Mallory-Weiss syndrome의 내시경적 진단과 치료

송근암(Geun Am Song),김태오(Tae Oh Kim),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang),배상문(Sang Moon Bae),류수형(Soo Hyung Ryu),안준협(Jun hyup An),이성훈(Seong Hwun Lee) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : Mallory-Weiss syndrome is a laceration of gastroesophageal junction due to abruptly increased intraabdominal pressure. Bleeding from Mallory-Weiss tears stops spontaneously within 2-3 days without specific therapy in 80-90% of cases, but in some cases, aggressive treatment is required due to massive bleeding. Methods: Among two hundreds and fifteen cases of upper gastrointestinal bleeding from January 1997 to January 1999, twenty three cases (10.7%) were diagnosed as Mallory-Weiss syndrome by endoscopy. We assessed the site, number, coexisting diseases, precipitating factors and bleeding lesion according to the time interval after the tears. After supportive care or specific therapy, we performed follow-up endoscopy to evaluate the healing of the lesions. Results: The mean age was 49.1 years and male:female ratio was 4.8:1. The most common precipitating factors were nausea, vomiting and alcohol drinking. In twenty cases, coexisting diseases such as gastritis and esophageal varix were detected. As for the number of tears, one tear was the most common (69.6%), while two tears were identified in five cases and three were in two cases. Thirteen cases of the Mallory-Weiss tears were located on the gastroesophageal junction, seven cases on the lower esophagus, one case on the cardia and two cases from lower esophagus to cardia. Eighteen cases were diagnosed by endoscopy within 24 hours after bleeding, of whom fourteen cases had active bleeding. Among four cases diagnosed after 24 hours, endoscopic finding revealed active bleeding in two cases and blood clots in the other two cases. We treated thirteen cases with supportive care, one case with hypertonic saline injection and nine cases who had active bleeding or deep and long tears with endoscopic band ligation. One or two weeks later, we performed follow-up endoscopy, and no bleeding was detected in all cases. Conclusion: We diagnosed twenty three cases of Mallory-Weiss syndrome by endoscopy and treated all cases with supportive care or endoscopic band ligation successfully.(Korean J Med 58:542-547, 2000)

간흡충 감염가토의 간내 담관에 대한 병리조직학적 및 조직화학적 연구

송근암(Geun Am Song),김진도(Jin Do Kim),이동완(Dong Wan Lee),손춘희(Choon Hee Son),양웅석(Ung Suk Yang),허윤(Yoon Hue),문한규(Han Gue Moon),유방현(Bang Hyun Liu),이선경(Sun Kyung Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A This study was undertaken to examine the histopathological changes of the bile duct in rabbits heavily infested with Clonorchis sinensis for 6-18 months, and then to investigate the histochemical properties and compositions of epithelial mucosubstances. In 9 rabbits, each rabbit was orally infested with about 500 metacercariae and was sacrificed when general conditions were poor. The specimens were stained with H-E, PAS, alcian blue (pH 2.5), alcian blue (pH 1.0), alcian blue (pH 2.5) -PAS, and FITC- conjugated lectins. The results obtained were as follow 1) The pathological changes in the infested rabbits were papillary and adenomatous hyperplasia, goblet cell and mucus-cell metaplasia, ductal wall fibrosis, and infiltration of eosinophils in the ductal wall, and then the metaplasia of ductal epithelium was more marked in the deep gland than in the surface. 2) The epithelial mucosubstances in the normal intrahepatic bile duct were produced in the border and supranuclear portion of the epithelium. The histochemical composition of these was a mixture of neutral and acid mucosubstances with a predominant acid group. 3) In infested rabbits, the epithelial mucosubstances were produced in the border and supranuclear portion of the covering epithelium, goblet cell, and hyperplasia and metaplasia cells of the deep gland. The mucosubstances were much more produced in the goblet cell, hyperplasia and metaplasia cell of deep gland, and the composition was mixture of neutral and acid substances with a predominance of the neutral group in goblet cell and adenomatous hyperplasia, and a predominance of the acid group in mucus-cell metaplasia of the deep gland. 4) In the normal intrahepatic bile duct, labeling of FITC-conjugated lectins of WGA and Con-A was weakly localized in the border of the epithelium and its grade was trace. 5) In infested rabbits, F1TC-WGA and FITC-Con-A labeling was seen in the border and supranuclear portion of the covering epithelium, goblet cell, and hyperplasia and metaplasia cells of the deep gland, but FITC-PNA and FITC-SBA labeling was graded from zero to trace. 6) Mucin secreting cell metaplasia stained by PAS and AB showed very significant labeling of E1TC-WGA and FITC-Con-A, which are lectins that are highly specific in their recognition of glycosylated residues.

