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한승효 ( Seung Hyo Han ),홍수진 ( Su Jin Hong ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.3
Transient lower esophageal sphincter (LES) relaxation (TLESR) is defined as LES relaxation without a swallow. TLESRs are observed in both of the normal individuals and the patients with gastroesophageal reflux disorder (GERD). However, TLESR is widely considered as the major mechanism of the GERD. The new equipments such as high resolution manometry and impedance pH study is helped to understand of TLESR and the related esophageal motor activities. The strong longitudinal muscle contraction was observed during development of TLESR. Most of TLESRs are terminated by TLESR related motor events such as primary peristalsis and secondary contractions. The majority of TLESRs are associated with gastroesophageal reflux. Upper esophageal sphincter (UES) contraction is mainly associated with liquid reflux during recumbent position and UES relaxation predominantly related with air reflux during upright position. The frequency of TLESR in GERD patients seems to be not different compared to normal individuals, but the refluxate of GERD patients tend to be more acidic during TLESR.
개회충증에 의한 심낭 삼출액을 동반한 급성 담낭염 1예
명유식,문종호,최현종,한승효,윤형근,이태훈,조영덕,박상흠,김선주 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1
서론: 내장유충이행증(visceral larva migrans)은 기생충의 유충이 장벽을 뚫고 간문맥이나 간조직에 침투하여 발생하는데 괴사, 간질성 부종,출혈, 육아종성 반응을 일으키며, 간 조직을 벗어나 눈, 중추 신경계, 심근, 폐 등을 침투하여 임상증상을 나타낼 수 있다. 이러한 내장유충이행증의 가장 일반적인 기생충은 개회충증(Toxocariasis)으로 알려져 있으며, 현재까지 국내문헌에 눈과 폐를 침범한 증례가 드물게 보고되었지만, 아직까지 개회충중에 의한 담낭이나 심낭의 침범은 보고된 바가 없다. 저자 등은 개회충증에 의한 현저한 호산구 증가 소견과 함께 심낭 삼출액을 동반한 급성 담낭염 1예를 경험하였기에 보고하는 바이다. 증례: 39세 여자 환자로 내원 4일전부터 발생한 발열을 동반한 우상복부 통증을 주소로 응급실에 내원하였다. 신체 검사에서 우상복부 압통, Murphy`s sign 양성 소견을 보였다. 검사실 소견에서 WBC11850/uL(호산구 l 7.2%), AST/ALT 44/39 IU/L, total bilirubin 0.76 mg/dL, ALP 67 IU/L r-GT 49 IU/L, ESR 6 mm/hr CRP 1.34 mg/dL보였으며 심전도에서는 정상 동성 리듬을 보였다. 복부 초음파 검사에서 담낭종대 및 담낭벽의 비후가 관찰되었고, 복부 전산화 단층촬영에서 낭종대 및 담낭벽의 비후 외에 중등도의 심낭 삼출액 소견이 관찰되었다. 급성 담낭염 진단하에 금식 및 항생제 치료 유지하였고 심낭 삼출액에 대해 심낭천자술 및 배액술을 시행하였다. 심낭 삼출액 분석에서 WBC 2640/mm3(호산구 47%) 소견보였고, 추적 말초혈액검사에서 WBC10160/uL(호산구 58%)로 호산구증가증이 관찰되었다. 호산구증가증에 대한 원인 감별을 위해 시행한 Toxocariasis canis ELISA 항체 검사에서 0.515 (양성판정기준;0.250)으로 양성소견을 보였다. 개회충증 진단 하에 albendazole 400 mg 하루 2회 7일간 복용하였고 환자의 우상복부통증 및 심낭 삼출 배액량이 현저히 호전되었다. 추적 혈액검사에서 호산구증가증 호전된 상태로 특이 증상없이 외래에서 경과 관찰 중이다. 결론: 저자들은 우상복부 통증을 주소로 내원한 환자에서 개회충증에 의한 급성 담낭염 및 심낭 삼출액 발생을 경험하였기에 보고하는 바이다.
