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한국인에서 Helicobacter pylori 감염의 혈청학적 역학 연구
김현수 ( Hyun Soo Kim ),이용찬 ( Yong Chan Lee ),이홍우 ( Hong Woo Lee ),유효민 ( Hyo Min Yoo ),이천균 ( Chun Gyon Lee ),김준명 ( Joon Myung Kim ),이광재 ( Kwang Jae Lee ),김범수 ( Pum Soo Kim ),문병수 ( Byung Soo Moon ),박효진 ( 대한소화기학회 1999 대한소화기학회지 Vol.33 No.2
Background/Aims: The aims of this study were to investigate the seroprevalence of H. pylori infec-tion and to find out the various epidemiologic factors related to H. pylori infection in Korea. Methods: From May, 1997 to July, 1997, 2,449 healthy subjects from 5 health center responded to the self- administered questionnaires for various epidemiologic factors. At the same time, H. pylori IgG level in serum were tested by ELISA (GAP test) and proved to be H. pylori 'positive' in cases whose cut-off values were over 15 μ/mL. Results: The overall seroprevalence of H. pylori infection was 44.8%. In relation to age, the seroprevalence of H. pylori infection was 57.8% in adults (age>18), and 15.3% in children (age, 1-18). The seroprevalence was 1.1% in younger group than 5, 12.8% in group aged between 5 and 9, 20.4% in group aged between 10 and 14, 33.3% in group aged between 15 and 19, and 66.7% in the 20' s. The results mean that the prevalence increases with age (p<0.001). Besides age, the other significant epidemiological factors affecting the seroprevalence of H. pylori infection were occupation, water source, presence of gastrointestinal symptoms in adults and FH of PUD and number of family members in children. Conclusions: In this study, the seropre-valence of H. pylori infection in adults was 57.8% which is lower than that of previous reports Further epidemiologic studies is needed to identify the role of epidemiologic factors of childhood and adolescent period, the major affected periods. (Kor J Gastroenterol 1999;33:170 - 182)
성인에서 반복적인 복부통증을 유발한 Meckel 게실염에 의한 복막유착
김영수(Young Soo Kim),신용운(Yong Woon shin),문희용(Hee Yong Moon),김명식(Myong Sik Kim),권계숙(Kye Sook Kwon),방제소(Jei So Bang),조현근(Hyeon Geun Cho),김범수(Pum Soo Kim),김준미(Joon Mee Kim) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.6
Meckel,s diverticulum is generally acknowledged to be the most prevalent congenital anomaly of the gastrointestinal tract. In the autopsy series, the incidence ranged from 0.5 to 2 percent. The preoperative diagnosis of Meckels divemiculum is difficult, especially in the adult, because of the lesions ability to masquerade as one of a variety of much more common abdominal pathologies. The diagnostic accuracy may be affected by the age of the patient and by complications of diverticulum. The complications that may result include ulcer bleeding, intestinal obstruction, perforation, diverticulitis, stone, and neoplasm. The ways a Meckels diverticulum can cause bowel obstruction are different. Recently we experienced a case of Meckels diverticulitis causing intlammatory reaction and adhesion with the abdominal wall and causing recurrent abdominal pain and obstruction in a 22-year-old woman. Therefore, we present this case with a brief review of the related literature. (Korean J Gastroenterol 1997; 30:826-830)
상부위장관질환과 Helicobacter pylori 독성인자 유전자 아형의 연관성
이진우(Jin Woo Lee),정석(Seok Jeong),김인한(In Han Kim),권계숙(Kye Sook Kwon),최원(Won Choi),이돈행(Don Haeng Lee),조현근(Hyeon Guen Cho),김범수(Pum Soo Kim),김형길(Hyung Gil Kim),신용운(Yong Woon Shin),김영수(Young Soo Kim),최연호(Yo 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2
