위에 발생한 조기 림프종

박수헌(Soo Heon Park),최명규(Myung Gyu Choi),조세현(Se Hyun Cho),한준열(Jun Yeul Han),최규용(Gyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),강창석(Chang Suck Kang) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

A 34-year old female was admitted to St. Mary Hospital because of indigestion. E,ndoscopy showed cobble stone appearance of gastric mucosa on the antrum. Computed tomography showed normal gastric wall thickness and no evidence of lymph node enlargement. Upper gastrointestinal barium study showed poorly defined granular depressed lesion on the antrum. Gastric mucosectomy specimen showed centrocyte-like cells of small lymphocytes, collection of lymphocytes infiltrating and partially destroying isolated glands(lymphoepithelial lesion). After the gastric resection, she was diagnosed as a malignant lymphoma of mucosa-associated lymphoid tissue(MALTOMA) with submucosal infiltration. In analogy to the early gastric cancer, early gastric lymphoma is defined as a tumor with a maximum depth of infiltration extending into the submucosa. After chernotherapy with a regimen of cyclophosphamide, vincrisiine, adriamycin, bleomycin, H-lone, procabazine, she was discharged with complete remission. Hence we present a case of MALT-lymphoma wilh literature. (Korean J Gastroenterol 1996;28: 111 - 117)

만성적인 후두증상을 주소로한 환자에서의 식도내압검사 및 24 시간 보행성 pH 검사소견

방춘상(Choon Sang Bhang),노대근(Dae Keun Lo),박수헌(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeul Han),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),김부성(Boo Sung Kim),조승호(Seung Ho Ch 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: The exact causes of nonspecific chronic laryngitis or laryngeal symptoms are unknown, but many cases of this disease are associated with gastroesophageal reflux or motility disorders of esophagus. We suppose that because Korean people have less gastroesaphageal reflux diseases and the life style including food is different from those of western people, the causes of chronic laryngeal symptoms nre different, So we studied the patients who complained the chronic laryngeal symptoms for evaluation of the role of esophageal motility disorders and gastroesophageal reflux. Methods: 19 patients(male 3, female 16, mean age 40(26-66)) with hoarseness, globus sensation, sorethroat of chronic nature(greater than 3-month duration), not response to conventional therapy of otolaryngologist in St. Mary's Hospital were referred to department of internal medicine. A group of normal, 15 healthy subjects(male 7, female 8, mean age39(24-57)) who had no esophageal or laryngeal symptoms was studied as a control group. All patients and normal controls had manometric studies and 24 hour ambulatory pH monitoring. abnormal findings required pathologic reflux or results greater than the mean plus 2 SDs of normal controls. Results: 1) The chronic laryngeal symptoms were hoarseness in 15 patients(79%), globus sensation in 14 patients(74%), sorethroat in 6 patients(32%), pulmonary symptoms in 3 patients(16%), dysphagia in 2 patients(11%) and heartburn in 1 patient(5%). 2) The lower esophageal sphincter pressure by the rapid pull through tecnique(mean±SD, 27,9± 6.9mmHg) in patients was not different compared with normal controls(31,1±11.0nmHg), 3 patients (16%) had esophageal body dysmotility and all of these were non specific motility disorder. 3) The upper esophageal sphincter pressure(mean±SD, 53.2±23.8mmHg) in patients was not different compared with normal controls(40.9±20.8mmHg), but 2 patients(10.5%) had high upper esophageal sphincter pressures(>82,5mmHg), The postrelaxation pressure of upper esophageal sphincter(mean±SD,98.3±32.1mmHg) was not different compared with normal controls(79,8±30.6mmHg), but 2 patients(10.5%) had high postrelaxation pressures of upper esophageal sphincter(>141mmHg). 4) The time(mean±SD, 321±193msec) between lowest point of upper esophageal sphincter relaxation and onset of pharyngeal contraction was not different compared with normal controls(273.5±179,8msec). 5) The percentage of time of pH less than 4 was 2.4±4.7% in total periods, 2.5±2.3% in upright position and 2.4±9.7% in supine position. Two patients (10.5%) had pathologic reflux(more than 4% of percentage of time pH less than 4 in total periods) and one patient with 2.5% of persentage of time pH less than 4 had high symptom index(66.7%(4/6)). 6) According to above results either of abnormal esophageal pressure or dysmotility was seen in 6 patients(32%) and either of more than 4% of persentage time pH less than 4 in total periods or positive symptom index was seen in 3 patients(16%), Positive results in either of two tests were seen in 7 patients(37%). Conclusion We suggest that some patients who complain the chronic laryngeal symptoms in Korean may have abnormal esophageal motility or gastroesophageal reflux.

수근관증후근을 동반한 위장관 유전분증

박수헌(Soo Heon Park),박선숙(Sun Sook Park),최명규(Myung Gyu Choi),조세현(Se Hyun Cho),한준열(Jun Yeul Han),최규용(Gyu Yong Choi),정인식(In Shik Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),강창석(Chang Suck Kang) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2

A 58-year old man was admitted to our hospital because of right upper quadrant pain and tingling sensation of both wrists. On physical examination, liver was palpable below thie low costal margin at the right mid-clavicular line. Liver biopsy and gastric mucosal biopsy clemonstrated amyloid deposition. EMG showed the denervated pattern in both median nerves and partial muscular atrophy. On his hospital day, his renal function deteriorated with gastrocolic symptoms. Hemodialysis was initiated. But the patient's condition was not recovered and he died l week after initiation of hemodialysis. Hence, we reported a case of gastrointestinal amyloidosis with carpal tunnel syndrome with the literature. (Korean J Gastroenterol 1995;28: 286 - 291)

