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Jeong Ook Wi,Sung Jae Shin,유준환,Jeong Woo Choi,Byung-Hyun Yoo,Sun-Gyo Lim,Kee Myung Lee,김진홍 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.4
Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.
위정욱 ( Jeong Ook Wi ),진남철 ( Nam Chul Jin ),한의령 ( Eui Ryoung Han ),윤병조 ( Byung Jo Yoon ),박상훈 ( Sang Hun Park ),고영일 ( Young Ll Koh ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.4
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug hypersensitivity syndrome characterized by fever, skin rash, blood eosinophilia and multiple organ involvements including liver and kidney developed following drug administration. Vasculitis could be infrequent one of manifestations of DRESS syndrome. Mortality rate of DRESS syndrome is at least 10%. Here, we reported a case of DRESS syndrome with vasculitis. A 67-year-old man with essential hypertension presented with fever and maculopapular rash after being given allopurinol over 2 weeks for gout. He had severe oral mucositis. He had peripheral blood eosinophilia and abnormal hepatic and renal functions. A skin biopsy showed leukocytoclastic vasculitis. Gastroduodenoscopy showed spontaneous mucosal oozing in mid-to-lower esophagus. He was diagnosed as having DRESS syndrome with vasulitis. Allopurinol was stopped and systemic corticosteroid was administrated. His clinical manifestations improved gradually. However, he died of sudden onset of massive intracranial hemorrhage. The case suggests that DRESS syndrome could sometimes present manifestations of vasculitis, which might be fatal. (Korean J Asthma Allergy Clin Immunol 2010;30:320- 324)
무증상 폐침윤과 중심성 기관지확장증을 보인 알레르기성 기관지폐 아스폐르길루스증
이우진 ( Woo Jin Lee ),김창성 ( Chang Seong Kim ),윤병조 ( Byoung Jo Yoon ),위정욱 ( Jeong Ook Wi ),한의령 ( Eui Ryoung Han ),고영일 ( Young Il I. Koh ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.4
알레르기성 기관지폐 아스페르길루스증(allergic bronchopulmonary aspergillosis, ABPA)에서 일시적 또는 영구적인 폐병변이 나타날 수 있다. 저자들은 ABPA 증상 악화 없이 새로운 폐침윤과 중심성 기관지확장증이 발생한 증례를 경험하여 이를 보고하는 바이다. 46세 남자로 천식으로 진단받고 규칙적으로 항천식약물을 복용하고 있던 중, 추적관찰 목적으로 검사한 흉부방사선사진에서 우연히 우상엽에 고립성 폐결절이 관찰되었다. 호흡기증상 또는 폐기능 악화의 소견은 동반되지 않았다. 말초혈액 호산구, 혈청 총 IgE, Aspergillus fumigatus-특이 IgG 등이 증가되었고, 경흉부세침생검 검사에서 폐결절은 ABPA 폐침윤이었다. 폐침윤은 경구용 스테로이드 사용 후 없어졌으며, 흉부 고해상전산화단층사진에서 폐침윤이 생겼던 부위에 과거에 보이지 않았던 중심성 기관지확장증 병변이 새롭게 발견되었다. 본 증례를 통하여 ABPA 환자에서 악화 증상이 없더라고 단순 흉부방사선 추적관찰은 폐침윤을 조기에 발견할 수 있으며, 결국 영구적 폐손상을 예방 또는 최소화하는데 도움이 될 수 있을 것으로 생각된다. (Korean J Asthma Allergy Clin Immunol 2009;29:293-297)
( Sun Gyo Lim ),( Kwang Jae Lee ),( Kwang Wook Suh ),( Seung Yeop Oh ),( Soon Sun Kim ),( Jun Hwan Yoo ),( Jeong Ook Wi ) The Editorial Office of Gut and Liver 2013 Gut and Liver Vol.7 No.3
Background/Aims: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. Methods: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. Results: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. Conclusions: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction. (Gut Liver 2013; 7:311-316)
증례 : 알레르기 ; 만성 호산구성 폐렴의 임상양상을 동반한 급성 호산구성 폐렴 1예
김성수 ( Sung Soo Kim ),고영일 ( Young Il Koh ),한의령 ( Eui Ryoung Han ),위정욱 ( Jeong Ook Wi ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6
본 증례를 통하여 급성 호산구성 폐렴은 아토피질환 존재등의 만성 호산구성 폐렴의 임상양상을 일부 동반할 수 있으며, 만성 호산구성 폐렴과의 감별이 어려운 경우 기관지폐 포세척술을 시행하여 세척액내 호산구뿐만 아니라 림프구 및 호중구의 증가 소견을 증명하면 급성 호산구성 폐렴의 진단에 도움이 될 수 있을 것으로 생각된다. Acute eosinophilic pneumonia (AEP) represents a clinical entity distinct from chronic eosinophilic pneumonia (CEP). In contrast with CEP, AEP is characterized by duration of symptoms less than 5 days, hypoxemic respiratory failure, no blood eosinophilia at presentation, no atopic background or history of asthma, and no recurrence. However, we report a case of AEP with some features of CEP. A 33-year-old man presented with respiratory symptoms for 4 days. He was diagnosed with AEP based on hypoxemic respiratory failure, diffuse alveolar-interstitial chest X-ray infiltrates, and eosinophilia, lymphocytosis and neutrophilia from bronchoalveolar lavages. However, he had two atopic diseases, asthma and atopic dermatitis. In addition, he presented with blood eosinophilia, which are all features of CEP. Thus, there might be some overlap of clinical features between AEP and CEP. The presence of increased lymphocytes and neutrophils in the bronchoalveolar lavage can be an important finding to help distinguish between AEP versus CEP in difficult cases. (Korean J Med 79:724-728, 2010)