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박리성 올가미로 지혈한 대장의 거대 용종양 동정맥기형 1예
지정선 ( Jeong Seon Ji ),이보인 ( Bo In Lee ),김병욱 ( Byung Wook Kim ),최황 ( Hwang Choi ),조세현 ( Se Hyun Cho ),최규용 ( Kyu Yong Choi ),정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),채현석 ( Hyun Suk Chae ),정인식 ( In S 대한장연구학회 2004 Intestinal Research Vol.2 No.1
Arteriovenous malformation is well known cause of lower gastrointestinal bleeding in elderly patients. This is relatively uncommon in people younger than 50 years of age. Endoscopically, it generally appears as bright red flat or elevated bright red lesion. A polypoid appearance is extremely uncommon. We report a case of large polypoid arteriovenous malformation of colon in 81-year-old male patient. He has complained of hematochezia for 4 days. During colonoscopy, a 3.5 cm sized semipedunculated polypoid mass in the proximal transverse colon was detected. For prevention of bleeding, detachable snare was applied and biopsy was done. 3 days later, follow up colonoscopy was done. There was no hemorrhege. We performed endoscopic mucosal resection. Polypoid arteriovenous malformation of colon was comfirmed by microscopic findings. Histologically, section of excised polyp shows ulceration, hemorrhage and the dilated, irregularly thick walled blood vessels in the mucosa and submucosa.
정지윤 ( Ji Yun Jung ),김준성 ( Joon Sung Kim ),김병욱 ( Byung Wook Kim ),박성민 ( Sung Min Park ),김기준 ( Gi Jun Kim ),류승지 ( Seung Ji Ryu ),김영욱 ( Young Wook Kim ),지정선 ( Jeong Seon Ji ),최황 ( Hwang Choi ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.3
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a widely accepted and well established procedure because of its curative potential and low invasiveness compared with surgery. Perforation is a potential major complication during ESD, and non-surgical treatments such as endoscopic closure with clips are sufficient in most cases. Here, we report a case of perigastric abscess that occurred as a complication of ESD for EGC. The patient improved with administration of antibiotics without surgical intervention. (Korean J Gastroenterol 2016;67:142-145)
바터팽대부 선종의 내시경적 유두절제술 후 발생한 급성 비결석성 담낭염
임정욱 ( Jeong Uk Lim ),김병욱 ( Byung Wook Kim ),이민영 ( Min Young Lee ),김준성 ( Joon Sung Kim ),지정선 ( Jeong Seon Ji ),최황 ( Hwang Choi ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2
Endoscopic snare papillectomy (ESP) for ampulla of Vater tumor (AVT) has been performed successfully instead of surgical ampullectomy (SA) because ESP is a less invasive procedure than SA. Hemorrhage, perforation and pancreatitis are relatively common complications of ESP and other rare complications such as cholangitis, liver abscess has been reported. Recently we encountered a case of acute acalculous cholecystitis after ESP for AVT, which was treated successfully with percutaneous cholecystostomy with intravenous antibiotics. We therefore report this case with a brief review of the literature.
