위암 조직에서 Integrin α5, α6, αV, β1, β3, β4 아단위의 발현

감창우 ( Chang Woo Gham ),박승우 ( Seung Woo Park ),신율 ( Yule Shin ),김현욱 ( Hyun Wook Kim ),김한수 ( Han Soo Kim ),송시영 ( Si Young Song ),정재복 ( Jae Book Chung ),강진경 ( Jin Kyung Kang ),노성훈 ( Sung Hoon Noh ) 대한소화기학회 2002 대한소화기학회지 Vol.40 No.6

Background/Aims: The integrins play a central role in maintaining the morphology of cell and tissue, growth, differentiation, migration, survival and apoptosis of cells, and angiogenesis. Although integrins are implicated in carcinogenesis and tumor angiogenesis, their precise contributions to the process are largely unknown. Methods: For paraffin embedded tissue samples of 102 gastric cancers (23 differentiated, 79 undifferentiated), the expression of integrin α5, α6, αV, β1, β3, β4 subunits and factor VIII were examined by immunohistochemical staining. The relationships between the expression of each integrin and several clinicopathologic parameters were analyzed. Results: The positive rates of integrins were as follows: α5 24%, β1 8%, α6 16%, β4 24%, αV 29%, and β3 34%. The expression of α5, α6, and αV was well correlated with the expression of β1, β4, and β3, respectively. The αV integrin was highly expressed in tumors of advanced T stage. The expressions of α6 and β4 integrins were significantly higher in differentiated tumors, but the β3 integrin was significantly expressed in undifferentiated tumors. The number of tumor vessels has positive correlation with αV integrin expression. Conclusions: These findings suggest that integrin α6β4 is one of the key factors in determining tumor differentiation and growth pattern. The integrin αVβ3 may be related to the angiogenesis especially in advanced gastric cancer. (Korean J Gastroenterol 2002;40:355-363)

헬리코박터 제균 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과

이은재 ( Eun Jae Lee ),감창우 ( Chang Woo Gham ),박태운 ( Tae Woon Park ),홍성일 ( Sung Il Hong ),고근준 ( Geun Jun Ko ),최창환 ( Chang Hwan Choi ),한기준 ( Ki Joon Han ),조현근 ( Hyeon Geun Cho ),이재은 ( Jae Eun Lee ),김재영 ( J 대한내과학회 2006 대한내과학회지 Vol.71 No.2

목적: 헬리코박터 제균 요법은 소화성 궤양 환자의 치료에서 필수적인 부분이나, 기능성 소화불량증 환자의 치료에 있어서는 아직 그 유용성에 대하여 논란이 많은 상태이다. 본 연구에서는 기능성 소화불량증 환자와 소화성 궤양 환자에 있어서 제균 요법 이후의 증상 호전상태를 추적, 비교함으로써 기능성 소화불량증 환자에서의 제균 요법의 유용성을 평가하고자 하였다. 방법: 2003년 3월부터 2004년 2월에 걸쳐 헬리코박터 감염이 증명된 기능성 소화불량증 환자 123명과 소화성 궤양 환자 80명을 대상으로 하여 1주 또는 2주 간의 rabeprazole을 포함한 3제 제균 요법을 시행하였으며, 치료종결로부터 최소 4주가 경과한 후 제균 상태를 확인하였다. 증상척도 변화에 대한 추적 조사는 치료 전 및 치료 후 최장 18개월까지 3개월 간격으로 시행하였으며, 평균 추적기간은 12개월이었다. 결과: 평균 제균율은 82.8%로 소화성 궤양군과 기능성 소화불량증군 간에 의미 있는 차이는 없었으며, 1주 또는 2주의 제균 기간에 따른 유의한 차이도 없었다. 치료 후 3개월째 양 군 모두에서 치료 전(소화성 궤양군; 3.5±1.1 vs. 기능성 소화불량증군; 3.4±0.1)에 비하여 유의한 증상의 호전을 보였으며(1.4±0.4 vs. 1.6±0.5), 이러한 증상의 호전은 상당수의 환자에서(72.5% vs. 67.4%) 12개월 이상의 추적기간동안 유지되었다. 양 군에서 모두 제균에 실패한 경우 유의한 증상의 악화를 보였으며, 제균에 성공한 경우에 비해 유의하게 높은 누적 재발률(66.7% vs. 25.5%; 57.1% vs. 21.2%)을 보였다. 결론: 헬리코박터 감염이 있는 기능성 소화불량증 환자의 치료에 있어서 헬리코박터 제균 요법은 유용한 선택이 될 수 있으며, 제균의 실패는 증상 재발의 한 요인일 수 있다. 그러나 기능성 소화불량증 환자의 치료에 있어서 제균 요법의 역할을 정확히 규명하기 위해서는 보다 큰 규모의 무작위 연구 및 비용-효과 분석이 필요하다고 판단된다. Background: In the functional dyspepsia, Helicobacter pylori has been suggested as a causative agent. But, the effect of H. pylori eradication is still debated on functional dyspesia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in the improvement of the symptoms in patients with functional dyspepsia. Methods: The convenience sample consisted of 123 patients with functional dyspepsia and 80 patients with peptic ulcer diseases who were infected with H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked about their symptomatic improvement every three months. The degree of symptom was rated on a five-point Likert scale. Results: Overall eradication rate of H. pylori was 82.8% (168/203), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up period was 12 months. The symptomatic improvement in both group was maintained over 12 months in most patients (PUD 72.5% vs. FD 67.4%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure in both group (FD p=0.007 vs. PUD p=0.014). Conclusions: The eradication therapy of H. pylori can be one of the therapeutic options for patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom. (Korean J Med 71:141-148, 2006)

