1980年度 痢疾樣 大便을 가진 患兒들에 對한 臨床的 細菌學的 觀察

趙龍勳,南聖枝,具滋薰,安斗洪,薛盛用 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.2

1980年 1月부터 1980年 8月까지 滿 8個月間 痢疾樣 大便을 主訴로 本 小兒科에서 入院및 來院한 患兒 75名을 對象으로 臨床的, 細菌學的 觀察을 하여 다음과 같은 咸績을 얻었다. 年齡別 分布는 1歲에서 5歲 사이가 35例(47%)로 가장 높았으며 이들中 Shigella는 23例(30%), Entameba histolytica는 13例(17%)였고 Vibrio parahaemolyticus는 한 例도 檢出되지 않았다. 檢出된 Shigella 23菌株는 모두 Shigella flexneri 였다. 月別分布는 6月 16例(20%), 7月 30例(40%)로서 最多數를 占하였으나 細菌性 痢疾의 경우 月別에 관계없이 均等하게 分布하고 있었다. 臨床症狀및 理學的 所見으로는 細菌性痢疾의 경우 38℃ 以上의 發熱 19例(83%), 嘔吐 6例(26%), 腹痛 8例(35%), 痙攣 5例(22%)였으며, 아메바性 痢疾에서는 發熱 4例(31%), 痙攣 1例(8%)로서 細菌性 痢疾에서 아메바性 痢疾보다 發熱과 痙攣이 빈번히 나타났다. 泄瀉의 性狀에서는 細菌性 痢疾 23例中 血粘液性이 19例(83%)였는데 비해 아메바性 痢疾 13例에서는 粘液性이 8例(62%)였다. 泄瀉의 回數에서도 細菌性 痢疾에서는 대부분이 11回以上이었는데 比해 아메바性 痢疾에서는 대부분이 10回未滿이었다. 末梢血液에서의 白血球數는 全例의 35%에서 白血球 增多症을 보였다. 分離된 Shigella 23菌株에 對한 抗生劑 感受性 檢査를 平板混合포稀釋法에 依해 調査해 본 結果 kanamycin, gentamicin, amikacin, cephaloridine, rifampin이 100%의 感受性을 나타내어 가장 높았고, nalidixic acid에서도 87%의 感愛性을 나타냈으며, sulfonamide, chloramphenicol, streptomycin, tetracycline, ampicillin, bactrim 에서는 한 菌株를 제외한 모든 菌株에서 耐性을 나타냈다. 그리고 이들 Shigella 23菌株中 1菌株를 제외한 나머지 모든 菌株에서 6種 以上의 抗生物質에 對해 多抗生物質耐性을 보여 주었다. A clinical and laboratory study was conducted on 75 children with dysentery-like stool, who were admitted or visited to our pediatric department during 8 months period from January to August 1980. The following results were obtained: One to five years of age group was affected most frequently (47%). Shigella flexneri was identified by stool culture in 23 cases (30%) and Entameba hitolytica in 13 cases (17%). In bacillary dysentery group, fever was the most common symptom occuring in 83%, followed by abdominal pain in 35%, vomiting in 26% and convulsion in 22%. In amoebic dysentery group, fever was noted in 31% and convulsion in 8%, showing some contrast to the frequency of fever and CNS manifestation. About the character of diarrheal stools, 83% of bacillary dysentery group showed bloody, mucoid stool and 62% of amoebic dysentery group mucoid ones. Frequency of diarrhea was 11 times per day or more in 73% of bacillary dysentery patients, and 10 times per day or less in 92% of amoebic dysentery patients. The result of sensitivity test of isolated Shigella to various antibiotics were as follow: 100% sensitive to kanamicin, gentamicin, amikacin, cephaloridine and rifampin. 87% to nalidixic acid, and 4.3% to sulfonamide, chloramphenicol, streptomycin, tetracyclin, ampicillin and bactrim. And 22 out of 23 isolated Shigella strains revealed multiplydrug-resistance patterns to 6 or more antibiotics.

