Min Lee ) 대한소화기학회 2022 대한소화기학회지 Vol.80 No.3

Langerhans cell histiocytosis (LCH) is reported less frequently in adults than in children. The most common site of involvement in adults is the bone, accounting for 30-50% of cases. The gastrointestinal tract is very rare, accounting for approximately 2%. We present a case of Langerhans cell histiocytosis that simultaneously invaded multiple organs, including the stomach and colon, in an adult. A 37-year-old woman with no underlying disease complained of chest discomfort and a palpable right submandibular mass. A right Level II neck mass and mediastinal LN enlargement were confirmed on the pharynx and chest CT scan. Multiple subepithelial masses with central ulceration and erosion were observed in the corpus and fundus on the esophagogastroduodenoscopy and in the right colon on the colonoscopy. The histopathology findings were the same in each tissue biopsied from the stomach, colon, and right neck lymph nodes. Langerhans cells with classical reniform nuclei and prominent eosinophils invaded the normal glands, and S100 and CD1a were positive in the immunohistochemical stain. Gastrointestinal involvement of LCH in adults is rare, asymptomatic,and can involve multiple digestive organs simultaneously, so upper endoscopy and colonoscopy should be considered for a diagnosis. (Korean J Gastroenterol 2022;80:149-153)

사례보고 : 만성 C형간염 환자에서 Peginterferon α-2b와 Ribavirin 병합치료 중 발생한 돌발성 난청 1예

신민기 ( Min Ki Shin ),김태효 ( Tae Hyo Kim ),주강 ( Kang Ju ),하창윤 ( Chang Yoon Ha ),민현주 ( Hyun Ju Min ),정운태 ( Woon Tae Jung ),이옥재 ( Ok Jae Lee ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3

돌발성 난청은 페그인터페론 치료 시에 발생하는 드문 부작용으로 알려져 있다. 저자 등은 60세 만성 C형간염 환자에서 페그인터페론알파와 리바비린 병합치료 중 42주째에 우측 귀에 돌발성 난청이 발생하여, 페그인터페론 치료를 중단하고 스테로이드 투여 후 완전히 회복된 사례를 경험하였다. 페그인터페론 치료 시 청력에 대한 세심한 관찰이 필요하며, 청력소실 발생 시 치료의 지속 여부에 대해서는 발생 시점, 환자의 치료 의지, 청력소실의 정도 등에 따라 임상의가 주의 깊게 판단해야 할 것으로 생각한다. Combination therapy of pegylated interferon α and ribavirin has been associated with various adverse effects, but sudden-onset hearing loss is uncommon. We report a 60-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon α and ribavirin for chronic hepatitis C. This patient had been diagnosed with chronic hepatitis C (genotype Ib) and early-stage liver cirrhosis 3 years previously, and had been treated with conventional interferon-α and ribavirin for 12 months. However, 6 months from the end of the treatment course the patient relapsed and received combination retreatment with pegylated interferon α-2b and ribavirin. He developed sudden-onset right-side hearing loss and tinnitus 42 weeks after the start of this retreatment. Pure-tone audiometry revealed a right-side hearing loss of 60~90dB. The patient consequently immediately discontinued the pegylated interferon therapy and was given prednisone 60 mg/day for 10 days, after which the hearing loss had almost completely recovered. (Korean J Hepatol 2009;15:370-374)

식도 암육종 환자에서 이시적으로 발생한 식도 편평상피세포암

차라리 ( Ra Ri Cha ),정운태 ( Woon Tae Jung ),오혜원 ( Hye Won Oh ),김희진 ( Hee Jin Kim ),하창윤 ( Chang Yoon Ha ),김홍준 ( Hong Jun Kim ),김태효 ( Tae Hyo Kim ),고경혁 ( Gyung Hyuck Ko ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.6

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogastroduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma. (Korean J Gastroenterol 2014;64:364-369)

