대장암에 의해 발생한 위결장 누공

양선영 ( Sun Young Yang ),변태준 ( Tae Jun Byun ),윤영섭 ( Yeong Seop Yun ),박재일 ( Jae Il Park ),손주현 ( Joo Hyun Sohn ),이동후 ( Dong Hoo Lee ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5

Gastrocolic fistula is an uncommon complication caused by benign or malignant diseases on the stomach or colon. It was known to occur in gastric ulcer, trauma and infection. However, recent studies indicate that the malignant diseases such as stomach cancer and colon cancer emerged as a main causative factor. Gastrocolic fistula is likely to be most commonly diagnosed by barium enema, and occasionally detected by the upper gastrointestinal series or endoscopy. Recently, incidence of gastrocolic fistula is decreased due to early diagnosis of stomach or colon cancer. We report a case of gastrocolic fistula in a patient with transverse colon cancer found by both barium enema and upper gastrointestinal series. (Korean J Gastroenterol 2003;41:406-409)

부자간에 발생한 가족 크론병

조현석 ( Hyun Seok Cho ),변태준 ( Tae Jun Byun ),안상봉 ( Sang Bong Ahn ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol ),김용석 ( Yong Seok Kim ),한동수 ( Dong Soo Han ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.4

Crohn`s disease (CD), one of the major forms of idiopathic inflammatory bowel disease (IBD), is thought to be related to genetic susceptibility coupled with environmental factors. A positive family history is the strongest risk factor for the development of CD. The 10-fold increase in the familial risk of CD strongly suggests that these disorders have a genetic background. The prevalence of IBD in Asian populations is lower than in Western populations, which may be due to genetic influences, environmental factors, or a combination of both. In a Korean study, only 0.25% of parents had IBD in CD probands and all of them had ulcerative colitis. The term of familial CD was used only for those with one or more first-degree relatives with confirmed CD. There are few case reports about familial Crohn`s disease in Korea. We report a case of familial CD that the father, the first degree relative was diagnosed as small bowel CD after confirming his son as having CD. (Korean J Gastroenterol 2008;52:247-250)

복부 종괴로 발현된 다발성 침윤 장 자궁내막증 1예

조현석 ( Hyun Seok Cho ),한동수 ( Dong Soo Han ),박세우 ( Se Woo Park ),변태준 ( Tae Jun Byun ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),손주현 ( Joo Hyun Sohn ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1

Endometriosis is one of the most common benign gynecologic conditions in women of childbearing age. Endometriosis involving the gastrointestinal tract occurs in 5.3-12% of women and the most commonly affected site is the rectum and the sigmoid colon. The reports of intestinal endometriosis in Korea are too few to obtain a rate of occurence, and in these cases, the depth of invasion was limited to the serosa, resulting in no significant symptoms or signs. Intestinal endometriosis can show up as a mass suggestive of malignant neoplasm on imaging studies, which can result in serious errors in diagnosis and treatment. In Korean studies, the masses were solitary, and there was no reported case of multiple endometriosis in the sigmoid colon, ascending and descending colon. We report a case of multiple deep infiltrating intestinal endometriosis presenting as an abdominal mass. (Intest Res 2007; 5:87-91

담도계를 침범한 원발성 간세포암종 담관침범을 동반한 간세포암종

조현석 ( Hyun Seok Cho ),손주현 ( Joo Hyun Sohn ),변태준 ( Tae Jun Byun ),안상봉 ( Sang Bong Ahn ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ) 대한간암학회 2008 대한간암학회지 Vol.8 No.-

대량 출혈을 동반한 공장의 Dieulafoy 병변 1 예

이항락(Hang Lak Lee),윤병철(Byung Chul Yoon),변태준(Tae Jun Byun),한호(Ho Han),전운현(Woon Hyun Jun),박준용(Joon Yong Park),이숭환(Soong Hwan Lee),은창수(Chang Soo Eun),이오영(Oh Young Lee),전용철(Yong Chul Jun),한동수(Dong Soo Han) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. However, it is clinically important in that it can be associated with recurrent and massive gastrointestinal bleeding. The bleeding results from an abnormal large submucosal artery. On endoscopy, a small mucosal defect with a protruding vessel or fresh clot may be visualized if the patient is actively bleeding. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, but similar lesions have been described in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We experienced one case of recurrent and massive bleeding from a proximal jejunal Dieulafoy's lesion, which was confirmed by the pathologic examination of the resected specimen. (Korean J Gastroenterol 2002;39:123-127)

