문맥압 항진증 평가에 유용한 도플러 초음파 검사법 김규홍; Kyu Hong Kim; 김문영 ...
The Korean journal of medicine,
02/2008, Letnik:
74, Številka:
2
Journal Article
Recenzirano
목적: 문맥압 항진증의 평가는 간경변증 환자의 치료와 예후 판정에 중요하다. 간정맥 압력차의 측정이 현재로서는 문맥압 항진증을 평가하는 가장 정확한 방법이나, 침습적 방법으로 실제 임상에서 반복적으로 시행하기에는 제약이 있다. 비침습적인 도플러 초음파검사를 이용한 측정값과 침습적인 간정맥 압력차 측정값간의 상관관계를 알아봄으로써, 비침습적 도플러 초음파 ...검사가 문맥압 항진증을 평가하는데 유용한지 알아보고자 하였다. 방법: 문맥압 항진증에 의한 정맥류 출혈로 내원한 환자를 대상으로 혈역학적으로 안정된 후 도플러 초음파 검사로 간문맥 혈류속도와 혈류량, 비장정맥 혈류속도와 혈류량, 간, 비장, 신장 동맥의 박동지수와 저항지수, 간정맥 파형과 감쇄지수를 측정하여 간정맥 압력차와의 상관관계를 전향적으로 분석하였다. 결과: 도플러 간정맥 파형의 감쇄지수(Damping Index, DI)는 간정맥 압력차 값과 유의한 상관관계를 보였으며(p<0.01), 기타 도플러 초음파검사 지표값들은 간정맥 압력차 값과 유의한 상관관계를 보이지 않았다. 결론: 비침습적인 도플러 초음파 검사법을 이용한 간정맥 파형의 감쇄지수 측정은 문맥압 항진증의 정도 평가와 약물치료의 효과 판정에 사용할 수 있는 유용한 보조적 검사법이다.
Background/Aims: Portal hypertension occurs as a consequence of liver cirrhosis and is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. The hepatic venous pressure gradient (HVPG) is the gold standard for assessment of portal hypertension. However, use of the HVPG is limited by being an invasive test. This prospective study evaluated whether the parameters identified by the non-invasive Doppler ultrasonography reflect the HVPG and could potentially be used for the assessment of the severity of portal hypertension in patients with liver cirrhosis. Methods: HVPG and Doppler ultrasonographic parameters, including the damping index (DI) of the hepatic vein waveform, the portal venous velocity and flow, the splenic venous velocity and flow, the pulsatility and the resistive index of the hepatic, splenic and renal arteries were measured in 114 patients with liver cirrhosis and compared. Results: The DI of the Doppler hepatic vein waveform was significantly correlated with the grade of the HVPG, i.e. with a higher HVPG, an increase in the DI was observed (p<0.01). The other Doppler parameters did not correlate with the HVPG grade. Conclusions: The results of this study showed that the DI measurements of the hepatic vein waveform by Doppler ultrasonography might provide a noninvasive assessment of the severity of portal hypertension. (Korean J Med 74:139-145, 2008)
Malnutrition in patients with liver disease is common. Consequently, percutaneous endoscopic gastrostomy may be needed for the correction of malnutrition. Percutaneous endoscopic gastrostomy is ...rarely performed in patients with liver cirrhosis because of the presence of varices and coagulation abnormalities. However, if careful insertion technique along with thorough clinical assessment is undertaken, percutaneous endoscopic gastrostomy may be successfully performed in patients with liver cirrhosis. Here, we report successful application of percutaneous endoscopic gastrostomy in a patient with liver cirrhosis accompanied by both gastric and esophageal varices. (Korean J Gastroenterol 2006;48:51-54)
Proton pump inhibitors (PPI) and H2-receptor antagonists (H2RA) are commonly prescribed for the treatment of mild to moderate reflux esophagitis (MMRE). There remains great controversy in their ...usefulness as the first choice and the appropriateness. We prospectively compared the efficacy and safety of the 8-week low-dose PPI vs. standard-dose H2RA in MMRE.
One hundred patients with MMRE were randomized to receive either low-dose of omeprazole (L-OMP: 10 mg, q.d.) or standard-dose of ranitidine (S-H2RA: 150 mg, b.i.d.) for 8 weeks. The H. pylori status using rapid urease test, histological examination and culture, reflux esophagitis (RE) grading, gastrointestinal symptoms using 4-point scale, adverse event and the standard laboratory examination were assessed at baseline and 8-week end point of therapy.
Improvement rate of RE intention to treat (n=82)/per protocol (n=72) were shown in 69.1%/63.9% for L-OMP and 65.0%/63.9% for S-H2RA group (p=0.697, p=1.000). Complete healing rates of RE were 54.7%/50.0% for L-OMP and 42.5%/41.7% for S-H2RA. No significant difference in healing rate, the rapidity of symptom resolution, adverse events, and laboratory monitoring was found between the two groups.
The low-dose omeprazole therapy produced similar healing rates and safety in the treatment of MMRE. In addition, L-OMP is advantageous in its once-a-day dosing and might be an alternative to S-H2RA, especially in Korean patients with MMRE.