과민성 대장염환자에서 이중 맹검 투여한 Tiropramide의 치료 효과

정규원(Kyu Won Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),최명규(Myung Gyu Choi),최규용(Gyu Yong Choi),박수헌(Soo Heon Park),장창훈(Chang Hoon Jang),한준열(Jun Yeul Han) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

N/A A double-blind, randomized parallel group trial comparison study was performed in 63 patients with irritable bowel syndrome for evaluation of effectiveness and safety of Tiropramide. Over a treatment period of 4 weeks, Tiropramide (300 mgjday) were administered in 32 patients and placebo in 31 patients with irritable howel syndrome. The degrecs of symptom scores for abdominal pain, belching, flatulence, diarrhea, abdominal discomfortnesi, inadequate defecation, borborygmi, etc were assessed every week by interview of pat:ient.s during the treatment. At the end of the four week. treatment, 78.2% of the treatment group with Tiropramide and 40.5% of placebo group were markedly improved their symptoms. The degrees of symptom scores for abdominal pain, inconiplete evacuation, borborygmi, flatulence, abdominal distension, and intensity of nausea showed significant improvement in the treatment group compared with placebo group in each week assessrnent. One patient with Tiropramide treatment and two patients of placebo group experiencecl aggravation of symptoms during treatment but no one had adverse reaction during treatment. These results suggest that Tiropramide is effective and safe for the treatment of irriitable bowel syndrome.

양성 흉선종의 간전이

선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),조세현(Se Hyun Cho),최명규(Myung Gyu Choi),최규용(Gyu Yong Choi),정규원(Gyu Won Jung),강성호(Sung Ho Kang),한준열(Jun Yeul Han),박수현(Soo Heon Park) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

Thymoma is the most common neoplasm originating in the anteriosuperior mediastinum. It is usually a slow growing tumor and tends to recur within the thoracic cavity, However extrathoracic metastases are exceedingly rare and the reason for thoracic lirnitation is untnown. Recently we experienced a case of hepatic metastatic thymoma in a 58-year-old female patient, She had a benign thymoma removed in anteriosuperior mediastinum in March 1990. After four years, the patient complained of upper abdominal pain, and an abdominal CT scen showed encapsulated and homogenous low density lesion in the liver. Fine-needle aspiration was perfonned and metastatie thyrnoma in the liver was diagnosed. Hereir we report the case and review the literatures. (Korean J Gastroenterol 1997; 29:530-534)

소장에 발생한 MALT 림프종 1예

박수헌,정인식,김재광,정규원,김부성,최명규,조세현,선희식,강창석,오은숙,최규용,한준열,김한욱 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Mucosa-associated lymphoid tissue (MALT) lymphoma is the disease of distinctive clinicopathologic entities most of which are different from current lymph-node based lym- phoma classification. According to the circulatory properties of the lymphocytes and specific immunoglobulin isotype distribution, MALT is defined as the central lymphoid tissue and is opposed to peripheral somatic lymphoid tissue. It occurs most often in the gastrointestinal mucosa and the bronchial mucosa and may occur in other organs such as salivary gland, thyroid gland, conjunctiva, skin. The most common site of MALT lymphoma is gastrointestinal tract but non-gastrointestinal MALT lymphoma may present. The characteristics of pathology are reactive follicles surrounded by the diffuse infiltration of centrocyte-like (CCL) cells and lymphoepithelial lesion due to the gland invasion of CCL cells. It is a localized disease and has a long survival, Isaacson et al suggested the classification of primary gastrointestinal MALT lymphoma as low grade, high grade, immunoproliferative small intestinal disease (IPSID). The distribution is more often in the stomach than in the intestine. Intestinal MALT lymphomas have less favorable clinicnl courses than the gastric MALT lymphomas. Recurrences may appear in the same organ or in other extranodal sites. We report clinical, pathologic findings, and clinical course in a case of primary small intestinal MALT lymphoma in terminal ileum with literature review.

위장관 이식편대 숙주질환 4 예

박수헌,정인식,박종원,정규원,김부성,최황,최명규,조세현,선희식,김춘추,한준열,김석은,김동집 대한내과학회 1995 대한내과학회지 Vol.49 No.2

Graft-versus-host disease(GVHD) is a major cause of morbidity and mortality following bone marrow transplantation(BMT). Moderate to severs GVHD occurs in nearly one half of recipients of HLA identical sibling BMT, and 10-30% of these patients die due to acute GVHD or its complications. Target organs injured by GVHD include the skin, liver, and gastrointestinal tract. The clinical staging and grading of acute GVHD are based on the degree of target organ damage. In Korea, the occurrence of GVHD is about 20%. We report four typical eases of histologically con- firmed GUHD after allogeneic BMT, and review the literature to compare the difference$quot; in primary ill-ness, clinical manifestations, and disease progression.

위, 십이지장, 공장에 발생한 MALToma 1예

박수헌,최규용,김재광,김기범,조세현,나종순,박두호,차상복,조환석,배상수,한준열 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6

A 74- year old male was admitted to St. Mary's Hospital due to symptoms of diarrhea and fever. He was diagnosed with MALToma in the jejunum 6 months previously, but had refused any treatment. This time, an endoscopy revealed multiple erosions and nodular mucosa in the body, fundus of the stomach and 3rd portion of duodenum. Abdominal computed tomography showed wall thickening in 3rd portion of the duodenum and upper jejunum with multiple lymph nodes enlargement. Additionally, an endoscopic biopsy revealed MALToma in the stomach and duodenum. Salmonella group B grew in a blood culture and a chest PA determined pneumonic infiltration in the left lower lobe. He received sulperazone for 7 days, but again refused any further treatment and was thereby discharged after had improved condition.