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증례 : 소화기; 내시경 유두절제술로 제거한 거대 십이지장 주유두의 신경내분비종양
배승현 ( Seung Hyeon Bae ),김진용 ( Jin Yong Kim ),김창래 ( Chang Lae Kim ),최영권 ( Young Kwon Choi ),신보미 ( Bo Mi Shin ),홍승모 ( Seung Mo Hong ),김명환 ( Myung Hwan Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.3
Neuroendocrine tumors (NET) of the major duodenal papilla are rare and the natural history of this disease is not clear. We experienced a case in a 31-year-old male. Duodenoscopy revealed an enlarged major duodenal papilla with central umbilication and nodularity. Endoscopic ultrasonography (EUS) demonstrated a 3-cm hypoechoic mass that was confined to the submucosa. A biopsy led to the diagnosis of a grade 1 NET. The patient refused surgery, so we performed an endoscopic papillectomy. The tumor was removed completely. The resected specimen confirmed the diagnosis of a well-differentiated NET and all resection margins were negative. Surgical resection is currently considered to be the gold standard for the treatment of a large NET of the major duodenal papilla; however, endoscopic resection is a possible treatment modality for patients at high surgical risk or who are reluctant to undergo surgery.
담도암 진단을 위해 담도배액관에서 얻은 담즙세포진검사의 유용성에 관한 연구
김진용 ( Jin Yong Kim ),최준혁 ( Joon Hyuk Choi ),김진희 ( Jin Hee Kim ),김창래 ( Chang Lae Kim ),배승현 ( Seung Hyeon Bae ),최영권 ( Young Kwon Choi ),하연정 ( Yeon Jung Ha ),송민주 ( Min Joo Song ),최준호 ( Jun Ho Choi ),홍승모 대한소화기학회 2014 대한소화기학회지 Vol.63 No.2
Background/Aims: Biliary drainage is performed in many patients with cholangiocarcinoma (CCA) to relieve obstructive jaundice. For those who have undergone biliary drainage, bile cytology can be easily performed since the access is already achieved. This study aims to determine the clinical usefulness of bile cytology for the diagnosis of CCA and to evaluate factors affecting its diagnostic yield. Methods: A total of 766 consecutive patients with CCA underwent bile cytology via endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage from January 2000 to June 2012. Data were collected by retrospectively reviewing the medical records. We evaluated the diagnostic yield of bile cytology with/without other sampling methods including brush cytology and endobiliary forcep biopsy, and the optimal number of repeated bile sampling. Several factors affecting diagnostic yield were then analyzed. Results: The sensitivity of bile cytology, endobiliary forceps biopsy, and a combination of both sampling methods were 24.7% (189/766), 74.4% (259/348), and 77.9% (271/348), respectively. The cumulative positive rate of bile sampling increased from 40.7% (77/189) at first sampling to 93.1% (176/189) at third sampling. On multivariate analysis, factors associated with positive bile cytology were perihilar tumor location, intraductal growing tumor type, tumor extent ≥20 mm, poorly differentiated grade tumor, and three or more samplings. Conclusions: Although bile cytology itself has a low sensitivity in diagnosing CCA, it has an additive role when combined with endobiliary forceps biopsy. Due to the relative ease and low cost, bile cytology can be considered a reasonable complementary diagnostic tool for diagnosing CCA. (Korean J Gastroenterol 2014;63:107-113)
전신홍반루푸스에 동반된 불응성 혈구포식 림프조직구증식증에서 Tocilizumab 치료 1예
유빈 ( Bin Yoo ),오진선 ( Jin Sun Oh ),박진오 ( Jinoh Park ),이나겸 ( Nah Kyum Lee ),배승현 ( Seung Hyeon Bae ),김용길 ( Yong Gil Kim ),이창근 ( Chang Keun Lee ) 대한내과학회 2015 대한내과학회지 Vol.89 No.3
Macrophage activation syndrome (MAS) is a secondary hemophagocytic lymphohistiocytosis caused by autoimmune diseases, such as systemic lupus erythematosus (SLE). It is characterized by fever, cytopenia, coagulopathy, hepatosplenomegaly, elevated liver enzyme, and high ferritin, typically combined with hemophagocytic histiocyte proliferation in the bone marrow. Here, we report a case of MAS in a patient with SLE treated successfully by tocilizumab. She was transferred to our hospital due to persistent fever of unknown origin. Initial blood tests revealed cytopenia, elevated liver enzyme, and high ferritin. Bone marrow histology revealed the presence of hemophagocytic histiocytes. The patient was initially treated with high dose corticosteroids; however, fever and cytopenia were not controlled. Additional treatments with cyclosporine, intravenous immunoglobulin, and rituximab were applied consecutively, but the fever and cytopenia persisted. Symptom resolution was finally achieved following treatment with tocilizumab, resulting in rapid improved of fever, and resolution of pancytopenia within 2 months. (Korean J Med 2015;89:372-376)