정상 한국인에서 연령증가에 따른 혈장 Dehydroepiandrosteronesulfate ( DHEA-S ) 농도 및 DHEA - S / cortisol 비의 변화

박성우,유형준,임성희,최문기,유재명,박민숙,이권엽,박철수,김철홍,김현규,김두만,박규용 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.2

Backgroud: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. Methods: Healthy Korean(men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs(such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40- 49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4(Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. Results:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels(men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women(men; y= -3.152 * +292.6, r2= 0.8459, P$lt;0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P$lt; 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA- S/cortisol ratio. Conclusion: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu(aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index. (J Kor Soc Endocrinol 12:245-254, 1997)

The Presence of Urinary Ketones according to Metabolic Status and Obesity

Kim Bo-Reum,Seo Jeong Woo,Kim Sang Man,Kim Kyu-Nam,주남석 대한의학회 2020 Journal of Korean medical science Vol.35 No.31

Background: Recently, new concepts about obesity and normal weight subtypes with metabolic conditions are rising and ketone bodies are emerging as a significant indicator of metabolic health. This study aimed to find a relationship between ketonuria and those subtypes. Methods: The data of 19,036 subjects were analyzed in this cross-sectional study (2013–2017 Korea National Health and Nutrition Examination Survey, KNHANES). Based on body mass index and adult treatment panel III with modification of waist circumference, individuals were categorized into 4 groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). Individuals were divided into 2 groups, positive and negative ketonuria groups, and the metabolic parameters were compared. Results: The metabolic indicators of the positive ketonuria group showed better results than those of the negative ketonuria group and the MHNW group showed the highest proportion of positive ketonuria. The MHNW group showed higher urinary ketones than the MUO group (odds ratio [OR], 0.391; 95% confidence interval [CI], 0.254–0.601) in men. In women, OR of having ketonuria was 0.698 (95% CI, 0.486–1.002) in the MHO group and 0.467 (95% CI, 0.226–0.966) in the MUNW group compared to the MHNW group, respectively. Conclusion: Compared to the MHNW group, the MUO group showed lower presence of ketonuria in men, and tendency to have less ketonuria in women.

