지연용해형 캡슐내 방사선 비투과 표지자를 이용한 대장분절 통과시간

최황(Hwang Choi),최명규(Myung Gyu Choi),김병욱(Byung Wook Kim),김재광(Jae Kwang Kim),한석원(Sok Won Han),최규용(Kyu Yong Choi),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),손형선(Hyung Sun Son) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1

N/A Backgrounds/Aim: Scintigraphic measurement of colon transit has proven usefu1 clinically and in the research area, however this method requires well equipped laboratories. The aim of this study was to develop a new colon transit test using radiopapue markers instead of radiolabeled pellets in a methacrylate-coated capsule. Methods: Ten healthy volunteer. were studied. After simultaneous administration of two methacrylate-coated gelatin capsules containing activated ehareoa1 mixed with 8 mCi of (99m)Tc or a commercially used radiopaque marker, scintigraphies and plain abdominal X-rays were performed. We compared colon transit profiles as the geometric center at 4, 8, 24, and 48 hours after ingestian of gelatin capsules. This new radiopaque marker test was validated with a scintigraphic method as the gold standard. Results: Geometric centers (mean±SEM) of (99m)Tc-scintigraphy were 0.50±0.18 at 4 hours, l.l6±0.05 at 8 hours, 3.31±0.36 at 24 hours, and 4.16±0.29 at 48 hours. Geometric centers of the radiopaque marker method were 0.40±0,16, 1.13±0.05, 3.33±0.37, and 4.18±0.30 respectively. Transit profiles were the same with both methods and highly correlated (r=0.994, p<0.001). The difference between the two methods against the mean for the geometric center was within 2SD. Conclusions : A colon transit test using radiopaque markers in a methacrylate-coated, delayed release capsule was inexpensive, simple, and reliable. This new test could be applicable when a gamma camera is not available. (Korean Journal of Gastrointestinal Motility 2000;6:52-60)

만성 변비 환자에서 테가세로드의 효능에 영향을 미치는 요소

최황 ( Hwang Choi ),윤상헌 ( Sang Heon Yoon ),이원철 ( Won Chul Lee ),김주성 ( Joo Sung Kim ),장동경 ( Dong Kyung Chang ),진윤태 ( Yoon Tae Jeen ),김진오 ( Jin Oh Kim ),한동수 ( Dong Soo Han ),김효종 ( Hyo Jong Kim ),설상영 ( San 대한장연구학회 2007 Intestinal Research Vol.5 No.2

Background/Aims: The effect of tegaserod has been found to differ for Caucasian and black patients. The aims of this study were to demonstrate the efficacy of tegaserod on bowel habits and to investigate the factors affecting the efficacy of tegaserod in Korean patients suffering from chronic constipation (CC). Methods: This was an open-label, multi-center, observational study. Analysis of covariance with repeated measures was used to determine the overall effect of treatment and was used to determine the changes in the number of complete spontaneous bowel movements (CSBM) from baseline during the 8-week treatment period. Demographic and baseline characteristics were compared between responders (3 or more CSBM at 8-weeks) and non-responders by the use of multivariate analysis. Results: A total of 1,798 patients were included in the study. Tegaserod treatment resulted in a significant increase in the mean number of CSBM per week over weeks 2-8 from baseline levels (from 1.0 to 3.1 CSBM per week, p<0.0001). Tegaserod treatment was more effective for female patients, younger patients (age less than 65 years), patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. Conclusions: Treatment with tegaserod improved bowel movements and more effective in female patients, patients under the age of 65 years, patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. (Intest Res 2007;5:170-176)

급성 백혈병 환자에서의 감염양상 - 1981 년 ~ 1984 년과 1987 년 ~ 1991 년의 비교 -

최황(Hwang Choi),유진홍(Jin Hong Yoo),신완식(Wan Shik Shin),김양리(Yang Ree Kim),강문원(Moon Won Kang),김동욱(Dong Wook Kim),이종욱(Jong Wook Lee),박종원(Jong Won Park),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한내과학회 1994 대한내과학회지 Vol.46 No.4

