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캡슐내시경 시행 후 단일포트 복강경 수술로 제거한 공장의 이소성 췌장
공시은,백창렬,김은정,김형진,정지한,정우철,이강문,양진모 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.4
Heterotopic pancreas is an uncommon condition that commonly occurs in the gastrointestinal tract such as the stomach and small bowel. It is defined as the presence of pancreatic tissue outside its usual location and lacking anatomical and vascular continuity with the pancreas. A heterotopic pancreas is usually found incidentally and is mostly silent; however, it rarely causes abdominal pain, weight loss, bleeding, or ileus. A 49-year-old male presented with intermittent abdominal pain for 4 weeks. We report a case with submucosal features of a jejunal heterotopic pancreas with the aid of capsule endoscopy and a histological confirmation through a single port laparoscopic segmental jejunectomy. 이소성 췌장은 정상 췌장과 해부학적 또는 혈관을 통한 연관성 없이 고유의 위치가 아닌 다른 부위에서 발견되는 비교적 드문 질환으로 전 위장관에서 발생할 수 있다. 위와 소장에서 가장 흔하게 발견되는데 상부위장관내시경 검사를 통해 위와 십이지장에서 많이 발견되며 내시경이 도달하지 않는 소장에서는 상부위장관 수술 후 우연히 발견된다. 대부분 무증상으로 드물게 복통, 체중감소, 출혈, 장폐쇄 등을 유발할 수 있다. 이번 증례는 간헐적으로 복통을 호소한 49세 남자환자에서 캡슐내시경이 공장 점막하 병변을 의심하는데 도움이 되었던 경우이다. 이후 정확한 진단과 치료를 위해 단일포트 복강경 공장 구역절제술 후 공장 이소성 췌장으로 확진한 증례로 환자는 수술 후 특이증상 없이 외래 추적관찰 중이다.
급성 골수성 백혈병으로 항암치료 중 발생한 파종 칸디다증과 뒤 이은 돌발 폐 털곰팡이증 1예
김영민,공시은,김수정,김하늘,이경은,이석종,이하니,조민정,이정우,이동건 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in patients with acute leukemia who are receiving chemotherapy. Primary prophylaxis with antifungal agents has become the standard of care in this setting; as a result, invasive candidiasis has shown a significant reduction. However, broad use of antifungal prophylaxis has led to an increase in breakthrough candidiasis with reduced susceptibility or resistance to fluconazole. In addition, an increase in breakthrough mucormycosis has been reported in studies of voriconazole prophylaxis. We report on a case of disseminated candidiasis and subsequent breakthrough pulmonary mucormycosis in a patient with acute myeloid leukemia undergoing consolidation chemotherapy. To the best of our knowledge, in Korea,this is the first report of these two independent IFIs occurring in a single patient.
신민영,강예은,공시은,주상현,백민경,김군순 대한골대사학회 2015 대한골대사학회지 Vol.22 No.1
Malnutrition associated vitamin D deficiency contributes to the calcium loss from bone and results in osteoporosis and osteomalacia at final stage. Osteomalacia is characterized with softening of bone secondary to defective bone mineralization. Here, we report a case of possible osteomalacia caused by prolonged lactation and severe malnutrition in 35-year-old female. She was a housewife and her body mass index was 11.8 kg/m2. She was diagnosed with severe osteoporosis in regular health check-up 2 years ago, but did not take any medication. Nine months ago, she had been treated with anti-tuberculosis medications for 6 month due to active pulmonary tuberculosis. After complete remission of pulmonary tuberculosis, she had lost her appetite severely. Furthermore, she felt gait difficulty and suffered from generalized bone pain. On serologic examination, hypocalcemia, hypophosphatemia, high alkaline phosphatase, low vitamin D3 and high parathyroid hormone level were seen. In the bone mineral density, Z-score from her lumbar spine was -6.5. She was treated with oral calcium and vitamin D3 intramuscularly. After 1 year treatment, she felt significant improvement in bone pain and could walk alone. Also her serum calcium, phosphate and vitamin D3 level are all normalized.
