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유기덕 ( Ki Deok Yoo ),한동수 ( Dong Soo Han ),정승민 ( Seong Min Chung ),김선민 ( Sun Min Kim ),배중호 ( Joong Ho Bae ),은창수 ( Chang Soo Eun ),백승삼 ( Seung Sam Paik ),오영하 ( Young Ha Oh ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.2
Histiocytic sarcoma is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features. Patients with histiocytic sarcoma usually have a poor prognosis due to its aggressive clinical behavior. Here we report a rare case of extranodal histiocytic sarcoma of the stomach which was confirmed through immunohistochemical staining. A 71-year- old man was presented with epigastric pain. Gastroscopy, abdominal CT, and EUS revealed a mass located on the posterior wall of upper body and fundus of the stomach. Grossly, grayish white solid masses were seen extending down to the submucosal layer. Microscopically, the tumor cells had eosinophilic cytoplasm, abundant vacuole, and mitosis. Immunohistochemical staining revealed that the tumor cells were positive for LCA, CD68, and lysozyme. Early detection and accurate diagnosis of this rare neoplasm is important because it can make a great difference in prognostic outcomes. To make an accurate and definitive diagnosis, immunohistochemical staining is essential in the confimation of histiocytic orign. (Korean J Gastroenterol 2010;55:127-132)
증례 : 류마티스 ; 저용량 adefovir dipivoxil에 의한 저인산염혈증과 다발성 근육통 1예
유기덕 ( Ki Deok Yoo ),정종헌 ( Jong Heon Jeong ),조수경 ( Soo Kyung Cho ),김근호 ( Gheun Ho Kim ),최호순 ( Ho Soon Choi ),김동선 ( Dong Sun Kim ),전재범 ( Jae Bum Jun ) 대한내과학회 2010 대한내과학회지 Vol.78 No.2
ADV는 고용량에서 신독성을 유발할 수 있으나 저용량에서는 매우 드물다. 류마티스 영역에서 다발성 근육통, 관절통을 호소하는 환자의 병력을 청취할 때 약물복용에 대한 자세한 문진도 중요하다는 사실을 인지하여야 하겠다. 저자들은 라미부딘 내성 만성 B형 간염 환자에서 10 mg의 ADV를 사용하던 중 저인산염혈증과 동반된 다발성 근육통이 발생하여, 혈액 검사 및 영상학적 검사 소견으로 골연화증으로 진단된 후 ADV 투여 중지 이후 자각증상과 검사 소견이 호 Adefovir dipivoxil (ADV) effectively inhibits lamivudine-resistant hepatitis B virus replication. Hypophosphatemia and elevated serum creatinine are ADV-related nephrotoxicity caused by high-dose ADV. Hypophosphatemic osteomalacia is very rare and is induc
유기덕 ( Ki Deok Yoo ),전대원 ( Dae Won Jun ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4
Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease. The prevalence of NAFLD is growing gradually worldwide with increases in obesity, sedentary lifestyles, and an unbalanced diet. NAFLD ranges from simple steatosis without inflammation to steatohepatitis that can progress to cirrhosis. There is no single effective treatment that has widespread effects in NAFLD. The cornerstone of treatment is lifestyle modification, including weight reduction, diet, and physical activity. An approximately 7-10% weight reduction via diet or physical activity can improve the liver histopathology. Risk factors for NAFLD include a high-calorie diet, high-lipid diet, high-carbohydrate diet, saturated fatty acids, trans fatty acids, cholesterol, high fructose intake, and low-choline diet. Factors that protect against NAFLD include a low-calorie diet, low-carbohydrate diet, low-lipid diet, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), dietary fiber, coffee, green tea, and light alcohol consumption. Physical activity also helps to manage NAFLD with or without weight reduction. Recent reports found that resistance training is as effective as aerobic training. Lifestyle modification has very low compliance. To maintain a treatment program, a multidisciplinary team approach is required that includes physicians, dietitians, physical trainers, and psychologists. (Korean J Med 2014;86:416-424)