정윤화 ( Yun Hwa Jung ),장정원 ( Jeong Won Jang ),지정선 ( Jeong Seon Ji ),김병욱 ( Byung Wook Kim ),최황 ( Whang Choi ),최규용 ( Gyu Yong Choi ),맹이소 ( I So Maeng ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1
본 저자들은 윌슨씨병으로 진단된 젊은 여자 환자에서 합병된 담도 결석을 내시경적 담석제거술로 제거한 1예를 경험하였기에 보고하는 바이다. 윌슨씨병은 병인론에서 보듯이 간, 신경계 외에도 혈액학적 합병증을 수반할 수 있으며 이에 따라 담도계의 결석을 이차적으로 수반할수 있음을 증례를 들어 제시하며 역으로 고위험요소가 없는 환자에 있어서의 담도결석은 혈액질환이나 대사질환의 가능성을 시사함을 인지해야 할 것으로 생각된다. Wilson`s disease is a rare autosomal recessive metabolic disease. The ATB7B gene mutation results in a defect of biliary copper excretion and subsequent accumulation of copper in the liver, brain, and sclera. The usual clinical signs of Wilson`s disease include hepatitis, liver cirrhosis, movement disorder, or a Kayser-Fleisher ring in the sclera, but patients occasionally present with hepatic failure or hemolytic anemia. Under such metabolic conditions, free copper induce chronic hemolysis with oxidative damage via free radical production, and chronic hemolysis, in turn, can cause secondary pigment bililary stone formation. Herein we report a case of Wilson`s disease associated with cholelithiasis in a young female. (Korean J Med 75:82-87, 2008)
고령의 환자에서 자궁 절제 수술 후 발생한 저나트륨혈증
김진영 ( Kim Jin Yeong ),송명준 ( Song Myeong Jun ),지정선 ( Ji Jeong Seon ),김영수 ( Kim Yeong Su ),양철우 ( Yang Cheol U ),김용수 ( Kim Yong Su ),장윤식 ( Jang Yun Sig ),방병기 ( Bang Byeong Gi ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1
Postoperative hyponatremia is common clinical problem, which frequently develos in hospitalized patients. We experienced a case of postoperative hyponatremia with mental confusion and nausea after total hysterectomy in an old aged woman. Her mental status became alert and plasma sodium level was corrected after infusing 3% hypertonic saline for 24 hours. Postoperative hyponatremia is usually attributed to several factors : the infusion of excessive amounts of electrolyte-free water and second actions of antidiuretic hormone to prevent excretion of this electrolyte-free water. When hyponatremic encephalopathy develops, postmenopausal women more likely to either have mild symptoms or good response of treatment than menstruant women. The reasons for having much less morbidity among dlderly women than menstruant women are thought that the increasement of brain`s adaptation against hyponatremia and the absence of inhibition of such adaptation by estrogen. In summary, postoperative hyponatremia can develop in an old aged woman infused with isotonic solution, but can recovered safely with early detection and proper management. Thus, every effort should be made to avoid hyponatremia and measure plasma sodium level frequently in postoperative period, when hyponatremia developed, it needs proper management. (Korean J Nephrol 2004;23(1):138-142)
Helicobacter pylori 감염 위점막에서 Peroxisome Proliferator-activated Receptor (PPAR)γ의 발현
손성현 ( Seong Hyun Son ),김형근 ( Hyung Keun Kim ),지정선 ( Jeong Seon Ji ),조영석 ( Young Seok Cho ),김성수 ( Sung Soo Kim ),채현석 ( Hiun Suk Chae ),최명규 ( Myung Gyu Choi ),한석원 ( Sok Won Han ),최규용 ( Kyu Yong Choi ),정 대한소화기학회 2007 대한소화기학회지 Vol.49 No.2
목적: Peroxisome proliferator-activated receptorγ (PPAR γ)는 핵 전사인자로 염증과 악성종양에 관련된 여러 유전자의 발현을 조절한다. PPAR γ는 대장암뿐만 아니라 위암에서도 발현되며, PPAR γ 배위자는 암세포의 분화와 세포자멸사를 유도한다. H. pylori의 지속적인 감염은 만성위염과 소화성 궤양을 일으키고, 세포 전환율을 변화시킨다. 또한 H. pylori는 위암의 주요한 원인 인자이다. 이에 저자들은 H. pylori 감염이 위점막에서 PPAR γ 발현에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 상부위장관내시경검사를 시행한 39명에서 위점막 검체를 얻었다. H. pylori 감염 여부 확인을 위한 신속요소분해효소검사와 조직 검사를 시행하여 H. pylori 감염 정도와 염증세포들의 침윤 정도를 확인하였다. 면역조직화학염색을 시행하여 위점막 검체에서 PPAR γ 단백의 발현 위치, 발현 정도와 강도를 확인하였다. 또한 PPAR γ의 특이 primer를 이용하여 real time PCR을 시행하여 mRNA의 발현 정도를 확인하였다. 