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알코올성 간경화증에 동반된 상행 결장의 정맥류 출혈 1예
김흥업 ( Heung Up Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김봉수 ( Bong Soo Kim ),강영준 ( Young Joon Kang ),이재천 ( Jae Chun Lee ),김광식 ( Kwang Sik Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2
간경변증이나 문맥 고혈압에 의한 정맥류 출혈은 주로 식도와 위에 발생하나 일부에서는 소장과 대장 등에서도 발생할 수 있다. 대장의 정맥류 출혈은 주로 직장과 맹장에 발생하며 국내에서는 좌측 대장에 발생된 소수의 예만 보고되었고, 아직 상행 결장의 정맥류 출혈은 보고된 바 없다. 알코올성 간경변증으로 의심되는 43세 남자 환자가 대량의 혈변으로 내원하였고, 복부 전산화단층촬영 및 혈관조영술로 상행 결장의 정맥류를 확인하고 우 결장반절제술을 시행하였고, 수술 후 지혈되었으며 수술 검체에서 정맥류에 의한 출혈이 확인되었다. 저자는 43세 남자 환자에서 발생한 알코올성 간경화증에 의한 상행 결장의 정맥류 출혈을 문헌고찰과 함께 보고하는 바이다. We report a very rare case of colonic varix with massive bleeding. A 43-year-old male patient was transferred to our hospital for hematochezia. The patient had a history of chronic liver disease associated with alcohol use. The initial blood pressure was 93/73 mmHg, and the hemoglobin level was 8.4 g/dL. Severe hepatomegaly and periportal fatty infiltration were seen on abdominal computed tomography. Markedly ectatic veins protruded from the luminal side of the proximal ascending colon and drained to the dilated ileocecal and retroperitoneal veins. Emergent colonoscopy failed because of continuous hematochezia and hypovolemic shock, despite massive transfusion. Markedly dilated colonic varices were noticed around the ileocecal and ascending colon on superior mesenteric arteriography. An emergent right hemicolectomy was performed. The presumed bleeding focus was a protruding varix with a red clot on the top of a denuded vein on the anteromedial wall of the proximal ascending colon. (Korean J Med 75:215-220, 2008)
충수 기시부의 대장형 선암과 동시 발견된 대장암 및 충수 점액종
김흥업(Heung Up Kim),정인호(In Ho Jeong),강현욱(Hyun Wook Kang),김지훈(Ji Hun Kim),고형석(Hyoung Suk Ko) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.6
Primary adenocarcinoma of the appendix is an extraordinarily rare tumor, with fewer than 500 cases described in the collected world literature. However, it has been shown that the incidence of secondary neoplasm, such as synchronous or metachronous lesions, for primary adenocarcinoma of the appendix is much greater than that for colorectal cancer in general. In the present paper, the authors report a case of a 72-year-old male patient with immunoreactivity for P 53 and DCC protein and a review of the literature, who was operated on for an appendiceal orifice cancer and in whom colonic adenomas, a synchronous colon cancer and an appendiceal mucocele, was incidentally discovered after right hemicolectomy.
우측 대장에서 대장내시경 후굴에 의한 추가적인 폴립 발견율
김흥업 ( Heung Up Kim ),부선진 ( Sun Jin Boo ),나수영 ( Soo Young Na ),송현주 ( Hyun Joo Song ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.2
Background/Aims: There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. Methods: Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. Results: The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p<0.01). There were no RF associated perforation or severe complication. Conclusions: Using RF examination, additional 4.88% of polyps could be detected in the RC. This technique could be a useful and safe method to detect hidden polyp during colonoscopy.
항혈소판제를 복용한 환자에서 내치핵에 의한 생명을 위협하는 다량의 하부위장관 출혈
김미연 ( Mi Yeon Kim ),송현주 ( Hyun Joo Song ),김성현 ( Sung Hyun Kim ),조유경 ( Yoo Kyung Cho ),김흥업 ( Heung Up Kim ),송병철 ( Byung Cheol Song ),장원영 ( Weon Young Chang ),김승형 ( Seung Hyoung Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4
A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.
