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간문맥 내 가스와 장관 포상 기종으로 발현한 괴사성 대장염
송종규 ( Jong Gyu Song ),구자설 ( Ja Seol Koo ),강효성 ( Hyo Sung Kang ),박진용 ( Jin Yong Park ),김승영 ( Seoung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),이상우 ( Sang Woo Lee ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3
Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient``s prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery. (Korean J Gastroenterol 2015;65:177-181)
청원군 일개 면에서 산발적으로 신고한 세균성이질 집단 발병 역학조사
이용제,황의경,김종숙,김준영,이복권,구자설,강종원,Lee, Yong-Jae,Hwang, Ue-Kyoung,Kim, Jong-Suk,Kim, Jun-Young,Lee, Bok-Kwon,Koo, Ja-Seol,Kang, Jong-Won 대한예방의학회 2005 예방의학회지 Vol.38 No.2
Objectives: This study was undertaken to investigate the source of infection and mode of transmission of shigellosis, which occurred sporadically among residents and students in a subcounty of Cheongwon county, Chungbuk province, Korea, from June 4 to July 3 2003. Methods: 692 subjects completed a questionnaire and provided a swab for microbiological examinations,and 7 environmental specimens were examined for bacterial organisms. PFGE (pulsed-field gel electrophoresis) and fingerprinting were performed to find the genetic relationship among the temporally associated sporadic isolates. Results: A total of 29 patients had symptoms consistent with the case definition, with 13 confirmed and 16 suspected cases. The frequency of diarrhea was 6 times or more a day (80.8%), with a duration of 1 to 4 days (88.5%) in most cases. The most common symptoms accompanying the diarrhea were fever (80.9%) followed by abdominal pain (76.9%), headache (65.4%), chill (61.5%), vomiting (46.2%) and tenesmus (15.4%). The epidemic curve was characteristic of a person-to-person transmission. The PFGE and fingerprinting demonstrated identical or similar DNA patterns among the 3 Shigella sonnei isolates (A51, A53 and A61 types) found in this outbreak. Conclusion: A genetically identical strain of S. sonnei was estimated to be the cause of this outbreak, and the mode of transmission was most likely person-to-person.
위장관 ; 과민성 장 증후군 환자를 대상으로 Fenoverine과 Trimebutine에 대한 유효성과 안전성을 평가하는 무작위배정, 이중맹검, 평행, 다기관 제4상 임상시험
강성희 ( Seong Hee Kang ),진윤태 ( Yoon Tae Jeen ),구자설 ( Ja Seol Koo ),구양서 ( Yang Seo Koo ),김경오 ( Kyoung Oh Kim ),김유선 ( You Sun Kim ),김승영 ( Seung Yeong Kim ),문정섭 ( Jeong Seop Moon ),박종재 ( Jong Jae Park ),백일 대한소화기학회 2013 대한소화기학회지 Vol.62 No.5
목적: 진경제는 과민성 장 증후군의 치료제로 흔하게 사용하고 있다. 그러나, 과민성 장 증후군에 대한 이러한 진경제의 효과에 관해서는 여러 연구에서 다양한 결과를 보이고 있다. Fenoverine은 진경제의 하나로, 장관 내 평활근 세포막을 통한 칼슘 농도의 경사 조절을 통해 위장관 경축의 완화를 나타내는 약물이다. 이에 이번 연구는 과민성 장 증후군 환자에서 fenoverine과 trimebutine 약제의 효과를 비교하는 임상연구를 시행하였다. 대상 및 방법: 본 연구는 fenoverine과 trimebutine을 비교하기 위해 나이 및 성별에 따른 층화 무작위 배정, 이중 맹검, 약물 대조, 다기관, 제4상 임상시험으로 설계되었다. 피험자들은 8주간 임상 약물인 fenoverine (100 mg, 1일 3회) 혹은 trimebutine (150 mg, 1일 3회)을 투여받았다. 총 197명의 환자를 치료의도자(intention-to-treat, ITT) 통계 방법으로 분석하였다. 주 유효 변수는 투약 전에 장 증상 척도 중 하나인 복부 통증 혹은 불편감을 8주 후 다시 측정하여 30% 이상 개선된 피험자의 비율로 평가하였다. 이차 유효성 평가변수로 복부 통증 또는 복부 불편감, 복부 팽만감, 설사 정도, 그리고 설문 1주 전 전반적인 장 증후군 증상의 척도로 overall 장증후군 증상 척도(bowel symptom scale, BSS) 및 복부 통증 또는 복부 불편감, 복부 팽만감, 설사정도의 점수를 합친 total BSS 변화와 피험자의 치료 만족도를 통해 평가하였다. 결과: 8주 후 시험군(fenoverine)은 69.23% (54/78)에서 투약 전에 비해 30% 이상의 개선 효과를 보였으며, 대조군(trimebutine)은 67.47% (56/83)에서 30% 이상의 개선 효과를 나타내었다. 두 군 간의 평균 개선율의 차이인 1.76% (69.23%- 67.47%)에 대한 95% 양측 신뢰구간의 하한 -10.30%가 비열등성 한계인 20%보다 크므로, 시험군은 대조군에 비해 열등하지 않은 것으로 나타났다. 그 외 이차 유효성평가, 이상반응의 빈도와 중증도에 대해서도 두 군 간 차이는 없었다. 결론: 이번 연구는 과민성 장 증후군 환자의 치료에 있어서 fenoverine이 trimebutine에 비해 효과와 안전성 면에서 열등하지 않음을 보여주었다. Background/Aims: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. Methods: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. Results: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. Conclusions: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability. (Korean J Gastroenterol 2013;62:278-287)
