만성적인 후두증상을 주소로한 환자에서의 식도내압검사 및 24 시간 보행성 pH 검사소견

방춘상(Choon Sang Bhang),노대근(Dae Keun Lo),박수헌(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeul Han),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),김부성(Boo Sung Kim),조승호(Seung Ho Ch 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: The exact causes of nonspecific chronic laryngitis or laryngeal symptoms are unknown, but many cases of this disease are associated with gastroesophageal reflux or motility disorders of esophagus. We suppose that because Korean people have less gastroesaphageal reflux diseases and the life style including food is different from those of western people, the causes of chronic laryngeal symptoms nre different, So we studied the patients who complained the chronic laryngeal symptoms for evaluation of the role of esophageal motility disorders and gastroesophageal reflux. Methods: 19 patients(male 3, female 16, mean age 40(26-66)) with hoarseness, globus sensation, sorethroat of chronic nature(greater than 3-month duration), not response to conventional therapy of otolaryngologist in St. Mary's Hospital were referred to department of internal medicine. A group of normal, 15 healthy subjects(male 7, female 8, mean age39(24-57)) who had no esophageal or laryngeal symptoms was studied as a control group. All patients and normal controls had manometric studies and 24 hour ambulatory pH monitoring. abnormal findings required pathologic reflux or results greater than the mean plus 2 SDs of normal controls. Results: 1) The chronic laryngeal symptoms were hoarseness in 15 patients(79%), globus sensation in 14 patients(74%), sorethroat in 6 patients(32%), pulmonary symptoms in 3 patients(16%), dysphagia in 2 patients(11%) and heartburn in 1 patient(5%). 2) The lower esophageal sphincter pressure by the rapid pull through tecnique(mean±SD, 27,9± 6.9mmHg) in patients was not different compared with normal controls(31,1±11.0nmHg), 3 patients (16%) had esophageal body dysmotility and all of these were non specific motility disorder. 3) The upper esophageal sphincter pressure(mean±SD, 53.2±23.8mmHg) in patients was not different compared with normal controls(40.9±20.8mmHg), but 2 patients(10.5%) had high upper esophageal sphincter pressures(>82,5mmHg), The postrelaxation pressure of upper esophageal sphincter(mean±SD,98.3±32.1mmHg) was not different compared with normal controls(79,8±30.6mmHg), but 2 patients(10.5%) had high postrelaxation pressures of upper esophageal sphincter(>141mmHg). 4) The time(mean±SD, 321±193msec) between lowest point of upper esophageal sphincter relaxation and onset of pharyngeal contraction was not different compared with normal controls(273.5±179,8msec). 5) The percentage of time of pH less than 4 was 2.4±4.7% in total periods, 2.5±2.3% in upright position and 2.4±9.7% in supine position. Two patients (10.5%) had pathologic reflux(more than 4% of percentage of time pH less than 4 in total periods) and one patient with 2.5% of persentage of time pH less than 4 had high symptom index(66.7%(4/6)). 6) According to above results either of abnormal esophageal pressure or dysmotility was seen in 6 patients(32%) and either of more than 4% of persentage time pH less than 4 in total periods or positive symptom index was seen in 3 patients(16%), Positive results in either of two tests were seen in 7 patients(37%). Conclusion We suggest that some patients who complain the chronic laryngeal symptoms in Korean may have abnormal esophageal motility or gastroesophageal reflux.

Clinicopathological Characteristics of Colon Cancer Diagnosed at Primary Health Care Institutions

( Sang Hyun Park ),( Chi Wook Song ),( Yun Bae Kim ),( Young Sun Kim ),( Hwang Rae Chun ),( Jung Hyun Lee ),( Won Jong Seol ),( Hyung Sun Yoon ),( Myung Kwon Lee ),( Jong Hyup Lee ),( Choon Sang Bhang 대한장연구학회 2014 Intestinal Research Vol.12 No.2

Background/Aims: The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detectedat the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. Methods: Weanalyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified assenior. Results: The mean age (±SD) of subjects was 60.9±10.5 years and 61.1% were men. More than one quarter (28.2%) ofpatients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The mostfrequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%),respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patientswere more likely to display depressed or moderately differentiated adenocarcinoma (P <0.05). The mean age of the right coloncancer group was higher than that for the left colon cancer group (P <0.05). Among symptomatic patients, the most frequentsymptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer(P <0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P <0.05). Theprevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance(P >0.05). Conclusions: Study results indicated an increase of colon cancer amongst younger demographics in recent years.The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of welldifferentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right coloncancer tended to increase with age. (Intest Res 2014;12:131-138)

