십이지장 제2부에 전이된 자궁경부암 1예

이화영,손희정,이규택,김재준,백승운,이종균,이준혁,고광철,이풍렬,이종철,손정일,서연림,전성국 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.1

In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion.

한국인에서 네 번째 발병된 장카필라리아증 1예

이석호,이상구,류광현,고광철,이규택,김재준,최규완,이남용,백승운,이종균,이준혁,이종철,심상군,이풍렬,조승렬 대한소화기학회 1999 대한소화기학회지 Vol.34 No.4

Intestinal capillariasis is caused by Capillaria philippinensis. Among them, only 4 species have been found in humans: Capillaria hepatica, C. aerophila (Eucoleus aerophilus), C. plica and C. philippinensis. Reports of human infections with C. hepatica, C. aerophila and C. plica are rare, but reports of C. philippinensis infections are increasing and spreading geographically. Human infestation by C. philippinensis is a rare parasitic disease. We experienced a case of intestinal capillariasis which was misdiagnosed for intestinal tuberculosis or Crohn's disease at first but correctly diagnosed later by detection of numerous eggs of C. philippinensis on the stool examination. The eggs were found in stool only after ingestion of prednisolone for treatment of misdiagnosed Crohn's disease. The 42 year-old patient had a journey to Saipan island in Pacific ocean 6 months ago and ate sliced raw eels. Abdominal pain, watery diarrhea were subsided after therapy of albendazole.

식도정맥류에 대한 내시경적 정맥류 결찰요법 후 재출혈 및 재발과 연관된 위험인자들

이석호,이규택,김재준,백승운,최문석,이종균,이준혁,고광철,이풍렬,오성윤,이종철,최규완 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1

Background/Aims: Rebleeding and recurrence of varices are frequent problems following endoscopic variceal ligation (EVL). However, few data are available on the risk factors associated with rebleeding and recurrence. Our aims were to elucidate the clinical feaNres and risk factors associated with rebleeding and recuuence. Methods: One-hundred and eight patients who had undergone EVL due to bleeding esopltageal varices were included in the study. EVL was performed with the Stiegman-Goff Endoscopic Ligator at 2 week intervals until the varices are eradicated or reduced to grade 1 without red color sign (defined as successful EVL), followed by gastroscopy every 3 months. Rebleeding was defined using the descriptions from the Second Baveno International Consensus Meeting, in 1995. Recurrence was defined as increments of varices to grade 2 or greater or appearance of red color sign on follow-up examinations. The Kaplan-Meier method was used to determine the rebleeding and recurrence rate. The Log-rank lest and Cox regression lest were used for univariale and multivariate analysis of risk factors, respectively. Results: 1) The most common cause of rebleeding within 2 weeks from the EVL was esophageal ulcer (50%); whereas, the most common cause of rebleeding after 2 weeks was recurrent varices (38%). 2) In univariate analysis, persistence of esophageal ulcer at 2 weeks after the first EVL was associated with rebleeding (p=0.01); whereas, age, Child class, grade and extent of varices, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p >0.05). Persistence of esophageal ulcer at 2 weeks after the first EVL was associated with rebleeding also in multivariate analysis (relative risk 5.87, p=0.01). 3) In univariate analysis, grade (p=0.01) and extent (p=0.01) of varices were related to recurrence; whereas, age, Child class, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p >0.05). In multivariate analysis, grade of varices was the only risk factor associated with recurrence (relative risk 3.76, p=0.01). Conclusions: 1) Persistence of esophageal ulcer at second week after the first EVL was associated with rebleeding. 2) Frequent follow-up endoscopic examinations are necessary in patients who present with high grade of vaces since risk of recurrence is high even after successful EVL.

