복강경하 담낭절제술 시술예정 환자에서 총담관결석의 진단에 대한 내시경적 초음파단층촬영술의 유용성

주재학(Jae Hak Joo),박찬욱(Chan Wook Park),송동화(Dong Hwa Song),이준성(Joon Seong Lee),이문성(Moon Sung Lee),조성원(Sung Won Cho),심찬섭(Chan Sup Shim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4

N/A One hundred thirty two patients with symptomatic cholelithiasis were evaluated using endo- scopic ultrasonography(EUS), standard abdominal ultrasonography(US) and endoscopic retro- grade cholangiopancreatography(ERCP) for the detection of choledocholithiasis prior to laparoscopic cholecystectomy. Twenty eight patients(21.2% ) had choledocholithiasis and 21.4 % of patients with common bile duct stones had normal sized ducts in US. Whole common bile duct was successfully examined in all patients by EUS, but only 65.9% of patients by US and 94.7% of patienCS by ERCP. EUS det,ect,ed choledocholithiasis in 22 of 28 patientS(89.3% ), compared to 19 of 28 patients(67.9%) detected by US and 26 of 28 patients(92.9%) detected by ERCP. While no compliactions as a result of EUS encountered, complications resulting from ERCP occurred in 7 patients (5.3%), including cholecystitis in 2 patients, cholangitis in 3 patients and pancreatitis in 2 patients. These results suggest that EUS is more sensitive than standard abdominal ultrasonog..aphy and as sensitive as ERCP in the detection of choledocholithiasis. In view of complication and failure rates, EUS appears to offer significant advantages over ERCP. We concluded that EUS is safe and effective imaging technique in the diagnosis of choledocholithiasis prior to laparoscopic cholecystectomy.(Korean J Qastroenterol 1994; 26: 690 696)

호산구성 기관지염의 임상적 특징

주재학(Jae Hak Joo),박진(Jin Park),박상준(Sang Joon Park),서문정(Moon Jeong Seo),김도진(Do Jin Kim),어수택(Soo Taek Uh),김용훈(Yong Hun Kim),박춘식(Choon Sik Park) 대한내과학회 2001 대한내과학회지 Vol.60 No.1

N/A Background : Sputum examination is known to be a valid and reliable method in assessing airway inflammation. Eosinophilic inflammation of airway is usually associated with airway hyperresponsiveness and reversibility. But eosinophilic bronchitis present with chronic cough without the abnormality of airway function. The objectives of this study are 1) to investigate the incidence of eosinophilic bronchitis in the chronic cough syndrome and 2) to evaluate the clinical features of eosinophilic bronchitis. Methods : We evaluated 92 patients who had been coughing for more than 3 weeks. In addition to usual diagnostic protocol, we performed sputum analysis for differential cell count. Eosinophilic bronchitis was diagnosed if patients had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness, and sputum eosinophilia (>3%). Results : The causes of chronic cough were post-nasal drip in 33%, cough variant asthma in 16%, bronchitis in 15%, and eosinphilic bronchitis in 12%. Initial eosinophil percentage in sputum of patients with eosinophilic bronchitis was 26.8±6.1% (3.8-63.7%). Treated with inhaled steroid, subjective improvement in cough and significant decrease in sputum eosinophil percentage (from 29.1±8.3% to 7.4±3.3%) were observed. During the follow up period, increases in sputum eosinophil percentage with aggravation of symptom were found. Conclusion : Eosinophilic bronchitis is an important cause of chronic cough. Assessment of airway inflammation by sputum examination is important in investigating the cause of chronic cough. Symptoms in eosinophilic bronchitis are effectively controlled by inhaled corticosteroid, but they may follow chronic course.(Korean J Med 60:77-84, 2001)