결과: PPAR γ 단백은 선와상피세포의 핵에서 발현되었고, 장상피화생 조직과 위암 조직에서도 발현되었다. PPAR γ 단백 발현은 H. pylori 감염 군에서 3.8±0.4, 비감염군에서 2.6±1.0으로 의미있는 차이를 보였다(p=0.012). PPAR γ mRNA 발현은 대장암군에서 H. pylori 감염군과 비감염군에 비하여 유의하게 증가하였으나(p<0.05), H. pylori 감염군과 비감염군에서는 유의한 차이가 없었다(p>0.05). 결론: H. pylori 감염이 위점막에서 PPAR γ 단백 발현을 증가시킴을 확인하였고, PPAR γ가 H. pylori에 의해 유발되는 일련의 염증반응에 중요한 역할을 하는 것으로 생각한다. 추후 이에 대한 더 많은 연구가 필요하다. Background/Aims: Peroxisome proliferator-activated receptor γ (PPARγ), a nuclear transcription factor, plays a critical role in the regulation of gene expression associated with inflammation and cancer. PPAR γ is expressed in human gastric cancer as well as in colon cancer. Activation of PPAR γ by ligand produces pro-apoptotic effect and ameliorate growing of cancer cells. Helicobacter pylori (H. pylori) is a main etiologic agent for gastric inflammation, and raises cell turnover in gastric epithelium. Longstanding infection with this organism is related with the development of non-cardiac gastric cancer. The aim of this study was to investigate the effect of H. pylori on the expression of PPARγ protein and mRNA in chronic gastritis. Methods: Gastric biopsy samples were taken from H. pylori infected (n=18) and non-infected (n=21) patients during endoscopic examination. PPAR γ expressions were assessed by real time polymerase chain reaction and immunohistochemistry. Results: PPAR γ was localized to the nuclei of the foveolar epithelial cells in both infected and non-infected mucosa. PPAR γ protein expression was higher in H. pylori infected patients than in non-infected patients (3.8±0.4 vs. 2.6±1.0, H. pylori infected and non-infected, respectively; p<0.05). However, PPAR γ mRNA levels were not significantly different between the two groups (24±18 vs. 29±25, H. pylori infected and noninfected, respectively). Conclusions: PPAR γ expression is increased in the gastric mucosa of H. pylori infected chronic gastritis, which suggests a certain role of PPARγ in the mucosal inflammatory reaction to H. pylori infection. (Korean J Gastroenterol 2007;49:72-78)
내시경 절제술로 제거한 구불결장의 상피하종양 형태의 고립성 신경섬유종
이원직 ( Won Jik Lee ),박성민 ( Sung Min Park ),김병욱 ( Byung Wook Kim ),김준성 ( Joon Sung Kim ),지정선 ( Jeong Seon Ji ),최황 ( Hwang Choi ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.1
Neurofibromas are benign, slow-growing nerve sheath tumors of the peripheral nervous system, arising from Schwann cells, and classically associated with neurofibromatosis type 1 (Nf1, von Recklinghausen’s disease). They occur rarely in the gastrointestinal tract as isolated neoplasms, outside the classical clinical feature of neurofibromatosis. We herein present an isolated colonic neurofibroma without any systemic signs of neurofibromatosis. A 59-year-old female came to our hospital for constipation. On physical examination, general appearance showed no definite skin lesions. A subepithelial tumor measuring 0.8 cm was detected at the distal descending colon on colonoscopy. The lesion was removed completely by endoscopic resection. Microscopic examination showed proliferation of spindle cells in the mucosa and infiltration of inflammatory cells. Immunohistochemical staining was positive for S-100 protein. The above morphological and immunohistochemical characteristics were consistent with a diagnosis of a solitary neurofibroma of the sigmoid colon. (Korean J Gastroenterol 2016;68:45-48)
최황 ( Hwang Choi ),최규용 ( Kyu Yong Choi ),이보인 ( Bo In Lee ),김민국 ( Min Kuk Kim ),정현정 ( Hyun Jung Jung ),지정선 ( Jeong Seon Ji ),김태호 ( Tae Ho Kim ),오정환 ( Jung Hwan Oh ),이강문 ( Kang Moon Lee ),김상우 ( Sang Woo 대한장연구학회 2007 Intestinal Research Vol.5 No.1
