수술 후 잔위에서 Helicobacter pylori의 분포와 역할

최윤종 ( Yeun Jong Choi ),김현수 ( Hyun Soo Kim ),박동훈 ( Dong Hoon Park ),김문영 ( Moon Young Kim ),백순구 ( Soon Koo Baik ),이동기 ( Dong Ki Lee ),권상옥 ( Sang Ok Kwon ),박광화 ( Kwang Hwa Park ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

Background/Aims: The distribution of Helicobacter pylori (H. pylori) and its effect on postoperative remnant gastritis has not been clearly investigated. Thus, we carried out this study to examine H. pylori positive rate in the body and cardia and to assess the role of H. pylori on the pathogenesis of remnant gastritis. Methods: Eighty-two patients who had undergone gastric surgery (Billroth I, II) were studied. Four biopsy specimens were obtained from the cardia and oral side of anastomosis for histological analysis and CLO test. The histological grades of gastritis were determined by four parameters of visual analogue scales adopted by updated Sydney system. Results: The overall positive rate of H. pylori was 48.8%. Among the infected patients, H. pylori positive rate was significantly higher in the cardia than in the body (87.5% vs. 37.5%, p< 0.01). The H. pylori positivity was not associated with age, sex, primary disease, type of surgery, chemotherapy, and postopertive interval. The gastritis scores of inflammatory cell infiltration were higher in H. pylori positive patients. However, the scores of atrophy and intestinal metaplasia were not significantly different between the two groups. Conclusions: The H. pylori positive rate is higher in the cardia than in the body of postoperative remnant stomach. It suggests that H. pylori may play an important role in remnant gastritis through acute and chronic inflammatory cell infiltration. (Korean J Gastroenterol 2003;41:177-182)

간경변 환자에서 말초신경병증의 임상적 특성과 신경전도검사 소견

최윤종 ( Yeun Jong Choi ),백순구 ( Soon Koo Baik ),석기태 ( Ki Tae Suk ),김정민 ( Jung Min Kim ),지명관 ( Myeong Gwan Je ),김현수 ( Hyun Soo Kim ),이동기 ( Dong Ki Lee ),권상옥 ( Sang Ok Kwon ),박기철 ( Ki Chul Park ),이지용 ( Ji 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: In liver cirrhosis, symptoms such as paraesthesia and numbness are associated with peripheral neuropathy (hepatic neuropathy). The prevalence and nerve conduction study (NCS) of hepatic neuropathy have not been reported yet in Korea. This prospective study was designed to evaluate the prevalence, clinical characteristics, and NCS of hepatic neuropathy, and to compare peripheral neuropathy of alcoholic cirrhosis with that of nonalcoholic cirrhosis. Methods: Seventy-three patients with liver cirrhosis underwent neurological evaluations including a history and neurological examinations relevant to the peripheral nervous system. NCS was performed in all subjects. Results: Peripheral neuropathy was found in 53.4% of the patients. Sensory neuropathy was observed more frequently than motor neuropathy on NCS. Overall, the pattern of neuropathy was axonal degeneration. There was no difference in the characteristics of peripheral neuropathy between the patients with alcoholic cirrhosis and the patients with nonalcoholic cirrhosis. Among 29 patients with neurologic symptom and sign, 22 patients (76%) showed an abnormality in NCS. Conclusions: The prevalence of peripheral neuropathy is 53.4%. This study suggests that symptoms such as numbness or paraesthesia in patients with cirrhosis are related to peripheral neuropathy. (Korean J Gastroenterol 2003;41:486-492)

복수로 발현된 전신성 홍반성 루푸스

이지수 ( Ji Soo Lee ),최윤종 ( Yeun Jong Choi ),이원기 ( Won Ki Lee ),이찬희 ( Chan Hee Lee ),송창호 ( Chang Ho Song ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.1

The major presenting manifestations of systemic lupus erythematosus (SLE) in Korea are known to be cutaneous manifestations, arthritis, nephritis, and fever. The ascites due to peritoneal involvement in SLE is quite common. However, it is unusual for massive ascites to be major presenting manifestations of SLE. In this report, we describe a case of SLE patient whose disease manifested as intractable ascites. This illustrates an unusual presentation and natural history of a complex autoimmune disease.

