만성 요통환자중 비만그룹과 정상그룹과의 혈중지질 및 체력분석

황재철,한상완,김용남,Hwang, Jae-Chul,Han, Sang-Wan,Kim, Yong-Nam 대한물리치료과학회 2000 대한물리치료과학회지 Vol.7 No.2

To examine the blood lipids, muscle strength and flexibility at low back, and muscle strength in the knee joint, 44 women, who were diagnosed as chronic low back pain patients and aged between 40 to 50 years old, were recruited as the subjects. The women were divided into two groups: 1) body fat content less than 25% and 2) body fat content more than 30%. The results were: 1) No differences were found between two groups in blood lipids status. 2) The total cholesterol were less 3.78% in the normal group than the obese group. 3) The HDL-cholesterol were higher 4.85% in the normal group than the obese group. 4) The TG were less 13.1% in the normal group than the obese group. 5) No differences were found between two groups in muscle strength and flexibility 6) No differences were found between two groups in the peak torque of knee joint 7) The total work of the knee joints were higher in the normal group than the obese(P<.05). 8) The abdominal strength were higher 34.04% in the normal group than the obese group. 9) The flexibility of low back were higher 44.54% in the normal group than the obese group.

총담관결석의 진료 가이드라인: 난치성, 재발 담관결석의 내시경 치료

황재철 ( Jae Chul Hwang ),고동희 ( Dong Hee Koh ),최현종 ( Hyun Jong Choi ) 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.4

내시경역행담췌관조영술을 이용한 내시경 치료는 현재총담관결석의 주요한 치료법으로 사용되고 있으며 내시경유두괄약근절개술 시행 후 바스켓이나 풍선 카테터를 이용하는 전통적인 내시경적 방법을 이용하여 약 90%에서 결석의 제거가 가능하다. 그러나 이러한 통상적인 방법으로도 10%정도에서는 완전한 결석 제거가 불가능한 것으로 알려져 있다. 내시경역행담췌관조영술에서 담관결석이 완전히 제거되었음이 확인되어도 5년 이상 장기간 추적관찰연구들에서는 3~15% 정도의 결석의 재발을 보고하고 있다. 아직까지 국내에서는 통상적인 방법으로 제거가 어려운 총담관결석이나 재발성 총담관결석의 내시경 치료에 대한 권고안이 마련되어 있지 않아 현재까지 발표된 이에 대한 유럽, 영국과 미국에서의 가이드라인을 검토하고 이를 근간으로 대한췌담도학회의 진료 권고안을 제안하고자 한다. Endoscopic retrograde cholangiopancreatography and stone extraction are well-established therapeutic procedures for the treatment of common bile duct (CBD) stones. The endoscopic stone removal procedure involves extraction using various devices after endoscopic sphincterotomy (EST). Many reports state that at least 90% of stones are extracted after conventional EST. However, some cases are still difficult to treat. Despite apparently complete clearance of bile duct stones at endoscopic retrograde cholangiography, recurrent CBD stones developed in 3% to 15% of patients. We reviewed the guidelines currently enacted in United Kingdom, Europe and United Stated of America for the management of difficult and recurrent CBD stones. This guideline review suggests the guideline of Korean Pancreatobiliary Association for the endoscopic management of difficult and recurrent CBD stones.

관해기 궤양성 대장염의 재발률 및 재발 관련 인자들

박병준 ( Byoung Joon Park ),이광재 ( Kwang Jae Lee ),황재철 ( Jae Chul Hwang ),신성재 ( Sung Jae Sin ),정재연 ( Jae Yeon Chung ),조성원 ( Sung Won Cho ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.1

Background/Aims: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with heterogeneous clinical features. Data on the disease course and prognosis of UC patients who have been regularly treated are lacking. We aimed to investigate relapse rates of UC in remission and factors related to relapse. Methods: We retrospectively analyzed clinical courses of 84 patients (43 males, median age 43 years, ranged 20-73 years) diagnosed as UC at Ajou University Hospital between January 1997 and December 2005 based on clinical, endoscopic and pathologic findings, and who were regularly followed for at least one year after the remission. Results: Study subjects consisted of 32 proctitis (38%), 21 left-sided colitis (25%), and 31 subtotal or total colitis (37%). Of 84 patients, relapse was observed in 52 patients (62%) during the follow-up period (ranged 1-9 years). The relapse rate was 24%, 41%, 51%, 65%, 71%, and 79% at 1 year, 2 years, 3 years, 4 years, 5 years and 6 years, respectively. Among sex, age, hemoglobin, ESR, and the extent of disease on admission, decrease of hemoglobin level was the only independent factor related to relapse (odds ratio=2.67, 95% CI (1.32-5.42), p<0.01). Conclusions: In Korea, relapse of UC in remission is not rare. Decrease of hemoglobin level is an independent risk factor related to its relapse, while the extent of disease is not. (Korean J Gastroenterol 2008;52:21-26)

