간장 및 담도 : 삼출성 복수증의 감별진단과 복강경 검사

정규원(Kyu Won Chung),차상복(Sang Bok Cha),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),안병민(Byung Min Ahn),김재광(Jae Kwang Kim),김태룡(Tae Ryong Kim),최규용(Gyu Yong Choi) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1

N/A Exudative ascites should initiate an evaluation for peritoneal processes, most importantly infection and tumor. And the pathological diagnosis is required for a approapriate treatment in most cases. To assess the diagnostic accuracy and complication rates of diagnostic laparoscopy in patients with exudative ascites we studied in 73 patients with exudative ascites retrospectively. Thirty three patients had malgnancy related ascites, and peritoneal carcinomatosis was confirmed in thirty one patients. Twenty seven patients had tuberculous peritonitis, and thirteen patients had miscellaneous causes, among them eight patients had underlying liver cirrhosis and clinically spontaneous bacterial peritonitis were suspected in three patients in whom bacteria were cultivated in ascites. Pancreatic pseudocyst and leakage into peritoneal cavity was confirmed by endoscopic retrograde pancreatography in one case, but the remained four cases had not known the diagnosis. The most common primary cancer was gastric carcinoma which was diagnosed in fourteen patients, and then ovarian cancer in five patients, colon cancer in four patients, pancreatic cancer in three patients, mesothelioma in one patient and unknown origin in four patients. Cytology evaluation of the ascitic fluid was positive for tumor cells in 62% of patients with peritoneal carcinomatosis. Blind Cope needle biopsy yielded positive diagnosis of neoplastic or tuberculous in 65.4 per cent of rases. The major and minor complication rates of laparoscopy were 0% and 26.4%, respectively, with no fatalities. These findings compare favorably with general experience. We conclude that laparascopy is relatively safe and accurate diagnostic method of choice in exudative ascites, especially in cases when other non-invasive methods were failed.

십이지장의 원발성 악성임파종

정규원(Kyu Won Chung),선희식(Hee Sik Sun),최규용(Kyu Yong Choi),이일중(Ill Jung Lee),한명철(Myung Cheol Han),신상현(Sang Hyun Shin),최상욱(Sang wook Choi),차상복(In Sik Chung),정인식(Sang Bog Cha) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

We reported a case of 35-year old man who was diagnosed primary malignant lymphoma in duodenum confirmed by post-operation pathologic diagnosis. He complained of general weakness and epigastric pain. The endoscopy revealed marked duodenitis with necrosis and bleeding of the bulb and the 2nd portion of duodenum. The result of endoscopic biopsy was chronic inflammation with some atypism. The massive upper GI bleeding was developed and Whipples operation was done. The pathologic examination of specimens showed diffuse, well differentiated, lymphocytic malignant lymphoma.

위정맥류 출혈과 비장경색을 합병한 만성췌장염

문윤기(Yoon Gi Moon),이보인(Bo In Lee),강성호(Sung Ho Kang),양영상(Young Sang Yang),채현석(Hyun Suk Chae),최규용(Gyu Yong choi),정인식(In Sik Chung),차상복(Sang Bok Cha),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

Splenic infarction is an uncommon form of splenic pathology. It occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Other etiologic factors include splenic vascular disease, anatomic abnormalities, collagen vascular disease, nonhematologic malignancy, and pancreatic disease in the extremely rare form. Pancreatic disease may result in splenic infarction because of constriction of the splenic vessels by the fibrotic pancreas, tortuous aneurysm, or thrombosis of splenic vein. A pseudocyst in the tail of the pancreas may dissect into the hilum, causing vascular compromise and infarction. Recently we experienced a 47-year old man cpmplaining of left upper quadrant pain, which was diagnosed as gastric variceal bleeding and splenic infarction associated with chronic fibrosing pancreatitis confirmed by ultrasonogram of abdomen, abdominal CT, angiography, and operation. Distal pancreatectomy and splenectomy were performed, and subsidence of his symptoms was observed. We report this case with a review of the relevant literature. (Korean J Gastroenterol 1995;27:611 - 616)

