목이 있는 폴립형 위장관 기질종양에 의해 유발된 위십이지장 중첩증

석효선 ( Hyo Sun Seok ),손정일 ( Chong Il Shon ),서현일 ( Hyun Il Seo ),최영길 ( Young Ghil Choi ),정원길 ( Won Gil Chung ),원현선 ( Hyun Sun Won ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach. (Korean J Gastroenterol 2012;59:372-376)

비전격성 급성 A형 간염에 합병된 급성 신부전증의 1예

석효선 ( Hyo Sun Seok ),이용수 ( Yong Su Lee ),정원길 ( Won Gil Chung ),김석 ( Seok Kim ),김향 ( Hyang Kim ),김병익 ( Byung Ik Kim ),박문향 ( Moon Hyang Park ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

급성 A형 간염은 대부분 임상양상이 비교적 경하고 후유증 없이 회복되는 질환으로 비전격성 A형 간염에 급성 신부전이 합병되는 경우는 매우 드물게 보고되고 있다. 저자들은 급성 A형 간염에 동반된 급성 신부전 환자에서 신기능 호전을 위해 투석을 시행했으며, 신조직 검사상 부분적 세뇨관 괴사를 동반한 세뇨관사이질 콩팥염을 보인 예를 경험하였기에 이를 보고하는 바이다. Acute hepatitis A is generally a mild, self-limiting disease of the liver. Acute renal failure is extremely rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 27 years old male patient visited our hospital with complaint of fatigue, nausea and vomiting. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. The renal biopsy demonstrates tubulointerstitial nephritis with focal tubular necrosis on light microscopy. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.(Korean J Med 74:551-555, 2008)

건강한 한국인 성인 남자에서 성호르몬과 대사증후군과의 연관성

김석 ( Seok Kim ),이은정 ( Eun Jung Rhee ),석효선 ( Hyo Sun Seok ),최영길 ( Young Gil Choi ),정원길 ( Won Gil Chung ),이도영 ( Do Young Lee ),김세연 ( Se Yeon Kim ),정찬희 ( Chan Hee Jung ),박철영 ( Cheol Young Park ),이원영 ( Wo 대한내과학회 2007 대한내과학회지 Vol.73 No.6

목적: 여러 연구에서 남성호르몬의 감소가 제2형 당뇨병, 인슐린저항성, 고인슐린 혈증, 이상지질혈증, 대사증후군과 관련이 있다고 보고되었다. 그러나 아직까지 국내에서는 남성호르몬과 심혈관계에 위험인자로 알려진 이상지질혈증, 인슐린저항성과 대사증후군 등에 대한 연구가 부족한 실정이다. 본 연구는 한국인 성인 남성에서 성호르몬 농도와 대사증후의 연관성에 대해 알아보기 위해 시행되었다. 방법: 2003년 6월부터 2003년 7월까지 강북삼성병원검진센터에서 건강 검진을 받은 289명의 성인 남성을 대상으로 하였다. 연구는 검진센터에서 기록된 자료를 기초로 하였고, 수정된 국제 콜레스테롤 교육 프로그램 성인치료 패널 III 기준에 근거하여 대사증후군을 정의하였다. 혈중 총 테스토스테론 농도는 방사면역 측정법을 이용해서 측정하였고, 혈중 성호르몬 결합글로불린은 면역방사계측정법을 이용해서 측정하였다. 결과: 총 대상군에서 대사증후군의 유병율은 15.6%였고, 건강한 남성에서 연령과 체질량지수를 보정한 후에 총 테스토스테론의 농도는 고밀도 지단백 콜레스테롤, 공복 인슐린, 요산과 상관관계를 보였으며, 성호르몬 결합글로불린은 이완기 혈압, 요산, 중성지방, 공복 인슐린, 인슐린저항성 지표와 상관관계를 보였다. 나이, 흡연력, 음주력과의 상호작용을 통제한 후에도 총 테스토스테론과 성호르몬 결합글로불린의 감소와 에스트라디올의 증가는 대사증후군의 유병율과 유의한 상관관계를 보였다. 결론: 건강한 한국인 성인 남성에서의 성호르몬 결합글로불린의 감소와 에스트라디올의 증가는 대사증후군에 유병율에 유의한 영향을 미쳤고 이상지질혈증에도 관련이 있었다. 앞으로 테스토스테론 보충 요법 후의 여러 대사 지표들의 변화에 대한 연구도 흥미로울 것으로 생각된다. Background: Recent studies report an association of decreased testosterone levels with type 2 diabetes mellitus, insulin resistance, hyperinsulinemia, dyslipidemia and metabolic syndrome. However, studies on correlations of testosterone with dyslipidemia, insulin resistance and metabolic syndrome in Koreans are scarce. We analyzed the relationship between levels of sex hormones and metabolic syndrome, lipid profiles and insulin resistance in Korean adult males. Methods: A total of 289 males were selected among the participants in a medical health check-up from June to July 2003 at Kangbuk Samsung Hospital Health Promotion Center. Metabolic syndrome was defined according to the Modified National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III. The serum total testosterone level was measured using a radioimmunoassay and sex hormone binding globulin (SHBG) was measured using a radioimmunometric assay. Results: The prevalence of metabolic syndrome was 15.6% and the total testosterone level showed a significant correlation with the levels of high-density lipoprotein cholesterol, fasting insulin, and uric acid even after adjustment for age and body mass index (BMI). Serum SHBG showed a significant correlation with diastolic blood pressure, uric acid, triglyceride, fasting insulin and insulin resistance indices. In logistic regression analysis in which age, drinking history, and smoking status were adjusted, decreased total testosterone and SHBG levels as well as increased estradiol levels showed significant correlations with an increased prevalence of metabolic syndrome. Conclusion: This study shows that decreased total testosterone and SHBG levels and an increased estradiol level were significantly correlated with increased metabolic syndrome prevalence and dyslipidemia in healthy Korean male adults. Further studies are suggested for the association of sex hormone replacement and the changes in the metabolic status. (Korean J Med 73:565-574, 2007)

