위용종의 내시경적 생검과 내시경적 절제술 후 병리학적 진단의 불일치

윤원재 ( Won Jae Yoon ),이동호 ( Dong Ho Lee ),이국래 ( Kook Lae Lee ),장동경 ( Dong Kyung Chang ),김병관 ( Byeong Gwan Kim ),김지원 ( Ji Won Kim ),정지봉 ( Ji Bong Jeong ),김나영 ( Na Young Kim ),김진욱 ( Jin Wook Kim ),황진혁 ( 대한내과학회 2005 대한내과학회지 Vol.69 No.5

목적 : 위용종이란 위의 내강으로 돌출한 종괴를 의미한다. 거의 90%에서 조직학적으로 과형성 용종이며 이러한 경우 암으로의 진행은 매우 적은 것으로 알려져 있다. 그러나 위선종은 일부에서 국소적으로 암성 병변을 동반하거나, 동반하고 있지 않더라도 시간이 지남에 따라 암으로 진행하는 것으로 알려져 있다. 그러나 내시경적 겸자 생검과 전체 병변의 절제 후 조직 소견에서는 차이가 있는 것으로 알려져 있다. 저자들은 내시경검사에서 위용종이 발견된 후 내시경적 절제술을 시행받은 74명의 환자, 85예의 위용종을 대상으로 임상적 및 병리학적 특성을 알아보고 겸자 생검과 내시경적 절제술 후 병리학적 진단의 불일치를 알아보고자 하였다. 방법 : 1996년 4월부터 2003년 2월까지 내시경검사에서 위용종이 발견된 후 내시경적 생검과 내시경적 절제술 후 조직학적 진단이 모두 이루어진 74명의 환자를 대상으로 내시경 사진, 의무 기록 및 병리 기록을 분석하였다. 결과 : 74명의 환자에서 총 85개의 용종을 관찰할 수 있었다. 위용종은 전정부에서 가장 호발하였으며(58.8%) 그 다음으로는 체하부(18.8%)에 호발하였다. 내시경적 겸자 생검에서 관상 선종은 48.2%, 과형성 용종은 30.6%, 염증성 용종은 15.3%, 위저선 용종은 2.4%, 이형성증은 2.4%, 관상융모 선종은 1.1%였다. 내시경적 절제술 후 조직학적 검사상 관상 선종은 45.9%, 과형성 용종은 31.8%, 염증성 용종은 9.4%, 과오종은 3.5%, 위저선 용종은 2.4%, 관상융모 선종은 2.4%, 선암은 2.4%, 이형성증은 1.1%, 점막 위지방종증은 1.1%였다. 내시경적 겸자 생검 결과와 내시경적 절제술 후 조직학적 진단의 불일치율은 27.1%였다. 용종의 크기에 따른 진단 일치율의 차이는 없었다(p>0.05). 결론 : 위용종의 겸자 생검과 내시경적 절제술 후 조직검사 소견은 차이가 있을 수 있다. 용종의 크기는 진단 일치율에 영향을 미치지 못했다. 따라서 특히 선종이 의심되는 경우에는 크기에 상관없이 내시경적 절제술을 통한 전체 병변의 조직검사가 필요할 것으로 생각된다. Background : Gastric polyp is a descriptive term referring to mucosal prominence that protrudes beyond the flat lining of the stomach. Almost 90% of gastric polyps are hyperplastic polyps. Adenomatous polyps may contain focal carcinomatous foci or undergo carcinomatous changes. It is known that there is some degree of discordance between the results of endoscopic forceps biopsy and pathology of resected specimens. The aim of this study was to investigate the discordance in pathologic findings between endoscopic forceps biopsy and endoscopic resection specimen of gastric polyps. Methods : We reviewed endoscopic photographs and medical records of the patients who underwent endoscopic resection from April, 1996 through February, 2003. Results : A total of 85 cases of gastric polyps from 74 patients were reviewed. Male-to-female ratio was 1:1.96. Mean age was 59.9±10.8 years. Multiple polyps were observed in 10.8%. Gastric polyps occurred in the antrum most frequently (58.8%). Pathology results on resected specimens were as follows: tubular adenoma 45.9%, hyperplastic polyp 31.8%, inflammatory polyp 9.4%, hamartoma 3.5%, fundic gland polyp 2.4%, tubulovillous adenoma 2.4%, adenocarcinoma 2.4%, dysplasia 1.1%, and mucosal pseudolipomatosis 1.1%. Discordance rate between endoscopic biopsy and pathology of resected specimens was 27.1%. There was no relationship between the size of the polyp and concordance rate. Conclusions : There was considerable discordance in pathologic findings between endoscopic forceps biopsy and resected specimens. Approaches to review the histology of an entire polyp should be performed, especially when an adenoma is suspected.(Korean J Med 69:481-486, 2005)

한국인의 궤양성 대장염 연관 대장암의 현황 대한장연구학회 다기관 공동연구

장동경 ( Dong Kyung Chang ),김영호 ( Young Ho Kim ),변정식 ( Jeong Sik Byeon ),양석균 ( Suk Kyun Yang ),정용우 ( Yong Woo Chung ),한동수 ( Dong Soo Han ),김상균 ( Sang Gyun Kim ),김태일 ( Tae Il Kim ),김원호 ( Won Ho Kim ),진윤태 대한소화기학회 2005 대한소화기학회지 Vol.46 No.4

