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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
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)
김흥업 ( Kim Heung Eob ),김영호 ( Kim Yeong Ho ),최원혁 ( Choe Won Hyeog ),김정환 ( Kim Jeong Hwan ),육청미 ( Yug Cheong Mi ),이재욱 ( Lee Jae Ug ),심상군 ( Sim Sang Gun ),손희정 ( Son Hui Jeong ),이풍렬 ( Lee Pung Lyeol ),김재준 대한소화기학회 2003 대한소화기학회지 Vol.42 No.5
In western countries, symptomatic diverticulitis develops in about 20% of the population with colonic diverticula, and it is mainly located at the left-sided colon. The clinical characteristics of diverticulitis have rarely been investigated although its incidence is increasing in Asia including Korea. The aim of this study was to compare diverticulitis with asymptomatic diverticulosis and to compare the clinical characteristics of right-sided diverticulitis with those of left-sided diverticulitis. Methods: We retrospectively investigated the medical records of the patients who had symptoms and signs of diverticulitis. Their diagnosis was confirmed with computed tomography, barium study, colonoscopy and/or operations at Samsung Medical Center from September 1998 to February 2002. The control cases of asymptomatic and incidental diverticulosis were randomly selected during routine health check-up after matching age and sex. Results: Twenty-seven patients with diverticulitis (male:female=14:13) were included. The mean age was 53 (27~86). The ratio of right and left diverticulitis was 20:7, which was similar to the ratio of diverticulosis. The complications, especially perforation, were more frequent in the patients with left-sided diverticulitis (p<0.05). Conclusions: Colonic diverticulitis is more prevalent at the right colon and left colonic diverticulitis has more complications than right colonic diverticulitis in Korea. (Korean J Gastroenterol 2003;42:363-368)
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.
알코올성 췌장염 환자에서 흡수장애로 유발된 전신경화증과 유사한 경화부종 1예
김태윤 ( Tae Yun Kim ),김재왕 ( Jae Wang Kim ),김흥업 ( Heung Up Kim ),김진석 ( Jin Seok Kim ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.3
Scleroderma pathogenesis is the accumulation of extracellular matrix proteins and is a relatively rare connective tissue disorder characterized by skin fibrosis, obliterative vasculopathy, and distinct autoimmune abnormalities. However, many other clinical conditions known collectively as the scleroderma-like syndrome present with substantial skin fibrosis and may be confused with scleroderma, sometimes leading to an incorrect diagnosis. Due to this, early and correct diagnosis is very important to for appropriate treatment available for scleroderma-like syndrome. We report a rare case of scleredema mimicking systemic sclerosis with hypoalbuminemia induced by malabsorption in alcoholic chronic pancreatitis. In this case, the patient`s skin sclerosis and joint contracture dramatically improved after high dose steroid theraphy.
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.
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.
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.
급성 위확장증으로 발현된 신경성 식욕부진증 환자에서 발생한위 기종 1예
김태윤 ( Tae Yun Kim ),김흥업 ( Heung Up Kim ),송현주 ( Hyun Joo Song ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.5
Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum. (Korean J Gastroenterol 2012;60:315-319)