원발성 식도이완 불능증에서 공기 확장술의 효과 - 식도 내압검사 소견을 중심으로 -

정숙향(Sook Hyang Jung),김주성(Joo Sung Kim),윤정환(Jung Hwan Yoon),이풍렬(Poong Lyul Rhee),정현채(Hyun Chae Jung),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.3

N/A Pneumatic balloon dilatation is generally accepted as the preferred method of onoperative treatment for idiopathic achalasia of the esophagus. l he purpose of this study was to present the results of forceful pneumatic dilatation of 18 cases of idiopathic achalasia and to evaluate the manometric findings associated with the effect of treatment and would be suggested as a prognostic indicator. Out of the 14 patients who could be evaluated before and after dilatation, 13(93%) showed clinically satisfactory results and 10(71%) showed radiologically definite improvement. During the mean follow-up period of 14,3 months, all 6 patients who could be traced, remained without clinical or radiological sign of relapse. Dilatation-associated esophageal perforation occurred in 2 patients out of 18(11%). On the other hand, we found a case demonstrating complete relaxation of LES and another case which showed return of normal peristaltic wave after pneumatic dilatation. The manometric findings associated with the successful dilatation were a decrease in the LES pressure, a reduction of resting esophageal pressure and a decrease in the frequency of spontaneous wave. Whether these manometric findings are useful as prognostic indicators will need further long-term follow-up.

우리나라 간경변증 환자에서 원발성 간암 발생률 및 이에 영향을 미치는 인자들에 관한 전향적 연구

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),류지곤(Ji Kon Ryu),정숙향(Sook Hyang Jung) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A This prospective, longitudinal study was to determine the incidence of hepatocellular carcinoma (HCC) and the risk factors of the development of HCC in patients with liver cirrhosis in Korea. We enrolled 285 patients with liver cirrhosis who had experienced the esophageal variceal bleeding and had been treated by endoscopic injection sclerotherapy in our hospital and survived more than 3 months. They were closely followed up with ultrasonography (USG) of the liver and determination of serum alpha-fetoprotein (a-FP) levels for the detection of HCC. The mean age of the patients at the time of the first episode of esophageal variceal bleeding was 47.9+-9.6 with the male to female ratio of 3.75:1. The positive rate of serum HBsAg was 64.6% and decreased with aging. The cumulative incidence was 2.6%, 6.7%, 12 3%, 18.8% and 21.5% in 1, 2, 3, 4 and 5 years, respectively. The annual incidence of HCC in HBsAg positive and negative patients was 5.2% and 2.4%, respectively and the difference was statistically significant (p<0.05). Among HBsAg positive patients, the annual incidence (9.9%) of HCC in elderly patients (>50 years) was significantly higher than that of younger (3.2%). The annual incidence in male patients (4.5%) was likely to be higher than in female (2.8%) though the difference was not statistically significant. In conclusion, the high incidence of HCC in patients with liver cirrhosis was reconfirmed by prospective study. HBsAg positivity, old age (above 50 years) and male sex turned out to be factors which increased the risk of the development of HCC.

간장 ( 肝臟 ) · 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 고 - 고빌리루빈혈증을 보인 간실질 질환 및 담도 폐쇄 환자들의 단기 예후

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),정숙향(Sook Hyang Jung) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.4

N/A Serum bilirubin level seldom exceeds 30 mg/dl in the patients with complete extrahepatic biliary obstruction. Therefore, hyper-hyperbilirubinemia which is defined as hyperbilirubinemia above 30 mg/dl of serum bilirubin level is rarely found only in patients with accompanying pigment overload or renal failure in addition to preexisting parenchymal liver disease or biliary obstruction. In this study, shor-term prognosis of 85 patients with hyper-hyperbilirubinemia were evaluated according to the underlying hepatobiliary diseases and precipitating factors. Of 85 patients, 57(67%) were patients with primary parenchymal liver diseases which included 2 cases of acute hepatitis, 4 cases of toxic hepatitis, 5 cases of chronic viral hepatitis, 23 cases of cirrhosis, 22 cases of primary liver cancer, and 1 case of alcoholic liver disease. Seventy six patients (89%) showed clinical deterioration of which 30 terminated to death and 46 were subjected to hopeless discharge. Only 9 patients (11%) were clinically improved during hospitalized period. Most of the survived patients had acute liver diseases, suggesting that preexisting liver disease was important in the determination of short-term prognosis. Analysis of precipitating factors revealed that 96% of patients had either pigment overload or renal failure. All patients except one, who had renal failure with or without pigment overload showed clinical deterioration. Of 21 patients having only pigment overload without renal failure, 8(38%) showed clincial improvement. We concluded that the patients with hyper-hyperbilirubinemia super- imposed on preexisting acute liver disease because of pigment overload had better prognosis than those with hyper-hyperbilirubinemia because of renal failure.

