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악성 점막하 종양과의 구별이 어려웠던 Gastritis Cystica Profunda 1예
선제형,박진석,한민석,김수항,김우진,박인형,이숭,유종선,박찬국 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3
Gastritis cystica profunda (GCP) is a rare disease characterized by gastric foveolae elongation along with hyperplasia and cystic dilatation of the gastric glands extending into the tissue beneath the submucosa. GCP mainly develops at the gastroenterostomy stoma but can arise in a stomach that has not undergone surgery. The proposed pathogenesis is related to chronic inflammation, ischemia and the presence of a foreign body. GCP may present as a submucosal tumor, Polyp or a giant gastric mucosal fold. Endoscopic ultrasonography (EUS) is an effective diagnostic method for differentiating GCP from protruding and elevated gastric lesions. We report a case of GCP along with the endoscopic and EUS findings that were indistinguishable from a malignant submucosal tumor.
최인기,김선문,선제형,천상열,김용석,이태희,임의혁,허규찬,최용우,강영우 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.2
Background/Aims: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions. Methods: We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months. Results: A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course. Conclusions: A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching. 목적: 상부위장관 내시경 시행 도중에 발생하는 의인성 Mallory-Weiss 증후군은 흔치 않으며 발병률은 0.07∼0.49%로 보고된다. 저자들은 의인성 Mallory-Weiss 증후군의 빈도와 임상적 특징에 대하여 알아보고자 하였다. 대상 및 방법: 건양대학교병원 소화기내과에서 54,188예의 상부위장관 내시경 검사 중 진단된 의인성 Mallory-Weiss 증후군 환자 46명(0.08%)을 대상으로 후향적으로 조사하였다. 결과: 대상 환자 46명의 평균나이는 52.5±19.6세이었고, 남자는 35명(76%), 여자는 11명(24%)이었다. 상부위장관 내시경 검사 도중 트림이나 구역 후에 발생한 경우는 36명(78.2%)이 있었고, 식도 열공 탈장(hiatal hernia)이 동반된 환자는 20명(43.5%)이었다. 대상 환자들을 분석한 결과 남자에서 우세하게 발병하였고 통계적으로 유의한 차이가 있었다. 연령대에 따른 발병률도 유의한 차이가 있었다. 모든 예에서 점막의 열상과 함께 삼출성 출혈을 보였으며 지혈술을 받은 환자는 16명(34.8%)이었다. 추적 상부위장관 내시경 검사를 받은 수는 17명(36.9%)이었고 경과는 모두 양호하였다. 심한 임상 경과를 보인 환자는 없었다. 결론: 의인성 Mallory-Weiss 증후군의 발병률은 0.08%로 드물게 발생하며 대부분 양호한 경과를 보였다. 상부위장관 내시경 검사 시에 예견 가능한 위험인자가 있는 경우나 호발하는 동반 질환이 있는 경우에 트림과 구역을 최소화할 수 있도록 주의를 요한다.
이두영,김성호,선제형,박진석,손존광,선홍주,이승,박찬국 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2
Gastric candidiasis is an uncommon disorder. It is an opportunistic pathogen in immune compromised individuals, alcoholics, persons treated with broad-spectrum antibiotics, immunosuppressive and chemotherapeutic agents. Besides, the use of drugs that reduce the gastric acid production may be a cause of gastric candidiasis. We experienced a case of gastric candidiasis following advanced gastric adenocarcinoma. A 85-year-old woman was admitted to our hospital because of epigastric soreness. Endoscopic findings revealed a large ulcero-infiltrating mass with yellow exudate at cardia of the stomach, which suggested an advanced gastric cancer. Endoscopic biopsy revealed spores and pseudohyphae infiltrating through the ulcerated stomach wall, diffuse infiltration of tumor cells and abortive tumor glands. After treatment with fluconazole 100 mg daily for 21 days, no evidence of the gastric candidiasis was seen on endoscopic biopsy and pathologic findings. The case is herein reported of gastric candidiasis following advanced gastric adenocarcinoma along with a review of corresponding literature.