Helicobacter pylori에 감염된 십이지장궤양과 비궤양성 소화불량에서 ABO 혈액형과 HLA의 연관

채현석(Hiun Suk Chae),김태규(Tai Gyu Kim),한훈(Hoon Han),김성수(Sung Soo Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),차상복(Sang Bok Cha),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: It has been known that genetic factors, for example, blood group, non-secretor and HLA system, are associated with duodenal ulcer and that Helicobacter pylori infection is the major cause of peptic ulcer. However, Helicobacter pylori is also found in non-ulcer dyspepsia and asyrnptomatic patients without ulcer formation. But, it is still not known regarding what kind of genetic factors have an effect on ulcer formation at the time of Helicobacter pylori infection. This study was performed to make clear wbich genetic factors are re1ated with duodenal ulcers among Koreans, and what kind of genetic factors could influence on the ulcer formation in the patients with Helicobacter pylori infection according to ABO blood groups and HLA antigen.'.. Methods: The duodenal ulcer patients (36), non-ulcer dyspepsia (19) and norraal healthy controls (103) were included in this study. Helicobacter pylori infection was detected with phenol red spray method in vivo which was confirmed with Warthin-Starry silver stain. HLA antigen expression (HLA-A,B) of peripheral blood T lymphocytes was studied with microlymphocytotoxicity teclmique. Results: Tbe frequency of HLA-A 33 was higher in duodenal ulcer patients (l4/36, 38.9%) compared with the control group (21/103, 20.4%). On the contrary, no difference in HLA-B has been shown between duodenal ulcer patients and controls. Among patients with Helicobacter pylori infection, blood group 0 was significant1y more frequent in patients with duodenal ulcers (21/36, 58.3%) than in non-ulcer dyspepsia (5/19, 26.3%). In patients with HLA-A 33, blood group 0 was significantly more frequent in duodenal ulcer patients (7/)4, 50%) than in non-ulcer dyspepsia patients (0/7, 0%). Conclusions: In Helicobacter pylori-infected patients, HLA-A 33 is related with duodenal ulcers and the patients with both blood group 0 and HI.A-A 33 are more likely to have duodeual ulcers than those with HLA-A 33 and without blood groop O. (Korean J Gastrnenterol 1996; 28:623 - 631)

Mirizzi 증후군 1예

김용수,정인식,주상용,정규원,정환국,선희식,차상복,전성주 대한소화기내시경학회 1984 Clinical Endoscopy Vol.4 No.1

Mirizzi syndrome is an uncommon cause of obstructive jaundice. It consists of the following elements: (1) an anatomic arrangement of the cystic duct such that it lies almost parallel to the common hepatic duct, (2) impaction of a gallstone in the cystic duct or neck of the gall bladder, (3) partial mechanical obstruction of the common hepatic duct by the atone itself or the resulting inflammatory reaction, and (4) recurrent cholangitis or ultimately cholangitic cirrhosis due to the partial obstruction. We have recognized I case of this syndrome diagnosed by ERCP and report it with review of literaturea. A 40-year-old man was admitted to the St. Mary's hospital, Catholic Medical College, because of anorexia, jaundice, generalized itching sensation, and right upper quadrant pain. He was well until 1 month earlier, when he began to feel anorexia and right upper quadrant pain. 2 weeks before admission jaudice and generalized itching sensation were developed. On examination he appeared acutely ill. Sclera was icteric and there was mild tenderness over the right upper quadrant. There were multiple scratching wounds in the skin. CBC, urinalysis, serum electrolyte, and renal function Eest were within normal limit. Liver function test revealed significant elevation of serum bilirubin, SCOT, SGPT, gamma GTP, and alkaline phosphatase. Simple X-ray films of the chest and abdomen showed non-specific findings. IVC showed nonvisualization of extrahepatic and intrahepatic biliary radicles. Abdominal ultrasonography showed enlarge GB with thickened wall, and high echogenecity probably in the GB or cystic duct. Intro-hepatic radacles were dilated. ERCP showed that cystic duet lay parallel to the common hepatic duct, and that common hepatic duct llad an narrowing area. Intro-hepatic radicles were dilated. At operation first portion of duodenum was adhered to GB and liver. Enlarged GB was noted with large single stone in the neck of GB. Yellowish, thick pus was accumulated in GB. GB wall was thickened. CBD was not dilated without stone. Postoperative T-tube Cholangiography revealed patent common hepatic duct. This patient discharged in good general condition without postoperative complication.

