오디 괄약근 기능 이상으로 인한 소아의 재발 급성 췌장염 1예

최병호,박선민,김호각,김정미,홍석진,김정옥,조민현,최병호,Choi, Byung-Ho,Park, Sun-Min,Kim, Ho-Gak,Kim, Jung-Mi,Hong, Suk-Jin,Kim, Jung-Ok,Cho, Min-Hyun,Choe, Byung-Ho 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.2

저자 등은 원인이 확실하지 않았던 재발성 급성 췌장염의 14세 소아 환자에서 오디 괄약근 운동 검사로 오디 괄약근 운동 이상을 진단하고, 내시경 췌관 유두 괄약근 절개술을 시행하여 치료한 증례를 경험하였기에 보고한다. Recent studies suggest that sphincter of Oddi dysfunction (SOD) is one of the possible causes of unexplained recurrent acute pancreatitis in children. A 14-year-old boy who had suffered from idiopathic recurrent acute pancreatitis was diagnosed with SOD. Abdominal ultrasonography, computerized tomography, and magnetic resonance cholangiopancreatography revealed no evidence of stone, tumor, or pancreatic ductal anomaly. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincter of Oddi manometry (SOM) revealed elevated basal pressure and tachyoddia consistent with SOD. Hence, an endoscopic pancreatic sphincterotomy was performed. We report a case of recurrent acute pancreatitis associated with SOD in a child. ERCP and SOM may be considered in patients with multiple unexplained attacks of pancreatic pain and negative abdominal imaging.

만성 B형 간염 상담: 국내 인터넷 상의 흔한 오류를 중심으로

최병호,Choe, Byung-Ho 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.1

Comprehensive understanding of the natural course of chronic hepatitis B virus (HBV) infection is mandatory for the management and treatment of chronic hepatitis B, of which the natural course consists of immune tolerance, immune clearance, inactive carrier state, and reactivation phase. Evidence based medical approach is essential for the management of HBV carriers and treatment of active hepatitis to decrease risks of liver cirrhosis and hepatocellular carcinoma as well as to increase survival. In addition, education of patients or their parents are required to achieve a better therapeutic outcome and to prevent unconfirmed alternative medicine and anecdotal approaches.

RF Sputter 방법으로 제조한 투명전도막 ZnO 특성

최병호,Choe, Byung-Ho 한국재료학회 1992 한국재료학회지 Vol.2 No.5

Ga-doped polycrystalline ZnO films on glass substrates were prepared by sputtering the targets, which had been prepared by sintering discs consisting of ZnO powder and various amounts of G$a_2O_3$, to investigate the effects of gallium doping and sputtering conditions on electrical properties. Optimizing the RF power density, argon gas pressure and gallium content, transparent Ga-doped ZnO films with resistivity less than 1$0^{-3}$ohm-cm are obtained. Electron concentration of undoped and Ga-doped ZnO films are order of $10^{18}$, $10^{21}$/c$m^2$respectively. After heat treatment in air and $N_2atmosphere, $ the resistivity of Ga-doped ZnO films increases by about two orders of magnitude. The optical transmission is above 80% in the visible range and the optical band widens as the Ga content increases. Ga 첨가효과 및 Sputter 제조조건이 전기적 특성에 미치는 영향을 고찰하기 위해 ZnO분말과 G$a_2O_3$분말을 소결하여 타겟트를 제조하여 Sputter법으로 유리기판에 Ga-doped ZnO 다결정박막을 제조하였다. RF 전력밀도, 아르곤 개스압력 및 Ga 함유량등을 최적화한 후 제조한 투명한 Ga-doped ZnO 박막의 비저항은 1$0^{-3}$ohm-cm이며, undoped 및 Ga-doped ZnO 박막의 전자농도는 각 $10^{18}$, $10^{21}$/c$m^2$이였다. 공기와 질소분위기에서 열처리를 행하였을 때 Ga-doped ZnO 박막의 비저항은 $10^{2}$ order 증가하였다. 가시광영역의 투과율은 80% 이상이였으며, Ga 함유량이 증가하면 optical band gap도 넓어졌다.

