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이정환(Jung Whan Lee),송치욱(Chi Wook Song),허병원(Byung Won Hur),강창돈(Chang Don Kang),진윤태(Yoon Tae Jeen),전훈재(Hoon Jai Chun),이홍식(Hong Sik Lee),이상우(Sang Woo lee),엄순호(Soon Ho Um),최재현(Jai Hyun Choi),김창덕(Chang Duck 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
N/A Background/Aims: It is suggested that diffuse esophagenl spasm (DES), nutcracker esophagus (NUT), and hypertensive lower esophageal sphincter (HLES) could be re-classified together as a spastic esophageal motility disorder of similar clinical background. However, there were no studies to evaluate the pathophysiological characteristics of these motor abnormalities. The aim of the study was to evaluate the changes of esophageal motor function depending on the different types of the bolus (water vs semi-solid bolus). Methods: Twenty-one healthy subjects and 42 subjects with primary esophageal motility disorders (4 DES, 12 NUT, 5 HLES, 12 nonspecific esophageal motility disorders, 9 normal) underwent a perfusion manometry with a low compliance pneumo-hydraulic capillary infusion system. Consecutively, each patient had l0 swallows of water and 10 swallows of Jello, 5 ml each. Results: In the healthy controls, the Jello swallow showed an increased amplitude and duration of distal esophageal contraction, and the velocity of peristalsis was decreased (p<0.05). Among all patients diagnosed by manometry with the water swallow, 2 cases diagnosed with HLES (40%) and 4 with NUT (33%) were changed to a diagnoses of DES after the Jello swallow. Moreover, HLES was found in 1 patient with DES (25%) and in 6 patients with NUT (50%). Conclusions: Semi-solid bolus swallows increase the contractile force of the esophagus more than water swallows. A conventional manometric diagnosis could be changed to a different spastic motility disorder of the esophagus after a semi-solid bolus swallow. It is suggested that DES, NUT, and HLES can be considered as a spectrum of spastic esophageal motility disorders sharing a similar pathophysiology. (Korean Journal of Gastrointestinal Motility 2000;6;ll-19)
강창돈(Chang Don Kang),송치욱(Chi Wook Song),구자설(Ja Soul Koo),손수민(Soo Min Sohn),김혜랑(Hye Rang Kim),진윤태(Yoon Tae Jeen),전훈재(Hoon Jai Chun),엄순호(Soon Ho Um),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.1
N/A Background/Aims: The competency of the gastroesophageal junction (GEJ) holds the key in unlocking pathophysiologic mechanisms of gastroesophageal reflux disease (GERD). However, a relationship between GERD and the incompetent GEJ has not been established. The aim of our study was to assess the relationship between the shape of the GEJ and gastroesophageal acid reflux. Methods: Forty six patients with reflux symptoms underwent an endoscopy, esophageal manometry and 24-hour esophageal pH monitoring. Patients were placed in 3 groups according to the shape of their GEJ, categorized by a retroflex view of the endoscopy; type I - gastroesophageal fold without a pouch, type II - no pouch and no fold, and type III - a pouch without a fold. Results: In type II and III, LESP was reduced. However, %of time with the pH < 4.0 was increased in type III only. There was a significant correlation between the size of a hiatal hernia and the shape of the GEJ. There was a relationship between the grade of esophagitis and the shape of the GEJ. Conclusions: The retroflex endoscopic finding of the GEJ focusing on the presence or absence of a GE fold and hiatal pouch, could be an indicator of whether a patient has GERD.(Korean Journal of Gastrointestinal Motility 2001;7:29-35)
