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최덕례 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1
Background/Aims: Our aims in this study were to determine histopathology and distri-bution of small colonic polyps (up to 6 mm). Small polyps were found frequently in the colon and rectum at colonoscopy. The size of polyps which should be removed endo-scopically has been controversial. Methods: Medical reports of all patients undergoing total colonoscopic examination during 8-year period were reviewed. Results: Eight hun-dred thirty-three small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Of the small polyps, 58.8% were neoplastic, 17.7% were hyperplastic, 22.7% were inflammatory; 0.1% contained atypia, 0.1% were carcinoid, 0.6% were xan-thoma, 0.1% were adenocarcinoma. In the colon except rectum, neoplastic polyps were more common than non-neoplastic polyps. The difference in distribution of the major types of polyps in the right colon and transverse colon was significant (p <0.0001). Conclusions: Most small polyps proximal to the rectum are neoplastic. All polyps should e removed when encountered during colonoscopy due to the high prevalence of adenoma among small polyps.
김동호,최덕례,이석주,우상민,김광일,김홍성 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.1
Spontaneous retroperitoneal hemorrhage due to liver cirhosis associated with impaired coagulopathy is very rare disease. Spontaneous retroperitoneal hemorrhage has been recorded as having originated from many retroperitoneal organs and blood vessels, and it may be due to local disease and/or systemic factors. In the majority of patients the bleeding arose from the kidney or adrenal gland. Among the systemic causes of spontaneous retroperitoneal hemorrhage are anticoagulation therapy and chronic hemodialysis during the course of which hemorrhagic complications may occur at many site, including the retroperitoneal space. Blood dyscrasias have been a rare cause of spontaneous retroperitoneal hemorrhage. Conditions reported have been included hemophilia, leukemia, polycythemia and sickle cell trait. Virtually every hemostatic function may be impaired in patients with severe hepatic disease as the result of failure of both the biosynthetic and clearence function of the liver, thrombocytopenia, platelet dysfunction, intravascular coagulation and fibrinogenolysis, and the effects of products of fibrinogen catabolism on the coagulation mechanism. We are reporting a case of spontaneous retroperitoneal hematoma in a patient with alcoholic liver cirrhosis with brief review of literature.
신정맥하부를 포함한 간이하 하대정맥 및 총장골정맥의 선천성결손 1 예
김미숙,최덕례,백만순 대한내과학회 1997 대한내과학회지 Vol.52 No.2
Obstruction of the inferior vena cava may presented with unusual and varied pathologic condition and be due to thrombus, extension of tumor, extrinsic compression, or intrinsic caval disease. Thrombus is major cause of obstruction of the inferior vena cava and congenital absence of the inferior vena cava with azygos continuation is extremely rare. In congenital absence of the inferior vena cava (Infrahepatic interruption of inferior vena cava with azygos continuation), infrahepatic inferior vena cava is obliterated but infrarenal portion of the inferior vena cava is patent. In this anormaly, blood from the lower extremities and kidney drained into azygous vein and hemiazygous vein via ascending lumbar vein which eventually into the superior vena cava. These anormaly is seen in 0.6% of patients with congenital heart disease, particularly in cases of polysplenia. We experienced one case of congenital absence of the infrahepatic inferior vena cava, which involved infrarenal portion and the common iliac vein with azygos continuation in 63-year-old male. He was complained of lower abdominal pain, constipation. We report this case with reviewing literatures.
박병수,최호순,최덕례,최우석,조병석,안진형,고정희 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.2
Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.
포스터 발표 : 담도,췌장 ; 중증 급성 췌장염에서의 다발성 장기부진의 예후적 중요도
윤상정 ( Sang Jeong Yoon ),최덕례 ( Duck Yeii Choi ),박성규 ( Seong Kyu Park ),김배영 ( Bae Young Kim ),이승민 ( Seung Min Lee ),조윤주 ( Yun Joo Jo ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
〈목적〉 급성 췌장염은 임상적으로 경증에서 중증에 이르기까지 다양하면, 동반된 합병증으로 초기에 정확한 진단과 적절한 치료가 이루어져야 한다. 저자들은 급성 췌장염 환자에서 장기부전의 발생빈도를 알아보고, 장기부전이 예후에 미치는 영향을 평가하고자 하였다. 〈방법〉 본 연구에서 1996년부터 199년까지 4년간 을지의과 대학 병원에 내원하여 급성 췌장염으로 진단 받고 치료받았던 환자 187예를 대상으로 하였다. 이들은 남자 140예, 여자 47예였고,
최우석(Woo Seok Choi),최덕례(Deok Rye Choi),나용호(Yong Ho Na),문형배(Hyung Bae Moon) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5
N/A Background/Aims: Currently, the endoscopic biopsy technique is the most accurate diagnostic modality detecting the ga'tric carcinoma. But, it is thought importantly to evaluate the significance of touch cytology in diagnosing the gastric lesion because the representative area of gastric lesion is possible to be removed during the process making the specimen. Methods. After l,333 cytologic specimens from 1,235 patients were made by touch of the biopsied tissue on the slide glass and were stained by Papanecolaous method, the tissue specimens were obtained by the usual specimen making technique. The results of the cytologic diagnosis were compared to the biopsy results. Results: The accuracy of the cytologic diagnosis was 99.0%(1,108/1,119 cases) in the gastritis or benign ulcer, 20.4%(11/54 cases) in the atypical epithelial lesions, and 75.0%(120/160 cases) in the malignancy. The overall accuracy of the cytologic diagnosis was 92.9%(1,239/1,333 cases). False positivity of the cytologic diagnosis was 0.4%(5/1,177 cases) and false negativity was 16.9%(27/ 160 cases). All of the 4 cases, which were diagnosed class IV or V in the cytologic diagnosis and gastritis or benign ulcer in the biopsy diagnosis in the first study, were found to be benign lesions in the follow up cytologic and biopsy studies. Conclusion: This study indicates that touch cytologic examinations supplementary to biopsies are not so significant enough to performed spending many efforts since biopsied specimen represent the majority of gastric lesion, if they were sampled at correct site of lesion at all. (Korean J Gastroenterol 1995;27: 517 - 513)
Ulcerative Colitis 를 동반한 Lunch Syndrome 1 1 예
김홍식,김상준,김주호,허갑도,최덕례,조성락 대한내과학회 1988 대한내과학회지 Vol.35 No.2
Lynch syndrome I is primarily caused by inherited factors and patients are susceptible to colonic cancer on a family basis. Virtually all family members who have inherited the critical gene can be expected to develop cancer eventually. It is therefore extremely important that biomarkers be investigated which might enable genotype carrier identification before phenotypic expression(clinical cancer). This syndrome appears to be inherited in autosomal dominant fashion with high penetration and is characterized by a lack of antacedent. Much of colonic cancer in young adults predeliction for occurance in the proximal colon and is associated with multiple primary colonic cancer, both synchronous and metachronous.