간;바이러스간염 환자에서 복강경소견과 조직학적 소견의 비교관찰

박수헌,이영길,정규원,김부성,조세현,한준열,선희식,방춘상 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.2

Background/Aims: The authors compared laparoscopic changes of the diseased liver surface according to Shimadas classification with laparoscopic needle biopsy in order to clarify whether the two diagnostic criteria have consistency or discrepancy in each other. By serologicai tests the patients with chronic hepatitis B were 179 cases, chronic hepatitis C 22 cases and NBNC hepatitis 54 cases. Histologically the patients with non-specific reactive hepatitis were 35 cases, chronic lobular hepatitis 20 cases, chronic persistent hepatitis 18 cases, chronic active hepatitis 8~5 cases, subacute hepatic necrosis 32 cases, circumscribed hepatic necrosis 9 cases and liver cirrhosis 56 cases. Methods: We performed laparoscopy on 255 patients with chronic hepatitis and laparoscopic guided liver needle biopsy was done in all cases. Results: 1) Age incidence of chronic viral hepatitis was peak in chronic hepatitis C, and then that in chronic hepatitis B and NBNC heatitis in decreasing order. 2) Code numbers of liver surfaces were mainly numbers between 200 and 300 in chronic hepatitis B and NBNC hepatitis, but those of chronic hepatitis C were numbers between 300 and 400 which meant advanced patterns. 3) Comparing macroscopic fmdings of liver surfaces with histologic diagnosis by guided liver biopsy, the consistency of two criteria was 83.9% in all cases and the discrepancy was 16.1%. 4) Among the cases with diagnostic discrepancy, the patients showing macroscopically chronic hepatitis but histologically liver cirrhosis were predominant in chronic hepatitis B under the age of 40. In contrast to this, the cases showing surface changes of liver cirrhosis but histologically chronic hepatitis was mainly in chronic hepatitis C over the age of 40. Conclusions: The above results suggest that laparoscopy and guided liver biopsy may be very useful diagnostic tools to determine correct diagnosis, adequate treatment and prognosis.

건강성인에서 Helicobacter pylori 감염이 위의 운동 및 감각 기능에 미치는 영향

김병욱,최명규,최황,박성규,방춘상,김진일,한석원,선희식 대한소화관운동학회 1999 Journal of Neurogastroenterology and Motility (JNM Vol.5 No.2

Parkinson 씨 병 환자에서 발생한 대장 가성폐색증 1 예

추교영(Kyo Young Choo),최명규(Myung Gyu Choi),최황(Hwang Choi),방춘상(Choon Sang Bhang),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun) 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2

Colonic pseudo-obstruction (CPO) is a syndrome characterized by obstructive symptoms and signs without mechanical obstruction. Parkinson's disease is one of the various clinical situations developing CPO. Recently, one study group reported that neostigmine was significantly more effective than placebo in rapidly decreasing colonic dilatation in the majority of patients with acute CPO. We experienced a 69-year-old male patient with Parkinson's disease who complained abdominal distension. There was a marked colonic dilatation on plain abdominal radiographs without mechanical obstruction. Colonic dilatation failed to improve with conservative management. Immediate clinical response was achieved after patient received 2.0 mg of neostigmine intravenously under monitoring by electrocardiography. One month later, he had recurrent colonic dilatation, but no clinical response to second administration of neostigmine, leading to colonic decompression. After a third recurrence of colonic dilatation, the patient was refractory to conservative management, and he underwent surgical treatment. (Korean Journal of Gastrointestinal Motility 2001;7:251-256)

인두로 전이된 식도암 1예

박수헌,정규원,최명규,선희식,박두호,노대근,방춘상 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.1

Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures.

운동이상형 소화불량증을 호소하는 당뇨병 환자에서 주석산 시사프리드의 효과

김선명(Sun Myung Kim),추교영(Kyo Young Choo),최명규(Myung Gyu Choi),김진일(Jin Il Kim),방춘상(Choon Sang Bhang),한석원(Sok Won Han),김병욱(Byung Wook Kim),최황(Hwang Choi),김성수(Sung Soo Kim),이동수(Dong Soo Lee),최규용(Kyu Yong Ch 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.1