간내 담관암에서 17번 염색체의 이형접합소실 발생 빈도
김효정 ( Hyo Jung Kim ),강창돈 ( Chang Don Kang ),이성준 ( Sung Joon Lee ),조성진 ( Sung Jin Cho ),김재선 ( Jae Seon Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.3
목적: 간내 담관암은 간에 발생하는 두 번째로 흔한 원발간암으로 예후가 매우 불량한 질환이며 발생기전과 발암유전자에 대해 잘 알려져 있지 않다. p53 종양억제유전자 불활성화는 암 발생에 관여하는 가장 흔한 유전자 변이다. 이번 연구는 p53과 관련이 있는 17번 염색체에서의 유전자 변이를 이형접합소실(loss of heterzygosity, LOH)을 이용하여 알아보고자 하였다. 대상 및 방법: 간내 담관암으로 진단받고 간 절제술을 시행 받은 20예의 수술 조직을 이용하였고, 종양 부위와 정상 부위의 조직을 이용하여 4가지 극소위체 표지자로 PCR 시행 후, 이형접합소실률을 조사하였다. 결과: 간내 담관암 20예 중 5예에서 LOH-high, 10예에서 LOH-low이었고, 5예에서는 LOH가 검출되지 않았다. TP53, D17S796, D17S5, D17S513의 LOH 검출률은 각각 29.4% (5/17), 21.4% (3/14), 38.9% (7/18), 35.3% (6/17)였다. 저분화암, 종괴 형성, 그리고 종양 색전이나 혈관 침윤이 있었던 예들에서 상대적으로 높은 검출률이 관찰되었다. 결론: 간내 담관암 17p에서의 LOH는 75%에서 양성을 보였고, D17S5에서 38.9%로 가장 높은 검출률을 보였다. 간내 담관암의 유전자 변이에 대해서는 다양한 표지자를 이용한 지속적인 연구가 필요하다. Backgrounds/Aim: Intrahepatic cholangiocarcinoma is the second most common intrahepatic neoplasm. Carcinogenesis is believed to be a multistage process that occurs as a result of mutations in oncogenes and tumor suppressor genes. Loss of heterozygosity (LOH) is the phenotype of genetic instability which has been used as a tool for detecting genetic phenotype alterations. Large number of the molecular alterations have been described in human cancer. Among them, that of p53 is quite common. The aim of this study was to determine the frequency of LOH at chromosome 17p related with p53. Methods: Twenty cases who underwent hepatic resection due to intrahepatic cholangiocarcinoma, were included. LOH was analysed with four microsatellite markers by PCR. For the clinicopathologic parameters, tumor size, differentiation, and metastasis were evaluated. Resuslts: Fifteen patients (75%) showed LOH at one of the loci at the least. Five patients were LOH-high and 10 were LOH-low. The highest frequency of LOH was observed at D17S5 by 38.9%. Those of TP53, D17S796 and D17S513 were 29.4%, 21.4% and 35.3%, respectively. In addition, LOH tended to be more frequent when the tumor is mass forming type, poorly differentiated, or has tumor emboli or vascular invasion. Conclusions: This study showed that LOH was positive in 75% on chromosome 17p in intrahepatic cholangiocarcinoma which was relatively frequent at D17S5. (Korean J Gastroenterol 2006;48:188-194)
박성현 ( Sung Hyun Park ),강창돈 ( Chang Don Kang ),박진명 ( Jin Myung Park ),김지현 ( Ji Hyun Kim ),정재훈 ( Jae Hoon Jung ),정진선 ( Jin Seon Jeong ),김도준 ( Do Jun Kim ),문다해 ( Da Hye Moon ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.2
위암의 전이는 주로 혈행성 전파, 림프절을 통한 전이, 주위 장기를 통한 직접 침윤과 복강내 파종을 통해 이루어지며 장기로는 주로 간, 폐, 뼈로 전이가 된다고 알려져 있다. 위암의 담낭 전이는 흔하지 않고 예후가 좋지 않으며 담낭염으로 발현한 경우 더 예후가 나쁘다고 알려져 있다. 본 저자들은 위암의 담낭으로의 전이와 담낭염이 동반된 증례를 경험하여 보고하는 바이다. Gastric cancer mainly spreads to the liver, peritoneum, and lymph nodes and rarely metastasizes to the gallbladder. The prognosis of gastric cancer with metastasis to the gallbladder is reported to be very poor, and presentation with cholecystitis is a prognostic factor. Herein, we present a case of gastric cancer with metastasis to the gallbladder, accompanied by acute cholecystitis. Korean J Pancreas Biliary Tract 2017;22(2):98-101
