내시경적 역행성 담췌관조영술 후의 발열에 대한 연구 - 위험인자와 예방적 항생제 사용 효과 분석 -

서승오(Seong O Seo),천재희(Jae Hee Chun),김상균(Sang Kyun Kim),김진(Jin Kim),장유현(Yoo Hyun Chang),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Background/Aims : Fever and cholangitis can be serious complications after endoscopic retrograde cholangiopancreatography (ERCP). The risk factors of these complications and the efficacy of prophylactic antibiotics are not clearly verified yet. In this study, we investigated the frequency, risk factors, pathogens of the fever after ERCP, and evaluated the effect of prophylactic antibiotics. Methods : Retrospective analysis was performed on 674 patients who underwent ERCP between 1996 and 1999. Results : Fever after ERCP occurred in 68 of 674 cases (10.1%). Twenty-six kinds of bacteria were isolated in 23 of 68 febrile cases (33.8%). Fever occurred more frequently in patients (33.4%) in whom therapeutic ERCP failed to remove common bile duct (CBD) stones or to drain obstructed bile duct than in patients (7.3%) with effective drainage (p<0.001). Therapeutic procedure after ERCP caused fever more frequently (16.7%) than diagnostic ERCP only (4.2%)(p=0.03). Moreover, fever was also developed frequently after endoscopic retrograde biliary drainage (ERBD). Prophylactic administration of more than 2 kinds of antibiotics can reduce the rate of fever occurrence after ERCP. Conclusions : Therapeutic ERCP procedures especially after ERBD or unsuccessful biliary drainage were the high risk factors for fever after ERCP. Prophylactic antibiotic treatment using more than two kinds of antibiotics can reduce the incidence of the fever after ERCP. (Kor J Gastroenterol 2000;36:390 - 397)

감염 경로에 따른 화농성 농양의 비교

최창수 ( Chang Soo Choi ),서검석 ( Geom Seog Seo ),조은영 ( Eun Young Cho ),김기훈 ( Ki Hoon Kim ),서승오 ( Sung O Seo ),오효정 ( Hyo Jeong Oh ),신새론 ( Sae Ron Shin ),김태현 ( Tae Hyeon Kim ),최석채 ( Suck Chei Choi ),김학철 ( H 대한내과학회 2008 대한내과학회지 Vol.75 No.1

목적: 최근 간농양에 대한 보고는 원인적 균주의 변화나 기저 질환의 분류에 따른 특징에 대한 내용이 대부분으로, 감염경로의 원인적 분류에 따른 임상양상 및 경과, 농양의 특징, 균주, 동반질환 등의 차이에 대해 알아보고자 하였다. 방법: 2004년1월부터 2006년 11월까지 병원에 내원하여 화농간농양을 진단받은 118명의 환자의 대상으로 임상양상, 방사선학적 소견, 치료, 예후 등을 비교하였다. 결과: 화농성 간농양 118명의 환자 중 담관군은 56예, 원발군은 62예였고, 담관군에서 평균 연령이 67.6세로 원발군의 59.9세에 비해 의미있게 높았다. 증상 및 징후에서 대부분에서 두 군의 차이는 없었으나, 담관군에서 황달의 빈도가 유의하게 높았다(p=0.02). 기저 질환으로 간경변이 담관군에서 높았다. 농양강의 특징에서 담관군에서 다발성 농양의 빈도가 높은 경향을 보였으며, 농양강의 크기가 의미있게 작았다(p=0.02). 원인균은 두 군에서 모두 K. pneumonia가 가장 많이 검출되었고, 담관군에서 상대적으로 E. coli의 검출이 유의하게 높았다. 간농양의 치료는 담관군에서 항생제 단독치료가 유의하게 많았고, 원발군에서 배액치료와 항생제 병용 치료가 유의하게 많았다(p<0.01). 합병증은 두 군간의 차이는 없었고, 사망은 담관군에서 유의하게 높았다 (p=0.04). 결론: 담관군은 고령이며, 황달의 발생이 높고, 농양의 크기, 기저질환, 원인균 및 치료적 측면, 사망률 등이 원발군과 유의한 차이를 보였다. 이는 향후 대규모 전향적 연구를 통한 평가가 필요할 것으로 생각된다. Background/Aims: The aim of this study was to evaluate the clinical features, radiologic findings, treatment modalities, and outcomes based on the origin of infection in patients with pyogenic liver abscesses. Methods: We retrospectively analysed the medical records of 118 patients who were treated for pyogenic liver abscesses between January 2004 and December 2006. Of the 118 patients, 56 patients had biliary risk factors. Results: The clinical characteristics were similar between the two groups, but the biliary risk group was characterized by an older age and the presence of jaundice. The size of the abscess was smaller in the group with biliary risk factors than in the cryptogenic group (p=0.02). Klebsiella pneumonia was the most common organism overall; however, Escherichia coli was more prevalent in the biliary risk group than in the cryptogenic group (p=0.03). Comparing the treatment modalities between the two groups, antibiotic therapy alone was more frequently used in the biliary group (p<0.01). The death rate was higher in the biliary group than in the non-biliary group (7.1 vs. 0.0%, p=0.04). The higher death rate in the biliary group was associated with multi-organ failure, absence of biliary drainage, and underlying diseases. Conclusions: There were differences between the two groups with respect to the size of the abscess, patient age, cultured organisms, and treatment modalities. The death rate was higher in the biliary group than the cryptogenic group. (Korean J Med 75:60-67, 2008)

