건강인에서 소장의 감각능과 팽창도에 대한 선택적 5-HT4 수용체 부분 작용제 tegaserod의 효과

정정조 ( Jeong Jo Jeong ),최명규 ( Myung Gyu Choi ),조유경 ( Yu Kyung Cho ),전은정 ( Eun Jung Jun ),조영석 ( Young Seok Cho ),정우철 ( Woo Chul Chung ),이인석 ( In Seok Lee ),김상우 ( Sang Woo Kim ),최상욱 ( Sang Wook Choi ),정인 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1

목적: 위장관의 내장 감각능 이상은 기능성 소화불량증의 중요한 병인으로 알려져 있으나 위장관의 감각을 지각하는 기전은 정확히 알려져 있지 않다. 세로토닌은 위장관의 운동과 감각능을 조절하는데 중요한 역할을 한다. 저자는 5-hydroxytryptamine-4 (5-HT4) 수용체 부분 작용제인 tegaserod가 건강인에서 소장의 감각능과 팽창도에 어떠한 영향을 주는지 알아보고자 하였다. 대상 및 방법: 건강 지원자 16명을 대상으로 위약이나 tegaserod (6 mg 하루 2회) 두가지 약물중 한 약제를 단일 맹검, 무작위 순서로 3일간 전투약한 후 검사를 시행하였다. 십이지장 3부에 최대 용적 120 mL의 풍선이 부착된 검사관을 위치시킨 후 바로스타트에 연결하여 소장의 팽창도 및 소장의 감각능을 평가하였다. 풍선의 용적을 단계적으로 증가시키면서 최초 인지 용적(처음으로 감각을 느끼는 용적), 최대 인내 용적(불편감/통증으로 참기 힘들때의 용적)을 기록하고 압력 변화를 관찰하여 소장 팽창도를 계산하였다. 소장 감각능은 20 mL, 40 mL, 60 mL의 3가지 팽창 자극을 무작위 순으로 3회씩 주어 피험자가 느끼는 감각을 시각적 선형척도에 기록하게 하여 평가하였다. 고칼로리 유동식인 엔슈어를 지속적으로 소장에 주입하면서 다시 무작위 순서로 3가지의 팽창자극을 주면서 피험자의 감각을 측정하였다. 결과: Tegaserod 투여군의 소장 팽창도는 2.59±0.74 mL/mmHg로 위약 투여군의 소장 팽창도 2.25±0.42mL/mmHg에 비해 유의한 차이가 없었다. tegaserod 투여군과 위약 투여군 사이에 최초 인지 용적의 차이는 없었지만 최대 인내 용적은 tegaserod 투여군에서 55.7±12.9 mL로 위약투여군 41.7±7.3 mL에 비해 유의하게 높았다( p<0.05). 20,40, 60 mL의 팽창자극을 하였을 때 오심, 팽만감, 불편감/통증 및 총 감각 지수는 tegaserod 투여군과 위약 투여군 사이에 차이가 없었다. 유동식을 주입하면서 팽창자극을 주었을때에도 두 군간에 팽창 자극에 대한 감각 점수에는 유의한 차이가 없었다. 결론: Tegaserod군과 위약군 사이에 빠른 위상성 팽창 자극에 대한 감각의 차이는 없었으나 단계적 팽창 자극에 대한 최대 인내 용적이 tegaserod군에서 위약군에 비해 유의하게 높아 tegaserod가 소장의 감각을 완화시키는 것으로 추정할 수 있다. Backgr ound/Aims: Disturbances in visceral perception contribute to postprandial symptoms in patients with functional dyspepsia. However, the mechanism of perceiving sensation has not been clearly defined. Our aim in this study was to evaluate the effect of tegaserod on compliance and visceral perception in the proximal small intestine. Methods: Sixteen healthy subjects were included in this study. Subjects underwent single blinded randomization to either a placebo group or a regimen group of 3-day pretreatment with tegaserod (6 mg bid). Thirty minutes after the insertion of a balloon-equipped, double-lumen tube into the duodenum, we sequentially measured the compliance and maximal tolerable volume to stepwise balloon distension. The maximum volume of the balloon was 120 mL, and an electronic barostat was used to maintain a constant volume within the balloon. Sensory function was assessed by grading accompanying symptoms of nausea, fullness, and abdominal discomfort/pain during random-ordered isovolumetric ditension of the balloon at volumes of 20 mL, 40 mL, and 60 mL. We made additional assessments on sensory function by slightly modifying the above method of randomized balloon distension to include continuous infusion of liquid meal into the tube. Results: There was no significant difference in compliance between the two groups. Maximal tolerable volume was significantly larger in the tegaserod group than in the placebo group (55.7±12.9 mL vs. 41.7±7.3 mL, p<0.05). Perceived sensations measured using the visual analogue scale during random ordered rapid phasic distension (20, 40, 60 mL) did not reveal differences between the two groups. Conclusions: Tegaserod had no effect on perceived sensation during rapid phasic distension, but it did increase the maximal tolerable volume during stepwise distension. These results suggest that tegaserod reduces the sensitivity to small bowel distension in healthy subjects. (Kor J Neur ogastr oenter ol Motil 2004;1:35-42)

