위식도역류질환에서 십이지장위식도역류 - 장시간 보행성 식도내 pH및 빌리루빈의 동시측정에 의한 평가

최명규(Myong Gyu Choi),박수헌(Soo Heon Park),방춘상(Choon Sang Bang),한준열(Joon Yul Han),김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4

N/A Background/Aims: Esophageal reflux damage may be produced by agents other than acid and the term alkaline esophagitis has been applied. Methods using esophageal pH monitoring to assess duodenogastroesophageal reflux have been suggested but gastric neutralization has made these methods difficult to prove conclusively. The purpose of this study were to investigate the role of duodenogastroesophageal reflux in gastroesophageal reflux disease(GERD) and to understand the relationship between pH and duodenogastroesophageal reflux. Methods: we performed simul- taneous esophageal pH and bilirubin rnonitoring(Bilitec 2000, Synetics) in 14 symptomatic patients with gastroesophageal reflux and 10 healthy controls. Abnormal gastroesophageal reflux was defined when the percent total time of pHC4 or bilirubin absorbance 0.14 exceeded the 95th percentile of the range obtained in healthy volunteers. Results: Abnormal gastroesophageal reflux was diagnosed in 12(85.7%) of 14 patients, who could be categorized into 3 acid refluxers, 1 bile refluxer or 8 combined acid and bile refluxers. All 6 patients with severe esophagitis(grade 2 by Savary Miller classification) were combined acid and bile refluxers and had markedly prolonged acid and bile reflux compared to 8 patients with normal or mild esophagitis(% total time of pH 4(mean+SE): 13.4+2.96 vs 5.0+1.8, p<0.05; % total time of bilirubin absorbance 0.14(mean+SE): 25.2+4.6% vs 7.9+3.8%, p<0.05). Mean pH of esophageal refluxate during bile reflux episode lasting longer than 5 minutes was 6.0(7.1% for pH C4, 8.8% for pH 4 5, 26.6% for pH 5-6, 47% for pH 6-7 and 8.3% for pH7). 4) 8 patients with a symptom index greater than 25% experienced 24 reflux symptoms of which 12(50.0%) were associated with acid reflux, 5(20.8%) were associated with bile reflux and 7(29.2%) were not associated with bile or acid reflux. Conclusions: Alkaline esophageal reflux is a misnomer. Esophageal pH monitoring does not adequately identify symptomatic non-acidic duodenogastroesophageal reflux. Patients with com- bined acid and bile reflux are more likely to develop severe esophagitis. (Korean J Gastroenterol 1996; 28:469 - 476)

식도 정맥류 경화요법후 발생한 장간막 정맥 혈전증

정규원(Kyu Won Chung),정환국(Whan Kook Chung),선희식(Hee Sik Sun),정인식(In Sik Chung),안병민(Byung Min Ahn),김승남(Seung Nam Kim),이여민(Yeo Min Lee),방춘상(Choon Sang Bang),강혜정(Hye Jung Kang),최명규(Myung Kyu Choi),이용각(Yong K 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

Although there has not been a satisfactory treatment for esophageal variceal bleeding, recently clinicians take interests in endoscopic sclerotherapy. But several complications were also reported after endoscopic sclerotherapy. One of these was mesenteric venous thrombosis which developed more prevalently when the sclerotherapy used in combination of vasopressin infusion. We experienced one case of mesenteric venous thrombosis after esophageal sclerotherapy with vasopressin infusion for control of esophageal variceal bleeding.

총담관 결석에 의한 간농양으로 발견된 간암 1 예

이상훈,김진일,박선미,이광민,박영민,정규원,배시현,방춘상,선희식,장은덕,유수은,박두호,김동빈,성용직 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.3

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-occupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection. (Korean J Hepatol 1999;5:253-258)

반복성 늑막삼출로 발현된 Boerhaave 증후군 1 예

김선화,최명규,방춘상,윤종구,이동수,김성수,김상우,강미자,한석원,채현석,추교영,천지성,이대훈 대한소화기학회 2000 대한소화기학회지 Vol.36 No.6

Spontaneous rupture of the esophagus is an uncommon disease which was firstly reported by Boerhaave in 1724. It can cause fatal results unless diagnosed and treated early. Delayed diagnosis is mostly caused by lack of knowledge and atypical clinical symptom. Its mortality increases proportionally to the time between esophageal perforation and treatment. We experienced a case of spontaneous esophageal perforation. The patient was a 40-year-old alcoholic, who complained of epigastric, shoulder, and back pain following forceful hematemesis. The results of chest X-ray was normal on admission. Alcoholic delirium tremens developed 12 hours after admission. On the 3rd hospital day, massive preural effusion developed. Pleural effusion was drained completely and recurred on the 4th hospital day. Under the suspicion of esophageal rupture, we performed chest computed tomography, which revealed airs, fluids, and tiny soft tissue densities in the mediastinum. Operation was performed on the 4th hospital day. There was a 7-8 cm sized longitudinal tearing in lower esophagus. He died 5 days after operation.

췌장 가성 낭종에 의한 비정맥 폐색 1 예

김인식,최정현,김부성,방춘상,이창돈,박영민,윤성노,임규택 대한내과학회 1991 대한내과학회지 Vol.40 No.4

Upper gastrointestinal bleeding from gastroesophageal varices secondary to splenic vein thrombosis caused by pancreatitis or pancreatic cancer is recognized with increasting frequency. Because the splenic vein runs along the posterior of the tail and body of the pancreas and joins the portal vein directly, the inflammatory process of the pancreas often distorts or even obstructs the splenic vein and accounts for development of $quot;left-sided or sinistral portal hvpertension$quot; and secondary gastroesophageal varices. Recently, we experienced a 42-yearold male patient showing intermittent hematemesis and tarry stool, who was diagnosed as having gastric variceal bleeding due to splenic vein obstruction caused by pancreatic pseudocyst. A splenectomy was performed, and a subsidence of gastric varices was observed. We report this case with a review of relevant literature.

