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우측 신 탈장을 동반한 성인형 Bochdalek 탈장 1례
고병성(Byeong Seong Ko),김도형(Do Hyung Kim),배장환(Jang Whan Bae),전현정(Hyeon Jeong Jeon),최강현(Kang Hyeon Choe) 대한내과학회 1998 대한내과학회지 Vol.54 No.4
Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hemia including kidney herniation in 68 years old man manifested by hernoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom. Bochdalek hernia through Bochdalek foramen, defect at the posterolateral side of the diaphragm is one of the congenital diaphragmatic hernias. It usually occurs in infants, but very rare in old age and also on the right side. We experienced the right-side Bochdalek hemia including kidney herniation in 68 years old man manifested by hernoptysis. CT scan revealed diaphragmatic defect and herniated liver, colon and kidney. Thoracotomy was performed and the 10 cm-sized large defect was closed with patch. After then, the patient has been well without symptom.
1 차 약제에 내성을 보인 결핵성 장염에서 2 차 약제로 완치된 1 예
고병성(Byeong Seong Ko),김병관(Byeong Gwan Kim),김주성(Joo Sung Kim),정현채(Hyun Chae Jung),송인성(In Sung Song) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.4
Recently, the incidence of pulmonary tuberculosis has increased. In addition, extrapulmonary tuberculosis and multi-drug resistant tuberculosis have also increased. We experienced a 34-year-old male with intestinal tuberculosis which failed to respond to primary anti-tuberculosis therapy. He presented with loose stool, abdominal pain, and weight loss. The caseating granuloma was histologically found. The patient had taken primary anti-tuberculosis drugs for 13 months. However, his symptoms and weight loss did not improve. A colonoscopy showed multiple shallow geographic ulcerations in the cecum and ileocecal valve. Histopathologic examination also showed caseating granuloma. We started primary anti-tuberculosis therapy (isoniazid, rifampin, ethambutol, pyrazinamide), but follow-up colonoscopic findings after 2 months revealed no change of multiple ulcerations. After conversion of anti-tuberculosis therapy from primary drugs to secondary rescue regimen (prothionamide, cycloserine, para-aminosalicylic acid, levofloxacin, streptomycin), the patient's symptoms have improved. A follow-up colonoscopy revealed only scarring change in the cecum. (Korean J Gastroenterol 2002;39:299-303)
흰쥐 결장운동에서 5-Hydroxytryptamine4 (5-HT4) Receptor Partial Agonist (Tegaserod)의 작용기전
김미성 ( Mi Sung Kim ),고병성 ( Byeong Seong Ko ),오석진 ( Seok Jin Oh ),한정호 ( Joung Ho Han ),전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1
목적 : 5-Hydroxytrypatmine4 (5-HT4) 수용체의 부분적 촉진제인 테가세로드(Tegaserod, Tega)는 연동반사를 자극하고 개의 소장 및 대장의 운동성과 통과를 촉진하는 것으로 알려져 있다. 본 연구는 흰쥐에서 혈류와 장내 신경이 온전히 유지된 채 결장을 분리한 실험모델을 사용하여 Tega가 결장운동에 미치는 영향 및 작용기전에 대해 알아보고자 하였다. 방법 : 상장간막 동맥을 포함하여 분리한 흰쥐 결장에서 Tega 10, 70, 140과 1400 pM을 단계적으로 동맥에 투여하여 근위부와 원위부 결장내압을 측정하였다. 운동성은 각 농도별 운동지수를 계산하여 기저치의 운동지수에 대한 %변화인 수축반응으로 표시하였다. 이후 억제 유무를 알아보기 위하여 근위부와 원위부에 각각 140 pM의 Tega 를 투여하였을 때와 비교하였고 phentolamine, propranolol, hexamethonium, atropine (ATR)과 tetrodotoxin (TTX)를 각각 전처치 후 Tega를 함께 관류시켜 운동성 변화를 측정하였다. 결과 : Tega를 10, 70, 140, 1400 pM의 다양한 농도로 각각 주입하였을 때 근위부 결장에서 수축반응은 각각 40±20.17, 101±92.43, 122±120.57, 101±89.05%, 원위부 결장에서 수축반응은 각각 20±22.05, 73±41.47, 93±75.45, 73±54.91%로 근위부 및 원위부 결장 모두 기저기의 결장운동과 비교시 유의하게 증가하였다(p<0.05). 근위부와 원위부를 비교하였을 때 근위부에서 원위부보다 운동지수의 증가가 더 강력하였다. 또한 특히 원위부에서는 10 pM에서 140 pM까지 농도-의존적인 운동지수의 증가가 관찰되었다. (p<0.05). Tega에 의한 결장운동 증가효과는 ATR에 의해 억제 되었으나 TTX, propranolol, phentolamine과 hexamethonium의 전처치 후에는 억제되지 않았다. 