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재감염 없이 재발한 저위도 점막연관림프조직형 위림프종 1 예
우열근(Yeol Keun Woo),곽금연(Geum Youn Gwak),박수철(Su Cheol Park),예병덕(Byong Duk Ye),이상협(Sang Hyub Lee),김병관(Byeong Gwan Kim),김주성(Joo Sung Kim),정현채(Hyun Chae Jung),송인성(In Sung Song),김우호(Woo Ho Kim) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1
More than 90% of low-grade B-cell gastric mucosa-associated lymphoid tissue (MALT) lymphoma is associated with Helicobacter pylori (H. pylori) infection. High remission rates for these lymphomas have been observed after H. pylori eradication. However, 10% of gastric MALT lymphoma treated with H. pylori eradication therapy have been reported to relapse, which is associated with H. pylori reinfection, or transform to high-grade MALT lymphoma or T-cell lymphoma. We experienced a case of low-grade gastric MALT lymphoma which relapsed without H. pylori reinfection. Initially, the patient was diagnosed as having low-grade gastric MALT lymphoma and treated with anti-H. pylori therapy. The patient had a relapse and was retreated with 2nd-line anti-H. pylori therapy, but complete remission was not observed. Thus, we concluded that the relapse was not associated with H. pylori. The patient finally received total gastrectomy. In gastric MALT lymphoma, the eradication of H. pylori is a very effective treatment. However, as shown in this case, gastric MALT lymphoma can relapse without H. pylori reinfection. Therefore, close long-term follow-up is needed even if complete remission is observed after H. pylori eradication therapy. (Korean J Gastroenterol 2002;39:45-49)
대장 내시경하 폴립절제술에서 점막하 식염수-에피네프린 주입술의 적절한 적용 기준은 무엇인가?
이상협,이경수,우열근,예병덕,이종열,박수철,이광혁,박영수,황진혁,정숙향,김나영,이동호,김상균,김주성,정현채,송인성 대한소화기내시경학회 2006 Clinical Endoscopy Vol.33 No.2
Background/Aims: Indications for submucosal saline- epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI. Methods: Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (≤8 mm or >8 mm) and gross morphology (pedunculated or sessile), also. Results: Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5 4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had >8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology. Conclusions: SSEI should be performed in colonoscopic snare polypectomy for >8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician. (Korean J Gastrointest Endosc 2006;33:77-84) 목적: 대장 내시경하 폴립절제술은 대장 폴립의 표준 치료이나, 여러 합병증을 수반할 수 있다. 가장 흔한 합병증인 출혈 예방을 위해 폴립절제술 시 점막하 식염수-에피네프린 주입술이 널리 이용되지만 구체적인 적용 기준은 시술자의 선호에 따라 다르다. 본 연구에서는 대장 내시경하 폴립절제술의 안정성을 살펴보고, 폴립절제술 시 시행되는 점막하 식염수-에피네프린 주입술의 적절한 적용 기준을 알아보고자 하였다. 대상 및 방법: 2003년 5월부터 2004년 10월까지 분당서울대학교병원에서 576명의 환자에서 시행된 1,745예의 대장 내시경하 폴립절제술의 임상상과 합병증을 후향 분석하였고, 563명의 환자에서 올가미법으로 시행된 1,039예의 폴립절제술에서 점막하 식염수-에피네프린 주입술의 시행 여부에 따른 출혈 발생률을 분석하였다. 아울러 폴립의 크기(≤8 mm 또는 >8 mm)와 육안적 형태(유경성 또는 무경성)에 따라 분류된 4군에서도 점막하 식염수-에피네프린 주입술의 시행여부에 따른 출혈 발생률을 분석하였다. 결과: 분석된 환자 중 남자는 430명(74.7%), 여자는 146명(25.3%)이었으며 나이는 평균 59.4±10.1세였다. 폴립은 좌측 대장에 주로 분포하였다. 폴립의 크기는 평균 7.4±4.8 mm이고, 환자 1인당 평균 3.1±2.9예의 폴립절제술이 시행되었다. 폴립의 육안적 형태는 무경성 폴립이 1,521개(87.2%)로 주를 이루었다. 절제된 폴립의 조직학적 분류를 보면 양성 선종이 1,139개(65.3%)로 주를 이루었다. 폴립절제술 후 합병증으로 31예(1.8%)의 출혈과 3예(0.2%)의 장천공이 발생하였다. 직장 폴립과 악성 폴립이 각각 교차비 3.49와 8.39로 폴립절제술 후 출혈과 유의하게 관련된 위험인자였다. 올가미법으로 시행된 폴립절제술에서는 직장 폴립, 악성 폴립 및 점막하 식염수-에피네프린 주입술을 시행하지 않은 경우에 각각 교차비 4.71, 10.48 및 3.44로 폴립절제술 후 출혈이 유의하게 많았다. 그러나 크기와 육안적 형태에 따른 분류 후 시행한 분석에서는 8 mm보다 큰 무경성 폴립에서만 점막하 식염수-에피네프린 주입술이 폴립의 위치 및 조직병리 소견과 무관하게 교차비 16.41로 폴립절제술 후 출혈의 발생률을 유의하게 낮추었다. 결론: 대장 내시경하 폴립절제술은 비교적 안전한 시술로, 올가미법에 의한 대장 내시경하 폴립절제술 시 점막하 식염수-에피네프린 주입술은 8 mm보다 큰 무경성 폴립에서는 반드시 시행하고, 다른 폴립 들에서는 선택적으로 시행하는 것이 좋다고 생각한다.
