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원발성 담즙성 간경변증-자가면역성 간염의 중복증후군 1예
안상준,권병표,이상화,이태영,장진석,정진숙,한상영 대한내과학회 2004 대한내과학회지 Vol.66 No.2
저자들은 지속적으로 간기능 악화를 보이는 환자에서 간조직 검사를 통해 원발성 담증성 간경변증-자가면역성간염의 중복증후군 환자를 진단하였기에 문헌고찰과 함께 보고하는 바이다. Primary biliary cirrhosis and autoimmune hepatitis are the two main immune-mediated liver diseases. They are generally differentiated easily on the basis of clinical, biochemical, serological, and histological findings. Occasionally, the normally distinctive features overlap and classification of a given patient's chronic liver disease is difficult. Series of such patients with Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome were reported. We report a case of primary biliary cirrhosis-autoimmune hepatitis overlap syndrome proven by clinicopathology. The patient showed hepatitis features including easy fatigability, icteric sclera. Markers of hepatitis B and C virus were absent. The liver biopsy showed chronic hepatitis with piecemeal necrosis, infiltration of inflammatory cell surrounding bile duct. The clinical data of high titers of antinuclear antibodies and antimitochondral antibodies, elevated serum IgM, suggest mixed features of primary biliary cirrhosis-autoimmune hepatitis. The patient as given only ursodeoxycholic acid (600 ㎎/day), then was observed follow-up regularly.
급성 전골수구성 백혈병(M3) 환자에서 플루코나졸로 치료한 간 칸디다증 1예 : Successful treatment with fluconazole
원종진,권병표,김성현,이혁,권혁찬,김재석,김효진 대한내과학회 2004 대한내과학회지 Vol.66 No.5
일반적으로 대부분의 임상의들은 혈액학적 악성질환 환자들에게 항암화학요법 이후 간 칸디다증이 진단되며 amphotericin B를 우선 정주 한다. 그러나 본 증례에서처럼 혈액진 균배양검사 결과상에서 배양이 되지 않을 경우 amphotericin B의 정주 후에도 임상소견 및 거사실 소견의 호전이 없다면 fluconazole의 정주로 치료 전략을 바꾸는 것이 바람직 하다고 생각한다. The frequency of invasive fungal infections has increased during the period of chemotherapy. Fungal infections are an increasing cause of morbidity and mortality in patients with hematological malignancies. The most common organism are Candida albicans. This report describes our experience in a 28-year-old woman who developed symptoms of hepatic candidiasis which were confirmed with liver biopsy after remission induction chemotherapy for acute myeloid leukemia. In our case, the patient did not improve clinically despite administration of 610 mg amphotericin B. Severe leukocytosis, increasing alkaline phosphatase and clinical deterioration developed rapidly, and then we switched to flconazole, taking into consideration successful fluconazole treatment of patients with chronic disseminated candidiasis and acute hepatic candidiasis. She remains in clinically and radiological improving at the time of this report.
p-ANNA 강양성을 보인 제1형 자가면역성 간염 1예
정동성,정제혁,권병표,안상준,장진석,한상영,김경희 대한내과학회 2004 대한내과학회지 Vol.66 No.3
38세 여자에서 강양성의 p-ANNA 수치를 보여 ERCP로 원발성 경화성 담관염을 배제 후 제1형 자가면역성 간염으로 진단을 하였다. p-ANNA와 자가면역성 간염의 관계에 대해서는 추후 연구가 필요할 것으로 보인다. Autoimmune hepatitis (AIH) is an undissolved inflammatory process of the liver characterized by the periportal hepatitis on histological examination and serum autoantibody. AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. Perinuclear-Antineutrophil nuclear antibody (p-ANNA) are detected in up 세 88% of patient with primary sclerosing cholangitis (PSC) and presence of p-ANNA in PSC makes them a reasonable diagnostic maker in conjuction with standard diagnostic test. But p-ANNA in AIH is rare and it's role remain unclear. We report the first case of 39 year-old-female patient with AIH type-1 with p-ANNA strong positivity.
급성충수돌기염으로 발견된 위선암에서 전이된 충수돌기 선암 1예
나경준,이재영,백현철,김정훈,배상훈,김동현,제인수,권병표,이태영,김상현,송철수,김민석,이진숙 대한소화기내시경학회 2007 Clinical Endoscopy Vol.34 No.5
Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma. (Korean J Gastrointest Endosc 2007;34:274-277) 일반적으로 충수돌기의 원발성 선암은 드문 질환으로 알려져 있으며, 다른 장기에서 전이된 충수돌기의 선암도 드물게 보고되는 희귀 질환이다. 저자 등은 급성 충수돌기염으로 진단된 72세 남자의 수술적 방법을 통해 발견된 원발성 위선암에서 전이된 충수돌기 선암의 1예를 경험하여 드문 증례이기에 문헌 고찰과 함께 보고하는 바이다.
이신애 ( Shin Ae Lee ),한상영 ( Sang Young Han ),이은주 ( Eun Joo Lee ),권병표 ( Byung Pyo Kwon ),고인영 ( In Young Koh ),최해종 ( Hae Jong Choi ),김민찬 ( Min Chan Kim ),조진한 ( Jin Han Cho ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6
Splenic pseudocyst is a rare complication of abdominal trauma. Although it is rare, splenic pseudocyst is well-documented in the literature. According to the current classification, approximately 30% of all splenic cysts or pseudocysts result from direct abdominal trauma. In addition, chronic pancreatitis leads to change of nearby organs with possible acute and chronic complications including splenic lesions. This unusual complication can occur in both emergent and nonemergent conditions. The useful diagnostic procedures to assess intrasplenic pseudocyst are sonogram, CT scan, splenic scan, and occasionally angiography. However, definite diagnosis of pseudocyst is possible only after splenectomy when the absence of epithelial lining is confirmed histologically. Splenic pseudocyst requires surgical resection. We experienced a 31-year-old man who confirmed of warmness in the left side of back with left upper quadrant abdominal pain for several months. First impression was splenic lymphangioma based on CT scan and sonogram finding. Splenectomy was performed. Microscopic examination revealed splenic pseudocyst with fibrous capsule without epithelial lining. (Korean J Gastroenterol 2006;48:427-430)
이재영 ( Chae Yong Yi ),나경준 ( Gyoung Jun Na ),백현철 ( Hyun Choul Baek ),김정훈 ( Jeong Hoon Kim ),배상훈 ( Sang Hun Bae ),김동현 ( Dong Hyun Kim ),제인수 ( In Soo Je ),권병표 ( Byoung Pyo Kwon ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.1
Although most of pseudocysts as one of complications of pancreatitis occur primarily within the pancreas, the extrapancreatic locations of pseudocysts, especially in the liver, are rare events. With advanced technology of imaging studies including abdominal computed tomography, ultrasonography, and magnetic resonance imaging, their frequency seems to be increasing. We report here a case of left intrahepatic pancreatic pseudocyst following acute pancreatitis. Percutaneous puncture revealed a high level of amylase and lipase in the collection, confirming the diagnosis of intrahepatic pseudocyst. Symptomatic intrahepatic pseudocysts can be managed surgically, transcutaneously or endoscopically, and asymptomatic intrahepatic pseudocysts can be treated conservatively. We report this case with a review of literature. (Korean J Gastroenterol 2008;51:56-59)