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위장관 소화성 궤양의 재출혈에서 반복적인 내시경적 지혈술의 유용성과 치료 실패의 예측인자
정재연(Jae Youn Cheong),이용찬(Yong Chan Lee),장혁재(Hyuk Jae Chang),송시영(Si Young Song),김원호(Won Ho Kim),한광협(Kwang Hyub Han),정재복(Jae Bock Chung),전재윤(Jae Yoon Chon),강진경(Jin Kyung Kang),박인서(In Suh Park),문영명(Young 대한소화기학회 2001 대한소화기학회지 Vol.37 No.5
Background/Aims: After endoscopic treatment of peptic ulcer bleeding, rebleeding occurs in 15 to 20 percent of patients. We investigated the factors predicting the failure of initial endoscopic treatment in patients with peptic ulcer bleeding and the usefulness of repeated endoscopic treatment in peptic ulcer patients with rebleeding after initial endoscopic treatment. Methods: Clinical data were retrospectively collected from 376 patients (311 males and 65 females, mean age 53.9 years) with peptic ulcer bleeding between June 1995 and May 1999. Results: Of 376 patients, rebleeding after initial endoscopic treatment occurred in 50 patients (13.3%). Eight patients who failed to initial endoscopic hemostasis underwent operation immediately. The presence of major stigmata on endoscopy (p=0.001) and shock at admission (p=0.001) were two significantly independent factors predictive of rebleeding after initial endoscopic treatment. Among the patients with rebleeding, repeated endoscopic treatment was successful in 26 patients (61.9%), but 16 patients (38.1%0 underwent salvage surgery due to the failure of hemostasis. Patients who did not respond to endoscopic retreatment were more likely to have ulcers ≥2 cm in diameter (p=0.027). Conclusions: Repeated endoscopic treatment can reduce the need for surgery. Ulcer size ≥2cm is an independent factor in predicting the failure of repeated endoscopic treatment in peptic ulcer patients with rebleeding. Therefore, surgery should be considered in the case. (Korean J Gastroenterol 2001;37:319-326)
만성 염증성 장질환 환자에서 항호중구 세포질 항체의 의의
문윤재(Yoon Jae Moon),배희동(Hee Dong Bae),박효진(Hyo Jin Park),김원호(Won Ho Kim),정석훈(Suk Hoon Chung),김현숙(Hyun Sook Kim),전재윤(Chae Yoon Chon),박인서(In Suh Park) 대한내과학회 1997 대한내과학회지 Vol.52 No.5
Objective: Anti-neutrophil cytoplasmic antibody (ANCA), known as a useful diagnostic marker in patients with ulcerative colitis (UC), are specific for granule proteins of granulocytes and monocytes and induce distinct fluorescence patterns. To evaluate the significance of ANCA in chronic inflammatory bowel disease (IHD), the presence of ANCA in chronic IBD was studied using indirect immunofluorescent test (IIF), Methods: Between March, 1994 and September 1995, 51 patients with chronic inflammatory bowel disease were subjected in this study. We had analysed the correlation between duration, disease activity, location by colonoscopy and radiologic examinations, steroid treatment. Results: 1) Among 34 patients with ulcerative colitis (UC), ANCA was demonstrated in 23 patients (67.6%). Among 19 patients with other chronic IBD (4 Crohn's disease, 6 Behcet's colitis, 7 intestinal tuberculosis and 2 radiation colitis) 2 patients (10.5%) had ANCA. The positivity of ANCA in patients with UC was significantly higher than in patients with other chronic IBD. 2) In patients with UC, c-ANCA was positive in 2 (5.9%) patients and p-ANCA was positive in 21 (61.8%) patients. In patients with other chronic IBD, ANCA was positive in one patient with Behcet's colitis or one patient with intestinal tuberculosis but negative in all patients with Crohn's disease or radiation colitis. 3) The mean duration of disease in ANCA positive patients was 42.4±39.4 months and the mean duration of disease in ANCA negative patients was 44.9±36.8 months, but there was no significant difference. 4) The number of patients in clinically mild, moderate and severe group were 23 (37.6%), 6 (83.2%) and 5 (14.7%) respectively. Among these groups the number of ANCA positive patients were 15 (65.2%), 5 (83.2%) and 3 (60%) respectively, but there was no significant difference. 5) The number of patients with proctitis, left side colitis and pancolitis were 9 (26.5%), 14 (41.2%) and 11 (32.4%) respectively, Among these groups the number of ANCA positive patients were 4 (44.4%), 10 (71.4%) and 9 (81.8%) respectively, but there was no significant difference. 6) Among 13 patients with steroid treatment 9 patients (69.2%) were ANCA positive. Among 21 patients without steroid treatment 16 patients (76.2%) were ANCA positive, but there was no significant difference. Conclusion: Although there was no correlation between ANCA and duration, disease activity, location or steroid treatment in UC patients, ANCA could be a diagnostic marker of UC in chronic IBD patients.