在美 韓國 老人의 健康 및 生活 實態에 關한 硏究

金應翊,朴祥華,韓允愚,徐敬萬 대한보건협회 1992 대한보건연구 Vol.18 No.1

This study was perfomed to figure out the health status and life style of aged population in Korean-Americans living in Los Angeles in the United States. The number of subjects in this study were 283 persons aged 65 and over (male 141. female 142) drawn from Los Angeles Country in U.S.A. The data were collected by trained interviewers from July to August. 1991. The questionaire consisted of 1) general characteristics, 2) health status and medical health services, 3) 24 questions of CMI, and 4) the level of adaptations and difficulties to immigrant society. The results of this study are as followings: 1. In age distribution, 33.2 percent of total subjects was 65-69 age group, and 33.1 percent was 70-75 age group. The average duration of immigration were 7.89 years in male and 10.18 years in female, and percent distribution by duration of migration were 33.3 percent in 1-4 years, 30.5 percent in 5-9 years, 23.7 percent in 10-14 years, and 13.5 percent in 15 years and over. Of total subjects. 84.7 percent had permanent residence and only 13.8 percent had citizenship. In the reason of immigration of the elderly, 76.4 percent of them responded as reason for helping and joining to family, and only 8.5 percent of subjects were economic reason. The educational level of the subjects were generally high. Only 9.0 percent of the subjects recevied no or little education in the modern day education system. Primary graduates were 35.7 percent, middle and high school graduates were 37.8 percent and university(college) and over graduates constituted 16.6 percent. The educational level of the male were generally higher than that of female. A large proportion of the subjects(94.3 percent) responded as having religion, and 67.8 percent were protestant, 16.7 percent were catholic and 7.4 percent were buddhist. In the family structure. 75.6 percent of the elderly lived alone and with their spouses and 22.1 percent live in a family with 2 generation living together. The marital status of male showed that 80.7 percent of them lived with their spouses, 14.3 percent of men were widowed, and only 26.3 percent of female lived with their spouses and 71.5 percent of female were widowed. 2. One out ten of the elderly was presently smoking. Of the smokers, there were 4 times as many male smokers as female smokers. In response to a question about their drinking habits, 82.0 percent of the aged replied that they did not consume alcohol. Those who consumed alcohol 'daily' constituted 3.6 percent, 'frequently' were 4.3 percent 'sometimes' were 7.9 percent and 'scarcely' constituted 2.2 percent. Among the exercises and sports which the elderly were doing for the fitness and preservation of health. A walking was the most popular at 32.1 percent of the population. More rigorous sports such as hiking, jogging, physical cardiovascular exercises and ball games were being enjoyed by only a very few. 37.2 percent of the elderly replied that they did not exercise regularly. In the major pastime of daily life activities. 40.9 percent of the subjects responded 'none', 14.7 percent of them were domestic duty for family, about 10 percent of them were hobby, religion activities, social work and participating in social education program respectively. In the problems and difficulties of immigration, 78.1 percent of them responded 'yes' in the early times of immigration and 30.4 percent in the present time of immigration. Six major problems were identified by respondent. They were, in the rank order of their language; homesickness: transportation; income and economic and custom. 3. Most of the respondents considered themselves healthy. The proportion of the question to their health at the time of study, 36.2 percent in male and 23.2 percent in female replied that they seemed to be 'excellent healthy', 34.7 percent in male and 32.4 percent in female be 'good', and 4.3 percent in male and 2.1 percent in female be 'Very poor'. In considering specific parts of their body as having problems, many of the ederly pointed out the disease of circulatory system(17.7 percent in male and 23.2 percent in female). Comparatively few of the elderly thought that they had something wrong with their musculoskeletal system(5.7 percent in male and 16.1 percent in female), digestive system(9.2 percent in male and 5.6 percent in female) and endocrine and metabolic disease(6.4 percent in made and 9.9 percent in female). Of those elderly who perceived of some problems with their circulatory and musculoskeletal systems, there were more elderly women compared to elderly men. The largest percentage of the elderly(20.7 percent in male and 26.5 percent in female) indicated palsy as the disease they fear most. Thereafter, the order of diseases feared by the elderly was diabets. hypertension, neuralgia, cancer, and dotage. A majority of the elderly, 54.6 percent of men and 44.4 percent of women, replied that they did not visit a medical institution or a pharmacy to treat their diseases during the one month prior to the survey. Of the total survey subjects who did visit a medical facilities, those complaining of circulatory system disease constituted 13.5 percent in male and 14.8 percent in female, and digestive system diseases were 7.8 percent in male and 8.5 percent in female. For the endocrine and metablic disease, disease of nervous and sens organs and musculoskeletal system were all each less than 7 percent of all the study subjects. Of the total elderly, 49.0 percent utilized medical facilities such as hospitals, herbal clincics, pharmacies and others to treat illness within one month prior to the time of survey; the utilization of clinicl and hospital were 86.0 percent, herb clinic were 8.4 percent and pharmacy were 4.2 percent. 34.8 percent of men and 11.3 percent of female did not take a medicine for treatment and promoting nutrition at the time of the survey. 55.4 percent of total elderly used the drug for treatment of diseases, and 16.6 percent for promoting nutrition. 4. Except for group of questions concerning urinary system more women than men generally complained of problems and discomforts in each groups. More elderly suffered from problems associated with musculoskeletal system than any others, and the decreasing order of the groups of problems with which most complaints were indicated are the problems associated with mental condition, urinary system, circulatory system, nervous system, visual and auditory organs, respiratory system and digestive system.

