위 장형화생과 위축 위염에서 다유전자 발현 분석

최석렬 ( Seok Reyol Choi ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.4

내시경점막하박리법을 이용한 조기위암과 위선종의 치료

장진석 ( Jin Seok Jang ),이은주 ( Eun Joo Lee ),이성욱 ( Sung Wook Lee ),이종훈 ( Jong Hun Lee ),노명환 ( Myung Hwan Roh ),한상영 ( Sang Young Han ),최석렬 ( Seok Reyol Choi ),정진숙 ( Jin Sook Jeong ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.6

목적: 내시경점막하박리법(endoscopic submucosal dissection, ESD)은 큰 병소를 일괄절제할 수 있다는 장점이 있으나 시간이 오래 걸리고, 출혈과 천공과 같은 합병증의 발생률이 높다. 저자들은 위선종과 조기위암에서 ESD의 치료성적을 분석하여 ESD의 효율성과 안전성에 대해 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2005년 12월까지 동아대 학교병원에 입원하여 위선종 및 조기위암으로 진단되어 ESD을 받은 101명의 환자에서 총 101예의 병변을 대상으로 후향으로 조사하였다. 결과: 1) ESD가 시행된 병변의 평균 크기는 2.58 cm였다. 2) ESD군의 일괄절제율은 90.1%였으며, 이는 병변의 크기가 큰(≥3 cm) 경우에 유의하게 감소하였다. 3) 완전절제율은 83.2%로, 병변 크기에 따른 차이는 없었으나 저도형성이상과 고분화형조기위암에서 특히 완전 절제율이 높았다. 4) 출혈은 41.6%로 응급 수술이 필요할 만큼의 유의한 출혈은 없었고, 내시경 치료로 쉽게 지혈하였다. 5) 재발률은 2.0%였다. 결론: ESD법은 조기위암과 위선종의 치료법으로 효과적이고 비교적 안전한 방법으로 향후 장기적인 추적 관찰이 필요하다. Background/Aims: Endoscopic Submucosal Dissection (ESD) is a new endoscopic mucosal resection (EMR) technique which enables en bloc resection even in large and depressed lesions. The aims of this study were to assess the therapeutic efficacy and the safety of ESD in gastric adenoma and in early gastric cancer (EGC). Methods: We analyzed 101 lesions in 101 patients. ESD with insulated-tipped (IT) knife were performed in 52 adenomas and 49 EGCs from January 2003 to December 2005 in Dong-A University Hospital. Results: The mean size of the lesion was 2.58 cm (0.7-4.5 cm). En bloc resection rate was 90.1% which was influenced by size (p>0.05). Complete resection rate was 83.2% even in large or in malignant tumors (p>0.05). Bleeding after ESD occurred in 41.6%. Tumor recurrence rate was 2.0%. Conclusions: ESD with IT knife is effective for the treatment of EGC and gastric adenoma even in large or in malignant lesions without definite increased risk of complications. (Korean J Gastroenterol 2007;49:356-363)

위암에서 EUS 및 CT에 의한 T-병기의 정확도

김기한,김민찬,최석렬,정갑중,김형호,Kim, Ki-Han,Kim, Min-Chan,Choi, Seok-Reyol,Jung, Ghap-Joong,Kim, Hyung-Ho 대한위암학회 2003 대한위암학회지 Vol.3 No.4