제주 지역에서 23S rRNA 점 돌연변이와 관련된 Clarithromycin 내성 Helicobacter pylori
김태윤 ( Taeyun Kim,),송현주 ( Hyun Joo Song ),신선영 ( Sun Young Shin ),김조헌 ( Jo Heon Kim ),나수영 ( Soo Young Na ),부선진 ( Sun Jin Boo ),최은광 ( Eun Kwang Choi ),조유경 ( Yoo Kyung Cho ),김흥업 ( Heung Up Kim ),송병철 ( Byu 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5
Background/Aims: The point mutations in 23S rRNA gene accounts for the majority of the clarithromycin resistance of Helicobacterpylori. This study aimed to investigate the association between the clarithromycin-resistance of H. pylori and the failure of primary H. pylori eradication therapy in Jeju Island. Methods: Between April 2011 and October 2012, 6,937 patients underwent endoscopy, and H. pylori infection was evaluated in 2,287 patients (33.0%). Total of 110 patients with H. pylori infection were treated with proton pump inhibitor (PPI)-based triple therapy. The result of eradication was evaluated with urea breath test, histology and PCR which were conducted 4 weeks from the last dose of medicine. Results: The patients who had point mutations were 33 (26.0%). A2142G and A2143G mutations were observed in 10 patients (7.9%) and 23 patients (18.1%). Among 110 patients treated with PPI-based triple therapy, the success rate of the eradication therapy was 52.7% (58/110) and 70.7% (58/82) by intention-to-treat and per-protocol analysis, respectively. Fifteen of the 24 patients who failed the eradication therapy showed point mutations; 1 patient (4.2%) showed A2142G mutation and 14 patients (58.3%) showed A2143G mutation. Patients with A2143G mutation H. pylori showed higher failure rate of 87.5%. Patients with A2142G mutation H. pylori showed similar failure rate compared to those of the patients with wild type H. pylori. Conclusions: In Jeju Island, the frequency of 23S rRNA point mutations is similar (26.0%) with other regions of Korea (15.8-31.3%). A2143G mutation is associated with the failure of H. pylori eradication.
허동진(Dong-Jin Hur),김흥업(Heung-Up Kim),강현욱(Hyun-Wook Kang) 대한체질인류학회 2008 해부·생물인류학 (Anat Biol Anthropol) Vol.21 No.3
제주지역거주민 머리뼈의 형태학적 특징을 파악하고, 한국 및 동북아시아 인접국가와 비교분석하여 체질 인류학적 차이를 알아보고자 한다. 제주지역거주민으로 2005년 7월부터 2007년 8월까지 뇌혈관조영 및 머리뼈 부위를 대학병원에서 다중검출전산화단층촬영기로 촬영된 20세 이상 정상성인 200명의 3차원 영상을 대상으로 하였다. 머리뼈 계측항목에서 아래턱뼈가지 최소너비와 바닥점-위이틀앞점을 제외한 모든 항목에서 여자보다 남자의 평균값이 더 컸다(p<0.05) 최대머리뼈길이, 최대머리뼈너비, 최대머리뼈높이, 얼굴너비, 위얼굴높이, 코높이, 코너비, 코지수, 머리뼈길이너비지수, 머리뼈걸이높이지수, 머리뼈너비높이지수의 11항목을 이용하여 비교항목이 유사성을 기초로 비슷한 것끼리 그룹으로 분할하는 군집분석한 결과 3개의 그룹(중국인과 일본인 그룹, 한국인과 제주지역거주민 그룹, 몽골인 그룹)으로 분류하였다(p<0.05). 머리뼈길이너비지수를 이용하여 제주지역거주민의 머리모양 분포는 긴머리형 (1.0%), 중간머리형 (13.5%), 짧은머리형 (42.0%), 아주짧은머리형 (43.5%)의 결과로 나타났고 남녀의 빈도는 유의한 차이를 보이지 않았다. 머리뼈의 크기는 인구집단 및 개인에 따라 차이가 있다는 사실을 확인하였고, 제주지역거주민의 체질인류학적 특징은 한국인과 밀접한 관계가 있다고 사료된다. The purpose of this study was to grasp the morphological characteristics of Jeju population's skulls and investigate the differences of the anthropological characteristics in comparison with those of several samples from the Northeast Asia and Korea. Data analysis has been carried out on the skull and angiographic of two hundred normal adults that had been taken with the multidetector-row computed tomography at Jeju National University Hospital between July, 2005 and August, 2007. The results were as follows. Out of the 30 criteria of the skull metric traits, 28 show measurement differential between male and female. The mean of man was greater than that of woman (p<0.05). The groups were classified into three categories: Chinese and Japanese group, Korean and Jeju population group, Mongol group as the result of the group analysis using eleven data (maximum cranial length, maximum cranial breadth, maximum cranial height, facial width, upper facial height, nasal height, nasal breadth, nasal index, cranial length breadth index, cranial length height index, and cranial breadth height index). There were four types dolichocrany (1.0%), mesocrany (13.5%), brachycrany (42.0%), hyperbrachycrany (43.5%) of skull in Jeju populations using the cranial length breadth index (p<0.05) and sex of skull types were not significant. We confirmed the difference in the size of the skull according to the human community by race, nationality, region and sex. There was close correlation between Korean and Jeju population of anthropological characteristics.
부선진 ( Sun-jin Boo ),김흥업 ( Heung Up Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1
The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications. (Korean J Gastroenterol 2018;72:1-5)