증례 : 호산구성 복수와 방광염을 동반한 호산구성 장염 1예

김상수 ( Sang Soo Kim ),최창환 ( Chang Hwan Choi ),최형섭 ( Hyung Sub Choi ),박일운 ( Il Woon Park ),감창우 ( Chang Woo Gham ),조현근 ( Hyeon Geun Cho ),이상엽 ( Sang Yeop Yi ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

호산구성 위장관염은 소화기 증상이 있으며, 기생충 감염 없이 소화관벽에 호산구의 침윤을 특징으로 하는 질환으로 장관벽내 호산구가 침윤하는 층에 따라서는 점막형, 근층형, 장막형 등의 세 가지 아형으로 구분할 수 있다. 알레르기성 원인이 제시되었지만 아직까지 원인과 병리기전은 정확히 밝혀지지 않았다. 임상 증상은 침범한 소화관의 부위와 소화관벽 층에 따라 다양한데 주요한 증상은 복통, 설사, 오심, 구토, 그리고 복수이다. 장막층의 침범은 환자의 약 10%에서 관찰되는데 대개는 점막층도 같이 침범하며 호산구성 복수를 동반한다. 호산구성 복수를 동반한 예는 그 보고가 적으며, 또한 소화관 이외 장기를 침범한 몇몇 증례도 보고되었지만 이 역시 매우 드문 실정이다. 저자들은 물 설사와 복통을 주소로 내원한 40세 남자에서 방광벽의 미만성 비후와 복수를 동반한 호산구성 장염 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Eosinophilic gastroenteritis (EG) is an uncommon disorder characterized by presence of gastrointestinal symptoms, eosinophilic infiltration of one or more divisions of the gastrointestinal tract without involvement of other organs, and absence of infestation by parasites. The etiology and the pathogenesis of EG are poorly understood. The clinical presentation depends on the gastrointestinal division affected and the wall layers infiltrated. The usual symptoms are abdominal pain, diarrhea, nausea and vomiting, and recurrent ascites. Involvement of the serosa, observed in 10% of cases, typically results in the formation of eosinophilic ascites. It has been suggested that EG can be accompanied by extraintestinal involvement, although, it is very unusual. We experienced a case of eosinophilic enterocolitis involving small bowel and colon with eosinophilic ascites and cystitis in a 40-year-old male with abdominal pain and watery diarrhea. We report this case with a brief review of the literatures. (Korean J Med 69:S746-S752, 2005)

증례 식도 상부의 이소성 위점막에서 발생한 원발성 선암

이중민 ( Jung Min Lee ),박승우 ( Seung Woo Park ),배상운 ( Sang Woon Bae ),김재학 ( Jae Hak Kim ),감창우 ( Chang Woo Gham ),이세준 ( Se Joon Lee ),송시영 ( Si Young Song ),정재복 ( Jae Bock Chung ),강진경 ( Jin Kyung Kang ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

The incidence of esophageal adenocarcinoma is steadily increasing. Most of them, however, are attributable to adenocarcinoma arising from the lower esophagus, which is quite contrary to rare incidence of upper esophageal adenocarcinoma. The origins of esophageal adenocarcinoma are postulated to be Barrett`s esophagus, ectopic gastric mucosa, and esophageal gland. Barrett`s esophagus is widely accepted as being associated with lower esophageal adenocarcinoma. On the other hand, ectopic gastric mucosa, which is believed to remain due to congenital defect during the developmental stage and which is found as many as 10% of routine esophagogastroscopy, has been rarely proven to be the origin of upper esophageal adenocarcinoma. In Korea, to our knowledge, no case has been reported yet, and we herein report a case of upper esophageal adenocarcinoma originated from ectopic gastric mucosa with a brief review of previous reports. (Korean J Gastroenterol 2003;41:224-228)