하대정맥에 발생한 혈관외 평활근육종 1예

이준규(Lee Joon Kyu),김상균(Sang Gyun Kim),천재희(Jae Hee Chun),서승오(Seung O Seo),석웅(Woong Seok),정용진(Yong Jin Jung),채인호(In Ho Chae) 대한내과학회 2000 대한내과학회지 Vol.58 No.6

N/A We report a case of extraluminal leiomyosarcoma of inferior vena cave(IVC) in a 56 year old woman. She was admitted to our hospital because of right lower quadrant discomfort for a month. Radiologic finding including ultrasonography, computerized tomography, magnetic resonance imaging showed heterogenous solid mass adhering to IVC and the confirmative diagnosis was made by ultrasonography guided percutaneous needle biopsy. She underwent radical resection surgery. No adjuvant treatment was performed and she has been in the follow up without recurrence of the disease.(Korean J Med 58:681-685, 2000)

구인두 연하곤란을 동반한 다발성근염

김기훈 ( Ki Hoon Kim ),서검석 ( Geom Seg Seo ),김태현 ( Tae Hyeon Kim ),김용성 ( Yong Sung Kim ),최창수 ( Chang Soo Choi ),이명수 ( Myeung Su Lee ),오효정 ( Hyo Jung Oh ),서승오 ( Sung O Seo ),신새론 ( Sae Ron Shin ),최석채 ( Suck 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.2

The oropharyngeal dysphagia results from variable etiologies such as neuropathies, drugs, myopathies, structural disorders of esophagus. Polymyositis is rare and 12~54% of the patients develop dysphagia. Many patients with oropharyngeal dysphagia are complicated by asphyxia, aspiration during swallowing, severe pneumonia or death. Early diagnosis and proper management is important for the prevention of complication. The patients with oropharyngeal dysphagia can be diagnosed by the investigations such as barium contrast swallowing test, videofluoroscopy, esophagoscopy, esophageal manometry. We report a case of polymyositis with oropharyngeal dysphagia that diagnosed by clinical symptoms, EMG finding and elevated muscle enzyme treated with high dose prednisolone. (Kor J Neuro-gastroenterol Motil 2007;13:152-155)

인슐린비의존형 당뇨병 환자에서 심전도상 QT 간격 변수들과 허혈성 심장질환 발생의 관계

서승오,진도균,박진철,진희종,임성희,유형준,박성우,박종태 대한노인병학회 2000 Annals of geriatric medicine and research Vol.4 No.3

전경대원에서 발생한 결핵의 임상 양상

문창기,박상준,조민구,김영중,김소연,김윤권,정준오,안석진,김은실,서승오,김지훈,최원제,이윤영,박형기,최규영,김현근 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Background: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. Materials and Methods:We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. Results:In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (±1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/10^(5) and 17.4/10^(5) person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. Conclusion:There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea. 배경 : 국내 결핵의 발생은 감소 추세에 있으나 여전히 후진국형 발생양상을 보이고 있다. 특히 집단생활을 하는 젊은이들에서 발생하는 결핵의 유행이 간헐적으로 알려지고 있어 우려를 낳고 있다. 이에 저자들은 최근 전경대원의 결핵 발병 양상에 대해 알아보고자 본 연구를 시행하였다. 재료 및 방법 : 2002년 1월부터 2004년 12월까지 3년간 경찰병원에서 결핵 진료를 받은 전경대원의 의무기록을 후향적으로 분석하여 연도별 결핵 신환발생률, 도말양성결핵 신환율, 진단 지연, 집단발병, 다제내성결핵을 조사하였다. 결과 : 연도별 결핵 신환자 수(10만명당 발생추정치)는 2002년 50명(83.6명), 2003년 42명(83.7명), 2004년 42명(93.5명)이었고 도말양성 폐결핵 신환자 수는 2002년 10명(16.7명), 2003년 11명(21.9명), 2004년 6명(13.4명)이었다. 3년간 도말양성 폐결핵 환자는 31명이 있었고 그 중 12명은 호흡기 증상 발생 30일이 지나서 진단을 받았다. 다제내성 결핵은 2명이 있었으며 결핵의 집단발병이 의심되는 사례는 2차례 있었다. 결론 : 전경대원과 20-29세 연령군 일반인의 결핵 신환발생률, 도말양성 폐결핵 발생률의 통계적으로 유의한 차이는 없었다.

