최근 3년간 서울 지역 단일기관에서 급성 바이러스 간염의 원인

문장식 ( Jang Sik Mun ),김형준 ( Hyung Joon Kim ),허채 ( Chae Hue ),김상중 ( Sang Joong Kim ),문홍주 ( Hong Ju Moon ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),도재혁 ( Jae Hyuk Do ),장세경 ( Sae Kyung Chang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

목적: 최근 급성 바이러스 간염 중 급성 A형 간염이 급격히 증가하고 있으며, 급성 E형 간염바이러스 간염도 드물지 않게 보고되고 있다. 이에 최근 3년간 단일기관에서의 급성 바이러스성 간염의 원인과 이 중 급성 A형과 E형 간염의 중복감염의 임상적 특징을 알아보고자 하였다. 방법: 2005년 1월부터 2007년 7월까지 중앙대학교병원에서 IgM anti-HAV, IgM anti-HBc, HCV RNA, IgM anti-HEV의 검사들 중 한 가지 이상에서 양성인 급성 바이러스성 간염으로 입원한 111명 환자들을 후향적으로 조사하였다. 결과: 전체 111예 중 A형 간염은 105예(94.6%), B형 간염 5예(4.5%), C형 간염 1예(0.9%)였다. 급성 A형 간염 105예 중 27예(24.3%)에서 IgM anti-HEV가 양성으로 급성 A형 및 E형 간염의 중복감염으로 확인되었고, 이중 9예(8.6%)에서 추적검사상 IgM anti-HEV가 음전되었다. 급성 A형 단독 간염(78예)과 급성 A형과 E형 간염의 중복감염(27예)의 임상양상을 비교 분석한 결과 급성 A형 단독 간염과 급성 A형 및 E형 간염의 중복감염의 평균연령(29세 vs 28세), 재원기간(12일 vs 10일), 남녀의 비(51:27 vs 14:13)는 두군 간에 차이가 없었다. 입원 당시 임상증상과 생화학적 간기능 검사 및 일반혈액소견은 두 군 간에 차이가 없었다. 두 군 모두 전격성 간부전, 사망 등의 중대한 합병증은 없었으며 8주내에 생화학적 간기능 검사가 정상화 되었다. 결론: 국내에서 최근 발생하는 급성바이러스 간염의 대부분의 원인은 A형 간염 바이러스이며, 흥미롭게도 급성 A형 간염과 E형 간염의 중복 감염 예가 관찰되었으며, 급성 A형 단독간염과 급성 A형과 E형 간염의 중복 감염에서 두 군 간의 임상 증상 및 경과에 큰 차이가 없었다. Background/Aims: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. Methods: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. Results: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. Conclusions: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.(Korean J Med 74:624-631, 2008)

응급실 내원 천식발작 환자수와 발작 중증도의 최근 변화 추세 -단일기관연구-

문장식 ( Jang Sik Mun ),최인선 ( Inson S. Choi ),심명기 ( Myoung Ki Sim ) 대한천식알레르기학회 2005 천식 및 알레르기 Vol.25 No.4

Background: There have been few studies concerning the change in asthma severity in Korea. Objective: To investigate the recent trend in the prevalence and severity of acute asthma at a hospital in Gwangju. Method: The charts of 332 adult asthma patients, who were selected randomly from 1,240 patients who visited the emergency department from 1996 to 2003 except 2000, were reviewed retrospectively. Result: The proportion of asthma to total visits increased progressively from 0.20% to 0.28%, 0.44%, 0.45%, 1.04%, 0.99%, and 0.98% (P<0.001). The proportion of patients with severe asthma attack (FEV 1< 50%) and the age also increased progressively (P<0.001, respectively), and there was increasing tendency in male sex. When compared between before and after 2000, the mean annual number of asthma patients increased 3.43 times from 87 to 298, and the mean proportion of asthma 2.90 times from 0.34% to 1.00%. The proportion of patients with severe asthma attack increased significantly (52.1 % vs. 69.5%, P < 0.01), and post-treatment FEV1 decreased significantly (69.l±2.6% vs. 63.3 ± 1.6%, P < 0.05). Conclusion: The prevalence and severity of acute asthma at a hospital in Gwangju was progressively increased from 1996 to 2003, with increases in age and the male sex, and irreversible airflow obstruction. (Korean J Asthma Allergy Clin Immunol 2005;25:284-290)

토혈을 동반한 상장간막 동맥증후군 1예

문승원 ( Seung Won Moon ),박혁 ( Hyeuk Park ),문장식 ( Jang Sik Mun ),명보현 ( Bo Hyun Myoung ),김도현 ( Do Hyun Kim ),김호동 ( Ho Dong Kim ),한철 ( Chul Han ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