증례 : 류마티스 ; 직장-S상 결장접합부 거대 궤양을 통해 진단된 전신홍반 루푸스 1예
유인경 ( In Kyung Yoo ),유서희 ( Seu Hee Yoo ),최성재 ( Sung Jae Choi ),구자설 ( Ja Seol Koo ),이영호 ( Young Ho Lee ),지종대 ( Jong Dae Ji ),송관규 ( Kwan Kyu Song ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2
저자들은 비특이적인 위장 증상으로 내원한 전신홍반루푸스 환자에서 S상결장 부위의 부분-완전 폐색을 동반한 커다란 직장궤양을 발견하였고, 기저 질환으로 루푸스를 진단하고 경구스테로이드 치료로 호전되었기에 이를 보고하는 바이다. Systemic lupus erythematosus (SLE) is a multi-system inflammatory disorder that has many symptoms. Gastrointestinal symptoms are common, while colonic involvement in the form of ischemic colitis or a colonic ulcer is rare in SLE. The differential diagnosis of ischemic proctitis with ulceration includes an infected ulcer, ulcerative colitis, Crohn`s disease, solitary rectal ulcer colitis, malignant tumor, and lupus colitis. Here, we report a 22-year-old male with abdominal pain and diarrhea, who had a huge rectal ulcer that nearly obstructed the rectosigmoid junction. This turned out to be a rare gastrointestinal manifestation of lupus. He recovered after being treated with high-dose oral steroids. Our case demonstrates that a rectal ulcer is a rare, but important, complication of SLE and can be the initial clinical manifestation of the disease. (Korean J Med 2012;82:252-256)
급성 하부위장관 출혈로 인하여 진단된 급성 화농성 충수염 1예
김대하 ( Dae-ha Kim ),이주한 ( Ju Han Lee ),김동우 ( Dongwoo Kim ),황수현 ( Suhyun Hwang ),강규호 ( Kyuho Kang ),구자설 ( Ja Seol Koo ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.1
A 49-year-old man visited the emergency room of Korea University Ansan Hospital with hematochezia starting the day before the visit. Recently, he was on anti-platelet medication due to hypertension. The patient had no definite symptoms other than hematochezia. Digital rectal exam was positive and laboratory tests showed severe anemia. Sigmoidoscopy was initiated and almost no fecal material was observed in the intestinal tract, allowing insertion into the cecum. Active bleeding from the appendiceal opening was noted. On abdominal CT, contrast enhancement was observed at the tip of the appendix. Under suspicion of acute appendicitis, we consulted with a surgeon. The patient underwent appendectomy with partial cecal resection. Pathologic examination revealed a diagnosis of appendix bleeding due to acute suppurative appendicitis. The patient had no further bleeding after surgery and was discharged in a stable state. Careful observation by the endoscopist is necessary for accurate diagnosis of lower gastrointestinal hemorrhage. Appendiceal hemorrhage is very rarely reported, but it has various pathophysiologies. CT scan is useful when appendiceal hemorrhage is confirmed by endoscopic findings. Surgical treatment was needed in almost all cases reported worldwide. If bleeding from the appendix is confirmed, surgical treatment should be considered for both therapeutic and diagnostic purposes. (Korean J Gastroenterol 2019;73:45-49)
젊은 환자에서 이중풍선소장내시경으로 진단한 소장암 1예
