십이지장 누공을 동반한 장결핵 1예

박은범,진윤태,안재홍,서상준,이순재,박낙순,금보라,서연석,김용식,전훈재,이홍식,엄순호,이상우,최재현,김창덕,유호상 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.5

장결핵은 폐외결핵 중에서 높은 빈도를 보이는 질환이다. 대부분 비특이적인 임상증상을 호소하며 특징적인 검사소견이 없으므로 진단이 늦어지는 경우가 흔하고, 장폐색, 장천공, 복강내 농양, 장출혈, 누공 형성 등의 합병증이 발생할 수 있다. 체중감소와 설사로 내원한 25세 남자 환자에서 시행한 상부위장관 내시경 검사와 십이지장 조직 검사를 통해 십이지장 누공을 동반한 장결핵을 진단하였다. 2개월의 항결핵 치료 후 환자는 증상 호전과 함께 십이지장 누공은 폐쇄되었다. 저자들은 매우 드문것으로 알려진 장결핵에 동반된 십이지장 누공 1예를 경험하였기에 보고하는 바이다. Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis. A diagnosis of intestinal tuberculosis is difficult as the symptoms and laboratory findings are not specific for the disease. Intestinal tuberculosis may cause various complications, such as intestinal obstruction, intestinal perforation, intraabdominal abscess, intestinal hemorrhage and fistula formation. A duodenal fistula caused by tuberculosis is an especially rare condition. We experienced a case of intestinal tuberculosis with a duodenal fistula as a complication. The patient was a 25- year-old man that presented with weight loss and diarrhea. Esophagogastroduodenoscopy showed a deep ulcerative lesion on the third portion of the duodenum with a fistula opening. A histological finding revealed granulomatous inflammation with multinucleated giant cells. In addition, the result of a Tb PCR assay was positive. After two months of treatment with the appropriate medication, the symptoms improved and the fistula has closed completely. We report the case with a review of the literature. (Korean J Gastrointest Endosc 2007;35:346-350)

반응성 밀링에 의해 제조된 Cr₂O₃ 분산강화형 Cu 합금의 미세조직과 입자조대화

박은범 ( Eun-bum Park ),황승준 ( Seung-joon Hwang ) 한국열처리공학회 2018 熱處理工學會誌 Vol.31 No.4

Copper powder dispersed with 4 vol.% of Cr₂O₃ was successfully produced by a simple milling at 210 K with a mixture of Cu₂O, Cu and Cr elemental powders, followed by Hot Pressing (HP) at 1123 K and 50 MPa for 2h to consolidate the milled powder. The microstructure of the HPed material was characterized by standard metallographic techniques such as XRD (X-ray Diffraction), TEM and STEM-EDS. The results of STEMEDS analysis showed that the HPed materials comprised a mixture of nanocrystalline Cu matrix and Cr₂O₃ dispersoid with a homogeneous bimodal size distribution. The mechanical properties of the HPed materials were characterized by micro Vickers hardness test at room temperature. The thermodynamic considerations on the heat of formation, the incubation time to ignite MSR (Mechanically induced Self-sustaining Reaction), and the adiabatic temperature for the heat of displacement reaction between the oxide-metal are made for the delayed for mation of Cr₂O₃ dispersoid in terms of MSR suppression. The results of TEM observation and hardness test indicated that the relatively large dispersoids in the HPed materials are attributed to the significant coarsening for the high temperature consolidation; this leads to the low Vickers hardness value. Based on the thermodynamic calculation for the operating processes with a limited number of parameters, the formation kinetics and coarsening of the Cr₂O₃ dispersoid are discussed. (Received June 14, 2018; Revised June 25, 2018; Accepted July 5, 2018)

이중 풍선 소장내시경으로 치료한 소장의 혈관성 종물 1예

안재홍,최재현,박은범,이순재,서상준,김동일,정성우,구자설,임현준,이홍식,이상우 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.6