사염화탄소에 의해 활성화된 간성상세포에서 G1 Cyclin 및 Rb-E2F 의 발현과 비타민 E 의 효과
이광재(Kwang Jae Lee),이관식(Kwan Sik Lee),한광협(Kwang Hyub Hahn),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),오상환(Sang Hwan Oh),김호근(Ho Keun Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Background/Aims: It is obscure when the activation of hepatic stellate cells and the expression of its related factors occur in acute liver injury. Vitamin E is expected to prevent hepatic fibrosis. The aims of this study were to establish the model of hepatic stellate cell activation in acute liver injury and to confirm the effect of vitamin E for preventing hepatic fibrosis. Methods: Male Sprague-Dawley rats were classified into two groups. The one group received a single injection of CCl4 and the other group received injection of vitamin E daily and a single injection of CCl4. The serial changes of serum ALT, and [3H]thymidine uptake, α-SMA, cyclin D1, CDK4, cyclin E, CDK2, Rb, E2F-1 and NF-κB of stellate cells were measured. Results: The serial changes of serum ALT levels, [3H]thymidine uptake, and α-SMA positive cells showed maximum increase at 32 hours after CCl4 injection. However, they were significantly decreased with injection of vitamin E. CDK4, cyclin E and CDK2 showed definite band at 16, 32, 48 hours after CCl4 injection, which diminished or disappeared with injection of vitamin E. Cyclin D1, Rb, E2F-1 and NF-κB showed definite band at 32 hours after CCl4 injection, which also diminished or disappeared with injection of vitamin E. Conclusions: We established an in vivo model of hepatic stellate cell activation in acute liver injury and confirmed the effect of vitamin E in preventing hepatic fibrosis. (Korean J Gastroenterol 2001;38:262-269)
간세포암 환자에서 간동맥 화학색전술 후 발생한 급성 간부전의 위험인자
백용한 ( Yong Han Paik ),전재윤 ( Chae Yoon Chon ),조재용 ( Jae Yong Cho ),안상훈 ( Sang Hoon Ahn ),이관식 ( Kwan Sik Lee ),한광협 ( Kwang Hyub Han ),문영명 ( Young Myoung Moon ),이도연 ( Do Yeon Lee ),이종태 ( Jong Tae Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.6
Background : Transcatheter Arterial Chemoembolization (TACE) has been the most widely used treatment for advanced hepatocellular carcinoma (HCC) in Korea. However a number of complications associated with TACE have been reported in many studies. Acute hepatic failure is one of the most serious complications of TACE, because of its grave prognosis. The aim of this study was to investigate the risk factors associated with acute hepatic failure after TACE. Methods : A total of 263 TACE procedures performed in 163 patients with HCC were included in this study. We reviewed retrospectively the complications that occurred after TACE and analysed the risk factors associated with acute hepatic failure after TACE. Results : Complications included post-embolization syndrome (187 cases), temporary hepatic insufficiency (90 cases), acute hepatic failure (13 cases), hepatic arterial injury (9 cases), intrahepatic biloma (4 cases), liver infarction (2 cases), liver abscess (2 cases), tumor rupture (1 cases), gastrointestinal bleeding (14 cases), septicemia (3 cases), gall bladder infarction (2 cases), thrombocytopenia (2 cases), gastric perforation (1 cases), pneumonia (1 cases), urticaria (1 cases), sensorineural hearing loss (1 cases), femoral artery aneurysm (1 cases). According to univariate analysis, risk factors associated with acute hapatic failure after TACE were serum bilirubin and albumin, prothrombin time, dose of adriamycin, pre-TACE Child-Pugh class, tumor size, diffuse tumor type, portal vein thrombosis and TNM stage. Multivariate analysis revealed that serum bilirubin {odd ratio=3.86 (95% CI: 1.59-9.32)}, and diffuse tumor type {odd ratio=5.29 (95% CI: 1.46-23.86)} were statistically significant risk factors. Conclusions : It is recommended that above mentioned risk factors should be considered carefully before TACE to prevent the occurrence of acute hepatic failure after TACE in HCC patients.(Korean J Med 69:622-630, 2005)
