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증례 : 소화기 ; 궤양성 대장염과 동반된 궤양성 십이지장염 1예
임대욱 ( Dae Wook Rhim ),김규홍 ( Kyu Hong Kim ),김재우 ( Jae Woo Kim ),김문영 ( Moon Young Kim ),석기태 ( Ki Tae Suk ),백순구 ( Soon Koo Baik ),최영 ( Ying Cui ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4
궤양성 대장염은 직장을 침범하면서 연속적인 분포를 보이는 대장 점막의 만성 염증성 질환이다. 이전의 보고에 따르면 궤양성 대장염에서는 상부 위장관 염증이 발생하지 않는 것으로 알려져 있으나, 최근 궤양성 대장염 환자에서 위 십이지장의 염증성 병변 발생에 대한 보고가 증가하고 있다. 그러나 실제적으로 위 십이지장 병변은 드문 것으로 알려져 있고, 일반적으로 위 십이지장은 궤양성 대장염의 표적장기로 여겨지지는 않는다. 저자들은 내시경 및 조직학적으로 궤양성 대장염과 유사한 소견을 보이는 궤양성 십이지장염 증례를 경험하였기에 보고하는 바이다. Ulcerative colitis (UC) is a chronic inflammatory disorder of the colonic mucosa that characteristically affects the rectum and involves the large bowel in a contiguous distribution. Upper gastrointestinal inflammation was not believed to be present in UC, but a few recent studies have reported a high incidence of gastroduodenal inflammation in patients with UC, although such occurrences are apparently rare and the stomach and duodenum are not generally considered target organs in UC. Here, we present the case of a 29-year-old man with UC who was found to have diffuse ulcerative duodenitis with endoscopic and histologic features identical to UC. (Korean J Med 77:493-497, 2009)
간경변증 환자에서 도플러를 이용한 복부혈역학검사값의 초음파 장비 간 차이
지명관 ( Myeong Gwan Jee ),백순구 ( Soon Koo Baik ),박동훈 ( Dong Hun Park ),김문영 ( Moon Young Kim ),임대욱 ( Dae Wook Rhim ),조기원 ( Ki Won Jo ),홍진헌 ( Jin Hon Hong ),김재우 ( Jae Wook Kim ),김현수 ( Hyun Soo Kim ),권상옥 ( 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.4
김규홍 ( Kyu Hong Kim ),김문영 ( Moon Young Kim ),백순구 ( Soon Koo Baik ),박동훈 ( Dong Hun Park ),임대욱 ( Dae Wook Rhim ),김정민 ( Jung Min Kim ),석기태 ( Ki Tae Suk ),김재우 ( Jae Woo Kim ),권상옥 ( Sang Ok Kwon ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2
목적: 문맥압 항진증의 평가는 간경변증 환자의 치료와 예후 판정에 중요하다. 간정맥 압력차의 측정이 현재로서는 문맥압 항진증을 평가하는 가장 정확한 방법이나, 침습적 방법으로 실제 임상에서 반복적으로 시행하기에는 제약이 있다. 비침습적인 도플러 초음파검사를 이용한 측정값과 침습적인 간정맥 압력차 측정값간의 상관관계를 알아봄으로써, 비침습적 도플러 초음파 검사가 문맥압 항진증을 평가하는데 유용한지 알아보고자 하였다. 방법: 문맥압 항진증에 의한 정맥류 출혈로 내원한 환자를 대상으로 혈역학적으로 안정된 후 도플러 초음파 검사로 간문맥 혈류속도와 혈류량, 비장정맥 혈류속도와 혈류량, 간, 비장, 신장 동맥의 박동지수와 저항지수, 간정맥 파형과 감쇄지수를 측정하여 간정맥 압력차와의 상관관계를 전향적으로 분석하였다. 결과: 도플러 간정맥 파형의 감쇄지수(Damping Index, DI)는 간정맥 압력차 값과 유의한 상관관계를 보였으며(p<0.01), 기타 도플러 초음파검사 지표값들은 간정맥 압력차 값과 유의한 상관관계를 보이지 않았다. 결론: 비침습적인 도플러 초음파 검사법을 이용한 간정맥 파형의 감쇄지수 측정은 문맥압 항진증의 정도 평가와 약물치료의 효과 판정에 사용할 수 있는 유용한 보조적 검사법이다. Background/Aims: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. Methods: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. Results: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. Conclusions: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension. (Korean J Med 74:139-145, 2008)
도플러 초음파검사는 정맥류출혈의 위험성을 판정하는데 유용한가?