포스터 전시 : 하부위장관 ; 중심부궤양을 동반한 위 점막하종양으로 오인된 횡행결장암의 위 직접 전이 1예

조근종 ( Jo Geun Jong ),김현재 ( Kim Hyeon Jae ),길욱현 ( Gil Ug Hyeon ),남유정 ( Nam Yu Jeong ),김진수 ( Kim Jin Su ),이지인 ( Lee Ji In ),한상우 ( Han Sang U ),김성훈 ( Kim Seong Hun ),박지찬 ( Park Ji Chan ),정정조 ( Jeong Jeon 대한소화기학회 2003 대한소화기학회 추계학술대회 Vol.2003 No.-

<서론> 위 점막하 종양은 점막교가 특징적으로 관찰되며 정상과 같은 양상의 점막소견을 보인다. 횡행결장암이 위로 직접 전이한 전이위암의 경우 점막하종양 양상으로 나타날 수 있고 이때 위결장누공을 형성할 수 있다. 위결장누공은 위궤양, 외상, 감염 등과 위와 대장의 악성 종양에 의해 발생하는 합병증으로 최근 위암과 대장암이 조기진단되면서 점차 감소하고 있다. 이러한 위결장누공을 형성하는 횡행결장암의 위 직접 전이는 국내에서 드물게 보고되고 있다. 저자들은

단순반복염기서열의 변이 형태에 따른 위암 내시경 조직의 유전자형 분류

최영덕,최상욱,전은정,정정조,민기옥,이강훈,이성,유문간,Choi Young Deok,Choi Sang Wook,Jeon Eun Jeong,Jeong Jeong Jo,Min Ki Ouk,Lee Kang Hoon,Lee Sung,Rhyu Mun Gan 대한위암학회 2004 대한위암학회지 Vol.4 No.2

Purpose: Individual gastric cancers demonstrate complicated genetic alterations. The PCR-based analysis of polymorphic microsatellite sequences on cancer-related chromosomes has been used to detect chromosomal loss and microsatellite instability. For the purpose of preoperative usage, we analyzed the correspondance rate of the microsatellite genotype between endoscopic biopsy and surgical specimens. Materials and Methods: Seventy-three pairs of biopsy and surgical specimens were examined for loss of heterozygosity and microsatellite instability by using 40 microsatellite markers on eight chromosomes. Microsatellite alterations in tumor DNAs were classified into a high-risk group (baselinelevel loss of heterozygosity: 1 chromosomal loss in diffuse type and high-level loss of heterozygosity: 4 or more chromosomal losses) and a low-risk group (microsatellite instability and low-level loss of heterozygosity: 2 or 3 chromosomal losses in diffuse type or $1\∼3$ chromosomal losses in intestinal type) based on the extent of chromosomal loss and microsatellite instability. Results: The chromosomal losses of the biopsy and the surgical specimens were found to be different in 21 of the 73 cases, 19 cases of which were categorized into a genotype group of similar extent. In 100 surgical specimens, the high-risk genotype group showed a high incidence of nodal involvement (19 of 23 cases: $\leq$5 cm; 23 of 24 cases: >5 cm) irrespective of tumor size while the incidence of nodal involvement for the low-risk genotype group depended on tumor size (5 of 26 cases: $\leq$5 cm; 18 of 27 cases: >5 cm). Extraserosal invasion was more frequent in large-sized tumor in both the high-risk genotype group ($\leq$5 cm: 12 of 23 cases; >5 cm: 23 of 24 cases) and the low-risk genotype group ($\leq$5 cm: 7 of 26 cases; >5 cm: 16 of 27 cases). The preoperative prediction of tumor invasion and nodal involvement based on tumor size and genotype corresponded closely to the pathologic tumor stage (ROC area >0.7). Conclusion: An endoscopic biopsy specimen of gastric cancer can be used to make a preoperative genetic diagnosis that accurately reflect the genotype of the corresponding surgical specimen.