Background/Aims: Clinical outcome of Helicobacter pylori (H. pylori) infection may be associated with specific virulence-related bacterial genotypes. The present study aimed to assess the relationship between the H. pylori virulence factors such as cagA, vacA, iceA and severity of upper gastrointestinal diseases. Methods: PCR was used to examine cagA, vacA, and iceA genotypes of H. pylori isolates obtained from 92 infected patients with different clinical presentations (14 cases of nonulcer dyspepsia, 26 cases of gastric ulcer, 30 cases of duodenal ulcer, 22 cases of gastric cancer). If sl was positive, DNA sequence was analyzed for its subtype. Results: The positive rate of cagA varies from 78.6% to 96.7% in the clinical subcategories. The positive rates of iceA1 and iceA2 were 88.5% and 0% in patients with gastric ulcer, 86.7% and 3.3% in patients with duodenal ulcer, 72.7% and 13.6% in patients with gastric cancer, and 92.9% and 0% in patients with nonulcer dyspepsia, respectively. No significant difference was found in the prevalence of cagA and iceA among these groups. The vacA genotype slc and ml were predominant in most subjects irrespective of the clinical outcome and we could not find slb and s2 subtypes. The genotype of cagA+ iceAl vacA slc-ml was predominant in Korean H. pylori strains. Conclusions: We could not confirm the previous reports of relationship between the cagA, vacA, iceA status and clinical outcome of patients with upper gastrointestinal diseases. Further study is needed to examine the specificity of H. pylori strains in Koreans. (Korean J Gastroenterol 2001;38:89-97)
비만한 성인 남자에서 혈중 렙틴과 비알코올성 지방간과의 관계
이은상(Eun Sang Lee),이돈행(Don Haeng Lee),김승연(Seung Youn Kim),김진영(Jin Young Kim),김화숙(Wha Sook Kim),이훈재(Hoon Jae Lee),최원(Won Choi),김범수(Pum Soo Kim),김형길(Hyung Gil Kim),김영수(Young Soo Kim) 대한내과학회 2001 대한내과학회지 Vol.61 No.6
N/A Background: The non-alcoholic fatty liver is characterised by accumulation of triglycerides within liver parenchymal cells without intake of alcohol. Leptin is produced by peripheral adipose cells and it's blood concentrations are positively correlated with blood insulin levels, independent of body mass index. Non-alcoholic fatty liver is associated with insulin resistance and hyperinsulinemia even in lean subjects. Therefore, we aimed to elucidate whether hyperleptinemia is associated with non-alcoholic fatty liver, independent of age and obesity. Methods : The age, weight, BMI and blood laboratory data such as LFT, lipid profiles, insulin, and leptin were analyzed on 26 control subjects and 30 non-alcoholic fatty liver subjects with BMI above 25 kg/㎡ in male adults. Results: There was no significant difference in their age, height, weight, and BMI between normal control group and non-alcoholic fatty liver group. But, blood triglyceride, leptin, and insulin level of patients with non-alcoholic fatty liver were significantly higher than those of normal control group. Conclusion: Blood leptin levels of non-alcoholic fatty liver group were significantly higher than that of control group. Thus, high circulating leptin concentrations may play a role in the pathogenesis of non-alcoholic fatty liver, regardless of age and obesity.(Korean J Med 61:634-640, 2001)
박현주,이현규,김범수,노형근,Park Hyun-Joo,Yi Hyeon-Gyu,Kim Pum-Soo,Roh Hyung-Keun 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
Acid ingestion can cause not only caustic injury on esophagus and stomach but also fatal outcome through systemic complications. We report the case of a patient who died early after severe caustic injury with strong acid. A 38-year-old man who ingested about 400ml of hydrochloric acid of unknown concentration was transferred to our hospital from a private clinic, in which he was managed with gastric irrigation through a nasogastric tube. He was complaining dyspnea and abdominal pain. Physical examination demonstrated tenderness and rebound tenderness on epigastric region. Severe metabolic acidosis and leukocytosis were noted. Radiological findings suggested perforation of gastrointestinal tract, although the physical signs were not typical. Endoscopy revealed caustic injuries of grade I on esophagus and of grade Ⅲ on stomach, which indicate more severe injury on the stomach than on the esophagus. Exploratory surgery was recommended but unfortunately not permitted by his family. Despite intensive measures, his vital signs deteriorated rapidly and he died 50 hours after the ingestion.