N/A Background: Infection, as a potential life-threatening factor, remains a major concern in the management of patients with acute leukemia, especially whose peripheral neutrophil counts are decreased (below 1000/mm³). The spectrum of infection has been changed by many factors. We observed the changing pattern of the spectrum of infection in patients with acute leukemia according to febrile day, number of leukocyte, infection site, pathogen, and prophylactic use of oral antibiotics for the purpose of reduction in morbidity and mortality by infection. Methods: The spectrum of infection of 200 patients with acute leukemia from January, 1987 to December, 1991 was compared with that of 90 patients from Jsnuary, 1981 to June, 1984 (reported previously). Results: 1) The most common ca of death in patients with acute leukemia was infection, The mortality due to hemorrhage was decreased in group of 1987-1991 and the death from infection was increased, relatively. 2) The more prolonged period of leukopenia was, the longer febrile days were. 3) The most common site of infection during both period was lung (58.0%, 49.6%, respectively). Bacteremia was increased from 7.1% to 20.3%. 4) Microbiologically defined infection was increased in 1987-1991 group (46.9%) compared with 1981-1984 group (17.3%), and the incidence of clinically defined infection was 28.1% in 1981-19S4 group and 35.3% in 1987-1991 group. 5) There was no statistically significant difference in the incidence of organisms causing infection in both group. In 1981-1984 group, it was 37.5% of gram-negative organism and 32.5% of gram-positive organism, and in 1987~1991 group, 40.3%, 39.7%, respectively. Pseudomonas among gram-negative organisms and Staphylococci among gram-positive organisms accounted for over 509 of pathogens and streptococcal infection was increased. Fungal infection was decreased. 6) In view of the relationship between prophylactic use of oral antibiotics and infecting organism, the ratio of gram-negative to gram-positive organism was 51.3% : 31.6% in group receiving non-absorbable antibiotics and 32.5% : 49.5% in group receiving absorbable antibiotics, therefore the frequency of infection by gram-positive organisms was higher in group receiving absorbable oral antibiotics. Conclusion: Infection has been a major cause of morbidity and mortality in acute leukemia patients, and it is closely related to the severity and duration of leukopenia. Lung was the most common site of infection, gram-negative organism was a predominant pathogen, and gram-positive organism was relatively more common in patients receiving prophylactic absorbable oral antibiotics. Since the spectrum of infection has been changed by many factors, it is necessary to understand this changing pattern and to manage the infection promptly and appropriately.

소장 협착의 내시경적 감별

최황 ( Hwang Choi ),최규용 ( Kyu Yong Choi ),이보인 ( Bo In Lee ),김민국 ( Min Kuk Kim ),정현정 ( Hyun Jung Jung ),지정선 ( Jeong Seon Ji ),김태호 ( Tae Ho Kim ),오정환 ( Jung Hwan Oh ),이강문 ( Kang Moon Lee ),김상우 ( Sang Woo 대한장연구학회 2007 Intestinal Research Vol.5 No.1