결론 : Tega는 근위부 및 원위부 결장 운동을 증가시켰으며 이러한 작용은 TTX-민감성 신경전도와 관련 없이 직접 국소적 콜린동작성 무스카린 수용체를 통해 작용할 것으로 판단된다. Backgrounds/Aim: A 5-Hydroxytrypatmine4 (5-HT4) partial agonist, Tegaserod (Tega), stimulated the peristaltic reflex in vitro and increases canine intestinal and colonic motility and transit. The objectives of this study were to investigate the action mechanism of Tega on colonic motility using a vascularly perfused rat colon. Methods: Thirty three Sprague-Dawley rat colons with attached superior mesenteric arteries (SMA) were isolated. Tega was administered to SMA and the intraluminal pressures were monitored in the proximal and distal colon of them. Phentolamine, propranolol, hexamethonium, atropine (ATR) or tetrodotoxin (TTX), 140 of pM Tega administered and the pressures were monitored. Results: Contractile responses were increased significantly by Tega at concentrations of 10, 70, 140 and 1400 pM in the proximal colon (40±20.17, 101±92.43, 122±120.57 and 101±89.05%, respectively) and in the distal colon (20±22.05, 73±41.47, 93±75.45 and 73±54.91%, respectively)(p<0.05). In particular, the stimulating effects of Tega on colonic motility were more potent in the proximal colon than in the distal colon. In addition the motility of the distal colon was increased by Tega in a concentration-dependent manner at concentrations of 10, 70 and 140 pM (P<0.05). The effect of Tega was inhibited by ATR but not by other drugs in the proximal and distal colon. Conclusions: Tega increased colonic motility in vascularly perfused rat colon. The activation of the muscarinic receptor rather than by TTX-senstive nerve conduction might be responsible for the excitatory effect of Tega on colonic motility in rats.
고혈압 임부에서 24 시간 활동 중 혈압 측정의 임상적 유용성
전현정(Hyeon Jeong Jeon),고병성(Byeong Seong Ko),곽남주(Nam Ju Kawk),김도형(Do Hyeong Kim),배장환(Jang Hwan Bae),김동운(Dong Woon Kim),남기병(Gi Byoung Nam),조명찬(Myeong Chan Cho),정은환(Eun Hawn Jeong) 대한내과학회 1998 대한내과학회지 Vol.55 No.1
Objectives: In the third trimester hypertensive pregnancies, we would like to evaluate effects of white coat hypertension, severity of hypertension and diurnal variation of blood pressure on the fetal outcome by using 24-hour ambulatory blood pressure monitoring. Methods: Hypertensives(n=50) and normotensives (n=14) in the third trimester of the pregnancy underwent 24-hour ambulatory blood pressure monitoring. We excluded hypertensives(n=5) who became pre-eclampsia patients. Hypertensives(n=45) were classified as white coat hypertensives(n=14, mean ambulatory blood pressure <139/87mmHg) and sustained hyprtensives(n=31). Sustained hypertensives(n=31) were divided as moderate to severe hypertensives(n=5, systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100mmHg ) and mild hypertensives(n=26). Sustained hypertensives were also divided into two grwps which had diurnal variation of blood pressure or not. To exclude effects of hypertension severity, effects of diurnal variation wane evaluated in hypertensives with similar mean arterial blood pressure. Gestational age, body weight, body weight for gestational age were used as parametars of the fetal outcome. Results : 1) The prevalence of white coat hypertension was 28%(14/50). 2) There were no significant differences in the fetal outcome between normotensives(n=14) and white coat hypertensives(n=14). 3) Body weight of fetus and body weight for gestational age in moderate to severe hypertensives(n=5) were less than those of mild hypertensives(n=26), but gestational age was not significantly different between two groups. 4) Body weight of fetus and body weight for gestational age in sustained hypertensives without diurnal variation(n=10) were less than those with diurnal variation(n=8), but gestational age was not significantly different between two groups. 5) All hypertensives who became pre-eclampsia (n=5) were severe hypertensives and had no diurnal variation of blood pressure. Conclusion: White coat hypertension in the third trimester was quite often and did not affect on the fetal outcome. The more severe hypertension and/or absence of diurnal variation of blood sure caused poor fetal outcome. Patients who became pre-eclampsia were severe hypertensives and had no diurnal variation of blood pressure. Ambulatory blood pressure monitoring may have several roles in the antenatal management of hypertenison.
