진행성 위암환자에서 종양맥관형성과 예후와의 상관관계

조현근(Hyeon Geun Cho),전재윤(Chae Yoon Chon),김호근(Ho Guen Kim),정준표(Jun Pyo Chung),박효진(Hyo Jin Park),이관식(Kwan Sik Lee),박인서(In Suh Park),손승국(Seung Kook Sohn) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4

N/A Background/Aims: It has been demonstrated that several solid tumors are angiogenesis-dependent in their growth and metastasis. The purpose of the study is to investigate the correlation between tumor angiogenic activity and clinicopathologic factors, and to evaluate the availability of angio- genic activity as an independent prognostic factor in patients with advanced gastric carcinoma. Methods: One hundred and fifty-seven patients with advanced gastric carcinoma who underwent curative radical surgery in Yonsei University, Yong-Dong Severance Hospital from Jan. 1986 through Dec. 1989 were studied retrospectively. The most representative section having the invasive component of the tumor by hematoxylin and eosin stain were stained with monoclonal antibody against factor VIII-related antigen. Results: Of 157 patients, the mean survival duration was 55.6 months and the mean microvessel count was 78.1/field(200 times of magnification). The microvessel count increased with AJCC tumor stage(p=0.0165) by univariate analysis. Clinico- pathologic factors independently related to microvessel count were AJCC tumor stage(p=0.0041) and the location of tumor(p=0.0429), but clinicopathologic factors including histologic type, gross morphology, size, age and sex were not independently related to microvessel count. T'he prognosis of the group of which microvessel count more than 78/field was significantly worse than that of the group for which microvessel count was 78/field or less(p=0.0232). Clinicopathologic factors independently related to the survival were AJCC tumor stage(Ib vs. IIIb, p=0.0017) and microves- sel count(<78 vs. 78, p=0.0281) but presence of chemotherapy and other clinicopathologic factors were not independently related to the survival. Conclusions: The number of microvessel showed positive correlation with tumor stages in patients with advanced gastric carcinoma who underwent curative radical surgery. The number of rnicrovessel may be an independent available prognostic factor. (Korean J Gastroenterol 1996; 28:502 - 512)

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)

출혈성 소화성 궤양의 위험인자 분석

김영수,최원,김영배,김인한,신용운,이돈행,김범수,김형길,권계숙,조현근 대한소화기학회 2000 대한소화기학회지 Vol.35 No.2

Background/Aims: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is known to be associated with a high incidence of upper gastrointestinal tract bleeding in the elderly. Increase in prevalence of Helicobacter pylori (H. pylori) infection according to age, implicates that an interaction between use of NSAIDs and H. pylori infection may explain the higher incidence of ulcer complications in the elderly. In the present study, we analysed risk factors existed in peptic ulcer patients with upper gastrointestinal bleeding. Methods: A retrospective study was performed for 420 consecutive peptic ulcer patients (bleeding: 98, nonbleeding: 322). The bleeding group had bleeding symptoms and endoscopic stigmata of bleeding. Use of NSAIDs was evaluated by interview and H. pylori infection was confirmed by endoscopic biopsy specimens and CLO test in all cases. Results: The rates of duodenal ulcer were 62.5% in bleeding group and 50.5% in nonbleeding group (p$lt;0.05). NSAIDs and H. pylori-infection didn't show a significant correlation with bleeding (p$gt;0.05). However, CagA showed a positive correlation with the peptic ulcer bleeding, especially gastric ulcer bleeding (p$lt;0.05). Conclusions: In peptic ulcer patients, duodenal ulcer is more prone to bleeding than gastric ulcer. Use of NSAIDs doesn't increase the risk of upper gastrointestinal bleeding. Location of ulcer and CagA positivity seem to be risk factors of upper gastrointestinal bleeding.

상부위장관 출혈을 동반한 위 기생충성 호산구성 육아종 1예

박효진,손승국,박인서,전재윤,정준표,이관식,김기황,김호근,서정건,조현근 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.1

The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.

간외담관암과 이형성 조직에서 p53 , K - ras , Ki - 67 발현의 임상적 의의

김영수,이은상,김영배,이건영,김진영,이진우,신용운,권계숙,이돈행,김범수,김형길,신석환,조현근 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2

Background/Aims: We examined the expression of p53, K-ras, and Ki-67 in extrahepatic bile duct (EHBD) carcinoma, dysplasia, hyperplasia, and normal tissues. Then, their clinical significance was determined. We also investigated if dysplasia and hyperplasia are the precancerous lesion in EHBD carcinoma. Methods: Specimens of 23 patients with surgically resected EHBD carcinoma were classified into normal, hyperplasia, dysplasia, and carcinoma. Then, they were immunostained to examine the expression of p53, K-ras, and Ki-67 antibody. Results: p53 was detected in 46.7% of dysplasia and 66.7% of carcinoma but not in hyperplasia. K-ras was positive in 46.7% of dysplasia and 55.6% of carcinoma but not in hyperplasia. Ki-67 was positive in 18.1% of hyperplasia, 73.3% of dysplasia, and all the carcinoma. None of them was detected in normal tissue. There was no significant correlation between p53 immunoreactivity and gender, histological grade, stage of EHBD carcinoma, and survival. K-ras and Ki-67 immunoreactivity was not associated with gender, age, histological grade, stage of EHBD carcinoma, and survival. Conclusions: These data suggest that p53 and K-ras mutations may have a role in the carcinogenesis of EHBD carcinoma and that dysplasia may be a precancerous lesion of EHBD carcinoma. Ki-67 may be useful in differentiation of carcinoma from dysplasia. There is no prognostic relationship significantly between p53, K-ras, Ki-67 expression, and the clinicopathologic parameters.