기관과 기관지내 다발성 점막 병변을 동반한 Churg-Strauss 증후군

부선진 ( Sun Jin Boo ),이광하 ( Kwang Ha Lee ),나승원 ( Seung Won Ra ),진영주 ( Young Joo Jin ),박경민 ( Gyung Min Park ),홍상범 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

Churg-Strauss syndrome is a rare form of systemic necrotizing vasculitis that occurs exclusively in patients with asthma, and is associated with blood and tissue eosinophilia. The classic pathology findings in the lung include a combination of eosinophilic pneumonia, granulomatous inflammation and necrotizing vasculitis. However, there are few reports of tracheobronchial mucosal lesions in Churg-Strauss syndrome. We report a case of Churg-Strauss syndrome with multiple tracheobronchial mucosal lesions in a 33-year-old man with a history of bronchial asthma and allergic rhinitis. He had been diagnosed with community acquired pneumonia at another hospital and was treated with antibiotics. However, the chest radiographic findings were aggravated and showed multifocal consolidations in the whole lung fields. He was transferred to the Asan Medical Center. Fiberoptic bronchoscopy revealed multiple nodular mucosal lesions of the trachea and bronchi. The histopathology of the mucosal lesions revealed necrotizing bronchial inflammation with eosinophilic infiltration. Video Assisted Thoracic Surgery was performed. The wedge resected lung tissue revealed chronic eosinophilic pneumonia that was consistent with Churg-Strauss syndrome. Methylprednisolone (1 mg/kg q 8 hr) was prescribed and his symptoms resolved gradually. The chest radiographic findings improved significantly, and a follow-up fiberoptic bronchoscopy performed eight days later showed that the tracheobronchial mucosal lesions had resolved. The patient was prescribed oral prednisolone for 20 months after discharge. Currently, the patient is not taking steroids and is being followed up. (Tuberc Respir Dis 2008;65:405-409)

췌장 전이성 종양의 임상적 특징

부선진 ( Sun Jin Boo ),김명환 ( Myung Hwan Kim ),김유석 ( Yu Seok Kim ),류충헌 ( Choong Heon Ryu ),김홍준 ( Hong Jun Kim ),박도현 ( Do Hyun Park ),이상수 ( Sang Soo Lee ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ),김송철 ( So 대한소화기학회 2011 대한소화기학회지 Vol.57 No.6

Background/Aims: Histologically confirmed metastatic pancreatic cancers are infrequent. The aim of this study was to analyze clinical, therapeutic and prognostic features of pancreatic metastases. Methods: We retrospectively evaluated stage of primary malignancies, interval between diagnosis of primary tumors and detection of pancreatic metastases, treatment for metastases to the pancreas, survival rate, and prognostic factors in 31 patients with pancreatic metastases. Results: The mean age at the time of primary cancer diagnosis was 52.4±13.2 years. Primary cancers were renal cell carcinoma (n=16), non-small cell lung cancer (n=6), small cell lung cancer (n=3), colorectal carcinoma (n=2), osteosarcoma (n=1), gastric carcinoma (n=1), malignant melanoma (n=1), and thymic carcinoma (n=1). Pancreatic metastases were synchronous in six cases and metachronous in twenty five cases, with median interval time of 40.8 months (range 3-186) between the diagnosis of primary tumor and detection of pancreatic metastases. The median survival after the detection of the metastases was 16 months. In multivariate analysis, non-renal cell carcinoma as primary malignancy and positive symptom related to pancreatic metastases were associated with poor prognosis (hazard ratio [HR], 8.33; 95% CI, 2.1-33; p=0.003, and HR, 4.02; 95% CI, 1.27-12.7; p=0.018). Conclusions: Metastatic tumors to the pancreas have to be kept in mind when a patient with pancreatic mass has a history of other malignancy, even if treated several years before. In the absence of widely metastatic disease, aggressive diagnostic and therapeutic approach may offer the chance of long-term survival in selected patients. (Korean J Gastroenterol 2011;57:358-364)

특발성 식도이완불능증 치료에서 경구 내시경 근절개술과 복강경 헬러 근절개술의 임상 성적 비교: 전향적, 다기관, 무작위 연구

부선진 ( Sun-jin Boo ) 대한소화기학회 2020 대한소화기학회지 Vol.75 No.1

양성자펌프억제제는 위암의 위험인자인가?