식도에 발생한 원발성 악성 흑색종 1예

권지혜,임평숙,김기훈,서승오,최창수,서검석,최석채,윤기중 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

당뇨병 환자의 생활사건과 관련된 스트레스의 양과 당뇨병 관리의 연관성

김현규,유재명,박성우,최경애,임성희,임정원,유형준,김두만,최문기,조영중,정유선,서승오,최철수 대한당뇨병학회 2001 Diabetes and Metabolism Journal Vol.25 No.3

Background: The life events which diabetic patients experience has an influence on conduct and communication pattern that is essential to control diabetes. The psychosocial life events which patients experienced in recently, as well as in the past has an important meanings in the process of the plan, implementation and evaluation of diabetic control. However, the most researches on this issues are scanty. Thus, we evaluated the relation of diabetic control to stress amounts associated with the life event which diabetic patients experience for the past one year. Methods: In this study, 81 diabetic patients admitted to H hospital from March, 1999 to February 2000 were examined in stress amounts associated with life events, blood sugar, HbA1C, duration, complication, family history, treatment to inspect the hypothesis that stress experiences for recent 1 year are related to diabetic control. The 'Life Psychosocial Event Scale' invented by Lee was used. To examine the hypothesis that diabetic control may be influenced by the amount of stress, we investigated the difference of the means between the two groups (upper 30% of patients vs. lower 30% of patients) by T-test. Results: The mean age was 56.9±15.1 years and the mean duration of diabetes was 8.9±7 years. Fasting plasma glucose (FPG) was 200.3±71.0 mg/dL, PP2 was 292.9±87.2 mg/dL, HbA_(1C) was 10.5±2.6%, complication was 0.8±0.9. The age showed negative correlation with stress amounts. The other variables did not show significant correlation with stress amounts. Thus, our study indicated that the hypothesis that stress experiences for recent 1 year are related to diabetic control was rejected. However, considering the perception-phenomenological approach on stress, if we study the relationship between stress with diabetic control inclusively, it seems that we can recognize such relationship. Conclusion: To address relation between stress with diabetic control inclusively, we need to consider stress factors in diversified aspects more than only one. Therefore, we must investigate how do patients perceive and cope with stress inclusively, because the crisis of life is influenced on the stress coping skill of patients. The study on this issue must be continued to identified the key factors associated with stress in diabetes.

니켈에 의한 호산구성 폐렴 1예

김동규,송진영,김정한,이명구,장현주,이승준,정기석,서승오,현인규,박명재,손지웅 대한내과학회 2000 대한내과학회지 Vol.58 No.1

Eosinophilic lung diseases are a heterogeneous group of disorders characterized by eosinophilic pulmonary infiltrates and, commonly peripheral blood eosinophilia. A vast number of drugs have been associated with eosinophilic pneumonia and drug reactions are one of the most commonly reported causes of pulmonary infiltrates with blood and/or alveolar eosinophilia. Nickel exposure may occur in occupations including nickel maker, nickel smelters, stainless steel makers, battery makers, electroformer, electroplater, refining operations etc, and has been associated with an increased risk of lung and nasal cancers. Nickel dust has been reported to induce eosinophilic pneumonia, infrequently. We experienced a case of nickel-induced eosinophilic pneumonia in a 55 years old male patient who has been working at a stainless press factory for 25 years until retirement at January 1998. He complained of dry cough and exertional dyspnea, and presented peripheral eosinophilia and multiple small nodular opacities on chest radiograph. Pathological examination of open lung biopsy revealed diffuse vasculitis involving variable-sized vessels with diffuse infiltration of inflammatory cells, particulary eosinophils. Nickel concentration measured from two dried lung tissue was 39.66 ㎍/g and 25.14 ㎍/g, respectively.(Korean J Med 58:102-106, 2000)

대량 출혈로 발현한 원발성 위장관 말초 T세포 림프종 1예

김유선,송인성,정현채,김상균,김우호,김정룡,김주성,천재희,서승오,박규주 대한소화기학회 2000 대한소화기학회지 Vol.36 No.2

Most primary gastrointestinal lymphomas are B-cell origin. T-cell lymphomas of the intestine comprise the small portion of gastrointestinal lymphomas. Peripheral T-cell lymphomas (PTCL) rarely affect the gastrointestinal tracts at their initial presentation and the majority of primary gastrointestinal PTCL involve the small intestine. There has been few reports about the diffuse and extensive involvement of gastrointestinal tracts by PTCL. In Korea, there has been no report of a primary gastrointestinal PTCL so far. The common manifestations of PTCL involving the gastrointestinal tracts are abdominal pain, gastrointestinal bleeding, perforation, and diarrhea. However, these are not sufficient for the correct diagnosis. Several other gastrointestinal diseases may mimic PTCL. Its low incidence and clinical similarity to other gastrointestinal diseases make a correct diagnosis difficult. We report a case of primary gastrointestinal PTCL involving the whole gastrointestinal tracts, which rarely casuses massive bleeding, with a review of literatures.