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박경남,한동수,이민호,최호순,이동후,손주현,기춘석,함준수,손영우,전용철,윤병철,조윤주 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3
The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.
내시경 결찰술을 이용하여 치료한 위 동정맥 기형 1 예
한동수,이민호,최호순,윤병철,이동후,이오영,손주현,조윤주,함준수,전용철,기춘석,박경남,박석규,손영우,윤경택 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3
Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.
췌장 외분비 기능검사로서 내시경적 췌관 내 세프레틴 검사 (Intraductal Secretin Test)의 유용성
한동수,이민호,최호순,윤병철,이동후,손주현,조윤주,함준수,전용철,기춘석,박경남,박일규 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3
Background/Aims: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients witd chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation cf the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. Methods: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. Results: When we regarded mean-l.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. Conclusions: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.
박경남,한동수,이민호,최호순,이동후,조용현,함준수,이성희,전용철,기춘석,윤병철,손주현 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6
Candidiasis of the gastrointestinal tract typically occurs in a setting of decreased resistance to opportunistic infection, but also occurs in apparently normal individuals. Mucosal lesions in the gastrointestinal tract predominantly involve the esophagus, and gastroduodenal and enteric candidial lesions, which are less frequent, have only infrequently been detected antemortem. A case was experienced involving esophageal and gastroduodenal candidiasis in the patient of hepatocellular carcinoma and spinal metastasis treated with emergent radiotherapy and corticosteroid. He complained of anorexia and dyaphagia in the 4th day of radiotherapy. Endoscopy revealed multiple, large raised, white plaques and patches covering the mid- and distal esophageal mucosa, and several superficial aphthous ulcerations covered with white plaques in the entire stomach, and two deep excavating ulcers at the angle and antrum. The duodenal mucosa was covered with multiple small, white plaques, and a huge penetraing ulcer was seen in the duodenal bulb. Endoscopic biopsy showed budding yeast and pseudohyphae infiltrating through the ulcerated mucosa. Cultures of the same material canfirmed the organism to be Candida albicans. The patient was treated with fluconazole for 2 weeks. The case of esophgeal and gastroduodenal candidiasis is reported with reviiew of relevant literature.
만성 B 형 간염환자에서 인터페론 치료 중 발생한 급성 신부전 1 예
김종철,박경남,한동수,이민호,강경원,최호순,윤병철,이동후,손주현,이오영,함준수,이원미,박문향,전용철,기춘석 대한내과학회 2001 대한내과학회지 Vol.61 No.1
Hepatitis B virus infection is known to be associated with various types of glomerulonephritis (GN), including membranous GN, membranoproliferative GN, and mesangial proliferative GN. Although there has been considerable experiences with interferon in clinical trials during the past decade, acute renal failure as a complication of interferon treatment has rarely been reported. We report a case in which acute renal failure with proteinuria was associated with interferon-alpha treatment. A 33-year-old man with chronic hepatitis B presented with diarrhea and RUQ pain. Two weeks after INF-alpha treatment, Oliguria and proteinuria suddenly occurred, although the hepatic function was improved. With discontinuation of interferon treatment and ultrafiltration, his renal function was improved. (Korean J Med 61:59-63, 2001)
박준용,박경남,한동수,이광수,이민호,조윤주,최호순,이동후,손주현,손영우,기춘석,은창수,전용철,임현철,고병희,함준수,윤병철 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1
Tumor emboli of intrahepatic cholangiocarcinoma in bile duct rarely cause obstructive jaundice. Intraductal tumor embolus is associated with advanced stage of tumor within the liver, and shows poor prognosis and brief survival. However, jaundice by tumor embolus from intrahepatic cholangiocarcinoma must be distinguished from jaundice by common cause, which can be palliated safely and effectively. A patient presented with 1-month history of jaundice and epigastric pain. On cholangiography, polypoid filling defect was observed in the common hepatic duct, which had dilated proximal intrahepatic bile duct and mass shadow on the left lobe of liver. Tumor resection, embolectomy, and bile duct decompression were performed and the obstructive jaundice was relieved. Tumor embolus from intrahepatic cholangiocarcinoma was confirmed intraoperatively and pathologically as the cause of bile duct obstruction. In this report, we describe the rare case of obstructive jaundice by tumor emboli from intrahepatic cholangiocarcinoma with a review of literatures.