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신운건 ( Woon Geon Shin ),박철희 ( Cheol Hee Park ),정재원 ( Jae One Jung ),문준호 ( Joon Ho Moon ),김경오 ( Kyoung Oh Kim ),정용우 ( Yong Woo Chung ),백광호 ( Gwang Ho Baek ),한태호 ( Taeho Hahn ),유교상 ( Kyo Sang Yoo ),박상훈 ( 대한장연구학회 2006 Intestinal Research Vol.4 No.1
목적: 허혈성 대장염은 허혈성 장질환 중에 가장 흔한 질환으로 자연 치유되는 경우부터 수술이 필요한 경우까지 다양한 임상 경과를 나타낸다. 하지만 보존적 치료에 반응하지 않는 환자를 예측할 수 있는 인자에 대한 연구는 부족한 실정이다. 본 연구에서는 허혈성 대장염의 예후 인자를 알아 보고 허혈성 대장염에서 고해상도 초음파의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 1999년 4월부터 2004년 3월까지 대장에 국한된 허혈성 대장염을 진단 받은 60명의 환자를 대상으로 하였다. 보존적 치료로 호전된 예후가 좋은 군과 수술적 치료가 필요했거나 사망한 예후가 나쁜 군으로 나누어 나이, 성별, 증상, 복수의 유무, 재원기간, 동반 질환, 침범한 결장의 위치를 비교하였고 고해상도 초음파로 얻은 병변의 위치와 심한 정도를 대장내시경 소견과 비교하여 고해상도 초음파 검사의 민감도, 특이도, 양성예측도, 음성예측도를 계산하였다. 결과: 수술하거나 사망한 군의 평균 나이는 72세로 보존적 치료군의 56세보다 통계학적으로 의미 있게 많았고(p=0.017), 병변 부위가 우측 대장인 경우에 수술하거나 사망한 환자들이 많았다(p=0.001). 혈변이 있었던 환자는 보존적 치료로 호전되는 경우가 많았다(p=0.017). 로그회귀분석 결과에서 병변부위가 우측 대장에만 국한된 경우가 독립적인 불량한 예후 인자였다(95% confidence interval), 1.7- 46.4; p=0.01). 고해상도 초음파는 민감도 85%, 특이도 82%였는데 특히 맹장과 상행결장의 병변에 대한 민감도는 100%였다. 양성예측도와 음성예측도는 각각 74%와 90%이었다. 결론: 우측 대장을 침범한 허혈성 대장염은 독립적인 불량한 예후 인자였으며 고해상도 초음파는 우측 결장의 허혈성 병변을 평가하고 추적 관찰하는데 유용한 검사법이었다. 따라서 심한 허혈성 대장염이 의심되는 환자의 초기 검사로 S상결장경 검사와 고해상도 초음파 검사를 병행하는 방법도 유용할 것이라고 생각한다. Background/Aims: Although the majority of ischemic colitis have excellent prognosis by supportive management, there are a lot of controversies in relation to the prognostic factors. Lately, role of sonography has been emphasized in colonic ischemia. The aim of this study is the identification of the prognostic factors and the usefulness of high-resolution ultrasonography in detecting involved site and severity of ischemic colitis. Methods: The clinical databases were reviewed between April 1999 and March 2004. 60 cases were diagnosed as ischemic colitis. Clinical characteristics, coexisting illness, segment of colon involved, and sonographic finding were analyzed. Results: The poor prognosis group was significantly older than the good prognosis group (p=0.017). The difference in involved colonic segment between the two groups was statistically significant (p=0.001). However, in logistic regression, only right colonic involvement was an independent poor prognostic factor (95% confidence interval, 1.7-46.4; p=0.01). Ultrasonography had a sensitivity of 85% and a specificity of 82%. Conclusions: Only right colonic involvement was an independent poor prognostic factor. Noninvasive high-resolution ultrasonography was a valuable technique for the detection and the follow-up of colonic ischemia. Therefore, sigmoidoscopy and sonography are preferable to heavy going colonoscopy in severe colonic ischemia. (Intestinal Research 2006;4:32-38)
대장암 및 대장용종 환자에서 상부위장관 병변의 동반 빈도
신운건(Woon Geon Shin),김학양(Hak Yang Kim),허필석(Pil Seog Heo),이자영(Ja Young Lee),김억(Aukk Kim),김진봉(Jin Bong Kim),서중산(Joong San Suh),이진헌(Jin Hyon Lee),김종혁(Jong Hyeok Kim),장웅기(Woong Ki Chang),김동준(Dong Joon Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.5
Background/Aims: It is unclear whether further evaluation for upper gastrointestinal tract is needed in the patients with colorectal lesions. We conducted this study to investigate the prevalence of simultaneous upper gastrointestinal lesion in the patients with colon cancer or polyp. Methods: Data of 904 consecutive patients who received both colonoscopic and gastroduodenoscopic examination from July 1997 to August 2000 were analyzed retrospectively. Gastroduodenal mucosal lesions such as gastric ulcer, duodenal ulcer, gastric polyp or gastric cancer were classified as clinically significant lesions. We compared the prevalence of upper gastrointestinal mucosal lesions between the patients with and without colonic lesions. Results: Fifty-five (25.9%) of 212 patients with colonic lesions and 87 (12.6%) of 692 patients without colonic lesions had simultaneous gastroduodenal lesions. The patients with colonic polyp or cancer had more gastroduodenal lesions than those without colonic lesions (p<0.05). According to histologic finding of colonic lesion, the prevalence of gastroduodenal lesions was higher in the patients with hyperplastic polyp (p<0.05) and tubular adenoma (p<0.05) than in the patients without colonic lesions. Conclusions: It is suggested that many of the patients who have colonic hyperplastic polyp and tubular adenoma may have simultaneous colonic and gastroduodenal lesions. Therefore, upper gastrointestinal endoscopy should be performed in the patients with colon neoplasia. (Korean J Gastroenterol 2001;38:336-341)
