1996년도 제35차 대한소화기학회 추계학술대회 / 일반연제 : 위장관 ; 소화성궤양 출혈 환자에서 내시경적 Hemoclip 요법 , Hypertonic Saline Epinephrine ( HSE ) 국소 주입 요법과 병합요법의 비교

정일권,성재락,이태영,황산,윤석기,김흥수,박상흠,이문호,김선주 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

소화성궤양 출혈 환자에서 내시경적 Hemoclip 요법, Hypertonic Saline Epinephrine (HSE) 국소 주입 요법과 병합요법의 치료효과

이태영,이문호,김홍수,장재영,김선주,정일권,박상흠,성재락 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding. Various different endoscopic hemostatic methods were introduced to treat bleeding peptic ulcer. Many studies reported the efficacy and comparision of various methods. Endoscopic injection therapy is the most comman method among them because it is inexpensive and easy in use. Complications of injection therapy such as aggravation of bleeding, tissue neerosis and perforation were repoted rarely. Recently endoscopic hemoclipping method is considered to be safe and effective hemostatic method for upper gastrointestinal bleeding, Methods: During the period between January 1993 and August 1996, we have conducted clinical trial and retrospective analysis among 100 patients in whom active bleeding or visible vessel was identified.Results: 1) Three groups was divided, Hemaclip group 26 cases, Hypertonic Saline Epinephrine(HSE) group 59 cases, Combinittion group 15 cases. 2) The sources of bleeding in Hemoclip group were gastric ulcer in 23 cases and duodenal ulcer in 3 cases, end in HSE group, gastric ulcer in 44 cases, duodenal ulcer 14 cases and stomal ulcer in one case, and in combination group, gastric ulcer in 10 cases, duodenal ulcer in 3 caseb and stomal ulcer in two cases. HSE and cot~bination method were performed more than Hemoclip method in duodenal ulcer(23.7% and 20.0% versus 11.5%). 3) As the stigmata of bleeding in Hemoclip and HSE and Combination group, spurting were seen: in 5 cases and 3 cases and 4 cases, and ooang in 10 cases and 17 cases and 3 cases and nonbleeding visible vessel in 11 cases and 39 cases and 8 cases, respectively. Hemeclip method was performed more than HSE method in active bleeding state(57.6% versus 33.9%). 4) Initial hemostasis was achieved in 24 cases(92.3%) in Heanoclip group ad 52 cases(88.1%) in HSE group, 13 cases(86:7%) in Combination group. 5) The rebleeding developed in 1 casae(4.2%) in Hemoclip group and 8 cases(15.4%) in HSE group and I case(7.6%) in Combination group, the emergent operation was undewent 2 cases(7.7%) in Hemoclip group and 10 cases(17.0%) in HSE group and 1 case(6.7%) in Combination group, respectively. 6) The death was noticed in 1 cases(3.9%) in Hemoclip group and 2 cases(3.4%) in HSE gioup and 2 case(13.3%) in Combination group, respectively. 7) Permanent hemostasis by only endoscopic treatment was achieved in 24 cases(92.3 %) in Hemoclip group and 48 cases(81.4%) in HSE group, 12 cases(80.0%) in Combination group. 8) Complication was noticed only in HSE group, aggravation of bleeditlg in one case and hematoma in two cases. Conclusion: Hemoclip method was effective hemostatic method same as HSE injection method, and safe method with low complication in bleeding peptic ulcer. We suggest more detail selectian of endoscopic hemostatic method in variously individualized endoscopic features.

대장내시경으로 진단된 게실염에 의한 장중첩증 1예

김영선,이태영,김홍수,이문호,김선주,박상흠,정일권,성재락,목지오,황산 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.4

Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. The incidence of the adult intussusception is low. It constitutes approximately 5% of all intussusception and accounts for 5% of all cases of intestinal obstruction in adult. The clinical feature in adults is not typical. General symptoms and signs of intestinal obstruction dominate the clinical feature of intussusception in adult. The classic appearance of intussusception on barium studies is the coil spring appearance as contrast is trapped between the intussusceptum and intussuscipiens. Ultrasound and CT scan shows a target-like lesion. Colonofiberscopy shows a round invaginated mass with congested mucosa and by air inflation, round mass is decreased in size and is changed in shape. Differential diagnosis can be made by colonofiberscopy because the most common cause of colonic intussusception in adult is a primary colon cancer. A case of diverticulitis associated with intussusception diagnosed by colonofiberscopy in a 72 years old man was presented with brief review of the literature.