부식제에 의한 위장관 손상 환자에서 상부 위장관 조영술 후 발생한 위유문부 폐쇄 1례
김정구,조혜진,이승희,김범수,노형근,Kim, Jeong-Goo,Cho, Hye-Jin,Lee, Seung-Hee,Kim, Pum-Soo,Roh, Hyung-Keun 대한임상독성학회 2003 대한임상독성학회지 Vol.1 No.1
Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach, In the acute stage, perforation and necrosis may occur. Long-term complications include esophageal stricture, antral stenosis and the development of esophageal cancer. Endoscopy should be performed as soon as possible in all cases to evaluate the extent and severity of damage, unless there is evidence of perforation. Endoscopy is the diagnostic procedure of choice. However, when the endoscopy cannot be passed through due to esophageal stricture, upper GI barium studies may be useful as a follow-up measure and in the evaluation of complications. A 44-year-old man visited our hospital complaining frequent vomiting 1 hour after ingestion of unknown amount of hydrochloric acid. At the time of arrival, the patient's oral cavity was slightly swollen and erythematous. On the endoscopic examination fourteen hour after the caustic ingestion, marked swelling of the arytenoids and circumferential ulceration with brown and black pigmentation at the upper esophagus were observed. Four weeks after the caustic injury, upper esophageal narrowing was observed and then the scope could not be advanced to the stomach. Upper GI barium study performed at that time revealed diffuse luminal narrowing of the esophagus and concentric luminal narrowing from prepyloric antrum to pylorus with disturbance of barium passage. At a week after the Upper GI study, through endoscopic examination after bougie dilatation of the esophagus, barium impaction in the stomach and the pylorus was noticed.
위십이지장동맥 동맥류와 십이지장 사이 누공에서의 만성 출혈
김인태 ( In Tae Kim ),최자성 ( Ja Sung Choi ),김범수 ( Pum Soo Kim ),송순영 ( Soon-young Song ),김유진 ( Yu Jin Kim ) 대한내과학회 2016 대한내과학회지 Vol.91 No.3
Gastroduodenal artery (GDA) aneurysm is a very rare event, but it induces life-threatening clinical manifestations upon rupture or bleeding. The causes of GDA aneurysm are atherosclerosis, infection, trauma, surgery, iatrogenic lesions, mycotic or tuberculous disease, and autoimmune disease. We report the case of a 77-year-old female who presented with melena and vomiting. Upper gastrointestinal endoscopy revealed a 4 cm pulsatile extrinsic mass with a duodenal fistula at the duodenal bulb. Abdominal computed tomography showed a large aneurysm of the GDA. We successfully conducted transcatheter embolization of the aneurysm. After the procedure, the patient did not present with melena, and her hemoglobin level was stable. Follow-up endoscopy showed that the GDA aneurysm-duodenal fistula had decreased in size and was leaking a small amount of blood. An arteriography was performed and showed no evidence of contrast filling in the aneurysmal sac. (Korean J Med 2016;91:277-282)
김태일(Tae Il Kim),박효진(Hyo Jin Park),김범수(Pum Soo Kim),박인서(In Suh Park),김충배(Choong Bai Kim),유형식(Hyung Sik Yoo),전우택(Woo Taek Jeon),하은혜(Eun Hye Ha) 대한내과학회 1995 대한내과학회지 Vol.49 No.6
N/A Objectives: The globus sensation and dysphagia are common symptoms originated from esophagus in the absence of organic lesions, Although the exact mechanism of these symptoms remains unknown, it is believed to be related to multiple etiopathogenesis. However, many of the results are controversial. So in this study, the relationship of esophageal motility disorder, gastroesophageal reflux and psychic disturbances were evaluated in patients with globus sensation or dysphagia. Methods: In 66 patients with globus sense and 23 patients with dysphagia, esophagogastroduodenoscopy, esophageal manometry, 24-hour esophageal pH monitoring and psychiatric evaluation(M.M.P.I.) were done. Results: 1) In patients with globus sense, forty seven among sixty six patients(71.2%) demonstrated motility abnormalities in esophageal manometry. Among the abnormalities, the most frequent finding was a nonspecific esophageal motility disorder(31.8%). 