증례 : 선택적 동맥내 칼슘주입법으로 진단된 Zollinger-Ellison 증후군 1예

송홍석 ( Hong Seok Song ),정정조 ( Jeong Jo Jeong ),송경섭 ( Kyung Sup Song ),전은정 ( Eun Jung Jeon ),지병수 ( Byoung Soo Jie ),전연주 ( Yeon Joo Chun ),최상욱 ( Sang Wook Choi ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5

저자들은 내원 일주일 전부터 시작된 상복부 동통과 속쓰림을 주소로 내원한 60세 남자에서 상부위장관 내시경 시행 결과 역류성 식도염과 십이지장 구부 이후의 다발성 궤양을 보이고 공복 혈청 가스트린치가 1,470 pg/mL 이상으로 현저히 상승되어 산발성 Zollinger-Ellison 증후군으로 진단하였고, 복부 전산화단층촬영과 선택적 동맥내 칼슘 주입법으로 종양의 위치 파악에 성공한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Zollinger-Ellison syndrome is a very rare disease that`s caused by tumor having gastrin-producing cells, and this is accompanied by hypergastrinemia leading to gastric acid hypersecretion, peptic ulcer and their complications. A 60-year-old man presented with epigastric pain and soreness he had experienced for 7 days. The endoscopic findings showed reflux esophagitis and multiple active ulcers at the antrum, the duodenal bulb and the 2nd and 3rd portions of the duodenum. The fasting serum gastrin level was markedly elevated above 1,470 pg/mL and this was consistent with the findings of gastrinoma. We confirmed the presence of gastrinoma via the abdomen CT scan and selective intra-arterial calcium injection. This is the first Korean case report of gastrinoma that was localized by selective intra-arterial calcium injection. (Korean J Med 72:529-535, 2007)

탈황폐수 처리공정의 Scale 제어 방안

정환용 ( Hwan-yong Jeong ),김영규 ( Young-kyu Kim ),정정조 ( Cheong-jo Cheong ),정상철 ( Sang-chul Jung ),이경동 ( Gyeong-dong Lee ),라덕관 ( Deog-gwan Ra ) 한국환경기술학회 2007 한국환경기술학회지 Vol.8 No.4