위장관 ; 알파 태아단백 생성 위암 환자들의 임상적, 병리학적 특성과 예후

유동훈 ( Dong Hoon Lew ),정운태 ( Woon Tae Jung ),김홍준 ( Hong Jun Kim ),민현주 ( Hyun Ju Min ),하창윤 ( Chang Yoon Ha ),김현진 ( Hyun Jin Kim ),김태효 ( Tae Hyo Kim ),고경혁 ( Gyung Hyuck Ko ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.6

목적: AFP 생성 위암은 조기 간전이 및 이에 따른 불량한 예후가 몇몇 연구에서 보고되어 있다. 대상 및 방법: 이번 연구에서는 단일 기관에서 2005년 1월부터 2013년 3월까지 혈청 AFP가 측정되고 조직학적으로 위암으로 확진된 909예의 환자에 대하여 임상적 특징과 예후를 조사하였다. 혈청 AFP가 10 ng/mL 이상인 경우를 AFP 생성 위암으로 정의하였으며, 간질환이 있는 환자는 제외하였다. 결과: AFP 생성 위암은 진단 당시 진행성 위암인 경우가 많고, 수술 후 간전이 발생률이 높으며, 생존기간이 유의하게 짧았다. 다변량 분석에서 생존율에 유의하게 영향을 미치는 요소는 AFP 생성 위암 여부와 병기 및 흡연력이었다. 같은 병기 내에서 AFP 생성 위암 환자군과 AFP 비생성 위암 환자군을 비교하였을 때 AFP 생성 위암 환자군에서 유의하게 생존율이 짧은 것을 확인할 수 있었으며, 간전이가 있는 경우에도 통계적으로 유의하지는 않았지만 AFP 생성 위암 환자군에서 생존율이 짧은 것을 확인할 수 있었다. 이번 연구는 후향적 연구라는 점과 몇 가지 제한점이 있었으며, 향후 AFP 생성 위암에 대한 추가적인 연구가 필요하다. 결론: AFP 생성 위암은 빠른 간전이를 보이고 수술 후에도 간전이 발생률이 높아 예후가 좋지 않다. 위암 환자에 있어서 혈청 AFP 수치가 증가되었을 경우에 이 암종을 의심하고 조직학적 진단의 재확인 및 간전이 여부 확인이 필요하다. Background/Aims: Several studies reported a subgroup of gastric cancer patients showing elevated serum alpha-fetoprotein (AFP) at the time of diagnosis. We investigated the clinicopathological characteristics and prognostic factors of AFP producing gastric cancer (AFPPGC) by comparing with AFP non-producing gastric cancer (AFPNPGC). Methods: A total of 909 patients were diagnosed with gastric cancer from January 2005 to March 2013 at Gyeongsang National University Hospital and their AFP levels were measured at the time of diagnosis. After excluding 138 patients with underlying liver diseases, 34 patients with elevated serum AFP level over 10 mg/mL were assigned to AFPPGC group and the remaining 737 patients with serum level of AFP below 10 ng/mL were assigned to AFPNPGC group. Results: The median survival length was shorter in AFPPGC group than AFPNPGC group (18.3±25.5 months vs. 30.0±22.0 months, p=0.004). The incidence of liver metastasis (47.1% vs. 3.3%, p<0.001) and lymph node metastasis (91.2% vs. 31.6%, p<0.001) was significantly higher in AFPPGC group. The probability of encountering metachronous liver metastasis after the operation was higher in AFPPGC group (44.4% vs. 2.0%, p<0.001). Multivariate analysis revealed that patients in the AFPPGC group who received chemotherapy (p=0.037) or underwent operation (p=0.001) had a better survival rate. Conclusions: AFPPGC behaves more aggressively and shows a worse prognosis. Therefore, serum AFP level should be routinely checked in all patients diagnosed with gastric cancer. (Korean J Gastroenterol 2013;62:327-335)