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박선영 ( Seon Young Park ),김현수 ( Hyun Soo Kim ),윤경원 ( Kyung Won Yoon ),조성범 ( Sung Bum Cho ),이완식 ( Wan Sik Lee ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4
Background/Aims: It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma. Methods: We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features. Results: Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p<0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (≥50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma. Conclusions: The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma. (Korean J Gastroenterol 2009;54:220-226)
비당뇨병 환자에서 인슐린 정주로 치료한 고중성지방혈증에 의한 급성 췌장염 1예
박선영 ( Seon Young Park ),정진욱 ( Jin Ook Chung ),조동근 ( Dong Keun Cho ),이완식 ( Wan Sik Lee ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ),정민영 ( Min Young Chung ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6
Heparin and/or insulin stimulate lipoprotein lipase and are known to decrease serum triglyceride level. However, their efficacy in hypertriglyceridemia-induced acute pancreatitis in nondiabetic patients is not well documented. We report a case of hypertriglyceridemia-induced pancreatitis in 43-year-old nondiabetic woman in whom treatment with insulin was accompanied by reduction in serum triglyceride level and the resolution of pancreatitis. She presented to the emergency department with abdominal pain and biochemical evidence of acute pancreatitis. Her medical history was unremarkable. There was no history of alcohol consumption, and biliary imaging was not remarkable. Subsequent laboratory investigation revealed marked hypertriglyceridemia (1,951 mg/dL), impaired fasting glucose, and normal HbAlc level. The Ranson`s score and APATCH II score were 1 and 4. Abdominal CT showed diffuse enlargement of pancreas, peripancreatic fat infiltration, and multiple fluid collections around the pancreas. We treated the patient with the infusion of 5% dextrose and 1.5 unit/hr regular insulin to reduce serum triglyceride level. The level of serum triglyceride was decreased to 305 mg/dL on day 5. During the remainder of hospitalization, her clinical symptoms and laboratory values gradually improved. (Korean J Gastroenterol 2010;55:399-403)
김영일 ( Young Il Kim ),박선영 ( Seon Young Park ),기원주 ( Won Joo Ki ),기호석 ( Ho Seok Ki ),윤경원 ( Kyoung Won Yoon ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.2
Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed. (Korean J Gastroenterol 2010;56:113-116)
초음파유도하 경피적 배액술에 의해 성공적으로 치유된 비장피막하 출혈을 동반한 췌장가성낭종
김영일 ( Young Il Kim ),박선영 ( Seon Young Park ),이정현 ( Jeong Hyeon Lee ),기원주 ( Won Ju Kee ),박창환 ( Chang Hwan Park ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6×13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients. (Korean J Gastroenterol 2011;57:258-261)
간세포암종 환자에서 경동맥화학색전술 후 발생한 뇌 혈관 색전증
정필진 ( Pil Jin Chung ),박선영 ( Seon Young Park ),김영일 ( Young Il Kim ),윤경원 ( Kyoung Won Yoon ),조성범 ( Sung Bum Cho ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2
Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Although various complications of TACE have been reported, cerebral lipiodol embolism after TACE is rare. We report a 67-year-old man, who had patent foramen ovale and developed cerebral lipiodol embolism after TACE via the inferior phrenic artery. At 20 months after third TACE of 3 cm sized HCC in the left hepatic lobe, computed tomography (CT) revealed about 1.6 cm newly developed HCC in the anterior superior segment of right hepatic lobe. The angiogram revealed the HCC was supplied from the right inferior phrenic artery. Toward the end of TACE, there were accumulations of the iodized oil in the pulmonary vasculature. Immediately after TACE, he complained of weakness in right upper and lower limbs and sensory decrease in right limbs and right hemitrunk. Magnetic resonance imaging revealed a cerebral lipiodol embolism. Transesophageal echocardiography revealed no visible thrombi but contrast-echocardiography using hand agitated saline revealed an intracardiac right to left shunt consistent with patent foramen ovale. Motor weakness and sensory decrease were gradually improved, and all neurological symptoms disappeared over 4 weeks. (Korean J Gastroenterol 2009;54:130-134)
김연주 ( Yeon Joo Kim ),김현수 ( Hyun Soo Kim ),박선영 ( Seon Young Park ),박상우 ( Sang Woo Park ),최유덕 ( Yoo Duk Choi ),박창환 ( Chang Hwan Park ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.3
We report herein a case of intestinal amyloidosis with grave prognosis that caused intractable diarrhea and intestinal pseudo-obstruction, alternately in spite of intensive conservative treatment. A 44-year-old woman was admitted for fever, diarrhea, and crampy abdominal pain which had been continuned during 6 months. Abdomen CT scan showed edematous wall thickening of the small bowel and right colon, and colonoscopic biopsy revealed amyloid deposition in the mucosa. Monoclonal light chains in serum and/or urine were not detected and highly elevated serum amyloid A was shown. In spite of intensive treatment including oral prednisolone and colchicine, diarrhea and intestinal pseudo-obstruction developed alternately, general status rapidly got worsened and died after two months. (Korean J Gastroenterol 2012;60:172-176)
각종 간질환에서 혈청 Adenosine Deaminase 활성도
최성규(Sung Kyu Choi),양대현(Dae Hyun Yang),조정곤(Jong Kon Cho),박해옥(Hae Ok Park),박일종(Il Jong Park),범희승(Hee Seung Bom),류종선(Jong Seon Rew),윤종만(Chong Mann Yoon) 대한내과학회 1988 대한내과학회지 Vol.34 No.5
N/A To evaluate the clinical significance of serum ADA activity, serum ADA acitivities and their correlation with other liver function tests were analyzed in various hepatitic diseases, Sera of 30 normal adults, 18 patients with acute viral hepatitis R, 3 fulminant hepatitis, 13 chronic persistent hepatitis, 17 chronic active hepatitis, 47 liver cirrhosis, 15 primary hepatoma and 7 metastatic hepatoma were analyzed with colorimetric method of Guisti for serum ADA activity. The result obtained are as follows 1) In normal adults, the mean value of serum ADA activity is 18.84±4,00 U/L. 2) The mean value of serum ADA activity are 48,94±14.68 U/L in acute B viral hepatitis, 40.14±14.20 U/L in chronic persistent hepatitis, 56.02±3.61 U/L in chronic active hepatitis, 60.31±23.22 U/L in liver cirrhosis, 45. 82±21.09 U/L in primary hepatoma, 26.67±9.01U/L in metastatic hepatoma. There is significant difference between normal and various hepatic diseases. But there is no significant difference among various hepatic diseases. 3) There is no significant correlation between serum ADA activity and liver function test(AST, ALT, ALP) in various hepatic diseases. 4) In acute viral hepatitis B, serum ADA activity is decreased with time lapse. And as liver function test returns to normal, serum ADA activity is also normalized. 5) In one expired cases of fulminant hepatitis, serum ADA activity is decreased before death, while other liver function test (AST, ALT) are not reduced. But, in survived cases serum ADA activity and other liver function tests are not decreased for 3 weeks.
