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보툴리눔 독소 주입 후 증상 호전을 보인 미만성 식도 경련
한재필 ( Jae Pil Han ),홍수진 ( Su Jin Hong ),김훈일 ( Hoon Il Kim ),변진명 ( Jin Myung Byun ),김화종 ( Hwa Jong Kim ),고봉민 ( Bong Min Ko ),이준성 ( Joon Seong Lee ),이문성 ( Moon Sung Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2
Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up. (Korean J Gastroenterol 2012;60:109-112)
원발성 담즙성 간경변증으로 진단되고 자가면역성 간염의 Feature를 보이는 한국인 환자에 대한 Simplified Scoring Criteria의 의미
김민석 ( Min Suk Kim ),김영석 ( Young Seok Kim ),김상균 ( Sang Gyune Kim ),변진명 ( Jin Myung Byun ),윤라영 ( La Young Yoon ),한동훈 ( Dong Hoon Han ),문종주 ( Jong Joo Moon ),남재형 ( Jae Hyung Nam ),김태진 ( Tae Jin Kim ),이세환 대한내과학회 2013 대한내과학회지 Vol.84 No.2
목적: 원발성 담즙성 간경변증과 자가면역성 간염의 임상적, 조직학적 특징이 동시에 혼재되어 나타나는 경우가 1970년 대부터 보고되고 있다. 이를 일반적으로 중복증후군(overlap syndrome)이라고 한다. 현재까지 IAIHG에서 제시한 simplified scoring criteria를 원발성 담즙성 간경변증 환자군에서 중복 증후군을 진단하는 데 이용한 연구는 거의 없는 실정으로 본 연구에서는 simplified scoring criteria를 한국인에게 적용하여 중복증후군을 진단하는 데 있어 진단적 가치 및 유용성을 평가, 비교하고자 하였다. 방법: 2004년 11월부터 2009년 12월까지 순천향대학교 부천병원과 서울병원에서 임상양상, 생화학검사, 자가항체 및 간조직검사 결과를 통해 원발성 담즙성 간경변증으로 진단 되었던 25명의 환자를 대상으로 의무기록지를 통해 후향적으로 분석하였다. 환자군을 revised scoring criteria와 simplified scoring criteria를 각각 적용하여 중복증후군으로 진단된 군과 진단되지 못한 군으로 나누어 서로의 특성을 비교 분석하였다. 결과: simplified scoring criteria 적용 시 ANA 양성률에 있어 높은 양성률을 보여 18명에서(72%) 중복증후군에 해당되었으며 중복증후군 환자군은 원발성 담즙 간경변군과 비교하여 IgG에서 높은 수치를 나타냈으나 통계적으로 유의하진 않았다(p=0.092). 또한 중복증후군 환자군은 원발성 담즙 간경변증 환자군과 비교하여 조직학적 소견에서 섬유화가 진행된 경향(p=0.017)을 보였으며 ANA 양성률에서 높은 비율을 나타내었다(100% vs. 43%, p=0.03). 또한 양 군 간 ANA 역가를 비교하였을 때 중복증후군에서 ANA 역가가 높은 환자(ANA≥1:80)의 비율이 높은 것으로 나타났다(p=0.000, Table 6). 따라서 ANA 양성률과 역가가 중복증후군 진단에 있어 중요한 인자임을 나타내었다. 결론: 본 연구는 simplified scoring criteria를 원발성 담즙성 간경변증 한국 환자에게 적용하였을 때 중복증후군을 screening 하는 데 도움이 될 수 있다는 것을 보여주었다. Background/Aims: The diagnosis of primary billiary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome remains challenging. In 2008, a simplified scoring system was proposed by the International Autoimmune Hepatitis Group, which aimed for wider applicability in routine clinical practice. We evaluated the performance of the new simplified AIH scoring criteria as a diagnostic tool for overlap syndrome. Methods: We retrospectively reviewed the clinical histories, chemistry, autoimmune studies, and liver biopsy results of 25 patients diagnosed with PBC who visited Soonchunhyang University Hospital, Bucheon and Seoul, between November 2004 and December 2009. Parameters relevant to the revised and simplified scoring criteria were recorded, and outcomes were compared between those with and without features of overlap syndrome. Results: Of 25 patients with a definite diagnosis of PBC, five (20%) were diagnosed with overlap syndrome using the revised criteria, and 18 patients (72%) were diagnosed with the simplified criteria. Those patients diagnosed according to the simplified scoring criteria revealed an increased frequency of anti-nuclear antibody (p=0.030) and serum IgG levels (p=0.092). Additionally, advanced fibrosis was significantly more frequent in patients with overlap syndrome (p=0.017). Conclusions: The simplified scoring criteria seemed to be useful as a diagnostic tool to recognize overlap syndrome in Korea. However, a relatively small number of patients were included in our study, so further clinical trials based on larger populations should be performed. (Korean J Med 2013;84:211-220)
