간동맥 화학색전술 치료를 받은 간세포암 환자의 예후와 혈청 α1 - Antitrypsin 과의 관계

손정일(Chong Il Sohn),황선호(Seon Ho Hwang),박문승(Mun Seung Park),이오영(O . Young Lee),윤병철(Byoeng Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),서흥석(Heung Suk Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

N/A Objectives: Hepatocellular carcinoma(HCC) has a poor prognosis, and only by early detection, cure can be expected by surgery. With development of chemoembolization therapy, we may expect better survival even in the advanced HCC, There many reports about prognostic factors for HCC treated with TAE. We examined relationship between survivals and prognostic factors especially serum a 1-antitrypsin levels in patients with HCC treated with TAE. Methods: 42 patients who had been diagnosed as HCC by ultrasonography and hepatic angiography from 1987 to 1994 were examined for prognostic factors and their survival. Results: Patient's survival who had a single mass was longer (average 21 months) than that of patients who had diffuse tumor(average 4 months, p=0.005). Patient's survival without portal vein thrombosis was longer (average 16 months) than that of patients with portal vein thrombosis (average 4 months, p<0.001). Serologically, patients with low α-fetoprotein level(AFP<40ng/ml) survived longer (average 14 months) than patients with high AFP level(AFP>400ng/ml, average 4 months, p<0.001). Patients with low αl-antitrypsin level (AAT<300 mg/dl) survived longer (average 14 months) than patients with high AAT level (AAT>300mg/dl, average 4 months, p<0.001). Especially, in HCC with low AFP level (AFP<400ng/ml), patients with low AAT level (AAT<300mg/dl) survived longer(average 21 months) than patients with high AAT level (AAT>300mg/dl, average 14 months, p=0.001). Patients with Child's classification A and B showed no signigicant differences in their survival. Conclusion: Serum AAT level may be an important prognostic index in patients with HCC and especially it may be more valuable in patients who had low serum AFP level.

Changes in Gallbladder Motility in Gastrectomized Patients

Joon Soo Hahm,Joon Yong Park,Yun Ju Cho,Chang Soo Eun,Yong Wook Lee,Ho Soon Choi,Byoeng Chul Yoon,Min Ho Lee,Choon Suhk Kee,Kyung Nam Park,Heon Kil Lim,Sung Joon Kwon 대한내과학회 2000 The Korean Journal of Internal Medicine Vol.15 No.1

Objectives: Gastric resection may predispose gallstone formation. However, the mechanism has not been clearly understood. To evaluate the relationship between gastric resection and gallstone formation, we compared gallbladder(GB) motility in gastrectomized

내시경적 낭종배액술로 치료한 췌장 가성낭종 2예

박경남,한동수,이민호,조윤주,최호순,조용현,손주현,기춘석,함준수,전용철,윤병철,노우균 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6

Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter.

담낭절제술과 대장암과의 상관관계

김기찬,박경남,한동수,이민호,최호순,이동후,손주현,이오영,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: It has been suggested that cholecystectomy can be related with the developmen of colon cancer and altered bile acid metabolism after cholecystectomy may be an important facto in the carcinogenesis. Thus, we have conducted a retrospective case-control study to clarify the relationship between cholecystectomy and subsequent development of colon cancer. Methods: We compared the incidence of previous cholecystectomy in 424 patients with colon cancer who had treated in our clinic during the period of 1983 to 1997 and in 424 age- and sex-matched controls Results: There was no significant difference in a prevalence of cholecystectomy and gallstones between colon cancer patients and controls (Cholecystectomy: odds ratio=1.17, 95% confidence interval=0.39-3.51; Gallstone: odds ratio=1.27, 95% confidence interval=0.73-2.21). The prevalence of cholecystectomy and gallstones was a little high in right-sided colon cancer group, but there was no statistically significant difference between right and left colon. Conclusions: The present study showed that there was no statistically significant association between cholecystectomy and colon cancer. To clarify whether colon cancer is associated with cholecystectomy or gallstones, further study with large sample size and a prospective study of the incidence of colon cancer afte cholecystectomy are proposed.

