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이항락 ( Lee Hang Lak ),전용철 ( Jeon Yong Cheol ),김진배 ( Kim Jin Bae ),박준용 ( Park Joon Yong ),한동수 ( Han Dong Soo ),손주현 ( Hyun Sohn Joo ),최호순 ( Choi Ho Soon ),함준수 ( Hahm Joon Soo ),장세진 ( Jang Se Jin ),박용욱 ( 대한소화기학회 2003 대한소화기학회지 Vol.42 No.1
Carcinoid tumors originate from the enterochromaffin cells in the gastrointestinal mucosa. Gastric carcinoids are rare and usually well-differentiated tumors with variable prognosis. Three types of gastric carcinoids have been recognized. Type I is associated with type A chronic atrophic gastritis, achlorhydria and pernicious anemia. Type II is associated with Zollinger-Ellison syndrome and multiple endocrine neoplasia type I. Type III appears as a large malignant neoplasm and has no association with atrophic gastritis or hypergastrinemia. We experienced a rare case of gastric carcinoid tumor type III with multiple liver metastasis. Thus, we report here this case with a review of the literature. (Korean J Gastroenterol 2003;42:81-85)
증례 : 소화기 ; 내시경 췌관 배액술로 완치된 췌장-흉막루
이항락 ( Hang Lak Lee ),이오영 ( Oh Young Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),정명호 ( Myung Ho Jeong ),심성곤 ( Sung Gon Shim ),조승철 ( Sung Cheol Jo ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
췌장-흉막 누공은 만성·급성 췌장염, 수술에 의한 합병증 또는 외상에 의해 일어날 수 있는 매우 드문 합병증이다. 췌장이 우측보다는 좌측 횡격막에 가깝게 위치하고 있기 때문에 흉막 삼출의 위치는 주로 좌측에 위치한다. 만성 췌장염의 합병증으로 흉막 삼출이 발생한 환자의 대부분은 복부 불편감과 같은 복부 증상을 호소하지만, 복부 증상없이 대량의 흉막 삼출이 발생한 경우에는 원인 규명을 위해 많은 검사가 필요하다. 저자들은 3년 전 알코올성 만성 췌장염으로 진단받고 약물 치료 중 기침 시 심해지는 흉통과 호흡곤란으로 내원한 56세 남자 환자에서 다량의 늑막 삼출을 동반한 췌장-흉막루를 진단하고 금식, 흉관삽입 등의 보존 치료 및 내시경 비-췌관 배액술 및 내시경 췌관 스텐트 삽입을 통해 치료한 증례를 경험하였기에 보고한다. A pancreaticopleural fistula is a rare complication of acute or chronic pancreatitis or traumatic destruction of the pancreatic duct. The pleural effusions related to pancreatitis are usually left-sided because the pancreas is closer to the left hemidiaphragm than to the right. A pancreatic pleural effusion is often misdiagnosed as pulmonary disease rather than abdominal disease because of the predominance of pulmonary complaints. After chest X-rays, the diagnosis is usually made on thoracentesis, when the pleural fluid contains markedly elevated amylase and lipase levels and a high albumin content. We report a case of pancreaticopleural fistula that presented with a huge pleural effusion as a complication of pancreatitis, and that was treated successfully with endoscopic nasopancreatic drainage and pancreatic duct stenting. (Korean J Med 77:S1148-S1152, 2009)
이항락 ( Hang Lak Lee ),손주현 ( Joo Hyun Sohn ),김진배 ( Jin Bae Kim ),한동수 ( Dong Soo Han ),전용철 ( Yong Chul Jeon ),함준수 ( Joon Soo Hahm ),이동후 ( Dong Hoo Lee ),기춘석 ( Chun Suk Kee ),박용욱 ( Yong Wook Park ) 대한소화기학회 2005 대한소화기학회지 Vol.46 No.3
Leiomyosarcoma is an uncommon tumor which arises from various sites including uterus, stomach, retroperitoneum, superficial soft tissues, bladder, kidney, and lung. Primary hepatic leiomyosarcoma is a very rare tumor and fewer than 70 cases of primary hepatic leiomyosarcoma have been reported since the first publication in Japan. And there was only one case report of cutaneous metastasis from hepatic leiomyosarcoma. We recently experienced a case of primary hepatic leiomyosarcoma presenting as subcutaneous palpable mass. Herein we report this case with a review of literatures. (Korean J Gastroenterol 2005;46:233-236)
독성 거대결장과 단백상실성 장병증 소견을 보인 위막성 대장염
이항락 ( Hang Lak Lee ),한동수 ( Dong Soo Han ),김진배 ( Jin Bae Kim ),박준용 ( Joon Yong Park ),전용철 ( Yong Chul Jeon ),손주현 ( Joo Hyun Sohn ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5
With increasing therapeutic and prophylactic use of antibiotics, Clostridium difficile colitis or antibiotics-induced colitis has become a major clinical problem. The clinical spectrum of presentation of antibiotics-induced colitis ranges from an asymptomatic carrier state to fulminant toxic colitis or toxic megacolon. Toxic megacolon and protein losing enteropathy have rarely been reported in the course of antibiotic-induced pseudomembranous colitis. We experienced a 68-year-old patient who was referred to our hospital due to abdominal distension, edema, fever, and diarrhea two days after spine operation. We could diagnose the case as toxic megacolon and protein losing enteropathy complicated by pseudomembranous colitis. After conservative management including removal of the offending antibiotics, bowel rest, and oral metronidazole, the patient completely improved. (Korean J Gastroenterol 2003;41:410-413)