위내시경에서 육안적 이상 없이 진단된 저위도 점막연관림프조직형 위림프종 2예
이상협,송인성,정현채,김철우,김정룡,김주성,이진혁,우열근,예병덕,곽금연,이종열,이준규 대한소화기학회 2001 대한소화기학회지 Vol.37 No.1
Low-grade gastric mucosa associated lymphoid tissue (MALT) lymphoma has a broad spectrum of endoscopic presentations, which ranges from diffuse erosion to ulcerative mass. The bland appearance of this disease in some patients may reflect the early stage of the disease. We report 2 cases of low-grade gastric MALT lymphoma in which the endoscopic presentation consisted with normal appearing mucosa of the stomach. The patients were successfully treated with anti-Helicobacter pylori therapy. Endoscopy is useful to diagnose and follow up low-grade gastric MALT lymphoma. However, in the early stages of the disease, the histologic evaluation of biopsy specimens obtained from all gastric areas can be the more reliable diagnostic procedure to detect this neoplasm.
낭액의 Carcinoembryonic Antigen 및 Carbohydrate Antigen 19-9 증가를 보인 간내담관낭선종 1예
김태호,이동호,이상협,김정룡,이국래,정중기,윤용범,장미수,우열근,예병덕,곽금연 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1
A 39-year-old woman who had a two-year history of right upper quadrant abdominal mass was admitted. Abdominal ultrasonography and computed tomography revealed a large, multiloculated cystic tumor in the liver. This tumor was noted with elevated levels of carcinoembryonic antigen (CEA) (397 ng/mL) and carbohydrate antigen (CA)19-9 (24,000 U/mL) in the cystic fluid and elevated serum CA19-9 level (438 U/mL). A 18×15×6 cm, 1,220 gm cystic mass was removed by cystectomy. The cut section revealed a multilocular cyst containing yellowish mucinous fluid surrounded by a smooth and glistening wall. It was diagnosed histologically as an intrahepatic biliary cystadenoma with mesenchymal stroma, which consisted of single layer of a cuboidal epithelial lining and an ovarian-like stroma. Six weeks after surgery, the serum CA19-9 level was decreased to 59 U/mL. These findings may be useful in the differential diagnosis of intraheptic cystic tumors and thus, we report this case with a review of the literatures.
성인에서 발생한 대장의 Aganglionosis 1 예
박수철(Su Cheol Park),김병관(Byeong Gwan Kim),김 원(won Kim),우열근(Yeol Keun Woo),이종열(Jong Yeul Lee),이상협(Sang Hyub Lee),예병덕(Byong Duk Ye),김주성(Joo Sung Kim),박규주(Kyu Joo Park),김우호(Woo Ho Kim),정현채(Hyun Chae Jung 대한소화기학회 2001 대한소화기학회지 Vol.37 No.6
Aganglionosis is a rare form of neuronal intestinal malformation, which includes hypoganglionosis, neuronal intestinal dysplasia A (NID type A), B (NID type B) or combined type. Classic aganglionosis, or Hirschsprung’s disease is a neurogenic form of neonatal bowel obstruction characterized by a congenital absence of ganglionic cells in the submucosal and myenteric plexus, and presents in childhood with symptoms of constipation, colonic obstruction or sepsis due to enterocolitis. However, aganglionosis can be diagnosed first in adult due to short segment Hirschsprung`s disease with mild symptom and maybe also due to acquired process. We experienced a case of adult type aganglionosis assumed to be acquired type without malignancy or other neurological involvement. (Korean J Gastroenterol 2001;37:470-474)
예병덕(Byong Duk Ye),곽금연(Geum Youn Gwak),김원(Won Kim),박수철(Su Cheol Park),우열근(Yeol Keun Woo),이상협(Sang Hyub Lee),김병관(Byeong Gwan Kim),정현채(Hyun Chae Jung),송인성(In Sung Song),김우호(Woo Ho Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.3
Esophageal involvement of tuberculosis is rare. It is usually secondary to tuberculous infection of contiguous organs and most commonly presented as ulcerative lesion in esophagoscopy. This report describes the case of a 62-year-old woman who complained of dysphagia and left chest discomfort on swallowing foods. Initial esophagoscopy revealed submucosal tumor of esophagus, and surgical management was planned. But surgery was delayed, and in the meantime, the enlargement of left submandibular lymph node was detected. The aspiration cytology of lymph node revealed chronic granulomatous inflammation. Subsequently, standard anti-tuberculous drug therapy was started. Follow-up esophagoscopy showed decreased size of submucosal mass and the histologic examination of the lesion revealed chronic granulomatous inflammation. Based on this clinical course, the diagnosis of esophageal tuberculosis presented as submucosal tumor with tuberculous submandibular lymphadenopathy was made. We think that in the differential diagnosis of submucosal tumor of esophagus, tuberculous lesion should be included. (Korean J Gastroenterol 2001;38:203-206)