장관 Behcet 병의 임상적 고찰 및 Sulfasalazine의 치료효과

유효민(Hyo Min Yoo),한광협(Kwang Hyub Han),김범수(Pum Soo Ki m),김원호(Won Ho Kim),강진경(Jin Kyung Kang),박인서(In Suh Park),방동식(Dong Sik Bang) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

N/A Background/Aims: Intestinal Behcet disease often has a serious course, and a high frequency of perforation and hemorrhage has been reported. The standard treatment for this disease has not been settled. Methods: For the understanding of the clinical features of intestinal Behcet disease and the therapeutic effects of sulfasalazine, 31 patients with Behcet disease who were admitted to the Yonsei University Medical College Hospital from 1981 to 1993 were reviewed. Results: The mean age wos 35.5 years and the ratio of male to female was 1.8:1. The main clinical symptoms were abdorninal pain, bloody stool, and diarrhea. The intestinal lesions were most comrnonly found in the ileoceca] region(84%) and the most common lesions were discrete ulcers(94%). The localized distribution(81%) of ulcers was rnore prevalent than the diffuse form and the incidence of a single ulcer was similar to that of multiple ulcers. Operation were performed in 13 cases and the indications of operation were peritonitis(3 cases), persisted abdominal pain(2 cases), fistula t'ormation(J case), intestinal obstruction(1 case), massive bleeding(1 case), and obscure diagnosis(S cases). Steroid and colchicine were used in 22 cases and sulfasalazine in 14 cases. Symptomatic or colonoscopic improvernent was more frequent in sulfasalazine(79%) than steroid & colchicine(36%). Conclusions: Intestinal Beh<et diseases should be treated with medical therapy than surgery except the inevitable cases such as bowel perforation or massive lower gastrointestinal hemorrhage. Sulfasalazine is relatively effective and could be used as the primary drug in intestinal Behc,et disease. (Korean J Gastroenterol 1997;29:465-472)

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)

담낭 선종증을 동반한 Gardner 증후군

김원호(Won Ho Kim),박찬일(Chan Il Park),김태승(Tai Seung Kim),김남규(Nam Kyu Kim),유효민(Hyo Min Yoo),임현이(Hyun Ee Yim),신석균(Sug Kyun Shin),김희성(Hee Sung Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

Gardner's syndrome is a rare hereditary disorder transmitted by autosomal dominant inheritance and charactrized by multiple adenomatous polyps throughout large intestine associated with multiple osteomas, epidermal cysts, fibromas, etc. Extracolic tumors such as periampullary carcinoma, papillary carcinoma of the thyroid gland, adrenal adenoma/carcinoma and tumors of the CNS have been reported to be associated with Gardner's syndrome. The authors report a case of Gardner's syndrome in a 53-year-old male who presented colorectol polyposis with osteoma of the frontal bone, schwannoma of neck and multiple adenomas of the gallbladder. A review of literature with empha.'is on the association of adenomata of the gallbladder was made. The colorectum was carpeted by multiple sessile and pedunculated polyps with microscopic foci of adenocarcinoma confined to the submucosa. The gallbladder was stuffed with multiple polyps, which were histologically adenomas with varying degrees of atypical change from mild dysplasia to carcinoma in situ.

장관 Beh et병의 임상적 고찰 및 Sulfasalazine의 치료효과

유효민,한광협,김범수,김원호,강진경,박인서,방동식 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.4

Diversion Colitis

이준규,이충렬,조용석,유효민,김원호,민진식,기정혜,김호근 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.3