크론병 환자에서 고관절 구축을 동반한 요근 농양

박혜정 ( Hye Jeong Park ),전용철 ( Yong Cheol Jeon ),이경아 ( Kyeong A Lee ),변태준 ( Tae Jun Byun ),김태엽 ( Tae Yeob Kim ),은창수 ( Chang Soo Eun ),한동수 ( Dong Soo Han ),손주현 ( Joo Hyun Sohn ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.3

A psoas abscess (PA) is a rare clinical entity but is potentially serious condition which presents diagnostic and therapeutic challenges. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delay in diagnosis and treatment of PA is the major poor prognostic factor. We describe herein a case of the sterile psoas abscess complicating Cronh`s disease which presented as hip flexion contracture. A 29-year-old man, at remission stage of CD involving ileocolic segment, was admitted due to pain from hip contracture. He had no bloody diarrhea and no abdominal pain. PA was confirmed by abdominal ultrasound. PA with hip contracture was completely treated with surgical excision, irrigation, drainage, and antibiotics. PA was sterile and there was no evidence of a fistulous communication from the bowel. Once suspected, aggressive diagnostic work up and definitive operative intervention is needed. (Korean J Gastroenterol 2008;52:188-191)

Helicobacter pylori 제균 후 위축위염과 장상피화생의 변화

이용구 ( Yong Gu Lee ),전용철 ( Yong Cheol Jeon ),구태연 ( Tai Yeon Koo ),조현석 ( Hyun Seok Cho ),변태준 ( Tae Jun Byun ),김태엽 ( Tae Yeob Kim ),이항락 ( Hang Lak Lee ),은창수 ( Chang Soo Eun ),이오영 ( Oh Young Lee ),한동수 ( D 대한소화기학회 2007 대한소화기학회지 Vol.50 No.5

