Nd : YAG 레이저빔을 이용한 알루미늄합금과 스테인리스강의 용접

채병대(Byoung Dae Chae),강창규(Chang Gyu Kang),이철구(Chul Ku Lee) 대한기계학회 2002 대한기계학회 기타 간행물 Vol.2002 No.11

담낭 대장 루

하헌돈(Heon Don Ha),강창규(Chang Gyu Kang),김영운(Young Un Kim),오성광(Sung Kwang Oh),황석주(Soek Joo Hwang),김대영(Dae Young Kim),임선재(Seon Jae Yim),박승욱(Seung Wook Park),이두용(Doo Yong Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

Internal biliary fistula is a very rare disease. Fistula is usunlly produced by chrnnic disease of liiliary tract associated with ;allstone,and may be produced by peptic ulcer, by malignancy or traurna The common types giien in order are cholecystoduodenal, cholecystocolic, choledochoduo- <Ienal, cholecystogastric fistula. Etc. The mechanism of fistula forniatinns is due to adherence of the inflnmmed gallbladder or cnn mnn bile duct to adjacent viscus and exit of a gallstone into the adjacent orgm. Thc clinical .,ymptoms,signs, laboratory findings are often so nnnspecific that f'istiila is u.iually difficult tn <Jiagnose preoperatively. Preoperative diagnostic rate is io between 31% fn m7% of reported case. A 4S years old male visited Dae Senn SlJN general hospital because of persistent diarrhea ond abdominal discomfort. Of' 15 years prior to his visit, he had been suffered from the severe RlSQ pain ancl treated by medical regimen nnder impression of acute cholecystitis associated with gallstnne. And occasionally intermitent RIJQ pain persisted imtill 6 years ago, when sudden disappearence oF RUO pain developed, then followed by persistent diarrhea and lower abdominal discomfort. Pneumchilia is found on abdorninal sonogram, and the fistula trnct between gallbladder arvt colon has bee disclosed on barium enema study and F.RCP, abdominal CT. But surgical intcrvcntinn h,I t eer delayed because of patients cvnsent. (Korean 3 tastroenterol ]995:27: 893-89'7l

만성 재발성 췌장염 후에 발생한 췌장 - 늑막루

선정민(Joung Min Sun),강창규(Chang Gyu Kang),하헌돈(Heon Don Ha),권주원(Joo Won Kwon),김봉화(Bong Hwa Kim),박승욱(Seung Wook Park),이두용(Doo Yong Lee),김종설(Chong Suhl Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

The common cause of pancreatic fistula were trauma and pancreatic surgery. Pancreatic fistula due to pancreatitis is rare. Pseudocyst of the pancreas as a sequelae to pancreatitis or to abdominal trauma has been known, while hydrothorax (without fistula) occurs frequently in conjuntion with pseudocyst, however fistulization to the pleural cavity is a rare event. Authors experienced a case of pancreaticopleural effusion resulting from a pancre- aticopleural fistula demonstrated during ERCP and hereby reports the case with the review of the literature. (Korean J Gastroenterol 1994; 26: 384 388)

집단 발생한 Extended-spectrum β-lactamase(ESBL) 생산 Shigella sonnei 감염에 의한 세균성 이질에 관한 연구

임현택,이소희,이정화,김정은,김교순,정은주,이승현,강창규,홍성진,Lim, Hyun Taek,Lee, So Hee,Lee, Jung Hwa,Kim, Jeong Eun,Kim, Kyo Sun,Jeong, Eun Ju,Lee, Seung Hyun,Kang, Chang Gyu,Hong, Seong Jin 대한소아청소년과학회 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.10