Background/Aims: The diagnosis of small bowel stricture was made by operation. Capsule endoscopy has been useful for diagnosis of small bowel diseases but has limited value in cases with stricture. Double balloon endoscopy is the useful method to visualize the entire small bowel. The aims of this study are to evaluate the feasibility of double balloon endoscopy and to differentiate the endoscopic findings in patients with small bowel stricture. Methods: Between March 2004 and February 2007, fifteen consecutive patients were referred for the evaluation of small bowel stricture. Small bowel strictures were suspected in small bowel series and CT in eleven patients. Capsule endoscopies were performed in six patients and entrapped in three patients. Double balloon endoscopy (EN-450P5/20, Fujinon, Japan) was performed with midazolam (median 5 mg, range 5-10 mg) and meperidine (median 50 mg, range 50-100 mg). All lesions except one were found within 60 minutes. One patient had been excluded because of false-positive finding of capsule endoscopy. Clinical and endoscopic findings were compared between strictures of Crohn’s disease (group I, n=6) and those of other causes (group II, n=8). Results: Double balloon endoscpies were performed with good tolerance without side effect. Age, chief complaints, duration of symptom, and initial hemoglobin and serum albumin levels were not different between two groups. The proportion of male sex was higher in group I than group II (100%, 38%, respectively; p=0.031). The strictures below 0.5 cm in diameter were 83% in group I and 13% in group II (p=0.026). The arrangement of stricture in group I was more eccentric than that in group II (100%, 17%, respectively; p=0.015). The location of stricture, appearance of surrounding mucosa, associated ulcer, and ulcer margin were not different between two groups. Conclusions: Endoscopic differentiation using double balloon endoscopy can be made easily and safely in patients with small bowel stricture. The strictures of small bowel in patients with Crohn``s disease were narrower and more eccentric than thosein patients with other diseases. (Intest Res 2007;5:38-44)

스테로이드-의존성 궤양성대장염 환자에서 원심분리 백혈구제거요법의 임상적 유용성: 장기간 추적관찰 결과

최황 ( Hwang Choi ),최규용 ( Kyu Yong Choi ),이보인 ( Bo In Lee ),강형주 ( Hyong Ju Kang ),박수정 ( Soo Jeong Park ),김병욱 ( Byung Wook Kim ),한치화 ( Chi Wha Han ),정인식 ( In Sik Chung ) 대한장연구학회 2005 Intestinal Research Vol.3 No.2

목적: 궤양성 대장염의 병인은 아직 명확하지 않으나 활성화 백혈구가 중요한 역할을 하고 있다. 활동기의 스테로이드-의존성 궤양성 대장염 환자에서 백혈구제거요법의 효과와 부작용에 대하여 알아보고자 하였다. 대상 및 방법: 궤양성대장염 환자 가운데 스테로이드에 의존성을 보여 백혈구제거요법을 받고 2년 이상 추적 관찰이 가능하였던 8명(남자 3명)을 후향적으로 조사하였다. 대상 환자의 병변범위는 광범위 대장염 4예, 좌측 대장염 4예였다. 백혈구제거요법은 원심분리 방법(Cobe Spectra 2 Arm, Gambro BCT, Inc, USA)의 백혈구성분채집술을 사용하였다. 상완 말초정맥에 삽관하여 6시간 동안 실시하였다. 일주일 간격으로 5회를 시행한 후 한달 간격으로 시행하였다(평균 총 시행횟수 9.5회, 범위 6-17회). 백혈구제거요법 전후 임상적 효과를 단순 임상 장염 활성지표를 사용하여 평가하였으며, 말초혈액검사를 실시하고, 부작용을 관찰하였다. 결과: 단순 임상 장염 활성지표는 백혈구제거요법 전 평균 8.75(표준편차 1.83, 범위 6-12)에서 0.5로 감소하였다(p<0.001). 백혈구제거요법 후 평균 44개월의 추적 관찰 기간 동안, 4명은 재발하여 스테로이드와 6-MP를 다시 투여하였으며, 이 중 한 명은 백혈구제거요법을 재차 시행하였다. 재발은 백혈구제거요법 후 평균 18.5개월에 발생하였다. 백혈구제거요법 전후 ESR과 CRP의 유의한 변화는 없었다. 백혈구제거요법 후 백혈구 수는 일시적으로 감소하였으며, 혈색소는 감소하였다. 혈소판의 유의한 감소가 있었으나 임상적으로는 문제가 없었으며 일주일 이내에 회복되었다. 두 명에서 백혈구제거요법 도중 입술과 눈 주위, 손 등에 감각이상을 호소하였으나 칼슘 정주 후 곧 회복되었다. 결론: 원심분리방법의 백혈구제거요법은 스테로이드-의존성 궤양성대장염 환자에서 유용한 치료방법이며, 스테로이드 장기 사용에 따른 부작용을 줄일 수 있을 것이다. 향후 전향적인 대조연구가 필요할 것으로 생각한다. Background/Aims: Although the etiologies of ulcerative colitis have not been proven yet, activated leukocytes have a great role in the pathogenesis of ulcerative colitis. We studied to evaluate the long-term clinical usefulness and adverse effect of the leukocyte removal technique (leukapheresis) for the patients with steroid-dependent ulcerative colitis. Methods: Eight patients who had performed leukapheresis for management of steroid-dependent active ulcerative colitis were analyzed retrospectively. We used a centrifugal method (Cobe Spectra, Gambro BCT, Inc, USA) for the leukapheresis. The schedule was one session weekly for 5 weeks of intensive therapy and one session monthly of maintenance therapy. The number of leukapheresis performed was average of 9.5 cycles. The simple clinical colitis activity index (SCCI) and complete blood counts were checked before and after each sessions of leukapheresis. We observed the side effects of leukapheresis and clinical outcomes of the patients over 2 years. Results: After 5 sessions of leukapheresis, the average SCCI decreased from 8.75 to 0.5 (p<0.001). All patients could easily taper the steroid dose during leukapheresis and 7 patients stopped the use of steroid after leukapheresis. During mean follow-up of 44 months, 4 patients relapsed and started steroid and 6-mercaptopurine. Two patients complained of numbness and parasthesia on the face and fingers during leukapheresis and theses symptoms were relieved after the injection of calcium. Conclusions: Centrifugal leukapheresis was an effective and safe method for the treatment of the patients with steroid-dependent active ulcerative colitis. We expect further prospective controlled studies. (Intestinal Research 2005;3:110-116)

