건강한 성인에서 공복 및 식후의 장음 변화 분석과 혈중 5-hydroxytryptamine 농도 변화에 관한 연구

정연수 ( Yon Soo Jeong ),박효진 ( Hyo Jin Park ),최은주 ( Eun Ju Choi ),김영균 ( Young Gyun Kim ),이상인 ( Sang In Lee ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.3

Background/Aims: Auscultation of bowel sounds is a traditional technique for evaluating patients with abdominal symptoms. It is, however, subjective and qualitative method in general. Recently, analysis of bowel sounds becomes possible. We analyzed bowel

간외담도 결석의 내시경적 치료 성적과 이에 영향을 미치는 요인

백순구(Soon Koo Baik),김준명(Jun Myeong Kim),김광현(Kwang Hyun Kim),정연수(Yon Soo Jeong),이동기(Dong Ki Lee),권상옥(Sang Ok Kwon) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives : Developments in endoscopic technique and equipments have improved duct clearance rate in patients with extrahepatic bile duct(EHBD) stone. In this study, we reviewed our experience in extracting EHBD stones with standard and more advanced technique and equipments such as mechanical lithotripsy and extracorporeal shock wave lithotripsy. Aims of this study were to determine the overall success rate of endoscopic extracting for EHRD stone, to identify risk factors for failed duct clearance at initial and final therapeutic ERCP. Methods : We retrospectively reviewed 214 consecutive patients who underwent Endoscopic Retrograde Cholangiopancreatography(ERCP) for EHBD stone over 45 months period. Factors evaluated for failed duct clearance included stone size, stone number, stone shape, concomitant stone of gallbladder and intrahepatic duct, presence of distal bile duct stricture, periampullary diverticula(PAD), Billroth-II gastrojejunostomy, and sepsis at admission. Results: The overall success rate of endoscopic treatment for EHBD stone was 93.5% (200/214). The causes of failed duct clearance were failed endoscopic sphincterotomy in 5/214 (2.3%), technical failure of extracting stone in 5/214(2.3%), and aggravation of acute cholecystitis between therapeutic endoscopic sessions in 4/214(1.9%), Risk factors for failed duct clearance with endoscopic extraction of EHBD stone were size and shape of the stone, concomitant stone of gallbladder and intrahepatic duct, and stricture of distal common bile duct. The duct clearance rate with initial therapeutic ERCP was 56.5%(121/200). Risk factors for failed duct clearance with initial therapeutic ERCP were size, shape and number of stone, and sepsis at admission. The complications of endoscopic treatment for EHBD stone were major bleeding in 5/200 (2.5%), pancreatitis in 18/200 (9.0%), but there was no perforation. Conclusion: Eventhough risk for failure of endoscopic treatment for EHBD stone were giant or piston shaped stone, concomitant stone of gallbladder and intrahepatic duct, and stricture of distal common bile duct, we conclude that endoscopic treatment for EHBD stone is safe and effective treatment modality, and choice of treatment.

급성 췌장염의 진단에 있어서 Urinary Trypsinogen-2 Dipstick 검사의 유용성

황성준 ( Seoung Joon Hwang ),정준표 ( Jun Pyo Chung ),김영균 ( Young Gyun Kim ),송대훈 ( Dae Hoon Song ),이재성 ( Jae Sung Lee ),백승석 ( Seung Seok Baek ),김도연 ( Do Yun Kim ),이덕용 ( Dok Yong Lee ),정연수 ( Yon Soo Jeong ) 대한소화기학회 2004 대한소화기학회지 Vol.43 No.6

Background/Aims: The clinical usefulness of urinary trypsinogen-2 dipstick test is still in controversy. We evaluated the usefulness of urinary trypsinogen-2 dipstick test in patients with acute pancreatitis. Methods: Urinary trypsinogen-2 dipstick test was prospectively performed in 50 patients with acute pancreatitis, 50 patients with non-pancreatic abdominal pain, and 50 healthy controls. Results: On admission, urinary trypsinogen-2 dipstick test was positive in 36 of 50 patients with acute pancreatitis (sensitivity, 72%) and in 4 of 50 patients with non-pancreatic abdominal pain (specificity, 92%). On the other hand, it was all negative in controls. The sensitivity and specificity of serum lipase were 78% and 94%, respectively. At 24 hours after admission, the positive rate of urinary trypsinogen-2 dipstick test rose from 72% to 94% (p=0.02). The results of urinary trypsinogen-2 dipstick test was positive in 14 of 15 patients with severe pancreatitis and 22 of 35 patients with mild pancreatitis according to the criteria by Atlanta International Symposium, 1992. Conclusions: Urinary trypsinogen-2 dipstick test is comparable to serum lipase in diagnosing acute pancreatitis. Delayed measurement and severe pancreatitis are more likely to yield positive results with urinary trypsinogen-2 dipstick test. Thus, we suggest that the cut-off value of urinary trypsinogen-2 dipstick test should be lowered to increase its sensitivity. (Korean J Gastro-enterol 2004;43:364-369)

내시경 초음파검사에서 Levovist 투여 후 조영증강을 보인 위점막하 종양

김현수,이종인,김광현,백순구,조미연,권상옥,이동기,정연수 대한소화기학회 2000 대한소화기학회지 Vol.35 No.5

Contrast enhancing media has been mainly used in enhancing the color doppler signal so far. Since conventional abdominal ultrasonography can not detect the small particles of contrast enhancer due to its low frequency range, it was rarely used in B-mode imaging. However, endoscopic ultrasonography (EUS) with a high frequency range can detect the particles and produce a contrast-enhancing effect when injecting a contrast enhancer such as Levovist . Gastric submucosal tumor shows various ultrasonograpic features, depending on histopathology, but its differential diagnosis is limited. We experienced two cases where the enhancing features on EUS for submucosal tumors were recognized by using Levovist and this helped preoperative prediction of differential diagnosis. The use of contrast enhancer such as Levovist during EUS of submucosal tumor enables us to learn the hemodynamic features of the tumor. Therefore, the differential diagnosis and prediction of the characteristics of the submucosal tumor are possible with this helpful modality.