증례 : 소화기 ; 복부 대동맥류에 의한 대동맥십이지장루 및 척추 미란 1예
이동규 ( Dong Gyu Lee ),천광진 ( Kwang Jin Chun ),최대희 ( Dai Hee Choi ),강창돈 ( Chang Don Kang ),이성준 ( Sung Joon Lee ),이길수 ( Kil Soo Yie ),김형래 ( Hyung Rae Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
국내에서는 아직 복부 대동맥류에 의해 대동맥십이지장루와 척추 미란이 함께 동반한 경우는 보고된 바가 없다. 저자들은 토혈을 주소로 내원한 43세 남자 환자에서 반복적 상부 내시경으로 원발성 대동맥십이지장루를 진단하여 수술을 통해 성공적으로 치료하였던 예를 문헌고찰과 함께 보고 한다. A primary aortoenteric fistula is an uncommon complication of an abdominal aortic aneurysm, but can be fatal due to the high risk of massive bleeding and sepsis. Rarely, an abdominal aortic aneurysm can cause vertebral erosion. We report uncommon complications of an abdominal aortic aneurysm that caused an aortoduodenal fistula and lumbar vertebral erosion. To our knowledge, this is the first case of an abdominal aortic aneurysm complicated by an aortoduodenal fistula and vertebral erosion simultaneously. (Korean J Med 78:99-103, 2010)
증례 : 소화기 ; 보존적 치료로 호전된 알코올성 췌장염에 의한 비장피막하혈종 1예
김희정 ( Hee Jung Kim ),이성준 ( Sung Joon Lee ),최대희 ( Dae Hee Choi ),강창돈 ( Chang Don Kang ),정대준 ( Dae Joon Jeong ),박명옥 ( Myeong Ok Park ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6
췌장염이 있을 때 췌장과 비장의 인접한 위치와 해부학적인 연속성 때문에 드물게 비장피막하혈종이 생길 수 있다. 치료는 비장절제술, 경피적 도관 배액술 및 보존요법이 있는데 저자들을 혈역학적으로 안정한 환자에게 보존적 치료를 통해 호전된 경우를 1예 경험하였기에 문헌고찰과 함께 보고하는 바이다. Splenic complications may occur during the course of pancreatitis, as the pancreas and spleen lie adjacent to each other. However, splenic complications associated with pancreatitis are rare, including splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. The management for subcapsular splenic hematoma with pancreatitis remains controversial. We report a case of a 51-year-old man with alcoholic pancreatitis and the rare complication of a large subcapsular splenic hematoma, which was managed conservatively with a good outcome. (Korean J Med 79:681-685, 2010)
증례 : 소화기 ; Lactococcus Lactis에 의한 간농양 1예
천광진 ( Kwang Jin Chun ),이동규 ( Dong Gyu Lee ),박명옥 ( Myoung Ok Park ),강창돈 ( Chang Don Kang ),이성준 ( Sung Joon Lee ),최대희 ( Dae Hee Choi ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
이전에는 건강한 성인에서 병원균으로 인식되지 않던 Lactococcus가 최근들어 국외에서 간농양, 소뇌농양, 괴사성 폐렴 및 관절염 등을 일으켰다고 보고되었다. 하지만 아직까지 국내에서는 이 균으로 인한 간농양이 보고되지 않았다. 본 저자들은 Lactococcus lactis로 인한 간농양 1예를 경험하였기에 보고하는 바이다. Lactococcus lactis, a facultative anaerobic, Gram-positive bacterium, is not considered a major pathogen in humans, especially in immunocompetent hosts. However, this species can, on rare occasions, cause cerebellar abscesses, endocarditis, necrotizing pneumonitis, and liver abscesses. We present the case of a previously healthy 43-year-old woman with a liver abscess caused by Lactococcus lactis spp. lactis. In addition, the patient had brain and tubo-ovarian abscesses. She was treated successfully with percutaneous abscess drainage and adequate antibiotics. To our knowledge, this is the first case of a liver abscess due to Lactococcus lactis in Korea. (Korean J Med 77:S1128-S1132, 2009)
문합부 후방 탈장으로 발생한 위 허혈과 소장 경색 1예