2009년 국내 Influenza A의 대유행과 급성 A형간염 발병률의 감소
김부성 ( Boo Sung Kim ),박재우 ( Park jae woo ),변진명 ( Jin Myung Byun ),김상균 ( Sang Gyune Kim ),( Yuan Yuan Zhang ),김영석 ( Young Seok Kim ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),홍수진 ( Soo Jin Hong ),문 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: There was a spiking incidence of acute hepatitis A (AHA) in 2009 summer, but it went down drastically after an outbreak of influenza A (H1N1). We assessed the relationship between 2009 H1N1 pandemic and AHA prevalence from August to December 2009. Methods: We compared AHA cases nationwide and in our hospital for the period from the latter half of 2008 to the end of 2010. H1N1 cases in our hospital from August 2009 to December 2009 were included in the study and the correlation between 2009 H1N1 pandemic and AHA prevalence was assessed. Results: The national surveillance system reported 2,233, 7,895, 15,231 and 7,660 AHA cases from 2007 to 2010, respectively. A similar trend was noted in our hospital in the same periods. Although the national total incidence was increased in 2009, it showed steep decreasing trend line in the final 21 weeks of 2009 (weeks 32-52), as compared with 2008 and 2010. The mean weekly incidence percentage (AHA cases in a week/total in a year) in weeks 32-52 of 2009 was 1.17±0.55%, significantly lower than that in 2008 and 2010 (1.61±0.43% and 1.56±0.51%; p<0.001). Furthermore, we found a significant negative correlation between 2009 H1N1 pandemic and AHA in our hospital for weeks 32-52 of 2009 (r=-0.597; p<0.001). Conclusions: The widespread occurrence of 2009 H1N1 pandemic highlighted the benefits of health care and good hygiene, such as effective hand washing and wearing of masks, which may have also interrupted hepatitis A virus transmission. (Korean J Gastroenterol 2012;59:360-365)
김은정 ( Eun Jung Kim ),윤일선 ( Il Seon Yun ),이재성 ( Jae Sung Lee ),이주영 ( Ju Young Lee ),변진명 ( Jin Myung Byun ),윤성우 ( Sung Woo Yoon ),김영민 ( Young Min Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3
Emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires prompt diagnosis and the emergent intensive treatment. Emphysematous pyelitis is a distinct entity from emphysematous pyelonephritis and describes the presence of gas localized to the renal collecting system. Medical treatment is sufficient therapy if there is no obstruction. We report a case of both hydronephrosis complicated with emphysematous pyelitis which was occurred in 59-year-old diabetic patient. The patient was recovered by medical treatment alone.
윤일선 ( Il Seon Yun ),이지영 ( Jee Young Lee ),이재성 ( Jae Sung Lee ),이주영 ( Ju Young Lee ),변진명 ( Jin Myung Byun ),김은정 ( Eun Jung Kim ),박진영 ( Jin Young Park ),박진경 ( Jean Kyung Park ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.6
Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered. (Korean J Gastroenterol 2008; 51:377-380)