탈황폐수처리 공정에서 발생되는 스케일의 생성 원인을 규명하고, 스케일 생성 억제제 및 생성 스케일의 용해제를 개발하여 탈황폐수 처리공정에 적용하였다. 탈황폐수 처리공정에서 생성되는 스케일의 주성분은 Si, Al, S성분이며, 그 외 Fe, Mg, Ca성분을 함유하고 있는 것으로 나타났다. 탈황폐수에 포함된 석탄회 성분과 석고, 석회석이 반응하여 스케일의 성장을 촉진시킨다. 탈황폐수 처리공정 제1 반응조의 경우 체류시간이 길어질수록, pH가 높아질수록 황산 제1철과 염소이온이 반응하여 침전물인 Fe₂(SO₄)₃을 발생시켜 스케일의 부착과 성장이 촉진되기 때문에 스케일 생성을 줄이기 위해서는 체류시간을 줄이고, pH를 2로 조절해야 한다. 스케일 생성 억제제 D가 스케일 생성 억제에 가장 효과가 있었으며, 적합한 주입량은 500mg/L로 나타났다. 스케일 용해제의 유효성분(KOH와 Sodium Gluconate) 각 20%에 첨가제 B 2%, 분산 및 침투제 A 0.5% 주입한 경우 스케일의 용해도가 가장 우수하였다. 현장에 스케일 생성 억제제를 주입한 결과 SS 및 COD의 제거효율이 우수하였으며 적합한 주입 농도는 400mg/L로 나타났다. The aim of this study is to examine closely the cause of scale production that is being created during the FGD(Flue Gas Desulfurization) wastewater treatment process. During the examination, the scale producing inhibitor and scale solvent could be developed and these products were used in FGD wastewater treatment process. The results are as following. The main elements of scale that had been formed in FGD wastewater treatment process, were known as Si, Al, S. Additionally, Fe, Mg, Ca were shown as miner components. The scale production was promoted by the reaction with coal, gypsum and limestone existed in FGD wastewater. With prolonging the water retention time of first reaction pond in FGD wastewater treatment process and increasing pH, the settler as Fe₂(SO₄)₃ that is produced by reaction sulfites and chloride ion, promoted the scale production. Therefore, in order to reduce scale, a management was needed that shorter the water retention time and control the pH to 2. The most effective scale producing inhibitor was determined as D, and its optimal dosage was determined by 500mg/L. The superior scale solvent could be made up by adding admixture B 2%, breakup and permeation matter A 0.5% into effective component(KOH and sodium gluconate) 20%, respectively. From the results of using the scale producing inhibitor on-site, SS and COD removal efficiency was superior and the optimal concentration of inhibitor at that time was shown to be 400mg/L.

염화철(Ⅲ)처리 활성탄을 이용한 수중의 질산성질소 제거

유찬서 ( Chan-seo You ),정승광 ( Seung-gwang Jeong ),정정조 ( Cheong-jo Cheong ),정상철 ( Sang-chul Jung ),이경동 ( Gyeog-dong Lee ),라덕관 ( Deog-gwan Ra ) 한국환경기술학회 2009 한국환경기술학회지 Vol.10 No.3

염화철(Ⅲ)처리 입상 활성탄을 제조하여 수중에 존재하는 질산성질소의 제거 방안에 대하여 검토하였다. 염화철처리 활성탄은 일반 활성탄에 비하여 표면에 피흡착질을 축적할 수 있는 수많은 세공들이 관찰되었다. 질산성질소 제거율은 염화철처리 활성탄 첨가량 20g/L에서 96.2%로 가장 높았고, pH변화에 따른 질산성질소 제거율은 큰 차이가 질산성질소 나타나지 않았다. 온도가 증가할수록 질산성질소의 제거율은 감소하는 경향을 나타냄으로써 반응이 발열반응임을 확인할 수 있었다. 제거를 위한 적정 온도는 10℃이었으며, 그때 제거율은 96.2%를 나타냈다. 흡착등온식은 Freundlich식이나 Langmuir식으로 표현이 가능하였다. In order to remove the resolved nitrate in natural water, this study was carried out to investigate the nitrate removal efficiency by using an Iron chloride(Ⅲ) treated activated carbon. The treated activated carbon could be observed a lot of porosity better than conventional activated carbon that showed an elevated capacity of pollutant accumulation on its surface. The highest nitrate removal efficiency was recorded to 96.2 % by adopting of 20 g/L the treated activated carbon. Though the removal efficiency was not affected by pH variation, it showed a tendency in inverse proportion to water temperature. So this process was known to be an exothermic reaction, and optimum temperature in order to get 96.2 % nitrate removal efficiency was concluded to be 10℃. Additionally, the nitrate adsorption reaction between nitrate and Iron chloride(Ⅲ) treated activated carbon was well able to followed to Langmuir and Freundlich adsorption isotherm.