백서 소장점막의 부위별 Angiotensin Converting Enzyme의 효소 특이활성도차이에 대한 유전적 조절기전에 관한 연구

송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),김재준(Jae Jun Kim),박중원(Joong won Park),윤병철(Byung Chul Yoon),정현채(Hyun Chae Chung),이풍렬(Poong Ryul Lee),임경욱(Kyoung Wook Yim),정숙향(Sook Hyang Chung),유 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Recent reports indicate that angiotensin converting enzyme (ACE) in intestinal mucosa may be involved in protein digestion in vivo. The specific activities of intestinal ACE show regional difference. We performed this experiment to define the level of genetic regulation determining the regional difference of ACE specific activities by the relationship between ACE specific activities and ACE mRNA levels. Small intestines of 3 Wistar rats were removed and divided into 3 segments of equal length. Mucosal homogenate and brush border membrane (BBM) were prepared from scraped mucosa and ACE specific activities were measured in both samples by fluorometric method. Total RNA was extracted by guanidinium thiocyanate and isolated by Cesium chloride,ultracentrifugation. Each 6 ug of isolated RNA was transferred to nitrocellulose membrane by dot and slot apparatus. Northern hybridization with radiolabeled ACE 5 cDNA of mouse was performed and ACE mRNA was detected by autoradiography. The means of ACE specific ar.tivities (uM/ug protein/min) in harnogenate and BBM of proximal intestines were 23.4+- 4.8, 286.3+-80.6, in those of middle intestines were 21.3+-2.0, 211.0+-78.8 and those of distal intestines were 8.2+-1.9, 76.4+-10.7. The means of relative amounts of ACE mRNA in proximal, middle and distal intestines were 75%, 96% and 10% respectively. In linear regression analysis between ACE specific activities of BBM and relative amounts of ACE mRNA, R-value was 0.60 (p<0.05). We concluded that transcription was considered as the level of genetic regulation determining the regional difference of ACE specific activities.

무증상 한국 성인의 대장 용종과 비만의 임상 고찰

지정훈 ( Jeong Hoon Ji ),박범준 ( Bum Joon Park ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwang ),정숙향 ( Sook Hyang Chung ),김나영 ( Na Young Kim ),이동호 ( Dong Ho Lee ),정현채 ( Hyun Chae Jung ),송인성 ( In Sung Song ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.1