N/A evaluated the effects of cisapride tartrate on gastrointestinal symptoms and gastric emptying times in diabetic patients with dysmotility like dyspeptic symptoms. Methods: Cisapride was administered before each meal in 61 patients for 4 weeks. The intensity of gastrointestinal symptoms before and after cisapride administration was scored from 0 to 4, in the order of increasing severity of symptoms. In addition, a gastric emptying test was performed. Results: A significant reduction in the total intensity score of symptoms was observed during the first two weeks, from 8.5±2.1 to 4.0±3.0 (p<0.05), and a further reduction was noted during the next two weeks, to 2.8±2.8 (p<0.05). Good to excellent improvement was obtained in 70.4% of the patients, but the improvement in symptoms was not related to age, duration of diabetes, glucose, Hb A1c, neuropathy, or retinopathy. Treatment with cisapride induced a significant regression of symptoms and a significant improvement of delayed gastric emptying from 104.0± 31.7 minutes to 79.5±17.1 (p<0.05). However, there was a lack of association between the changes in gastric emptying times and improvements in symptoms(r2=0.00186). Only 3 patients complained of loose stool, nausea, or dizziness. Conclusions: Cisapride was effective in improving dysmotility like dyspeptic symptoms in diabetic patients without serious side effects. (Korean Journal of Gastrointestinal Motility 2001;7:56-64)

상용량의 Cyclooxygenase-2 선택적 및 비선택적 비스테로이드성 항염제가 위점막 손상, Prostaglandin E2, Tumor Necrosis Factor-alpha 및 중성 백혈구 침윤에 미치는 영향

김진일,정인식,유진영,선희식,박두호,성용직,한석원,김성수,송호진,방춘상 대한소화기학회 2001 대한소화기학회지 Vol.37 No.2

Background/Aims: Recent studies suggested that neutrophil and tumor necrosis factor-alpha (TNF-α) could play a significant role in NSAID-induced gastric mucosal damage. However, there is no data about the relationship between daily usual doses of NSAID and prostalglandin, neutrophil, or TNF-α. Methods: We divided mice into 3 groups and administered indomethacin (3 mg/kg, indomethacin group), NS-398 (3 mg/kg, NS-398 group) or vehicle alone (control group) orally to each mice group for 7 days. Then, we evaluated the concentrations of prostaglandin E2 (PGE2) and TNF-α, neutrophil infiltration and mucosal damage score for their gastric tissue. Results: Indomethacin group showed the lowest concentration of PGE2 and the highest values in TNF-α concentration, neutrophil infiltration and mucosal damage score (p$lt;0.01). NS-398 group showed a lower PGE2 concentration and a higher microscopic mucosal damage score than the control group (p$lt;0.01), but there were no differences in TNF-α concentration, neutrophil infiltn and gross mucosal damage scores. The PGE2 concentration was inversely related to TNF-α concentration (r=-0.768). Conclusions: We suggest that decrease of prostaglandin concentration and increase of TNF-α production and neutrophil infiltration play important roles in NSAID-induced gastric mucosal damage. Cyclooxygenase-2 (COX-2) selective inhibitors, which have less effect on prostaglandin and TNF-α concentration and neutrophil infiltration, can reduce the gastric mucosal damage, as compared with the conventional NSAID.

Helicobacter Pylori에 대한 약제의 감수성 검사

김진일,성용직,김성수,방춘상,박수헌,최명규,김재광,한석원,박두호,염정선,정인식,Kim, Jin-Il,Sung, Yong-Jick,Kim, Seong-Soo,Bhang, Choon-Sang,Park, Soo-Heon,Choi, Myung-Gyu,Kim, Jae-Kwang,Han, Sok-Won,Park, Doo-Ho,Yum, Chung-Sun,Chung, I 대한임상약리학회 1999 臨床藥理學會誌 Vol.7 No.1

