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수술로 호전되지 않은 췌장 농양을 내시경 치료로 완치한 1 예
서희영;전태주;김선영;강미선;허란;박지영;서동대;오태훈 인제대학교 백병원 2011 仁濟醫學 Vol.32 No.-
Necrotizing pancreatitis develops in about 10-20% of patients with acute pancreatitis, and pancreatic abscesses develop in 3% of them. The mortality of pancreatic abscess has been reported up to 40% in one study. Recently, there are several reports that show good results with n on-surgical therapy, such as percutaneous drainage and endoscopic drainage, but if the non-surgical drainage fails, surgical therapy are recommended. However, there is no definite therapeutic method which is suggested yet so far after the failure of the surgical drainage. So we report the case in which we experienced successful treatment of pancreatic abscess by endoscopic removal of necrotic tissue through the gastrocystostomy, after the failure of the surgical debridement and internal drainage through gastrocystostomy.
김병규;전태주;박지영;서희영;오태훈;김현정 인제대학교 2011 仁濟醫學 Vol.32 No.-
Syphilis is a chronic systemic infectious disease caused by Treponema pallidum. Syphilitic involvement of the stomach can occur via the blood flow in the primary or secondary period of syphilis, but its incidence is very rare. Gastric syphilis should be considered in patients at risk of sexually transmitted disease who complains of abdominal pain, nausea and vomiting and in whom unusual endoscopic or radiographic features are found. Because gastric syphilis has no pathognomic clinical findings and it can simulate gastric cancer or lymphoma, it’ s not so easy to diagnose. If diagnosed, however, gastric syphilis can be easily treated with proper antibiotics. We report on a case of gastric syphilis that manifested epigastric pain, anorexia and weight loss. It was initially thought to be lymphoma, but it was correctly diagnosed by serologic testing and progress.
김진호,김재선,연종은,변관수,이창홍,김종극,임형준,박영태 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6
Background/Aims: Esophageal segmental dysmotility has been extensively studied, while reports regarding segmental hypotonic peristalsis are rare. This study was carried out to elucidate the possible relationship between segmental hypotonic peristalsis and midesophageal diverticulum. Methods: Fifteen patients with midesophageal diverticulum and 15 age- and sex-matched controls were evaluated with conventional and mapping esophageal manometry. Results: Conventional manometric parameters were similer in the patients and controls. The conventional manometry identified motility disorders in 5 patients (33%) (4 nonspecific esophageal motility disorders and 1 nutcracker esophagus). The mapping manometry showed that segmental hypotonic peristalsis was noted in 6 patients (40%), but it was not found among the controls. Five patients (33%) showed no abnormality from either manometric method. Conclusions: This observation suggests that segmental hypotonic peristalsis is frequently found in patients with idesophageal diverticulum, although its clinical significance and role in the pathogenesis of diverticulum remain to be investigated. Mapping manometry may be a useful tool in the cases with suspected segmental esophageal dysmotility including diverticulum, even though the conventional manometry shows normal finding.
만성 B형 간염에서 라미부딘 치료중 발생한 Viral Breakthrough 예의 임상 결과
안수현,장윤정,오성남,최도원,백수정,정원석,최창원,김경오,임형준,조남영,박종재,김재선,박영태,이명석,연종은,변관수,이창홍 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.4
목적: 만성 B형 간염의 치료 중 발생하는 약제 내성 변이종은 임상적으로는 치료 중 음전되었던 혈청 HBV DNA가 다시 양전되는 viral breakthrough 로 진단할 수 있다. 현재 약제 내성 변이종이 발생했을 경우라도 라미부딘 치료를 계속 유지하는 것을 권장하고 있으나, viral breakthrough 발생 예들의 장기적 임상경과가 아직도 불명확하여 이것을 일반화하기는 어려운 상황이다. 이에 라미부딘 사용 중 viral breakthrough 가 발생한 예들을 대상으로 그 임상경과를 알아보고자 하였다. 대상과 방법: 9개월 이상 라미부딘을 투약한 만성 B형 간염 환자로 viral breakthrough가 발생한 74명을 대상으로 하였다(남/여 54/20, 평균연령 42세). Viral breakthrough 후 혈청 ALT치, 총 빌리루빈치, HBV DNA 역가, HBeAg, anti-HBe를 정기적으로 검사하면서 임상경과를 관찰하였다. Viral breakthrough 후 라미부딘의 투약기간은 평균 13개 월(1-41개월)이었다. 결과: Viral breakthrough 발생후 혈청 ALT치가 정상으로 유지되었던 환자는 8예(11%)에 불과했고 나머지 66예(89%)에서는 ALT치가 증가하였으며, 이중 30예(41%)에서 급성 악화(ALT 정상 상한치의 5배 이상 상승)를 보였다. 급성악화는 viral breakthrough 후 3개월 내에 19예 (63%)에서 발생하여 3개월 내에 발생한 예가 많았으나 12개월 이상 지나서 나타나는 예도 약 20%에서 있었다. 비대상성 악화는 6예에서 관찰되었다. Viral breakthrough 후 급성악화가 일어난 예와 없었던 예의 비교에서 급성악화를 예측할 수 있는 인자는 발견할 수 없었다. Viral breakthrough 후 발견할 수 없었다. Viral breakthrough 후 HBeAg이 음전된 예는 8예(11%)였으나 그 임상경과는 양호하지 않았다. 결론: 만성 B형 간염 환자 에서 라미부딘 투여 중 발생한 viral breakthrough 예 중 상당수에서 급성악화가 발생하였으며, HBeAg 이 소실되더라도 그 임상경과는 양호하지만은 않았다. Viral breakthrough 발생 후 주의 깊은 임상경과 의 관찰이 요구되며, 앞으로 viral breakthrough 후 급성악화 예에 대한 대규모 연구와 적절한 치료방향의 제시가 이루어져야 할 것으로 생각된다. Background/Aims: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. Methods: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. Results: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. Conclusions: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.(Korean J Hepatol 2002;8:389-396)
(Young Tae Bak),(Gil Man Jung),(Jong Eun Yeon),(Jae Seon Kim),(Kwan Soo Byun),(Jin Ho Kim),(Jong Guk Kim),(Chang Hong Lee),(Han Kyeom Kim),(Nam Hee Won) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.2
N/A Objective:In areas where intestinal metaplasia of the stomach is highly prevalent, diagnosing Barrett`s esophagus solely by the presence of specialized columnar epithelium in the distal esophagus may lead to many false positive diagnoses. The aim of this study was to test the validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett꼜 esophagus in Korea. Methods:During routine gastroscopy, the length of columnar-lined esophagus was measured and biopsy samples were taken from the mucosa immediately distal to the squamocolumnar junction. Under light microscopy, alcian blue-positive cells were identified. Results:Prevalence of the specialized columnar epithelium in cases without the columnar-lined esophagus and with the short segment columnar-lined esophagus was 57.1% and 31.2%, respectively (P=0.0281). The specialized columnar epithelium is frequently seen around the cardia in Koreans with or without the columnar-lined esophagus. Conclusions:Simple presence of the specialized columnar epithelium is not a valid criterion for a diagnosis of Barrett긯 esophagus. We propose that both the short segment Barrett꼜 esophagus and the goblet cell metaplasia of the cardia might be grouped together under a title of the specialized columnar epithelium around the gastroesophageal junction as a potential preceding condition of adenocarcinoma around the cardia.