영아기 담즙정체성 황달 질환 중 담도폐쇄증의 조기 배제 진단

최병호,Choe, Byung-Ho 대한소아소화기영양학회 2011 Pediatric gastroenterology, hepatology & nutrition Vol.14 No.2

The persistence of jaundice beyond the first 2 weeks of life require further investigation and this can be determined if the conjugated bilirubin levels are greater than 1.5 mg/dL or greater than 20% of the total bilirubin level. There is a diverse differential diagnosis for the cause of neonatal cholestasis due to hepatobiliary disease including biliary atresia, which eventually leads to liver cirrhosis if uncorrected before 60~80 days of life. Long-established initial studies include abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy, but better diagnostic methods are needed. Promising new options are described including MRCP (magnetic resonance cholangiography), ERCP (endoscopic retrograde cholangiography), and PCC (percutaneous cholecysto-cholangiography). Though no single test can differentiate biliary atresia from other neonatal cholestasis with confidence, a combination of diagnostic methods is usually consistently beneficial. By excluding biliary atresia as early as possible, the risk of unnecessary explolaparotomy with intraoperative cholangiography is decreased. Further evaluation would be required for the diagnosis of neonatal cholestasis after excluding biliary atresia.

간세포이식을 통한 간질환 극복과 유전자 치료의 가능성

최병호,Choe, Byung-Ho 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.11

한국 소아 B형 간염의 역학과 현황

최병호,Choe, Byung-Ho 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.7

Korea is now classified as an area of intermediate endemicity for hepatitis B virus (HBV), due to the implementation of universal HBV vaccination and national preventive programs for HBV infection. A national program of HBV vaccination was launched in Korea in 1988 for school-going children and was listed on a vaccination guideline in 1991. In 1995, universal vaccination for newborn infants was started for the prevention of perinatal HBV transmission. The prevalence of HBsAg among Korean middle school students has shown marked decreased from 3.2% in the late 1990s to 0.44% in 2007. HBsAg positivity in preschool children was 0.9% in 1995, decreased to 0.2% in 2007 by national prevention program of hepatitis B vertical transmission, launched in 2002. Vaccine failure rate of HBV immunoprophylaxis is 4.2% by this program. The infected children should be monitored per 6-12 months interval. Lamivudine and interferon are approved therapies for children with chronic hepatitis B in immune-clearance phase in Korea.

소아의 B형 만성 활동성 간염에서 저용량 ${\alpha}$-Interferon과 Thymodulin의 병용 치료 효과

최병호,고철우,Choe, Byung-Ho,Ko, Cheol-Woo 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