Purpose: Preoperative staging of gastric cancer is crucial because the treatment modality and the prognosis depend upon the stage of gastric cancer. Current treatment modalities for early gastric cancer have focused on the quality of life. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) are commonly used diagnostic tools to evaluate the invasiveness (T stage) of the primary tumor. The purpose of this paper is to evaluate the sensitivity and the specificity of preoperative EUS and CT in comparison with postoperative pathology. Materials and Methods: From October 2001 to October 2002, EUS and abdominal CT were performed simultaneously on 75 patients who underwent radical gastric surgery for the treatment of gastric cancer. Through analyzing the clinical T stage and the pathologic T stage, We evaluated the diagnostic sensitivities and specificities of endoscopic ultrasonography and abdominal computed tomography. Results: The male-to-female sex ratio was 1 : 0.6 (males: 47, females: 28). The mean age was 55.4 years in males (range: $28\~81$) and 54.4 years in females (range: $23\∼77$). The clinical T stage based on EUS included 22 T1mm, 7 T1sm, 22 T2, and 24 T3. The clinical T stage based on CT included 20 Tx, 23 T2, and 32 T3. The permanent pathologic report confirmed 23 T1mm, 10 T1sm, 17 T2, 24 T3, and 1 T4. The sensitivity and specificity of EUS were $84.2\%\;and\;94.7\%$, respectively. However, the sensitivity and specificity of abdominal CT were $53.3\%\;and\;77.0\%$, respectively. Conclusion: Our data suggest that EUS is a very useful diagnostic tool for evaluating the T stage of gastric cancer because EUS has higher specificity than abdominal CT. Therefore, EUS may have a significant role as a preoperative diagnostic modality in patients undergoing minimally invasive surgery.

내시경 점막하 박리술 시행 전 위선종과 점막암종에서 혈청 IL-6, VEGF, CRP의 예측인자로서의 중요성

장진석 ( Jin Seok Jang ),최석렬 ( Seok Reyol Choi ),한상영 ( Sang Young Han ),노명환 ( Myung Hwan Roh ),이종훈 ( Jong Hoon Lee ),이성욱 ( Sung Wook Lee ),정진숙 ( Jin Sook Jeung ),김민찬 ( Min Chan Kim ),손영기 ( Young Ki Son ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

Background/Aims: Endoscopic submucosal dissection (ESD) is commonly used for radical resection of gastric adenoma and mucosal cancer, but there is about 30% of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by ESD. The aim of this study was to clarify the clinical significance of IL-6, VEGF, CRP before ESD. Methods: We investigated the correlation between serum IL-6, VEGF, CRP level and discrepancy rate of gastric neoplastic lesions (10 low-grade dysplasias, 18 high-grade dysplasias, and 25 early gastic cancers). Results: Serum levels of IL-6 in gastric adenoma and mucosal cancer patients were significantly higher than in healthy controls (p<0.05). Especially, serum IL-6 level of high-grade dysplasia patient was significantly higher than low-grade dysplasia and mucosal cancer patients, and the positive rate, sensitivity, and negative predictive value of serum IL-6 levels were higher in high-grade dysplasia patient compared to low-grade dysplasia patient and mucosal cancer patient. Serum levels of VEGF in patients with gastric adenoma and mucosal cancer were significantly higher than healthy controls (p<0.01). Serum levels of CRP in patients with mucosal cancer were significantly higher than in the controls (p<0.05), and the positive rate, sensitivity, and positive predictive value of serum CRP levels were higher in high-grade dysplasia and mucosal cancer patients compared to low-grade dysplasia patient. Conclusions: Serum levels of IL-6, VEGF, and CRP in patients with gastric neoplastic lesions were significantly higher than healthy controls, especially, serum IL-6 level of high grade dysplasia patient was significantly higher than low-grade dysplasia and mucosal cancer patients. (Korean J Gastroenterol 2009;54:99-107)

위암 환자에서 Chronotherapy 의 부작용에 대한 고찰

윤욱돈(Uk Don Yun),최석렬(Seok Reyol Choi),지삼룡(Sam Ryong Jee),박성욱(Seong Wook Park),이태영(Tae Yeong Lee),이종훈(Jong Hun Lee),한상영(Sang Young Han) 대한소화기학회 2002 대한소화기학회지 Vol.40 No.4