증례 : 소화기 ; 췌관내유두상점액종양과 바터 팽대부 선종에 의한
오창교 ( Chang Kyo Oh ),유기덕 ( Ki Deok Yoo ),최호순 ( Ho Soon Choi ),이강녕 ( Kang Nyeong Lee ),구건우 ( Gun Woo Koo ),이승 ( Seung Lee ),장기석 ( Ki Seok Jang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.5
특발성 급성 재발성 췌장염의 원인을 찾는 것은 환자의 치료방침 결정에 있어서 매우 중요하다. 1차적인 검사로 원인을 찾지 못한 췌장염의 경우 내시경 초음파, 내시경 역행성 담췌관 조영술 등의 내시경 검사로 적극적인 원인 규명이 필요하다. 저자 등은 최근 2개월 동안 두 차례의 급성 재발성 췌장염에 대해 기존의 영상학적인 검사 방법으로는 췌관내유두상점액종양 이외에는 특이 소견을 찾지 못하다가 내시경 역행성 담췌관 조영술로 바터 팽대부의 선종의 동반을 진단하고 내시경 유두괄약근 절개술 시행 후 호전된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute pancreatitis is an inflammatory disease that can extend to extra-pancreatic tissues and distant organs. Detecting the underlying cause is important because it helps provide an appropriate treatment plan and improve prognosis. An underlying cause cannot be identified after initial evaluation in 10-30% of patients with acute pancreatitis, and they are diagnosed with idiopathic acute pancreatitis. Here, we report a case of a 77-year-old woman with acute recurrent pancreatitis caused by a branch duct-type intraductal papillary mucinous neoplasm (IPMN) and an ampulla of Vater adenoma. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed only IPMN. However, endoscopic retrograde cholangiopancreatography revealed a mucosal abnormality of the ampulla of Vater. The mucosal abnormality was documented to be an ampulla of Vater adenoma with high-grade dysplasia. (Korean J Med 2014;87:579-584)
고영선 ( Young Sun Ko ),유기덕 ( Ki Deok Yoo ),현일식 ( Yil Sik Hyun ),정해룡 ( Hae Ryoung Chung ),박수역 ( Soo Yuk Park ),김선민 ( Sun Min Kim ),전용철 ( Yong Cheol Jeon ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.3
Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission. (Korean J Gastroenterol 2010;55:198-202)
회복된 B형간염 환자에서 Rituximab 치료 이후 발생한 전격성 간부전을 동반한 B형간염 바이러스의 재활성화 1예
정승민 ( Seong Min Chung ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),유기덕 ( Ki Deok Yoo ),안용우 ( Yong Woo Ahn ),배중호 ( Joong Ho Bae ),전용철 ( Yong Cheol Jeon ),최정혜 ( Jung Hye Choi ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.4
It is well known that the reactivation of hepatitis B virus (HBV) may occur as an acute hepatitis after chemotherapy or immunosuppressive therapy. Although most of these cases have been reported in HBsAg-positive patients, there have been a few reports of HBV reactivation in HBsAg-negative patients. There have been concerns for the need to screen the reactivation as well as anti-viral prophylaxis in HBsAg-negative patients with possible HBV occult infection who are planning to undergo chemotherapy or immunosuppressive therapy. Rituximab, an anti-CD20 monoclonal antibody, is effective in the treatment of non-Hodgkin`s lymphoma. However, rituximab can affect the immunity against HBV, consequently increasing viral replication. In fact, there have been reports of HBV reactivation after treatment with rituximab. Here, we report a case of HBV reactivation following rituximab plus systemic chemotherapy in diffuse large B cell lymphoma patient who was HBsAg negative, anti-HBs positive, and anti-HBc positive, ultimately leading to treatment-unresponsive fulminant hepatic failure.