한국인에서 담석증과 인슐린 및 인슐린 저항성과의 관계

김정미 ( Jung Mi Kim ),이항락 ( Hang Lak Lee ),문원 ( Won Moon ),고동희 ( Dong Hee Koh ),이오영 ( Oh Young Lee ),윤병철 ( Byoeng Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민호 ( Min Ho Lee ),이동후 ( Dong Hoo 대한소화기학회 2007 대한소화기학회지 Vol.50 No.3

고인슐린혈증과 인슐린 저항성은 허혈 심질환이나, 대장암과 같은 여러 병의 중요한 원인인자로 알려졌으나, 담석증과의 관계는 불확실하다. 이전의 많은 연구에서 이미 당뇨 환자에서는 당뇨 자체가 담석 발생의 위험인자이며, 고인슐린혈증과 담석증이 관련이 있다고 밝혀졌으나, 당뇨가 없는 환자에서 담석증에 대한 연구는 아직 미미하며 국내에서는 아직 없다. 이에 한국인에서 당뇨의 과거력이 없으며, 금식 후 혈장 혈당이 126 mg/dL 미만인 환자를 대상으로 담석증과 인슐린 또는 인슐린 저항성과의 연관성을 알아보고자 하였다. 대상 및 방법: 당뇨 과거력이 있거나, 금식 후 혈장 혈당이 126 mg/dL 이상인 환자는 제외한 118명의 환자를 대상으로 29명의 담석증이 있는 환자군과 89명의 담석증이 없는 정상 대조군을 나누어 비교하였다. 키, 체중, 허리와 엉덩이둘레, 체지방률, 체질량지수[체중(kg)/키의 제곱(m2)], 공복 혈청 인슐린, 혈당, 콜레스테롤, 중성지방, 저밀도 콜레스테롤을 측정하였다. 담석증 여부는 복부 초음파 검사를 통해 결정하였으며, 인슐린 저항성의 지표로는 homeostasis model assessment of insulin resistance (HOMA-IR)을 사용하였다. 결과: 담석증을 가진 환자군이 정상 대조군보다 혈중 인슐린, HOMA-IR 지수, 중성지방, 체질량지수, 체지방률이 더 높게 나왔으나, 두 군 간에 유의한 차이를 보인 것은 혈중 인슐린(p=0.037), HOMA-IR 지수(p=0.024), 체질량 지수(p=0.024)이며, 중성지방은 p=0.076으로 경계값에 있었다. 유의하게 나타난 인자로 로지스틱 회귀분석을 사용하여 분석한 결과, 혈중 인슐린(p=0.014, odds ratio=1.376)과 HOMA-IR 지수(p=0.013, odds ratio=2.006)가 담석증의 위험을 증가시키는 것으로 나타났다. 결론: 한국인에서 당뇨가 없으며, 정상 혈당을 가진 사람에서도 혈중 인슐린 수치가 높거나, 인슐린 저항성이 있으면 담석증 빈도가 높으며, 담석증 발생 위험이 증가한다. Background/Aims: Diabetes is one of the risk factors of gallstone diseases. Many studies found a positive association between insulin and gallstones in individuals with diabetes. However, this association is unclear in non-diabetes. So we conducted a case-control study for the evaluation of the association between gallstone diseases and fasting serum insulin level, insulin resistance in non-diabetic Korean general population. Methods: This study was a prospective case-control study on 118 Korean subjects which included clinical examination, abdominal ultrasound, and blood chemistries. Serum fasting insulin level were determined by radioimmunoassay and concentrations of cholesterol, glucose, and triglycerides by standard enzymatic colorimetric methods. Insulin resistance was determined by the homeostasis model assessment (HOMA-IR). Body mass index (BMI), percentage of body fat, and waist hip ratio were also measured. Results: We studied 118 subjects with no clinical evidence of diabetes mellitus and serum glucose <126 mg/dL. Compared with controls (n=89), cases (n=29) had higher levels of serum insulin, glucose, triglyceride levels, and BMI. In t-test and chi-square test for variables, the association between gallstone disease and serum insulin, HOMA-IR index, and BMI were statistically significant (p<0.05). In multiple logistic regression analysis, gallstone disease risk increased with the level of serum insulin (p=0.024, odds ratio=1.376) and HOMA-IR index (p=0.013, odds ratio=2.006). Conclusions: We suggest that hyper-insulinemia and insulin resistance could be associated with gallstone formation in individuals without clinical diagnosis of diabetes mellitus and with normal serum glucose level. (Korean J Gastroenterol 2007;50:183-187)

궤양성 대장염과 유사한 양상을 보인 살모넬라 대장염 1예

손병관,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Salmonella species have recently been shown to involve the colon in a fashion resembling ulcerative colitis by radiographic and endoscopic appearance. The presentation of Salmonella colitis is usually similar to that of ulcerative colitis; and often leads to delayed or inappropriate management. Furthermore, Salmonella infection and inflammatory bowel disease (IBD) can coincide in the same patient. Salmonella colitis in the setting of undiagnosed underlying IBD can present a diagnostic dilemma for the clinician. We report a case of Salmonella colitis in which the radiographic and colonoscopic findings were similar to those of ulcerative colitis.