간 세포암에서 VEGF, TGF-β1, b-FGF 발현의 의의

김성용,남충현,주종우,채만규,백무준,이문수,김형철,안현철,김홍수,김창진,김창호 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: Angiogenesis is important for the proliferation and the metastasis of solid tumors. The growth of a solid tumor is widely recognized to depend on the process of neovascularrozation. Without angiogenesis, tumors cease to grow beyond even a few milimeters in diameter. It has been shown that tumor vascular density is an independent prognostic marker in several types of human tumors and is known to correlate with poor prognosis. To date, many angiogenic factors have been identified, such as transforming growth factor-α(TGF-α), transforming growth factor-β(TGF-β), fibroblast growth factor family(FGF), vascular endothelial growth factor(VEGF), platelet derived endothelial cell growth factor(PD-ECGF), tumor necrosis factor-α(TNF-α), and angiogenin. Hepatocellular carcinoma(HCC) is the second most common tumor in Korean males and is known as a typical hypervascular tumor with frequent portal vein invastion. The authors identified the expreesion of VEGF, TGF-β1, and b-FGF in HCC specimens and evaluated the relationship between these growth factors and the clinicopathologic characteristics of HCC. Method: We reviewed the medical records of 30 patients who were diagnosed as hepatocellular carinoma treated with hepatic resection between January 1994 and December 1998 in Soonchunhyang University Chunan Hospital. The selection of the cases was decided according to the condition of paraffin block fixation. The prognostic factors such as age, sex, tumor size, concentration of serum α-fetoprotein, presence of liver cirrhosis, presence of tumor emboli in portal vein, TMN stage, amount of transfusion during the operation, hepatitis B virus(HBV) infection, and Edmonson-Steiner(E-S) grade were investigated. Relationship between the prognostic factors and the immunopathologic expression of the TGF-β1, b-FGF, and VEGF was examined. Result: Thirty patients (24 males, 6 females) were included in the current study. The patient's mean age was 50.6 years and the age ranged from 36 to 65 years. The mean size of the tumor was found to be 5.2cm. All the patients were follewed up for 7 to 63 months. Child's classification A patients were 23(76.7%)cases, B patients were 7(23.3%)cases, and C was none. Immunohistochemical staining of HCC tumor mass in VEGF expression patients were 17(56.7%), b-FGF expression patients were 10(33.3%), and TGF-β1 expression patients were 10(33.3%). VEGF expression or more than one positive expression among the three factors correlated with tumor size and the stage of HCC but did not correlated with other clinicopathological characteristics. TGF-β1 and b-FGF did not correlate with any clinicopathological characteristics. Conclusion: The results suggest that the expression of VEGF or more than one positive expression among the three factors in HCC cells may be a significant prognostic factor of HCC.

