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산발적 비유두부 십이지장 종양의 내시경 절제: 단일 기관 연구
남윤정 ( Yoon Jeong Nam ),이시형 ( Si Hyung Lee ),김경옥 ( Kyeong Ok Kim ),장병익 ( Byung Ik Jang ),김태년 ( Tae Nyeun Kim ),김용진 ( Yong Jin Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.1
목적: 십이지장 종양은 비교적 드문 질환으로 명확한 치료법은 아직 정립되지 않았다. 십이지장 종양에 대한 내시경 절제술은 최근 널리 적용되고 있고 수술 치료를 대체하고 있다.이 연구는 십이지장 종양에 대한 내시경 절제술의 안정성 및 절제술 후 결과를 측정하고자 하였다.대상 및 방법: 2005년 1월부터 2014년 12월까지 산발성 비유두부 십이지장 종양으로 치료를 받은 환자의 자료를 후향적으로 분석하였으며, 총 33명의 산발성 비유두부 십이지장 종양을 가진 환자를 대상으로 하였다. 각 환자에 있어서 병변의 크기, 위치, 조직학적 특징, 내시경 시술의 종류에 대하여 분석하였고 시술의 성공 여부 및 합병증, 재발에 대하여 조사하였다.결과: 절제된 종양의 평균 크기는 8.6±5.2 mm (2-20 mm)였고 종양의 위치는 십이지장 제2부가 18명(54.5%)으로 가장 많았다. 33명의 환자 중에서 32명(97.0%)은 EMR을 시행하였고, 나머지 한 명에서는 ESD를 시행하였다. 십이지장 선종의 조직학적 소견에서는 관상선종이 가장 흔한 종류로 나타났다.시술 후 출혈은 없었으나, ESD를 시행한 1명(3.0%)의 환자에서 천공이 발생하여 수술 치료를 시행하였고, 재발은 1명(3.0%)의 환자에서 3개월 후 추적내시경을 시행하였을 때 내시경 절제술을 시행한 곳에서 발생하였다.결론: 십이지장 종양의 내시경 절제술은 수술 치료를 대체할수 있는 안전하고 효과적인 치료법이다. 내시경 절제술 후 재발 및 잔존 병변에 대한 치료를 위하여 정기적인 추적관찰이 필요하다. Background/Aims: Sporadic non-ampullary duodenal neoplasms are rare and optimal treatment for these lesions remains undefined. Endoscopic resection of duodenal neoplasms is widely used recently and it is an alternative treatment strategy to surgical excision. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms and to determine its outcomes.Methods: Patients who underwent endoscopic resection for non-ampullary duodenal neoplasms between January 2005 and December 2014 were analyzed retrospectively. Data including size, morphology, histology, location and endoscopic procedural technique were reviewed. The main outcome measurements were success rate, complication, recurrence and follow-up assessments.Results: The study included 33 patients with duodenal neoplasms. The mean size of resected lesion was 8.58 mm. The results of histologic examination were as follows: 23 (69.7%) adenomas, 2 (6.1%) adenocarcinoma, 3 (9.1%) Brunner’s gland tumor and 3 (9.1%) neuroendocrine tumor. Tubular adenoma wase the most common type (63.6%) of non-ampullary duodenal neoplasms. Eighteen (54.5%) lesions were found in the second portion of the duodenum, and 10 (30.3%) lesions on bulb and 3 (9.1%) lesions on superior duodenal angle. Of the 33 cases, 32 (97.0%) were managed by endoscopic mucosal resection technique during a single session and one case was managed by endoscopic submucosal dissection (ESD). One episode of perforation occurred after ESD. During a median follow-up period of 5.76 months, recurrence was observed in only one case of in a patient with tubular adenoma.Conclusions: Endoscopic resection of duodenal neoplasm is a safe and effective treatment modality that can replace surgical resection in many cases. Careful endoscopic follow-up is essential to manage recurrence or residual lesions.(Korean J Gastroenterol 2016;67:8-15)
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남윤정 ( Yoon Jeong Nam ),김태년 ( Tae Nyeun Kim ),김국현 ( Kook Hyun Kim ),구민근 ( Min Geun Gu ),이재영 ( Jae Young Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.3
Primary retroperitoneal mucinous cystadenoma is an extremely uncommon tumor, even though mucinous cystadenoma often develops in the ovary and less frequently in the pancreas. A 21-year-old female was admitted to our hospital due to severe abdominal pain. A well-demarcated, oval shaped cystic tumor at the retropancreatic area with displacement of the pancreas and surrounding major vessels was observed on CT and MRI. Exploratory laparotomy was performed, and complete excision of the entire cyst was performed without complication. The pathologic finding was consistent with primary retropancreatic mucinous cystadenoma. To the best of our knowledge, this report is the first to describe a case of retropancreatic mucinous cystadenoma arising from the retropancreatic area in Korea.