상장간막동맥증후군은 매우 드문 질환으로 식후 상복부 동통, 복부팽만, 구역, 구토, 체중감소 등의 상복부 폐쇄 증상을 일으키며 상부 위장관 조영술 등 방사선 검사로 진단할 수 있다. 평소 건강한 66세 남자 환자가 토혈로 내원 후상부위장관 조영술 및 복부전산화단층촬영 검사에서 상장간막동맥 증후군으로 인한 장폐쇄와 이차적인 식도 궤양 출혈로 진단되어 내과적 및 외과적 치료 후 좋은 결과를 얻은 증례를 보고하는 바이다. Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. The most characteristic symptoms are postprandial epigastric pain, fullness, voluminous vomiting, and eructation. The diagnosis may be difficult, but can be confirmed by upper gastrointestinal (UGI) contrast studies. We report a case of SMA syndrome in a 66-year-old patient with hematemesis. Endoscopy showed deep circular ulcerations with bleeding in the distal esophagus. Computed tomography (CT) and an UGI contrast series revealed distension of the stomach and duodenum, with a cut-off in the third portion of the duodenum. We treated the patient conservatively, but the patient`s symptoms did not improve. Ultimately, the patient underwent successful gastrojejunostomy with a favorable postoperative outcome. (Korean J Med 76:727-731, 2009)

크롬과 Toluene Diisocyanate에 의한 직업성 천식

조석 ( Seok Cho ),고영일 ( Young Il Koh ),문장식 ( Jang Sik Mun ),지승규 ( Seung Gyu Ji ),안재숙 ( Jae Sook Ahn ),정종원 ( Jong Won Chung ),최인선 ( In Seon Choi ) 대한천식알레르기학회 2005 천식 및 알레르기 Vol.25 No.3

육안으로는 보이지 않고 현미경 검사로만 진단된 점액과분비 담관유두종증

정종혁 ( Jong Hyeok Jeong ),박혁 ( Hyeuk Park ),문승원 ( Seung Won Moon ),문장식 ( Jang Sik Mun ),명보현 ( Bo Hyun Myoung ),김도현 ( Do Hyun Kim ),김호동 ( Ho Dong Kim ),한철 ( Chul Han ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.3

The mucin-hypersecreting biliary papillomatosis is a premalignant neoplasm characterized by intraductal papillary proliferation involving extensive areas of the intrahepatic and/or extrahepatic bile duct. We report a case of mucin-hypersecreting biliary papillomatosis manifested as obstructive jaundice and diagnosed only by microscopy, with a review of literatures. A 74-year-old female, who had a past history of cholecystectomy about 13 years ago, was admitted to our hospital with jaundice. A CT scan showed marked dilatation of intrahepatic and extrahepatic bile duct without intraductal filling defect or extrabiliary mass. During endoscopic retrograde cholangiopancreatography, mucin extrusion from the duodenal major papilla and dilated common bile duct with amorphous filling defects was noted. Percutaneous transhepatic biliary drainage for cholangioscopy was failed. In the operation field, there was a lot of mucin but was no visible mass at the common bile duct with bare eyes and cholangioscopy. However, papilloma was detected at the random biopsy specimen by microscopy. The patient underwent partial resection of common bile duct and choledocho-jejunal anastomosis. (Korean J Gastroenterol 2009;53:206-210)

당뇨병 유무와 치료 방법에 따른 대장 선종의 빈도

김상중 ( Sang Jung Kim ),최창환 ( Chang Hwan Choi ),문홍주 ( Hong Ju Moon ),문장식 ( Jang Sik Mun ),이현웅 ( Hyun Woong Lee ),김형준 ( Hyung Joon Kim ),도재혁 ( Jae Hyuk Do ),장세경 ( Sae Kyung Chang ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: Diabetes mellitus (DM) is associated with an increased incidence of colon cancer. However, the relationship between DM and colorectal adenoma is not definite. In this study, we sought to determine the association between DM and the prevalence of colorectal adenoma. Methods: We enrolled 606 patients with DM and 606 asymptomatic adults who underwent colonoscopy for routine health evaluations from June 2003 to June 2007. The frequency and characteristics of the colorectal adenomas were analyzed and compared between the two groups. Results: The sex ratio and mean age were 1.67:1 (M:F) and 58.1±10.6 years, respectively, in patients with DM, and 1.68:1 and 57.6±8.9 years, respectively, in patients without DM, and these values were similar. The frequency of colorectal adenoma was 33.2% for the patients with DM and 32.3% for the patients without DM. The frequency, location, number, size and histopathologic findings of the colorectal adenomas were not different between the two groups. Among the patients with DM, the frequency of colorectal adenoma was 35.7% in the patients treated with oral hypoglycemic agents and 31.4% in the patients treated with insulin. Also, the other characteristics of the colorectal adenomas were not different according to the treatment method. Conclusions: The frequency and characteristics of colorectal adenomas were not different between the patients with and without DM. (Intest Res 2008;6:50-55)

