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[´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ Áý´ãȸ - ºÎ»ê °í½Å´ë]

Áý´ãȸ Àü °í½Å´ëÇб³ º´¿ø ¼ÒÈ­±â¼¾ÅÍ ³»½Ã°æ½ÇÀ» ¹æ¹®ÇÏ¿´½À´Ï´Ù. ÃÖ±Ù ³»½Ã°æ½ÇÀ» ½ÅÃàÇÏ¿´´Ù°í ÇÕ´Ï´Ù. Å« ¹ßÀüÀ» ±â¿øÇÕ´Ï´Ù.


Áõ·Ê 1. Retroperitoneal fibrosis

4³âÀü ±Þ¼º½É±Ù°æ»öÁõÀ¸·Î stent¸¦ ÇÏ°í aspirinµîÀ» º¹¿ëÇÏ°í ÀÖ´ø 58¼¼ ³²ÀÚÀÔ´Ï´Ù. 7¿ù ÃÊ ¾à°£ÀÇ Á¦ÃÊÁ¦¸¦ ÈíÀÔÇÏ´Ù°í ÇÏ°í (±ò²ô¹Ì-º¥¼³Çª·Ð,ÇÁ·¹Æ¼,´ÙÀ̹ǷÐÀÔÁ¦) ±× ¹«·Æ ÀÌÈÄ·Î nausea°¡ ¹ß»ýÇÏ¿´°í LMC¿¡¼­ ¸î °¡Áö °Ë»ç¸¦ ÇÏ¿´À¸³ª ƯÀ̼ҰßÀÌ ¾ø¾ú½À´Ï´Ù. ÀÌÈÄ Áõ»óÀÌ Áö¼ÓµÇ¸é¼­ 10 kg üÁß°¨¼Ò°¡ ÀÖ¾ú½À´Ï´Ù.

ESR 120, CRP »ó½Â, Creatinine 1.7

ÃÊÀ½ÆÄ: aorta¸¦ µÑ·¯½Î´Â mass°¡ ÀÖ°í ¾çÂÊ hydronephrosisÀÖÀ½.

Non-enhance CT, MRI¿¡¼­ aorta¸¦ °¨½Î´Â mass°¡ º¸ÀÓ

Both kidney PCNÀ» ½ÃÇàÇÏ¿´°í ÀÌÈķΠȯÀÚÀÇ nausea¿Í ºÒÆíÇÑ Áõ¼¼°¡ ±Þ°ÝÈ÷ È£ÀüµÇ¾ú½À´Ï´Ù.

Steroid »ç¿ë ÈÄ aorta ÁÖº¯ÀÇ fibrosis°¡ ÇöÀúÈ÷ È£ÀüµÇ¾ú°í labµµ ÁÁ¾ÆÁ³½À´Ï´Ù. ÀÓ»ó °æ°ú¸¦ ¿ä¾àÇÏ¸é ¾Æ·¡¿Í °°½À´Ï´Ù.


[±³¼ö´Ôµé comment]

Á¤ÈÆ¿ë: º¹ºÎ ûÁøÀ» Çϸé ÇöÀüÇÑ bruit°¡ µé¸± °ÍÀÔ´Ï´Ù (ûÁø¿¡¼­ ÀâÀ½ÀÌ µé¸®Áö ¾ÊÀ» °Í °°´Ù°í ¸»¾¸ÇϽŠ±³¼ö´Ôµµ ¸¹¾Ò½À´Ï´Ù.^^). Retroperitoneal fibrosis Ä¡°í´Â ³Ê¹« ºü¸£°Ô ÁÁ¾ÆÁö´Â °Í °°½À´Ï´Ù.

ÀÌÁØÇà: Ãʱ⠰˻翡¼­ ´ëº¯ °Ë»ç¸¦ ²À Æ÷ÇÔ½ÃÄÑ¾ß ÇÕ´Ï´Ù. ESRÀÌ ¿Ã¶ó°¬°í bilateral hydronephrosis°¡ ÀÖÀ¸¸é retroperitoneal fibrosis¸¦ ÀǽÉÇØ¾ß ÇÕ´Ï´Ù.

