산발적으로 발생한 급성 E형 간염 3예

김동한 ( Dong Han Kim ),박혁 ( Hyeuk Park ),문승원 ( Seung Won Moon ),정종혁 ( Jong Hyuk Jeong ),양혁승 ( Hyuk Seung Yang ),김도현 ( Do Hyun Kim ),김호동 ( Ho Dong Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.50 No.2

Acute hepatitis E is an endemic disease, commonly reported in Indian subcontinent, China, Africa, Central America, and so forth. It is a self-limiting disease like other acute hepatitis except in pregnant patient. Although sporadic hepatitis E is noted all over the world, most of them are associated with travel history to HEV-endemic area. In Korea, Hepatitis E is rarely reported. Moreover, sporadic acute hepatitis E without travel history to HEV-endemic area is very rare. We experienced three sporadic cases of acute hepatitis E, without travel history. All of them presented acute hepatitis symptoms, elevated aminotransferase, and positive IgM HEV Ab. Symptoms and aminotransferase levels were normalized during hospitalization and IgM HEV Ab converted negative after 4-8 months. We report three sporadic cases of onset-acute hepatitis E without travel history to HEV-endemic area.(Korean J Gastroenterol 2007;50:121-125)

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)

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)

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)

증례 : 복막으로부터 전이된 대장의 융기형 장액성 낭선암 1예

최홍엽 ( Hong Youp Choi ),고광현 ( Kwang Hyun Ko ),김정기 ( Jeong Ki Kim ),박혁 ( Hyeuk Park ),정은미 ( Eun Mi Jeong ),홍성표 ( Sung Pyo Hong ),박필원 ( Pil Won Park ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S

대장 관샘종에서 면역조직화학염색을 이용한 Telomerase 발현

김호동 ( Ho Dong Kim ),오영상 ( Young Sang Oh ),김수현 ( Soo Hyun Kim ),김상필 ( Sang Pil Kim ),신현학 ( Hyun Hak Shin ),박주용 ( Ju Yong Park ),박혁 ( Hyeuk Park ),명보현 ( Bo Hyun Myoung ),김도현 ( Do Hyun Kim ),이영직 ( Young 대한소화기학회 2007 대한소화기학회지 Vol.50 No.3

목적: Telomere는 세포 염색체의 말단에 존재하며 염색체 안정을 유지하는 데 필수적인 역할을 수행한다. 이러한 telomere의 합성을 촉매하는 telomerase 활성이 전암 병변에서도 관찰되면서 이 효소의 활성화는 발암과정의 초기 현상으로 암화과정에 기여하는 것으로 생각하고 있다. 대장암의 전암 병변으로 알려진 대장 관샘종의 형성이상 단계에 따른 telomerase의 활성도를 측정하고 연관관계를 밝히고자 하였다. 대상 및 방법: 본원에셔 2006년 1윌부터 2006년 12윌까지 대장내시경 용종절제술 또는 수술 받은 환자들 중 병리 조직검사에셔 경도 형성이상과 고도 형성이상으로 확진한 환자 48예를 대상으로 하여 후향적으로 연구하였다. 광학현미경에서 면역조직화학염색에 양성반응을 보이는 형성이상 세포의 비율이 50% 이하로 염색된 human telomerase reverse transcriptase (hTERT) 저염색군과 51% 이상 염색된 hTERT 고염색군으로 나타내었다. 염색은 세포의 핵에 국한된 경우로 하였다. 결과: 면역조직화학염색에서 hTERT 저염색군은 경도 형성이상 22예(96%), 고도 형성이상 13예(52%)이었으며 hTERT 고염색군은 경도 형성이상 1예(4%), 고도 형성이상 12예(48%)로 경도 형성이상과 고도 형성이상 간에 telomerase 활성도의 유의한 차이가 있었다(p<0.05). 결론: 대장 관샘종의 형성이상이 경도에셔 고도로 갈수록 telomerase 활성도가 높아졌다. Background/Aims: Telomeres are simple repeat elements located at each chromosome end of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer but also precancerous lesion. In this study, we compared the telomerase expression between low grade and high grade colorectal tubular adenoma. Methods: Among thissues from forty eight patients with colorectal tubular adenoma (23 low grade and 25 high grade colorectal dysplasia), telomerase expressions were evaluated by immunohistochemical staining. Results: We classified 48 patients into two groups by the extent of nuclei staining pattern. High telomerase expression was a group which showed staining nucleus pattern above 50% in tubular adenoma. Low telomerase expression was a group which showed staining pattern nucleus below 50%. Twelve in 25 high grade colorectal dysplasia showed high telomerase expression (48%). Only one in 23 low grade colorectal dysplasia showed high telomerase expression (4%). Telomerase expression was much higher in the tissues from the patients with high grade than in those with low grade colorectal dysplasia (p<0.05). Conclusions: Activation of telomerase may be related to the malignant potential in colorectal epithelial cells. Further studies are needed to define the role of telomerase in colorectal tumorigenesis. (Korean J Gastroenterol 2007;50:164-169)

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)

담관암을 동반한 신경섬유종증 1 형 1 예

이은우,김도현,강동구,강명원,여향순,임연근,김윤아,박혁 대한내과학회 2000 대한내과학회지 Vol.59 No.4

저자들은 심와부 동통을 주소로 내원한 환자에서 담관암을 동반한 신경섬유종증 1형 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Neurofibromatosis is characterized by multiple cutaneous neurofibromas, cafe-au-lait spots and a broad spectrum of clinical, pathologic and radiologic finding. The incidence of malignant neoplasms complicating neurofibromatosis has never been satisfactorily estabilished ; estimates range from 3% to 15%. The malignant tumors are usually derived from neural crest tissue. Gastrointestinal involvement appears to be rare and usually consists of neurofibromas, ganglioneuromas and leiomyomas. Hepatobiliary involvement in neurofibromatosis is rare and mostly located at the periampullary region. Most of theses tumors are carcinoids or less frequently neurofibromas. The authors report a case of peripheral cholangiocarcinoma associated with neurofibromatosis type 1.(Korean J Med 59:463-466, 2000)