간암의 술전 검사로서 CT AP , CT HA 및 Lipiodol CT 의 유용성

이석호,이규택,김재준,김승훈,백승운,이종균,이준혁,고광철,이풍렬,이종철,최규완,도영수 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Background/Aims: Computed tomography during arterial portography (CTAP), computed tomo-graphy during hepatic arteriography (CTHA) and Lipiodol CT are highly sensitive methods to detec intrahepatic tumor. Their sensitivity and accuracy are over 90% and 85%, respectively. We evaluated the usefulness of CTAP, CTHA and Lipiodol CT as a preoperative examination. Methods: For eighty two patients with hepatocellular carcinoma which were considered as the resectable on spiral CT and angiogram, CTAP and CTHA were performed. The additional nodules on CTAP and CTHA were confirmed by Lipiodol CT. Results: CTAP and CTHA could find additional nodules in 28% of the patients. The treatment plan was changed from surgical to nonsurgical method in 12% of the patients The larger tumor nodules were on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA (p=0.03). The probability of finding additional nodules on CTAP and CTHA is no related with the counts of tumor nodules on the spiral CT (p=0.84). CTAP and CTHA could find additional nodules in 6 cases of 27 cases who underwent Lipiodol CT. The treatment plan was changed to nonsurgical treatment in 3 cases by the results of CTAP and CTHA. Conculusions: We concluded that CTAP, CTHA and Lipiodol CT are useful in avoiding unnecessory operation.

백서의 척수에서 GABAB 수용체의 심혈관 조절 작용

이석호,이상구,류광현,이규택,김재준,김창섭,강인구,최규완,백승운,이종균,이준혁,고광철,이풍렬,이종철,성인경,심상군,최문석 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Objectives : The purpose of present study is to investigate the influence of a spinal gamma-aminobutyric acid B (GABAB) receptor on a central regulation of blood pressure(BP) and heart rate(HR), and to define its mechanism in the spinal cord. Methods : In urethane-anesthetized, d-tubocurarine- paralyzed and artificially ventilated male Sprague-Dawley rats, intrathecal administration of drugs were carried out using injecton cannula(33-gauge stainless steel) through the guide cannula(PE 10) which was inserted intrathecally at lower thoracic level through the puncture of a atlantooccipital membrane. Results : Intrathecal injection of an GABAB receptor agonist baclofen(30, 60, 100 nmol) decreased both blood pressure and heart rate dose-dependently. Pretreatment with 8-bromo-cAMP(50 nmol), a cAMP analog or glipizide(50 nmol), a ATP-sensitive K+ channel blocker attenuated the depressor and bradycardic effects of baclofen (100 nmol) but not with 8-bromo-cGMP(50 nmol) a cGMP analog. Conclusions : The GABAB receptor in the spinal cord plays an inhibitory role in central cardiovascular regulation and that this depressor and bradycardic actions are mediated by the decrease of cAMP via the inhibition of adenylate cyclase and the opening of K+ channel.

내시경적 조직검사로 진단된 위 분선충증 1 예

이석호,이화영,이규택,강인구,최규완,백승운,이종균,이준혁,고광철,이종철,오영륜,현재근,이풍렬,김재준,채종일 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.

간암 환자의 술전 검사로서 CTAP와 CTHA 의 유용성

이석호,이규택,김재준,강인구,김승훈,백승운,도영수,이종균,이준혁,고광철,이풍렬,최규완,오성윤,이종철 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.4

Background / Aims : Combined computed tomography during arterial portography(CTAP) and computed tomography during hepatic arteriography(CTHA) are more sensitive methods compared to conventional spiral CT in detection small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CTHA as a preoperative study of hepatocellular carcinoma for surgical treatment. Methods : Eighty -two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angigraphy were included. CTAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventional spiral CT and angiography. Results : 1)105 nodules were found on spiral CT plus angiography , whereas, 138 nodules found on combined CTAP and CTHA : 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases : 9 cases(10%) with bilobar involvement, and 1 case(1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA : combined CTAP and CTHA were able to find more nodules in 21% of tumor ≤3cm, 27% of tumor with 3- 10cm, and 71% of tumor > 10 am on spiral CT (p=0.03). Conclusion : Compared to spiral CT plus angiography, CTAP and CTHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.