장 게실염에 동반된 녹농균 패혈증에 의한 문맥염 및 간 농양 1예
문윤권 ( Yoon Gwon Mun ),손성완 ( Seong Wan Son ),김민아 ( Minah Kim ),김인수 ( Insoo Kim ),김용희 ( Yong Hee Kim ),정일순 ( Il Soon Jung ),고병성 ( Byeong Seong Ko ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.6
Pylephlebitis, or suppurative thrombophlebitis of the portal venous system, is a rare condition occurring secondary to abdominal infections such as diverticulitis. Pylephlebitis can be diagnosed via ultrasonography or CT scan, and is characterized by the presence of a thrombus in the portal vein and bacteremia. However, the diagnosis may be delayed due to the vague nature of the clinical symptoms, causing morbidity and mortality due to pylephlebitis to remain high. Early diagnosis and immediate antibiotic therapy are important for favorable prognosis. Therefore, pylephlebitis should be considered in the differential diagnosis for cases of nonspecific abdominal pain and fever. We report a case of pylephlebitis secondary to diverticulitis, associated with Pseudomonas aeruginosa sepsis. Such cases have not been widely reported. (Korean J Gastroenterol 2016;67:327-331)
내시경 역행 담췌관 조영술 중 발견한 팽대부 주위 게실 출혈의 성공적인 지혈
박보근 ( Bo Geun Park ),유영욱 ( Young Wook Yoo ),송준철 ( Joon Cheol Song ),감성희 ( Sung Hee Gam ),김미성 ( Mi Sung Kim ),고병성 ( Byeong Seong Ko ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.3
Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications. (Korean J Gastroenterol 2016;67:146-149)
정지봉(Ji Bong Jeong),양용모(Youg Mo Yang),전원중(Won Joong Jeon),서정철(Jeong Chul Seo),이경수,이현희(Hyun Hee Lee),고병성(Byeong Seong Ko),채희복(Hee Bok Chae),박선미(Seon Mee Park),윤세진(Sei Jin Youn) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
N/A Background/Aims: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. Methods: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean±SE%) over the basal period in response to a meal. Results: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal Ml during the first 30 min after the meal are significantly increased (p<0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62±18 in A, 29±18 in B, 12±8 in C and 306±l02% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p<0.05). 3) In B and C, the percentage changes in the l MI during the first 30 min after the meal in the descending colon were 105±38, 11±7, respectively, which shows a significant difference between the two groups (p<0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62±18, 12±8, respectively, which shows a significant change between the two groups (p<0.05). Conclusion: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome. (Korean Journal of Gastrointestinal Motility 2(00;6:20-31)
Slipped Capital Femoral Epiphysis 를 동반한 Kallmann`s Syndrome 1예
김도형,고병성,전현정,배장환,오태근,강승백 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.3
The Kallmann's syndrome is the most common form of isolated hypogonadotropic hypogonadism in which anosmia or hyposmia resulting from agenesis of hypoplasia of the olfactory lobes is associated with LHRH deficiency, This syndrome is genetically heterogeneous and can be trans-mitted as an X-linked, autosomal dominant or autosomal recessive trait. The hypogonadotropic hypogonadism results in absent or incomplete pubertal development and may be associated with anosmia or hyposmia, mid-line defect(color blindness, cleft-lip or -palate, unilateral renal agenesis, nerve deafness), cryptorchidism and skeletal abnormalities. The slipped capital fernoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate. The clinical association between slipped capital femoral epiphysis and endocrine disorder. We experienced a case of the slipped capital femoral epiphyis associated with Kallmanns syndrome in a 17 years old male(J Kor Soc Endocrinol 11:318-323, 1996).