한국인 크론병의 Infliximab 유지치료 시 Infliximab 단독 투여와 Infliximab과 Azathioprine 병합 투여 비교

원현선 ( Hyun Sun Won ),박동일 ( Dong Il Park ),전창욱 ( Chang Uk Chon ),석효선 ( Hyo Sun Seok ),김태완 ( Tae Wan Kim ),허운제 ( Woon Je Heo ),이창균 ( Chang Kyun Lee ),은창수 ( Chang Soo Eun ),한동수 ( Dong Soo Han ),이석호 ( Suc 대한장연구학회 2011 Intestinal Research Vol.9 No.3

Background/Aims: The benefits and risks of concomitant immunomodulators with infliximab maintenance therapy in patients with luminal Crohn`s disease (CD) have not been adequately evaluated. We studied the influence of immunomodulator discontinuation in patients in remission with infliximab therapy through a restrospective case- control study. Methods: Medical records of 37 patients with luminal CD who received infliximab at four medical centers were retrospectively analyzed. We compared clinical and follow-up data of patients who were treated with infliximab alone with that of patients with combination therapy. Results: Among 37 patients, 31 (83.7%) were treated with infliximab plus azathioprine and six (16.2%) were treated with infliximab alone. Of the 31 patients receiving combination maintenance therapy, 26 (83.9%) were in complete remission after 12 months, as compared with five of six patients (83.3%) receiving infliximab alone. No significant difference was observed in remission rate between two groups (P=0.735). In total, 16.1% of patients in combination therapy and 16.7% in infliximab alone group reported side effects (P=1.000), but serious adverse events such as reactivation of tuberculosis were noted in only one patient in combination therapy group. Conclusions: Concomitant immunomodulators did not improve efficacy in patients with luminal CD who received scheduled infliximab maintenance. (Intest Res 2011;9:189-195)

임부의 구강보건지식에 관한 조사연구

김광옥 ( Kim Kwong-ok ),이선옥 ( Lee Sun-ok ),강성애 ( Kang Seong-ae ),김가영 ( Kim Ga-young ),김경희 ( Kim Kyung-hee ),오선희 ( Oh Sun-hee ),정선애 ( Jaung Sun-ae ),석효선 ( Seok Hyo-seon ),김미정 ( Kim Mi-jeong ),손정희 ( Son Je 여성건강간호학회 2016 여성건강간호학회지 Vol.22 No.4

Purpose: This paper examined the relationship between knowledge differences of maternal oral health and of relevant demographic variables. Methods: Participants included 239 pregnant women who were recruited from Women`s Hospital located in B city who agreed to participate in this study. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation analysis using the SPSS 21.0 program. Results: Maternal knowledge of oral health was moderate level (10.22±2.36). Scores of maternal knowledge of oral health were different according to age, education, occupation, parity, and dental care experience in pregnancy. Level of oral healthcare knowledge was weakly related to age and education. Conclusion: Consequently, it is necessary to encourage pregnant women to take part in oral health education program during antenatal care.

