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이준혁(Joon Hyoek Lee),백승운(Seung Woon Paik),심상군(Sang Goon Shim),류광현(Kwang Hyun Ryu),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),이종철(Jong Chul Rhee),최규완(Kyoo Wan Choi),이석호(Suk Ho Lee),이규택(Kyu Taek Lee),이종균(Jong 대한내과학회 1999 대한내과학회지 Vol.57 No.1
N/A Low-grade gastric MALT lymphoma arises from long-standing Helicobacter pylori(Hp) infection. High remission rates for these lymphoma have been observed after H. pylori eradication. There was debates on the optimal treatment of low-grade gastric MALT lymphoma. The purpose of this study is to investigate clinical and endoscopic characteristics of primary low-grade gastric MALT lymphoma and to assess short-term clinical outcome of various modalities of treatment. Methods : 30 patients(14 male, 16 female, mean age 44.9 years, range 26-76, mean follow-up 22.9 months) with primary low-grade gastric MALT lymphoma, diagnosed at the Samsung Medical Center from March 1995 to September 1998, were evaluated in a retrospective study. We evaluated patient's presenting symptoms, endoscopic finding, Hp status, staging by Musshoff system, and recurrence rate according to treatment mordalities. Results : The most common symptom is epigastric discomfort or pain(36.7%). Endoscopic appearances of gastric MALT lymphoma shows the wide variation from mucosal thickening to overt malignancy. The most common site of gastric MALT lymphoma is the gastric antrum and lower body(9 and 6 patients). Histologically, 70% were found to be Hp infected. Of 21 Hp(+) patients, 11 patients were clinical stage IE and received Hp eradication by PPI-based triple regimens. 81.8%(9/11) showed complete remission. Among 11 patients, 6 patients studied by PCR. After Hp eradication, 5 in 6 patients showed persistent IgH rearangement by PCR. The mean follow-up time is 22.8 months(range 3 to 36 months), One patient, who showed complete histologic regression during second endoscopy, relapsed MALT lymphoma after 6 months. The other one patient showed no change of lymphoma and underwent surgery. 12 patients underwent surgical treatment and showed no evidence of relapse. The mean follow-up time is 35.9 months. 2 patients received chemotherapy with CHOP regimen and showed complete remission. The mean follow-up time is 6.7 months. 2 patients received radiotherapy and showed no evidence of relapse. The mean follow-up time is 15 months. Conclusion ' Our study shows that complete remission rate after Hp eradication is as high as some studies recently reported. This suggest that Hp eradication may be considered as first-line therapy of low-grade gastric MALT lymphoma of stage IE.
한국인 건강검진자에서 연령 특이적 A형간염바이러스 항체 혈청 양성률
송영봉 ( Young Bong Song ),이준혁 ( Joon Hyoek Lee ),최문석 ( Moon Seok Choi ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ),최윤호 ( Yoon Ho Choi ),손희정 ( Hee Jung Sohn ),이경한 ( Kyung Han 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.1
급성 신기능 손상을 동반한 A형 간염의 임상상과 예후 인자
이진희 ( Jin Hee Lee ),최문석 ( Moon Seok Choi ),곽금연 ( Geum Yeon Gwak ),이준혁 ( Joon Hyoek Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Background/Aims: We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA. Methods: We reviewed medical record of 391 patients with AHA admitted at our institution since 2000. Results: AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7±8.7 years vs. 31.3±7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI. Conclusions: AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect. (Korean J Gastroenterol 2010;56:359-364)
이규택 ( Kyu Taek Lee ),이종균 ( Jong Kyun Lee ),이준혁 ( Joon Hyoek Lee ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae Jun Kim ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),이종철 ( Jong Chul Rhee ),노재형 ( Jae Hyung Noh 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6
A biliary enteric fistula may form between any part of the extrahepatic biliary system and any adjacent portion of the gastrointestinal tract. The incidence of biliary enteric fistulas varies between 0.9 and 5% of all cases of biliary disease. These fistulas are usually sequelae or complications of long standing calcareous biliary tract disease. The diagnosis is to be suspected whenever air is demonstrated within the biliary system on roentgenographic examination and may be confirmed by additional measures. The most common site of a biliary enteric fistula is between the gallbladder and the duodenum, and next common types of fistulas are cholecystocolic and choledochoduodenal. Cholecystocholedochocolic fistula is a very rare type of internal biliary fistulas. Recently, we encountered a case who suffered from hepatic abscess by ascending infection due to pre-existing gallstones combined with cholecystocholedochocolic fistula. So, we report a case of cholecystocholedochocolic fistula which was treated successfully by operation with a review of relevant literatures.(Korean J Gastroenterol 1997;29:853-858)
이상구 ( Sang goo Lee ),이준혁 ( Joon Hyoek Lee ),백승운 ( Seung Woon Paik ),고광철 ( Kwang Cheul Koh ),최문석 ( Moon seok Choi ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae Jun Kim ),이종철 ( Jong Chul Rhee ),최규완 ( Kyoo Wan Cho 대한내과학회 1999 대한내과학회지 Vol.56 No.6
Objective : This study was aimed to characterize the clinical features and course of acute hepatitis A in Korean adults. Methods : One-hundred and thirteen cases of acute hepatitis A, diagnosed between Jan. 1995 to July 1998 at 6 medical centers in Korea, were reviewed retrospectively. The clinical course of 94 cases with follow-up duration longer than 3 months were analyzed. Results : The median age was 26 (16-65) years and 97.3% of the patients were under 40 years. The presumed sources of infection were identifed in 62 cases (54.9%). Among those, the leading source was ingestion of raw food. All patients showed normalization of bilirubin level within 8 weeks. The ALT levels normalized within 8 weeks in all patients except three patients (3.2%). Three patients with prolonged elevation of ALT showed second rise of ALT, suggesting a possibility of relapsing hepatitis. Prolonged fever (>38℃) more than 10 days was observed in 3 patients (3.2%). One case showed prolonged elevation of alkaline phosphatase (> x3 upper normal limit). No case of fulminant hepatic failure or death was observed. Conclusion : The majority of cases with acute hepatitis A in Korean adults showed self-limited course with full recovery.