Obscure gastrointestinal bleeding is defined as an intermittent or continuous loss of blood in which the source has not been identified after an upper endoscopy and colonoscopy. Small bowel bleeding is one of the most common causes of obscure gastrointestinal bleeding and constitutes 2∼10% of all gastrointestinal bleeding. As the small intestine lies in the mid-portion of the intestine and has a long length, it is difficult to diagnose and treat small bowel bleeding using conventional endoscopy. Although the development of wireless capsule endoscopy has increased the diagnosis rate of small bowel disease, the use of capsule endoscopy has some limitations. The use of capsule endoscopy depends on intestinal peristalsis, and while visual diagnosis is possible, obtaining a biopsy or providing treatment is not possible with the use of the procedure. Capsule endoscopy has a few other limitations, such as the lack of air insufflation and the unavailability of rinsing. The use of the new double balloon enteroscopy procedure has advantages over the use of capsule endoscopy. With this method, it is possible to obtain biopsies and it is possible to perform therapeutic procedures, rinsing and air insufflation. We report a case of a vascular mass of the small bowel with recurrent bleeding, which was treated with endoscopic sclerotherapy. (Korean J Gastrointest Endosc 2007;35:415-419) 소장의 출혈성 병변은 위장관 출혈 중 기존의 상부 위장관 내시경검사와 대장 내시경검사에서 출혈의 원인을 찾을 수 없는 원인 불명의 위장관 출혈의 중요한 원인이다. 이러한 소장 병변에 의한 출혈은 전체 위장관 출혈의 중요한 원인으로 2∼10%를 차지한다. 그러나 소장은 소화관의 가운데 위치하여 내시경 삽입의 통로인 구강과 항문에서 멀리 떨어져 있고 길이가 길며, 많은 고리를 형성하고 있어 기존의 내시경을 이용하여 소장의 출혈성 병변을 진단하고 치료하는 데 어려움이 있다. 소장의 출혈성 병변의 진단을 위해 캡슐내시경이 도입된 이후 진단율은 향상되었으나 캡슐내시경검사는 병변의 진단을 기록된 영상에 의존하여야 하고 조직검사나 치료를 시행할 수 없다는 단점이 있다. 최근 개발된 이중 풍선 소장내시경은 소장 병변의 진단뿐만 아니라 치료에도 이용할 수 있는 장점이 있다. 이에 저자들은 이중 풍선 소장내시경을 이용하여 소장의 혈관성 종물에 의한 반복적인 검은변의 병력이 있는 환자를 내시경 경화요법으로 치료한 증례를 경험하여 보고하는 바이다.

Ticlopidine에 의해 유발된 담즙정체간염과 진정적혈구계무형성증 1예

이지연 ( Ji Yeon Lee ),박은범 ( Eun Bum Park ),안재홍 ( Jae Hong Ahn ),서상준 ( Sang Jun Suh ),정영걸 ( Young Kul Jung ),김지훈 ( Ji Hoon Kim ),신봉경 ( Bong Kyung Shin ),양진혁 ( Jin Hyuk Yang ),연종은 ( Jong Eun Yeon ),변관수 ( 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.1

총담관 결석을 동반한 이중 담낭 1예

박낙순,이홍식,김지훈,이동훈,김은선,김영진,박은범,김진남,구자설,이상우,최재현,김창덕,유호상 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.5

A double or bilobed gallbladder is a rare congenital anomaly, occurring at a rate of 1/4,000∼5,000. We encountered a case of a double gallbladder that was diagnosed by an endoscopic retrograde cholangiogram. In view of the paucity of this anomaly, we report the case of a patient with a double gallbladder (Y duplication) accompanied by a common bile duct (CBD) stone. We also discuss the characteristics, classification, embryology and treatment of the double gallbladder. (Korean J Gastrointest Endosc 2007;35:369-372) 이중 담낭은 드문 선천성 기형으로 빈도는 4,000∼5,000명 중 한명으로 발생한다. 이중 담낭은 담즙정체와 염증을 잘 일으켜 담석, 담낭농양, 담낭장루, 염전, 유두종, 담낭암 등을 잘 동반한다. 저자들은 총담관 결석을 주소로 내원한 환자에서 우연히 발견된 이중 담낭을 경험하였고 이를 문헌 고찰을 통하여 이중 담낭의 분류, 태생학적 발생, 진단 및 치료에 대해 살펴보았다.

해외에서 유입된, 급성 간염을 동반한 뎅기열 1예

서상준 ( Sang Jun Suh ),서연석 ( Yeon Seok Seo ),안재홍 ( Jae Hong Ahn ),박은범 ( Eun Bum Park ),이순재 ( Sun Jae Lee ),손장욱 ( Jang Uk Sohn ),엄순호 ( Soon Ho Um ) 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.4

말기신부전 환자에서 투석치료의 시작이 염증상태 및 면역반응에 미치는 영향에 관한 연구

이재원 ( Jae Won Lee ),김혜원 ( Hye Won Kim ),박은범 ( Eun Bum Park ),부창수 ( Chang Su Boo ),고강지 ( Gang Jee Ko ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

Purpose : inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. Methods : 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-α, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-α and IL-10 were measured for the evaluation of immune response by external stimuli. Results : As uremia was reduced by initiating dialysis, serum level of TNF-α was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. Conclusion : Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.