직장 및 S자 결장에서 관찰되는 비교적 드문 질환

송근암 ( Geun Am Song ) 대한장연구학회 2006 Intestinal Research Vol.4 No.1

The rectum is approximately 10 to 15 cm in length and extends from the sigmoid colon to the anal canal. It contribute to defecation as the rectal walls expand, stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. There are some differences between rectum and colon. The rectum is divided into two portion by peritoneal reflection and makes pouch. The pouch is associated with many pathologic conditions, such as rectal shelf in stomach cancer, rectal endometriosis, and spread of pelvic inflammation. The inferior mesenteric arteries and middle, inferior rectal arteries supply the rectum. This dual blood supply system causes different incidence of ischemic inserts and metastatic site in rectum and colon cancer. The function of anal sphincter and rectum in pelvic cavity is significantly important in defecation and its disturbance causes some specific rectal disease. Due to its position, rectum may be injuried by external and internal events and show the initial suggestion of colorectal disease. We describe uncommon specific diseases in rectum classified into inflammatory diseases, functional disease and tumor. (Intestinal Research 2006;4:1-6)

궤양성 대장염에서 대장 점막 Mucin의 조직화학적 특성과 Lectin 반응

송근암(Geun Am Song),김태오(Tae Oh Kim),안진광(Jin Kwang An),이준홍(Jun Hong Lee),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Backgrounds : In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. Methods : The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. Results : In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. Conclusions : This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.(Korean J Med 58:532-541, 2000)

수술과 항암치료 후 종양표지자 검사의 상승으로 복막 가성점액종의 재발을 확인한 1례

한인섭,송근암,김광하,이봉은,백동훈,이성준,이문원,한성용,In Sub Han,Geun Am Song,Kwang Ha Kim,Bong Eun Lee,Dong Hoon Baek,Seong Jun Lee,Moon Won Lee,Sung Yong Han 대한소화기암연구학회 2016 Journal of digestive cancer reports Vol.4 No.1

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by profuse jelatinous materials in the abdominal cavity and pelvis with mucinous implants on the peritoneal surface. There are some studies for serum tumor markers, including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125), to assess the risk of recurrence following cytoreductive surgery and intraperitoneal chemotherapy. However, rare cases were reported about recurrence with increasing serum CEA levels. Herein, we report a case of recurrence of PMP according to serially elevated serum CEA.

만성 B형 간염 환자에서 조직 활동도와 IL-1β, IL-1RN 유전자 다형성의 관련성

송준현 ( Song Jun Hyeon ),박진홍 ( Park Jin Hong ),이동현 ( Lee Dong Hyeon ),허정 ( Heo Jeong ),김광하 ( Kim Gwang Ha ),강대환 ( Kang Dae Hwan ),송근암 ( Song Geun Am ),조몽 ( Jo Mong ),양웅석 ( Yang Ung Seog ) 대한소화기학회 2003 대한소화기학회 추계학술대회 Vol.2003 No.-

<배경 및 목적> 만성 B형 간염 바이러스 감염자의 일부에서 간의 염증 및 섬유화가 진행하여 간경변으로 진행한다. 만성 B형 간염환자에서 인터루킨-1 (IL-1)의 활동도 증가는 간 섬유화 정도를 증가시키는 것으로 알려져 있다. 만성 HBV 감염자에서 IL-1β와 IL-1RN 유전자 다형성을 분석하여 유전자형 및 대립형질 양상이 생화학 검사, 혈청 HBV DNA 및 간 조직 활동도에 미치는 영향을 조사하고자 하였다. <대상 및 방법> 2001년 8월부터

제3차 대한간학회 춘계학술대회 초록집 : 쥐의 간절편을 이용하여 t-butylhydroperoxide로 유발한 지질 과산화 및 세포 독성에 대한 Ca2+ 통로차단제, 세포 외부 칼슘 이온 농도와 phospholipase A2 저해제의 효과

송철수 ( Song Cheol Su ),허정 ( Heo Jeong ),김광하 ( Kim Gwang Ha ),박승근 ( Park Seung Geun ),송근암 ( Song Geun Am ),조몽 ( Jo Mong ),양웅석 ( Yang Ung Seog ),문한규 ( Mun Han Gyu ) 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.2(S)

대장암의 위험 인자: 비만과 인슐린 저항성

김태오 ( Tae Oh Kim ),송근암 ( Geun Am Song ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3

척수손상 환자에서 항문직장 내압검사의 유용성 평가

김동욱 ( Dong Uk Kim ),송근암 ( Geun Am Song ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ) 대한소화기기능성질환·운동학회 2009 Journal of Neurogastroenterology and Motility (JNM Vol.15 No.1

