식도정맥류의 내시경적 결찰술 전후의 하부 식도 내압 검사의 변화

유재규(Jae Kyu Ryu),김형언(Hyeong Eon Kim),류준형(June Hyung Lyou),최석채(Suck Chei Choi),김학철(Haak Cheoul Kim) 대한내과학회 1995 대한내과학회지 Vol.48 No.6

N/A Objectives: Endoscopic injection sclerotherapy is one of the effective therapeutic modalities for treating acutely bleeding esophageal varices. However, there are a number of complications and one of them is the changes in lower esophageal motility. A recently developed method that uses small rubber bands for treating bleeding varices, endoscopic variceal ligation (EVL), may change the lower esophageal motility. This study was designed for investigating the effects on lower esophageal motility in paients with esophageal varices before and after EUL. Methods: We prospectively performed lower esophageal manometry(using 8 lumen ESMR catheter, Arndorf, Medical Specialities Inc. in 20 patients with esophageal varices to investigate the length, pressure, relaxation percent, relaxation duration of lower esophageal sphincter(LES) and the speed of peristaltic wave, contraction amplitude, contraction duration in the lower esophagus before and after EVL therapy. EVL was performed with a Pentax EG2900 fiberoptic endoscope and Stiegmann-Goffligator kit. Results: There were noted mild epigastric discomfort, nausea, chest discomfort and sinus bradycardia during and after EVL that were improved spontaneously. The EVL caused considerable diminution in the size of esophageal varix by mean 8.7(range 3-21) ligations in mean 1.8(range 1-3) sessions. LES length after EVL was 3.7±0.8cm vs 3.7±0.7cm before treatment. LES pressure after EVL was 13.1±3.9mmHg vs 12.7±6.9mmHg before treatment. LES relaxation percent after EUL was 90.5±9.6 % vs 87.8±8.1% before treatment. LES relaxation duration after EVL was 9.1±1.8sec vs 9.5±2.1 before treatment. In the lower esophagus 3cm above LES, the speed of peristaltic waves after EVL was 3.46±0.8lcm/sec us 3.1±0.8cm/sec before treatment, contraction amplitude after EVL was 87.9±44.2 vs 73.0±39.8mmHg before treatment and contraction duration after EVL was 3.3±0.5 sec vs 2.7±0.5 sec before treatment. There were no significant changes in the length, pressure, relaxation percent and duration of the lower esophageal sphincter(LES) and in the speed of peristaltic wave in the lower esophagus after EVL. There were significant differences in the contraction amplitude and duration in the lower esophagus after EVL. Conclusion: Variceal ligation therapy may improve esophageal peristalsis due to increase in the contraction amplitude and duration in the lower esophagus and cause lesser motility dysfunction in the lower esophagus. In conclusion, EVL is a safe, easy and effective therapeutic modality in patients with esophageal varices.

간경변증 환자에서 식도 정맥류의 내시경적 정맥류 결찰요법이 보행성 24시간 식도내 pH에 미치는 영향

김형언(Hyeong Eon Kim),유재규(Jae Kyu Ryu),김학철(Haak Cheoul Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Endoscopic variceat ligation(EVL), a recently developed method for controlling active variceal bleeding and eradicating esophageal varices with similar efficacy to endoscopic injec- tion sclerotherapy(EIS), has a minimal risk of complications that may damage to the esopha- gus. EIS is known to decrease the lower esophageal sphincter tone and induce gastroesophageal reflux. The effects of EVL on the esophageal motor function have recently been described compared to those of EIS, but yet there are no reports to be found describing the effects on the intraesophageal pH in the individual patient. We performed EVL in 20 patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding. To investigate the effect of EVL on intraesophageal pH, ambulatory 24-hour esophageal pH monitorings were performed both be- fore and after EVL, and analysis of pH tracing was done. The incidence of gastroesophageal reflux disease was noted to be 4D% in patients with cirrhosis of liver(in 8 patients out of 20). After performing I to 3 EVL treatment sessions(mean 1.8) with a 7-day interval in between each session and using 3 to 21 ligations(mean 8.7), the effect of EVL showed a reduction in size of the esophageal varices in all cases. All of the results of pH monitoring studies showed that there were no significant differences in all pH parameters between those before and after EVL. In conclusion, no significant EVL-related gastroesophageal refluxes were observed when a relatively small number of legations were performed. Our study supports several recent stud- ies describing that fibrosis due to EVI- is limited to the mucosa or submucosa of the esopha- gus.(Korean J Gastroeriterol 1994; 26 : 9-16)

이면성 심초음파도에 의한 관상동맥 우회로술후 좌심실 국소 벽운동의 변화

원수연(Soo Yeon Won),전일문(Il Mun Jeon),박명선(Myoung Seon Park),장명규(Myoung Kyu Jang),유재규(Jae Kyu Ryu),정진원(Jin Won Jeong),박양규(Yang Kyu Park),박옥규(Ock Kyu Park),최종범(Jong Bum Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.6