최윤지 ( Yoon Ji Choi ),정성우 ( Sung Woo Jung ),엄준원 ( Jun Won Um ),이응석 ( Eung Seok Lee ),구자설 ( Ja Seol Koo ),임형준 ( Hyung Joon Yim ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hyun Choi ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4
A 17-year old female presented with a chief complaint of melena and epigastric pain. She had a family history of colon cancer, her mother having been diagnosed with hereditary nonpolyposis colorectal carcinoma (HNPCC). After close examination including double-balloon enteroscopy, the patient was diagnosed with small bowel carcinoma, in spite of her young age. Here we report this rare case of small bowel carcinoma in a young patient with a family history of HNPCC. (Korean J Gastroenterol 2011;58:217-220)
양잿물에 의한 식도협착 환자에서 편평세포암종으로 오인된 거짓상피종 증식
한장수 ( Jang Soo Han ),이상우 ( Sang Woo Lee ),서강흠 ( Kang Heum Suh ),김승영 ( Seung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),임형준 ( Hyung Joon Yim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.6
Pseudoepitheliomatous hyperplasia is a benign condition that may be caused by prolonged inflammation, chronic infection, and/or neoplastic conditions of the mucous membranes or skin. Due to its histological resemblance to well-differentiated squamous cell carcinoma, pseudoepitheliomatous hyperplasia may occasionally be misdiagnosed as squamous cell carcinoma. The importance of pseudoepitheliomatous hyperplasia is that it is a self-limited condition that must be distinguished from squamous cell carcinoma before invasive treatment. We report here on a rare case of esophageal pseudoepitheliomatous hyperplasia in a 67-year-old Korean woman with a lye-induced esophageal stricture. Although esophageal pseudoepitheliomatous hyperplasia is infrequently encountered, pseudoepitheliomatous hyperplasia should be considered in the differential diagnosis of esophageal lesions. (Korean J Gastroenterol 2014;63:366-368)
과형성 위용종의 내시경적 제거 후 헬리코박터 파일로리 감염상태에 따른 위용종 재발률
강규호 ( Kyu Ho Kang ),황수현 ( Su Hyun Hwang ),김동우 ( Dongwoo Kim ),김대하 ( Dae-ha Kim ),김승영 ( Seung Young Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),정영걸 ( Young Kul Jung ),임형준 ( Hy 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4
목적: 본 연구는 과형성 위용종을 내시경으로 제거한 이후 최종 H. pylori 감염 상태와 H. pylori 제균 여부에 따른 과형성 위용종의 재발률에 대해 알아보고자 하였다. 대상 및 방법: 2011년 1월부터 2016년 12월까지 과형성 위용종을 내시경으로 제거하고, 상부위장관 내시경 추적 검사를 시행한 79명의 환자를 대상으로 진료기록을 후향적으로 분석하였다. H. pylori 감염과 성공적인 제균 여부는 내시경 생검조직의 cresyl violet 특수염색과 CLO test, 또는 요소호기검사를 통해 평가하였다. 상부위장관 내시경 추적 검사에서 과형성 위용종의 재발을 조사하고, 최종 H. pylori 감염 상태와 제균 여부에 따른 차이가 있는지 비교하였다. 결과: 평균 16.4개월의 대상 환자 추적 기간 동안, HP pos-itive status group이 HP negative status group보다 과형성 위용종의 재발률이 유의하게 더 높았다. HP eradicated group과 HP persistent group과의 비교에서는 HP persistent group에서 재발률이 더 높았으나, 통계적 유의성은 없었다. 위용종의 재발에 영향을 미치는 인자에 대한 단변량 및 다변량 분석결과, 최종 H. pylori 감염 상태가 재발률에 유의한 영향이 있었다. 결론: 최종 H. pylori 감염 상태는 과형성 위용종을 내시경으로 제거한 이후 위용종의 재발에 유의한 영향이 있었으나, H.pylori 제균 여부에 따른 위용종의 재발률은 통계적 유의성이 없었다. Background/Aims: Several previous studies suggest that eradication of Helicobacter pylori (H. pylori) leads to the disappearance of gastric hyperplastic polyps. However, little is known about the effect of H. pylori status and eradication on the recurrence of gastric polyps after endoscopic removal. Here, we investigated the recurrence of gastric polyps according to the final H. pylori status in patients who underwent endoscopic removal of gastric hyperplastic polyps. Methods: Between January 2011 and December 2016, patients who underwent endoscopic removal of gastric hyperplastic polyps and were followed-up for more