단무지 공장에서 발생한 질식 사고의 원인과 방사선학적 소견: 중례보고 및 가스분석 결과

박충기,김만구,김흥철,안범규,박만수,황우철,최철순,강익원 江原大學校 附設 環境硏究所 1994 環境硏究 Vol.11 No.-

목 적:단무지 공장에서 질식사고를 일으켰던 가스의 종류를 알아내고, 이러한 가스중독의 방서선학적 소견을 소개하기 위하여 본 연구를 하였다. 대상 및 방법:단무지 공장에서 발생한 질식 사고자 3예중 생존자 1예를 대상으로 단순흥부X-선검사와 CT 소견을 분석하였으며, 가스의 종류를 알아내기 위하여 단무지를 유리병에 넣어 발생된 가스를 가스크로마토그래픽을 이용하여 분석하였다. 결 과:단무지 공장에서 발생한 질식사고자중 생존한 1명의 방사선학적 검사에서 신속히 호전되는 폐경결(consolidation)을 볼 수 있었으며 이는 폐부종의 소견임을 알 수 있었다. 협기성 상태에서 단무지를 담은 유리병의 상층부 가스를 실험 분석한 결과 이산화탄소, 에칠알코올이 다량으로 검출되었으나 독성가스는 주로 황화수소이였다. 결 론:단무지 공장의 질식 사고자에서 폐방사선학적 소견은 폐경결을 보이는 폐부증으로서 이는 실험을 통해 단무지에서 발생되는 유독가스인 황화수소 때문임을 입증하였다. Purpose: To identify the main toxic gas released from salted radish in rice bran(Dan-M-Ji) and to introduce the radiological findings of the patient who was exposed to the gas. Materials and Methods: Chest radiographs and CT scans of one survivor among three men who were exposed to the gas from Dan-Mu-Ji were reviewed. Gas obtained from the closed bottle containing Dan-Mu-Ji was analized by using the gas chromatography. Results: The radiographlc examinations of the survivor were suggestive of pulmonary edema with it's rapidly improving consolidations in both lung. The headapace gas within the bottle containing Dan-Mu-Ji was mainly composed with carbon dioxide, ethyl alcohol and hydrogen sulfide, of which hydrogen sulfide was considered the main toxic gas released. Conclusion: Under the anaerobic condition, Dan-Mu-Ji released toxic hydrogen sulfide. Inhalation of hydrogen sulfide might produce non-cardiogenic pulmonary edema.

췌장의 가성낭종 파열에 의한 하부 위장관 출혈 1예

장성종,김병수,부귀범,김동규,박찬국,김만우,김정용,박상헌 조선대학교 부설 의학연구소 2000 The Medical Journal of Chosun University Vol.25 No.1

Pancreatic pseudocysts usually develop as a complication of acute pancreatitis or repeated attacks of chronic pancreatitis. Pseudocysts may also develop as a result of traumatic injuries or neoplasms. An uncommon complication is massive hemorrhage inside the pancreatic pseudocyst. The exact mechanism of hemorrhage is unknown. Enzymatic digestion, pressure erosion from the cyst mass or a combination of these processes may play an important role. Gastrointestinal hemorrhage associated with a pancreatic pseudocyst can occur in 10 percent of cases. When hemorrhage occurs because of erosion into a blood vessel involved in the pseudocyst, surgery is indicated since the episodes of hemorrhage are often severe and may even be fatal. When there is colonic involvement, various complications may occur. The most dangerous one is spontaneous rupture into the colon, which requires immediate surgical treatment because of high incidence of fulminating sepsis or massive hemorrhage. We examined a sixty eight-year-old man complaining of hematochezia and dizziness, and reported that it was a case of massive lower gastrointestinal hemorrhage caused by pseudocyst of the pancreas ruptured into the colon associated with chronic pancreatitis. On operative findings, the peripancreatic fatty tissue had severe adhesions to transverse colon and tail portion of pancreas, where the pseudocyst had formed. A distal pancreatectomy, splenectomy and resection of transverse colon were performed. By microscopic examination, hemorrhagic necrosis and inflammatory change were observed in the pancreas specimen. The tail portion of pancreas had a 6×6 cm sized cystic mass and was proven to be a pseudocyst with no epithelial lining.

일개 대학병원에서 일년간 분리된 반코마이신 내성 장구균의 임상 분자역학적 연구

송진영,김창억,김성욱,우흥정,김미란,이규만,이란,장미화,정희진,김우주 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.4