대장내시경 시행 전 맑은 유동식이 시행 여부에 따른 대장정결도 비교

정우신 ( Woo Shin Jeong ),박동일 ( Dong Il Park ),석효선 ( Hyo Sun Seok ),김성은 ( Seong Eun Kim ),이석호 ( Suck Ho Lee ),이창균 ( Chang Kyun Lee ),은창수 ( Chang Soo Eun ),한동수 ( Dong Soo Han ) 대한장연구학회 2012 Intestinal Research Vol.10 No.3

Background/Aims: Adequate bowel preparation is essential for full visualization of colonic mucosa because detection of small polyps and neoplasms depends on the quality of bowel cleansing. The aims of this study were to compare the efficacy, tolerability of preparation and side effect between two groups: clear-liquid diet with polyethylene glycol (PEG) solution versus no diet restriction with PEG solution. Methods: This was a randomized single-blind prospective study. A total of 330 patients were randomly assigned to receive either 2 L PEG solution with a clear-liquid diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 1) or 2 L PEG solution with a general diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 2). Results: 162 patients were assigned to group 1 and 168 patients to group 2. The satisfactory quality of bowel preparation was not significantly different between the two groups (80.2%, 78.6%, P=0.707). Patient`s compliance of the clear-liquid diet in group 1 was 50%. The satisfactory quality of bowel preparation was weakly better when the clear-liquid diet was given 2 or 3 times a day (group 1A) than 0 or once a day (group 1B) (74.1%, 86.4%, P=0.048). The tolerability of the PEG solution and side effects of preparation were not significantly different in the two groups (P=0.573, 0.686). Conclusions: Bowel preparation with no diet restriction and split-dose PEG solution was similar to preparation with a clear-liquid diet in efficacy, tolerability and side effect. Therefore, the use of the clear-liquid diet protocol should improve patient`s compliance. (Intest Res 2012;10:272-279)

증례 : 하공정맥의 스텐트 삽입술로 난치성 복수의 호전을 보인 알코올성 간경변증에 병발한 Budd-Chiari 증후군 1예

이현종 ( Hyun Jong Lee ),김병익 ( Byung Ik Kim ),석효선 ( Hyo Sun Seok ),고영률 ( Young Lyul Koh ),강문수 ( Mun Su Kang ),조용균 ( Yong Kyun Cho ),김승권 ( Seung Kwon Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1S

췌장의 선암을 동반한 Lymphoplasmacytic sclerosing pancreatitis 1예

최영길 ( Young Ghil Choi ),김홍주 ( Hong Joo Kim ),석효선 ( Hyo Sun Seok ),김석 ( Seok Kim ),정원길 ( Won Gil Chung ),이도영 ( Do Young Lee ),채승완 ( Seoung Wan Chae ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1

Lymphoplasmacytic sclerosing pancreatitis는 자가면역성 췌장염으로 스테로이드 치료에 반응이 좋은 양성질환으로 알려져 왔다. 자가면역성 췌장염의 특징적인 방사선학적 면역학적 검사 소견이 보고되었으나 종괴를 형성하는 경우에는 수술 전 악성 종양과의 감별이 쉽지 않고 수술 후 병리소견에 의해 진단되는 경우가 많으며 악성 종양이 동반된 보고는 없었다. 저자들은 췌장의 종괴와 국소 췌관의 협착을 보이는 환자에서 췌장 아전절제술 후 LPSP에 췌장의 상피내종양과 함께 침윤성 선암이 동반된 예를 경험하였기에 이를 보고하는 바이다. Lymphoplasmacytic sclerosing pancreatitis (LPSP) is a rare entity that has been described under many different names; LPSP is an autoimmune form of chronic pancreatitis. LPSP may simulate a neoplastic process both clinically and radiologically. We report a case of LPSP with pancreatic adenocarcinoma. A 70-year-old woman was admitted to our hospital for evaluation of pancreatic duct dilatation. The CA 19-9 level was normal and the antinuclear antibody titer was negative. An abdominal CT revealed a low density nodule, 8 mm in size, in the body of the pancreas with parenchymal atrophy and mild dilatation of the main pancreatic duct in the body and tail portion. Endoscopic retrograde cholangiopancreaticography demonstrated a stricture of the main pancreatic duct in the body of the pancreas and mild dilatation of the upstream duct. She underwent subtotal pancreatectomy and splenectomy. The results of the pathologic examination of the resected tissue included pancreatic ductal adenocarcinoma with pancreatic intraepithelial neoplasia in the background of lymphoplasmacytic sclerosing pancreatitis. (Korean J Med 75:88-92, 2008)