목적: 대장암은 생활환경과 식생활의 변화와 더불어 최근 암 발생률, 사망률 모두 증가하고 있다. 이번 연구에서 대장암의 전구 병소로 잘 알려진 선종용종과 체질량지수를 이용한 비만과의 연관성에 대해 알아보고 대장 용종의 수, 크기, 조직 분류와 생화학검사 수치들을 비교하였다. 대상 및 방법: 2002년 3월부터 2005년 4월까지 분당서울대병원의 건강증진센터를 방문한 검진자에서 에스자결장경 검사를 시행했던 환자 6,706명과 이 중 대장내시경을 시행한 860명을 후향으로 분석했다. 체질량지수가 25 이상인 군을 비만군, 25 미만인 군을 대조군으로 정하였다. 이외의 변수로는 성별, 연령, 콜레스테롤, 중성지방, 당화혈색소, 고밀도지질단백, CRP 등이 있으며 이들과 함께 대장 용종의 육안 및 조직병리분류, 용종의 해부학 분포, 크기와 수 등을 체질량지수와 비교하였다. 결과: 대상 환자의 평균 연령은 51.1±10.5세였으며 연령분포는 18세에서부터 83세 사이였다. 남녀 비는 1.1:1이었다. 선종 빈도는 정상군 16.0%과 비만군 20.4%로 유의한 차이를 보였다. 대장내시경을 시행한 860명을 용종군과 대조군으로 나누어 비교하였을 때 대장 용종의 유무에 따른 체질량지수의 평균은 대조군에서 23.9±2.8, 용종군에서 24.3±2.8로 차이를 보이지 않았고 용종 크기에 따른 체질량지수 차이도 없었다. 체질량지수에 따른 대장 선종 빈도는 정상군에서 32.5%였으며 비만군에서는 38.5%로 차이를 보이지 않았으며, 관상선종군과 융모선종군의 체질량지수의 평균치는 각각 24.3±2.7, 24.4±3.1로 통계적인 유의성은 없었다. 그러나 대장내시경 검사에서 선종수가 4개 이상으로 증가하는 경우 체질량지수와 유의한 관계를 보였다. 이 외에 연령, 중성지방은 대장 용종의 유무에 따라 의미있는 차이를 보였다. 결론: 대장 선종 유무에 따른 체질량지수의 차이는 관찰되지 않았으나 대장 선종 수가 증가할수록 체질량지수의 차이가 있었으며 연령, 중성지방 등도 대장 선종 발생의 위험요소일 수 있음을 확인하였다. Background/Aims: Obesity is a rising problem in industrialized countries. Numerous epidemiologic studies have shown a positive association between obesity and colorectal polyps. There are few studies investigating the association between colorectal adenomatous polyps and body fat composition in Korea. We tried to examine the relationship between body fatness and colorectal adenomatous polyps in health check-up subjects in Korea. Methods: Six thousand seven hundred and six routine health check-up subjects, who visited our hospital between March 2002 and April 2005 and underwent distal colon examimation with sigmoidoscopy, were enrolled in this study. Among them, colonoscopy was done in 860 patients to evaluate the entire colon. We tried to reveal the relationship between body mass index (BMI) and size, location, number and histopathological type of polyps. BMI was used as an indicator of obesity. Results: The mean value of BMI in total polyp-free group (23.8±2.9) was not different from that of the polyp group (24.5±2.8, p=0.09). The frequency of rectosigmoid polyps in obese patients (20.4%) was higher than that in non-obese patients (16.0%, p<0.05). The frequency of adenomatous polyp was not different between obese and non-obese group. Number of polyps (≥4) correlated well with obesity. Moreover, age and triglyceride level in patients with colonic adenoma were significantly higher than in patients without colonic adenom. Conclusions: This study shows that obesity is not associated with colonic adenomatous polyp in Korean population. However, we observed that obesity may be associated with rectosigmoid colon polyps. Furthermore, age and triglyceride level might be the risk factors of colonic adenomatous polyps in Korean population. (Korean J Gastroenterol 2007;49:10-16)

연구논문 : C형간염바이러스 유전자형 1b에 감염된 한국인 환자에서 인터페론 감수성 결정 영역의 유전자 돌연변이 양상

진영주 ( Young Joo Jin ),박윤경 ( Yoon Kyung Park ),윤귀준 ( Gui Jun Yun ),이한주 ( Han Chu Lee ),정숙향 ( Sook Hyang Jeong ),김강모 ( Gang Mo Kim ),임영석 ( Young Suk Lim ),정영화 ( Young Hwa Chung ),이영상 ( Yung Sang Lee ),서 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: The treatment response to interferon could differ with mutations in the interferon-sensitivity-determining region (ISDR) in patients infected with hepatitis C virus (HCV) genotype-1b (HCV-Ib). We examined the pattern of ISDR mutations and analyzed whether the number of amino acid substitutions influences the treatment response to peginterferon plus ribavirin in chronic hepatitis or cirrhotic patients infected with HCV-Ib. Methods: The study population comprised 52 patients who visited Seoul Asan Medical Center and Seoul National University Bundang Hospital from January 2006 to December 2008 and who received peginterferon alpha-2a (n=37) or -2b (n=15) plus ribavirin, and whose serum was stored. We analyzed the early virologic response, end-of-treatment response, and sustained virologic response (SVR), and examined the ISDR using direct sequencing. Results: The proportions of patients with ISDR mutation types of wild (0mutations), intermediate (1-3 mutations), and mutant (≥4 mutations) were 50.0%, 42.3%, and 7.7%,respectively, and the corresponding SVR rates were 63%, 50%, and 67% (p>0.05). The SVR rates were 59.4% and 50.0% in patients with <2 and ≥2 mutations, respectively (p>0.05). On univariate analysis, age was the only predictive factor for SVR (p=0.016). The pretreatment HCV RNA titer tended to be lower in those with SVR, but without statistical significance (p=0.069). Conclusions: The frequency of ISDR mutations was low in our cohort of Korean patients infected with HCV-Ib. Therefore, ISDR mutations might not contribute to the response to treatment with peginterferon plus ribavirin.