±è»ó±Õ: ±ò²ô¹Ì¿¡ ÀÇÇÑ hypersensitivity reactionÀÏ ¼ö ÀÖ½À´Ï´Ù. Á¦ÃÊÁ¦ ±ò²ô¹Ì¸¦ ÈíÀÔÇÏ¸é ½Äµµ ÇùÂøÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Á÷¾÷ ³óºÎ°¡ ¾Æ´Ñ »ç¶÷ÀÌ Á¦ÃÊÁ¦¸¦ »ç¿ëÇϸ鼭 ¹Ù¶÷ ¹æÇâÀ» À߸ø Àо ÈíÀÔÇÏ´Â °æ¿ì°¡ ¸¹´Ù°í ÇÕ´Ï´Ù.

½ÅÀå³»°ú ½ÅÈ£½Ä ¼±»ý´Ô²²¼­ ½ÅÁúȯ ȯÀÚÀÇ nausea¿¡ ´ëÇÏ¿© ªÀº ¸®ºä¸¦ ÇØ Áּ̽À´Ï´Ù.


2015³â 11¿ù 20ÀÏ ºÎ»ê °í½Å´ë º´¿ø¿¡¼­ ¿­¸° Ç︮ÄÚ¹ÚÅÍÇÐȸ Áý´ãȸ¿¡¼­ retroperitoneal fibrosis¿¡ ´ëÇÑ ³íÀÇ°¡ ÀÖ¾ú½À´Ï´Ù (¸µÅ©). Retroperitoneal fibrosisÀÇ Åõ¾à¹æ¹ý¿¡ ´ëÇÑ ¹®ÀÇ°¡ ÀÖ¾î »ï¼º¼­¿ïº´¿øÀÇ ÁöħÀ» ¼Ò°³ÇÕ´Ï´Ù.

Steroid therapy for idiopathic retroperitoneal fibrosis
Initial60 mg prednisolone p.o. during the initial 2 months
(with famotidine 20 mg 1T bid, Oscal 1T tid)
→ 40 mg for 2 weeks
→ 20 mg for 2 weeks
→ 10 mg for 2 weeks
Maintenance5 mg daily (2 years)
Follow-up laboratory testCBC, chemistry, ESD, CRP


Áõ·Ê 2. Gastric amyloidosis due to multiple myeloma

´Ù¹ß¼º ±Ë¾çÀ̶ó°í ¸ðµÎ AGMLÀÎ °ÍÀº ¾Æ´Õ´Ï´Ù. ÀÇ¿Ü·Î CBC¿Í chemistry°¡ µµ¿òÀÌ µÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. Á¤ÈÆ¿ë ¼±»ý´Ô²²¼­´Â gastric syphilis°¡ ºñ½ÁÇÑ ¸ð¾çÀ» º¸ÀÏ ¼ö ÀÖ´Ù°í ¸»¾¸Çϼ̽À´Ï´Ù.

* Âü°í: EndoTODAY À§¾Æ¹Ð·ÎÀ̵µÁõ

* Âü°í: EndoTODAY À§¸Åµ¶


Áõ·Ê 3. ±Ë¾ç ÃâÇ÷·Î ³»¿øÇÏ¿´°í ³»½Ã°æ ÀýÁ¦¼ú·Î Ä¡·áÇÑ Á¶±âÀ§¾Ï

Á¶Á÷°Ë»ç atypical gland hyperplasia·Î ³ª¿Ô°í PPI »ç¿ë ÈÄ ±Ë¾çÀº scar·Î ¹Ù²î¾úÀ¸¸¶ Á¶Á÷°Ë»ç¿¡¼­ °è¼Ó atypical·Î ³ª¿Í Áø´ÜÀû EMR-C¸¦ ÇÏ¿´°í 4 mm ¾ÏÀÌ ³ª¿Ô½À´Ï´Ù.