28개월 다운증후군 유아의 총담관 담석을 내시경 유두 풍선확장술로 제거한 1예
강지헌,박도현,박정훈,오명호,한승효,안형수,이용하,박상흠,이석호,정일권,김홍수,김선주 대한소화기내시경학회 2006 Clinical Endoscopy Vol.33 No.2
Although cholelithiasis is an uncommon condition in infants, a recent study documented the increasing detection of this disorder. This increase may be explained by the wide use and improvement in abdominal ultrasound. Choledocholithiasis with cholestatic jaundice in infants usually requires therapeutic intervention, even though the incidence of spontaneous resolution has been reported to be higher in infants than adults. Choledocholithiasis in children has traditionally been managed surgically with open common duct exploration. Recently, endoscopic stone removal was accepted as a standard therapy in pediatric choledocholithiasis. We report a case of the successful removal of common bile duct stone using endoscopic papillary balloon dilation (EPBD), in a 28-month-old infant with Down's syndrome. (Korean J Gastrointest Endosc 2006;33:125-129) 영유아에서 담석증은 드문 질환으로 알려져 있지만 최근 복부초음파의 발달과 높은 이용률로 그 유병률은 증가되어 보고되고 있다. 영유아에서 총담관 담석은 대부분 무증상이고 성인과 달리 저절로 용해되어 자연소실되는 비율이 높지만 담즙정체성 황달을 보이는 경우에는 치료적 중재술을 필요로 한다. 전통적으로 영유아에서 발생한 총담관 담석은 수술로 치료하였으나, 최근 소아에서도 내시경을 이용한 비수술적 담석제거술이 표준치료로서 인정받고 있다. 저자들은 황달을 주소로 내원한 28개월 다운증후군 남아에서 총담관 담석을 진단하고 내시경 유두 풍선확장술을 이용하여 성공적으로 제거하였기에 문헌고찰과 함께 보고하는 바이다.
김화종,홍수진,전영우,한재필,한승효,강지현,태재웅,임희숙,김희경,고봉민,이문성 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.1
Background/Aims: The pathogenesis of bone loss in patients with inflammatory bowel disease (IBD) is complex, multifactorial, and only partly understood. We aimed to examine the extent and risk factors of bone mass reduction and to analyze the impact of early onset of a disease before attaining peak bone mass in IBD patients. Methods: We compared the risk factors for osteoporosis and BMD at the lumbar spine and the hip bone in IBD patients. Results: A total of 44 patients with IBD were enrolled. Twenty-one and 23 patients were diagnosed as IBD before and after the age of 30and designated as group A and group B, respectively. Group A had significant bone mass reduction at the lumbar spine than group B (BMD, 1.01±0.10 vs. 1.14±0.17, p<0.01; T-score, -1.22±0.84 vs. -0.08±1.39, p<0.01; Z-score, -1.11±0.81 vs. -0.03±1.32, p<0.01, respectively). Multivariate analysis showed that patients diagnosed as IBD before the age of 30 had possible risk factor of bone mass reduction (hazard ratio, 3.96; p=0.06). Conclusions: Bone mass reduction was more severe in patients who were diagnosed with IBD before the age of 30 than in those diagnosed after the age of 30.
Correlation of Narrow Band Imaging with Magnifying Colonoscopy and Histology in Colorectal Tumors
유희용,이문성,고봉민,김희경,안형수,한승효,배준용,민슬기,이종찬,유창범 대한소화기내시경학회 2011 Clinical Endoscopy Vol.44 No.1
Background/Aims: Narrow band imaging (NBI) is a new technique that uses optical filters for imaging of mucosal morphology. The aim of this study was to correlate findings of NBI with magnifying colonoscopy and histology for prediction of neoplastic colorectal lesion. Methods: Between September 2005 and December 2007, 107 colon polyps from 68 patients were detected by conventional colonoscopy and subsequently evaluated by NBI with magnifying colonoscopy and analyzed for a pit pattern and a capillary pattern. More analysis was done regarding thickness and irregularity of capillary features. Results: Pit pattern with NBI magnification to discriminate between neoplastic and non-neoplastic lesions had a sensitivity of 88.9% and a specificity of 87.5%; capillary pattern yielded test performance characteristics of 91.9% and 87.5%. In respect of capillary thickness, invisible capillaries were found significantly more often in hyperplastic lesions. All thick capillaries were found in neoplastic polyps, and found significantly more often in carcinomas with submucosal massive invasion (sm-m) (p<0.01). In respect of capillary irregularity, invisible capillaries were found significantly more often in hyperplasic lesions, and severely irregular capillaries were found significantly more often in sm-m lesions (p<0.01). Conclusions: Observation of capillary thickness and irregularity