비스테로이드 항염제에 의한 위장관 손상의 위험인자 및 연령의 중요성
이항락 ( Hang Lak Lee ),한동수 ( Dong Soo Han ),김진배 ( Jin Bae Kim ),김종표 ( Jong Pyo Kim ),전용철 ( Yong Chul Jeon ),손주현 ( Joo Hyun Sohn ),함준수 ( Joon Soo Hahm ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.5
Background/Aims: It is clinically important to analyze the risk factors of NSAID-induced gastropathy because there could be no symptoms. Age is the most important risk factor according to previous reports. The aim of this study was to find risk factors of
대장 선종의 위험 인자로 복부 비만 및 인슐린 저항성에 대한 연구
이항락 ( Hang Lak Lee ),손병관 ( Byoung Kwan Son ),이오영 ( Oh Young Lee ),전용철 ( Yong Chul Jeon ),한동수 ( Dong Soo Han ),손주현 ( Ju Hyun Sohn ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3
목적: 대장암은 유전 소인, 흡연, 음주, 식습관 등의 환경인자가 작용하여 발생하며 또한 비만, 고지혈증, 고혈당, 고인슐린 혈증 및 인슐린 저항성이 대장암의 발암과정과 연관이 있다. 다양한 비만 지표를 이용해서 대장 선종과 비만 및 인슐린 저항성과의 연관성을 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2004년 10월까지 한양대학병원에서 검진 목적으로 대장내시경검사와 기타 검사를 시행 받은 환자를 대상으로 전향적으로 환자 대조군 연구를 시행했다. 크기가 0.5 cm 이상이며 조직학적으로 대장 선종이 증명된 50명의 환자를 대상으로 했으며, 대조군은 동일 기간 중 대장내시경검사를 시행 받았으나 특이 병변이 없었던 자로 정했다. 결과: 인슐린, 공복혈당, 총 콜레스테롤, triglyceride, LDL, HDL 수치, 수축기 및 이완기 혈압은 환자군에서 모두 증가되었으나 환자군과 대조군 사이에 유의한 차이는 없었다. HOMA-IR은 환자군에서 인슐린 저항성 수치가 높았으나 통계적인 유의성은 없었다. 그러나 체질량지수, 복부 비만, 체지방, 비만도는 환자군이 대조군 보다 유의하게 높았다. 다변량 분석에서 복부 비만이 가장 의미 있는 위험 인자였으며 체질량지수가 증가함에 따라 대장 선종의 위험도도 증가했다. 체지방, 비만도 역시 중요한 위험 인자였다. 결론: 비만과 대장 선종의 연관성에서 복부 비만이 가장 중요한 위험 인자였으며 복강 내 지방조직이 중요한 역할을 할 것으로 기대한다. 향후 대규모의 환자 대조군 및 코호트 연구가 필요하며 복강 내 지방의 역할에 대한 분자생물학적인 연구가 필요하다. Background/Aims: Abdominal obesity and hyperinsulinemia or insulin resistance are of interest in connection with colon carcinogenesis. We conducted a prospective case controlled study for the evaluation of relationship between abdominal obesity, insulin resistance, and colorectal adenoma. Methods: Fifty patients with colorectal adenoma and fifty healthy subjects were included in this study. Total colonoscopic examinations were performed in all the subjects. Fasting blood sugar (FBS), insulin, homeostasis model assessment (HOMA-IR), triglyceride (TG), cholesterol (CROL), BMI (body mass index), WHR (waist hip ratio), percent body fat (PBF) and obesity degree (OD) were measured. HOMA-IR was considered to represent insulin resistance. Diabetic patients were excluded from this study. Results: There were no differences in sex, serum insulin, FBS, HOMA-IR, TG, CROL between adenoma and control group. Subjects with high BMI, WHR, percent body fat, and obesity were more likely to have colonic adenoma. Multiple logistic regression analysis after adjusting confounding factors, had revealed that WHR was the most important independent risk factor for colon adenoma. Conclusions: Abdominal obesity was most closely related to colonic adenoma. However, insulin resistance was not related to colonic adenoma. A larger case controlled study is needed. (Korean J Gastroenterol 2007;49:147-151)
대량 출혈을 동반한 공장의 Dieulafoy 병변 1 예
이항락(Hang Lak Lee),윤병철(Byung Chul Yoon),변태준(Tae Jun Byun),한호(Ho Han),전운현(Woon Hyun Jun),박준용(Joon Yong Park),이숭환(Soong Hwan Lee),은창수(Chang Soo Eun),이오영(Oh Young Lee),전용철(Yong Chul Jun),한동수(Dong Soo Han) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2
Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. However, it is clinically important in that it can be associated with recurrent and massive gastrointestinal bleeding. The bleeding results from an abnormal large submucosal artery. On endoscopy, a small mucosal defect with a protruding vessel or fresh clot may be visualized if the patient is actively bleeding. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, but similar lesions have been described in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We experienced one case of recurrent and massive bleeding from a proximal jejunal Dieulafoy's lesion, which was confirmed by the pathologic examination of the resected specimen. (Korean J Gastroenterol 2002;39:123-127)
한국 위암환자에서 개정된 UICC/AJCC 위암병기 7판이 과연 유용한가?
이항락 ( hang Lak Lee ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.5
The Comparison between 6th and 7th International Union Against Cancer/American Joint Committee on Cancer Classification for Survival Prognosis of Gastric Cancer (Korean J Gastroenterol 2011;58:258-263)