목 적: 만성 B형 간염 환자의 치료에 많은 항바이러스제와 면역조절 물질이 시도되었지만 현재까지는 ${\alpha}$-interferon만이 일정한 효과가 있는 것으로 보고되고 있다. 또 면역조절제 중에는 현재thymodulin 등의 면역증강 물질이 시도되어지고 있다. 저자들은 interferon 치료시 thymodulin을 병용하면 소아의 B형 만성 활동성 간염에 interferon 단독 치료보다 효과가 있는지를 조사해 보았다. 대상 및 방법: 1990년 3월부터 1996년 2월까지 경북대학교병원 소아과에 입원하였던 환아 중 6개월 이상 HBsAg과 HBeAg 및 HBV DNA가 양성(1+~4+)이고, 혈청 AST와 ALT치가 상승되어 있으며 간조직 검사상 만성 활동성 간염으로 확진된 환아 23명($9.8{\pm}2.8$세)을 대상으로 recombinant ${\alpha}$-interferon 300 MU($280\;MU/m^2{\pm}68$; 범위: $189{\sim}448\;MU/m^2$)를 주 3회씩 6개월간 피하 주사하였다. 그 중 10명에게는 thymodulin 60 mg을 매일 복용시켰고 13명은 ${\alpha}$-interferon만 투여하였으며 치료 종료 후 최소 12개월 이상 추적 검사를 하였다. 양군간의 모든 변수에서 통계학적 유의차는 없었다. 결 과: 1) 23명 전예에서 interferon 치료 중에 AST, ALT 및 HBV DNA의 감소가 있었고 12개월째 추적 검사상 9명(39%)에서 평균 3.1개월째에 HBeAg과 anti-HBe의 혈청전환 및 HBV DNA의 음전이 생겼으며 18개월째 추적검사에서는 이 중 2명에서 ${\alpha}$-interferon 중단 후 8개월과 9개월에 HBeAg이 다시 나타났고 또 다른 2명에서 추가로 혈청전환이 생겨서 전체적으로는 23명의 환아 중 11명(48%)에서 혈청전환이 생겼고 재발한 2명을 빼면 최종 성적은 9명(39%)이 된다. 2) 수직 감염이 있는 7례 중 2례(29%)에서 혈청 전환이 생긴 반면 수직 감염이 없는 12례 중 6례(50%)에서 혈청전환이 생겨 수직 감염 유무는 혈청전환과의 상관 관계가 밀접하다고 생각한다. 3) ${\alpha}$-interferon 치료 전의 ALT치가 정상치의 2배 이하인 경우 8례 중 3례(38%)에서 혈청전환이 있었는데 비해 2배 이상이었던 경우는 15예 중 8례(53%)에서 혈청전환이 있어서 ${\alpha}$-interferon 치료전의 높은 ALT치가 좋은 치료 효과를 예측하는데 도움이 될 수 있을 것으로 생각한다. 4) ${\alpha}$-interferon 치료 전의 HBV DNA가 3+ 이상이었던 경우는 12례 중 5례(42%)에서 혈청전환이 있었는데 비해 1+ 이었던 경우는 11례 중 6례(55%)에서 혈청전환이 있어서 ${\alpha}$-interferon 치료전의 낮은 HBV DNA가 좋은 치료 효과를 예측하는데 도움이 될 수 있을 것으로 생각한다. 5) B형 만성 활동성 간염 환아 23례 중 10례에게 thymodulin을 병용하여 투여하였으나 10례 중 5례(50%)에서 혈청전환이 있었으며 이는 대조군인 ${\alpha}$-interferon 단독 치료 시의 13례 중 6례(46%)와 비교할 때 통계적인 의의를 찾을 수 없었다. 결 론: 면역조절 물질인 thymodulin의 투여로써 숙주 면역계의 기능을 증강시켜 바이러스의 제거를 촉진하고자 소아의 B형 만성 활동성 간염에 ${\alpha}$-interferon 치료시 thymodulin을 병용하여 치료하였으나 ${\alpha}$-interferon 단독 치료보다 더 효과가 있다고 볼 수는 없었으며 향후 더 많은 환아를 대상으로 한 interferon과 다른 종류의 항바이러스제 및 면역조절제 등과의 병용 치료 연구가 더 좋은 결과를 얻기 위해 필요할 것으로 생각한다. Purpose: Though many antiviral or immunomodulatory agents have been used in patients with chronic HBV hepatitis, interferon is considered to be the only effective therapeutic agent so far. Among immunomodulatory agents, thymodulin, the oral form of thymosin, is currently in clinical trial. We compared the efficacy of alfa-interferon therapy alone with a combined therapy of alfa-interferon and thymodulin in children with chronic active hepatitis B. Method: Twenty three children aged 4.4~13.7 years who were known to be positive for HBsAg and HBeAg in serum for at least 6 months and who had biopsy-proven chronic active hepatitis were given either combined therapy of alfa-interferon and thymodulin or alfa-interferon alone, and all children were HBV DNA positive in their serum at the beginning. Follow-ups have been done for at least 1 year after a 6 month course of therapy and clearance of viral replication markers has been evaluated. Results: 1) During follow up period, 11 (48%) children were seroconverted to anti-HBe and were cleared of HBV DNA from their serum. However, 2 of them relapsed after discontinuance of interferon therapy. 2) Seroconversion occurred more frequently among those who had not been vertically transmitted, had elevated serum ALT levels and low HBV DNA levels before interferon therapy. 3) There was no significant advantage of the combined therapy with thymodulin compared to interferon therapy alone. Conclusion: Combined therapy of alfa-interferon and thymodulin failed to demonstrate synergistic effect. We think that combination therapies of alfa-interferon with other antiviral or immunomodulatory agents need to be studied in order to achieve better therapeutic responses.