비열대성 스프루(Celiac disease)와 감별이 어려웠던 장병증-형태 장관 T-세포 악성 림프종 1예

이재성,박효진,정연수,이정일,이상인,박찬일,-- 대한내과학회 2004 대한내과학회지 Vol.66 No.5

저자들은 최근 장병증으로 내원한 환자에서 임상적, 병리학적으로 비열대성 스프루와 감별이 힘들었던 소장의 T-세포 악성 림프종을 경험하였기에 이를 보고하는 바이다. T-세포 림프종은 상당히 드물지만, 예후가 극히 불량하므로 비특이적이고 빠른 임상 경과를 취하는 장관병증을 보이는 환자가 있다면 비록 상하부 내시경상 특이한 점막 소견이 없더라도 심이지장 제2부를 포함한 위장관 각 부위의 점막 생검은 감별 진단을 위하여 꼭 필요하며 경우에 따라서는 보다 적극적으로 개복 소장 생검술 등도 고려해야 할 것으로 생각된다. Primary gastrointestinal lymphomas are commonly B-cell type in contrast to the rare T-cell type, which has been noted as a complication of celiac disease that has not been reported in Korea so far. Primary T-cell lymphoma is commonly associated with enteropathy, and we report a case of small bowel T-cell lymphoma associated with enteropathy, with minimal mucosal lesion lesions as flattening of folds, which was difficult to differentiate with celiac disease clinically and pathologically.

한국인 당뇨병 환자에서 효소면역법과 방사면역법에 의한 항 GAD 항체 측정 : 지진형 인슐린의존형 당뇨병 환자의 병인에 관한 연구 Study for pathogenesis of slowly progressive IDDM

김희선,정춘희,이한효,신영구,김홍승,정연수,김장영,박덕우,윤갑준 대한당뇨병학회 1997 Diabetes and Metabolism Journal Vol.21 No.3

Non-Hodgkin`s Lymphoma와 동반된 IgA 신병증 1예

이은영,김진수,이종인,최승옥,심영학,홍순원,정연수,이형준 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5

The development of glomerular injury in patients with malignancy is considered as paraneoplastic syndrome. The most frequently observed renal lesions associated with malignancies are the membraneous glomerulonephritis on carcinomas and minimal change nephrotic syndrome on Hodgkin's disease. However, glomerular diseases on non-Hodgkin's lymphoma were only occasionally reported. Here we report a case of IgA nephropathy associated with non-Hodgkin's lymphoma. A 53-year-old woman who had complained of gross hematuria and fever was admitted to Wonju Christian Hospital. A urinalysis revealed 2? proteinuria and red blood cells $gt;30/HPF. A 24-hour urinary protein excretion was 379mg. She was diagnosed as IgA nephropathy on renal biopsy. Subsequently, biopsy of her enlarged neck node was performed for evaluation of fever of unknown origin and it revealed non-Hodgkin's lymphoma(Ki-1 positive anaplastic lymphoma null cell type). Combination chemotherapy was instituted with cyclophosphamide, adriamycin, vincristine andprednisone. After 3 cycles of chemotherapy, she showed no evidence of proteinuria and hematuria with clinical and radiological improvement of malignant lymphoma. Therefore we suggest of certain association between IgA nephropathy and non-Hodgkin's lymphoma by the observation of corresponding disease activity.

담도 배액관 유도 유두부 절개술 : 난해한 유두부주위 게실 및 위 부분절제술 환자에서

김현수,김광현,백순구,권상옥,이동기,정연수 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.1

Background/Aims: Patients with a congenitally or surgically altered anatomy such as a large diverticulum in which an ampullary orifice exists or a Billroth-II gastrectomy, have an increased complication rate after endoscopic sphincterotomy (EST) compared to normal anatomies. An experience involving a stent-guided sphincterotomy using an endoprosthesis is herein reported. Methods: 10 patients with a Billroth-II gastrectomy and 9 patients with a large diverticulum received a stent-guided EST. In the diverticula cases, all the ampullary orifices were located either inside the diverticulum or in an unusual position. All patients had common bile duct stones and symptoms of cholangitis. After a 0.035 inch guide wire was inserted through the side-viewing duodenoscope, a 10 Fr. endoprosthesis (MTW, Germany) was inserted and a needle-knife sphincterotome was introduced. In patients with a Billroth-II anatomy, the incision was made from the papillary orifice of the 12 o'clock position toward 6 o'clock. In patients with periampullary diverticula, the incision was made with sweeps of the needle-knife in a 6 to 12 o'clock direction. The cautery current was applied to the mucosa along the stent and the stent was retrieved by a polypectomy snare through the biopsy channel without removal of an endoscope. Results: Among the 19 patients, the guide wire and stent insertion were possible in all except one patient due to the inability of selective cannulation. An EST was performed in all patients after stent insertion. There were no serious complications during and after the stent-guided EST except for two minor bleedings which were treated with a coagulation current using the needle-knife. Consequently, complete endoscopic stone removal was achieved in all patients including three patients in whom a mechanical lithotriptor was needed. Conclusions: In stent-guided EST, the stent not only guides the adequate direction of the incision but also allows a controlled incision under a favorable visual field. Therefore, blind cutting and exploration during EST can be avoided and successful EST is possible even in difficult situations such as that created by an altered anatomy.