용종제거술로 절제한 대장 과립세포종 1예

최규용,정인식,정규원,김부성,선희식,차상복,최영진,이안희,최재경,최명규 대한소화기내시경학회 1991 Clinical Endoscopy Vol.11 No.2

This case report describes a patient with semipedunclated granuylar cell tumor(granular cell myoblastoma) of the proximal ascending colon removed by endoscopic polypectomy. A 39-year old femalie was visited to our hospital for intermittent abdominal pain and loose stool. Colonoscopic examination showed a semipedunclated lesion covered with yellowish white smooth mucosa in the proximal ascending colon. The tumor was removed by endoscopic polypectomy. The collected specimen was 0.9x0.8 cm in size. The cut surface of the specimen showed a white round firm tumor covered with mormal epithelium of the colon. Using immunohistochemical study, the tumor cells were to be positively stained by S-100 protein and negatively stained by desmin, which supports the concept of the Schwann cell origin of granular cell tumor. In Korea, 2 cases of granular cell tumor of the colon and rectum, which were treated by surgical removal, have been reported. This case in the first endoscopic polypectomy of granular cell tumor of the colon and retum in Korea. The endoscopic polypectomy is thought to be useful for the therapy of small pedunclated or semipedunclated granular cell tumor, intracolonic type.

루푸스 방광염 1 예

정인식,김부성,박두호,이창돈,차상복,박성규,채현석,방춘상,이보인,윤종현,정용학 대한내과학회 1997 대한내과학회지 Vol.53 No.3

Systemic lupus erythematosus is a disease of unknown cause which involves various organs and primary involvement of urinary bladder is very rare. We experienced a case of a female patient with SLE and urologic manifestations (interstitial cystitis, hydroureters and hydronephrosis), which were resolved spontaneously without any immunosuppressive therapy. There was no significant correlation between clinical course and disease activity index.

소장 내시경으로 진단된 공장 평활근 육종 출혈 1예

정인식,김부성,선희식,박두호,차상복,이태원,양영상,최규용,문윤기,채현석 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.3

In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, $quot;push$quot; enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.

대량출혈을 동반한 십이지장 이소성 췌장 1예

정인식,박두호,차상복,장기육,최규용,오수혁,채현석 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.2

Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration.

개인용 컴퓨터를 이용한 내시경소견의 기록과 관리시스템의 개발

최규용,정인식,정규원,김부성,최명규,최병길,선희식,차상복 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.2

The authors developed a computerized documentation system to record and store all the data pertaining to an endoscopic examination of the upper digestive tract. The system was programmed using the database management system Clipper Version 5.01. It is easy and convenient to use due to advanced deaign of input screen using menu bars and pull down menu and windows. The system was designed to permit the easy storage and retrieval of data by personnel who lack computer skills and who may only have limited typing ability. Today this system has been in daily use for 1 year at the endoscopic units of 8 different branch hospitals of Catholic university,medical college. Overall the experience in these centers has been positive, with excelient or good participation. Characteristics of this system are a menu-driven system, data input by predefined list, instantaneous report generation, on line access to previous examination, late entry of yathologic regerts. and record retrieval, listing according to different criteria. For the description of endoscopic findings and diagnosis, structured input is maintained. All of the findings are chosen from predefined list using pop-up screen and also free text typing is allowed. Therefore time effort was not increased compared to conventional documentation. Structured input and the resulting categorical data affer several advantages.