크론병 환자에서 의사별 치료 행태의 차이

최황 ( Hwang Choi ),김상우 ( Sang Woo Kim ),이강문 ( Kang Moon Lee ),이보인 ( Bo In Lee ),정대영 ( Dae Young Cheung ),김민국 ( Min Kuk Kim ),정현정 ( Hyun Jung Jung ),김형근 ( Hyung Keun Kim ),지정선 ( Jeong Seon Ji ),박수헌 ( So 대한장연구학회 2009 Intestinal Research Vol.7 No.1

Background/Aims: The incidence and prevalence of Crohn’s disease are increasing in Korea. However, the guidelines for the management of Crohn``s disease have not been established in Korea. In the current study we determined the difference in the treatment methods between physicians in Korea for Crohn’s disease. Methods: We retrospectively analyzed the use of medical and surgical treatment modalities in 92 patients with newly diagnosed Crohn``s disease. We compared the treatment strategies among 4 physicians at 3 different institutions. Results: Prednisone, 5-aminosalicylates, antibiotics, immunomodulators, infliximab, and surgery were prescribed or preformed in 64%, 92%, 24%, 35%, 9%, and 22% of the patients, respectively. The surgical procedures included 12 bowel resections and 8 fistulectomies. The prescription rates for 5-aminosalicylates, prednisone, antibiotics, and infliximab did not differ, but of the use of immunomodulators was significantly different between physicians (p=0.012). The mean interval between diagnosis and the start of immunomodulators was 14 months, and was not different between physicians. The median dosage of immunomodulators was 50 mg per day, and was not different between physicians. Conclusions: A difference in medical treatment strategies for Crohn’s disease between physicians exists in Korea. Specifically, there was a significant difference in the use of immunodulators between physicians. The development of treatment guidelines for Crohn’s disease, together with efforts to decrease the inter-physician difference for treating Crohn’s disease are needed. (Intest Res 2009;7:41-46)

위장관 ; 한국인에서 위저선용종과 결장암의 상관관계: 16년간 후향적 고찰

황선미 ( Sun Mee Hwang ),김병욱 ( Byung Wook Kim ),채현석 ( Hiun Suk Chae ),이보인 ( Bo In Lee ),최황 ( Hwang Choi ),지정선 ( Jeong Seon Ji ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ),맹이소 ( Lee So Maeng ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1