섬유모세포에서 내독소 자극에 따른 Interleukin - 6 생성의 신호전달과정

주재학(Jae Hak Joo),기신영(Shin Young Ki),문승혁(Seung Hyek Moon),정성환(Seong Hwan Jung),김현태(Hyeon Tae Kim),어수택(Soo Taek Uh),김용훈(Yong Hoon Kim),박춘식(Choon Sik Park) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Objectives: Stimulation of cell results in a variety of early biochemical events, known as signal transduction pathway and ultimately leads to final outcome like cell proliferation or cytokine production. The intracellular signal transduction pathway of IL-6 production by LPS stimulated fibroblast is not well defined. In present study, we investigated what signal transduction pathway is involved in IL-6 production. Methods: We examined the effects of various inhibitors of signal transduction pathway including pertussis toxin, cholera toxin, genistein, indomethacin, EDTA, nifedpine, sphingosine, staurosporine, and HH on the production of IL-6 by human fetal fibroblast MRC-5 after stimulation with LPS. IL-6 was measured by bioassay in supernatant of LPS stimulated fibroblast MRC-5 after pretreatment with inhibitors. Results: Calcium inhibitor (EDTA) and protein kinase inhibitor (staurosporine) reduced IL-6 production by LPS stimulated fibroblast. Protein tyrosine kinase inhibitor((Genistein) and PKC inhibitor(sphingosine) had no influence on IL-6 production. Cholera toxin and prostaglandin inhibitor (indomethacin) led to increase in IL-6 production by LPS stimulated fibroblasts. Conclusion: These results suggest that G protein associated receptors, through the calcium dependent pathway, are working in IL-6 production by LPS stimulated fibroblasts.

노인천식에서 천명의 인지

주재학(Jae Hak Joo),박선혜(Seon Hye Park),서문정(Moon Jeong Seo),박상준(Sang Joon Park),이준혁(Jun Hyek Lee),어수택(Soo Taek Uh),김용훈(Yong Hoon Kim),박춘식(Choon Sik Park) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. Methods : Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. Results : One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. Conclusion : In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.(Korean J Med 59:657-662, 2000)

노인 천식 환자에서 천식 증상 발현 빈도 및 임상적 특징

김기업(Ki Up Kim),주재학(Jae Hak Joo),김재한(Jae Han Kim),기신영(Shin Young Ki),어수택(Soo Taek Uh),김용훈(Young Hoon Kim),박춘식(Choon Sik Park) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.1

N/A Background: The clinical and physiological aspects of asthma in the elderly are different from children and young adults. Symptoms such as wheezing, coughing, dyspnea are less commonly reported in the elderly compared to younger patients. Objective : 1) To evaluate the difference of symptoms and physiologic aspects between elderly and younger asthmatics. 2) To determine whether the difference of symptoms is related to changes in physiologic parameters or other clinical features. Subject and method: Sixty-four young, fifty-three-middle aged, and twenty-five elderly stable asthmatic subjects were studied. We conducted questionnaire survey and performed pulmonary function test, allergy skin test and methacholine challenge test. Result : Duration of disease was not different in the three groups. Allergy skin test reactivity rate decreased by age. In the elderly patients, the prevalence of symptoms was significantly lower than in younger patients. There was no correlation between the presence of symptoms, sex, smoking history and alteration of pulmonary function. Conclusion : Compared with younger patients, the symptoms such as coughing, wheezing, and dyspnea are obscure in elderly patients. But the appearance of symptoms is not related to the alteration of physiologic functions. This study emphasizes the importance of routinely performing lung function test in elderly patients to diagnose bronchial asthma, even if their symptoms are not typical.

원발성 경화성 담관염 2예

이은학(Eun Hag Lee),주재학(Jae Hak Joo),이명렬(Myung Lyel Lee),박찬욱(Chan Wook Park),송동화(Dong Hwa Song),이준성(Joon Seong Lee),이문성(Moon Sung Lee),조성원(Sung Won Cho),심찬섭(Chan Sup Shim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.1

Primary sclerosing cholangitis characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation is a chronic cholestatic liver disease that often progresses to cirrhosis and premature death from liver failure. Because histologic findings are not diagnostic in the majority of patients, the gold standard for diagnosis of primary sclerosing cholangitis is cholangiography. We present two cases of primary sclerosing cholangitis diagnosed by typical cholangiographic findings through the endoscopic retrograde cholangiography(ERC). (Korean J Gastroenterol 1995;27:138-143)