이상훈 ( Sang Hoon Lee ),박성철 ( Sung Chul Park ),이성준 ( Sung Joon Lee ),강창돈 ( Chang Don Kang ),남승주 ( Seung-joo Nam ),이승엽 ( Seung Yup Lee ),홍성권 ( Seong Kweon Hong ),이승구 ( Seung Koo Lee ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.2
After gastrojejunostomy, a small space can occur between the jejunum at the anastomosis site, the transverse mesocolon, and retroperitoneum, which may cause an intestinal hernia. This report presents a rare case of intestinal ischemic necrosis caused by retroanastomotic hernia after subtotal gastrectomy. A 56-year-old male was admitted to Kangwon National University Hospital with melena, abdominal pain, and nausea. His only relevant medical history was gastrectomy due to stomach cancer. Endoscopic findings revealed subtotal gastrectomy with Billroth-II reconstruction and a bluish edematous mucosal change with necrotic tissue in afferent and efferent loops including the anastomosis site. Abdominopelvic CT showed strangulation of proximal small bowel loops due to mesenteric torsion and thickening of the wall of the gastric remnant. Emergency laparotomy was performed. Surgical findings revealed the internal hernia through the defect behind the anastomosis site with strangulation of the jejunum between 20 cm below the Treitz ligament and the proximal ileum. Roux-en-Y anastomosis was performed, and he was discharged without complication. Retroanastomotic hernia, also called Petersen’s space hernia, is a rare complication after gastric surgery, cannot be easily recognized, and leads to strangulation. (Korean J Gastroenterol 2019;73:109-113)
CT 및 EUS 상 원격전이 소견이 없는 진행위암에서 복강경 검사의 유용성
허병원(Byung Won Hur),전훈재(Hoon Jai Chun),진윤태(Yoon Tae Jeen),강창돈(Chang Don Kang),이정환(Jung Whang Lee),이홍식(Hong Sik Lee),송치욱(Chi Wook Song),엄순호(Soon Ho Um),이상우(Sang Woo Lee),최재현](Jai Hyun Choi),김창덕(Chang Du 대한내과학회 2001 대한내과학회지 Vol.61 No.2
N/A Background : The proper staging of advanced gastric cancer has crucial role in determining resectability and operative method, to prevent unnecessary operation and to predict the prognosis and survival rate. Although marked improvements have been made in computed tomography (CT) technology and endoscopic ultrasonography (EUS) in recent years, reassessment of the laparoscopy for gastric cancer is required as a preoperative staging tool. Therefore, we determined the usefulness of laparoscopy for staging of advanced gastric cancer without distant metastasis in CT and EUS. Methods : Staging laparoscopy was performed in 48 patients with advanced gastric cancer staged T3 or T4 by CT and EUS. Laparoscopy was carried out with the patients under local anesthesia, and included visual inspection of abdomen, and biopsies for suspicious metastatic lesions. Laparoscopic results were compared with the postoperative pathologic findings. Results : Laparoscopy was performed successfully in 48 patients. Laparoscopy disclosed unrecognized distant metastases in 7 patients (14.6%) judged to be eligible for potentially curative resection by CT and EUS. Preoperative laparoscopy showed an accuracy of 74% for serosal infiltration. Conclusion : Our results suggest that laparoscopy is an effective means of evaluating resectability of advanced gastric cancer staged T3 or T4 and can provide valuable help in planning surgical approach.(Korean J Med 61:127-132, 2001)