Background/Aims: There is an ongoing debate on the relationship between gastric fundic gland polyps and increased incidence of colorectal neoplasia in Caucasians. However, there was no report on the relationship between gastric fundic gland polyp and colorectal neoplasia in Korea. The aim of this study was to identify the characteristics of gastric fundic gland polyps and whether a relationship exists between fundic gland polyps and colorectal neoplasia in Korean population. Methods: Persons who underwent an esophagogastroduodenoscopy and colonoscopy from 1992 to 2007 at the Health Promotion Center of Incheon St. Mary`s Hospital, The Catholic University of Korea were reviewed retrospectively. The relationship between gastric fundic gland polyps and colorectal neoplasia were analyzed. Results: Among 22,451 subjects, fundic gland polyps were found in 328 subjects (1.5%). Fundic gland polyps were more common in women than in men (odds ratio of 6.25; 95% CI of 4.68-8.34). The odds ratios for colorectal neoplasia in all subjects with gastric fundic gland polyps were 0.56 (95% CI of 0.33-0.95) and men who were 50 years of age or older had an odds ratio of 2.81 (95% CI of 1.03-7.66) as compared to the control group. However, age and sex-adjusted odds ratios for all gastric fundic gland polyps were 0.73 (95% CI of 0.42-1.26), for men 1.78 (95% CI of 0.80-3.98), and for women 0.37 (95% CI of 0.16-0.87). Conclusions: Surveillance colonoscopy in patients with fundic gland polyps can be performed in the same manner as general population in Korea. (Korean J Gastroenterol 2011;58:20-24)

비뇨기과 환자에서의 염색체 이상에 관한 연구

김광명,최황,오선경,문신용,Kim, Kwang-Myung,Choi, Hwang,Oh, Sun-Kyung,Moon, Shin-Yong 대한생식의학회 1986 Clinical and Experimental Reproductive Medicine Vol.13 No.2

A chromosomal study was performed in a total of 162 urological patients during past 2$2{\frac{1}{2}}$ years (Feb. 1984 - Aug. 1986). Of these 78(48%) patients had abnormal chromosome complements. Among all patients with chromosome abnormalities, 88% (69/78) had aberrations of chromosome number, 8% (6/78) had aberrations of chromosome structure and 4% (3/78) had aberrations of both. 90% (65/72) of numerical abnormality was Klinefelter's syndrome and the structural abnormality rate (5.6%, 9/162) was less than that (6.99%) of general population. The chromosomal study was mandatory for the detection of intersex in small testes or hypospadias with cryptorchism or clitoromegaly or bilateral cryptorchism. But unilateral cryptochism or hypospadias with normal scrotal testes was not thought to be indication of the chromosomal study if the external genitalia are otherwise quite normal.

간세포암 환자에서 간 동문맥 단락의 임상적 의의

정규원,선희식,최황(Hwang Choi),김병욱(Byung Wook Kim),문성배(Sung Bae Moon),김보경(Bo Kyoung Kim),한준열(Joon Yeol Han),최명규(Myung Gyu Choi),김재광(Jae Kwang Kim),한성태(Seong Tai Hahn),이재문 대한내과학회 1999 대한내과학회지 Vol.56 No.2

N/A Arterioportal (AP) shunt is related to hepatocellular carcinoma (HCC) with variable frequency but its clinical significance is not well known. We retrospectively studied the prevalence and clinical significance including mortality of the AP shunt combined with HCC. Methods : The clinical data and radiologic features of HCC patients who were performed hepatic angiography from 1992 to 1997 at St. Mary's Hospital in Korea were reviewed. The data of HCC patients with AP shunt were compared with that of randomized samples of HCC patients without AP shunt. Results : The prevalence of AP shunt in HCC was 7.3%(45/616 HCC patients). There was no significant difference in clinical symptoms and signs such as ascites, encephalopathy, or variceal bleeding and laboratory findings between the HCC patients with AP shunt and those without. The AP shunt was more common in diffuse, poorly demarcated, large HCC. Especially, portal vein thrombosis (PVT) was one of the most common causes of AP shunt. Cumulative survival rate of the HCC patients with AP shunt was lower than that of those without. But only the size of HCC was significantly related with poor prognosis. Conclusion : AP shunt occurred in some HCC which was large in size or combined with PVT. AP shunt did not increase the severity of symptoms and signs, but decreased the survival because of its relation to tumor size.