약물치료에 반응을 하지 않았던 비폐쇄성 연하곤란 1 예

조영석(Young Seok Cho),최명규(Myung Gyu Choi),정우철(Woo Chul Chung),정정조(Jeong Jo Jeong),이인석(In Seok Lee),김상우(Sang Woo Kim),김성수(Sung Soo Kim),채현석(Hiun Suk Chae),한석원(Sok Won Han),정인식(In Sik Chung),박두호(Doo Ho Pa 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.1

Dysphagia is a frequent symptom which is observed in about 6% of all population. The most common causes of nonobstructive dysphagia are reported to be esophageal motility disorders, systemic disease and GERD. About 30% of GERD patients complain of dysphagia. Dysphagia in GERD patients is mostly due to peptic stricture but occasionally related to transient segmental esophageal motor disorder. A 42-year old male patient was admitted because of dysphagia and weight loss. He had renal transplantation 5 years ago. The results of esophagogastroduodenoscopic examination, esophagogram and esophageal manometry were normal. Treatment with proton pump inhibitor, prokinetic and anti-depressant was begun but the patient continued to complain of dysphagia. The result of 24 hour ambulatory pH monitoring revealed pathologic reflux. The results of 24 hour ambulatory esophageal manometry and video fluoroscopy were normal. After reassured, he didn`t complain of dysphagia. We report this case of nonobstructive dysphagia accompanied with GERD refractory to medical treatment in patient who had renal transplantation.(Korean Journal of Gastrointestinal Motility 2002;8:47-52)

포스터 전시 : 하부위장관 6 ; 혈전성 혈소판 감소성 자반증을 동반한 출혈성 대장염 1예

조영석 ( Young Seok Cho ),채현석 ( Hiun Suk Chae ),정정조 ( Jeong Jo Jung ),김성수 ( Sung Soo Kim ),한석원 ( Suk Won Han ),이창돈 ( Chang Don Lee ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ),선희식 ( Hee Sik Sun ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

3차 의료기관에서 Helicobacter pylori 제균의 성적 질환과 투여된 약제, 투여 기간에 따른 제균의 성적과 제균 후 재감염에 대한 조사

정우철 ( Woo Chul Chung ),조영석 ( Young Seok Cho ),정정조 ( Joeng Jo Jeong ),이인석 ( In Seok Lee ),김상우 ( Sang Woo Kim ),양진모 ( Jin Mo Yang ),최명규 ( Myung Gyu Choi ),정인식 ( In Sik Chung ),박두호 ( Doo Ho Park ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.1

Background/Aims: Controversies regarding the indications and regimens for the eradication of Helicobacter pylori (H. pylori) still exist. Failure rates have been reported to range from 5% to 10%. This study aimed to evaluate the efforts for the eradication of H. pylori of a tertiary clinic. We assessed the eradication rates according to the diseases, therapeutic regimens, and duration of therapy. In addition, we examined the effectiveness of secondary regimens in patients who failed to respond to primary regimens and the reinfection rate after a successful eradication. Methods: We investigated 389 patients with documented H. pylori infection between January 1996 and December 2001. Results: The overall eradication rate was 79.2%. There were no significant differences in the eradication rates according to the diseases and therapeutic regimens. However, there was a significant difference according to the duration of therapy. Proton pump inhibitor-based 10-day and 14-day regimens were superior to 7-day regimens. The eradication rate of secondary regimens in patients who failed to respond to primary regimens was 76.9%. The reinfection rate after a successful eradication was 4.4%. Conclusions: These results suggest that proton pump inhibitor-based triple regimens with 10 or 14 days of duration should be considered as primary H. pylori eradication therapy. (Korean J Gastroenterol 2003;41:1-8)

상수슬러지에 의한 해수중의 인 및 Cochlodinium polykrikoides의 제거 특성

이영식(Lee Yeong Sig),박영태(Park Yeong Tae),정정조(Jeong Jeong Jo) 大韓環境工學會 2004 대한환경공학회지 Vol.26 No.2