Role of Hyperinsulinemia and Glucose Intolerance in the Pathogenesis of Nonalcoholic Fatty Liver in Patients with Normal Body Weight

(Joon Hyoek Lee),(Poong Lyul Rhee),(Jong Kyun Lee),(Kyu Taek Lee),(Jae Jun Kim),(Kwang Cheol Koh),(Seung Woon Paik),(Jong Chul Rhee),(Kyu Wan Choi) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.1

N/A Objectives : The pathogenesis of nonalcoholic fatty liver in non - obese persons is poorly understood. We aimed to elucidate whether hyperinsulinemia and glucose intolerance are associated with development of fatty liver in patients with normal body weight Methods : Forty - seven ents with fatty liver were divided into non-obese (n=25) and obese groups (n=22) according to age adjusted body mass index. Inclusion criteria were as follows: (I) elevated transaminase levels during more than 3 months of follow up period, (2) no detectable HBsAg or anti-HCV in the serum, (3) alcohol consumption less than 40 gm/week, (4) no use of potential hepatotoxic drugs within 3 months and (4) sonographic evidence of fatty liver(moderate to severe degree). Baseline insulin levels and oral glucose tolerance test using 75gm of glucose were performed and the results were compared in each group of patients. Results : Mean baseline insulin levels were elevated in both groups above the reference value, 9.3± 3.5 μU/L in non-obese group and 9.9±3.5 μU/L in obese group (p=0.26). Seventeen of non-obese patients (68%) had elevated basal insulin level and 16 of obese patients (73%) had elevated basal insulin level (p=0.39). In oral glucose tolerance test, there was no difference in glucose level between non-obese and obese groups from O minute to 180 minutes (p > 0.05). Eleven patients from the non-obese group (44%) and 8 patients from the obese group (36%) had either impaired glucose tolerance or diabetes (p=0.29). Conclusion : Our data suggest that hyperinsulinemia and glucose intolerance may play a role in the pathogenesis of fatty liver in patients with normal body weight as well as in patients with obesity.

만성 Cadmium 중독 백서의 간장에서 킬레이트 제제의 Cadmium 잔류량에 미치는 영향

이석호,이규택,김재준,백승운,이종균,이준혁,고광철,이풍렬,이종철,최규완 대한간학회 1998 Clinical and Molecular Hepatology(대한간학회지) Vol.4 No.1

Background/Aims : The heavy metals like cadmium (Cd) are neither destroyed nor produced in human body and may infiltrated into air, water, soil, food, human body and redistributed by biological and geographical circulation. With advent of recent industrialization detrimental heavy metal poisoning in human body is increased by industrial pollution. We aimed to establish the relative abilities of chelators to mobilized liver cadmium contents in chronic cadmium intoxication rats. Methods - Sprague-Dawley albino male rats weighing 200 to 250 mg were used. All animals were loaded with 3 intraperitoneal injections of cadmium chloride (1.5 mg/kg) given at % hourly interval. Intraperitoneal injection of chelators commenced 1 week after the last loading injection and continued every 72 hour for a total of 10 injections. Chelators were given at a level of 1 mmole/kg (except 0.01 mmol/kg of BAL). The chelators used in present experiment are 1,2-diaminocyclohexane tetra acetate (CDTA), disodium calcium ethylene diamine tetra acetate (EDTA), sodium 2.3-dimer capto propane sulfonate (DMPS), sodium di ethyl dithio carbamate (DDTC), dimercapto succinate (DMSA), 2,3-dimer capto propanol (BAL), diethylene triamine penta acetate (DTPA), triethylene tetr amine hexa acetate (TTHA), D-penicillamine(DPA), Nacetyl penicillamine (NAPA). Results : 1) The residual liver cadmium content was reduced in rats administered DPA, EDTA, NAPA, CDTA,DDTC and DMSA (32%, 23%, 19%, 17%, 16% and 15% respectively) compared with control group. 2) The residual kidney cadmium content was reduced in rats administered DPA, DDTC, CDTA and EDTA (33%, 21%, 18% and 17% respectively) 3) The summation of residual cadmium content in liver and kidney was reduced in rats administered DPA, EDTA, DDTC and CDTA (33%, 20%, 18% and 17% respectively) compared with control group. Conculusions - We suggested that DPA, EDTA, CDTA and DDTC might have protective role against the toxic effects of cadmium (Korean J Hepatol 1998;8:59 - 68)

The Role of Mucosal Biopsy in the Diagnosis of Chronic Diarrhea: Value of Multiple Biopsies when Colonoscopic Finding is Normal or Nonspecific

( Joon Hyoek Lee ),( Poong Lyul Rhee ),( Jae Jun Kim ),( Kwang Chul Koh ),( Seung Woon Paik ),( Joung Ho Han ),( Howe J. Ree ),( Jong Chul Rhee ) 대한내과학회 1997 The Korean Journal of Internal Medicine Vol.12 No.2