소화성궤양 가이드라인 특수한 질환에서 소화성궤양 치료의 가이드라인
김지현 ( Ji Hyun Kim ),문정섭 ( Jeong Seop Moon ),지삼룡 ( Sam Ryong Jee ),신운건 ( Woon Geon Shin ),박수헌 ( Soo Heon Park ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.5
The pathogenesis, incidence, complication rates, response to acid suppression and Helicobacter pylori (H. pylori) eradication therapy in peptic ulcer associated with chronic disease such as liver cirrhosis, chronic renal failure, diabetes mellitus, and critically ill conditions are different from those with general population, so that the management strategies also should be differentiated. The eradication of H. pylori are not so effective for preventing recurrence of peptic ulcer in liver cirrhosis patients as shown in general population, and conservative managements such as preventing deterioration of hepatic function and decrease in portal pressure are mandatory to reduce the risk of ulcer recurrence. The standard triple therapy for H. pylori eradication are as effective in chronic renal failure patients as in normal population, but the frequency of side effects of amoxicillin is higher in the patients not receiving dialysis therapy. Delay in eradication therapy until beginning of dialysis therapy or modification of eradication regimen should be considered in such cases. High prevalence of asymptomatic peptic ulcers and increased mortality in complicated peptic ulcer disease warrant regular endoscopic surveillance in diabetic patients, especially with angiopathy. The prolongation of duration of eradication therapy also should be considered in diabetic patients with angiopathic complication because of lower eradication rate with standard triple regimens as compared to normal population. Prophylactic acid suppressive therapy is highly recommended in critically ill patients with multiple risk factors. Herein, we propose evidence-based treatment guidelines for the management of peptic ulcer disease in special conditions based on literature review and experts opinion. (Korean J Gastroenterol 2009;54:318-327)
이상호 ( Sang Ho Lee ),김형수 ( Hyoung Su Kim ),김성준 ( Sung Jun Kim ),신운건 ( Woon Geon Shin ),김경호 ( Kyung Ho Kim ),장명국 ( Myoung Kuk Jang ),이진헌 ( Jin Heon Lee ),김학량 ( Hak Yang Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2
Clostridial septicemia usually occurrs in patients with immunocompromised diseases such as diabetes and malignancy. Clostridial liver abscess is very rare but highly fatal. We experienced a case of Clostridial septicemia due to liver abscess in a 73-year-old man. He was presented with fever and chills. On admission, abdominal CT scan showed about 35 mm sized hypoattenuated lesion with multiple central air-bubbles. After the diagnosis of liver abscess, the patient underwent prompt empirical antimicrobial therapy and percutaneous drainage. In spite of early therapy, the patient had gone into shock and death.
Deflazacort로 성공적으로 치료한 결절성 다발성 동맥염
최종형 ( Jong Hyoung Choi ),김대훈 ( Dae Hoon Kim ),박성훈 ( Sung Hoon Park ),신운건 ( Woon Geon Shin ),이준호 ( Jun Ho Lee ),강인수 ( In Soo Kang ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3
Polyarteritis nodosa(PAN), a systemic vasculitis involving multiple organs including the nervous system, requires a long-term glucocorticoid therapy. Deflazacort is a synthetic glucocorticoid, which has been claimed to have less side effects, but its use for vasculitis has never been reported in the literature. We report a case of polyarteritis nodosa presenting with mononeuritis multiplex causing a left foot drop, which was successfully treated with deflazacort.
문준호 ( Joon Ho Moon ),박철희 ( Cheol Hee Park ),정재원 ( Jae One Jung ),신운건 ( Woon Geon Shin ),김종표 ( Jong Pyo Kim ),김경오 ( Kyoung Oh Kim ),한태호 ( Tae Ho Hahn ),유교상 ( Kyo Sang Yoo ),박상훈 ( Sang Hoon Park ),김종혁 ( 대한소화기학회 2006 대한소화기학회지 Vol.48 No.2
Colon cancer is the most serious intestinal complication in patients with Crohn`s disease. Although an association between Crohn`s disease and colon cancer has not been clearly defined, a number of studies in western countries reported an increased rate of colon cancer in patients with Crohn`s disease. In Korea, Crohn`s disease is rare when compared to western countries, and only a single case of colon cancer associated with Crohn`s disease has been reported. We recently experienced a 66-year-old women with colon cancer associated with Crohn`s disease. (Korean J Gastroenterol 2006;48:124-127)