Efficacy and Safety of TJP-008 Compared to 2 L PEG with Ascorbate in Colon Cleansing: A Randomized Phase 3 Trial

Koo Ja Seol,Byeon Jeong-Sik,Lee Bo-In,Jung Sung-Ae,Kim Tae Il,Jeen Yoon Tae 거트앤리버 소화기연관학회협의회 2022 Gut and Liver Vol.16 No.2

Background/Aims: Polyethylene glycol (PEG)-based bowel preparations are effective cleansing agents for colonoscopy. However, they require relatively large volumes to be used even with agents such as 2 L PEG with ascorbate (2LPEG). This phase 3, randomized, single-blinded, multicenter, parallel-group study compared the efficacy of 1 L PEG with high-dose ascorbate, TJP-008, to 2LPEG. Methods: Patients undergoing colonoscopy were randomized (1:1:1) to receive TJP-008 as 1-day split dose (TJP-008-1) or 2-day split dose (TJP-008-2) regimen or to receive 2LPEG as a 2-day split dose regimen. Cleansing efficacy was evaluated using the Harefield Cleansing Scale. The primary endpoint was overall bowel cleansing success. Full analysis set (FAS) and per protocol set (PPS) analyses were performed. Results: Of the 314 screened patients, efficacy was assessed in the following patient numbers (FAS/PPS): total (293/285), TJP-008-1 (98/94), TJP-008-2 (97/95), and 2LPEG (98/96). FAS revealed noninferiority between TJP-008 and 2LPEG with regard to overall success (TJP-008- 2, 99.0%; TJP-008-1, 95.9%; 2LPEG, 94.9%; p=0.100 and p=0.733, respectively). PPS also showed noninferiority (p=0.721 and p=0.211, respectively). However, the PPS analyses showed a higher bowel cleansing score for TJP-008-2 for high-quality cleansing in the right colon (TJP- 008-2 83.2% vs 2LPEG 62.5%; p=0.005). Conclusions: TJP-008 is a new low-volume cleansing agent with a colon cleansing efficacy comparable to that of standard 2LPEG that exhibits significant safety and tolerability.

Poster Session : PS 0864 ; Lower GI Tract : Matrine Induces Intestinal Apoptosis in Experimental Colitis Model

( Ja Seol Koo ),( Chun Hee Kim ),( Seung Young Kim ),( Jong Jin Hyun ),( Sung Woo Jung ),( Yoon Tae Jeen ),( Sang Woo Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Matrine, the major alkaloid component from Sophora flavescens, has been used to treat chronic hepatitis in China. It has been reported that matrine has several pharmacological effects including regulation of immune reaction, anti-inflammation. However, the impact of matrine on apoptosis of intestine is unknown. Methods: Intestinal epithelial cells (IEC-18) were used to determine the in vitro effect of matrine on LPS-induced apoptosis signaling. The therapeutic efficacy of matrine was assessed using dextran sulfate sodium (DSS) exposed mice. Matrine treatment (100 or 200 mg/kg) was adminstered by using oral gavage. Disease activity index including weight loss, stool consistency, and stool blood and histologic score was used to determine the colitis severity. Apoptosis of mouse was evaluated with western blot and TUNEL assay. Results: In vitro study, the expression of Bax significantly increased, Bcl-2 and Cox decreased in IEC-18 cells treated with matrine. The effect for inhibition of appoptosis, evaluated by Western blot was increased with dose of matrine. In DSS-induced acute colitis, disease activity index and histological scores were not significantly different among the mice groups according to the matrine treatment. As shown in vitro study, the expression of Bcl-2 was decreased in the matrine treatment mice. However, Bax was increased in low dose matrine (100 mg/kg) and decreased in high dose (200 mg/ kg). In the same manner, cleaved Caspase-3 was increased in the mice group treated with low dose matrine. Furthermore, Tunel assay in colon tissues of matrine treated mice was not signficantly different with that of matrine untreated mice. Conclusions: In our study, matrine increased apoptosis on LPS-induced IEC-18 cells. In DSS-induced colitis, low dose matrine resulted in decrease of the anti-apoptotic protein Bcl-2 and increase of the proapoptotic protein Bax and cleaved Caspase-3.

Abdominal Obesity as a Risk Factor for the Development of Erosive Esophagitis in Subjects with a Normal Esophago-Gastric Junction

( Ja Seol Koo ),( Sang Woo Lee ),( Sun Min Park ),( Sung Woo Jung ),( Hyung Joon Yim ),( Jong Jae Park ),( Hoon Jai Chun ),( Hong Sik Lee ),( Jai Hyun Choi ),( Chang Duck Kim ),( Ho Sang Ryu ) 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4

