Ticlopidine에 의한 답즙정체성 간염 3예

이광혁(Kwang Hyuk Lee),김태헌(Tae Hyun Kim),우광훈(Gwang Hoon Woo),윤정환(Jung Hwan Yun),이효석(Hyo Suk Lee),김정룡(Chung Yong Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Ticlopidine, an antiplatelet agent, is widely used for the prevention of coronary artery stent thrombosis or for secondary prevention of stroke and transient ischemic attack. Although asymptomatic elevation of liver enzymes has been reported in 5% of patients taking ticlopidine, jaundice due to ticlopidine was rare. We have recently experienced three cases presented with jaundice due to ticlopidine. All three patients developed first symptoms less than 30 days after ticlopidine medication. Their liver function test showed elevation of serum alkaline phosphatase level and hyperbilirubinemia. Histopathologic examination which was performed in two of them showed cholestatic hepatitis. In two patients who have been followed up, jaundice was disappeared 22 and 28 weeks after cessation of the drug, respectively. Thus, in diagnosis of a patient who shows abnormal liver function test of cholestatic pattern while taking ticlopidine for less than one month, we should consider the possibility of ticlopidine induced hepatitis and forbid the patient to take the drug at appropriate time. (Kor J Gastroenterol 2000;36:419 - 423)

종례 : 궤양성 대장염 환자에서 발생한 하대정맥 혈전증과 급성 췌장염 1예

신도현 ( Do Hyun Shin ),이광혁 ( Kwang Hyuk Lee ),김치훈 ( Chi Hoon Kim ),김갑현 ( Kap Hyun Kim ),박성현 ( Sung Hyun Park ),장동경 ( Dong Kyung Chang ),이종균 ( Jong Kun Lee ),이규택 ( Kyu Taek Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.4

A 21-year-old man admitted complaining of sudden severe epigastric pain for 1 day. He had been diagnosed as ulcerative colitis (UC) and taking mesalazine for two months. UC was in nearly complete remission at admission. He never drank an alcohol, and serum amylase was 377 IU/L. CT scan showed inferior vena cava (IVC) thrombosis in addition to mild acute pancreatitis. To evaluate the cause of acute pancreatitis and IVC thrombosis, magnetic resonance cholangiopancreatogram (MRCP), endoscopic ultrasonogram (EUS), lower extremity Doppler ultrasonogram (US) and blood test of hypercoagulability including factor V, cardiolipin Ab, protein C, protein S1, antithrombin III, and anti phospholipids antibody were performed. There was no abnormality except mild acute pancreatitis and IVC thrombosis in all the tests. He was recommended to stop taking mesalazine and start having anticoagulation therapy. After all symptoms disappeared and amylase returned normal, rechallenge test with mesalazine was done. Flare-up of abdominal pain occurred and the elevation of serum amylase was observed. Ulcerative colitis came to complete remission with short-term steroid monotherapy. Acute pancreatitis and IVC thrombosis were completely resolved after 3-month anticoagulation therapy with no more mesalazine. We postulated that IVC thrombosis occurred due to hypercoagulable status of UC and intra-abdominal inflammation caused by mesalazine-induced pancreatitis. (Korean J Gastroenterol 2010;56:255-259)

간내 담관석 환자에서 담관암의 위험인자 분석

이우진,김용태,김정룡,이준성,윤용범,김선희,변정식,이광혁 대한소화기학회 1999 대한소화기학회지 Vol.34 No.1

Background/Aims: Hepatolithiasis is a risk factor for cholangiocarcinoma, but it is difficult to detect early cholangiocarcinoma which occurs as a complication of hepatolithiasis. To elucidate the risk factors for cholangiocarcinoma associated with hepatolithiasis, we evaluated the clinical characteristics of patients who had cholangiocarcinoma with hepatolithiasis. Methods: Twenty-seven patients who had hepatolithiasis with cholangiocarcinoma and 71 patients with hepatolithiasis only were recruited in this study. We analyzed sex ratio, age, location of intrahepatic stone, combined hepatic atrophy, and serum carcinoembrionic antigen (CEA) level for these two groups. Results: The sex ratio, location of intrahepatic stones, and rate of combined hepatic atrophy were not different between the two groups. Although the mean age was not statistically different, the proportion of patients aged over 40 was higher in the cholangiocarcinoma-complicating hepatolithiasis group (HC) (96.3%) than in the hepatolithiasis (H) group (71.8%) (p$lt;0.05). The serum CEA levels were higher in the HC group (60.7±110.8 ng/ml) than in the H group (2.5±1.2 ng/ml)(p$lt;0.05). Conclusions: We should suspect a concurrent cholangiocarcinoma in patients with hepatolithiasis, especially those with age over 40 and high serum CEA level.