Minocycline Hydrochloride 1회 주입으로 치료된 거대 간낭종 1예

이준수,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수,김용수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Hepatic cysts are usually asymptomatic, and require no treatment, but occasionally they may become large enough to cause symptoms. Aspiration of cystic fluid, surgical intervention, or instillation of various sclerosing agents has been used. Recently, some reports have shown that treatment with minocycline hydrochloride instillation into the cyst produces good results. We experienced a successful treatment of a huge hepatic cyst by instillation of minocycline hydrochloride. After cystic fluid was aspirated, 600 mg of minocycline hydrochloride was instilled into the hepatic cyst, 15 cm in diameter, through the pigtail catheter under ultrasound guidancee. After 2 months, the cyst could not be detected by diagnostic imaging, and no recurrence was observed. We report a case of successful treatment of a huge hepatic cyst with instillation of minocycline hydrochloride.

유두괄약근 절개술 후에 발생된 유두부 재협착 1예

박경남,한동수,이민호,최호순,이동후,손주현,기춘석,함준수,손영우,전용철,윤병철,조윤주 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.

만성 간 질환에서 경직장 Thallium-201 간 스캔의 임상적 의의 및 방사능 분포 양상

박경남,이민호,박근태,김진배,최호순,기춘석,함준수,윤병철,조석신,박문승 대한소화기학회 1998 대한소화기학회지 Vol.30 No.4

Background/Aims: Quantification of the portosystemic shunt is important for properly managing the patients, predicting prognosis and adjusting dosages of oral iirugs for chronic liver disease. In this study, we evaluate the clinical significance of thallium-201 liver scan for chronic liver diseases mainly in the aspects of radioactivity distribution. MethndIs: From February 1991 to April 1994, 54 patients with chronic liver disease(25 patients with chi anic active hepatitis, 22 Child A cirrhotics, and seven Child B cirrhotics) underwent the scan. The shunt index(H/L ratio) was determined and was classified into three groups according to the patterns of distributioo of radioactivity performed in them(Type I: normal, Type II: filling defect in the liver with or without extra hepatic radioactivity, Type III: extrahepatic radioactivity only) Results: The shunt index in cirrhotics was higher than chronic active hepatitis(0.56±0.38 vs 0.35±024 p$lt;0.05). In terms of patterns of distribution of radioactivity l3 patients among 14 patients with type I(93%) were patients with chronic active hepatitis, 14 patients among 25 patients with type II(56%) were cirrhotics and the remaining were patients with chronic active hepatitis. 14 patients among 15 patients with type Ill were cirrhotics. In terms of shunt indices according to the patterns of distribution of radioactivity the shunt index of type III was higher than that of type II and that of type II was higher than type I(0.79±0,40:0.39±0.29 p$lt;0.01, 0.39±0.29:0.21±0.14 p$lt;0.05). Conclusions: Determination of the shunt index using a per rectal thalliurn-201 liver scan wa:$gt; a useful method for quantifying the porto- systemic shunt noninvasively and it can differentiate chroruc active hepatitis from cirrhosis. Considering that the graver the chronic liver disease is, that moie frequent type III is, we assume that transformation from type I to type III indicates a progres. Ion of chronic active hepatitis to cirrhosis.

담도 배액관 교체 후 발생한 혈담증

박경남,한동수,이민호,최호순,손주현,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Hemobilia is defined as hemorrhage into the biliary tract and occurs when injury or disease cause communication between the biliary tract and blood vessels. The causes of hemobilia are trauma (accidental, iatrogenic), inflammation, gallstone, neoplasm, and vascular lesions. Currently, the mos common cause of hemobilia is trauma. Specially, iatrogenic causes are considered as the mos important. Iatrogenic cause of hemobilia has increased now because invasive procedures such as liver biopsy, biliary drainage (PTBD, ERBD) were popular. We experienced 2 cases of iatrogenic hemo bilia developed after exchange of ERBD stent.