성인에서 발생한 지방성 폐렴의 임상적 고찰

현재근 ( Jae Geun Hyun ),이종헌 ( Chong H. Rhee ) 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6

크론병의 임상적 고찰

류민규(Min Kyu Ryu),김영호(Young Ho Kim),현재근(Jae Geun Hyun),문원(Won Moon),이경수(Kyung Su Lee),이상수(Sang Soo Lee),이준행(Jun Haeng Lee),손희정(Hee Jung Son),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백 대한내과학회 2001 대한내과학회지 Vol.60 No.1

N/A Backgound : Crohn's disease (CD) is a chronic inflammatory disease that has difficulty in treatment due to various complications and frequent recurrence. There have been many studies on the clinical aspects of CD in western countries, however there have been few studies in Korea. We try to perform this study to elucidate the clinical features of CD in Korea. Methods : We retrospectively reviewed the medical records of 62 patients diagnosed as CD in Samsung Medical Center from October 1994 to July 1999 and investigated their clinical features. Results : Male to female ratio was 1.7:1 and the mean age at diagnosis was 29.6 years. The most common symptom was abdominal pain (58%), followed by diarrhea. Perianal lesions were observed in 27 cases (44%) of 62 patients. Fistula was the most common (60%) among the perianal lesions, followed by abscess, fissure, and stricture. Extraintestinal manifestations were observed in 23 cases (37%) of 62 patients. Arthritis was the most common (44%), followed by oral, skin, and ocular lesions. All patients were classified into three groups on the basis of disease extent by the radiologic and endoscopic findings; combined type (66%), colitis alone (23%), and small bowel disease alone (11%). Empirical anti-tuberculous medications were administered to 28 cases (45%) of 62 patients before CD was diagnosed. The presenting features were classified into inflammatory (71%), fistulizing (14.5%), and fibrostenotic (14.5%) type. Operation was performed in 31 cases (50%) of 62 patients during clinical course. The causes of operation were fistulizing complication (48%), fibrostenotic obstruction (32%), and indefinite diagnosis (20%). Conclusion : We noticed little difference in the clinical features of CD in Korea compared to those of western countries. And, intestinal tuberculosis should be considered in differential diagnosis of CD in endemic areas of tuberculosis like Korea.(Korean J Med 60:46-50, 2001)

혈관침범이 의심되는 췌장암 환자에서 절제 가능성과 생존율 분석

박동일(Dong Il Park),이종균(Jong Kyun Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),이규택(Kyu Taek Lee),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),최규완(Kyoo 대한내과학회 2000 대한내과학회지 Vol.58 No.6

N/A Background : One of the major limitations of curative resection in pancreatic cancer patients is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were (1) to assess the clinical value of contrast enhanced spiral CT in predicting the resectability and survival of pancreatic cancer patients with suspicious vascular invasion and (2) to assess the influence of curative resection on survival in these patients.Methods : Forty cases of the pancreatic cancer patients who were suspected of having involvement of adjacent large vessels and subsequently underwent operation with curative intent were enrolled in this study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, type and number of vessel involved. Survival rate was compared between curative and palliative resection groups. And survival was also compared between resected and non-resected groups. Results : Of the 40 patients with adenocarcinoma of the pancreas, 14 patients had curative resections, and 26 patients had palliative resections. The probability of curative resection was higher in patients with segment length less than 2 cm, compared with those with more than 2 cm. However, there was no difference in survival between two groups. There were no differences of resectability and survival according to the degree of encasement, type and number of vessel involved. There were no difference in survival between curative and palliative resection groups, and between resected and non-resected groups. Conclusion : A survival benefit is not achieved by curative resection in pancreatic cancer patients with vascular invasion. So other non-operative treatments should be considered as effective tools prior to resection in these patients.(Korean J Med 58:651-656, 2000)

기능성 소화불량증 환자에서 자율신경 기능장애에 관한 연구

박동일(Dong Il Park),이풍렬(Poong Lyul Rhee),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),김창섭(Chang Sup Kim),장재권(Jae Kwon Jang),심상군(Sang Goon Shim),성인경(In Kyung Sung),김영호(Young Ho Kim),손희정(Hee Jun 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

N/A Background/Aims : The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. Methods : Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. Results : (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. Conclusion: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.

국내에서 개발된 대장통과시간 측정용 방사선 비투과성 표지자의 유용성

김지은(Jee Eun Kim),이풍렬(Poong Lyul Rhee),김영호(Young Ho Kim),성인경(In Kyung Sung),박동일(Dong Il Park),현재근(Jae Geun Hyun),이준행(Jun Haeng Lee),손희정(Hee Jung Son),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woo 대한내과학회 2001 대한내과학회지 Vol.60 No.4

N/A Background: Among various methods for measuring colon transit time, radio-opaque marker study is simple, reproducible and economical method. The commonly used marker, Sitzmarks? (Konsyl Pharmaceuticals Inc. Texas) had limitation in it s use due to expensiveness and difficulty in importation. We thought that the new domestic marker comparable to Sitzmarks is necessary and made a Kolomark (Korean colon marker )TM. The comparison of radio-opaqueness and the measurement of colon transit times by two markers were done. Methods: In two 1000 ml beakers, 350 ml of rice-gruel, sever al chicken-bones and ten rings of Sitzmarks? and KolomarkTM were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by Image and the value of pixels were obtained. These were repeated five times. Colon transit times were measured in 60 healthy persons stratified by age, 30 by Sitzmarks? and 30 by KolomarkTM. Results: The mean value of pixel of KolomarkTM was much lower than that of Sitzmarks?. The difference between background or beaker and KolomarkTM was much greater than that of Sitzmarks?. There was no significant difference between colon transit time studied by Sitzmarks? and KolomarkTM. Conclusion: KolomarkTM, a more radio-opaque and cheaper marker than Sitzmarks? will be applied usefully for measuring colon transit time.(Korean J Med 60: 337- 341, 2001)