김현수,서정인,박용순,백순구,임대욱,박성진,김재우,권상옥,이동기 대한소화기학회 2000 대한소화기학회지 Vol.36 No.4
Background/Aims : Prediction of variceal bleeding has been based on the large variceal size and the red color sign observed during endoscopy. By comparing the characteristic hemodynamic features of Doppler ultrasonography between liver cirrhosis patients with and without variceal bleeding, we aimed to evaluate the usefulness of Doppler ultrasonography in assessing the risk of variceal bleeding. Methods : One hundred patients with liver cirrhosis were divided into two groups: variceal bleeding group and non-variceal bleeding group. The diameter, mean velocity, and blood flow volume of the portal vein and splenic vein were measured in patients with and without variceal bleeding. The resistive index and pulsatility index of splenic artery, which have been known to reflect portal hypertension, were also measured in both groups. Results : In univariate analysis, we found that the values of the diameter and blood flow volume of the portal vein, and the diameter, mean velocity and blood flow volume of the splenic vein, and the size of spleen were significantly increased in the group with variceal bleeding. However, multivariate analysis (multiple logistic regression analysis) showed no significant independent value for the group with variceal bleeding. Conclusions : There is no single hemodynamic characteristic on Doppler ultrasonography which can assess the risk of variceal bleeding in patients with liver cirrhosis. It is likely that variceal bleeding is affected not by a single hemodynamic factor but by complex hemodynamic features of the portal system.
서정인,백순구,김재우,임대욱,박용순,김현수,이동기,권상옥,장세진 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2
Background/Aims - Renal dysfunction commonly develops in patients with established liver disease. The assessment of renal function is of clinical importance in patients with cirrhosis and ascites. Renal function indices such as glomerular filtration rate and the plasma renin activity (PRA) could be better predictors of survival than the parameters usually used to estimate liver function including Child - Pugh score. This study was designed to find whether renal function indices are useful in determining the prognosis concerned with the survival of patients with liver cirrhosis. Methods - A total of 110 patients was selected and followed for 89 weeks. As indices reflecting renal function, creatinine clearance rate, PRA, aldosterone concentration, and the pulsatility index (PI) and resistive index (RI) by Doppler ultrasonography were measured. The prognostic values of these indices were determined by comparison and analysis according to survival or death of the patients. For the statistics, univariate and multivariate analysis was done. Results - Child - Pugh score (≥10), creatinine clearance rate ($lt;80 Ml/min), plasma alodosterone concentration (≥15 ng/Dl), PRA ( ≥8 ng/Ml/hr), renal PI ( ≥1.15) and RI (≥0.7) were prognostic indicators in univariate analysis (p$lt;0.05). Multivariate analysis disclosed two independent survival predictors of creatinine clearance rate ( $lt; 80 Ml/min) (OR:5.37, 95% CI: 2.09-13.8) and plasma aldosterone concentration (≥15 ng/Dl) (OR: 3.65, 95% CI: 1.09-12.18). Conclusion - Various renal function indices are closely related to the survival of patients with liver cirrhosis. Creatinine clearance rate and plasma aldosterone concentration are especially important prognostic factors in predicting the survival of patients with liver cirrhosis.
Theophylline(Etheophyl(R))에 의한 약물 유발성 간염 1 예
이동기,김태헌,권상옥,박용순,김태헌,백순구,임대욱,서정인,박학천,조미연,신계철,리원연,용석중 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2
Theophylline has been widely used in the treatment of asthma and chronic obstructive lung disease. To date, there have been very few reports on hepatotoxicity due to theophylline. We diagnosed, through biochemical testing and a liver biopsy, a case of acute cholestatic hepatitis developed after oral consumption of theophylline. A 43 year-old man was admitted to the department of internal medicine due to jaundice and pruritus which developed after ten days administration of oral theophylline (Etheophyl). Liver function tests showed elevated serum bilirubin at 13.2 mg/dL with AST and ALT of 71 U/L and 194 U/L. Alkaline phosphatase and γ - GTP were also elevated at 175 U/L and 301 U/L. There was no evidence of viral or autoimmune hepatitis in laboratory tests. The patients symptoms and liver function tests were improved after conservative treatment. After 9 months oral theophylline was readministered for the control of relapsed asthma. Then, jaundice and pruritus again developed again. A liver biopsy showed a fw lymphocytes and eosinophilic inflammatory cell infiltration in portal tract and cholestasis in the lobule. Drug - induced hepatitis was diagnosed with a typical clinical course, the exclusion of all possible causes of acute hepatic dysfunction,' and a positive response to accidental readministration of drug. We report this case with a review of the literature.(Korean J Hepatol 2001;7:213-215)