대한소화기학회 : 구연 ; 간 : 간경변 환자의 정맥류 출혈에서 Terlipressin과 Somatostatin의 치료 효과 비교

현종진,엄순호,정성우,유상균,김용식,진윤태,이홍식,전훈재,이상우,최재현,김창덕,류호상,현진해 대한소화기학회 2004 대한소화기학회 추계학술대회 Vol.- No.-

정상 면역 성인에서 발생한 Cryptococcus 림프절염 1예

현종진,최종환,박상훈,정혜원,정성주,기세윤,정희진,김우주,최정우,이주한,이나리,전승민 대한감염학회 2005 Infection and Chemotherapy Vol.37 No.6

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis. Cryptococcus neoformans는 주로 면역 저하 환자들에게서 감염을 일으키는 진균으로, 정상 면역 환자에서도 여러 가지 감염 증을 일으킬 수 있으나 그 중 cryptococcus 림프절염은 아주 드물다. 저자들은 경부 림프절 종대와 3주간 지속되는 발열을 주소로 내원한 정상 면역 환자에서 발생한 cryptococcus 림프절염 1예를 경험하여 보고하고자 한다. 경부와 흉부 컴퓨터 단층 촬영에서 양쪽 폐문 및 종격동 그리고 우측 쇄골 상부에 중심부 저 음영과 주변부 조영증강을 보이는 다발성 림프절 종대가 관찰되었다. 우측 쇄골 상부의 림프절 조직 검사와 PAS, GMS 염색, 그리고 조직 배양 검사를 통하여 Cryptococcus neoformans에 의한 림프절염을 진단할 수 있었다. 이와 같이 정상 면역 환자에게서도 cryptococcus에 의한 감염이 일어날 수 있으며 림프절염으로도 나타날 수 있다는 것을 항상 염두에 두어야 할 것이다.

Feasibility of Obtaining Quantitative 3-Dimensional Information Using Conventional Endoscope: A Pilot Study

현종진,전훈재,금보라,서연석,김용식,진윤태,이홍식,엄순호,김창덕,유호상,Jong-Wook Lim,Dong-Gi Woo,Young-Joong Kim,Myo-Taeg Lim 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.3

Background/Aims: Three-dimensional (3D) imaging is gaining popularity and has been partly adopted in laparoscopic surgery or robotic surgery but has not been applied to gastrointestinal endoscopy. As a first step, we conducted an experiment to evaluate whether images obtained by conventional gastrointestinal endoscopy could be used to acquire quantitative 3D information. Methods: Two endoscopes (GIF-H260) were used in a Borrmann type I tumor model made of clay. The endoscopes were calibrated by correcting the barrel distortion and perspective distortion. Obtained images were converted to gray-level image, and the characteristics of the images were obtained by edge detection. Finally, data on 3D parameters were measured by using epipolar geometry, two view geometry, and pinhole camera model. Results: The focal length (f) of endoscope at 30 mm was 258.49 pixels. Two endoscopes were fixed at predetermined distance, 12 mm (d12). After matching and calculating disparity (v2-v1), which was 106 pixels, the calculated length between the camera and object (L) was 29.26 mm. The height of the object projected onto the image (h) was then applied to the pinhole camera model, and the result of H (height and width) was 38.21 mm and 41.72 mm, respectively. Measurements were conducted from 2 different locations. The measurement errors ranged from 2.98% to 7.00% with the current Borrmann type I tumor model. Conclusions: It was feasible to obtain parameters necessary for 3D analysis and to apply the data to epipolar geometry with conventional gastrointestinal endoscope to calculate the size of an object.

Experimental Models of Pancreatitis

현종진,이홍식 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.3

Acute pancreatitis is an inflammatory disease characterized by interstitial edema, inflammatory cell infiltration, and acinar cell necrosis, depending on its severity. Regardless of the extent of tissue injury, acute pancreatitis is a completely reversible process with evident normal tissue architecture after recovery. Its pathogenic mechanism has been known to be closely related to intracellular digestive enzyme activation. In contrast to acute pancreatitis, chronic pancreatitis is characterized by irreversible tissue damage such as acinar cell atrophy and pancreatic fibrosis that results in exocrine and endocrine insufficiency. Recently, many studies of chronic pancreatitis have been prompted by the discovery of the pancreatic stellate cell, which has been identified and distinguished as the key effector cell of pancreatic fibrosis. However, investigations into the pathogenesis and treatment of pancreatitis face many obstacles because of its anatomical location and disparate clinical course. Due to these difficulties, most of our knowledge on pancreatitis is based on research conducted using experimental models of pancreatitis. In this review, several experimental models of pancreatitis will be discussed in terms of technique, advantages, and limitations.

Clinical Significance of Hiatal Hernia

현종진,박영태 거트앤리버 소화기연관학회협의회 2011 Gut and Liver Vol.5 No.3

The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted “two-sphincter hypothesis.” The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.