부선진 ( Sun-jin Boo ) 대한소화기학회 2022 대한소화기학회지 Vol.79 No.1

식도의 이물: 치료와 합병증

부선진 ( Sun-jin Boo ),김흥업 ( Heung Up Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications. (Korean J Gastroenterol 2018;72:1-5)

신장 ; Ezetimibe가 말기 신부전 환자의 혈중 지질 및 혈전 지표에 미치는 영향

박경선 ( Kyung Sun Park ),여영선 ( Young Sun Yeo ),유미현 ( Mi Hyun Yoo ),최준석 ( Jun Seok Choi ),장지웅 ( Ji Woong Jang ),부선진 ( Sun Jin Boo ),유동준 ( Dong Jun Yoo ),김순배 ( Soon Bae Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

목적: 고지혈증은 말기 신부전 환자의 심혈관계 질환에 대한 주요한 위험인자 중 하나로, 고지혈증의 교정으로 심혈관계 질환의 빈도를 감소시킬 수 있다. 많은 수의 말기 신부전 환자들이 고지혈증에 대한 약물 치료를 시행함에도 혈중지질 이상이 적절하게 교정되지 않고 있다. 현재까지 주로 사용되었던 지질강하제와 다른 작용 기전을 갖는 새로운 약제인 ezetimibe는 정상 신장기능을 가진 일반인을 대상으로 한 기존 연구에서 우수한 지질 교정 효과와 내약성 및 안정성을 보였다. 이에 본원에서 혈액투석 및 복막투석을 시행 받고 있는 말기 신부전 환자들을 대상으로 ezetimibe 단독치료 시와 ezetimibe와 simvastatin을 병용하였을 때의 지질 강하 효과와 항 염증 효과 및 항 혈전 효과 등에 대해 알아보고자 하였다. 방법: 본원에서 3개월 이상 혈액투석 및 복막투석을 받고 있는 환자 중 저밀도 지단백 콜레스테롤 수치가 100 mg/dL 이상인 환자 65명을 대상으로 하였다. 이들을 ezetimibe 단독투여군과 ezetimibe/simvastatin 병용투여군으로 나누었다. ezetimibe 단독투여군에 속한 환자에게는 ezetimibe 10 mg을 하루 1회 복용하도록 하였고, ezetimibe/simvastatin 병용투여군에 속한 환자에게는 ezetimibe 10 mg과 simvastatin 10 mg의 혼합 제재를 하루 1회 복용하도록 하였다. 두 군 모두 8주간 약제를 복용하였다. 두 군의 환자 모두 연구 시작 시점과 종료 시점에 채혈을 하였다. 지질 지표로서 총 콜레스테롤, 저밀도 지단백 콜레스테롤, 고밀도 지단백 콜레스테롤 및 중성 지방 수치를 측정하였다. 염증 표지자로서 hs-CRP와 fibrinogen을 사용하였고, vWF는 내피세포 손상의 지표로 사용하였다. 혈관 내 혈전 생성의 지표로 D-dimer를 측정하였다. 결과: Ezetimibe 단독투여군과 ezetimibe/simvastatin 병용투여군 간에는 평균 연령, 성별, 투석 기간, 체질량지수에 차이가 없었다. 말기 신부전을 초래한 원인 질환에서도 두 군 간에 차이가 없었으며, 당뇨병, 고혈압, 심혈관계 질환, 간 질환, 갑상선 질환의 유병률에도 차이가 없었다. Calcium-channel blocker, β-blocker, angiotensin-converting enzyme inhibitor 및 angiotensin II receptor blocker의 사용 빈도도 두 군 간에 차이가 없었다. 혈중 지질수치의 기저치 및 hs-CRP, fibrinogen, vWF, D-dimer의 기저치에서도 두 군 간에 유의한 차이가 없었다. 약제사용 8주 후 ezetimibe 단독투여군에서 총 콜레스테롤 수치와 저밀도 지단백 콜레스테롤 수치는 각각 14.7%와 21.9% 감소하였다. 고밀도 지단백 콜레스테롤 수치와 중성 지방수치는 변화가 없었다. hs-CRP 감소하는 경향이었으나 통계적인 의미는 없었고, fibrinogen은 통계적으로 유의하게 증가하였다. vWF와 D-dimer는 증가하는 경향이었지만 통계적인 의미는 없었다. 약제사용 8주 후 ezetimibe/simvastatin 병용투여군에서 총 콜레스테롤 수치와 저밀도 지단백 콜레스테롤 수치는 각각 29.8%와 42.4% 감소하였다. 고밀도 지단백 콜레스테롤 수치와 중성 지방수치는 변화가 없었다. hs-CRP, fibrinogen, vWF, D-dimer는 감소하는 경향이었지만 통계적인 유의성은 없었다. 지질 지표와 hs-CRP, fibrinogen, D-dimer 수치의 변화 정도는 투석방법에 따라 차이가 없었지만 vWF는 ezetimibe 단독투여군과 ezetmibe/simvastatin 병용투여군 모두에서 복막투석 환자에서 유의하게 증가하였다. Ezetimibe 단독투여군과 ezetimibe/simvastatin 병용투여군 간에 부작용의 빈도 차이는 없었다. 결론: Ezetimibe는 말기 신부전 환자에게 단독사용 시에도 비교적 안전하게 혈중 지질 개선 효과를 보였으나, 내피세포 손상을 포함한 지혈 요소들이 증가하는 경향을 나타내었다. Statin과의 병용사용 시에는 단독사용 시와 비교하여 훨씬 더 우수한 혈중 지질 강하 효과를 나타내었고, 지혈 요소들도 증가하지 않았다. 