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췌장염에서 발생한 가성동맥류의 임상 양상: 단일기관 경험 및 국내문헌 고찰
김지현 ( Ji Hyun Kim ),김재선 ( Jae Seon Kim ),김창덕 ( Chang Duck Kim ),이홍식 ( Hong Sik Lee ),조영직 ( Young Jig Cho ),이종섭 ( Jong Sup Lee ),최도원 ( Do Won Choi ),한우식 ( Woo Sik Han ),김연호 ( Youn Ho Kim ),연종은 ( Jong E 대한소화기학회 2007 대한소화기학회지 Vol.50 No.2
서론: 만성 또는 급성 췌장염의 합병증으로 발생하는 가성동맥류는 복강이나 후복막 또는 위장관 출혈을 일으켜 치명적인 결과를 초래할 수 있다. 저자들은 췌장염의 합병증으로 발생한 가성동맥류의 임상 특징을 알아보고자 이 연구를 시행하였다. 대상 및 방법: 1995년 1월부터 2006년 3월까지 고려대학교 구로병원과 안암병원에서 췌장염의 합병증으로 가성동맥류를 진단받은 7예를 대상으로 환자의 특성과 임상 경과를 후향 분석하였다. 결과: 성별은 모두 남자였고, 연령은 평균 54.6세(43-67세)였다. 모든 예에서 가성낭이 동반된 만성췌장염에서 가성동맥류가 발생하였고, 음주가 만성췌장염의 원인이었다. 진단 당시의 주 증상은 5예에서 심와부 통증, 1예는 혈변, 1예는 토혈이 복통과 동반되었다. 출혈 양상은 5예에서는 가성낭 내로의 출혈이었으며 1예는 가성낭 내로의 출혈과 동반된 하행결장 누공형성에 따른 출혈, 1예는 가성낭 내로의 출혈과 동반된 췌관 출혈이었다. 증상 발생 후부터 가성동맥류 진단까지의 평균 기간은 7.8일(1-23일)이었다. 6예의 복부 전산화단층촬영에서 가성낭 내의 국소적 조영증강의 특징적인 소견이 관찰되어 진단이 가능하였으며, 3예에서 복부 전산화단층촬영 전에 복부 도플러초음파 검사를 시행하였으며 이 중 2예에서는 가성동맥류를 시사하는 소견이 관찰되지 않았다. 6예에서 초기 치료로 혈관색전술이 시행되었고 모든 예에서 재발은 없었으며 혈관색전술과 관련된 중대한 합병증은 관찰되지 않았으나 1예에서는 합병증으로 비장경색이 발생하였다. 1예는 초기 치료로 원위췌장절제술을 시행하였다. 결론: 췌장염의 합병증으로 발생한 가성동맥류는 다양한 임상 양상을 보이며, 초기 치료로 동맥색전술을 이용한 비수술적인 방법이 효과적이다. Background/Aims: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. Methods: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. Results: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. Conclusions: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality. (Korean J Gastroenterol 2007;50:108-115)
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조영직,전훈재,박동규,김윤배,고동욱,정록선,송치욱,엄순호,김창덕,류호상,현진해,신봉경,김인선 대한내과학회 2002 대한내과학회지 Vol.62 No.5
Dedifferentiated liposarcoma occurs in less than 10% of all liposarcomas and is found most often in the retroperitoneum and extremities. Although cases of the primary dedifferentiated liposarcoma have been sporadically reported internationally, only one case with 8×4.5×4 ㎝ size originated from spermatic cord and one case with 10×7×5 ㎝ size in right gluteal region have been reported in Korea, but not in retroperitoneum. We report one case of the primary giant dedifferentiated liposarcoma occurred in retroperitoneum with 32×22×20 ㎝ size and 4,250 g weight. A 56-year old man was admitted due to the weight loss and diffuse abdominal pain. The abdominal computed tomography showed that a round huge mass was pressing the surrounding structures and showed delayed enhancement. Surgical excision was carried out. Histologically the tumor was composed of well differentiated liposarcomatous area and malignant fibrous histiocytoma-like dedifferentiated area. The patient refused further treatment and now he is undergoing the follow-up.
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요소호기 검사로 평가한 치료 기간에 따른 Helicobacter pylori 제균율의 분석 : OAC 7, 10, 14 일간 병합요법의 비교
이상우,박동규,김성태,이성준,박재홍,이홍식,김창덕,진윤태,최재현,엄순호,류호상,현진해,박철희,조영직,전훈재,고동욱 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.4
Background/Aims: Efficacy of triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) for Helicobacter pylori (H. pylori) varies among different geographic regions and patient populations. And, there is no full consensus on how long this treatment should be maintained. We assessed the efficacy of the OAC regimen according to the treatment duration (7, 10 or 14 days) using (13)^C-urea breath test ((13)^C-UBT). Methods: Two hundred fifty five H. pylori positive patients with peptic ulcer were randomly assigned to a OAC (omeprazole 20㎎ b.d., amoxicilln 1.0 g b.d. and clarithromycin 500㎎ b.d.) 7, 10 or 14 days regimen. Eradication of H. pylori was assessed by (13)^C-UBT 4 weeks after the completion of the completion of therapy. Results: 140 male and 115 female (mean age, 51.3) patients were enrolled. The overall eradication rate of H. pylori in each group was significantly higher in OAC 14 days regimen than OAC 7 and 10 days regimen (91.9% in OAC 14 days, 74.4% in OAC 7 days, and 80.2% in OAC 10 days, respectively, p$lt;0.05). Conclusions: The overall eradication rate of H. pylori was highest in OAC 14 days regimen in our study. We have found significant differences in eradication rates with previous reports, using CLO and histology, in Korea. Thus, further studies focusing on the treatment period may be warranted.
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