Background/Aims: Obesity is reported to be associated with erosive esophagitis (EE). However, the temporal association of obesity and abdominal obesity with EE is unclear. We conducted this study to investigate the temporal association of obesity, especially abdominal obesity with EE. Methods: Among 1,182 subjects who underwent health screening examinations including upper endoscopy in both 2003 and 2006, a total 1,029 subjects with a normal esophagogastric junction on upper endoscopy in 2003 were enrolled. All subjects completed questionnaires and anthropometric measurements were obtained twice by trained personnels. The patients with newly developed EE were compared to the subjects without newly developed EE. Results: Among 1,029 subjects, 42 (4.1%) were newly diagnosed with EE and 82 (8.0%) with hiatal hernia. The mean body mass index (BMI) in both examinations was significantly different between the two groups based on the development of erosive esophagitis (p<0.05 in both examinations). The mean waist circumference (WC) in both examinations was also significantly different between the two groups (p<0.01 in both examinations). The multivariate analysis demonstrated that EE was not associated with the BMI in 2003 and the increase of BMI; however, it was associated with the WC in 2003 (Odds ratio, 7.21; 95% CI, 1.78 to 29.19; >90 cm vs <80 cm). Conclusions: Our study showed that abdominal circumference is an independent risk factor for EE, demonstrating a temporal relationship between abdominal obesity and EE. (Gut and Liver 2009;3: 276-284)

Poster Session : PS 0893 ; Lower GI Tract : Predictors of Clinical Response to Immuno-Modulators in Moderate to Severe Crohn`s Disease: Connect Study

( Sangyoon Chung ),( Ja Seol Koo ),( Kwang Seok Kim ),( Chang Bum Bae ),( Ji Kyoung Lee ),( Joo Hee Park ),( Seung Young Kim ),( Jong Jin Hyun ),( Sung Woo Jung ),( Bora Keum ),( Beom Jae Lee ),( Yoon 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background/Aims: Immunomodulators such as azathioprine (AZA) and 6-mercaptopurine (6-MP) have been used for induction and maintenance treatment of Crohn`s disease (CD) and have effect on decrease of the steroid dose in active CD. The aims of study is to evaluate the predictive factors of response to AZA/6-MP in patients with moderate to severe CD. Methods: Among total 1,499 patients registered on Crohn`s cohort in Korea, 1,382 were enrolled in this study. The medical records including baseline characteristics, location and type of CD, complications, treatment agents, and surgical treatments were reviewed retrospectively. The patients with AZA/6-MP treatments were divided into two groups according to the additional treatments such as biologic agents and/or surgical treatment. Univariate and multivariate analyses were conducted to evaluate the predictive factors of clinical response to immunomodulators. Results: Among 1,382 patients with CD, AZA/6-MP treatment was used in 926 (67.0%). Between two groups according to AZA/6-MP treatment, the treatment group was younger than the other group (mean age, 25.8 vs 32.4, p<.001). AZA/6-MP treatment was used more frequently in patients with ileocolonic CD (62.5% vs 45.4%, p=.007) and with perianal disease (29.5% vs 21.0%, p<.001). In 926 patients with AZA/6-MP treatment, 376 (40.6%) were treated with biologic agents and/or surgical treatment. Between two groups according to the result of AZA/6-MP treatment, the disease locations were significantly different (p=.007), although the disease behaviors were not different. Multivariate analysis revealed that the disease location (p=.003) and age at diagnosis (p=.029) were significantly associated with AZA/6-MP treatment failure. Conclusions: AZA/6-MP treatment is effective on induction and maintenance treatment in CD. However, early biologic treatment should be considered in young age, colonic CD, since their AZA/6-MP treatment is less effective.

The Korean Society of Gastroenterology & SIDDS 2053 : Slide Session ;K-LG-24 : Lower GI Tract ; Ten Years Follow Up Risk of Colorectal Neoplasia after Initial Negative Colonoscopy

( Sang Yoon Chung ),( Ja Seol Koo ),( Seung Young Kim ),( Jong Jin Hyun ),( Sung Woo Jung ),( Bora Keum ),( Beom Jae Lee ),( Yoon Tae Jeen ),( Sang Woo Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background/Aims: In Korea, the surveillance colonoscopy after initial negative colonoscopy is recommended 5 years after negative colonoscopy. We evaluated the risk factors for colorectal neoplasia after negative screening colonoscopy. Methods: Among the patients underwent screening colonoscopy at Korea University Ansan Hospital from Jan. 2002 to Dec. 2009, the subjects without adenomas wereenrolled in the study retrospectively. Baseline characteristics on index colonoscopy and surveillance colonoscopic fi ndings were reviewed. Advanced adenoma was de-fi ned as an adenoma that met more than one of the following criterias: a size =10 mm, the presence of a substantial villous component, the presence of high-grade dysplasia. The prevalence of any adenoma and advanced adenoma were identifi ed and the risk factors on surveillance colonoscopy after negative screening colonoscopy were evaluated by using Cox regression model. Results: Among total 3,516 patients with screening colonoscopy, 1,506 without any adenomas were enrolled. The median of follow up interval after screening colonoscopy was 47.3 months(range,12.0 ~ 124.8). The incidence of any adenoma within 5years after negative colonoscopy was 293(29.0%) and those of any adenoma from 5 to 10 years was 135(27.2%). The prevalences of same terms in advanced adenoma were23(2.5%) and 8(1.4%). In cox regression analysis, the prevalence of any adenoma on surveillance colonoscopy were significantly increased in male(P<0.001) and old age(P<0.001). However, male gender and age were not associated with risk of advanced adenoma. Conclusions: Among the subjects with no colorectal adenoma on initial screening colonoscopy, the incidence of advanced adenomas was 2.1% on 10 year follow up surveillance. Although gender and age is associated with metachronous colorectal adenoma on surveillance colonoscopy, those are not associated with advanced adenoma. Therefore, surveillance interval of colonoscopy can be prolonged to 10 years.