목적 : 한강성심병원에서는 2000년 3월 반코마이신내성 장구균이 처음 분리되어, 원내전파를 막기 위한 노력을 하였으나, 분리가 지속되었다. 따라서 이에 대한 좀더 자세하고 객관적인 자료를 얻기 위해 본원에서 분리된 반코마이신내성 장구균에 대한 임상분자 역학적 연구를 시행하게 되었다. 방법 : 2000년 3월부터 2001년 2월까지 한림대학교 한강성심병원에서 분리된 장구균을 대상으로 디스크 확산법, 최소발육억제 농도등의 측정을 통해 반코마이신 내성여부를 확인하였으며, 반코마이신내성 장구균을 대상으로 PFGE를 시행하여 형별 분석을 하였다. 결과 : 분리된 균주는 총 32균주로 모두 E. faecium이었다. 항생제 내성 검사 결과 모두 Van A형이었다. PFGE 결과 1a형이 8검체, 1b형이 5검체, 2a형이 4검체, 2b형이 4검체, 3a형이 2검체, 3b형이 5검체였고, 그 외 4, 5, 6형이 각각 1검체씩이었다. 총 32균주 중 56%(18/32)의 균주가 같은 시기, 같은 병실에서 동일한 PFGE 형을 보이면서 분리되었다. 결론 : 반코마이신내성 장구균의 PFGE 분석 결과 여러 종류의 반코마이신내성 장구균이 유행하였음을 알 수 있다. 그러나 같은 기간, 같은 병실에서 분리된 균주의 PFGE 형이 같은 것이 상당수 있었다. 이는 반코마이신내성 장구균의 원내 전파가 있었음을 의미한다. 따라서 반코마이신내성 장구균의 전파의 발생 및 전파 방지를 위해서는 보다 효과적인 감염관리 활동이 필요할 것으로 생각된다. Background: Vancomycin-resistant enterococci(VRE) have been a rising problem worldwide. In March 2000, VRE was first isolated from a patient in Hangang Sacred Heart hospital. Although efforts to prevent transmission of VRE were performed, isolations continued. So molecular epidemiological study of VRE was done. Method : The minimal inhibitory concentration(MIC) to vancomycin and teicoplanin, and pulsed field gel electrophoresis(PFGE) pattern of VRE isolated from March 2000 to February 2001 were evaluated. Results : 32 VRE were isolated. All of the VRE were Enterococcus faecium and showed Van A resistance phenotype. We found out that a significant number of VRE isolated during same period and in same room, were same PFGE patterns. (18 cases/ 32 isolates= 56%) Conclusion: This study demonstrated the spread of VRE of same PFGE patterns. It suggests the nosocomial spreads of VRE.

Case Report : Hepatoid Carcinoma of the Pancreas Combined with Neuroendocrine Carcinoma

( Ji Ye Jung ),( Yoon Jae Kim ),( Hee Man Kim ),( Hong Jeoung Kim ),( Seung Woo Park ),( Si Young Song ),( Jae Bock Chung ),( Chang Moo Kang ),( Joo Yeon Pyo ),( Woo Ick Yang ),( Seung Min Bang ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.1

Hepatoid carcinoma is a primary extrahepatic carcinoma whose morphology, immunohistochemistry, and behavior are similar to those of hepatocellular carcinoma. The most common sites of extrahepatic carcinoma are the stomach and ovary, but nine cases of hepatocellular differentiation of the pancreas have been reported in the literature. We report another case of hepatoid carcinoma of the pancreas that was associated with the development of a pancreatic endocrine carcinoma in a 46-year-old man. Serum alpha-fetoprotein (AFP) was elevated to 262.49 IU/mL and radiological examinations revealed a mass measuring 7.5 cm in diameter in the head of the pancreas. He underwent a conventional Whipple operation, and light microscopy showed adenocarcinoma that was immunopositive for AFP, hepatocyte antigen, cytokeratin, chromogranin, synaptophysin, and alpha-1 antichymotrypsin. Although hepatoid differentiation was not shown unequivocally histologically, other immunohistochemistry findings supported the diagnosis of hepatoid carcinoma combined with neuroendocrine carcinoma. The patient was healthy and had no evidence of recurrence at 4 months after the surgery. This report describes why hepatoid carcinoma should be considered as a differential diagnosis of a pancreatic mass, especially when serum AFP is elevated. (Gut Liver 2010;4:98-102)

제2형 당뇨병 외래 환자의 비만도에 따른 미세혈관합병증

이성규,조남한,김현만,이관우,정윤석,채봉남,김윤정,이미덕,노혜림,홍은경,조현경 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.1