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증례 : 순환기; 베체트병 환자의 복부 가성 대동맥류 혈관 내 스텐트 그라프트 치료
장혜윤 ( Hye Yoon Jang ),최종현 ( Jong Hyun Choi ),남윤정 ( Yoon Jeong Nam ),전무송 ( Moo Song Jeon ),이혜원 ( Hye Won Lee ),김상필 ( Sang Pil Kim ),이한철 ( Han Cheol Lee ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4
베체트병에서 발생하는 복부 가성 대동맥류는 그 빈도는드물지만 주요 사망 원인 중의 하나로 임상적 중요도가 높은혈관염 합병증이다. 만성적인 혈관의 염증상태로 인하여 수술적 치료 후 재발 및 가성 대동맥류의 형성 빈도가 높아 스텐트 이식편을 이용한 비침습적 방법이 대안으로 제시되고있다. 저자들은 베체트병으로 진단받은 46세 남자 환자에서발생한 거대 복부 가성 대동맥류를 수술 위험도와 재발의위험을 고려하여 스텐트 이식편 삽입으로 3년간 효과적으로치료된 1예를 경험하였기에 이를 문헌고찰과 함께 보고하는바이다. Behcet`s disease shows systemic involvement, including mucocutaneus, ophthalmical, neurological, pulmonary, gastrointestinal, urogenital, mucoskeletal, and cardiovascular disorders. Aneurysmal changes develop in 65% of patients with arterial involvement and are associated with a poor prognosis. Although many attempts have been made to surgically manage these serious arterial lesions, several reports have shown a high recurrence rate and operation-related complications. Stent-graft placement has been indicated for the treatment of pseudoaneurysms and aneurysms in patients with a high surgical risk, including those with Behcet`s disease. We herein describe an abdominal aortic pseudoaneurysm in a patient with Behcet`s disease that was successfully treated with stent-graft insertion without an endoleak after 36 months of follow-up. (Korean J Med 2014;86:494-499)
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강직성 척추염 환자에서 Infliximab 투여 후 헤노흐-쇤라인 자색반 1예
정우진 ( Woo Jin Jung ),남윤정 ( Yoon Jeong Nam ),이승근 ( Seung Geun Lee ),김지민 ( Ji Min Kim ),송마가렛 ( Margaret Song ),김문범 ( Moon Bum Kim ),김근태 ( Geun Tae Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5
저자들은 강직성 척추염 환자에서 infliximab을 사용한 이후 발생한 헤노흐-쇤라인 자색반을 진단하고 약제 중단 및 스테로이드 요법으로 재발 없이 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다. Tumor necrosis factor alpha (TNF-α) inhibitors are used widely to treat patients with active rheumatoid arthritis and ankylosing spondylitis (AS). Although various cutaneous reactions can occur as side effects of TNF-α inhibitors, systemic vasculitis requiring withdrawal of the agent and immunosuppressive drugs is rare. A 59-year-old male with AS who had been treated with infliximab for 60 months visited us with complaints of palpable purpura on both legs and severe abdominal pain. Abdominal computed tomography showed diffuse wall thickening of the proximal jejunum and ileum and a skin biopsy revealed leukocytoclastic vasculitis. The patient was diagnosed with Henoch-Schonlein purpura (HSP). Infliximab was discontinued and systemic steroid therapy at 0.5 mg/kg resulted in prompt resolution of the HSP. Here, we report the first case of HSP in a patient with AS after infliximab treatment. (Korean J Med 2013; 84:764-768)
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저용량 polyethylene glycol 용액에 아스코르빈산을 첨가한 장정결제로 대장내시경 전처치 후 발생한 발작을 동반한 저나트륨혈증
이재영 ( Jae Young Lee ),장병익 ( Byung Ik Jang ),남윤정 ( Yoon Jeong Nam ),송재이 ( Jay Song ),김민철 ( Min Cheol Kim ),정승민 ( Seung Min Chung ),장종걸 ( Jong Geol Jang ),조재호 ( Jae Ho Cho ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1
The widely used polyethylene glycol (PEG)-based solutions have been proven effective for bowel preparation when 4 L of the solution is administered before colonoscopy. However, large volumes of the solutions are generally poorly tolerated. A new PEG-based solution consisting of 2 L of PEG and a high dose of ascorbic acid has recently become available. Electrolyte abnormalities caused by PEG-based solutions have rarely been reported. We report on a case of acute severe hyponatremia with associated generalized tonic-clonic seizures after bowel preparation with a low-volume PEG plus ascorbic acid solution in a 74-year-old woman with no history of seizures. She took a beta blocker, an angiotensin-converting enzyme inhibitor, and glimepiride for hypertension and diabetes mellitus. She showed general weakness, nausea, agitation, muscle cramping, and seizures after ingestion of the PEG plus ascorbic acid solution. Her serum sodium level was 112 mEq/L. Her symptoms improved after intravenous administration of hypertonic saline. Physicians should pay attention to screening for electrolytes and development of neurological symptoms during bowel preparation.
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