Purpose: The first Korean national population- based cancer registry using nationwide hospital-based recording system and the regional cancer registries provided the source to obtain national cancer ...incidences for the period 1999∼2001.
Materials and Methods: The incidence of cancer in Korea was calculated based on the Korea Central Cancer Registry database, data from additional medical record review survey, the Regional Cancer Registry databases, site-specific cancer registry databases, and cancer mortality data from the Korea National Statistical Office. Crude and age-standardized rates were calculated by sex for 18 age groups.
Results: The overall crude incidence rates (CR) were 247.3 and 188.3 per 100,000 for men and women and the overall age-standardized incidence rates (ASR) were
281.2 and 160.3 per 100,000, respectively. Among men, five leading primary cancer sites were stomach (CR 58.6, ASR 65.6), lung (CR 42.1, ASR 50.9), liver (CR 41.9, ASR
44.9), colon and rectum (CR 24.2, ASR 27.3) and bladder (CR 7.7, ASR 9.2). Among women, the most common cancers were stomach (CR 30.8, ASR 25.8), breast (CR
25.7, ASR 21.7), colon and rectum (CR 19.6, ASR 16.7), uterine cervix (CR 18.4, ASR 15.5), and lung cancer (CR 15.1, ASR 12.4). In 0∼14 age group, leukemia was most
common for both sexes. For men, stomach cancer was most common in 15∼64 age group, but lung cancer was more frequent for over 65 age group. For women, thyroid
cancer in 15∼34 age group, breast cancer in 35∼64 age group, and stomach cancer in over 65 age group were most common for each age group. The proportions of
death certificate only were 7.5% for men and 7.4% for women.
Conclusion: This is the first attempt to determine the national cancer incidence and this data will be useful to plan for research and national cancer control in Korea. KCI Citation Count: 54
Mallory-Weiss 증후군 환자에서 재출혈의 예측인자 김재우; Jae Woo Kim; 김현수 ...
The Korean journal of gastroenterology,
12/2005, Letnik:
46, Številka:
6
Journal Article
Recenzirano
목적: Mallory-Weiss 증후군 환자의 대다수는 양호한 임상경과를 보이나 출혈이 재발하면 집중 치료가 필요할 뿐만 아니라 예후가 나쁘다. 이번 연구는 재출혈 여부에 따른 환자군의 특성을 비교하고 이에 관여하는 위험 인자들을 알아보고자 하였다. 대상 및 방법: 1999년 1월부터 2003년 12월 사이에 본원에서 Mallory-Weiss 증후군으로 ...진단 받은 환자들을 후향 분석하였다. 재출혈 유무에 따른 환자 특성, 내원 당시 임상 및 혈액학 변수, 그리고 내시경 소견을 비교하였고 재출혈에 대한 관련 인자를 평가하였다. 재출혈은 토혈 재발, 위관을 통한 출혈성 흡인물의 확인 또는 초기 지혈술 후 24시간 내에 혈색소가 1.5 g/dL 이상 감소한 경우로 정의하였다. 결과: 대상 환자는 총 159명(여자 22명, 남자 137명)이었으며 평균 나이는 48세였다. 재출혈은 17명(10.7%)에서 발생하였다. 재발군은 비재발군에 비하여 내원 당시 쇼크와 간경변증 동반율이 높았으며 내시경 소견에서 활동성 출혈 빈도가 높았고 내시경 지혈 시 에피네프린 함유 용액의 요구량이 많았다. 또한 내원 당시 혈색소와 혈소판수가 낮았으며 수혈 요구량과 입원 기간이 비재발군에 비해 증가하였다. 다변량 분석 결과 Mallory-Weiss 병변의 재출혈을 예측할 수 있는 위험 인자로는 초기 내원 시 쇼크 유무(비교위험도 3.71, 95% CI 1.07-14.90)와 내시경으로 확인된 활동성 출혈(비교위험도 9.89, 95% CI 1.88-51.98)이 의미 있는 인자로 나타났다. 결론: 초기 내원 시 쇼크의 존재와 내시경에서의 활동성 출혈은 Mallory-Weiss 환자에서 재출혈과 관련된 독립적인 위험 요소가 되므로 이러한 소견이 있는 경우 적극적인 감시와 집중 치료가 필요하리라 생각한다. Background/Aims: Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients. Methods: The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated. Results: A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis. Conclusions: Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients. KCI Citation Count: 1
The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve ...multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE).
Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured.
A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed.
Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
The "crisscross" heart and the heart with "superoinferior ventricles" are closely related congenital cardiac malformations that are characterized by twisted atrioventricular connections. The authors ...studied the morphologic characteristics of three hearts with twisted atrioventricular connections as seen on magnetic resonance (MR) images. The most important clue to the diagnosis was the distorted atrioventricular connections that were demonstrated on serial images. The axes of the atrioventricular connections through the atrioventricular valves were not parallel to each other. The presence of unusual recesses in the cardiac chambers, the angulated or curved configuration of the atrial and ventricular septa, and the unexpected great arterial relationship for the given combination of segmental connections supported the findings of twisted atrioventricular connections. MR imaging facilitated the precise morphologic diagnosis of these hearts.
PDF