중증 궤양성 대장염에서 치료 성적의 예측인자와 Cyclooxygenase - 2 발현과의 관계

박동일(Dong Il Park),김영호(Young Ho Kim),성인경(In Kyung Sung),이용육(Yong Wook Lee),이준행(Jun Haeng Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),장재권(Jae Kwon Jang),손희정(Hee Jung Son),이풍렬(Poong Lyul Rhee),김재준(Jae J . K 대한소화기학회 2001 대한소화기학회지 Vol.38 No.1

Background/Aims: Percutaneous endoscopic gastrostomy (PEG) has been widely performed for patients who require prolonged tube feeding support. A retrospective study was conducted to evaluate the complications of PEG and determine the predictors of wound infection. Methods: Medical records of 144 cases of PEG that was per- formed between January 1996 and June 2000 were reviewed to examine the types and frequency of complication, difference in wound infection rates according to age, sex, and underlying diseases. We also analyzed the effects of antibiotics prophylaxis on wound infection and the result of culture from wound infection site. Results: In 28 of 144 PEG cases (19.4%), several complications developed after procedure. Wound infection was the most common complication and occurred in 22 of 144 cases (15.3%) and Pseudomonas aeruginosa was the most common pathogenic microorganism. Other complications included bleeding from gastrostomy site, stomal leaks, and gastroesophageal reflux. There was no statistical difference in wound infection rates according to underlying diseases and antibiotics prophylaxis. However, wound infection developed more frequently in diabetes patients (p<0.05). Old age and underlying diabetes were predictors for developing wound infection after PEG in multiple logistic regression analysis. Conclusions: Old age and DM can be predictors of wound infection associated with PEG. (Korean J Gastroenterol 2001;38:23-28)

원발성 담즙성 경변증 16예의 임상상 : 단일 센터 경험

박동일(Dong Il Park),고광철(Kwang Cheol Koh),이준혁(Jun Hyek Lee),최문석(Moon Seok Choi),강태욱(Tae Wook Kang),문원(Won Moon),류민규(Min Kyoo Ryu),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),장재권(Jae Kwon Jang) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown etiology. The disease is relatively common in western countries, but so far, only about 20 cases have been reported in Korea. Thus, the purpose of our prospective study was to evaluate the clinical characteristics of PBC in Korea. Methods : Between October 1994 and February 1999, 16 patients diagnosed as PBC at our department were enrolled in this study. We analyzed these patients for the distribution of age and sex, initial symptoms and signs, associated disorders, laboratory, endoscopic, and radiologic and histologic findings. Results : Of the 16 patients, the ratio of male to female was 1:7 and the average age was 57.5 years. Pruritus (37.5%) was the most frequent presenting symptom followed by xerostomia and xerophthalmia (12.5%), jaundice (6.3%), chronic fatigue (6.3%), melena (6.3%). Associated disorders were Sj gren's syndrome (25%), arthropathy (12.5%), Raynaud's phenomenon (6.3%) and diabetes (6.3%). Abnormalities of liver function were found frequently. Antimitochondrial antibody (100%), antinuclear antibody (31.25%) and rheumatoid factor (31.25%) were found. Long-term administration of UDCA improved both clinical and biochemical signs in most patients, however, 2 patients experienced exacerbation during UDCA therapy. Conclusions : We experienced 16 cases of PBC within a short period. It is expected that we can find these patients more frequently if we suspect this disease in patients with pruritus and unexplained obstructive pattern of liver function abnormality.(Korean. J. Med 59:634-640, 2000)

내시경적 조직검사로 진단된 위 분선충증 1 예

이석호,이화영,이규택,강인구,최규완,백승운,이종균,이준혁,고광철,이종철,오영륜,현재근,이풍렬,김재준,채종일 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.

한국 성인에서 발생한 자가면역성 간염의 임상적 고찰

김재준,김지은,백승운,최문석,이준혁,고광철,이종철,최규완,박철근,현재근,오영륜,이풍렬 대한소화기학회 1999 대한소화기학회지 Vol.33 No.5

Background/Aims: Although autoimmune hepatitis (AIH) is common in western countries, only sporadic cases have been reported in Korea. The aims of the study were to analyze the clinical and histological features and to examine clinical course of AIH in Korea. Methods: One-hundred and ninety-seven patients with chronic liver disease of unknown etiology were screened with anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA). Fourteen (7.1%) patients had either antibodies and only 11 (5.6%) of them met the criteria suggested by the International Autoimmune Hepatitis Group as definite or probable. The clinical, laboratory and histologic features of these eleven cases were reviewed. Results: The mean age was 53.5 (31-73) years and all of the patient were female. The level of globulin and IgG were elevated in 63.6% and 75% of the patients respectively. ANA and SMA were positive in 54.5% and 72.7% of the patients, respectively. Eigh (72.7%) of the patients showed severe inflammation in liver iopsy. Among 8 patients who received immunosuppressive therapy, seven patients (87.5%) showed initial response, and biochemical and serologic remissions were achieved in 5 (62.5%) and 2 (25.0%) patients, respectively. Conclusions: AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. AIH should be suspected in female patients with chronic liver disease of unknown etiology, especially in case of hypergammaglobulinemia.

췌장의 림프상피성 낭종 1예

류광현,김용일,이규택,김재준,최규완,박동일,백승운,이종균,이준혁,이풍렬,이종철,이지민,박형석,현재근,고광철 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3

Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.