위선종과 조기위암에서 투명캡을 이용한 흡인점막절제술의 임상적 유용성 평가

김진일,이강문,정인식,방춘상,박두호,이동수,김성수,김상우,송호진,성용직,한석원,양영상,최규용,왕준호 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3

Background/Aims: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. Methods: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. Results: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (≤15 mm) was highly distinguished from that cf larger lesions (>15 mm). No serious complication was encountered. Coclusions: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.

직장 Carcinoid 종양 6예

최규용,정인식,양진모,정규원,김부성,최명규,방춘상,선희식,백남종 대한소화기내시경학회 1990 Clinical Endoscopy Vol.10 No.2

Carcinoid tumors arise from enterochromaffin cells that are located predominatly in the gastrointestinal mucosa. The vast majority of rectal carcinoid tumors are benign and can be safely treated by local excision. Lesions larger than 2 cm and invading the museular wall of the rectum should be considered malignancy and treated by more radical surgery such as abominoperined resection. We report 6 cases of rectal carcinoid tumor, three cases of them were less than 1 cm in size without metastasis. Two of these, small carcinoid tumor were treated with endoacopic polypectomy and one was treated with segmental resection. The others were 2.0 cm or larger in size with regional or liver mestasis. They were treated with segmental resection or electrical fugalization for tumor and transcatheter arterial embilization for liver metastasis or none.

만성 바이러스 간염에서 인터페론 치료의 효과에 대한 장기 추적 관찰 : 만성 바이러스 간염 222 예의 127 주간 추적관찰 in 222 cases during 127 weeks

박수헌,김진일,김재광,이영석,서정민,정규원,한준열,나종순,방춘상,선희식 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.3

Background/Aims: To evaluate the therapeutic efficacy of interferon in chrcnic viral hepatitis, interferon was administered to 222 patients with biopsy proven chronic viral hepatitis. Methods: 32 patients were excluded and the 190 patients was included, 149 men and 41 women. Average age was 34.4+-8.93 (14-67) years. 161 cases had HBsAg and HBeAg, and 29 cases had anti-HCV Ab. Three millicn units of interferon beta were given to 37 patients with chronic B hepatitis, daily for one month Six million units of interferon alpha were given to 124 patients with chronic B hepatitis and 29 patients with chr onic C hepatitis, three times a week for six months. Results: 1) Out of 124 patients with clronic hepatitis B treated with a-interferon, HBeAg negativity for more tban six months was observed in 25 patients (20.2%), and defined as responder group. The 23 patients (18.5%) were defined as probable responder, because of persistent seroregativity of HBeAg for the last 6 months, despite of fluctuation of sercangativity during the follow-up. The 29 patients (23.4%) were defined as probable non-responder because of recurrence of HBeAg, which once was cleared but reappeared during last 6 months. But there was no seroconversion in 47 cases (37.9%). The overall response rate was 38.7%. 2) Out of 37 patients with chronic hepatitis B treated with B-interferon, 7 patients (18.9%) were responder, 6 patients (16.2%) probable responder, 12 patients (32.4%) probable non-responder, 12 patients (32.4%) non-responder. The overall response rate was 35.1%. 3) Out of 29 patients with chronic hepatitis C treated with a-interferon, normalization of alanine aminotransferase (ALT) level for mcrre than six months was observed in 9 patients (31.0%), and defined as responder group. The 3 patients (10.3%) were defined as probable responder, because ALT levels fluctuated but wes normalized during the last 6 months. The 5 patients (17.2%) were defined as pobable ncn-mponder, because of persistent fluctuation of ALT levels during the last 6manths, which once were normalized but reelevated. In 12 patients (41.4%), there had never been a normalization of ALT level. The overall resporate was 41.1%. 4) The period of HBeAg seropositivity was 1.33 times longer than the period of seronegativity. The faster the seroconvmion, the more the tendency to be a respander for the patients with chronic hepatitis B. Conclusion: Interferon therapy may be effective in some cleonic viral hepatitis. (Korean J Hepatol 1997;6:241 251)

Ketoconazole 장기복용으로 발생한 간격막 섬유증 1 예

김영철,김진일,김용균,안병민,조재완,정규원,배시현,김부성,방춘상,선희식,박두호,성용직,강석진,고윤호,박영민 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.2

Ketoc onazole, an imidazole derivative, is a broad spectrum antifungal agent which has been used widely in the treatment of systemic or local fungal infections. Mild asymptomatic elevation of plasma transaminase activities occurs in approximately 6% to 17.5% of patients who have used ketoconazole. However, the incidence of symptomatic hepatic injury is low and overt hepatitis develops in about 5% of the patients. Nausea and vomiting are the most frequent side reactions. Histopathological features of the reported ketoconazole induced hepatotoxicity are massive or submassive hepatocellular necrosis involving the acinar zone 3, destroyed lobular architecture with bridging necrosis and inflammatory cell infiltration on portal tracts. However, hepatic septal fibrosis with liver cirrhosis has not been reported yet.We experienced a case of hepatic septal fibrosis that developed after 9 months of ketoconazole administration.(Korean J Hepatol 2000;6:241-245)