Background/Aims: The diagnosis of small bowel stricture was made by operation. Capsule endoscopy has been useful for diagnosis of small bowel diseases but has limited value in cases with stricture. Double balloon endoscopy is the useful method to visualize the entire small bowel. The aims of this study are to evaluate the feasibility of double balloon endoscopy and to differentiate the endoscopic findings in patients with small bowel stricture. Methods: Between March 2004 and February 2007, fifteen consecutive patients were referred for the evaluation of small bowel stricture. Small bowel strictures were suspected in small bowel series and CT in eleven patients. Capsule endoscopies were performed in six patients and entrapped in three patients. Double balloon endoscopy (EN-450P5/20, Fujinon, Japan) was performed with midazolam (median 5 mg, range 5-10 mg) and meperidine (median 50 mg, range 50-100 mg). All lesions except one were found within 60 minutes. One patient had been excluded because of false-positive finding of capsule endoscopy. Clinical and endoscopic findings were compared between strictures of Crohn’s disease (group I, n=6) and those of other causes (group II, n=8). Results: Double balloon endoscpies were performed with good tolerance without side effect. Age, chief complaints, duration of symptom, and initial hemoglobin and serum albumin levels were not different between two groups. The proportion of male sex was higher in group I than group II (100%, 38%, respectively; p=0.031). The strictures below 0.5 cm in diameter were 83% in group I and 13% in group II (p=0.026). The arrangement of stricture in group I was more eccentric than that in group II (100%, 17%, respectively; p=0.015). The location of stricture, appearance of surrounding mucosa, associated ulcer, and ulcer margin were not different between two groups. Conclusions: Endoscopic differentiation using double balloon endoscopy can be made easily and safely in patients with small bowel stricture. The strictures of small bowel in patients with Crohn``s disease were narrower and more eccentric than thosein patients with other diseases. (Intest Res 2007;5:38-44)
위장관 ; 한국인에서 위저선용종과 결장암의 상관관계: 16년간 후향적 고찰
황선미 ( Sun Mee Hwang ),김병욱 ( Byung Wook Kim ),채현석 ( Hiun Suk Chae ),이보인 ( Bo In Lee ),최황 ( Hwang Choi ),지정선 ( Jeong Seon Ji ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ),맹이소 ( Lee So Maeng ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1
Background/Aims: There is an ongoing debate on the relationship between gastric fundic gland polyps and increased incidence of colorectal neoplasia in Caucasians. However, there was no report on the relationship between gastric fundic gland polyp and colorectal neoplasia in Korea. The aim of this study was to identify the characteristics of gastric fundic gland polyps and whether a relationship exists between fundic gland polyps and colorectal neoplasia in Korean population. Methods: Persons who underwent an esophagogastroduodenoscopy and colonoscopy from 1992 to 2007 at the Health Promotion Center of Incheon St. Mary`s Hospital, The Catholic University of Korea were reviewed retrospectively. The relationship between gastric fundic gland polyps and colorectal neoplasia were analyzed. Results: Among 22,451 subjects, fundic gland polyps were found in 328 subjects (1.5%). Fundic gland polyps were more common in women than in men (odds ratio of 6.25; 95% CI of 4.68-8.34). The odds ratios for colorectal neoplasia in all subjects with gastric fundic gland polyps were 0.56 (95% CI of 0.33-0.95) and men who were 50 years of age or older had an odds ratio of 2.81 (95% CI of 1.03-7.66) as compared to the control group. However, age and sex-adjusted odds ratios for all gastric fundic gland polyps were 0.73 (95% CI of 0.42-1.26), for men 1.78 (95% CI of 0.80-3.98), and for women 0.37 (95% CI of 0.16-0.87). Conclusions: Surveillance colonoscopy in patients with fundic gland polyps can be performed in the same manner as general population in Korea. (Korean J Gastroenterol 2011;58:20-24)