• 대한상부위장관⦁헬리코박터학회지
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• 제18권3호
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• pp.209-212
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• 2018

We report a rare case of systemic amyloidosis with gastrointestinal and lymph node involvement. A 64-year-old woman was admitted to our hospital with dyspepsia and weight loss. Initial esophagogastroduodenoscopy (EGD) revealed nonspecific findings, and abdominal computed tomography showed necrotizing lymphadenopathy at the porta hepatis. Laparoscopic lymph node biopsy was performed under suspicion of tuberculous lymphadenopathy, but a definite diagnosis was not established. Follow-up EGD performed 6 months later revealed multiple telangiectasia-like lesions at the gastric body, and endoscopic biopsy revealed amyloid deposition. Through additional blood and urine protein electrophoresis, the patient was finally diagnosed with systemic amyloidosis associated with multiple myeloma. She was treated with dexamethasone, thalidomide, and bortezomib; however, she died 3 months after diagnosis because of pneumonia and multiple organ failure.

• Clinical and Experimental Pediatrics
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• 제49권3호
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• pp.268-272
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• 2006

목 적 : Helicobacter pylori 재감염률은 내시경적 생검만이 가능했던 시대에는 $^{13}C$-요소 호기 검사의 출현 이후에 비해 높게 보고되었다. 소아는 일반적으로 침습적인 내시경적 생검을 시행하기 용이치 않다. 본 연구는 $^{13}C$-요소 호기 검사와 내시경적 생검에 의한 재감염률을 비교하고, 그 차이에 영향을 미치는 인자를 찾고자 하였다. 방 법 : H. pylori 감염으로 치료받고 박멸이 확인된 소아들을 대상으로 하였다. 박멸 확인 후 18개월이 경과한 시점에 재감염을 확인하기 위하여 내시경적 생검(n=34명, 평균 연령 $11.5{\pm}3.7$세) 혹은 $^{13}C$-요소 호기 검사를(n=38명, 평균 연령 $10.0{\pm}3.6$세) 시행하였다. 첫 진단 시 내시경적 생검으로 위전정부 및 체부에서 세 절편을 채취하여 urease 검사, Giemsa 염색 및 Warthin-Starry 염색이 모두 양성으로 나오거나 생검 조직에서 H. pylori균이 배양된 경우 감염된 것으로 판정하였고, 박멸 치료 1-3개월 후 모든 검사상 음성인 경우 박멸된 것으로 판정하였다. $^{13}C$-요소 호기 검사는 최소 4시간 금식 후 75 mg의 $^{13}C$-요소를 주스에 섞어 마시도록 하는데, 복용 전 및 30분 후 Helikit(Isodiagnostika, Alberta, Canada)를 이용하여 숨을 불어넣도록 하고 delta $^{13}C$ per mil이 4.00 이상일 때를 양성으로 판독하였다. 결 과 : 내시경적 생검을 시행하였을 때 재감염률은 35.3%(12/34)였다. 내시경적 생검을 받은 모두가 당시 복부 증상이 있어 $^{13}C$-요소 호기 검사를 시행한 경우에 비해 복부 증상이 있는 경우가 유의하게 많았다(P=0.000). $^{13}C$-요소 호기 검사를 시행하였을 때 재감염률은 13.2%(5/38)였다. 추적 관찰 시 복부 증상이 있는 경우 재감염률이 유의하게 높았으며(P=0.008), 성별(P=0.694), 연령별(P=0.827). 궤양과 비궤양 간(P=0.730), 치료 방법 간에는(P=0.087) 재감염률에 차이를 보이지 않았다. 결 론 : 한국 소아에서 H. pylori 박멸 후 18개월이 경과하였을 때 비침습적인 $^{13}C$-요소 호기 검사를 이용한 재감염률은 13.2%이다. 내시경적 생검은 정확하나 침습적이어서 특히 무증상인 소아의 경우 이를 기피할 확률이 높아, 순응도에 따라 많은 영향을 받는다. 소아에서 재감염률 조사를 평가할 때에는 비침습적이면서 간편한 방법인가를 고려하여야 할 것이다.

• Tuberculosis and Respiratory Diseases
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• 제56권4호
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• pp.374-380
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• 2004

목 적 : 폐암의 진단에 있어서 진단율이 낮은 기관지주위나 점막하 병변에서 TBNA의 진단율을 조직 생검과 비교하여 TBNA의 임상적인 유용성에 대해 조사하였다. 방 법 : 연세대학교 의과대학 세브란스병원에서 1994년 1월부터 2002년 12월까지 5,582예의 굴곡성 기관지내시경검사를 시행하였으며, 기관지주위나 점막하 병변을 보여 TBNA와 조직생검을 시행한 환자 중 폐암이 확진되었던 120예를 대상으로 후향적으로 조사하였다. 결 과 : 기관지주위나 점막하 병변을 가진 폐암에서 TBNA의 진단율은 75.8%로 생검(52.5%)에 비해 진단율이 높았으며(p=0.001), 생검 단독에 비해 TBNA와 생검을 병용하는 경우 진단율이 유의하게 높았다(88.3%, p=0.0001). 폐암의 세포형이나 내시경적 형태에 따른 TBNA의 진단율은 유의한 차이가 없었으나, 소세포암에서 좀 더 높았다. 결 론 : 기관지주위나 점막하 병변을 가진 폐암의 진단에 있어서 TBNA는 생검보다 진단율이 높았고 생검과 같이 시행함으로써 폐암의 진단율을 향상시킬 수 있었다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권1호
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• pp.50-57
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• 2023