증례 : 소화기 ; 전신홍반루푸스에 동반된 자가면역 간염 1예

황영준 ( Young Jun Hwang ),정홍명 ( Hong Myung Jung ),박혁 ( Hyeuk Park ),문장식 ( Jang Sik Mun ),명보현 ( Bo Hyun Myung ),김도현 ( Do Hyun Kim ),김호동 ( Ho Dong Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1

전신홍반루푸스 환자에서 간효소 수치의 상승이 보였을 때 예후와 치료를 위해 원인을 파악하는 것은 중요하다. 특히 루푸스 간염과 자가 면역 간염을 감별하는 것은 필요하지만 두 질병의 유사성 때문에 감별이 쉽지 않다. 현재 문맥 주위의 조각 괴사, 간세포의 rossetting, 두터운 림프구 침윤과 같은 조직학적 소견과 antiribosomal P protein 항체, anti ds DNA 항체, anti Sm 항체 등의 자가항체가 두 질병을 구별하는데 도움을 줄 수 있다고 알려져 있으나 명확한 구별법은 아직 확립되지 않은 상태이다. 따라서 향후 이에 대한 연구가 필요하다고 사료되며 본 저자는 자가 면역성 간염과 동반된 전신홍반루푸스를 진단하고 스테로이드 치료로 호전된 증례를 경험하였기에 보고하는 바이다. Autoimmune hepatitis accompanied by systemic erythematosus lupus is rare. Usually, lupus-related advanced liver involvement is indistinguishable from autoimmune hepatitis accompanied by lupus, as they share common clinical, biochemical, serological, and histological manifestations. However, each disease has its own diagnostic criteria, and they have been defined as two different categories. Therefore, distinguishing between the two diseases is important to determine the correct diagnosis and treatment. A 41-year-old woman was hospitalized with jaundice and a malar rash. The patient met the diagnostic criteria of both systemic erythematosus lupus and autoimmune hepatitis. After corticosteroid treatment, the patient`s condition improved. Therefore, we report our experience of a rare case of autoimmune hepatitis accompanied by systemic erythematosus lupus with a review of the literature. (Korean J Med 78:95-98, 2010)

성인에서 발생한 원발 간 Burkitt 림프종 1예

이승현 ( Seung Hyun Lee ),김형준 ( Hyung Joon Kim ),문장식 ( Jang Sik Mun ),오형철 ( Hyoung Chul Oh ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),김정욱 ( Jeong Wook Kim ),도재혁 ( Jae Hyuk Do ),김재규 ( Jae Gyu Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4