만성 궤양성 대장염의 추적관찰 - 단기적 치료 반응 및 재발율을 중심으로

장동경(Dong Kyung Chang),이국래(Kook Lae Lee),김재규(Jae Gyu Kim),김용태(Yong Tae Kim),정현채(Hyun Chae Jung),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Young Kim),박재갑(Jae Gahb Park),이풍렬(Poong Lyul Rhee),최상운(Sa 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6

N/A Our retrospective study on 240 cases with chronic ulcerative colitis in Seoul National Uni- versity Hospital spanning from January,1975 to December,1993 revealed the following results. According to the extent of disease, there was 27.5% in proctitis, which was more frequent than that of the previous domestic reports, 15.8% in distal, 22.9% in left and 31.7% in exten- sive colitis. According to the severity of disease, there was 47.5% in mild, 32.9% in moderate and 19.6% in severe disease. There was a positive correlation between severity and extent of disease. The extraintestinal complications were not related with the extent, or severity. Howev- er 3 cases(1.3%) of toxic megacolon appeared in moderate or severe extensive colitis, one of which progressed to perforation. Two cases(0.8%) of mortality were noticed, one caused by perforation, the other by operation related complication. There was not a single case of colon cancer developed during follow up period. Most cases showed excellent short term response to medical treatment; the symptomatic remission rates were 90.3%, 85.7%, 72.9% and 58.9% in order of proctitis, distal, left and extensive colitis, and the endoscopic remission rates were 78.8%, 50.0%, 59.1% and 30.0% respectively. Higher remission rates corresponded with lower extent of the disease. According to the severity, the symptomatic remission rates of milder dis- ease were significantly higher. The cumulative relapse rates were 38.7% in 1 year, 62.4% in 2 years, 73.3% in 3 years and 81.9% in 5 years, which were not related to the extent but in- creased according to the severity. The cumulative operation rates were 5.0% in 1 year, 7.6% in 2 years, 10.2% in 3 years and 15.9% in 6 years. The emergency operation accounted for only 22.2% of all operation and the others were elective ones. The most frequent indication of surgery was medical intractability which was determined after mean 35 days of intensive med- ical therapy. We concluded that severity and extent of ulcerative colitis had predictive value of the responses to medical treatment or relapses, furthermore despite the high relapse rates, medical therapy was the first line treatment because of its high remission rates on a short- term base. (Korean J Gastroenterol 1994; 26: 907 918)

흰쥐의 Trinitrobenzene Sulfonic Acid ( TNBS ) 유발성 대장염에서 Flavonoids 계 Eupatilin 유도체 DA - 6034 의 효과

장동경(Dong Kyung Chang),진영주(Young Joo Chin),정현채(Hyun Chae Jung),송인성(In Sung Song),김정룡(Chung Yong Kim),손미원(Mi Won Son),유무희(Moo Hi Yoo) 대한내과학회 1998 대한내과학회지 Vol.55 No.3

N/A Objective: In traditional medicine, Artemisia capillaris has been used for treatment of chronic diarrhea. Previously we found Artemisia capillaris had an effect on rats with TNBS-induced colitis. Eupatilin, a kind of fla- vonoids, may be a probable effective component. To evaluate the effect of a eupatilin derivative compound DA-6034 on the rat with TNBS-induced colitis, we perfomed this study, Methods: Colitis was induced with 1ml of 50 mg/ml TNBS mixed with 60 % ethanol (vol/vol) in Sprague Dawley rats. From the next day, 1ml methylcellulose, 1 mg/kg prednisolone, 0.3 or 3 mg/kg of DA-6017 and DA-6034 were administered through once daily for 2 weeks. At 2days, lweek, and 2weeks later, we evaluated the effect by gross damage score (0-10) and measured myeloperoxidase, PGE2, and L from the damaged mucosa. Results: The mean gross damage scores of prednisolone end 3 mg/kg of DA groups were significantly lower than that of a placebo group at 2weeks(0.8, 0.9 vs. 4.0, p<0.05). Myeloperoxidase activities also seemed to be lower in those effective groups but were not statistically significant. LTB4 levels were lower in prednisolone and, 0.3 and 3 mg/kg of DA groups than in a placebo group at 2weeks(7.91, 7.23, and 7.13 vs, 13.90 ng/mg protein, p<0.05), PGE2 levels were decreased in prednisolone and 0.3 mg/kg of DA-6034 groups at 2days. DA17 showed no effects. Conclusions: Eupatilin derivative compound, DA-6034 was effective in rats with TNBS-induced colitis. In that LTE4 leve1 is lowered with some decrease of PGE2 level, this agent probably has an inhibitory effect on arachidonic acid metabolism.

