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대한간학회지 제8차 춘계학술대회 초록집 : 포스터 발표 ; 한국인 만성 간질환 환자에서 간성 골이형성증의 유병률: 간염과 간경변 환자 비교
정을조 ( Jeong Eul Jo ),허정 ( Heo Jeong ),김광하 ( Kim Gwang Ha ),배용목 ( Bae Yong Mog ),강대환 ( Kang Dae Hwan ),송근암 ( Song Geun Am ),조몽 ( Jo Mong ),양웅석 ( Yang Ung Seog ) 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.2(S)
김광하(Gwang Ha Kim),배용목(Yong Mock Bae),정을조(Eul Jo Jeong),문재현(Jae Hyeon Moon),안진광(Jin Kwang An),김진선(Jin Seon Kim),허정(Jeong Heo),강대환(Dae Hwan Kang),송근암(Geun Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2002 대한내과학회지 Vol.63 No.4
목적 : 저진폭 수축파와 연동운동 단절은 식도 내용물의 부적절한 배출과 역류와 연관성이 있어 기능적·임상적 중요성을 가진다. 이런 이유로 비특이성 식도운동장애(NEMD)에서 구분하여 비효율적 식도운동(IEM) 이라는 새로운 진단명이 제시되고 있다. 이에 저자들은 산역류가 있는 IEM 환자에서 식도 산청소능을 조사하고자 하였다. 방법 : 2001년 6월부터 2002년 5월까지 쉰 목소리, 인후 이물감, 흉통 등으로 식도운동검사와 보행성 식도산도검사를 시행 받은 252예 중에서 산역류를 보이는 정상식도운동군 51명(남:여 18:33, 평균 48.0세)과 IEM군 40명(남;여, 16:24, 평균 48.6세)을 대상으로 하여 식도운동검사와 보행성 식도산도검사 결과를 비교분석하였다. 적어도 wet swallow의 30% 이상에서 원위부 식도의 저수축 소견이 관찰되는 경우를 IEM으로 진단하였으며. 식도 산청소능은 원위부 식도 pH가 4 미만인 전체 시간(분)을 총 역류 횟수로 나눈 값으로 정의하여 양군 간에 결과를 비교분석하였다. 결과 : 1) IEM군에서 근위부 식도와 원위부 식도 수축파의 진폭, 하부식도괄약근압은 각각 47.3±21.9 mmHg, 60.0±27.5 mmHg, 18.0±6.7 mmHg로, 정상식도운동군(66.5±22.6 mmHg, 100.3±31.8 mmHg, 29.5±8.4 mmHg)보다 유의하게 낮았다(p<0.05). 2) IEM군에서 전체 검사시간 중, 기립시, 앙와위시 pH 4 미만인 전체 측정시간 백분율은 0.78±1.08%, 1.05±1.55%, 0.42±1.16%로, 정상식도운동군(각각 0.55±0.85%, 0.85±1.31%, 0.14±0.41%)과 유의한 차이는 없었다(p>0.05). 또한, 전체 측정시간 중 pH 4 미만의 역류가 일어난 횟수, 전체 측정시간 중 pH 4 미만의 역류가 5분 이상 일어난 횟수, Demeester 종합점수, 최장역류시간도 양군간에 유의한 차이는 없었다(p>0.05). 3) IEM군에서 앙와위시 식도 산청소능은 0.73±0.64분/회로, 정상식도운동군 0.31±0.29분/회보다 유의하게 증가되어 있었다(p=0.021). 하지만 기립시 식도 산청소능은 IEM군 0.51±0.42분/회, 정상식도운동군 0.41±0.40분/회으로 양군간에 유의한 차이는 없었다(p=0.096). 결론 : IEM군에서 정상식도운동군보다 앙와위시 유의한 식도 산청소능 증가가 관찰되었다. IEM이 위식도역류질환(GERD)에서 흔히 관찰되는 것을 고려한다면, IEM시 보다 더 적극적인 항역류 치료가 필요하며, 차후 GERD의 장기합병증과의 관련성에 대한 연구도 필요할 것으로 보인다. 이러한 상황을 고려해 볼 때 IEM은 NEMD에서 분리하여 독립된 운동질환으로 분류하는 것이 바람직하리라 사료된다. Background : Failed or hypotensive peristalsis, two of the diagnostic criteria for NEMD, correlates with impaired anterograde propulsion and retrograde escape of esophageal contents. The aim of this study was to evaluate esophageal acid clearance (EAC) in patients with ineffective esophageal motility (IEM). Methods : Of 252 patients performing esophageal manometry and ambulatory esophageal pH monitoring, 51 patients with normal motility and acid reflux and 40 patients with IEM and acid reflux were included. Results : The amplitude of peristaltic waves in the proximal and distal esophagus and lower esophageal sphincter pressure was lower significantly in patients with IEM than those with normal motility. Percentage of time of pH<4 in total, upright, and supine period and number of reflux episodes was not different in both. Supine EAC was significantly increased in patients with IEM when compared to those with normal motility. Upright EAC was not different in both. Conclusion : We concluded supine EAC is increased in patients with IEM. Since IEM is frequently associated with gastroesophageal reflux disease (GERD), a more intensive therapy must be needed. We propose IEM can be as a specific entity of primary esophageal motility disorder, especially in patients with GERD.(Korean J Med 63:386-393, 2002)
Classic Achalasia 와 Vigorous Achalasia 환자에서 임상양상 및 풍선확장술의 치료효과 비교
