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Octreotide 치료로 종양크기가 감소된 갑상선자극호르몬분비 뇌하수체선종
정준근(Jun Keun Jung),조재화(Jae Hwa Cho),남문석(Moon Suk Nam),이경미(Kyung Mi Lee),권선옥(Sun Ok Kweon),남수연(Su Youn Nam),이은직(Eun Gig Lee),김경래(Kyung Rae Kim),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),김동익(Dong Ik Kim) 대한내과학회 1995 대한내과학회지 Vol.48 No.3
TSH-secreting pituitary adenomas are aggressive, invasive tumors due to their silent features and occasionally may have poor response to available surgical and medical treatments. Inappropriate release of thyrotropin by these tumors can result in hyperthyroidism. The management includes agents that selectively suppress TSH hypersecretion both in patients with TSH-secreting tumor in whom pituitary surgery was unsuccessful and in those with selective pituitary resistance to thyroid hormone action. Among such agents, somatostatin administration has proven to be effective in blocking TSH hypersecretion. We experienced a case of 55-year old female with hyperthyroidism due to TSH- secreting pituitary adenoma. We treated her with the long-acting somatostatin analogue, octreotide, which was administered by subcutaneous injection in doses of 150 ㎍ every 12 hours for first 30 days, and thereafter in doses of 200 ㎍ bid for next 3 months. Serum levels of thyrotropin were dramatically reduced and also tumor size was significantly reduced. We assert that a potent and long-acting analog of somatostatin administration is an effective treatment for patients with neoplastic inappropriate secretion of TSH disorder able to suppress TSH hypersecretion from the adenomatous thyrotrophs and to restore clinical and biochemical euthyroidism in such patients. So we present this case of TSH-secreting pituitary adenoma with a literature review.
서정건(Jung Kun Seo),정준근(Jun Keun Jung),정준표(Jun Pyo Chung),박효진(Hyo Jin Park),전재윤(Chae Yoon Chon),지훈(Hoon Ji),김기황(Ki Hwang Kim),지훈상(Hoon Sang Chi),정우희(Woo Hee Jung) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3
Castlemans disease is a rare, benign disorder of the lymphoid tissue, and refers ta a distinctive type of giant lymphoid hyperplasia that forms tumor-like masses in lymph nodes and, occasionally, in extranodal sites. Although the mediastinum is its the most common location, it also occurs, albeit rare, in other areas of the body, where lymph nodes are normally found. It is difficult to differentiate between Castlernans disease and other malignant lesions preoperatively. We report a case of a hyaline-vascular variant of Castlemans disease presenting as a solitary retroperitoneal mass in a 39 year old female patient. We also present the MR features, together with conventional radiologic imagings, which made it possible to diagnose Castlemans disease preoperatively, although the mass of the patient was in an unusual location, This report may provide information on differentiation between primary retroperitoneal malignancies and Castlemans disease. (Korean J Gastroenterol 1996; 28:462-468)
Helicobacter pylori 감염 환자에서 CagA 및 VacA의 혈청학적 인식과 혈청 Gastrin 및 Pepsinogen 농도와의 관계
김경철(Kyung Chul Kim),박효진(Hyo Jin Park),이홍우(Hong Woo Lee),정준근(Jun Keun Jung),정준표(Jun Pyo Chung),이관식(Kwan Sik Lee),전재윤(Chae Yoon Chon),이상인(Sang In Lee),박인서(In Suh Park) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1
N/A Background/Aims: Helicobacter pylori(H. pylori) infection is associated with increases in serum gastrin and pepsinogen(PG) in patients with gastritis and peptic ulcer disease. H. pylori strains show phenotypic heterogeneity in their ability to express CagA(cytotoxin-associated protein) and VacA(vacuolating cytotoxin), which are tbought to be virulence factors. The aim of the study was to investigate whether the biochemical(serum gastrin and PG) changes in H. pylori infection are related to the bacterial expression of CagA and VacA. Methods: The subjects were 80 patients who had underwent diagnostic esophagogastroduodenoscopy; 49 with functional dyspepsia(FD), 10 with gastric ulcer(GU), 10 with duodenal ulcer(DU) and 11 with gastric cancer(GC). H. pylori infection was assessed by rapid urease(CLO) test and histology. Bacterial expression of CagA and VacA was determined indirectly by assaying serum IgG antibodies to these proteins by Western blotting using a Helico Blot 2.0 kit. Basal serum levels of gastrin, PG I and PG II were determined by radioimmunoassay. Results: The serologic positive rate for CagA in H. pylori-positive patients with FD, GU, DU and GC, was 80%, 88%, 100% and 88% respectively. For VacA, positive rate was 41%, 38%, 88%, and 63%, respectively(FD vs DU, p<0.05). Serum level of gastrin