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수술 고위험 중증 환자에게서 발생한 급성 담낭염의 경피적 담낭배액술 단독 치료와 담낭절제술 비교; 단일 기관, 단면 연구
차병효 ( Byung Hyo Cha ),송하헌 ( Ha Hun Song ),김영남 ( Young Nam Kim ),전원중 ( Won Jung Jeon ),이상진 ( Sang Jin Lee ),김진동 ( Jin Dong Kim ),이학현 ( Hak Hyun Lee ),이반석 ( Ban Seok Lee ),이상협 ( Sang Hyub Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1
Background/Aims: Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. Methods: All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. Results: The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists` physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. Conclusions: In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients. (Korean J Gastroenterol 2014;63:32-38)
증례 : 소화기 ; Isoniazid에 의한 가성용종을 동반한 급성췌장염 1예
차병효 ( Byung Hyo Cha ),이상협 ( Sang Hyub Lee ),황진혁 ( Jin Hyeok Hwang ),김장언 ( Jang Eon Kim ),이상진 ( Sang Jin Lee ),이충식 ( Chung Sik Lee ),김현 ( Hyun Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.5
Numerous medications have the potential to induce acute pancreatitis. However, isoniazid-induced acute pancreatitis is extremely rare. Drug-induced acute pancreatitis can be diagnosed by improvement after stopping the drug and recurrence of pancreatitis when rechallenged. We present a case of severe acute pancreatitis accompanied by multiple large pseudocysts after isoniazid treatment for pulmonary tuberculosis. We confirmed that isoniazid induced pancreatitis by rechallenging after treatment cessation. Most previous reports of isoniazid-induced pancreatitis have been clinically mild forms, and the patient fully recovered with supportive management. However, this case presents severe and permanent pancreatic damage that developed with 5 weeks of isoniazid treatment. When a patient presents with manifestations of pancreatitis during treatment of tuberculosis that includes isoniazid, the physician should consider isoniazid-induced pancreatitis. (Korean J Med 2012;82:594-598)
80세 이상 초고령환자에서 내시경 역행성 담췌관 조영술의 안전성 및 효과
김장언 ( Jang Eon Kim ),차병효 ( Byung Hyo Cha ),이상협 ( Sang Hyub Lee ),박영수 ( Young Soo Park ),김진욱 ( Jin Wook Kim ),정숙향 ( Sook Hyang Jeong ),김나영 ( Na Young Kim ),이동호 ( Dong Ho Lee ),황진혁 ( Jin Hyeok Hwang ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
Background/Aims: Endoscopic retrograde cholangiopancreatograpy (ERCP) is often used for the diagnosis and treatment of pancreaticobiliary diseases in the elderly patients. However, few studies have assessed its efficacy and safety in the very elderly. The purpose of this study was to evaluate the clinical outcomes of ERCP in the very elderly patients. Methods: Eight hundreds two patients who underwent ERCP at Seoul National University Bundang hospital were enrolled retrospectively. They were divided into three groups according to their ages (non-elderly group, elderly group and very-elderly group; <65, 65-79 and ≥80, respectively). The indications and clinical outcomes including the complications of ERCP were compared among groups. Results: The most common indication of ERCP was acute cholangitis in all the three groups. Periampullary diverticulum was more frequently observed in elderly and very-elderly patients than in younger patients. Mean duration of hospitalization was not different among three groups. ERCP success rate in all enrolled patients was approximately 90%, and there was no difference in terms of technical success rate between groups (p=0.1). However, the number of ERCP sessions was significantly higher in the very-elderly patients compared to in the non-elderly and elderly (1.38 vs. 1.13 and 1.18 respectively; p<0.001). There was no difference in mortality and complication rate between groups. Conclusions: ERCP can be performed safely in very-elderly patients. Therefore, only age should not be regarded as one of the major determining factors whether to perform ERCP. (Korean J Gastroenterol 2011;57:237-242)
대장내시경 전처치 4 L Polyethylene Glycol 단독요법과 2L Polyethylene Glycol 및 Sodium Phosphate 용액 병합요법 비교
이정원 ( Jung Won Lee ),김나영 ( Nayoung Kim ),차병효 ( Byung Hyo Cha ),이병환 ( Byoung Hwan Lee ),황태준 ( Tae Jun Hwang ),정유정 ( Yu Jeong Jeong ),최태혁 ( Tae Hyuck Choi ),김희섭 ( Hee-Sup Kim ),명형준 ( Hyung-Joon Myung ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.5
Background/Aims: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. Methods: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. Results: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group`s compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. Conclusions: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method. (Korean J Gastroenterol 2010;56:299-306)
증례 : S상 결장암에 동반된 부신생물 말초 호산구증가증 1예
이나리 ( Na Ri Lee ),전승민 ( Soung Min Jeon ),차병효 ( Byung Hyo Cha ),박길효 ( Kil Hyo Park ),이종섭 ( Jong Sup Lee ),문도호 ( Do Ho Moon ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 S상 결장암에 동반된 말초 호산구 증가증이 있는 56세 환자에서 간 및 주위 임파선에 다수 전이가 되어 예후가 불량했던 환자 1예를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. Eosinophilia is most commonly associated with allergic disorders or parasitic infestation. However, collagen vascular diseases, drug reactions, radiation therapy, and many types of human cancer are also associated with extensive eosinophilia. Peripheral eosinophilia associated with malignancy is a marker of extensive metastasis and is thus associated with a poor prognosis. A 56-year-old male presented with history of right upper quadrent pain and weight loss. Total white blood count was 29,800/㎣ with 69.2% eosinophilia. Abdominal ultrasonogram showed multiple metastasis in liver and abdominal CT scan showed paraaortic lymph node enlargement. Colonoscopy and biopsy revealed moderate to poorly differentiated adenocarcinoma in sigmoid colon. (Korean J Med 69:S753-S757, 2005)
박용은 ( Yong Eun Park ),이용준 ( Yong Joon Lee ),김치영 ( Chi Young Kim ),이지연 ( Ji Yeon Lee ),박서현 ( Seo Hyun Park ),박지혜 ( Ji Hye Park ),차병효 ( Byung Hyo Cha ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.3
Intramural duodenal hematoma (IDH) is a rare disease which defined a hematoma formation localized within the wall of the duodenum. The most common cause of IDH is due to blunt abdominal trauma while most of other cases of IDH are more related to the use of anticoagulants or coagulation disorders such as haemophilia and Von Willebrand disease. We report a very rare case of a large IDH caused by acute alcoholic pancreatitis without any kind of anticoagulation therapies nor coagulopathies. The patient was recovered by only medical treatment and observation without surgical intervention.