하행 대장의 장간막에 발생한 악성 신경초종

김문범(Moon Beom Kim),한상영(Sang Young Han),강도영(Do Young Kang),김선택(Sun Tac Kim),박일(Il Park),배상문(Sang Moon Bae),김재석(Jae Seok Kim),노명환(Myung Hwan Noh),최석렬(Seok Reyol Choi),신우원(Woo Won Shin) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

Malignant schwannoma(peripheral nerve sheath tumor) is relatively rare tumor. The extremity, trunk, head and neck are most frequently affected. We experienced a case of malignant schwan- noma in descending mesocolon which is very rare site. The patient was a 45-year-old ma]e who complained of abdominal distension. Abdominal CT scan showed a huge lobulated heterogeneous mass on abdominal and pelvic cavity. Abdominal exploration revealed a yellowish gray, friable, nodular and huge mass infiltrating sma]l bowel, large bowel and peritoneum partially. The tumor was resected with left hemicolectomy and partial resection of peritoneum and small bowel. Both histological and immuno-histochemical stain with S-100 protein revealed that it was a malignant schwannoma. The patient has received two courses of systemic chemotherapy and visited regulary at out-patient department. (Korean J Gastroenterol 1996; 28:439-444)

심근 손상에 있어서 심근 Troponin - T 측정의 유용성

김상곤(Sang Gon Kim),이성욱(Sung Wook Lee),김병철(Byeong Cheol Kim),이혁(Hyuck Lee),배상문(Sang Moon Bae),안원석(Won Suk An),도현국(Hyun Kuk Dho),김무현(Moo Hyun Kim),김영대(Young Dae Kim),김종성(Jong Seong Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: In coronary arterial disease, quantitative assessment of the extent of myocardial damage is important both in management of the patient and prediction of prognosis. Measurement of serum Troponin-T is a new method for detecting myocardial cellular injury, used as more specific marker of tissue damage and reperfusion status in acute myocardial infarction, This study was performed to evaluate the significance of serum Troponin-T measurement in various acute chest pain syndrome. Methods: 37 patients who presented anterior ischemic chest pain enrolled from April, 1994 to September, 1995, From the initial period of admission, serial measurements of serum level of cardiac enzymes (CK, CK MB, Myoglobin, Troponin-T) were made. Then release time, peak time and normalization time of each enzyme were derived and compared each other. To evaluate whether Troponin-T level can reflect the extent of ischemic injury, correlation between peak Troponin-T level and peak CK MB level was analysed by regression method. Results: 1) Acute myocardial infarction was confirmed in 15 cases; Q-wave myocardial infarction was 10 cases(anterior wall-5 cases, inferior wall-4 cases, lateral wall-1 cases), and non Q-wave myocardial infarction was 5 cases. Unstable angina was 22 cases. All cases had significant stenosis in coronary angiography. 2) The appearance in the serum level of 4 cardiac enzymes was as follows. The release time(hours) of 4 cardiac enzymes(Troponin-T, CK, CK MB, Myoglobin) were 7.1(1-30), 9.3(1-30), 9.9(1-30), 6.2(1-30). The peak time(hours) of 4 cardiac enzymes were 23.0(1.5-96), 21.6(2-66), 16.9(2-42), 12.7(3-40). The normalization time(hours) of the enzymes were over 72, 53.7(11-86), 52.3(11-94), 32.3(10-82). 3) Elevation pattern of cardiac enzymes showed concordance of all 3 enzymes(Troponin-T, CK MB, Myoglobin) in 29 of 43 cases(67.4%), There was concordance of 2 enzymes in 10 cases; 5 cases of CK MB and Myoglobin, 5 cases of Troponin-T and Myoglobin. In 4 cases, only Myoglobin level was in- creased. 4) There was significant correlation between peak Troponin-T level and peak CK level(r=0.66, p=0.0178), significant correlation was also observed between peak Troponin-T level and peak CK MR level(r=0.90, p=0.0001). Conclusion: In acute myocardial infarction serum Troponin-T was detectable as early as CK MB, and lasted longer after other enzyme level was normalized. There was significant correlation between peak Troponin-T level and peak CK, CK MB level, suggesting Troponin-T as useful marker for assessing the extent of myocardial damage.