Backgroud/Aims: Gastric cancer is one of the most common malignancy in Korea. In many reports, it has been known that chemotherapy does not improve survival rate of patients with gastric cancer. However, some Japanese reports showed that chemotherapy was effective. Side effects of chemotherapy increase with escalating dosage of chemotherapy drugs. There are some reports that chronotherapy could reduce the side effects and improve the survival rate in patients with gastric or colorectal cancer. We studied the side effects of chronotherapy in patients with gastric cancer. Methods: Fourteen patients with previously untreated gastric cancer received chronomodulated 5-FU ( 900 mg/m2/day, day 1-5) and cisplatin ( 90 mg/m2, day 1). Thirteen patients of control group received 5-FU ( 600 mg/m2/day, day 1-5) and cisplatin ( 60 mg/m2, day 1) during the daytime. The side effects of the two groups were evaluated for nausea and vomiting, diarrhea, peripheral neuropathy, mucositis, leukopenia, anemia, thrombocytopenia, and serum creatinine. Results: Compared to the control group, chronotherapy-treated group showed statistically significant decrease in nausea and vomiting ( p= 0.037), but not in others. Conclusions: Although only the incidence of nausea and vomiting was decreased significantly in the chronotherapy group, chronotherapy could be effective in reducing the side effects of chemotherapy in patients with gastric cancer considering that higher doses of drugs were used in the chronotherapy-treated group. ( Korean J Gastroenterol 2002; 40: 236-240)

복합 항암요법으로 성공적으로 치료한 동시성 식도암과 위선암

한지선 ( Ji Sun Han ),최석렬 ( Seok Reyol Choi ),장진석 ( Jin Seok Jang ),노명환 ( Myung Hwan Roh ),김대철 ( Dae Cheol Kim ),유승희 ( Seung Hee Ryu ),우수미 ( Su Mi Woo ),형건덕 ( Chien Ter Hsing ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2

Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m2) and CDDP (60 mg/m2). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option. (Korean J Gastroenterol 2012;60:113-118)

증례 : 소화기 ; 위에 발생한 사구종양 3예

윤현아 ( Hyun Ah Yoon ),최석렬 ( Seok Reyol Choi ),이종훈 ( Jong Hun Lee ),장진석 ( Jin Seok Jang ),백양현 ( Yang Hyun Baek ),이정민 ( Jeong Min Lee ),김민식 ( Min Sik Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5

사구 종양은 사구체(glomus body)의 변형된 평활근 세포에서 유래하는 양성종양으로 일반적으로 사지 말단에서 발생하나, 위장관의 사구종양은 매우 드문 것으로 알려져 있다. 저자들은 건강 검진 시 우연히 발견된 위 상피하종양을 주소로 내원한 환자에서 내시경 초음파 검사 및 CT 검사 후 수술을 통해 조직학적으로 사구종양으로 확인된 세 증례를 경험하였다. 세 증례 모두 내시경 초음파에서 제 4층에서 국소적 고에코를 보이는 비균질성 저에코 병변이 관찰되었고, CT에서 강한 조영 증강 및 이러한 조영 증강이 지연기까지 지속되는 과혈관 종양의 특징적인 소견을 보였다. 이중 한 증례는 특징적으로 쿠션 양성 소견과 CT에서 석회화 소견을 보였다. 저자들은 세 증례에서 사구종양의 서로 다른 특성을 경험하였기에 보고하는 바이다. Glomus tumors originate in modified vascular smooth muscle cells and are most commonly found in the dermis or subcutis but are rarely observed in the stomach. We report three cases of patients who presented with incidental findings of subepithelial tumors in the stomach. One patient showed a positive cushion sign, and the others showed negative cushion signs. Endoscopic ultrasonography (EUS) demonstrated sharply demarcated hypoechoic tumors with internal hyperechoic spots in the fourth layer of the gastric wall and several hypoechoic halos around the tumors. Contrast-enhanced abdominal computerized tomography (CT) showed homogeneous high enhancement of tumors up to the delayed scan, and one case showed calcification in the tumor. For treatment, laparoscopic wedge resections were performed. Histological and immunochemical analysis of the tumor cells were compatible with glomus tumors. These characteristic findings in EUS and CT seem to be useful for the diagnosis of gastric glomus tumors.