풍선 소장내시경을 이용한 내시경역행담췌관조영술

양민재 ( Min Jae Yang ),황재철 ( Jae Chul Hwang ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.3

다양한 중재 방법을 이용한 난치성 총담관결석의 내시경 치료 증례

김아름 ( Ah Reum Kim ),황재철 ( Jae Chul Hwang ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ),양민재 ( Min Jae Yang ) 대한췌장담도학회 2023 대한췌담도학회지 Vol.28 No.3

난치성 담관결석은 내시경 유두 괄약근 절개술 후 EPLBD, 기계적 쇄석술, 경구담관경 유도하 담관 내 전기수압쇄석술 혹은 레이저 쇄석술, 일시적 플라스틱 담관 스텐트 삽입, 경피경간담관경유도하 쇄석술, 체외충격파쇄석술 등 다양한 시술을 통해 해결될 수 있다. 본고에서는 가용 가능한 다양한 방법을 사용하여 난치성 총담관결석을 제거한 증례를 소개하고 각각의 과정에서의 시술의 어려움을 극복하는 대응방법을 논의하고자 하였다. Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser lithotripsy, temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy. We hereby describe the successful endoscopic treatment using various currently available interventional techniques in a case with multiple difficult common bile duct stones. Furthermore, we discuss the countermeasures to overcome the hurdles of each procedure. Korean J Pancreas Biliary Tract 2023;28(3):76-80

총담관결석의 진료 가이드라인: 개발 목적과 과정

김태현 ( Tae Hyeon Kim ),황재철 ( Jae Chul Hwang ),김진홍 ( Jin Hong Kim ),김용석 ( Yong Seok Kim ),김동욱 ( Dong Uk Kim ),서동완 ( Dong Wan Seo ) 대한췌장담도학회 2013 대한췌담도학회지 Vol.18 No.4

총담관결석은 임상의들이 흔히 진료할 수 있는 질환으로 임상적으로 무증상, 복통, 급성 담도염, 급성 췌장염, 그리고 응급처치가 필요한 패혈성 쇼크까지 임상증상이 다양하게 나타난다. 따라서 이를 신속하게 진단하고 적절한 치료를 조기에 시행하는 것은 국민보건과 삶의 질 향상에 매우 중요하다. 혈액검사, 복부 초음파, 복부 CT, MRCP, 내시경초음파 등의 여러 가지 영상 의학적 방법으로 총담관결석을 진단할 수 있다. 또한 대부분의 총담관결석은 내시경역행담췌관조영술과 내시경유두괄약근절개술로 치료가 되고 있지만, 필요에 따라서는 담도내시경, 내시경유두큰풍선확장술, 복강경총담관탐색술, 개복술 등이 사용될수 있다. 임상적인 증상, 총담관결석의 크기, 환자의 상태에 따라서 총담관결석 진단과 치료 방법의 선택이 다를 수있다. 이에 대한췌담도학회에서는 총담관결석의 진단과 치료에 관한 미국과 영국의 진료지침을 수용 개작하여 진료가이드라인을 개발하여 국민보건향상에 도움을 주고자 하였다. Common bile duct (CBD) stones are common and a potentially lethal disease that is associated with significant morbidity and consumes enormous health care resources. New imaging techniques such as multi-detector abdominal computerized tomography, magnetic resonance cholangiography, endoscopic ultrasonography offer the opportunity to accurately visualize the biliary system without instrumentation of the ducts. Endoscopic retrograde cholangiopancreatography has become a major procedure for the removal of CBD stones with a variety of othertechniques. As a consequence clinicians are now faced with a number of potentially valid options for managing patients with CBD stones.It is with this in mind that the following guidelines have been written. In preparing this guideline, a search of the medical literature was performed using variable medical search engines and expert meetings were held. This guideline is based on 2 guidelines proposed by Practical committee of the American Society for Gastrointestinal Endoscopy and British Society Gastroenterology.

총담관 결석의 내시경적 제거술 후 내시경적 경비담관 배액술의 유용성

김순선 ( Soon Sun Kim ),황재철 ( Jae Chul Hwang ),임선교 ( Sun Gyo Lim ),이다미 ( Da Mi Lee ),최재명 ( Jae Myoung Choi ),류경호 ( Kyoung Ho Ryu ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ) 대한췌담도학회 2012 대한췌담도학회지 Vol.17 No.1