성인 미세변화신증후군 환자의 임상경과에 관한 연구

박정하(Jung Ha Park),배성진(Sung Jin Bae),배상문(Sang Moon Bae),노명환(Myung Hwan Noh),김재석(Jae Seok Kim),박희승(Hee Seung Park),정원태(Won Tae Jung),김성은(Seong Eun Kim),김기현(Ki Hyun Kim),김영훈(Yeong Hoon Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.6

N/A Objectives - A series of biopsy-proven 76adult onset minimal change nephrotic syndrome(MCNS) was analyzed to estimate the clinical courses including the rate and the pattern of response to corticosteroids or cytotoxic agents and the characteristics of relapse, Methods: The diagnoses of all cases were made between 1985 and 1994. Mean follow up duration was 2.4±2.0 years. All the patients had the apparent onset of their disease when aged 16or more and presented with a full-blown nephrotic syndrome (proteinuria>3.0gm/day, serum albumin<3.0gm/dl and edema). None had either past history of a nephrotic syndrome or other renal disease. All the cases were classified to five groups (16-25, 26-35, 36-45, 46-55, above 56) according to age and were analyzed. The clinical and laboratory information was obtained on each patient at the time of presentation and at last follow-up. Renal tissues were examined by light, fluorescence and electron micorscopy. The initial prednisolone was used at a dose of 40mg/day p.o. given up to 16weeks and the response to prednisolone therapy was evaluated, then tapered by 10mg every 2weeks. Cyclophosphamide was used at a dose of 2mg/kg/day p.o. given for 8-10weeks(maximal daily dose of 100mg) and the response to cyclophosphamide therapy was also evaluated. When there was no apparent response to cyclophosphamide therapy, the prednisolone regimen same as initial therapy was added consecutively after completion of cyclophosphamide therapy. All cases were reviewed retrospectively and analysed with SPSS/PC' program. Results: 1) The prevalence of young patients(16-25 year group) was higher(37cases, 49%). There was a preponderance of males(2.6:1). 2) The outcomes for sixty-nine patients, who given an initial course of prednisolone were 50cases (73%) in complete remission(CR), 9cases (13%) in a partial remission(PR) and 10cases(14%) remained nephrotic. The 34(68%) of 50cases who achieved complete remission were relapsed. 3) Cyclophosphamide was used in 35patients. The response to cyclophosphamide therapy were 7cases(20%) in CR, 12cases(34%) in PR and 16cases(46%) remained nephrotic till eighth weeks of treatment. A CR was obtained in 63%(10/16) with subsequent use of prednisolone after cyclophosphamide therapy because of poor response to cyclophosphamide. The cumulative CR rate was 60% (21/35) within 28th weeks of treatment. 4) The age of patients had no relationship to the response rate, time to response, relapse rate and number of relapse after prednisolone therapy. 5) At the final follow-up, 52cases(68%) were in CR, 6cases(8%) were in PR and 18cases(24%) were nephrotic, but all cases preserved normal renal function. Conclusion: Adult onset MCNS showed relatively good response with an daily 40mg of prednisolone as initial dose. The response to cyclophosphamide therapy in those who had inadequate response to initial prednisolone therapy or recurrent relapse was 60% of complete remission. Furthermore, the subsequent use of prednisolone after cyclophosphamide therapy is supposed to increase the response rate in case of poor cyclophosphamide response. Finally, as known the disease has a favorable out- come without renal function impairment.