따라서 ezetimibe는 단독으로 사용하였을 때보다 statin과의 병용 투여 시에 말기 신부전 환자의 혈중 지질이상을 교정하는 효과가 우수하며, 말기 신부전 환자에게도 안전하게 사용될 수 있는 약제라고 할 수 있다. Background/Aims: Dyslipidemia is one of the major causes of cardiovascular disease in end-stage renal disease (ESRD) patients. Most of them are dyslipidemic despite the use of lipid-lowering agents. Ezetimibe is a novel chemical entity that inhibits the intestinal absorption of dietary and biliary cholesterol. This study evaluated the effects of ezetimibe on the lipid profile, inflammation markers, endothelial injury, and thrombogenesis in ESRD patients. Methods: Sixty-five patients with serum low-density lipoprotein (LDL)-cholesterol levels≥100 mg/d were recruited: 33 patients were on hemodialysis and 32 patients were on peritoneal dialysis. They were assigned randomly to the ezetimibe (10 mg) monotherapy group and the ezetimibe (10 mg) plus simvastatin (10 mg) combination therapy group. Both drugs were administered for 8 weeks. Results: There were no significant differences in the baseline demographic and laboratory characteristics between the two groups. In the monotherapy group, the total and LDL-cholesterol levels were reduced by 14.7 and 21.9%, respectively. There were no changes in the high-density lipoprotein (HDL)-cholesterol or triglyceride levels. Fibrinogen increased significantly (p=0.04). In the combination therapy group, the total and LDL-cholesterol levels were reduced by 29.8 and 42.4%, respectively. There was an additional 15.1% reduction in total cholesterol and an additional 20.5% reduction in LDL cholesterol compared with monotherapy. Several patients complained of minor adverse effects and only one patient in the ezetimibe monotherapy group discontinued medication, because of diarrhea. Conclusions: In ESRD patients, ezetimibe used as combination therapy with a statin is more effective than ezetimibe monotherapy in ESRD patients. (Korean J Med 77:461-471, 2009)

우측 대장에서 대장내시경 후굴에 의한 추가적인 폴립 발견율

김흥업 ( Heung Up Kim ),부선진 ( Sun Jin Boo ),나수영 ( Soo Young Na ),송현주 ( Hyun Joo Song ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.2

Background/Aims: There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. Methods: Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. Results: The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p<0.01). There were no RF associated perforation or severe complication. Conclusions: Using RF examination, additional 4.88% of polyps could be detected in the RC. This technique could be a useful and safe method to detect hidden polyp during colonoscopy.