췌관내 회충 미입증으로 발생된 급성 췌장염 1예

이영창,이태영,김홍수,이문호,박상흠,최우봉,정일권,성재락,황산,이낙원,목지오,김선주 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.5

Acute pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct is very rare. Authors hnve experienced one case of pancreatic ascariasis. Patient was a 62-year-old female with epigastric pain. Abdominal USG and endoscopic retrograde cholangiopancreatography showed characteristic finding of pancreatic ascariasis. Ascaris was removed with palypectomy snare and acute pancreatitis was resolved completely.

거대 표재성 분포형 조기위암 1예

이영창,김홍수,이문호,장재영,김선주,김대중,박상흠,정일권,성재락,오제호,목지오 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Superficial spreading stomach cancer, as first described by Stout in 1942, is superficially spreading cancer confined to mucosa and submucosa, and measuring up to 10 cm in diameter. Clinical manifestation is peptic ulcer like symptom with a long duration, and a gross appearance is characterized by reddening, irregular and slight nodular thickening of the involved mucosa. We should be careful to differentiate chronic atrophie gastritis or multiple superficial gastric erosions from superficial spreading stomach cancer. It is classified to a subtype of early gastric cancer type Ilc(IIc$quot;) and the prognosis is as good as early gastric cancer. A 60-yearold woman was admitted to our hospital because of epigastric pain for 2 years. She was confirmed to have superficial spreading stomach cancer by gastroduodenoscopy, endoseopic ultrasonography, and operation. We report a case of superficial spreading stomach cancer with a review of relevant literatures.

만성신부전증 신증후군 환자에서 발견된 원발성 알도스테론증 1예

김정호,이은영,박민선,한동철,문철,차미경,진소영,이희발,황승덕,성재락,송경일 대한신장학회 1997 Kidney Research and Clinical Practice Vol.16 No.1

Primary aldosteronism is characterized by hypertension, hypokalemia, low plasma renin activity (PRA) and elevated plama aldosterone (PA) level. Primary aldosteronism is suspected in patients with hypertension and unexplained hypokalernia. In chronic renal failure(CRF), however, renin-angiotensi naldosterone axis is altered by renal disease per se, antihyppertensive drugs used and volume status. Therefore, it is difficult to diagnose primary aldosteronism in CRF on the basis of serurn potassium, PRA and PA level. Recently, we experienced a case of primary aldosteronism associated with nephrotic syndrome and CRF. The patient was a 49 years old woman who presented with 10 year old history of high blood pressure and general weakness of one year's duration. Her initial serum creatinine was 7.3mg/dL and serum potassium 2.6mEq/L. PRA was decreased and PA was markedly increased. Persistent hypokalemia urged to evaluate adrenal gland in this case. The round mass was found in left adrenal gland and it was surgically removed. CRF and nephrotic syndrome can alter serum potassium and PRA and there lies the diagnostic dilemma for primary aldosteronsim. It will be well to consider associated primary alodsteronism in a patient with CRF and persistent hypokalemia.

급성 장 출혈로 발현된 원발성 분절성 회장 확장증 1 예

이태영,이문호,김대중,김홍수,김선주,박상흠,최우봉,정일권,성재락,황산,이낙원 대한내과학회 1998 대한내과학회지 Vol.54 No.1

Idiopathic segmental ileal dilatation is a rare congenital condition in which the caliber of the bowel lumen increases locally without distal luminal obstruction or thickening of the muscle coats in involved lumen. Congenital abnormalities such as exomphalos, malrotation of the midgut, and Meckel's diverticulum are found frequently in the patients with segmental dilatation of the small bowel. Intermittent abdominal pain or anemia may be the symptoms of segmental dilatation of the small bowel in infants, children and occasionally adults. The radiologic finding in barium studies of the small bowel is characteristic axial segmental dilatation. The pathologic finding is nonspecific ulcer and mild congestion, but it has normal nervous system and smooth muscle bundle. There are no evidence of ischemic changes, inflammatory changes or neoplastic changes. The condition can be cured with surgical excision of the dilated segment. A case of idiopathic segmental ileal dilatation associated with melena and recurrent abdominal pain diagnosed by enteroclysis in a 47 years old man was presented with brief review of the literature.