충수에서 발생한 선상유암종 1예

김경아,송인성,정현채,송호준,김정룡,김주성,문해,이광혁,김강모 대한소화기학회 1999 대한소화기학회지 Vol.34 No.6

An adenocarcinoid in the appendix is very rare, and its histologic and prognostic features are between those of carcinoid and adenocarcinoma. This report describes the case of a 36-year-old man with an adenocarcinoid in the appendix. Three years prior to admission, he received appendectomy due to right lower quadrant pain. However, a chronic colicky abdominal pain persisted and was aggravated for recent 15 days. Initially, we thought that adhesive ileus caused the pain, but the pain was not relieved by the management. Radiologic studies and endoscopic examination showed that the pain might result not from postoperative adhesive ileus but from another unknown disease. Therefore, operation was performed to find out its definite cause. Small bowel resection and radical right hemicolectomy was carried out to confirm the possibility of malignancy or other inflammatory bowel disease such as tuberculosis. Finally, it was diagnosed as an appendiceal adenocarcinoid with ischemic changes. The ischemic changes were attributed to surrounding fibrosis by appendiceal adenocarcinoid.

췌장가성낭에 대한 내시경적 배액술과 방사선학적 경피적 배액술의 치료 효과 비교

김태호,김경아,이동호,김용태,송호준,이국래,윤용범,류지곤,장유현,김정룡,이광혁,김강모,문해,이우진 대한소화기학회 1999 대한소화기학회지 Vol.34 No.4

Background/Aims: Surgical, percutaneous, and endoscopic techniques are used as drainage method for symptomatic and complicated pancreatic pseudocysts. However, there has been no study to compare the effect and complications of the endoscopic and percutaneous drainage methods. The aim of this study was to compare the effectiveness and side effects of these two nonsurgical techniques. Methods: We retrospectively examined the records of 25 patients who had undergone percutaneous or endoscopic drainage for pancreatic pseudocysts from 1995 to 1998. Results: Eleven patients were managed with endoscopic drainage (ED) and fourteen patients were managed with percutaneous drainage (PCD). There was no significant difference between ED group and PCD group in respect to success rate of first trials (9/11 and 14/14, respectively; p=0.183), rate of pain relief (3/5 and 4/6; p=1.00), hospital days (27.3±18.4 and 24.7±26.0 days; p=0.307), rate of conversion to surgical drainage (0/11 and 4/14; p=0.105), and complications (34 and 6/11; p=0.115). Moreover, no difference was detected in the rate of patients in whom removal of drainage tube was possible (7/10 and 9/10; p=0.370) or in the duration of drainage (109±47 and 137±116 days; p=0.874). Conclusions: There is no difference in effectiveness and side effect between endoscopic and percutaneous methods for draining pancreatic pseudocysts. The two methods can be used complementarily.

만성 특발성 가성 장폐쇄증 1예

김유선,송인성,정용진,정현채,김용일,박규주,김정룡,최일주,문해,이광혁,박재갑 대한소화기학회 1999 대한소화기학회지 Vol.34 No.6

Chronic intestinal pseudoobstruction (CIP) is a rare clinical syndrome caused by ineffective intestinal propulsion. It is characterized by symptoms and signs of intestinal obstruction without occluding lesion of the intestinal lumen. CIP may be primary or secondary to variable systemic illness. This clinical syndrome may reflect the involvement of smooth muscle organs other than the intestine, such as the esophagus, the ureter, and the bladder. Chronic idiopathic intestinal pseudoobstruction (CIIP) has often been used to denote the primary syndrome. It is divided into neuropathic and myopathic subtypes on the basis of intestinal histopathologic features. We report a case of CIIP presenting hypoganglionosis in myenteric plexus of colon.