목 적 : ESBL 생산 S. sonnei에 의한 장염의 대규모 발생은 과거 국내는 물론 세계에서도 유래를 찾아볼 수 없었다. 저자들은 집단 발생한 ESBL 생산 S. sonnei에 의한 장염 환자의 임상적 특징과 치료에 대한 반응 등을 분석하여 ESBL 생산 S. sonnei 감염증에 대한 치료 지침을 마련하는데 도움이 되고자 한다. 방 법 : 연구 대상은 2004년 11월 충주 ${\bigcirc}{\bigcirc}$초등학교를 중심으로 집단 발생한 급성 장염 환자 중 분변 배양 검사상 S. sonnei가 검출되어 치료받은 환자 103명을 대상으로 하였다. 환자에서 분리된 S. sonnei에 대해 항생제 감수성 검사와 DNA 염기 서열 검사를 시행하였고, 환자들의 임상적 특징과 검사 소견, 그리고 항생제에 대한 반응 등을 후향적으로 분석하였다. 결 과 : 임상 증상은 발열 96.1%, 설사 93.2%, 복통 76.7%, 두통 71.8%, 구토 65.0%, 그리고 구역 41.7% 순으로 나타났다. 발열은 평균 2.0일간 지속되었고, 설사는 평균 3.9일간 지속되었다. 설사의 양상은 수양성 설사는 69%, 점액성 설사는 26%, 그리고 혈변은 5%에서 관찰되었다. 말초 혈액 검사에서 백혈구 증다증을 보이는 경우는 53.4%이었고, 혈청 검사에서 CRP 양성을 보이는 경우는 78.6%이었다. 대변 직접 도말 검사에서 백혈구가 고배율 당 50개 이상인 경우가 11.7%, 그리고 5-20개인 경우 9.7%이었다. 대변 잠혈 반응은 71%에서 양성이었다. 본 유행에서 분리된 ESBL의 유형은 염기 서열을 분석한 결과 CTX-M-14 유형으로 밝혀졌다. 항생제 투여에 대한 미생물학적 치료 결과는 ciprofloxacin 투여자 중 100%(9/9), azithromycin 투여자 중 100%(5/5), cefdinir 투여자 중 6.9%(5/72), ceftriaxone 투여자 중 0%(0/8), ceftizoxime 투여자 중 12.5%(1/8), TMP/SMX 투여자 중 0%(0/8), ampicillin/sulbactam 투여자 중 42.9%(3/7), amoxicillin/clavulanic acid 투여자 중 20%(1/5), 그리고 imipenem/cilastatin 투여자 중 68.8%(11/16)에서 추적 검사상 음전 되었다. 결 론 : 소아에서 발생한 ESBL 생산 S. sonnei에 의한 세균성 이질에 대한 항생제 선택에서 비용-효과 면이나 안전성 면에서 azithromycin이 매력적인 일차 선택약일 수 있을 것으로 사료된다. Ciprofloxacin은 비용-효과 면에서는 우수한 약제일 수는 있으나 소아에서의 사용은 아직 이르다고 생각된다. Purpose : An outbreak of ESBL-producing Shigella sonnei enteritis was unprecedented not only in Korea but throughout the world in the past. We intended to devise a management guideline for ESBL-producing shigellosis based on analysis of clinical manifestations and response to therapy. Methods : We analyzed 103 patients who were admitted to the hospital with acute GI symptoms and were shown positive result for S. sonnei on stool culture. We performed sensitivity test to the antibiotics and DNA sequencing of ESBL gene in the isolated S. sonnei colonies. In addition, we retrospectively analyzed their clinical characteristics, laboratory results, and clinical and microbiological responses to the antibiotics. Results : Among the clinical manifestations, fever was the most frequent(96.1%), followed by diarrhea(93.2%), abdominal pain(76.7%), headache(71.8%), vomiting(65.0%), and nausea(41.7%). The fever was sustained for average of 2.0 days and diarrhea for 3.9 days. Watery diarrhea was the most common(69%) followed by mucoid(26%), and bloody stool(5%). On peripheral blood smear, leukocytosis was noted in 53.4% of patients, and 78.6% of patients tested positive for serum CRP response. On stool direct smear, 11.7% of patients showed more than 50 WBCs/HPF, and 9.7% of patients between 5 to 20 WBCs/HPF. Stool occult blood was positive in 71% of patients. Production of CTX-M-14 type ESBL was reported for all S. sonnei strains isolated from this outbreak. Microbiological eradication rates to various antibiotics were as follows : 100%(9/9) to ciprofloxacin, 100% 5/5) to azithromycin, 6.9%(5/72) to cefdinir, 0%(0/8) to ceftriaxone, 12.5%(1/8) to ceftizoxime, 0%(0/ 8) to TMP/SMX, 42.9%(3/7) to ampicillin/sulbactam, 20%(1/5) to amoxicillin/clavulanic acid, and 68.8 %(11/16) to imipenem/cilastatin. Conclusion : It is presumed that azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric population, given its cost-effectiveness and safety. Although ciprofloxacin is another cost-effective agent, its use in pediatric population may be a bit too premature.

담낭 대장 루 1예

하헌돈,강창규,김영운,오성광,황석주,김대영,임선재,박승욱,이두용 大韓消化器病學會 1996 大韓消化器病學會誌 Vol.28 No.6

Plummer-Vinson 증후군 1 예

김영운,이두용,김종설,박승욱,하헌돈,강창규,오성광,황석주,권주원,선정민 대한내과학회 1995 대한내과학회지 Vol.49 No.1

Upper esophageal webs consist of thin mucosal membranes projecting into the esophageal lumen at level of just below the cricoid cartilage. A specfic syndrome characterized by a cervical esophageal web with dysphagia, mucosal lesions of the mouth and pharynx, and iron deficiency anemia is variably known as Plummer-Vinson syndrome, Paterson Kelly syndrome or sideropenic dysphagia, These terms are all used interchangeably. Recently we experienced a case of upper esophageal web with dysphagia and iron deficiency anemia. A 46-year-old women had complained of dysphagia for 15 years. Esophagogram showed a anterior diaphragm-like web protruding into the esophageal lumen at the level of the 4th-to-5th cervical vertebrae. Also esophagoscopy showed a eccentric circular web at 18cm from incisors. Bougienation under endoscopy with Savary-Gilliard dilatory was perfomed Successfully and she could well tolerate in swallowing of solid food after this procedure. Hereby we report a case of classical Plummer-Uinson syndrome together with a review of literatures.

전소장과 대장 전체에서 발생한 원발성 위장관 림프종 1예

김영운,이두용,김종설,박승욱,하헌돈,강창규,권주원 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

Primary gastrointestinal lymphoma which is primarily confined to gastrointestinal tract without evidence of systemic involvement is a relatively rare disease. Non-Hodgkin's lymphoma has a tendency to involve extranodal areas as its primary site and the gastrointestinal tract is the most commonly involved extranodal site. Many cases of primary gastrointestinal lymphoma have been reported mostly of gastric origin followed by small howel, ileocecal portion and colon; however, the concurrent lymphoma of colon and small bowel is very rare in reported cases. This article is about a case of 55-year old male who was diagnosed as primary concurrent malignant lymphoma of the entire small bowel and colon. The colonoscopic finding revealed smootb pink-red colored multiple polypoid masses and ulcerations in the total colon. We suspected lymphoma by endoscopic punch biopsy, thereafter laparatomy was performed. Multiple subserosal nodules were scattered from Treitzs ligament to rectum, and mesenteric lymph node enlargement was also observed. As a result malignant lymphoma was confirmed pathohistologically. We report this case with a review of the related literature.