경정맥 간내문맥 - 간정맥 단락술로 십이지장정맥류 대량 출혈을 성공적으로 치료한 1 예
윤영준(Young Joon Yoon),한광협(Kwang Hyub Hahn),이도연(So Yun Lee),백용한(Yong Han Paik),정재연(Jae Yeon Chung),김철(Chul Kim),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Duodenal varices can be resulted from either liver cirrhosis or extrahepatic portal hypertension. Bleeding from duodenal varices is rare but often severe and life threatening. Bleeding of duodenal varices can be treated with non-surgical or surgical treatment. Non-surgical treatments include endoscopic variceal ligation, endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Surgical treatments include shunt surgery, variceal ligation, variceal resection, and duodenectomy. However, endoscopic treatments are not so effective and surgical interventions have many limitations. A 68-year-old man with liver cirrhosis was admitted to our department and presented with mental change and melena. He received a large amount of transfusion and it was not possible to perform gastrointestinal endoscopy. Emergency angiography revealed marked dilatation of mesenteric veins, which was treated by TIPS. After TIPS, transfusion requirement was markedly reduced and gastrointestinal endoscopy demonstrated duodenal varices without bleeding. We conclude that TIPS may be an effective therapeutic option for control of hemorrhage from duodenal varices. (Korean J Gastroenterol 2001;38:292-295)
이차성 비기능항진증에서 부분적 비장동맥색전술의 장기 치료 효과
이중민 ( Jung Min Lee ),전재윤 ( Chae Yoon Chon ),한재용 ( Jae Yong Han ),윤기태 ( Ki Tae Yoon ),문창모 ( Chang Mo Moon ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),이종태 ( Jong Tae Lee ),문영명 ( Young Myoung Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
Background: Liver cirrhosis causes secondary hypersplenism and thrombocytopenia is clinically troublesome. Splenectomy (SPL) was thought to be the curative management for correcting thrombocytopenia. However, decompensated liver function prevents any surgical approach due to high morbidity and mortality. Hence, partial splenic embolization (PSE) has been introduced, which is a less invasive procedure. The purpose of this study was to assess the long-term therapeutic effects of PSE and to compare them with those of SPL. Methods: This study was performed retrospectively in patients who underwent PSE or SPL from Jan. 1999 to Dec. 2003. The patients either had symptoms of bleeding or they needed to correct their thrombocytopenia for further treatment of associated diseases. The therapeutic effects were evaluated, and the complications were assessed. Results: Forty and 35 patients were enrolled in the PSE and SPL groups, respectively. WBC, platelet and hemoglobin counts were all significantly increased at the 2 year follow-up in both groups. Child-Pugh score significantly decreased in the PSE group from 6.5 before treatment to 5.5 after treatment (p=0.004). Minor complications were easily controlled with supportive care, and major complications very rarely occurred in both groups. Conclusions: PSE and SPL both proved to be effective measures with few serious complications for treating pancytopenia in patients with liver cirrhosis. Considering the improved liver function (the prothrombin time) and the Child-Pugh score after PSE, it may be more reasonable to initially recommend PSE for the patients with liver cirrhosis and secondary hypersplenism. (Korean J Med 72:470-479, 2007)