내시경적 점막절제술을 이용한 위의 전암병변 및 조기위암의 치료

정필호(Phil Ho Jung),이동기(Dong Ki Lee),이상철(Sang Cheol Lee),김준명(Jun Myeong Kim),백순구(Soon Koo Baik),김일희(Il Hoi Kim),최윤종(Yeun Jong Choi),조도연(Do Yeun Cho),이종인(Chong In Lee),권상옥(Sang Ok Kwon) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: Gastrectomy with lymph node dissection is the stare4rd treatment for early gastric cancer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. Method: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRI.), Resuts : The complete resection rate at the first step of EMR was 100%(13/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incompletely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in RX. We final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMHL, As pathologic results, all cases of F were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. Conclusion: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with prernalignant lesions.

간경변증에 동반된 특발성 세균성 복막염의 재발빈도 및 예견인자

백순구(Soon Koo Baik),권상옥(Sang Ok Kwon),박의련(Eui Ryun Park),김준명(Jun Myeong Kim),이용규(Yong Gyu Lee),최윤종(Yeun Jong Choi),김일희(Il Hoi Kim),이동기(Dong Ki Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objectives: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in u large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. Method: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. Results: The incidence of SRP was 21.8% (68 cases) and showed 80.9% in male, 19.1% in female. Seven- teen (25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrant SBP. Conclusion: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein ≤1.0 g/dl, prothrombin time 45% may not be a sensitive predictor of recurrent SBP.

공터키안을 동반한 쉬한 증후군에서 그레이보스 병이 병발된 2예

최윤종,정춘희,박의련,김홍승,신영구 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.4

The empty sella syndrome is characterized by obesity, frequent pregnancy, headache and high blood pressure, but its exact cause remains unknown. Usually the incomplete diaphragmatic sella has been considered as the cause of the empty sella syndrome, but some authors recently have suggested that the antipituitary antibody way be related to development of pituitary atrophy and the pituitary empty sella syndrome, and thus it may be clinically useful as screening test for the empty sella syndrome. We experienced two empty sella syndromes associated Graves disease and applied the antipituitary antibody as the diagnostic tool of the empty sella syndrome. But none of this two patients had antipituitary antibody and we report these cases with reviews of literatures. (J Kor Soc Endoerinol 11:517~522, 1996)

위 점막하 종양으로 발현된 동정맥 기형 1예

백순구,조미연,김준명,권상옥,이동기,김윤미,최윤종,김일회 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.4

Arteriovenous malformations (AVM) are an unusual cause of gastrointestinal (GI) bleeding. But most GI AVM can occur with GI bleeding. When conventional diagnostic studies have failed to reveal the source of GI bleeding, AVM have been one of the most common causes. But the incidence of AVM presented as bleeding of a gastric submucosal tumor is very low. A case of gastric submucosal tumor was experienced and reported as an AVM. This case is herein discussed with review of corresponding literature.

간경변 환자의 문맥압 항진증을 평가하는데 있어 도플러 초음파 검사와 간정맥 압력차 측정의 비교

정필호,백순구,최윤종,박동훈,김문영,김현수,이동기,권상옥,김영주,박중화,김남동 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3