Burkitt 림프종은 비호지킨 림프종에 속하는 드문 질환으로 주로 소아에서 발생한다. 간은 원발 악성 림프종이 잘 발생하지 않는 장기이며 원발 간 림프종은 림프절 이외 림프종의 0.4%를 차지한다고 알려져 있다. 저자들은 B형 간염 보균자에서 발생한 항암치료에 완전 관해를 보였던 원발 간 Burkitt 림프종 1예를 경험하였기에 보고하는 바이다. 19세의 남자가 2개월간의 심한 피곤함과 내원 1일 전부터 시작된 우상복부 통증을 주소로 내원하였다. 신체검사에서 3횡지의 간비대가 촉지되었으나 림프절은 만져지지 않았고 야간발한, 발열, 체중감소는 호소하지 않았다. 혈액 검사에서 혈색소 12.4 g/dL의 경도의 빈혈을 보였으며 생화학 간기능 검사에서 AST 53 IU/L, ALT 52 IU/L였으며 ALP 192 IU/L, LDH는 437 IU/L로 증가되어 있었다. 혈청 바이러스 표지자 검사에서 HBsAg, anti-HBs, anti-HBc (IgG)이 양성이었으며 Anti-HCV, anti-HIV는 음성이었다. 암종배아항원(CEA), 알파태아단백(AFP), CA19-9은 정상범위였다. HBV DNA 정량검사는 1.3×109 copies/mL였다. 복부 및 흉부 전산화 단층촬영에서 다양한 크기의 저밀도 음영을 갖는 결절들이 간에서 관찰되었으며 간에서 가장 큰 것은 11×7 cm였고 복강 및 흉강 내 림프절 비대는 관찰되지 않았다. 자기 공명영상에서 T1영상에서 저신호강도 T2영상에서 불균일한 고신호강도를 갖는, 조영증가가 잘되지 않는 결절들이 관찰되었다. 초음파 유도하 세침간생검에서 미만으로 침윤하는 세포들이 관찰되었고, 침윤된 세포는 중간크기이며 세포질은 호염 기성이었고 거친 염색질의 핵과 호염기성이며 중간크기인 핵소체를 가지고 있었다. 면역조직화학 염색에서 백혈구 공통항원, B세포에 양성이었고, T세포에는 소수의 세포들만이 양성 반응을 보였으며, Ki-67에 95% 이상의 세포에서 양성반응을 보여 Burkitt 림프종으로 진단되었다. 흉부 CT 및 골수, 척수검사에서 전이는 관찰되지 않았다. 환자는 15회의 CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) 복합항암화학요법과 cytosine arabinoside와 methotrexate를 이용한 중추신경계 항암화학예방요법치료를 받았으며 완전 관해 후 관찰 중이다. Burkitt`s lymphoma is a rare disease that belongs to the aggressive non-Hodgkin`s lymphoma. Herein, we report a case of primary hepatic Burkitt`s lymphoma. A 19-year-old man visited the hospital for right upper quadrant pain. He felt fatigue for two months. Physical examination revealed hepatomegaly and no palpable lymph node. He had no fever, weight loss, or night sweating. Laboratory finding showed mild anemia (hemoglobin, 12.4 g/dL), mild elevated transaminase (ALT, 52 IU/L), elevated lactate dehydrogenase (LDH, 437 IU/L), and alkaline phosphatase (ALP, 129 IU/L). The viral marker was positive for HBsAg, HBeAg, anti-HBs, and anti-HBc (IgG), and negative for anti-HBe, anti-HCV, and anti-HIV. CEA, AFP, and CA19-9 levels were within normal ranges. The HBV DNA quantitation was 1.3×109 copies/ml. Abdominal-Pelvis CT scan and abdominal MRI finding were compatable with malignant lymphoma. Liver biopsy examination confirmed Burkitt`s lymphoma. No metastasis was detected in the thoracic cavity, bone marrow, and spinal fluid. The patient was treated with the combination regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and high dose methotrexate. Cytosine arabinoside and methotrexate were added for CNS prophylaxis by intrathecal installation. Chemotherapy was administered every 3 weeks for fifteen cycles. Serial follow-up CT scan showed a marked decrease in the size of hepatic lesions. Follow-up CT scan and PET-CT scan were perfomed 4 weeks after the final cycle disclosed no definite residual or active lesion confirming the state of complete remission. (Korean J Gastroenterol 2008;51:259-264)

Urea Breath Test 양성인 정상 성인에서 Polyethylene Glycol(Colyte(R)) 투여 후 직장과 말단회장에서 배양과 Polymerase Chain Reaction을 이용한 Helicobacter pylori 발견

김도현 ( Do Hyun Kim ),정홍명 ( Hong Myong Jung ),황영준 ( Young Jun Hwang ),안용수 ( Yong Soo Ahn ),문장식 ( Jang Sik Mun ),명보현 ( Bo Hyun Myoung ),박혁 ( Hyeuk Park ),정은주 ( Eun Joo Jeong ),임윤미 ( Yun Mi Im ),오현민 ( Hyu 대한소화기학회 2010 대한소화기학회지 Vol.56 No.1

Background/Aims: Helicobacter pylori (H. pylori) transmission route is not yet clearly understood. Isolating H. pylori from stool, saliva, and vomitus is very difficult. However, H. pylori could be cultured from feces in the setting of rapid gastrointestinal tract transit. The aim of this study was to isolate H. pylori by culture and PCR in the rectum and terminal ileum during colonoscopy. Methods: Twenty subjects with positive UBT (urea breath test) were included. We performed polymerase chain reaction (PCR) test and culture of H. pylori with the rectal fluid and terminal ileal fluid during colonoscopy. Results: H. pylori was cultured with rectal fluid from 9 (45.0%) of 20 subjects and with ileal fluid from 11 (55.0%) of 20 subjects. H. pylori was a little more frequently cultured from the terminal ileal fluid than the rectal fluid without statistical significance (p>0.05). PCR test detected flaA (16/20, 80.0% and 17/20, 85.0%), 16S rRNA gene (16/20, 80.0% and 17/20, 85.0%), cagA (10/20, 50.0% and 12/20, 60.0%), and ureC (9/20, 45% and 11/20, 54.5%) from the rectal fluid and the terminal ileal fluid, respectively. The specificity and sensitivity of ureC were 100%. Conclusions: H. pylori could be cultured from the rectal fluid and terminal ileal fluid in the setting of rapid gastrointestinal tract transit. These results suggest of fecal-oral transmission of H. pylori. (Korean J Gastroenterol 2010;56:27-32)