우리나라 어린이 요로 감염의 치료 행태

강희경,김광명,정해일,최황,최용,Kang, Hee-Gyung,Kim, Kwang-Myung,Cheong, Hae-Il,Choi, Hwang,Choi, Yong 대한소아신장학회 2001 Childhood kidney diseases Vol.5 No.1

목 적 : 요로감염은 어린이에서 중요한 신요로계 질환으로 빠르고 정확한 진단과 치료로 신장 손상의 위험을 줄이고 불필요한 검사와 치료를 피할 수 있다. 저자들은 우리나라 어린이 요로감염 치료의 개선을 도모하는 첫걸음으로 설문 조사를 통해 요로감염의 진단, 치료, 영상 검사와 예방에 관한 진료 행태를 알아보았다. 대상 및 방법 : 전국의 소아신장전문의와 비뇨기과 전문의를 대상으로 설문조사를 통하여 요로감염의 진단, 치료, 영상검사, 예방의 진료형태를 조사하였다. 결 과 : 응답자들은 대부분 신생아에서는 소변 채취용 백을, 이후에는 중간소변 채취를 이용하여 소변 배양 검사를 하였고, 소변 배양검사가 음성인 경우에는 농뇨, nitrite 양성, 세균뇨 등의 소견을 보일 때 요로감염이라고 판단하였다. 요로감염 후에는 80$\%$가 예방적 항생제를 사용하였다. 방광 요관 역류가 있는 환아에서는 1-2세 이상의 환아가 고도의 방광 요관 역류를 보이거나 예방 요법 중에도 요로감염이 발생할 때 수술로 치료하는 경우가 많았으나 그 기준에는 차이를 보였다. 대부분이 요로감염 진단시에 신장 초음파 검사를 시행하였고 과반수에서 각각 다양한 시기에 배뇨 방광 요도 조영 검사와 DMSA scintigraphy를 시행하였다. 포경 수술은 대개 권하지 않았으며 반수에서 방광 요관 역류 환아의 형제에 대한 선별 검사를 시행하였다. 결 론 : 이 보고에서 밝혀진 다양한 치료 행태로 보아, 어린이 요로감염 치료의 개선과 발전을 위해 체계적인 진료 방침의 고안이 필요할 것으로 보인다. Purpose : Urinary tract infections (UTIs) of children require prompt and correct diagnosis and treatment to reduce the risk of renal damage. As a first step to improve the outcome of UTI in Korea, we investigated the practical variations in the methods of diagnosis, treatment, and evaluation of children with UTI and UTI prevention. Method :A questionnaire related to the individual policy on UTI diagnosis. treatment, imaging test, and prevention was submitted to 26 experts. Result Majority of the experts used bag-collected urine specimen for infants and mid-stream urine specimen for children for urinary culture. With a negative result of culture study, they diagnosed UTI when there was pyuria, positive results of the nitrite test, or bacteriuria. 80 $\%$ of experts prescribed prophylactic antibiotics after upper tract UTI. Operative treatment of vesicoureteral reflux (VUR) was indicated for children older than one or two years old with high-grade VUR, refractory breakthrough infections, or recurrent UTIs. Most of them performed kidney ultrasonography on the diagnosis of UTI and more than half of them evaluated children treated of UTI with vesicocystourethrogram and/or DMSA scintigraphy. Majority did not recommend circumcision. Half of the experts were screening siblings of VUR patients. Conclusion : Considering the variations exposed through this study systematic guidelines for management of children with UTI in Korean would be necessary. (J. Korean Soc Pediatr Nephrol 5 : 15-21, 2001)