연구배경 : Helicobacter pylori에 감염된 소화성 궤양에서 항생제를 이용한 제균 치료는 적극 시행되고 있으나, 가장 중요한 항생제 선택에는 아직 논란이 있다. 이에 연구자는 H. pylori가 감염된 상부 위장관 환자에서 H. pylori를 배양하여 항생제에 대한 감수성 검사를 시행하였다. 방 법 : 1998년 3월부터 1998년 9월까지 가톨릭대학교 의과대학 부속 병원에 상부 위장관 증상을 주소로 내원하여 내시경을 시행한 환자중 H. pylori에 감염된 환자 47명을 대상으로 하였다. 대상 환자는 만성위염 13명, 위궤양 11명 십이지장궤양 23명으로 남자 33명, 여자 14명이며, 평균 연령은 44.6${\pm}$11.25(26세-68세)세 였다. 대상 환자는 내시경 및 조직 생검을 시행하여 vortex를 이용하여 강하게 흔들어 상층액 200 ul를 혈액 한천 배지에 도말한 후 10% $CO_2$와 습도 95%의 조건으로 보정된 $CO_2$ 배양기에서 $37^{\circ}C$로 72시간 동안 배양하였으며, 혈액 한천 배지는 Glaxo selective supplement A를 이용하였다. H. pylori 집락이 나타나면 3회 계대 배양하여 순수 분리한 후 amoxicillin, tetracyclin, metronidazole, clarithromycin에 대한 감수성 검사를 시행하였다. 감수성 검사는 원판 확산 검사와 E-test를 병행하였다. 결 과 : (1) 배양 성공률은 58.8%였다. (2) H. pylori의 항생제에 대한 감수성 검사 47예에서 amoxicillin 43예 (91.5% ), tetracyclin 36예 (76.6% ), metronidazole 25예 (53.2% ), clarithromycin 36예 (76.6%)에서 항생제에 감수성을 보였다. (3) 47예의 대상 환자중 3예(6.4%) 에서 4가지 항생제 모두에 내성을 보였다. 결 론 : H. pylori 균주에 대하여 감수성 검사를 조사한 결과 우리 나라 에서는 amoxicillin에 대한 저항균이 처음으로 발견되었고, clarithromycin에 대한 저항균도 다른 나라보다 많았으며, metronidazole에 대한 저항균이 매우 많았다. 향후 4가지 항생제 모두에 내성을 보인 균주에 대한 치료 약제의 연구가 필요 할 것으로 생각된다. Background : Eradication therapy is recommended for the patients with Helicobacter pylori associated peptic ulcer, because eradication of H. pylori means cure of peptic ulcer disease. The eradication rate of H. pylori can be reached to 80% with PPI based triple therapy in Korea. Drug sensitivity, gastric pH, and compliance are known to affect the eradication rate of H. pylori. In Korea, drug sensitivity has not been studies because of the difficulty of H. pylori culture. It is required that the specific antimicrobial regimens be chosen in consideration of the resistant strains in Korea. Methods : To evaluate the susceptibility of the four antimicrobial agents (such as amoxicillin, tetracyclin, metronidazole, and clarithromycin) to H. pylori, and to determine the retreatment drugs for the patient who failed to initial eradication therapy, prospectively we evaluated 47 patients (23 duodenal ulcer, 11 gastric ulcer, 13 chronic gastritis). Upper endoscopy was performed in al1 patients, and H. pylori was cultured in blood agar plate included Claxo selective supplement A and drug sensitivity test was performed. Results : The results were as follows: 1) Overall culture rate of H. pylori was achieved in 47 of 80 patients (58.8%). 2) The bactericidal activity of amoxicillin, tetracyclin, metronidazole, and clarithromycin was 91.5%, 76.6%, 53.2%, and 76.6%, respectively. 3) The three strains (6.4%) were showed resistant to all four antibiotics. Conclusion : In Korea, amoxicillin resistant strains were identified for the first time, clarithromycin and metronidazole resistant strains were more frequent than in other developed countries.

B 형 바이러스 간염 환자의 간조직에서 Hepatitis Be Antigen 의 발현양상과 조직학적 소견의 비교

정규원(Kyu Won Chung),최창진(Chang Jin Choi),나종순(Jong Soon Na),방춘상(Choon Sang Bhang),박수현(Soo Heon Park),한준열(Jun Yeoul Han),김재광(Jae Kwang Kim),이영석(Young Suk Lee),차상복(Sang Bok Cha),선희식(Hee Sik Sun) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Background: It has been known that the sero- logic markers of infectivity and viral replication in patients with hepatitis B virus(HBV) infection are hepatitis B e antigen(HBeAg), HRV DNA and HBV DNA polymerase. Methods: In order to clarify the relationship between chronic liver diseases and HBV infection, and the mechanism of chronicity in HBV related liver diseases, the expression patterns of hepatic HBeAg by imrnunohistochemical stain and histologic activity index(HAI) were studied from 10% formalin fixed paraffin embedded tissues in 114 patients performed liver biopsy. Results: The results were as follows: 1) Incidence of serum HReAg positivity in HBsAg positive patients was 74.6% and that of hepatic HBeAg expression was 77.6% among serum HBeAg positive cases. Hepatic HBeAg expression was 72.4% in serum HBeAg negative cases. 2) In serum HBeAg positive cases, almost all infected hepatocytes exhibited cytoplasmic HBeAg expression and half of patients showed nuclear HBeAg expression, but cytoplasmic HBeAg expression was solely predominant in serum HBeAg negative cases. Hepatic HBeAg expression showed a decreasing trend from AVH and CPH, through CAH, to cirrhosis with or without HCC, which was a consistent finding with serum HBeAg in decreasing manner. Hepatic HBeAg expreassion was highly sustained in about 60-90% of cases, regardless of duration of their illnesses. 3) HAI showed slighf3y higher tendency in patients with hepatic HBeAg negative expression than in positive cases. Conclusion: The above results suggest that HBeAg may play a role as a viral target antigen for immune-mediated liver injury and may be also related to the pathogenetic mechanism of chronicity in chronic hepatitis B.