and PG were increased in patients with H. pylori-positive FD, GU, DU, and GC compared with patients with H. pylori-negative FD. In the patients with H. pylori-positive FD(n=34), the changes of serum levels of gastrin and PG were more prominent in serologic type I(CagA+/VacA+) infection than either type II(CagA-/VacA-) or type III(CagA+/VacA-) infection, especially the increase in PG I level being significant, Serologic recognition of VacA was associated with increased levels of serum PG I and PG II, whereas serologic recognition of CagA had no significant relation to the changes in serum level of either gastrin or PG. Conclusions: Biocbemical changes in patients with H. pylori infection, especially the increase in serum PG I level, were prominent in serologic type I(CagA+/VacA+) infection. Serologic recognition of VacA, which was more prevalent among DU patients than among FD patients, was associated with increases in serum level of PG I and PG II. Serologic recognition of VacA, as well as the increased level of serum PG, may serve as useful serum markers to predict the clinical status of H. pylori infection.(Korean J Gastroenterol 1997; 29:25 - 34)
김인재(In Jai Kim),박효진(Hyo Jin Park),정준근(Jun Keun Jung),정준표(Jun Pyo Chung),전재윤(Chae Yoon Chon),박인서(In Suh Park) 대한소화기학회 1998 대한소화기학회지 Vol.30 No.2
Oropharyngeal dysphagia is characterized by difficulty in transfer of food frorn the mouth through the upper esophageal sphincter into the upper esophagus. Idiopathic pharyngeal <iyskinesia, such as pharyngeal paresis is a rare moiility disorder in oropharyngeal dysphagia. The most comrnon abnormality of pharynx is decreased amplitude of pharyngeal contraction, which result in misdirection of bolus into the nasal, oral, or laryngeal cavity, and finally lead to aspiration pneumonia. Treatment consists of maneuver to reduce pharyngeal stasis and enhance airway protection under the direction of a trained swallow therapist, We experienced a case of idiopathic pharyngeal dyskinesia of 75 years old male who was treated with physiologic technique. (Korean J Gastroenterol 1997; 30:257-261)
크롬친화성세포종과 비슷한 증상을 동반한 급성 간헐성 포르피리아
이병권(Byoung Kwon Lee),배희동(Hee Dong Bae),박효진(Hyo Jin Park),정준근(Jun Keun Jung),정준표(Jun Pyo Chung),이관식(Kwan Sik Lee),이상인(Sang In Lee),박인서(In Suh Park) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1
Acute intermittent porphyrla(AIP) is a disorder that results frorn partial deficiency of porpbobi- linogen dearninase an has varlable clinical manifestations, such as acute abdominal pain, vomiting, nausea, constipation, perlpheral neuropathy, seizure, abnormal psychic symptoms, respiratory failure, tachycardia, and hypertension. If cases present severe acute hypertension, their clinical signs may mimick pheochromocytoma and the diagnosis of AIP would be delayed. We experienced a case of acute intermittent porphyria presenting with acute hypertension, mimicking pheochromo- cytoma in a 35 year-old female patient. She had history of two admissions to different hospitals with acute hypertension and abdominal pain. An extensive investigations had been done but no specific diagnosis was made. She had previously responded well to atenolol but after continuous treatement this led to hypotention. Her blood pressure was 210/140mmHg in both arms at admision to this hospital. She complained of acute abdominal pain and constipation, and she also had psychotic episodes. She had intermittent severe hypertension with the feature of pheochro- mocytorna. Tests for pheochromocytoma(including 24h urinary catecholamines, clonidine-inhibition test) were negative. Apart from slightly increased urinary excretion of catecholamines on one occasion, her symptoms were provoked by starvation and emotional stress and neurologic exami- nation revealed peripheral neuopathy. A screening test for porphobilinogen was strongly positive, but tests for uroporphyrin and coproporphyrin were negative. AIP was confirmed by clinical features and increased 24 hour urine delta-aminolevulinic acid(60.2 mg/1). Also, screening test for porphobilinogen was strongly positive in her mother and her brother. Supportive treatment with high glucose solution infusion and cimetidine resulted in symptomatic recovery and she was discharged after being educated on precipitating factors. The presenting feature of acute hypertension in this case baffled several doctors and the diagnosis of AIP was long delayed. AIP should be considered as one of the differential diagnosis of acute hypertension, especially when pheochrornocytoma is suspected but cannot be demonstrated. (Korean J Gastroenterol 1997;29: 113- 117)