목적: 척수손상 환자에서 신경인성 방광은 잘 알려져 있으나 신경인성 장은 체계적인 연구가 부족한 편이다. 이에 저자들은 척수손상 환자에서 척수손상의 정도와 위치에 따른 항문직장 내압검사의 차이를 비교하고자 하였다. 대상 및 방법: 신경인성 장의 증상을 가지고 있는 25명의 척수손상 환자를 대상으로 항문괄약근 휴식압, 압착압 및 직장항문억제반사, 직장 감각능, 배변을 시도할 때 직장과 항문의 압력변화 등을 측정하였다. 결과: 완전 척수손상과 불완전 척수손상 환자군 및 T5 이상과 T6 이하 척수손상 환자군 사이에 최대 항문괄약근 휴식압, 최대 압착압, 항문직장억제반사를 유발하는 최소부피는 차이가 없었다. 완전 척수손상 환자군에서 불완전 척수손상 환자군에 비해 배변감(p =0.041)과 긴박한 배변감(p=0.047)을 느끼는 최소용적 및 최대인내용적(p=0.047)을 측정할 수 없는 경우가 의미있게 많았다. 그러나, T5 이상과 T6 이하 척수손상 환자군 사이에 직장 감각능의 유의한 차이는 없었다. 전체 척수손상 환자군에서 배변을 시도할 때 최대 직장압, 항문괄약근 이완율, 배변지수는 모두 정상범위 이하로 감소되어 있었다. 완전 척수손상과 불완전 척수손상 환자군 사이에 최대 직장압, 항문괄약근 이완율, 배변지수의 차이는 없었으며, T5 이상과 T6 이하 척수손상 환자군 사이에 최대 직장압과 배변지수는 차이가 없었으나 항문괄약근 이완율(-1.7±25.8% vs.22.7±18.4%)은 T5 이상 척수손상 환자군에서 유의하게 감소되어 있었다(p=0.046). 결론: 완전 척수손상 환자에서 외항문괄약근의 기능이 감소되어 상대적으로 변실금을 더 많이 호소하며, T5 이상 척수손상 환자에서 배변을 시도할 때 직장압력의 상승에 따른 항문괄약근의 유기적 이완이 되지 않아 변비를 더 많이 호소할 것으로 예상된다. Background/Amis: To evaluate the characteristics of anorectal manometry based on the level of spinal cord injury (SCI) in patients with neurogenic bowel. Methods: Twenty five patients with SCI were classified as complete or incomplete lesions according to severity, and ≥T5 or ≤T6 SCI according to the level of injury. We measured the maximum anal resting pressure (MARP), maximum squeezing pressure (MSP), threshold of rectoanal inhibitory reflex (RAIR), rectal sensations, and intraluminal pressure changes while patients were bearing down. Results: In patients with SCI the MARP, MSP, and RAIR were: 77.8±41.9 mmHg, 92.4±53.5 mmHg, and 26.0±14.1 mL respectively. In patients with complete lesions, the MSP/MARP and minimal volume for the RAIR were lower than in the patients with incomplete lesions (p=0.030, p=0.039 respectively). Rectal sensations were affected more frequently and completely in patients with complete lesions than in patients with incomplete lesions. Bearing down in patients with ≥T5 SCI was associated with a higher percentage of decreased anal relaxation than in those patients with ≤T6 SCI (-1.7±25.8 mmHg and 22.7±18.4% respectively). Conclusions: Patients with SCI had abnormal findings on anorectal manommetry. Patients with complete lesions had decreased voluntary contractions of the external anal sphincter resulting in fecal incontinence. In addition, patients with ≥T5 SCI had paradoxical contractions or inadequate relaxation of the internal anal sphincter when bearing down resulting in more severe constipation. (Kor J Neurogastroenterol Motil 2009;15:52-57)

단일기관에서의 항혈소판제 복용 환자에서 누두절개술의 경험: 결과, 안정성 및 합병증

백동훈 ( Dong Hoon Baek ),송근암 ( Geun Am Song ),김동욱 ( Dong Uk Kim ),김광하 ( Gwang Ha Kim ),이봉은 ( Bong Eun Lee ),전혜경 ( Hye Kyung Jeon ),지준형 ( Joon Hyung Jhi ),배정호 ( Jung Ho Bae ),이현정 ( Hyun Jeong Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4

Background/Aims: The diagnostic and therapeutic utility of endoscopic retrograde cholangiopancreatography (ERCP) has been well demonstrated for biliary and pancreatic diseases. Biliary access can be allowed by infundibulotomy if failed by using the standard cannulation methods. However, no data are available regarding ERCP-related complications in patients taking antiplatelet agents who are undergoing infundibulotomy. Therefore, we aimed to assess the frequency of ERCP-related complications after infundibulotomy in patients taking antiplatelet agents. Methods: We performed a retrospective study, and enrolled 835 patients who underwent ERCP at Pusan National University Hospital from January 2011 to December 2012. Seventy-two patients had been taking antiplatelet agents prior to the procedure. Patients were classified into two groups according to the utilization of infundibulotomy: 20 patients underwent infundibulotomy (group 1), and 52 patients did not undergo infundibulotomy (group 2). Complications after ERCP were defined as bleeding, post-ERCP pancreatitis, and perforation according to Cotton`s criteria. Results: Between group 1 and 2, there were no significant differences in baseline characteristics. ERCP was successfully performed in all cases. Clinically significant bleeding was observed in one patient in group 1 (5%, 1/20) versus none in group 2. Post-ERCP pancreatitis was observed in 2 patients (10.0%, 2/20) in group 1, and 7 patients (13.5%, 7/52) in group 2 (p=0.691). However, none of these differences were statistically significant. No perforation occurred in both groups. Conclusions: Considering the low incidence of bleeding after infundibulotomy in patients taking antiplatelet agents, infundibulotomy may be safely performed in this group of patients.