대장내시경 전처치에서 4 L Polyethyleneglycol 단독투여와 45 mL Sodium Phosphate/2 L Polyethyleneglycol 병합투여의 비교: 전향적 무작위 대조 연구

현종진,진윤태,박상훈,이범재,최종환,천황래,정록선,김용식,전훈재,이홍식,엄순호,이상우,최재현,김창덕,류호상,현진해 대한소화기내시경학회 2005 Clinical Endoscopy Vol.31 No.6

Background/Aims: Polyethyleneglycol (PEG) is safe but its large volume and bad taste reduces patients' compliance. Sodium phosphate (NaP) is a hyperosmotic agent and its small volume can increase patients' compliance but electrolyte imbalance is a problem. Therefore, we conducted a study to determine whether patients' compliance can be enhanced and electrolyte imbalance reduced by combining these two agents. Methods: Forty-one admitted patients receiving colonoscopy at Korea University Hospital from June 28, 2004 to August 14, 2004 were randomly divided into two groups for colon cleansing with either PEG 4 L (n=21) or PEG 2 L plus NaP 45 mL (n=20). Patients were assessed for patient tolerance, quality of preparation, and changes of biochemical parameters. Results: Overall discomfort was statistically lower in the combination group, PEG 2 L plus NaP 45 mL (p=0.035). Although patients in the combination group reported less fullness (p=0.076) and nausea (p=0.087), the findings were not statistically significant. The quality of the preparation was comparable between the two groups (p=0.872). The phosphorus level in the combination group showed a statistically significant increase (0.58 0.46) after colon cleansing (p=0.020) but was not clinically significant. Conclusions: The combination of NaP 45 mL and PEG 2 L showed less overall discomfort with comparable quality of preparation and without serious electrolyte abnormality compared to 4 L of PEG. Therefore, the combination of NaP 45 mL and PEG 2 L could be used as an alternative colonoscopic colon cleansing agent when patients have trouble taking 4 L of PEG alone. 목적: 대장내시경 전처치로 흔히 사용되는 4 L PEG 정결액은 등장성의 전해질 용액으로 안정성이 확립되어 오래 전부터 널리 쓰이고 있으나 복용량이 많아 환자의 순응도가 떨어지는 단점이 있고, sodium phosphate (NaP) 정결액은 복용량이 적어 환자 순응도는 높으나 전해질 이상을 유발할 수 있는 문제점이 제기되어 왔다. 이에 저자들은 순응도를 높이면서 전해질 이상의 위험성을 줄일 수 있는 방법의 하나로 두 정결액의 병합투여에 대하여 연구하였다. 대상 및 방법: 2004년 6월 28일부터 2004년 8월 18일까지 고려대학교병원에 입원한 환자 중 대장내시경을 시행 받은 41명의 환자를 대상으로 전향적 무작위 대조 연구를 시행하였다. 대장 전처치는 4 L PEG 단독투여(n=21) 또는 45 mL NaP/2 L PEG 병합투여로(n=20) 실시하였으며, 양 군 간의 환자순응도, 대장내시경 정결의 정도 및 대장내시경 전후의 검사실 소견이상 유무를 비교하였다. 결과: 전체적인 불편감은 병합투여군에서 단독투여군에 비해 유의하게 낮았다(p=0.035). 병합투여군에 비해 PEG 단독투여군에서 복부 팽만감(p=0.076) 및 오심(p=0.087)을 더 호소하였으나 통계적으로 유의하지는 않았다. 대장의 정결도는 양 군 간에 의미 있는 차이는 관찰되지 않았다. 병합투여군에서 인(phosphorus)이 PEG 단독 투여군에 비해서 의미 있게 상승하였으나 임상적으로 의미가 있지는 않았다(p=0.020). 결론: NaP 45 mL와 PEG 2 L의 병합투여는 기존의 PEG 4 L 단독 투여에 비해서 전반적으로 불편감이 감소되었고 대장정결도는 유사하며 심각한 전해질 불균형을 유발하지 않았다. 따라서 향후 PEG 4 L의 투여가 곤란한 환자의 대장 정결 방법으로 PEG 2 L/NaP 45 mL의 병합투여가 하나의 대안이 될 수 있을 것으로 생각한다.

Optimal time for repeating the IgM anti-hepatitis A virus antibody test in acute hepatitis A patients with a negative initial test

현종진,서연석,안형진,임선영,서민호,김혜숙,김창하,김지훈,금보라,김용식,임형준,이홍식,엄순호,김창덕,유호상 대한간학회 2012 Clinical and Molecular Hepatology(대한간학회지) Vol.18 No.1