맹장-S결장루로 인한 세균과다증식과 관련된 대장가성폐쇄 1예
정경면 ( Kyoung Myeun Chung ),임성욱 ( Seong Uk Lim ),홍형주 ( Hyoung Ju Hong ),박선영 ( Seon Young Park ),박창환 ( Chang Hwan Park ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.2
Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations. (Korean J Gastroenterol 2014;63:125-128)
한국의 고령 화농성 간농양 환자들의 임상적 특성과 예후
위진우 ( Jin Woo Wi ),조은애 ( Eun Ae Cho ),전충환 ( Chung Hwan Jun ),박선영 ( Seon Young Park ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ),정숙인 ( 대한소화기학회 2015 대한소화기학회지 Vol.66 No.1
Background/Aims: Incidence of pyogenic liver abscess (PLA) has been increasing worldwide, especially in the elderly population. Therefore, the aim of this study is to elucidate the clinical features and outcomes of PLA in elderly patients. Methods: A total of 602 patients diagnosed with PLA from January 2003 to January 2013 were analyzed retrospectively. The patients were divided according to two age groups; ≥65 years (n=296) and <65 years (n=306). Results: The mean age was 73.59±5.98 (range, 65-93) years in the elderly group. Significantly higher incidence of females (52.4% vs. 29.1%, p<0.001), hepatobiliary disease (41.2% vs. 24.8%, p<0.001), hepatobiliary procedure (29.4% vs. 13.7%, p<0.001), underlying malignancy (18.2% vs. 4.6%, p<0.001), culture positivity of resistant organism (20.6% vs. 14.4%, p=0.047), occurrence of complication (19.6% vs. 12.8%, p=0.026), and higher white blood cell (13.44±6.56 vs. 12.26±5.89, p=0.021), but lower rates of right lobe abscess (67.2% vs. 80.4%, p<0.001), fever (68.6% vs. 79.3%, p=0.003), and lower CRP (16.79±9.67 vs. 18.80±9.86, p=0.012) was observed in elderly PLA patients, compared to younger patients. Regarding complications, elderly patients had higher incidence of septic shock (8.1% vs. 2.3%, p=0.001) and cardiovascular disease (2% vs. 0%, p=0.014). Conclusions: More atypical presentations and complications tend to occur in elderly PLA patients compared with younger patients. Clinicians should be aware of these age-related differences in PLA and devise management strategies accordingly. (Korean J Gastroenterol 2015;66:27-32)
내시경 정맥류 밴드 결찰술을 통한 항문직장 정맥류 출혈 치료 후 시행된 성공적인 경경정맥 간내문맥-정맥 단락술 및 색전술
박상우 ( Sang Woo Park ),전충환 ( Chung Hwan Jun ),최성규 ( Sung Kyu Choi ),김현수 ( Hyun Soo Kim ),박창환 ( Chang Hwan Park ),류종선 ( Jong Sun Rew ),박선영 ( Seon Young Park ),조은애 ( Eunae Cho ),김재규 ( Jae Kyu Kim ),김형욱 ( 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4
Anorectal variceal bleeding is a rare occurrence; however, in such event, it could be fatal due to large size and high blood flow rate of varices. However, to date, there is no standardized treatment modality. Although endoscopic treatment can be provided, in cases of recurrent anorectal variceal bleeding, other therapeutic modalities for hemostasis are necessary. Here, we present a case of 58-year-old female patient with liver cirrhosis, who suffered from massive bleeding of anorectal varices. Endoscopic variceal band ligation was performed for primary hemostasis. Additionally, transjugular intrahepatic portosystemic shunt (TIPS) with embolization was performed to reduce the risk of rebleeding. Following the procedure, she had no further bleeding episodes, and the size of anorectal varices decreased, as seen on an abdomino-pelvic computed tomography. Our case illustrates the effectiveness of combined radiological intervention of TIPS with embolization after endoscopic hemostasis, for variceal obliteration and prevention of rebleeding. (Korean J Gastroenterol 2018;71:234-238)