Á¤ÈÆ¿ë ±³¼ö´Ô: Extensive bleedingÀ» µ¿¹ÝÇÑ ±Ë¾ç ´ç½Ã »ó´çºÎºÐÀÇ Á¾¾çÀÌ ¶³¾îÁ® ³ª°¡±â ¶§¹®¿¡ ³²¾ÆÀÖ´Â Á¾¾ç¸¸À¸·Î ¿ø·¡ÀÇ depth of invasionÀ» ¿¹ÃøÇÒ ¼ö ¾ø½À´Ï´Ù. µû¶ó¼­ ¼ö¼úÀ» ±ÇÇß¾î¾ß ÇÒ °Í °°´Ù°í ÀÇ°ßÀ» Áּ̽À´Ï´Ù.

¶Ñ·ÇÇÑ ±Ë¾çÀ¸·Î presentation ÇÑ À§¾ÏÀÇ °æ¿ì Àú´Â ESD¸¦ ÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. Àǻ縶´Ù °ßÇØ°¡ ´Ù¸¥ ¿µ¿ªÀ̶ó°í »ý°¢µË´Ï´Ù.

Atypical¿¡ ´ëÇؼ­´Â Àú´Â ÀϹÝÀûÀ¸·Î ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù.

"ºñÀüÇüÀû ¼¼Æ÷(Atypia)´Â ¼¼Æ÷ÀÇ ¸ð¾çÀÌ ºñÀüÇüÀûÀ̶ó´Â, Áï Á¤»óÀÌ ¾Æ´Ï¶ó´Â ¶æÀÔ´Ï´Ù. ¿©±â¿¡´Â ¸¹Àº ¿øÀÎÀÌ ÀÖ½À´Ï´Ù. ÁÁÀº °ÍºÎÅÍ ³ª»Û °Í±îÁö »ó´çÈ÷ ´Ù¾çÇÕ´Ï´Ù. ¸ÕÀú ÁÁÀº ÂÊÀ» º¸ÀÚ¸é ´Ü¼øÇÑ À§¿° ¶Ç´Â À§±Ë¾ç ¶§¹®¿¡ ¼¼Æ÷ÀÇ ¸ð¾çÀÌ ºñÀüÇüÀû(atypical)À¸·Î º¯ÇÒ ¼ö ÀÖ½À´Ï´Ù. ¹Ý´ë·Î Àü¾Ï¼ºº´¼Ò ¶Ç´Â À§¾ÏÀÇ Á¶Á÷°Ë»ç¿¡¼­ ºñÀüÇüÀûÀ̶ó´Â °á°ú°¡ ³ª¿À´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ±× ºñÀ²À» Á¤È®È÷ ¸»Çϱâ´Â ¾î·ÆÁö¸¸ º¸Åë ¾Ï°ú °ü·ÃµÇÁö ¾ÊÀº °Í(À§¿°À̳ª ±Ë¾ç)ÀÌ Àý¹Ý, ¾Ï°ú °ü·ÃµÈ °Í(¼±Á¾À̳ª ¾Ï)ÀÌ Àý¹Ý Á¤µµÀÔ´Ï´Ù. µû¶ó¼­ ¿ÜºÎ ½½¶óÀ̵å ÀçÆǵ¶°ú ³»½Ã°æ Àç°ËÀÌ ÇÊ¿äÇÕ´Ï´Ù. ù Æò°¡¿¡¼­ Å« ÀÌ»óÀÌ ¾Æ´Ñ °ÍÀ¸·Î ³ª¿Íµµ Àç°ËÀ» ¹ÞÀ¸¼Å¾ß ÇÕ´Ï´Ù."