Background/Aims: The nonspecific clinical presentation of acute hepatitis A (AHA) mandates the detection of anti-hepatitis A virus IgM antibodies (IgM anti-HAV) in the serum for obtaining a definitive diagnosis. However, IgM anti-HAV might not be present during the early phase of the disease. The aim of this study was to determine the optimal time for repeating the IgM anti-HAV test (HAV test) in AHA patients with a negative initial test. Methods: In total, 261patients hospitalized with AHA were enrolled for this retrospective study. AHA was diagnosed when the test for IgM anti-HAV was positive and the serum alanine aminotransferase (ALT) level was ≥400 IU/L. Repeat HAV test was conducted after 1-2 weeks if the initial HAV test was negative but AHA was still clinically suspected. Results: The results of the initial HAV test were negative in 28 (10.7%) patients. The intervals from symptom onset to the initial-HAV-test day and from the peak-ALT day to the initial-HAV-test day were significantly shorter in the negative-initial-HAV-test group, but on multivariate analysis only the latter was significantly associated with negative results for the initial HAV test (β=-0.978;odds ratio [95% confidence interval]=0.376 [0.189-0.747]; P=0.005). The HAV test was positive in all patients when it was performed at least 2 days after the peak-ALT day. Conclusions: The results of HAV tests were significantly associated with the interval from the peak-ALT day to the HAV-test day. The optimal time for repeating the HAV test in clinically suspicious AHA patients with a negative initial HAV test appears to be at least 2 days after the peak-ALT day. (Korean J Hepatol 2012;18:56-62)

정상 면역 성인에서 발생한 Cryptococcus 림프절염 1예

현종진,최종환,박상훈,정혜원,정성주,기세윤,정희진,김우주,최정우,이주한,이나리,전승민 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

Cryptococcus neoformans는 주로 면역 저하 환자들에게서 감염을 일으키는 진균으로, 정상 면역 환자에서도 여러 가지 감염 증을 일으킬 수 있으나 그 중 cryptococcus 림프절염은 아주 드물다. 저자들은 경부 림프절 종대와 3주간 지속되는 발열을 주소로 내원한 정상 면역 환자에서 발생한 cryptococcus 림프절염 1예를 경험하여 보고하고자 한다. 경부와 흉부 컴퓨터 단층 촬영에서 양쪽 폐문 및 종격동 그리고 우측 쇄골 상부에 중심부 저음영과 주변부 조영증강을 보이는 다발성 림프절 종대가 관찰되었다. 우측 쇄골 상부의 림프절 조직 검사와 PAS, GMS 염색, 그리고 조직 배양 검사를 통하여 Cryptococcus neoformans에 의한 림프절염을 진단할 수 있었다. 이와 같이 정상 면역 환자에게서도 cryptococcus에 의한 감염이 일어날 수 있으며 림프절염으로도 나타날 수 있다는 것을 항상 염두에 두어야 할 것이다. Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

구연 : 단분절식도열공탈장의 임상적 의의

현종진,김세윤,최종환,김지현,김병규,김진용,박종재,김재선,박영태 대한소화관운동학회 2005 대한소화관운동학회 춘계학술대회 Vol.16 No.-

<목적> 식도열공탈장(이하 탈장)은 위식도역류질환의 중요한 원인 인자로 잘 알려져 있다. 그러나 단분절탈장의 경우 그 임상적인 의미에 대해서 아직 잘 연구된 바가 없으며, 대개 임상적으로 별 의미가 없는 것으로 간주되고 있다. 연자들은 2.0cm 미만의 단분절탈장의 임상적 의의를 확인하기 위하여 본 연구를 시행하였다. <방법> 본 병원 소화기내과를 방문하여 여러 가지 적응증으로 진단적 상부소화관내시경 검사를 처음으로 시행하는 연속 4592예(남:녀 20

Efficacy of Magnesium Trihydrate of Ursodeoxycholic Acid and Chenodeoxycholic Acid for Gallstone Dissolution: A Prospective Multicenter Trial

현종진,이홍식,김창덕,동석호,이승옥,류지곤,이돈행,정석,김태균,이진,고동희,박은택,이인석,유병무,김진홍 거트앤리버 소화기연관학회협의회 2015 Gut and Liver Vol.9 No.4

Background/Aims: Cholecystectomy is necessary for the treatment of symptomatic or complicated gallbladder (GB) stones, but oral litholysis with bile acids is an attractive alternative therapeutic option for asymptomatic or mildly symptomatic patients. This study was conducted to evaluate the efficacy of magnesium trihydrate of ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) on gallstone dissolution and to investigate improvements in gallstone-related symptoms. Methods: A prospective, multicenter, phase 4 clinical study to determine the efficacy of orally administered magnesium trihydrate of UDCA and CDCA was performed from January 2011 to June 2013. The inclusion criteria were GB stone diameter ≤15 mm, GB ejection fraction ≥50%, radiolucency on plain X-ray, and asymptomatic/mildly symptomatic patients. The patients were prescribed one capsule of magnesium trihydrate of UDCA and CDCA at breakfast and two capsules at bedtime for 6 months. The dissolution rate, response rate, and change in symptom score were evaluated. Results: A total of 237 subjects were enrolled, and 195 subjects completed the treatment. The dissolution rate was 45.1% and the response rate was 47.2% (92/195) after 6 months of administration of magnesium trihydrate of UDCA and CDCA. Only the stone diameter was significantly associated with the response rate. Both the symptom score and the number of patients with symptoms significantly decreased regardless of stone dissolution. Adverse events necessitating discontinuation of the drug, surgery, or endoscopic management occurred in 2.5% (6/237) of patients. Conclusions: Magnesium trihydrate of UDCA and CDCA is a well-tolerated bile acid that showed similar efficacy for gallstone dissolution and improvement of gallstone-related symptoms as that shown in previous studies.