위장의 용종 제거에 쓰이는 여러가지 방법의 비교 연구

정현채,송인성,김재준,최규완,윤병철,김정룡,이풍렬,임경욱,정숙향 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.1

The gastric polyps may be premalignant lesions and they should be removed as possible. The gastric polyps can be remoued by various endoscopic methods. The safety and therapeutic effectiveness of snare polypectomy, neodymium YAG laser therapy and electrocutery were compared in a total number of 106 patients who were diagnosed as benign polyps by means of endoscopic biopsy.Safety was evaluated by the rate of complications such as perforation and bleeding, and therapeutic effectiveness was evaluated by the average numbers of treatment session of each modality. Average numbers of treatment session of snare polypectomy, laser therapy and electrocautery were 1.04, 1.38 and l.44, respectively. Average numbers of treatment session of snare polypectomy were significantly (p$lt;0.05) lower than those of other two methods. Perforation was not occurred in any group. Bleeding rates after snare polypectomy, laser therapy and electrocautery were 17.4%, 1.0% and 3.8%, respectively. Bleeding was significantly (p$lt;0,05) more frequent after snare polypectomy than after other two methods. In conclusion therapeutic effectiveness was best in snare polypectomy but complication was most frequent after snare polypectomy. There was no difference between laser therapy and electrocautery for therapeutic effectiveness and safety. Therfore, laser therapy and electrocautery caa be used for the removal of flat adenoma, alternatively.

원발성 경화성 담관염, 궤양성 대장염 및 담관암종이 병발해 나타난 1예

김경현,김창민,정숙향,정진행,김연경,김유철,이병희,양정훈,최병국,최택희 대한소화기학회 1999 대한소화기학회지 Vol.34 No.2

Primary sclerosing cholangitis (PSC) is a progressive, inflammatory disease affecting extra- and intra- hepatic bile ducts with characteristic radiologic and histologic findings. PSC is frequently associated with ulcerative colitis (UC) and the incidence of cholangiocarcinoma is increased in those patients with PSC and UC. We experienced a case in which primary sclerosing cholangitis, ulcerative colitis, and peripheral cholangiocarcinoma were combined. The patient was a 37-year-old female and complained of jaundice. To our knowledge, this is the first report which has presented the association of three disease entities in Korea.

간세포암 환자에서 TACE 후에 발생한 상복부 피부발진 2 례

이병희,김창민,정숙향,임경진,정진행,이승숙,이진오,김유철,한철주,김종광,김연경,서요안,송용환 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.3

$quot;Transcatheter arterial chemoembolization (TACE) is a therapeutic option for unresectable hepatocellular carcinoma. Supraumbilical skin rash is a rare complication of TACE caused by patent hepatic falciform artery. We report herein two cases of supraumbilical skin rash developed after TACE for hepatocellular carcinoma, with discussion on the pathogenesis, prophylaxis, and treatment$quot;.

한국인에서의 만성적 궤양을 동반하는 대장염에 대한 임상적 고찰

이풍렬,윤한두,김나영,정숙향,유권,정현채,이효석,윤용범,송인성,최규완,김정룡,최상운 대한내과학회 1990 대한내과학회지 Vol.38 No.3

The purpose of this study is to compare the differences of the symptoms, signs and laboratory findings among colitis with chronic ulceration, such as ulcerative colitis, Behcet's colitis, tuberculous colitis and Crohn's disease in Korea. Were studied in Seoul National University Hospital from August 1982 to Oocober 1988. Forty-two cases of ulcerative colitis, 23 cases of Behcet's colitis, 53 cases of tuberoulous colitis and four cases of Crohn's disease were analyzed in terms of age, sex, symptomatology, laboratory findings and consequence of treatment. 1) The sex ratio of ulcerative colitis, Behcet's, colitis tuberculous colitis and Crohn's disease was 1 : 1.63, 4.74 : 1, 1 : 1. 30, and 3 : 1, respectively, and the mean age was 36.1, 34.3, 33.4, 22.5 years, respectively. 2) The duration of symptoms in tuberculous colitis was significantly shorter than in other diseases. 3) The items of symptoms and signs showed that significant differences were rectal bleeding, diarrhea, weight loss, tenesmus, oral ulcer, skin lesion and genital ulcer. 4) The items of laboratory findings revealed that significant differences were anemia, increased ESR, hypoalbuminemia and the evidenoe of tuberculous lesion on chest X-ray. 5) In view of the anatomical distribution of the lesions, the rectums of all the cases were involved in ulcerative colitis. In most cases of Behcet's colitis and tubercuious colitis, the right colon, including the cecum and the ileum, was involved. In Crohn's disease, the ileum and the jejumum were frequently involved. 6) From a discriminant analysis, we could find several items that differentiated the four diseases. There were rectal bleeding, diarrhea, oral ulcer, hypoalbuminemia and evidence of tuberculosis on chest X ray.