2015³â 11¿ù 20ÀÏ ºÎ»êÁý´ãȸ ÈÄ ½Ä»çÀÚ¸®¿¡¼­ ÇØ¿î´ë ¹éº´¿ø ¼ÒÈ­±â³»°ú ¾ç¼º¿¬ ±³¼ö´Ô°ú Àλ縦 ³ª´©¾ú½À´Ï´Ù. ¾ç±³¼ö´ÔÀº 2015³â 6¿ù Science¿¡ ÁÖÀúÀÚ·Î ³í¹®À» ¹ßÇ¥Çϼ̰í ( Inhibition of the prostaglandin-degrading enzyme 15-PGDH potentiates tissue regeneration. Science 2015), ´ëÇѸ鿪ÇÐȸ ¿ì¼ö³í¹®»ó, ÀÎÁ¦ ¿¬±¸´ë»ó µîÀ» ¹ÞÀ¸¼Ì½À´Ï´Ù. ¿ä¾àÇÕ´Ï´Ù.

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Tissue repair¿¡ ÇÁ·Î½ºÅ¸±Û¶õµò E2(PGE2)°¡ Áß¿äÇÑ ¿ªÇÒÀ» ÇÕ´Ï´Ù. 15-PDGH´Â ÇÁ·Î½ºÅ¸±Û¶õµò ºÐÇØÈ¿¼ÒÀε¥, 15-PDGH knock out mice´Â ´Ù¾çÇÑ ¼Õ»ó¿¡ ´ëÇÑ repair ´É·ÂÀÌ ÁÁ¾Ò½À´Ï´Ù. ´ëÀå¿° ¸ðµ¨¿¡¼­µµ °°Àº Çö»óÀÌ ÀÖ¾ú½À´Ï´Ù (The 15-PGDH-deficientmice respond to colon injury from dextran sulfate sodium (DSS) with a twofold increase in cell proliferation in colon crypts, which confers resistance to DSS-induced colitis). 15-PDGH¸¦ ¾ïÁ¦ÇÏ´Â ½Å¹°Áú SW033291µµ tissue repair¸¦ ÃËÁøÇÏ¿´½À´Ï´Ù. ¿¬±¸ÀÚµéÀº 15-PDGH°¡ Á¶Á÷Àç»ýÀ» ¾ïÁ¦ÇÏ´Â ±âÀüÀ̸ç (15-PGDH negatively regulates tissue regeneration and repair in the bone marrow, colon, and liver), Áß¿äÇÑ therapeutic targetÀ̶ó°í °á·Ð ¸Î¾ú½À´Ï´Ù. ¾ç¼º¿¬ ±³¼ö´Ô. ÃàÇÏÇÕ´Ï´Ù.


Áý´ãȸ ´ÙÀ½ ³¯ ºÎ»ê ³²±¸ À̱â´ë ÇؾȱæÀ» °É¾ú½À´Ï´Ù. °ñÇÁ¸¦ ¸øÄ¡´Ï »êÃ¥ÇÏ´Â ÀÏÀÌ ¸¹½À´Ï´Ù. ¿À´ÃÀº »êÃ¥º¸´Ù µî»ê¿¡ °¡±î¿ü½À´Ï´Ù. ¿À·úµµ±îÁö µÎ½Ã°£ ¹Ý Á¤µµ °É·È½À´Ï´Ù. ºÎ»ê ÃÖ°íÀÇ °æÄ¡¿´½À´Ï´Ù.

µÎ ¸íÀÇ ±â»ýÀÌ ¿ÖÀåÀ» ²¸¾È°í ¹Ù´Ù¿¡ ºüÁ® Á×¾ú´Ù°í ÇÕ´Ï´Ù. ±×·¡¼­ À̸§ÀÌ À̱â´ë(ì£ÐõÓæ)ÀÔ´Ï´Ù. ÁøÁÖ Ã˼®·ç¿Í ºñ½ÁÇÑ À̾߱âÀÔ´Ï´Ù.

½ºÄ«ÀÌ¿öÅ©¿¡¼­ ¹Ù¶óº» ¿À·úµµ

°øÇ×±îÁö´Â ¹«ÀÎ °æÀüö·Î ¿¬°áµÇ¾î ÀÖ¾ú½À´Ï´Ù.


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