Background: Korean type 2 diabetic patients who are frequently non-obese, may be genetically different from Western type 2 diabetics who are frequently obese. Therefore, the diabetic complications of type 2 diabetes mellitus in Korea may be also different from those of Western countries. Until now, most studies reported in Korea did not analyse the microvascular complications of type 2 diabetes mellitus according to obesity, and also the criteria in the diagnosis of microvascular complications were different in each study. We investigated the microvascular complications and its relationship with obesity, in type 2 diabetic patients visiting an outpatient clinic. Methods: The study subjects were type 2 diabetic patients visiting an outpatient clinic of Ajou University Hospital. We selected patients participating in a 75 g oral glucose tolerance test, retrospectively. Type 2 diabetes was diagnosed according to the WHO/NDDG classification of diabetes. Biochemical studies including lipid profile, plasma insulin and C-peptide levels were done. Anthropometric measurements were performed. Based on BMI (㎏/㎡), the patients were divided into the following groups: the lean group, when the BMI was less than 20 ㎏/㎡ the ideal body weight (IBW) group, if the BMI was between 20 ㎏/㎡ and 25 ㎏/㎡ in women and 20 ㎏/㎡ and 27 ㎏/㎡ in men; and the obese group, when the BMI was $gt;25 ㎏/㎡ in women and $gt;27 ㎏/㎡ in men. Results: 1. Neuropathy (45.2%) was the most frequent among the microvascular complications, and the frequency of retinopathy was 15.1%, and that of nephropathy was 4.9%. Within 5 years of diabetes duration, the frequency of neuropathy, retinopathy, and nephropathy was 43.2%, 11.8%, and 2.9%, respectively. 2. Glycosylated hemoglobin (HbA_(1c)) and fasting blood glucose levels were not different among the three groups. Beta cell function{Δ (insulin 30min - insulin Omin)/Δ(glucose 30min - glucose 0min)} was the highest in the obese group. However, beta cell function(ΔI/ΔG) divided by the basal insulin level, considered insulin resistance, was not different among the three groups. 3. Within 5 years of diabetes duration, retinopathy tended to be the most frequent in the lean group, whereas neuropathy tended to be the most frequent in the obese group, and body mass index influenced the retinopathy and neuropathy, statistically significantly. Conclusion: Diabetic neuropathy was the most frequent among microvascular complications of type 2 diabetes mellitus in our study subjects. At the time of presentation within 5 years of diabetes duration, the lean group of type 2 diabetics had a tendency of the more frequent retinopathy, the obese group had a tendency of the more frequent neuropathy. These results suggest that type 2 diabetes mellitus in Korea is also not a single disease entity, as in Western countries and is a heterogenous group of disorders with a diversity of microvascular complications. However, the more studies about this will be required.

제 1형 신경섬유종증 환자에서 발생한 위장관 간질종양 1예

원경준,이준,변유미,조민근,한경택,김원,홍란,임성철,김경종,김영대,박찬국,김만우 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm arising in the gastrointestinal tract, but this tumor is rarely seen in association with type l neurofibromatosis (NFl) Generally, the majority of GISTs are isolated neoplasm and they are sporadically found in the stomach, but the GISTs in NFl patients are usually multiple and usually found in the small intestine. We report a case of multiple GISTs in the jejunum of a 63-year-old woman diagnosed as NFl accompanied by complication of gastrointestinal bleeding, In this case, Patient had multiple cafe-au lait spots and neurofibroma on skin and had freckling on axilla and groin, and then, we made a diagnosis of NFl. Gastrointestinal bleeding is controlled by resection of multiple GISTs. Generally, only 3-5% of all gastrointestinal bleeding comes from the small bowel. Causes of small intestinal bleeding are angiodysplasia, neoplasm, NSAIDs induced ulcer etc. but, If patients have NFl accompanied by complication of gastrointestinal bleeding, GISTs on small bowel must be considered.