N/A Objectives: Studies on the effect of Coronary Artery bypass Graft Surgery (CABG) on segmental left ventricular wall motion have yield conflicting results. So we assessed changes of segmental left ventricular wall motion in patients with coronary artery disease after CABG and advantage of 2dimensional echocardiography on evaluating its effectiveness. Methods: 20patients with coronary artery disease (12unstable angina pectoris, 8 acute myocardial infarction) were studied with 2-dimensional echocardiography before and early 8.3±3.3 (mean±SD) and late 204.5±105.9 days after CABG. The changes in segmental wall motion were assessed quantitatively by assigning a segmental wall motion score recommended by ASE (1: normal, 2: hypokinesia 3: akinesia, 4: dyskinesia, 5: aneurysm) to each of 16echocardiographically defined segments by 45-degree rotating apical 4-plane views (8 in basal, 8 in apical). Results: 1) The mean left ventricular segmental wall motion score did not change significantly (1, 10±0.37, l.25±0.47, 1.12±0.40; befror, early and late after CABG respectively). 2) There was a significant change in septal wall motion at early postoperative study [37 (46%) of the 80septal segments; 1.14±0.41, 1.59±0.59(p<0.001): before and early after CABG respectively], and the worsening segments were nearly normalized at late postoperative study [24(92%) of 26segments]. 3) The segments with normal motion preoperatively remained normal late postoperatively [169(99%) of 171normal segments preoperatively]. 4) Most of the preoperative abnormal segments [23(96%) of 24segments] were in patients with acute MI and a half of them (11segments) were normalized at late postoperative study. 5) While the anterior or anteroseptal preoperative abnormal segments were usually improved postoperatively, the posterior or inferior abnormal segments were not changed significantly. Conclusion: A part of the abnormal segmental left ventricular wall motion in coronary artery disease can be improved after CABG and 2-dimensional echocardiography may be beneficial to assessing not only the changes of segmental left ventricular wall motion motion quantitatively but also the effectiveness of CABG.

십이지장 팽대부의 융모성선종

최석채(Suck Chei Choi),송승렬(Seung Ryel Song),임동석(Dong Suk Lim),조규혜(Kyoo Hye Cho),유재규(Jae Kyu Ryu),김학철(Hak Chel Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

Villous adenoma of the ampulla of Vater Which is sometimes the cause of extrahepatic obstructive jaudice is uncommon disease. But they are important in spite of their rarity, because of frequent malignant change in the tumor as a focal or all occult tumor. Recently, the early diagnosis of ampullary tumors has become possible due to the ide application of fiberoptic endoscopy and increasing knowledge about the ampullary tumors. Although the biopsies were taken during the endoscopy, sometimes one might miss the area of malignant degeneration. But, it could increase the diagnostic accuracy by performing a hiopsy at the highly suspected site ofl malignancy, like our case in which fixed and discolorecl areas in the lesion were biopsied. So we recommed an affn.ssive endoscopic study and hypotonic duodenogram. Even thought it is diagnosed as benign, and can be treated with endoscopic pelypectorny, but we recommend the complete resection of the tumor because of high incidence of recurrence and malign ant transformati on.

3대에 걸쳐 발생한 유전성 구상 적혈구증

장명규,유재규,박명선,이용구,윤귀현,조지현,문영회 大韓血液學會 1994 大韓血液學會誌 Vol.29 No.1

위식도 역류질환에서 식도염의 발현율

나용호,송승렬,유재규,장명규 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.2

The exact incidence of esophagitis in gastroesophageal reflux disease (GERD) remains poorly understood in Korea. To determine incidence of esophagitis in GERD, from August 1988 to July 1993, endoscopy, esophageal manometry with Bernstein test, and ambulatory 24 hour esophageal pH monitoring were carried out in a group of 349 patients with symptoms of heartburn or noncardiac chest pain. Based on these studies, 151(40%) patients had some degree of GERD and pstients were categorized as having: pathologic reflux, 98 patients; symptomatic reflux, 42 patients; and sensitive mucosal reflux, 11 patients. Among 151 patients with GERD, 27 patients(18%) had some degree of esophagitis. In conclusion, 40% of patients with symptoms suggestive of GERD have GERD. GERD is divided into subgroups; pathologic reflux, symptomatic reflux, and mucosal sensitive reflux. Less than 20% of GERD have esophagitis or esophageal mucosal injury and these low incidence of mucosal injury in Korean may be due to increased esophageal mucosal resistance.

원발성 유미 심낭 1 예

박명선,정진원,박양규,최종범,유재규,박옥규,장명규,원수연,전일문 대한내과학회 1994 대한내과학회지 Vol.47 No.1

Chylopericardum is particularly uncommon and usually secondary to intrathoracic operation, chest trauma, primary or metastatic tumors, chronic inflammation and congenital lymphatic anomaly which cause obstruction of the lymphatic drainage. However, primary chylopericardium unrelated to trauma or chylothorax is a rare condition and its etiology remains obscure in most cases. We have experienced a 69-year-old female patient with primary chylopericardium who was treated with repeated pericardiocentesis, pericardiectromy, and thoracic duct ligation. So we report a case of primary chylopericardium with a review of literature.

피부 병변 및 전신임파선증을 동반한 급성 골수성 백혈병 환자 1 예

이용구,송승렬,박명선,유재규,강정성,원수연,전일문,장명규 대한내과학회 1993 대한내과학회지 Vol.45 No.6

We describe a patient with acute myelogenous leukemia who demonstrated striking leukemia infiltration in back and large cervical, axillary and inguinal 1ymphadenopathy, A 62-year-old man had visited to our hospital with complaints of sore throat, cervical lymphadenopathy and multiple nodules on the skin. Skin biopsy specimen showed diffuse dermal, subcutaneous and fat infiltration of abnormal cells that appeared to be leukemic cell in nature. Bone marrow biopsy and aspiration specimen showed findings of acute monocytic leukemia. Treatment was initiated with combination chemotherapy (Thioguanine, Daunorubicin and Cytarabine) and radiation therapy. We report one case of acute monocytic leukemia patient who had multiple leukemia infiltration on the skin and generalzed lymphadenopathy.