Purpose: The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD. Methods: This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles. Results: HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk. Conclusion: HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제14권2호
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• pp.122-129
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• 2011

The persistence of jaundice beyond the first 2 weeks of life require further investigation and this can be determined if the conjugated bilirubin levels are greater than 1.5 mg/dL or greater than 20% of the total bilirubin level. There is a diverse differential diagnosis for the cause of neonatal cholestasis due to hepatobiliary disease including biliary atresia, which eventually leads to liver cirrhosis if uncorrected before 60~80 days of life. Long-established initial studies include abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy, but better diagnostic methods are needed. Promising new options are described including MRCP (magnetic resonance cholangiography), ERCP (endoscopic retrograde cholangiography), and PCC (percutaneous cholecysto-cholangiography). Though no single test can differentiate biliary atresia from other neonatal cholestasis with confidence, a combination of diagnostic methods is usually consistently beneficial. By excluding biliary atresia as early as possible, the risk of unnecessary explolaparotomy with intraoperative cholangiography is decreased. Further evaluation would be required for the diagnosis of neonatal cholestasis after excluding biliary atresia.

• Journal of Chest Surgery
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• 제10권2호
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• pp.349-354
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• 1977

Mediastinoscopy is a surgical endoscopic technique used mainly for examination and biopsy of lesions of the superior and posterior middle mediastinum. It is particularly concerned with diseases that primarily or secondary involve the paratracheal and parabronchial lymphatics. A total of 18 cases of mediastinoscopy are presented with a detailed analysis of indications and results. Of these mediastinoscopy was positive in i0 [56%] and negative in 8 [44%]. The 10 positive mediastinoscopies were diagnostic in 4 patients with malignant lymphoma, 5 patients with carcinoma of the lung, one patient with active pulmonary tuberculosis. Of 8 negative mediastinoscopies, one was inoperable due to recurrent laryngeal nerve involvement, 7 patients were subjected to radical resection. Complications of mediastinoscopy were developed in 2 cases, one was minimal degree of subcutaneous emphysema on anterior chest wall, and the other was widening of right mediastinal border due to hematoma. Two complications were completely absorbed after 7 days.

• Journal of Chest Surgery
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• 제29권8호
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• pp.923-926
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• 1996

식도 소세포암은 매우 드문 악성 종양으로 알려져 있다. 본 인제 대학교 부산백병원 흉부외과학교실에서는 식도에서 발생한 소세포암 1례를 수술 치험하였다. 68세된 남자로서, 술전 위내시경 조직검사에서 신경내분비종양이 의심되어 식도절제술 및 위-식도 문합술을 시행하였고, 술후 경과는 양호하여 합병 증없이 퇴원하였다.

• 전기학회논문지
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• 제67권7호
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• pp.928-933
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• 2018

Nowadays, gastropathy is a common disease. As endoscopic equipment are developed and used widely, it is possible to provide a large number of endoscopy images. Computer-aided Diagnosis (CADx) systems aim at helping physicians to identify possibly malignant abnormalities more accurately. In this paper, we present a CADx system to detect and classify the abnormalities of gastric lesions which include bleeding, ulcer, neuroendocrine tumor and cancer. We used an Inception module based deep learning model. And we used data augmentation for learning. Our preliminary results demonstrated promising potential for automatically labeled region of interest for endoscopy doctors to focus on abnormal lesions for subsequent targeted biopsy, with Az values of Receiver Operating Characteristic(ROC) curve was 0.83. The proposed CADx system showed reliable performance.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.98-101
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• 2004

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver characterized by portal hypertension and hepatic fibrosis. We experienced a case of congenital hepatic fibrosis with esophageal varix in a 9-year-old male. He complained hematemesis, hematochezia, dizziness. In laboratory examination, AST/ALT was slightly increased. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and hypoechoic lesion of periportal area were seen by abdominal CT scanning. Histologic finding of liver biopsy showed fibrous tracts containing dilated bile ductules connecting adjacent portal spaces that were widened by mature fibrosis. Endocopic sclerotherpy and ligation was done. We summarized a case with review of literatures

• Journal of Chest Surgery
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• 제37권10호
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• pp.888-891
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• 2004

기저양 편평세포암종은 생물학적으로 악성인 편평세포암종의 변종으로서 상부 호흡소화계에서 빈번하나 식도에서는 아주 드문 종양이다. 계명대학교 동산의료원 흉부외과에서 식도에서 발생한 기저양 편평세포암종 1예를 경험하였다. 환자는 64세 남자로서 위식도 내시경검사상 앞니로부터 35 cm 되는 부위에 점막에 결절이 발견되어 전원되었다. 위내시경 조직검사상 편평세포암종으로 진단받았다. 좌측 개흉술을 이용한 식도 절제술을 시행하였다. 수술 후 조직검사상 기저양 편평세포암종으로 진단 되었고 임파선 전이는 관찰되지 않았다.