배경 및 목적: 총담관 결석의 내시경적 제거 후 일상적인 내시경적 경비담관 배액술 (ENBD)의 유용성은 논란이 있다. 이에 저자들은 총담관 결석의 내시경적 제거술을 받은 환자를 대상으로 ENBD를 시행한 군과 시행하지 않은 군의 임상 치료성적 및 담도염과 잔류 결석의 발생률을 분석하고자 하였다. 방법: 2003년 3월부터 2008년 8월까지 총담관 결석 진단 하에 경구적 내시경적 담석 제거술을 받은 환자 중, 경피적 담관배액술 또는 경피적 담낭배액술을 먼저 시행한 환자, 간내 결석을 동반한 환자, 내시경적 역행성 담도배액술을 시행한 환자를 제외한 532명의 환자를 후향적으로 분석하였다. 결과: 총 532명(남자 282명, 평균나이 62.4세) 중 경구적 내시경적 담석 제거술에 의하여 담석이 완전 제거된 환자는 523명으로 98.3%의 성공률을 보였으며, 이들 523명의 초회 성공률은 96.9%였다. 적응증에 관계 없이 ENBD를 삽입한 군(ENBD-1군, n=28)과 삽입하지 않은 군(Non-ENBD-1군, n=504)을 비교하였을 때 담도염의 발생률(3.6% vs. 2.2%, P=0.48)과, 잔류 총담관 결석 발생률(3.6% vs. 0.6%, P=0.08)은 유의한 차이가 없었다. 총담관 결석의 내시경적 완전 제거 후 일상적인 ENBD삽입이 담도염 및 잔류 총담관 결석의 발생률에 미치는 영향을 알아보기 위하여 ENBD를 삽입한 군(ENBD-2군, n=9)과 삽입하지 않은 군(Non-ENBD-2군, n=500)을 비교하였을 때, 담도염발생률(0.0% vs. 2.2%, P=1.00)과 잔류 총담관 결석 발생률 (0.0% vs. 0.8%, P=1.00) 역시 유의한 차이가 없었다. 결론: 총담관 결석의 내시경적 제거술후 담도염 및 잔류 결석 발생률은 낮고, ENBD를 시행한 군과 시행하지 않은 군에서 차이가 없었다. 따라서 총담관 결석의 내시경적 제거 후 ENBD의 일상적인 시행은 신중하여야 하며, 향후 이에 대한 전향적 연구가 필요하다. Background/Aims: We aimed to compare the clinical outcomes between endoscopic nasobiliary drainage (ENBD) group and non-ENBD group after endoscopic common bile duct (CBD) stone extraction. Methods: From March 2003 to August 2008, a total of 532 patients (282 men; mean age 62.4 years) underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD stone extraction. Results: Among 532 patients, CBD stones were completely extracted in 523 patients (98.3%). Among 523 patients, CBD stone were completely extracted by 1st ERCP attempt in 507 patients (96.9%). ENBD-1 group comprised of 28 patients who received ENBD with any indication. ENBD-2 group comprised of 9 patients who received ENBD routinely after complete CBD stone removal. There was no significant difference in occurrence of post ERCP cholangitis or residual CBD stone between ENBD-1 group (n=28) and Non-ENBD-1 group (n=504) (3.6% vs. 2.2%, 3.6% vs. 0.6%, P=0.48 and P =0.08, respectively), and between ENBD-2 group (n=9) and Non-ENBD-2 group (n=500) (0.0% vs. 2.2%, 0.0% vs. 0.8%, P =1.00 and P =1.00, respectively). Conclusions: Post ERCP cholangitis and residual CBD stone occurred rarely after CBD stone extraction. Therefore routine insertion of ENBD for biliary decompression after CBD stone extraction should be considered prudently.

대장내시경에서 궤양의 특성에 따른 베체트 장염의 임상경과

김민철 ( Min Cheul Kim ),신성재 ( Sung Jae Shin ),임선교 ( Sun Gyo Lim ),이경록 ( Kyung Rok Lee ),우학 ( Hak Woo ),최상조 ( Sang Jo Choi ),조정수 ( Jung Soo Jo ),엄중호 ( Jung Ho Eum ),차동엽 ( Dong Youb Cha ),황재철 ( Jae Chul H 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet’s disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. Methods: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. Results: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. Conclusions: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively. (Intest Res 2010;8:40-47)

궤양성 대장염에서 위 유문부 폐쇄를 일으킨 거대세포바이러스 감염 1예

강성환 ( Sung Hwan Kang ),이기명 ( Kee Myung Lee ),신성재 ( Sung Jae Shin ),임선교 ( Sun Kyo Lim ),황재철 ( Jae Chul Hwang ),김진홍 ( Jin Hong Kim ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.6

In patients with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infections could aggravate the course of IBD but it is difficult to distinguish CMV infection from IBD exacerbation endoscopically. Usually, CMV tends to localize to the colon and other organic in-volvements were reported very rare in the IBD patients. Herein, we report a case that CMV gastric ulcer complicated with pyloric ob-struction in a patient with ulcerative colitis during ganciclovir therapy, which was resolved by surgical gastrojejunostomy with review of literature. (Korean J Gastroenterol 2017;69:359-362)

알레르기 환자에서 dipstick ( Allergodip(R) ) 검사의 유용성 평가

이영목(Young Mok Lee),전윤정(Yoon Jung Chun),황재철(Jae Chul Hwang),최정희(Jung Hee Choi),서유진(Yu Jin Suh),남동호(Dong Ho Nahm),박해심(Hae Sim Park) 대한천식알레르기학회 2001 천식 및 알레르기 Vol.21 No.5

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