Role of IL-1ra and Granzyme B as biomarkers in active Crohn’s disease patients

Kim, Tae Jun,Koo, Ja Seol,Kim, Sung Jin,Hong, Sung Noh,Kim, You Sun,Yang, Suk-Kyun,Kim, Young-Ho Informa UK (TaylorFrancis) 2018 Biomarkers Vol.23 No.2

Heterotopic Gastric Mucosa causing leading to Recurrent jejunal Intussusceptions

( Hwan Il Kim ),( Ja Seol Koo ),( Jee Hyun Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Heterotopic gastric mucosa (HGM) is a rare anomaly in the small bowel and supposed to be of vitellointestinal tract origin. In addition, HGM may cause intussusception as a lead point in the jejunum. A 5-year-old girl presented with chief complaints of vomiting and abdominal pains for 2 weeks. Her past medical and family histories were unremarkable. There was history of constipation. Medical therapy aimed at vomiting was unsuccessful. The abdominal computed tomography (CT) scan revealed the intussusception at proximal jejunal loops. Three times air reduction and once saline reduction was performed. At exploratory laparotomy, the intussusception could not be found. The patient continued to be symptomatic and referred for endoscopic evaluation. Enteroscopy withgastroscope showed some variable size polypoid mucosal lesions with erosions on proximal jejunum. We performed endoscopic mucosal resection to remove the jejunal lesion. Histopathologic evaluation showed hyperplastic polyps arising from heterotopic gastric mucosa. In immunohistochemical staining, these polyps expressed MUC4, MUC5AC, MUC6, MUC2, and c-erbB2, but negative for MUC1. Despite its rarity, HGM should be considered as a cause of recurrent intussusceptions and diagnostic studies should be performed

Predictors of Inadequate Bowel Preparation and Salvage Options on Colonoscopy

Ju Sung Sim,Ja Seol Koo 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.4

Inadequate bowel preparation is observed in more than 25% of all colonoscopies. Identification of predictive factors for inadequate colon cleaning is helpful and more detailed preparation methods should be used for patients at high risk. Age, male sex, inpatient status, and comorbidities were identified as independent risk factors in several previous studies. In patients with insufficient colon preparation, colon irrigation with endoscopic pumps or next-day colonoscopy following further bowel cleaning should be performed. In order to improve the efficacy and safety of both bowel preparation and colonoscopy, the endoscopic team should identify the patient’s medical conditions and choose the optimal bowel preparation agent and regimen.

S-13 : Enterohepatic Fistula developed after Therapeutic Embolization of Active Ileal Bleeding in GIST

( Yun Ho Lee ),( Ja Seol Koo ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Gastrointestinal stromal tumor is a rare mesenchymal tumor of gastrointestinal tract tumors and associated with fistula formation on adjacent organ in a few case reports. However, Gastrointestinal stromal tumor with enterohepatic fistula has been not reported. We report a case of enterohepatic fistula occurred after embolization of liver mass that originated in the distal ileum. An 87-year-old woman was hospitalized for melena. On initial conventional endoscopy, the bleeding focus was not found in the gastrointestinal tract. The enteroscopy was performed through the anus due to massive hematochezia and a protruding mass with ulceration was found on distal ileum, which was suspected to cause the bleeding. Electrocoagulation was done for bleeding control after biopsy but was not successful. Embolization was conducted to control the active bleeding of ileum. After embolization, she had high fever and severe abdominal tenderness and rebound tenderness. The follow-up abdominopelvic computed tomography revealed the enterohepatic fistula between the liver and distal ileum. The fistula was managed with surgical treatment such as including segmental resection of the distal ileum and unlooping of the liver mass.