목적: Helicobacter pylori 감염이 장기간 지속될 경우 위축위염과 장상피화생을 초래하여 위암 발생 위험이 증가한다. 그러나 H. pylori를 제균하는 것이 위축변화나 장상피화생을 회복시킬 수 있을지는 아직 이견이 많다. 따라서 저자들은 H. pylori 제균 후에 위축과 장상피화생의 변화 여부를 조사하였다. 대상 및 방법: 2001년 3월부터 2006년 4월까지 방문한 107명의 H. pylori 제균에 성공한 환자들을 대상으로 하였다. 전정부 조직검사를 통해 H. pylori 감염 여부를 판단하였으며 동시에 위축변화와 장상피화생의 정도를 updated Sydney System에 따라 점수화하였다. 전정부 조직검사는 제균 후 일정기간 후에 위내시경검사를 통해 재시행하였고, H. pylori 제균 여부도 조직검사로 확인하였다. 결과: 대상환자의 평균 연령은 55.3±11.3세였으며, 평균 추적기간은 28.7±13.9개월이었다. 내시경 진단은 위궤양, 십이지장궤양, 비궤양 전정부위염의 3가지로 구분하였다. 위축변화는 누락된 자료를 제외한 91명 중 41명에서 관찰되었고, 평균 점수는 0.73±0.92였다. 추적한 위축변화 점수는 0.38±0.70로 제균 후 회복되었다(p=0.025). 그러나 107명 중 49명에서 관찰된 장상피화생은 다소 호전되어 보였으나 통계적인 의미는 없었다. 새로이 발생한 위축변화와 장상피화생이 관찰되었으며 그 평균 점수는 제균 전 위축변화나 장상피화생이 있는 환자에서의 평균보다 낮았으나 통계적인 의미는 없었다. 결론: H. pylori 제균 후에 위축변화는 호전되지만 장상피화생은 호전 정도가 미약하여 호전을 확인하기 위해서는 더 오랜기간 관찰이 필요할 것이다. H. pylori 제균과 위 점막의 위축변화 및 장상피화생 사이의 관계를 확립하기 위해서는 추후 더 큰 규모의 대조군 연구가 필요할 것으로 생각한다. Background/Aims: Long-term Helicobater pylori infection results in atrophic gastritis and intestinal metaplasia, and increases the risk of gastric cancer. However, it is still controversial that eradication of H. pylori improves atrophy or metaplasia. Therefore, we investigated histological changes after the H. pylori eradication in patients with atrophy or metaplasia. Methods: One hundred seven patients who received successful eradication of H. pylori infection in Hanyang University, Guri Hospital from March 2001 to April 2006, were enrolled. Antral biopsy was taken before the eradication to confirm the H. pylori infection and grade of atrophy or metaplasia by updated Sydney System. After a certain period of time, antral biopsy was repeatedly taken to confirm the eradication and investigate histological changes of atrophy or metaplasia. Results: Mean age of the patients was 55.3±11.3, and average follow-up period was 28.7±13.9 months. Endoscopic diagnosis included gastric ulcer, duodenal ulcer, non-ulcer antral gastritis. Atrophy was observed in 41 of 91 and their average score was 0.73±0.92. After the eradication of H. pylori, atrophy was improved (0.38±0.70, p=0.025). However, metaplasia which was observed in 49 of 107, did not significantly improve during the follow-up period. Newly developed atrophy (7 of 38) or metaplasia (18 of 49) was observed in patients who without atrophy or metaplasia initially. Their average scores were slightly lower than those of cases with pre-existing atrophy or metaplasia without statistical significance. Conclusions: After the eradication of H. pylori infection, atrophic gastritis may be improved, but change of intestinal metaplasia is milder and may take longer duration for improvement. (Korean J Gastroenterol 2007;50:299-305)

상행 결장을 침범한 제 1형 신경섬유종증 1예

변태준,이오영,양선영,박성현,현일식,이항락,한동수,전용철,윤병철,최호순,함준수,이흥우,박문향,임현철 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Type I neurofibromatosis (NF-1), first clearly described by von Recklinghausen in 1881, is a dominantly inherited neuroectodermal dysplagia occurring in one of 3,000 births. It is fundamentally characterized by the existence of multiple neurofibromas, 'cafe au lait' spots and Lisch nodules (pigmented hamartomas of the iris). NF-1 may affect the gastrointestinal tract in about 25% of cases. Most NF-1 are located in the jejunum or stomach. In up to 40% of patients, there may be acute or recurrent gastrointestinal bleeding. We report the case of a 36-year-old patient diagnosed as having NF-1 in the stool occult blood test accidentally that was located in ascending colon with a review of literature.

성인 간이식 환자에 있어서 스테로이드 중단의 안정성에 관한 연구

김태엽,함준수,양선영,변태준,이항락,이성희,박준용,한동수,최호순 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Backgroud: Steroids have been a mainstay of immunosuppressive regimens in organ transplantation for many decades. However, longterm steroid use is fraught with side effects, such as obesity, diabetes, hypertension, hyperlipidemia, and many others. With the introduction of new immunosuppressive agents such as cyclosporin and FK506, it has now become feasible to consider steroid withdrawal in stable transplant recipients. Patients and Methods: We reviewed retrospectively data(obtaine from hospital charts and the transplant database) of all 173 patients who underwent orthotopic liver transplantation at multi center from October 1995 through February 1999. Of these 173 patients, we selected for study 50 adults. The study patients were separated into three groups, according to their pre-transplant liver diagnosis(non-immune cirrhosis, immune cirrhosis, cryptogenic cirrhosis). Numeric datas are reported as means and standard deviation of 3 groups, and were tested by ANOVA. Results: In the steroid withdrawal study group, patients with "immune" forms of liver disease tends to be younger and more often female than patients in the two non-immune groups. There were no significant differences in drug regimens between the three groups. The three groups did not differ with respect to the time(months) between transplantation and the beginning of steroid withdrawal, the duration of steroid taper, and the observation period after steroid withdrawal. Although patients who had acute rejection following steroid withdrawal has had more episodes of rejection in the first 3months after transplantation the those without post-withdrawal rejection, this difference was not statistically significant.