암 에피지네틱스

장동경 ( Dong Kyung Chang ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.1

뇌하수체 기능 저하증 , 요붕증 및 신기능 부전을 보인 유육종증 1 예

장동경(Dong Kyung Chang),김두만(Doo Man Kim),박경수(Kyong Soo Park),김성연(Seong Yeon Kim),심영수(Young Soo Shim),이홍규(Hong Kyu Lee),민헌기(Hun Ki Min) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A A 29-year-old man with generalized sarcoidosis is described. Symptomatic panhypopituitarism, diabetes insipidus, hypercalcemia and renal insufficiency as well as pulmonary involvement were noted. Tests of hypothalamio-pituitary function documented a deficiency of all anterior pituitary hormones and increase of prolactin. Water deprivation test revealed central diabetes insipidus. A contrast-enhanced thickened lesion of pituitary stalk was demonstrated by Magnetic Resonace Images(MRI). Histologically, sarcoidosis was proven by the biopsy of mediastinal lymph nodes. this is the first reported case of sarcoidosis with hypopituitarism, diabetes insipidus and renal insufficiency in Korea. The literature pertaining to those items is reviewed.

기획소화기 질환에서 영양공급에 대한 이해

장동경 ( Dong Kyung Chang ),송근암 ( Geun Am Song ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.6

The prevalence of hospital malnutrition is still high in patients with digestive diseases, especially for those suffering from cancer and bowel diseases which cause malabsorption. It is well known that malnutrition is associated with delayed wound healing, impaired immunity, infection, increased complication, and poor convalenscence. Recently, nutrition screening and assessment by nutrition support team has become essential for nutrition management, and gastroenterologists comprise a dominant member of the nutrition support team. In critically ill patients and older people with chronic disease, nutritional support with enteral feeding and early feeding contributes to recovery and rehabilitation of patients. Securing enteral feeding routes, such as feeding tube insertion and placement of percutaneous endoscopic gastrostomy/jejunostomy, is an essential part of nutrition care that should be accomplished by gastroenterologists without much difficulty. It will also be necessary to recommend nutrition care as one of the clinical routines in gastrointestinal clinical practices. Therefore, education on nutrition care is strongly required as a part of gastroenterologist’s training. (Korean J Gastroenterol 2015;65:333-335)

우리나라 염증성 대장암의 현황

장동경 ( Dong Kyung Chang ) 대한장연구학회 2006 Intestinal Research Vol.4 No.2

Ulcerative colitis is one of the important risk factor for colorectal cancer. The incidence of colitic cancer is proportioned to the duration of patient`s having ulcerative colitis. Patients with ulcerative colitis have been steeply increasing in Korea since mid-1980. Therefore, it is reasonable to presume patients with colitic cancer to begin to appear in earnest in Korea. Korean Association for the Study of Intestinal Diseases (KASID) performed a nation-wide survey on July to September in 2005 to obtain a whole picture about the current status of colitic cancer in Korea. This review summarises the data and suggests of the need of regular surveillance strategy to detect colitic cancer at an early stage. (Intestinal Research 2006;4:79-82)

만성 염증성 장질환에서 장투과성의 변화

송인성(In Sung Song),김정룡(Chung Yong Kim),정현채(Hyun Chae Jung),김윤준(Yoon Jun Kim),김병관(Byeong Gwan Kim),장동경(Dong Kyung Chang),우광훈(Gwang Hoon Woo),한철주(Chul Ju Han),김진(Jin Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3

N/A Background/Aims: Reports of the change of intestinal pemeability(IP) in various diseases have recently been made. We performed this study to investigate the change of IP in chronic inflammatory bowel diseases including Crohn's disease, Behcet's disease, intestinal tuberculosis and ulcerative colitis. Methods: We evaluated the change of IP in chronic inflammatory bowel diseases including Crohns disease(18 patients), Behcets disease(7), intestinal tuberculosis(2) and ulcerative colitis(15) by the use of lactulose and mannitol. Lactulose, which permeates via paracellular pathway, and mannitol, via transcellular pathway, are known so far as good probe molecules for measuring intestinal permeability. Results: The disease groups showed increased IP hut the increase never reached statistical significance. There was no difference in IP between Crohn's, Behcets and intestinal tuberculosis mainly involving small intestine and ulcerative colitis involving only colon. In the point of severity, the urinary lactulose recovery rate(Folac) in control, mild, moderate and severe groups was 0.51%, 0.747c, 1.22% and 1.82% respectively, the urinary mannitol recovery rate(%man) was 15.24%, 16.21%, 8.117o and 9.94% respectively and the lactulose mannitol recovery ratio was 0.033, 0.050, 0.187 and 0.302 respectively. The moderate to severe disease groups showed increased urinary lactulose recovery rate(p<0.05), decreased urinary mannitol recovery rate(p<0.05) and increased lactulose mannitol recovery ratio(p<0.05) as compared to mild to control groups. Conclusions: IP is increased in severe inflammatory bowel disease irrespective of dit'ferent regional involvement or disease entities. (Korean J Gastroenterol 1995;27:317 - 322)

소장 질환에서 이중풍선소장내시경의 유용성

민병훈 ( Byung Hoon Min ),장동경 ( Dong Kyung Chang ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.1