than two months were enrolled. The success of H. pylori eradication was assessed by histology and rapid urease test or urea breath test, at least 4 weeks after the completion of eradication treatment. At follow-up, the recurrence of gastric polyp was evaluated via esophagogastroduodenoscopy. Results: Seventy-nine patients were enrolled. During the mean follow-up period of 16.4 months, the recurrence rate of gastric polyp was 25.3%. Among those who received H. pylori eradication therapy, the H. pylori persistent group showed a higher recurrence of polyp than the H. pylori eradicated group; but there was no statistical significance (42.9% vs. 21.7%, p=0.269). Regarding the final H. pylori infection status, the recurrence rate of gastric polyps was significantly higher in the H. pylori positive group than in the H. pylori negative group (42.9% vs. 18.9%, p=0.031). In multivariate analysis, the final H. pylori infection status was a significant risk factor for gastric polyp recurrence after endoscopic removal. Conclusions: The final positive H. pylori infection status is significantly associated with higher recurrence of gastric hyperplastic polyps after endoscopic removal. (Korean J Gastroenterol 2018;71:213-218)
쐐기절제술과 소라페닙으로 성공적으로 치료된 간세포암의 단일 폐전이
이순재 ( Sun Jae Lee ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),김해림 ( Hae Rim Kim ),윤아일린 ( Eileen L. Yoon ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),정록선 ( Rok Son Choung ),이상 대한간암학회 2012 대한간암학회지 Vol.12 No.1
35-year-old female patient was diagnosed with hepatocellular carcinoma and underwent hepatic resection. 12 months after hepatic resection, serum AFP rose (119.6 ng/mL) but no definite recurrence was found on imaging modalities. 30 months after hepatic resection, serum AFP rose up to 1008.5 ng/mL and metastatic nodule was found in right lower lung in chest CT. Video assisted thoracoscopic wedge resection was performed and 400 mg/day of sorafenib was intiated. Serum AFP returned to normal range after 2 months of pulmonary resection. No evidence of recurrence is noted after 30 months of pulmonary resection. We think that pulmonary resection plus sorafenib combination therapy resulted in favorable treatment outcome in this patient.
간기능이 저하된 비대상성 간경변증 환자에서 약물방출미세구를 이용한 화학색전술을 통해 적극적으로 간암을 치료한 증례
윤아일린 ( Eileen L. Yoon ),임형준 ( Hyung Joon Yim ),정환훈 ( Hwan Hoon Chung ),이승화 ( Seung Hwa Lee ),김해림 ( Hae Rim Kim ),현종진 ( Jong Jin Hyun ),정성우 ( Sung Woo Jung ),구자설 ( Ja Seol Koo ),이상우 ( Sang Woo Lee ),최재 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Conventional transarterical chemoembolization (TACE) is the first-line treatment for patients with intermediate stage of hepatocellular carcinoma (HCC). However, irreversible liver failure after the procedure is one of the most feared complications and therefore, decompensated Child-Pugh C patients may not be the indication of the conventional TACE. Drug-eluting beads loaded with doxorubicin is a novel drug delivery embolization system and reported to have non inferior efficacy compared to conventional TACE. Also drug-eluting beads loaded with doxorubicin is associated with lower rates of acute liver failure after the procedure and lower rates of systemic toxicity of the chemotherapeutic agents. Herein, we report a case of aggressive treatment with transarterial embolization using drug-eluting beads loaded with doxorubicin for HCC in decompensated liver cirrhosis patient who was not eligible for conventional TACE treatment.