목적: 도플러 초음파 검사는 간경변증 환자에서 문맥압 항진증의 정도 판정이나 문맥압을 떨어뜨 리는 약물의 효과를 알아보는데 사용되어 왔으나, 실제 문맥압 측정을 대변할 수 있는지에 대해서는 논란이 많다. 이에 본 연구자들은 도플러 초음파 검사가 문맥압 항진증의 진단 및 약물의 효과를 판정하는데 간정맥 압력차를 대신할 수 있는지 알아보고자 하였다. 대상과 방법: 간경변 환자 105 예에서 도플러 초음파를 이용하여 간문맥과 비장정 맥의 혈류속도, 혈류량 그리고 간동맥, 비장동맥 및 신장동맥의 박동지수와 저항지수를 산출하여 간정맥 압력차와의 상관관계를 구하였다. 이 중 31 예를 대상으로 terlipressin 투여 전, 후 간정맥 압력차와 간문맥 혈류속도를 같이 측정하여 간정맥 압력차와 간문맥 혈류속도의 변화를 비교하였다. Terlipressin 투여 후 간정맥 압력차가 기저값보다 20% 이상 감소한 경우를 약물의 반응군으로, 그렇지 못한 경우에 비반응군으로 정의하였다. 결 과: 간문맥 혈류속도는 간정맥 압력차가 증가할수록 감소하는 경향을 보였으나 통계학적 의의는 없었다(p>0.05). 비장정맥 혈류속도 또한 간정맥 압력차와 유의한 관계는 없었다(p>0.05). 간동맥과 비장동맥 그리고 신장동맥의 저항 및 박동지수는 간정맥 압력차와 의미있는 상관관계를 보이지 않았다. Terlipressin 투여 후 간정맥 압력차의 감소율은 평균 28.3± 3.9% 였고, 간문맥 혈류속도의 감소율은 31.2± 2.2% 였다. 그러나 간문맥 혈류속도 는 약물 반응군과 비반응군 모두에서 기저값에 비해 각각 31.7± 2.4%, 29.5± 6.1%가 감소하였다. 결론: 도플러 초음파 검사는 문맥압 항진증의 진단과 약물에 대한 반응을 평가하는데 있어 간정 맥 압력차의 측정을 대신할 수 없다. Background/Aims: This prospective study aimed to determine if Doppler ultrasonography can be representative of hepatic venous pressure gradient (HVPG) in assessing the severity of portal hypertension and response to drug reducing portal pressure. Methods: The HVPG and the parameters of Doppler ultrasonography including portal venous velocity (PVV) and splenic venous velocity, the pulsatility and resistive index of hepatic, splenic and renal arteries were measured in 105 patients with liver cirrhosis. In 31 patients the changes of hepatic venous pressure gradient and portal venous velocity after administration of terlipressin were evaluated. The patients who showed a reduction in HVPG of more than 20% of the baseline were defined as responders to terlipressin. Results: Any Doppler ultrasonographc parameters did not correlate with HVPG. Both HVPG and PVV showed a highly significant reduction after the administration of terlipressin(-28.3± 3.9%, -31.2± 2.2% respectively). However, PVV decreased significantly not only in responders(31.7± 2.4%) but also in nonresponders(29.5± 6.1%). Conclusion: Doppler ultrasonography can not be representative of HVPG in assessing the severity of portal hypertension and response to drug reducing portal pressure in liver cirrhosis. (Korean J Hepatol 2002;8:264-270)

경구경유두적 경로로 제거가 불가능한 총수담관결석의 경피경간적 경로를 통한 치료의 유용성

서정인,이동기,최윤종,정필호,김문영,박동훈,김현수,백순구,권상옥 大韓消化器內視鏡學會 2002 Clinical Endoscopy Vol.25 No.6

도플러 초음파를 이용한 간경변증 환자의 복부 및 전신 혈역학에 대한 연구

장세진,김현수,백순구,어영,최윤종,권상옥,이동기 대한소화기학회 2000 대한소화기학회지 Vol.35 No.4

Background/Aims: This study was designed to find out the effects of nitric oxide (NO) on the splanchnic and extrasplanchnic vascular hemodynamics of patients with liver cirrhosis using Doppler ultrasonography. Methods: For 43 controls and 67 patients with cirrhosis (39 in Child A and B, 28 in Child C), blood flow and resistive index (RI), pulsatility index (PI) of the superior mesenteric artery (SMA), and cardiac output and systemic vascular resistance index were measured with Doppler ultrasonography. The serum NO concentration of all subjects was measured using Griess reaction. Results: In cirrhosis group, the flow of SMA blood was increased and the concentration of NO was significantly higher than in controls. The increase in SMA blood flow paralleled the degree of liver dysfunction. SMA RI and PI were significantly lower in cirrhosis group than in controls, and the decrease in SMA RI and PI paralleled the degree of liver dysfunction. NO had a significantly negative correlation with SMA RI and PI, but not with systemic vascular resistance index. Conclusions: Doppler ultrasonography may be a useful method for evaluating hemodynamics in patients with liver cirrhosis. Moreover, an increase in splanchnic blood flow maintaining portal hypertension is associated with a decrease in splanchnic vascular resistance which might be mediated by NO.