만성 HBsAg보유자에서 중합효소 연쇄반응법에 의한 혈청 HBV DNA의 검출

정일권(Il Kwun Jung),주재학(Jae Hak Joo),차상우(Sang Woo Cha),봉형근(Hyung Keun Bong),김진오(Jin Oh Kim),박찬욱(Chan Wook Park),이준성(Joon Seong Lee),이문성(Moon Sung Lee),조성원(Sung Won Cho),심찬섭(Chan Sup Shim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: The purpose of this study was to investigate the serum HBV DNA status and clinical significance of polymerase chain reaction(PCR) in patients with chronic hepatitis B and asymptomatic HBsAg carriers. Methods: The subjects of this study were 80 patients with chronic hepatitis B(53 HBeAg posiiive patients, 27 HBeAg negative patients), 19 asymptomatic HBsAg carriers(8 HBeAg positive patients, l l HBeAg negative patients). Serum HBV DNA was measured by Dot blot hybrydization with a ' P labeled HBV DNA in all patients studied, and the PCR was used to detect serum HBV DNA in Dot blot negative patients. The PCR was performed with 2 primers in the C gene region of HBV. Amplified sequences were detected with ethidium bromide staining(PCR-EB) and southern blot hybridization(PCR-SBH). Dot blot allowed the detection of 10 ' pg of cloned HBV DNA, while 10 pg and 10' pg were detected by PCR-EB and PCR-SBH, respectively. Results: In the 80 patients with chronic hepatitis, 76patients(95%) were positive for HBV DNA by Dot blot or PCR. All 53 HBeAg positive chronic hepatitis patients had HBV DNA detectable by Dot blot(77.4%) or PCR(18.97c by PCR-EB, 3.7% by PCR-SBH). Out of 27 HBeAg negative patients, 23(85.2%) were positive for HBV DNA by Dot blot (40.8/o) or PCR (29.61o by PCR-EB, 14,8% by PCR-SBH). In the 19 asymptomatic HBsAg carriers, 13(68.4%) were positive for HBV DNA by Dot blot or PCR. All 8 HBeAg positive asymptomatic carriers had sufficient HBV DNA detectable by Dot blot. Out of 1 l HBeAg negative carriers, 5(45.5 7c) were positive for HBV DNA by Dot blot (9.1%) or PCR(36.4%). The positive rate for HBV DNA in patients with chronic hepatitis was significantly higher than that in asymptomatic HBsAg carriers(P=0.002 by Fisher exact test) and there is a significant difference in serum HBV DNA between HBeAg positive and negative asymtomatic HBsAg carriers(P=0.02 by Fisher exact test). Conclusions: These results suggest that minute amount of HBV DNA detected by PCR may have pathogenic relevance in chronic hepatitis B, and PCR may be used as a prognostic factor in asymptomatic HBsAg carriers. (Korean J Gastroenterol 1995;27: 651 - 658)