이동현 ( Dong Hyun Lee ),김지영 ( Ji Young Kim ),박정래 ( Jung Lae Park ),허정호 ( Jeong Ho Heo ),배용목 ( Yong Mook Bae ),정을조 ( Eul Jo Jeong ),김광하 ( Gwang Ha Kim ),강대환 ( Dae Hwan Kang ),송근암 ( Keun Am Song ),조몽 ( Mo 대한내과학회 2002 대한내과학회지 Vol.63 No.5
N/A Background : Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs and the presence of chest pain. The lesser success of pneumatic balloon dilation, also, has been reported for the subset with vigorous achalasia. Nevertheless, some authors have questioned the usefulness of making this distinction. We evaluated the difference of clinical manifestations and response to pneumatic balloon dilation between classic and vigorous achalaisia. Methods : 28 cases involving patients with achalasia who underwent balloon dilation treatment were available for the review of their clinical findings, radiographic, manometric, esophageal scintigraphic parameters. Patients with vigorous achalasia [n=10] were defined by contraction amplitude .37 mmHg on esophageal manometry and patients with classic achalasia [n=18] as contraction amplitude <37 mmHg. Results : Both groups of patients had substantial overlap in clinical findings, radiographic, manometric and esophageal scintigraphic parameters. The success rates of balloon dilation, also, were similar for both groups (classic vs vigorous, 78% vs 70%). Conclusion : It is concluded that the distiction of achalasia as classic and vigorous by an amplitude criterion is arbitrary and not useful. (Korean J Med 63:513-520, 2002) Key Words : Achalasia, Balloon dilatation
아르곤 플라스마 응고소작술 (argon plasma coagulation)로 치료한 위전정부 혈관확장증 (gastric antral vascular ectasia) 1예
배용목,정을조,허정,김광하,주형준,강대환,조몽,양웅석,이창훈 대한내과학회 2002 대한내과학회지 Vol.63 No.1
Gastric antral vascular ectasia (GAVE) is a rare but important cause of chronic gastrointestinal bleeding. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Many treatment modalities of the gastric antral vascular ectasia exist. One of them, the argon plasma coagulation (APC) is an excellent therapeutic tool. Inactive argon gas is converted to ionized form by means of electrical energy. Ionized argon plasma conducts high frequency electrical energy to tissues and leads coagulation necrosis of tissues. We experienced a case of gastric antral vascular ectasia presenting melena for about one month in a 72-year-old man treated endoscopically in four sessions with argon plasma coagulation.
이상갑,김영채,이성화,이옥재,김기홍,임정욱,김현진,정을조 대한소화기학회 1999 대한소화기학회지 Vol.34 No.1
Intussusception occurs mostly in children and rarely (only about 5% of cases) in adults. In contrast to pediatric intussusception, most cases of adult intussusception result from benign or malignant tumors and is usually treated with surgical resection. Here, we present a case of chronic intussusception in adult. It was induced by lipomas in jejunum. A 57-year-old woman complained of intermittent, colicky abdominal pain and distention for about 1 month. A 10×20 cm sized, soft mass was palpable in the left abdomen during the development of pain. Abdominal computed tomography scan revealed a concentric ring of bowel with intramural thickening. At laparotomy, jejuno-ileal intussusception was identified and two polypoid masses were recognized after manual reduction. The masses and jejunal segment were resected. Microscopic examination of the masses showed the features of submucosal lipomas.