디지털 영상 전송 시스템을 이용한 원격진료

함준수,Shimizu, Shuji,Nakashima, Naoki,변태준,이항락,최호순,고용,이경근,김선일,김태은,윤지원,박용진 대한소화기학회 2004 대한소화기학회지 Vol.43 No.6

목적: 인터넷에 기초한 기술의 발달이 사회 전 분야의 발전을 가능하게 하였으며 특히 의료 분야의 자동화와 정보화가 이루어졌다. 많은 임상 의사가 원격 교류를 통해서 원격진료가 가능하게 되었으나 아직은 많은 제한점이 있다. 이 연구의 목적은 디지털 영상 전송 시스템을 사용함으로써 고화질의 영상을 가능하게 해 결국 원격진료 교육에 도움을 주고자 시작하였다. 대상 및 방법: 본 프로젝트는 정보통신부 산하 한국전산원의 지원으로 구축된 KJCN,KOREN (Korea advanced research network)의 활용을 위해현해/겐카이 프로젝트의 부프로젝트로 시작되었다. 일본과의 네트워크를 위해 KJCN의 케이블을 부산과 후쿠오카 사이 300 km 거리의 해저에 설치하였으며, 부산과 서울 한양대학교 사이의 약 300 km 거리는 KOREN을 이용하여 연결하였다. 기본적인 장비를 수술실과 세미나실에 설치하여 수술 현황을 세미나실에서 토의할 수 있도록 하였으며, 일본 후쿠오카의 큐슈대학병원과 네트워크를 연결하였다.2003년 2월 12일 최초로 한양대학병원과 일본 큐수대학병원간의 화상회의로 시작하였다. 결과: 수술 영상을 전송하여 의료진들은 각 회의에서 한 시간 또는 두 시간 동안 외과적 과정에 대해 서로 토론했고 이미지의 질은 원본 디지털 영상과 비교하여 차이가 없었고 일반 영상보다 뛰어났다. 수술시 해부 구조를 명확하게 인식할 수 있었고 그 과정도 잘 이해할 수 있었으며 실시간 전송에 이용된 수술은복강경 담낭제거술과 전립선제거술이었다. 이와 같이 인터넷 프로토콜 기반의 DVTS을 이용한 동영상의 전송은 성공리에 진행되었고 환자의 병력과 수술전의 상태 또한 정지 화상으로 볼 수 있었다. 결론: 본 연구는 인터넷을 통해 해외의 고화질의 영상 전송 시스템을 개발하였으며 이 시스템은 경제적이며 시행하기 쉬우므로 향후 원격진료에 유용한 방법이 될 것으로 생각한다. Background/Aims: The growth of technology based on internet protocol has affected on the informatics and automatic controls of medical fields. The aim of this study was to establish the telemedical educational system by developing the high quality image transfer using the DVTS (digital video transmission system) on the high-speed internet network. Methods: Using telemedicine, we were able to send surgical images not only to domestic areas but also to international area. Moreover, we could discuss the condition of surgical procedures in the operation room and seminar room. The Korean-Japan cable network (KJCN) was structured in the submarine between Busan and Fukuoka. On the other hand, the Korea advanced research network (KOREN) was used to connect between Busan and Seoul. To link the image between the Hanyang University Hospital in Seoul and Kyushu University Hospital in Japan, we started teleconference system and recorded image-streaming system with DVTS on the circumstance with IPv4 network. Results: Two operative cases were transmitted successfully. We could keep enough bandwidth of 60 Mbps for two-line transmission. The quality of transmitted moving image had no frame loss with the rate 30 per second. The sound was also clear and the time delay was less than 0.3 sec. Conclusions: Our study has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video transmission over internet protocol. It is easy to perform, reliable, and also economical. Thus, it will be a promising tool in remote medicine for worldwide telemedical communication in the future. (Korean J Gastroenterol 2004;43:370-375)