24- hour pH monitoring showed abnormal acid reflux in 5/35(14.3%) of patients. Hiatal hernia[12/43 (27.9%)] was the most common finding in esophagogastroduodenoscopy, and reflux esophagitis[9/43 (20.9%)] was the second most. When combining the results of endoscopy findings and 24-hour pH monitoring data, some signs of gastroesophageal reflux were demonstrated in 11/54(20.496) of patients. Psychiatric evaluation(M.M.P.I) was done in seven patients, and the patients showed hypochondriasis, a nxiety and depression tendency. 2) In patients with dysphagia, twenty one among twenty three patients(91,3%) showed motility abnormalities in esophageal manometry. Among the abnormalities, the most frequent finding was a non- specific esophageal motility disorder(39.1%), 24-hour pH monitoring showed abnormal acid reflux in 1/7 (14.3%) of patients. Reflux esophagitis[6/17 (35.3Yo)] was the most common finding in esophagogastroduodenoscopy, and hiatal hernia[3/17 (17.6%)] was the next. When combining the results of endoscopy findings and 24-hour pH monitoring data, some signs of gastroesophageal reflux were demonstrated in 6/17(35.3%) of patients, Psychiatric evaluation (M.M.P.I.) was done in five patients, and the patients showed hypochondriasis, depression and introver sion tendency. Conclusion: From the results obtained, it can be suggested that globus sensation and dysphagia have multiple etiologies. Abnormal esophageal motility findings were commonly found. Psychic disturbances may play a role in its etiopathogenesis. Therefore, esophagogastroduodenoscopy, esophageal manometry, 24-hour pH monitoring and, if needed, psychiatric evaluation should be included in evaluating globus sense or dysphagia. Furthermore, the treatment should be directed toward abnormal results of these evaluation.
알코올성 췌장염과 간경변 환자에서 알코올대사효소와 시토카인의 유전자 다형성
김명식 ( Myong Sik Kim ),이돈행 ( Don Haeng Lee ),강효승 ( Hyo Seung Kang ),박현신 ( Hyun Shin Park ),정석 ( Seok Jung ),이진우 ( Jin Woo Lee ),권계숙 ( Kye Sook Kwon ),김범수 ( Pum Soo Kim ),김형길 ( Hyung Gil Kim ),신용운 ( Yon 대한소화기학회 2004 대한소화기학회지 Vol.43 No.6
Background/Aims: Susceptibility to organ damage induced by alcohol may be related to inherited variations (polymorphisms) in alcohol-metabolizing enzymes, or polymorphisms affecting cytokines. The aim of this study was to compare the genotype and allelic frequencies of ADH2, ADH3, ALDH2, cytochrome P450-2E1, IL-1, IL-6, IL-8 and tumor necrosis factor-α in patients with alcoholic pancreatitis and alcoholic liver cirrhosis with those of controls. Methods: We determined the polymorphism of genes of the above-mentioned alcohol-metabolizing enzymes and cytokines in 29 alcoholic pancreatitis patients (AP), 22 alcoholic liver cirrhosis patients (LC) and 100 healthy blood donors (control). The genotypes were characterized by restriction fragment length polymorphism after amplification of genomic DNA by polymerase chain reaction. Results: The allelic frequency of CYP2E1*c2 was significantly different in three groups (AP: LC: Control=0.224: 0.136: 0.320, p<0.05). There was no significant difference in the other genotypes or allelic frequencies of the three groups. The allelic frequencies of CYP2E1*c2 and ALDH2*2 were more frequent in the control than patients with alcoholic liver cirrhosis (LC: Control=0.136: 0.320, p<0.05, LC: Control=0.114: 0.265, p<0.05). Allelic frequencies of ADH2 was statisitcally different between LC and control (ADH2*1; LC: Control=0.727: 0.495, ADH2*2; 0.227: 0.360, ADH2*3; 0.046: 0.145, p<0.05). Conclusions: There was no difference in the frequencies of genotype and allele of enzymes and cytokines among the three groups. However, frequency of ADH2*1 was significantly higher and those of CYP2E1*c2 and ALDH2*2 were significantly lower than LC group than control. (Korean J Gastro-enterol 2004;43:355-363)