악성화한 거대 위 융모종

장채령 ( Chae Ryeong Jang ),최석렬 ( Seok Reyol Choi ),조정환 ( Jeong Hwan Cho ),구영훈 ( Young Hun Koo ),한승호 ( Seung Ho Han ),유승훈 ( Seung Hoon Ryu ),이동현 ( Dong Hyun Lee ),장진석 ( Jin Seok Jang ),이종훈 ( Jong Hun Lee 대한소화기학회 2005 대한소화기학회지 Vol.45 No.6

Villous tumors of the stomach are somewhat rare with approximately 100 cases only reported in the literatures and have tendency to undergo malignant transformation as high as 72%. They are frequently multiple and associated with other gasrtrointestinal ne

식도절제술 환자에서 식도내압 및 위배출시간에 대한 고찰

이철종(Cheol Jong Lee),최석렬(Seok Reyol Choi),지삼룡(Sam Ryong Jee),김광진(Kwang Jin Kim),금동주(Dong Joo Keum),홍기봉(Ki Bong Hong),이종훈(Jong Hun Lee),한상영(Sang Young Han),최필조(Pill Jo Choi) 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2

N/A Backgroud/Aims: Resection of the esophagus for malignant disease or a benign stenosis, has a choice not only of palliative surgery, but also of replacement of the esophagus with a transposed stomach, jejunum, or colon. The first-line method is replacement with a tubulized stomach. The purpose of this study was to investigate the association of esophageal motor dysfunction and gastric emptying time with symptoms after esophagectomy. Methods: We performed the esophageal manometry and gastric emptying time after esophagectomy for esophageal cancer in 12 patients and for benign esophageal disease in 2 patients. Results: In manometric studies, a zone of high pressure in the esophago-gastric anastomosis distal to the upper esophageal sphincter was associated with symptoms after esophagectomy. The gastric emptying rate was slowed in 7 out of 14 patients, but not associated with symptoms after esophagectomy. Conclusions: Our data suggest that a high-pressure zone distal to the upper esophageal sphincter was associated with symptoms after esophagectomy in manometric study. The gastric emptying rate was not associated with postoperative symptoms. (Korean Journal of Gastrointestinal Motility 2001;7:197-203)

5-FU 내성 대장암 세포주에서 생물학적 지표로서 단백 분해효소발현의 유용성

조몽(Mong Cho),최석렬(Seok Reyol Choi),이주일(Joo Il Lee),이철종(Cheol Jong Lee),김영식(Young S Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

N/A There have been many reports that colon cancer responds poorly to chemotherapy. Several classes of matrix metalloproteinases(MMPs) have been implicated in the process of invasion of epithelial and endothelial basement membranes in several steps of tumor invasion and metastasis. This study was performed to determine the biologic behavior and the histopathological characteristics of a 5-FU resistant colon cancer cell line. Methods : We performed several biologic assays including liver colonization assay, cell adhesion assay, invasion assay and zymogram for protease activity using parental HT29 cell and 5-FU resistant HT29 cell (HT29-FU cell). Results : In liver colonization assay, HT29-FU cell revealed a 2.5-fold increase in the liver weight and tumor burden compared with HT29 cell. HT29-FU cell showed moderate increase in adhesion and invasion assays in comparison to HT29 cell. HT29-FU cell revealed increased activity of MMPs and serine protease. Xenograft tumors of HT29-FU cell formed moderately differentiated adenocarcinoma with more glandular formations of mucin. Conclusion : The increased expression of MMPs in 5-FU resistant colon cancer cell can explain poor prognosis. These are potentially poor prognostic indicators in 5-FU resistant colon cancer. Consequently, it can be suggested that modulation of MMPs is needed to prevent invasion and metastasis in colon cancer by using inhibitors of these enzymes. (Korean J Med 57:323-332, 1999)