천명음이 있는 기관지 확장증과 천식과의 관계

이준혁(Joon Hyeok Lee),홍기영(Ki Young Hong),주재학(Jae Hak Joo),김도진(Do Jin Kim),어수택(Soo Taek Uh),김용훈(Yong Hun Kim),박춘식(Choon Sik Park) 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Backgroud : Wheezes are the oscillation of airway walls that occures when there is airflow limitation, as may be produced by bronchospasm, airway edema or collapse or intraluminal obstruction by neplasm or secretions. Wheezes can be observed in about 34% of bronchiectasis, that defined as abnormal and permanent dilatation of bronchi. Bronchiectasis is associated with bronchial asthma in 2.7-42%. We studed the clinical significance of wheeze observed in bronchiectasis and interrelationships between the bronchiectasis with wheeze and bronchial asthma. Methods : We reviewed the 32 patients with bronchiectasis confirmed by HRCT. Exclusion criteria are acute exacerbation of bronchiectasis, neoplasm, bronchial asthma. The controlled group is 29 bronchial asthma patients and their diagnositc criteria is when the %change of FEV1 after inhaled bronchodilators is 12% or more and absolute change value is ≥200 mL. All patients were performed spirometry, bronchodilator test, bronchial hyperresponsiveness to methacholine, skin prick test and sputum analysis for cell counts. Results : The Wheeze observed in 43.7% of bronchiectasis patients. Wheeze group revealed the more obstructive pattern in spirometry than non-wheeze group (FEV1% 71.0±8.2% vs 91.7±5.5%, p=0.04; FEV1/FVC 61.1±4.4% vs 78.2±3.7%, p=0.009), more bronchodilator responses (8.4±2.1% vs 4.9±1.7%, p=0.045) and more bonchial hyperresponsiveness (positive results in PC20 : 2 in 6 patients vs no positive in 3 patients). Asthma control group has no significant differences with wheeze group. But compared with non-wheeze group, it has significantly decreased lung function (FEV1/FVC 65.5±2.9% vs 78.2±3.7, p=0.004), more bronchodilator responses (14.8±0.6% vs 4.9±1.7%, p=0.001) and more eosinophilic airway inflammations (sputum eosinphile% 11.4±2.0 vs 0.8±0.4, p=0.05). Conclusions : The wheezes observed in bronchiectasis are associated with bronchial hyperresponsiveness and eosinophilic airway inflammations.(Korean J Med 60:242-248, 2001)

공복 및 식후 장기간 경피경간적 Oddi 괄약근 내압검사

홍수진(Su Jin Hong),이남수(Nam Su Lee),주재학(Jae Hak Joo),조영덕(Young Deok Cho),김진오(Jin Oh Kim),봉형근(Hyung Keun Bong),이준성(Joon Seong Lee),이문성(Moon Sung Lee),김연수(Yun Soo Kim),황성규(Seong Gyu Hwang),심찬섭(Chan Sup Shi 대한소화기학회 1995 대한소화기학회지 Vol.27 No.4

N/A Background/Aims: The short-term perendoscopic manometry of the sphincter of Oddi(SO) may not be representative of overall SO motility. In an attempt to overcomc this limitation, we performed SO manometry using a motility catheter placed via a percutaneous transhepatic biliary drainage catheter in patients with intrahepatic duct stones who had undergone percutaneous transhepatic cholangioscopic lithotripsy. Methods: Long-term recording of percutaneous transhepatic manometry of SO(PTMSO) were performed to 15 of 19 patients, during fasting and after feeding. Results: The mean recording time was 90.0 ' 45.0 min(total: 1,628 min) during fasting and 77.0 23. L min(total: 1,156 min) after feeding. The frequency of contractions of SO in basal fasting conditions varied from 0 to 13/min(mean ' SD: 3.2 l.4/min), and high frequency contractions (HFC; frequency 8/min, duration >2 mins) were observed in l 1 patients from a total of 16 occasions without biliary pain. The mean duration of HFCs and mean interval between HFCs were 4.8 ' l.l min and 72.0 12.4 min respectively. The motility of SO was suppressed by food intake for up to 30min after feeding. In 4 patients, antroduodenal manometry via transnasal route and PTMSO was recorded simultaneously with the total recording time of 926 min. The HFCs of SO were recorded 20 times with 4.5 min of mean durations and 46 min of mean intervals. Migrating motor complexes(MMC.) were recorded in the antroduodenum simultaneously. All occasions of HFCs of SO(20) coincided completely with the phase III of the duodenal MMCs. Conclusions: In fasting, HFCs of SO were frequently observed periodically without biliary pain and completely coincided with the phase III of duodenal MMCs. This finding suggests that some cases of HFCs, previously regarded as tachyoddia' in SO dysfunction by using endoscopically placed motility catheter, may not he the true tachyoddia in SO dysfunction. (Korean J Gastroenterol 1995;27:423 432)

The 1st Interasma Conference , North Asia / Korea Chapter : Regulation of airway mucin in asthma

(Choon Sik Park),(Do Jon Kim),이명란(Myung Ran Lee),(Huen Soo Jang),주재학(Jae Hak Joo) 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 2000 The 1st Interasma Conference, North Asia / Korea C Vol.- No.-