급성 봉소염성 위식도염

김태훈 ( Taehoon Kim ),남궁연 ( Yeon Namgung ),정선영 ( Sun Young Jeong ),부선진 ( Sun-jin Boo ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.4

젊은 남자에서 캡슐내시경으로 진단한 급성 광범위 허혈성 소장염

정우성 ( Woo Seong Jeong ),송현주 ( Hyun Joo Song ),나수영 ( Soo Young Na ),부선진 ( Sun Jin Boo ),김흥업 ( Heung Up Kim ),김진석 ( Jin Seok Kim ),최국명 ( Guk Myung Choi ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.3

Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy. (Korean J Gastroenterol 2013;61:160-165)

위장관 ; 원인 미상의 위장관 출혈에서 역동적 조영증강 다중검출 전산화단층촬영술의 임상적 유용성

조재민 ( Jae Min Jo ),송현주 ( Hyun Joo Song ),부선진 ( Sun-jin Boo ),나수영 ( Soo-young Na ),김흥업 ( Heung Up Kim ),김승형 ( Seung Hyoung Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

목적: 원인 미상의 위장관 출혈은 전체 위장관 출혈 환자의5%를 차지한다. 역동적 조영증강 다중검출 전산화단층촬영술은 낮은 민감도 때문에 원인 미상의 위장관 출혈에서 일반적으로 권고되지 않지만, 일부 가이드라인에 따라 쉽고 빠른 진단을 위하여 사용이 되기도 한다. 이번 연구는 원인 미상의 위장관 출혈 환자에서의 역동적 조영증강 다중검출 전산화단층촬영술의 임상적 유용성을 평가하고자 진행하였다. 대상 및 방법: 2009년 3월부터 2014년 1월까지 역동적 조영증강 다중검출 전산화단층촬영술을 시행한 362명의 환자의 의무기록을 후향적으로 분석하였다. 총 45명의 환자들이 원인 미상의 위장관 출혈로 진단되어 연구에 포함되었다. 그들의 기저 특성과 치료과정을 후향적으로 분석하였고, 역동적조영증강 다중검출 전산화단층촬영술의 양성률과 이와 관련된 변수들을 평가하였다. 결과: 환자들의 평균 나이는 59세였고 남성이 51.1%를 차지하였다. 흑색변이 가장 흔한 증상이었다(44.4%). 역동적 조영증강 다중검출 전산화단층촬영술의 양성률은 20.0% (9/45)였고 장관내강 조영제 일혈 5명(55.6%), 장관내강 고음영의 혈종 또는 종괴 유사성 병변이 각각 2명(22.2%)이었다. 39명의 환자(86.7%)는 보존적 치료를 받았고 6명(13.3%)의 환자는 내시경 지혈술, 색전술, 또는 수술과 같은 특정 치료를 받았다. 역동적 조영증강 다중검출 전산화단층촬영술 양성 환자들은 특정 치료를 받는 경우가 많았다(44.4% vs. 5.6%, p=0.010).결론: 역동적 조영증강 다중검출 전산화단층촬영술은 낮은 양성률(20.0%)을 보였지만, 양성 소견을 보인 경우는 특정 치료로 시행하는 경우가 많았다. 역동적 조영증강 다중검출 전산화단층촬영술의 양성 소견은 원인 미상의 위장관 출혈 환자치료에 유용한 역할을 한다. Background/Aims: Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients. Methods: We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed. Results: The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010). Conclusions: Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB. (Korean J Gastroenterol 2016;67:198-206)