Clostridium difficile-Associated Disease 에 대한 임상적 고찰

김원호,조용석,이경원,이준규,유효민,이충렬 대한소화기학회 1999 대한소화기학회지 Vol.33 No.3

Background/Aims: Clostridium difficile-associated disease (CDAD) is a common cause of anti biotics-associated diarrhea. The purpose of this study is to understand the clinical, microbiological endoscopic and pathological features of CDAD. Methods: The analysis was performed for 31 patients who were diagnosed as CDAD by positive stool culture from Jan, 1988 to Dec, 1997 and subsequently underwent flexible sigmoidoscopy or colonoscopy. Results: Generally, CDAD occurred in elderly patients who were admitted and treated with antimicrobial agents for a long time. Majo symptoms were watery diarrhea, fever, hematochezia, abdominal pain, and vomiting. On endoscopy pseudo membranous colitis (PMC) and nonspecific colitis were observed in 58.1% and in 22.6% o the patients, respectively. Noraml findings was observed in 19.4% of them. Pathologic finding sho wed PMC in 19.4% of the patients, nonspecific colitis in 48.4%, normal finding in 22.6%. Most o CDAD were cured when the use of the presumptive causative antimicrobials was quitted and van comycin, metronidazole, or cholestyramine was used. Eight recurred cases were also cured by using vancomycin or metronidazole. Conclusions: CDAD is a common cause of antibiotics-associated diar rhea and shows a spectrum of endoscopic and pathologic findings from normal to PMC. CDAD i treated well by oral vancomycin or metronidazole, even in the recurred cases.

대장의 점막하 혈종과 출혈을 동반한 전신성 유전분증 1예

조용석,박인서,문영명,유효민,김원호,정배기 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.5

A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.

대장내시경검사 시 내시경 삽입 시간에 영향을 미치는 인자

김원호,김철,조영준,강진경,이승근,박인서,문영명,유효민 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.4

Background/Aims: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. Methods: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. Results: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2∼35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (>10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). Conclusions: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor.

Helicobacter pylori 감염증 치료에 실패한 환자의 임상상과 항생제 내성

이경원,김원호,박효진,박인서,이용찬,유효민 대한소화기학회 1999 대한소화기학회지 Vol.33 No.3

Background/Aims: The decisive factors influencing the eradication of H. pylori still remain unclear To identify such factors, we investigated the clinical characteristics and antibiotic resistance of patients. Methods: Patients with H. pylori infection were treated with dual or triple regimens. Eradication rates were analyzed on the basis of clinical factors, endoscopic factors and antibiotic resistance Results: Sixty-three H. pylori infected patients were enrolled (mean age 49.4). The eradication rate was significantly higher in compliant patients (71.9%) than in non-compliant patients (20%). Other clinical and endoscopic factors did not significantly influence the outcome of treatment. In 42 isolated strains, metronidazole resistance (MIC$gt;8 μg/mL) was observed in 35.7% of the strains and clari thromycin resistance (MIC$gt;2 μg/mL) was observed in 7.1%. The eradication rate in metronidazole resistant strains was 55.5%, which was lower than that in metronidazole sensitive strains (78.6%) The median value of mronidazole MIC in the group of successful eradication (0.94 μg/mL) was significantly lower than that in the group of failed eradication (64.0 μg/mL). Conclusions: Patient's compliance for regimens seems to be the most important factor which affect H. pylori eradication Metronidazole resistance which is highly prevalent in our population may influence the efficacy of anti-H. pylori treatment regimen containing metronidazole. (Kor J Gastroenterol 1999;33:311 - 320)

경구적 담관내시경검사로 진단된 총간관내 원발성간암의 종양색전에 의한 폐쇄성 황달 1예

박상진,강진경,박인서,전재윤,신용준,정재복,송시영,유효민 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.2

The causes of jaundice in patients with hepatocellular carcinoma are usually attributed to the underlying liver diseases or extensive hepatic destruction by tumor. Obstructive jaundice by the intraluminal tumor fragment of intrahepatic and/or extrahepatic bile duct in hepatocellular carcinoma is exceedingly rare and usually diagnosed by operation or autopsy. Recently, we observed a patient in whom the fragment of tumor from the primary hepatocellular carclnoma obstructed the common hepatic duct, which was confirmed by peroral choledochoscopy. Using peroral choledochoscopy. we could see the mass located at the common hepatic duct and diagnose histologically by cytologic examination of aspirated material of common bile duct. We describe here this rare case with review the literature on primary hepatocellular carcinoma with jaundice caused by biliary obstruction.