EPBD를 이용한 내시경적 담도 배액법

영웅석 ( Ung Suk Yang ),강대환 ( Dae Hwan Kang ),김상현 ( Sang Hyun Kim ),배상문 ( Sang Moon Bae ),차수강 ( Su Gang Cha ),종철수 ( Chul Soo Song ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ) 대한췌담도학회 1999 대한췌담도학회지 Vol.4 No.1

Endoscopic biilary drainage (EBD) for malignant obstructive jaundice is performed mostly with EST. But EST carries early complications such as bleeding, perforation and pancreatitis. We evaluated safety and usefulness of EBD using endoscopic papillary balloon dilation (EPBD) without endoscopic sphincterotomy (EST). Fifteen patients were treated from Sep. 1998 to Feb. 1999 in Pusan National University Hospital due to malignant obstructive jaundice. EBD was performed using EPBD. They were investigated to estimate the usefulness and early complications of EBD using EPBD. Effective drainage was achieved in 13 patients (87%). Procedure related complications developed in two patients; acute pancreatitis in two(minimal or mild, 13%), hemorrhage in three (clinically insignificant bleeding) EBD using EPBD is a safe and effective treatment method for malignant obstructive jaundice. However, prospective study is thought to be need in large patients group especially as to stent diameter and papilla size.

Mallory-Weiss syndrome의 내시경적 진단과 치료

송근암(Geun Am Song),김태오(Tae Oh Kim),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang),배상문(Sang Moon Bae),류수형(Soo Hyung Ryu),안준협(Jun hyup An),이성훈(Seong Hwun Lee) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. Methods: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. Results: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. Conclusion: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.(Korean J Med 58:542-547, 2000)

십이지장 유두 주위 게실과 원발성 총수담관 담석의 연관성

김상현,강대환,양웅석,이준홍,송근암,조몽,이재승,송철수,배상문,김형욱 대한소화기학회 1999 대한소화기학회지 Vol.33 No.2

Background/Aims: The association between periampullary diverticula and biliary calculi has been reported, but the results are different according to the anatomical location of the stones. The aim of this study was to investigate the association between periampullary diverticula and the incidence of gallstones according to the location of gallstones and the type of diverticula. Methods: For the seven hundred ninety five cases, the results of endoscopic retrograde cholangiopancreatography (ERCP) were analysed. The gallstones were classified into choledocholithiasis, cholecystolithiasis and combined case according to their locations. Incidence of gallstones was determined according to the type of periampullary diverticula. Results: The prevalance of biliary calculi was higher in patients with periampullary diverticula than in patients without it (p$lt;0.001). Considering the locations of gallstones choledocholithiasis was observed in 49.2% of patients with periampullary diverticula and in 28.0% of patients without it (p$lt;0.003). There was no statistical correlation between the type of periampul lary diverticula and the incidence of gallstones (p$gt;0.05). Conclusions: This study shows that there is a significant association between periampullary diverticula and primary choledocholithiasis and no correlation between the type of periampullary diverticula and the incidence of gallstones. (Kor J Gastroenterol 1999;33:252 - 257)

나환자에서 G 형 간염바이러스의 감염 유병률

김상현,강대환,조병만,양웅석,송근암,조몽,송철수,배상문 대한소화기학회 1999 대한소화기학회지 Vol.33 No.4

Background/Aims: Hepatitis C virus (HCV) infection is known to be prevalent in leprous patients Hepatitis G virus (HGV) is transmitted parenterally as HCV. This study was performed to assess the prevalence of HGV infection in leprous patients and non-leprous family members of leprous patients Methods: This study included 96 leprous patients and 47 non-leprous family members of leprous patients. HCV-antibody was tested by the 3rd generation enzyme linked immunosorbent assay (ELISA). Anti-HCV positive sera were confirmed by the 2nd generation recombinant immunoblot assay (RIBA) and reverse transcription-polymerase chain reaction (RT-PCR) from 5'-UTR. HGV-RNA was detected by RT-PCR from E1 region. Results: The prevalence of HCV infection in the leprous patients (55.2%) and the non-leprous family members (8.5%) was higher than that of genera population of Korea. The prevalence of HGV infection in the leprous patients and their non-leprous family members was 10.4% and 6.4% (95% confidence interval, 5.1-18.3%), rspectively. These values were higher than that of general population (1.4%). The higher prevalence of the HGV infection in the leprous patients was not related with leprosy nor HCV infection. Conclusions: Leprous patients are exposed to high risk of HGV infection as well as HCV infection.