류시영,우인숙,김윤지,공시은,김형우,김진일,한치화,이연수 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.4
To our knowledge, this is the first report of case of high-grade endometrial stromal sarcoma metastasized to the stomach. Endometrial stromal sarcoma is very rare, accounting for 0.2% of female genital tract malignancies. High-grade endometrial stromal sarcoma demonstrates more frequent infiltration into the muscle layer of the uterus or metastasis to other organs, having a poorer prognosis than low grade disease. During its clinical course, endometrial stromal sarcoma may involve ovary, fallopian tube and pelvic cavity. Distant metastasis to lung, liver, bladder, breast, heart, brain and bones have been reported. However, to the best of our knowledge, high-grade endometrial stromal sarcoma presenting with gastric metastasis has never been reported. We now report a case of a 52-year-old woman with previously diagnosed lung metastasis having stomach metastasis from endometrial stromal sarcoma of the uterus. 자궁 육종은 전체 자궁 악성 종양의 2∼6%를 차지하는 비교적 드문 종양으로, 이중 약 15%가 자궁내막기질육종이다. 고등급 자궁내막기질육종은 간, 폐, 뼈, 뇌, 대장, 후복막 등으로 원격 전이되는 것으로 알려져 있으나, 본 증례에서와 같이 위로 전이된 경우는 아직까지 국내외에서 보고된 바가 없다. 저자들은 고등급 자궁내막기질육종으로 전자궁적출술 및 양측 자궁부속기 절제술을 받고, 폐 전이로 쐐기절제술을 받은 후 위 전이를 보인 52세 여자 환자를 경험하였다. 복합항암요법을 시행하던 중 토혈을 보였고 출혈성 위 병변에 대하여 위 절제술을 시행하였다. 이후 간 전이 병변의 진행 및 간내 담관 폐쇄로 인한 황달이 나타났고, 보존적 치료 중 세균 감염 및 패혈증에 의한 쇼크로 사망하였다.
MIBI 스캔에 국소화가 어려웠던 갑상선암을 동반한 부갑상선선종 1예
고선영,이경은,이경수,강혜선,권아미,공시은,김영민,최유아,문성대 중앙대학교 의과대학 의과학연구소 2013 中央醫大誌 Vol.38 No.2
We report a 79-year-old woman with coexistence of primary hyperparathyroidism and papillary thyroid carcinoma. In this patient, preoperative localization studies were performed with combination of radionuclide parathyroid scan, ultrasonography and CT scan. Preoperative imaging for diagnosis revealed the presence of nodules in the inferior pole of right lobe and left lobe of thyroid gland. However, technetium (Tc)99m sestamibi (MIBI) scintigraphy did not localize parathyroid lesion. Right parathyroidectomy and total thyroidectomy was performed and the pathology revealed parathyroid adenoma with concurrent papillary thyroid carcinoma. MIBI scintigraphy is fairly good modality to detect parathyroid lesion in patient with primary hyperparathyroidism before the surgical intervention. The combination of MIBI scintigraphy and ultrasonography appear promising for localizing parathyroid adenoma. But the concomitant of thyroid disease influences MIBI scintigraphic and ultrasonographic detection for hyperparathyroidism. Hyperparathyroidism and concomitant thyroid cancer is complicated setting for diagnostic imaging.
헬리코박터 관련 소화성궤양 환자에서 위산펌프길항제 사용이 요소호기검사 결과에 미치는 영향
옥주현 ( Ju Hyun Oak ),정우철 ( Woo Chul Chung ),정성훈 ( Sung Hoon Jung ),최강현 ( Kang Hyun Choi ),김은정 ( Eun Jung Kim ),강봉구 ( Bong Koo Kang ),강보라미 ( Bo Ra Mi Kang ),공시은 ( Si Eun Kong ),백창렬 ( Chang Nyol Paik ),이 대한소화기학회 2011 대한소화기학회지 Vol.57 No.1
Background/Aims: Revaprazan (Revanex(R)) is a novel proton pump inhibitor (PPI) that has a somewhat different effect on proton pump compared with the other PPI`s, also (called as `acid pump antagonist`). We aimed to examine the false negative rate of (13)C-urea breath test (UBT) in the patients with Helicobacter pylori (H. pylori) associated peptic ulcer disease who were treated with revaprazan and evaluate the anti-urease activity of revaprazan. Methods: Total 55 patients were enrolled in this study. They received EGD examination between January 2009 and December 2009 and diagnosed histologically as H. pylori associated peptic ulcer disease. All patients took revaprazan only. Three patients were excluded because of underlying chronic disease and inappropriate breath sampling. The remaining 52 patients had UBT at 0, 2 and 4 weeks of revaprazan use. After 2 weeks of the cessation of revaprazan, they had the fourth UBT. Results: At 2 and 4 weeks, the false negative rates of UBT were 5.8% and 23.1%, respectively (p=0.05). After 2 weeks of the cessation, the cases of the false negative result were five. Four out of five patients had prolonged negative results on two or three successive tests, and baseline (13)C difference value did not predict the false negative results. Conclusions: False negative results of UBT were common and increased with prolonged use of acid pump antagonist. As PPI, it had also anti-urease activity and most patients (47/52, 90.4%) reverted to positive results by 2 weeks after the cessation of taking the medication. (Korean J Gastroenterol 2011;57:8-13)