경피 스텐트삽입술로 치료한 상장간막동맥박리

고근준 ( Geun Jun Ko ),한기준 ( Ki Jun Han ),한서구 ( Seo Goo Han ),황상연 ( Sang Yon Hwang ),최창환 ( Chang Hwan Choi ),감창우 ( Chang Woo Gham ),조현근 ( Hyeon Geun Cho ),송순영 ( Soon Young Song ),정진호 ( Jin Ho Jung ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.2

양성자 펌프 억제제(Proton Pump Inhibitors)의 임상적 고찰

감창우 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Proton Pump inhibitors(PPIs) are substituted benzimidazoles and a class of drugs that reduce the secretion of gastric acid by inhibiting the proton pump of the parietal cell. PPIs are the most effective inhibitor of gastric acid secretion available. In addition, PPIs are remarkably safe and well-tolerated by patients. Although PPIs can inhibit the absorption of ketoconazole and facilitate the absorption of digoxin, few of significant drug-interactions are clinically noted. With long-term use, the profound suppression of gastric acid secretion may create several problems such as PPI-induced hypergastrinemia, bacterial overgrowth in stomach, and increased risk of enteric infection. However, more apparent evidences are needed for these problems. In conclusion, PPIs are useful and safe in treating acid-related digestive diseases (e.g. peptic ulcer disease, gastroesophageal reflux disease, Zollinger-Ellison syndrome, etc).

헬리코박터 제균 3제 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과 : 평균 9개월 추적 결과

이은재,감창우,김상수,박태운,홍성일,최창환,한기준,조현근,이재은,김재영 關東大學校 醫科大學 醫科學硏究所 2004 關東醫大學術誌 Vol.8 No.1

Background: The eradication of Helicobacter pylori is approved as an essential therapy in the treatment of the peptic ulcer patients. In the functional dyspepsia patients, H.pylori has been suggested as a causative agent. However, the effectiveness of the eradication therapy is still debated in the treatment of the patients with functional dyspepsia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in patients with functional dyspepsia. In this study, we surveyed and compared the degree of symptom between the groups of patients with peptic ulcer disease and functional dyspepsia for nine months on the average after eradication of H. pylori. Methods: The convenience sample consisted of 119 patients with functional dyspepsia and 73 patients with peptic ulcer diseases who had infected by H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked every three months about the symptomatic improvements. The degree of symptom was rated on an 1(asymptomatic) to 5(symptomatic, unable to perform ADL) scale. Results : Overall eradication rate of H. pylor was 84.9%(163/192), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up periods were nine months. The mean score of the degree of symptom in pre-treatment state was 2.7±0.8 in peptic ulcer disease group and 2.6±0.7 in functional dyspepsia group. The degree of symptom was significantly lowered to 1.3±0.5 in peptic ulcer group (p<0.001) and 1.3±0.4 in functional dyspepsia group(p<0.001) three months after the treatment. The symptomatic improvement in both group was maintained over nine months in most patients(73.9%:76.7%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure (p=0.01). Conclusion : In the patients with functional dyspepsia, the symptoms were significantly improved after several weeks of treatment including eradication therpay of H. pylori. In 76.7% of patients with functional dyspepsia, the symptomatic improvement was maintained over nine months. Therefore, the study suggests that the eradication therapy of H.pylori can be one of the therapeutic options in the treatment of patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom.

간암발생 실험쥐의 γ - Glutamyl Transpeptidase 양성 병소에 대한 조직화학적 검색 및 Autoradiography 를 이용한 3H - Thymidine 표지 지표에 관한 연구

김성우,김종철,김홍주,이동후,이숭환,조용현,권기운,조영중,정철헌,감창우,백인규 대한간학회 1998 Clinical and Molecular Hepatology(대한간학회지) Vol.4 No.2

Diethylnitrosamine 으로 유도된 간암발생 과정에서의 γ - Glutamyl Transpeptidase 양성 병소에 대한 입체형태학적 분석 연구

김성우,김종철,김희수,김병훈,김홍주,박동일,이동후,이숭환,남승우,감창우,유용걸,양성규 대한간학회 1998 Clinical and Molecular Hepatology(대한간학회지) Vol.4 No.1

