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십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구
김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Suk Cho),채봉남(Bong Nam Chae),최진용(Chin Yong Choi),이계희(Kye Heui Lee),손인(In Son),박성훈(Sung Hoon Park),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.3
N/A Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18 months later. In CBS group, that was 33.3% in 1 year and 44.4% in 1H months later. In double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively. In triple therapy group, that was both 3.8% in 1 year and 18 months later. 4) When all of these patients were classified into two groups according to the eradication of H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that WBS 57.1% (24 patients) in the 42 patients with H. pylori not eradicated. Conclusion : From these results, we can conclude that in order to evaluate the eradication of H. pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of therapy than immediately after the therapy, and the eradication of H. pylori in DU patients reduces the recurrence of DU.
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장기간 Furosemide 의 복용으로 발생한 신수질 석회화가 동반된 가성 Bartter 씨 증후군
박성수,박경주,박송자,박성훈,윤여학,조윤숙,채봉남,이가희,김윤구,최진용 대한내과학회 1993 대한내과학회지 Vol.45 No.2
A 30-year-old married woman showed hypokalemic metabolic alkalosis, normotensive hyperreninemia, hyperaldosteronism and a high urinary sodium and chloride level. She was thought have Bartter's syndrome because she denied taking diuretics. But all the five tests of urine for furosemide by high performance liquid chromatography (HPLC) gave positive results. On being confronted with the results of urine analysis showing the presence of furosemide, she did admit to the taking of furosemide for 11 years. Renal radiologic studies including intravenous pyelography, ultrasonography, and computed tomography showed medullary nephrocalcinosis. This case is unique in that nephrocalcinosis have been related to long term furosemide ingestion in adults and we concluded that this apparent case of Bartter's syndrome with nephrocalcinosis was caused by long term surreptitious diuretic ingestion and suggest that this may occur more frequently than is generally appreciated.
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