사례보고 : 급성 신부전을 동반한 전격성 간염으로 발현하여 간이식을 시행한 A형간염 4예
오세훈 ( Se Hoon Oh ),이준혁 ( Joon Hyoek Lee ),황지원 ( Ji Won Hwang ),김혜영 ( Hye Young Kim ),이창훈 ( Chang Hoon Lee ),곽금연 ( Geum Youn Gwak ),최문석 ( Moon Seok Choi ),고광철 ( Kwang Chul Koh ),백승운 ( Seung Woon Paik ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3
A형간염은 대부분의 경우 가벼운 임상경과를 거치게 되나 드물게 전격성 간염으로 발전하여 사망에 이르거나 간이식을 시행하게 된다. 저자들은 비교적 높은 연령의 환자에서 급성 신부전을 동반한 전격성 간염으로 발현되어 간이식까지 시행했던 A형간염 4예를 경험하였기에 보고하고자 한다. 본 증례들은 공통적으로 1) 30대 후반 이상의 상대적 고령에 발생, 2) 급성 신부전을 동반, 3) 간종대를 동반, 4) 조직 소견에서 아광범성 간괴사 소견의 특징을 보였다. Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (≥39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of sub-massive hepatic necrosis. (Korean J Hepatol 2009;15:362-369)
담도 폐쇄로 인한 담도염 환자에 있어서의 담즙 내 세균에 대한 연구
성인경(In Kyung Sung),이규택(Kyu Taek Lee),이종균(Jong Kyun Lee),김영호(Young Ho Kim),이석호(Seok Ho Lee),송희정(Hee Jung Son),이준혁(Joon Hyoek Lee),이풍렬(Poong Lyunl Rhee),김재준(Jae Jun Kim),고광철(Kwang Chul Koh),백승운(Seung Wo 대한내과학회 1998 대한내과학회지 Vol.55 No.1
N/A has been focused on the Enterococcus due to increasing in incidence of nosocomial infection and resistance to broad range of antimicrobial agents of this organism The purpose of this study was to analyse the bacteriologic features of bile in patients with cholangitis. Methods : Bacteriological examination was made of bile from 356 patients with cholangitis due to biliary tract obstruction, 105 of them with common bile duct stone and 251 of them with malignant disease. Bile specimens were taken during percutaneous transhepatic biliary drainage of endoscopic nasobiliary drainage. The specimens were cultured aerobically and anaerobically and then the anti- biotic sensitivity test was done. Results: The overall positive culture rates was 81.4%. There was significant difference in positive culture rates between the patients with common bile duct stone and the patients with malignant disease,(88.5% vs 78.4%, p<0.05) But there was no significant difference in bacteriological features between the patients with common bile duct stone and the patients with malignant disease. The commonly isolated organisms were Enterococcus (21.6%), E.coli(19.7%), and Klebsiella(17.2%) respectively. The isolation rate of anaerobes were only 2%. The rate of polymicrobial infection was 78.1%. The rates of 3rd cephalosporins-resistant Klebsiella were over 30%. The rate of ampicillin-resistant Enterococcus was 35%. The rate of gentamicin-resistant Enterococcus was 28%. Conclusion : This study shows that 1) many micro- organisms have resistance to a broad range of antimicrobial agents, and 2) the antibiotic coverage against Enterococcus should be considered for the treatment of cholangitis due to the increasing tendency to Enterococcus infection.