Background/Aim - Hepatocarcinogenesis of microscopically altered foci could be shown to be progressed into a trabecular pattern of hepatocellular carcinoma. And it is reported that down-regulation of TGF beta II receptor and up-regulation of TGF alpha and c-myc reveal the progression of diethylnitrosamine-induced foci into liver cell cancer. Up-regulation of TGF beta II receptor, however, causes apoptosis of foci. To determine characteristic morphology and growth kinetics of putatively precancerous y glutamyl transpeptidase (GGT) positive foci and hyperplastic nodules, a stereological quantification was attempted in the Peraino's neonatal rat model initiated by diethylnitrosamine and promoted by phenobarbital. Materials/Methods - Fifteen Sprague-Dawley rats were I.p. injected with 0.15 pmole/g of body weight of diethylnitrosamine mixed in corn oil at one day after birth. From weaning at 4 weeks of life, the rats were continuously fed 0.035% phenobarbital in drinking water and sacrified 5 rats at each time point of 8 weeks, 16 weeks, and 32 weeks. Teklad standard diet was fed after weaning. The livers obtained were fixed in freshly prepared, cold ethanol-acetic acid (99:1 vo1%). For the GGT histochemical staining, Rutenberg's method was modified, and counterstained with H & E or toluidine blue. For the stereological analysis GGT positive foci and nodules were traced in 200 consecutive tissue sections and quantified the 3 dimensional volumes by computer assisted planimetry. Either spheroidal or non-spheroidal morphology was determined by parabola 2nd degree equation ' y=ax+bx+c (sphere a=-P,). Results - Thirty nine (55.71%) out of 70 representative lesions were nonspheroidal. Especially at 8 weeks, the 28 out of 40 GGT positive foci were irregular, nonspheroidal shape. Later times, however, GGT positive foci and reprogrammed nodular lesions were become spheroidal. Lilliefors probabilities test for spheroidal frequency was statistically significant (p$lt;0.05). Conclusion ' Stereologically non-spheroidal characteristics of the early GGT positive foci limit growth kinetic estimation by 3 dimensional volume quantitation but permit in later times in spheroidal, GGT positive foci and reprogrammed nodules showing fade-out of GGT activity. In other words, GGT positive foci may be clonally selected for growing into hyperplastic nodules and hepatocellular carcinoma or regressed by apoptosis. (Korean J Hepatol 1998;8:46 - 58) hyperplastic nodules and hepatocellular carcinoma or regressed by apoptosis. (Korean J Hepatol 1998;8:46 - 58)

만성 B형 바이러스성 간염 환자들에 대한 lamivudine 6개월 치료 효과에 대한 전향적 연구

이동후,이숭환,남승우,감창우,김성우,노병주 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.4

Background/Aims: The purpose of this study was to evaluate the effectiveness of lamivudine treatment in patients with chronic liver disease caused by chronic infection of hepatitis B virus (HBV). Methods: Thirty-five patients with chronic infection of HBV were included in this study who were diagnosed at Hanyang University Hospital from January 1998 to January 1999. They received 150mg of lamivudine per oral once daily for 6 months with follow-up of liver function test, serum HBV DNA and serologic markers for hepatitis B virus every two months. Lamivudine was well tolerated. Eight patients underwent liver biopsies before entering the study and follow-up biopsies were done at 5 patients. Results: Out of all 35 patients, chronic hepatitis patients histologically confirmed were 8, chronic hepatitis patients clinically diagnosed were 25 and liver cirrhosis patients clinically diagnosed were 2. The mean age was 35.7 years. Male-female ratio was 2.2:1. There was no hepatitis B surface antigen (HBsAg) negative seroconversion. The HBeAg loss rate was 26.9%(7/26) and HBeAg seroconversion rate was 10.7%(3/28) at the end of follow-up. Ten patients were anti-HBe positive prior to treatment, 3 of them became anti-HBe negative at the end of follow-up. Five patients underwent follow-up liver biopsies, in which histologic improvements were shown in 4 cases. Serum replicative HBV DNA by bDNA assay was decreased in all patients and HBV DNA was undetectable in 52.9%(9/17) at the end of treatment. Out of the 15 patients with abnormal alanine aminotransferase (ALT) levels at baseline, ALT level in 7 patients(46.7%) was normalized at treatment completion. Pretherapy ALT level was the only predictive factor for loss of HBeAg by stepwise logistic regression analysis(odds ratio : 1.0208) (95% Confidence Interval : 1.0023 ∼ 1.0396) (p value=0.0271). Conclusions: Lamivudine induced sustained suppression of HBV replication during treatment in all patients. In treating patients with lamivudine, who had chronic liver disease due to chronic ifection of HBV, the improvement of liver function test and suppression of viral replication appeared early and was sustained during the 6months treatment. This, in turn, may induce histological improvement as well. Pretherapy ALT level was the only predictive determinant for HBeAg loss during lamivudine therapy, and that should be kept in mind in selecting patients for treatment. (Korean J Hepatol 1999;5:282-290)