신생아 담즙정체성 간질환에서 간조직 유전자의 발현 양상

최보화,최병호,정은정,김경모,김행미,박진영,박우현,김문규,김정철,Choi, BoHwa,Choe, Byung Ho,Chung, Eun Jung,Kim, Kyung Mo,Kim, Heng Mi,Park, Jin Young,Park, Woo Hyun,Kim, Moon Kyu,Kim, Jung Chul 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

목 적: 담즙정체를 보이는 환자의 간조직에서 cDNA microarray를 이용한 유전자 발현 분석을 통 하여 담도 폐쇄증의 발생과정에 관여하는 유전자를 규명하고자 연구를 시행하였다. 방 법: 환자의 간조직은 담즙정체를 보이는 11명의 환자로부터 진단적 간생검시 얻은 간조직의 일부를 이용하였다. 이들의 원인 질환은 담도 폐쇄증이 7명, 신생아 간염 증후군이 4명이었다. 정상대조군의 간조직은 생체부분 간이식시 성인 공여자로부터 얻은 간조직의 일부를 이용하였다. 간조직에서 분리된 mRNA를 4.7K 인간유전자 cDNA microarray를 이용하여 유전자 발현의 양상을 분석하였다. 결 과: 분석한 4,700종의 유전자 중 담즙정체 환자 11명 모두의 간조직에서 발현이 증가된 유전자는 17종이 발견되었고, 발현이 감소된 유전자는 20종이 발견되었다. 담도 폐쇄증 환자와 신생아 간염 증후군 환자 사이에 49종의 유전자에서 발현의 차이가 관찰되었고, 특히 담도 폐쇄증에서는 발현이 증가하였으나 신생아 간염 증후군에서는 발현이 감소된 유전자는 24종이었으며 이들 유전자 발현의 차이에 의해서 두 군간의 감별이 가능하였다. 결 론: 신생아 간질환에서 담도 폐쇄증 환자들은 모두 일정한 양상을 보여주어 이에 대한 분석을 통하여 담도 폐쇄증의 조기 감별 진단을 할 수 있을것을 시사하였다. 또한 담도 폐쇄증에서 특이 발현을 보이는 유전자의 추가적인 기능 연구를 시행함으로써 담도 폐쇄증의 원인을 규명하는데 도움을 줄 수 있을 것으로 생각한다. Purpose: To identify genes specifically expressed in biliary atresia, we compared the patterns of gene expression between biliary atresia and neonatal hepatitis syndrome using cDNA microarray analysis. Methods: Liver tissues were taken from livers of 11 patients (7 patients with biliary atresia and four with neonatal hepatitis) with neonatal cholestasis by needle biopsy. Normal control could be obtained from donor liver tissue during living-related liver transplantation. Total RNA was extracted from each samples and reversely transcribed to make cDNA. Then fluorescent cDNA were pooled and hybridized to the clones on the microarray. Fluorescence intensities at the immobilized targets were measured. Utilizing cDNA arrays of 4.7 K human genes, gene expression profiles were analyzed. Results: Among 4,700 microarray clones, 17 cDNA clones were significantly over-expressed in all 11 patients with neonatal cholestasis, while 20 clones were significantly decreased. Genome-wide expression analysis was carried out in livers obtained at the time of diagnosis. We could identify 49 genes, in which there showed differential expression between biliary atresia and neonatal hepatitis syndrome. Conclusion: This study shows the pattern of differentially expressed genes in biliary atresia and neonatal hepatitis syndrome. We believe that this study can contribute to the understanding of pathogenesis of neonatal cholestasis.

Laparoscopic Removal of a Gastric Trichobezoar in an 8-Year-Old Girl - a Case Report -

최규석,최병호,박진영,Choi, Gyu-Seog,Choe, Byung-Ho,Park, Jin-Young Korean Association of Pediatric Surgeons 2010 소아외과 Vol.16 No.1

Gastric trichobezoars are commonly observed in young women with trichotillomania and trichophagia. We encountered an 8-year-old girl who had trichotillomania and trichophagia with abdominal pain and a mass, which was diagnosed as a large gastric trichobezoar. On physical examination, a huge, firm nontender mobile mass was palpated in her epigastrium. An upper gastrointestinal series and abdominal computed tomography (CT) scan showed a large mass in the stomach. Endoscopic removal was tried but failed. Laparoscopic removal was therefore performed. The trichobezoar was successfully retrieved through a gastrotomy and removed through an extended umbilical trocar incision. This case demonstrates that laparoscopic removal of large gastric trichobezoars is feasible and safe without a large abdominal incision.

영유아 급성 설사의 영양 공급: 탈수 치료 후 연령별 식이요법을 중심으로

추미애,최병호,Chu, Mi Ae,Choe, Byung-Ho 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.suppl1

The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.