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식도정맥류 출혈의 고위험군에서 예방적 내시경적 결찰요법과 B-blocker 투여의 비교 : 무작위 전향적 연구 a Randomized Prospective Study
김인호,송일한,류센,노임환,최정 대한소화기학회 1999 대한소화기학회지 Vol.34 No.2
Background/Aims: The prophylactic management for first bleeding in cirrhotic patients with esophageal varices is still debated. The aim of present study was to compare the outcomes of the prophylactic endoscopic variceal ligation (EVL) and propranolol administration for prevention of first bleeding in cirrhotic patients with high-risk esophageal varices. Methods: We performed a prospective, randomized trial for 61 cirrhotic patients with high-risk esophageal varices. The patients were divided into two groups: the EVL-treated group (31 cases) and the propranolol-administrated group (30 cases). Patients with history of esophageal variceal bleeding, hepatocellular carcinoma, and cardiopulmonary diseases were excluded in this study. Results: In 6 (19.4%) of the EVL-treated group and 7 (23.3%) of the propranolol-administered group, gastrointestinal bleeding occurred during follow-up. The cumulative variceal bleeding rates in the EVL group at 2 weeks, 6 months, 1 year was 3.2, 3.2, 9.7%, respectively, while that in propranolol group was 0, 10, 20%. The cumulative survival rate in EVL group at 6, 12, 18 months was 93.5, 90.3, 83.9%, respectively, while that in propranolol group was 90, 83.3, 73.3%. Conclusions: This study showed that in cirrhotic patients with high-risk esophageal varices, the prophylactic EVL tends to decrease the incidence of first variceal bleeding and death, compared with the -blocker administration. However, to confirm these results, the statistical significance for outcomes of the both treatment modalities should be assessed through the long term follow-up.
대장종양의 조직병리학적 소견과 선구 형태(Pit Pattern)의 비교
김정원,이우진,임창영,송일한,류센,강남용,허재형,진영주,노임환,고재향 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.6
Background/Aims: To investigate the morphological and histopathological associations between an individual pit seen on stereomicroscopy or magnifying colonoscopy and an individual crypt seen in histological sections of colorectal tumors. Methods: Fifty two colorectal lesions were examined by colonoscopy. The mucosal pits of the lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after administering indigo carmine spray. The pits of the excised specimens were observed by using a stereomicroscopy after 0.2% cresyl violet stain. The pit patterns were classified into six types: normal round pit (I); asteroid pit (II); small round pit (IIIs); large tubular pit (IIIL); gyrus-like pit (IV); and non-structural pattern or amorphysm (V). Histologic diagnoses were determined by H&E staining under light microscopy. Results: The histologic findings according to the pit patterns were 1 chronic nonspecific inflammation and 1 submucosal tumor in 2 cases with type I pit pattern; 4 hyperplastic polyps in 4 cases with type II; 1 hyperplastic polyp, 16 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 1 carcinoma in situ in 21 cases with type IIIL; 4 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 4 carcinoma in situ in 11 cases with type IV; 1 adenoma with low-grade dysplasia in 1 case with type II IIIL; 3 adenomas with low-grade dysplasia, 4 adenomas with high-grade dysplasia, and 2 carcinoma in situ in 9 cases with type IIIL IV; 1 adenoma with high-grade dysplasia, 2 carcinoma in situ, and 1 adenocarcinoma in 4 cases with type IV V. In assessing the histologic findings according to pit pattern by stereomicroscopy, the overall diagnostic predictive value was 82.6% (43/52), and the diagnostic accuracy in differential diagnosis between nonneoplastic and neoplastic lesions was 98% (51/52). The ratio of agreement of the pit pattern between the magnifying colonoscopy and the stereomicroscopy was 68% (17/25). Conclusions: The results suggest that there was a close correlation between the pit patterns and the histologic findings of colorectal tumors, and that the observation of pit patterns of colorectal lesions provides a differential diagnosis between neoplastic and nonneoplastic lesions.
Trichosporon cutaneum에 대한 침강 항체 양성인 과민성 폐렴 1 례
박재석,이계영,홍천수,김건열,박중원,지영구,류센,오형태,전용,황영준 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.6
A 25-year-old woman complaining of dyspnea on exertion, coughing, fever and chills was admitted in January, 1998. Her clinical, radiological, and pathological findings were compatible with hypersensitivity pneumonitis and precipitin antibody to Trichosporon cutaneum was detected in her serum. Although some cases of T. cutaneum-induced hypersensitivity pneumonitis developed during the winter season were reported in Japan, there had been no report of such a case in Korea. This case suggests that T. cutaneum-induced hypersensitivity pneumonitis can develop beyond the summer season in certain environments.