식도정맥류에 대한 내시경적 결찰요법의 치료효과 및 장기 추적관찰

이동호,정현채,송인성,김용태,이한주,이효석,김정룡,윤정환,김재규,이국래,윤용범,정운태 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

Hemorrhage from esophageal varices is a catastrophic complication of portal hypertension. Endoscopic variceal ligation(EVL) is a newly developed technique that may replace Endoscopic injection sclerotherapy(EIS). But there are a few reports of longterm follow-up of EVL in Korea. We analysed 42 patients to evaluate longterm effect of EVL for esophageal varices. Total 689 variceal ligations were performed during 117 separate EVL sessions. Control rate of acute bleeding was 90.5%(38 of 42 patients). Four patients who were failed on control of acute bleeding were taken EIS with successful bleeding control. The eradication rate of esophageal varix was 76.2%(32 of 42 patients), the mean session for eradication of varix was 3,0(2-6), the number of bands per person was 16.0(5-41), and the number of bands per session was 6.0(4-11). Rebleeding after initiation of EVL occured in 1l of 42 patient(26,2%). 81.8% of rebleeding occurred 6 months later after EVL was done. The mortality rate and survival rate after varix eradication during follow-up period(after 6-45 months, mean: 15.5 months) was each 14.3%(6/42) and 85.7%(36/ 42). The causes of death were hepatic failure (3/6), esophageal variceal bleeding(2/ 6) and hepatic encephalopathy(l/6). After EVL, there were no serious treatment-re lated complications: except mild complications: mild chest pain in 5 patient(12.0%), mild substernal pain in 7 patients(16.6%). These results suggest that EVL is a safe and effective method for treatment of variceal bleeding control and eradication of esophageal varices with least serious complication. But regular periodic examination(interval of 4-6 months) and repeat EVL after eradication of varices should be required becuse of recurrence of varix and rebleeding.

조기위암의 근치적 치료로서의 내시경적 점막절제술

이대희,이동호,송인성,정현채,정운태,최규완,김우호,이준행,김정룡,윤정환,임영석,이국래,김병관,황진혁,정준오 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.6

The endoscopic mucosal resection(EMR) is proposed by some Japanese investigators as a curative therapy of early gastric cancer(EGC) because of its minimal invasiveness and excellent results. To evaluate the possible role of EMR as a curative treatment modality of EGC, we retrospectively analyzed l9 casea with EGC initially treated by EMR in Seoul National University Hospital from December 1993 and January 1996. 1) The histologic diagnosis prior to EMR was adenocarcinoma in 12 cases(63%) and adenomatous polyp in 7 cases(38%), which were confirmed as adenocarcinoma after EMR. 2) The histologic curative resection was done in 7 cases(37%). Two cases of them showed recurrence of the gastric cancer and were treated by radical surgery. The other five cases have been closely observed by regular endoscopic examination without recurrence for the maximal period of 1~3 months. 3) Histoiogically inadequate resection(positive cancer cell in resection margin, submucosal cancer infiltration, or no cancer tissue in resected specimen) was done in 12 cases(73%). But two surgically resected cimens of them have no residual cancer cells, and there was no cancer cells in the follow-up biopsy of the other two patients. There 4 cases were seemed to he examples of buring effect of EMR. 4) After excluding five depressed lesions greater than 1 cm is long diameter, nine lesions were curatively treated by EMR. So successful EMR rate for strictly indicated lesions wsa 64%. 5) There was no signifieant complication related to the procedure. We thnnk that endoscopic mucosal resection has a potential role as a curative treatment modality in a highly selected patient with darly gastric cancer.

Helicobacter pylori 감염 진단에서 QuickVue H . pylori 검사와 기존의 IgG ELISA 검사와 비교 , 검토

이국래(Kook Lae Lee),임창영(Chang Young Lim),이동호(Dong Ho Lee),윤정환(Jung Hwan Yoon),이한주(Han Ju Lee),정현채(Hyun Chae Chung),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Background/Aims: To evaluate and compare the efficacy of QuickVue H. pylori test and IgG ELISA test in diagnosis of Helicobacter pylori infection. Methods: One hundred patients(46 gastritis patients, 18 gastric ulcer patients, 18 duodenal ulcer patients, 15 nonulcer dyspepsia patients, 3 others including gastric cancer and adenoma) were enrolled in this study. Endoscopic gastric antral biopsy specimens were obtained for microscopic examination of the bacteria and rapid urease test(CLO test). Bio-Rad GAP IgG ELISA test(Bio-Rad Chemical Division, U.S.A.) and QuickVue H. pylori test(Quidel, U.S.A.) were also performed for serologic diagnosis of H. pylori infection. Detection of H. pylori by microscopy was considered as true positive for H. pylori infection. Absence of H. pylori by microscopy and positive CLO test was considered as equivocal and these cases were exc]uded in the analysis of the data. Results: 57 patients(57%) were positive, 36 patients(36%) were negative and 7 patients(7%) were equivocal in H. pylori infection. The sensitivity of IgG ELISA test was 84.2% and the specificity was 52.8%. The sensitivity of QuickVue H. pylori test was 87.7% and the specificity was 61.1%. Conclusions: Both serologic tests for the diagnosis of H. pylori infection are comparable in sensitivity and specificity.(Korean J Gastroenterol 1997; 29:35 -40)

대장상피세포에서 IL-10 유전자 전달의 CXC 케모카인에 대한 억제 효과

이국래 ( Kook Lae Lee ),김찬규 ( Chan Kyu Kim ),김병관 ( Byung Kwan Kim ),이동호 ( Dong Ho Lee ),김주성 ( Joo Sung Kim ),정현채 ( Hyun Chae Jung ),송인성 ( In Sung Song ),이연 ( Yeon Lee ),박종상 ( Jong Sang Park ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

금식시 흰쥐 소장 점막 유당분해효소에 대한 갑상선 호르몬의 영향 및 이의 유전적 조절 기전

이국래(Kook Lae Lee),이동호(Dong Ho Lee),이한주(Han Ju Lee),윤정환(Jung Hwan Yoon),김재규(Jae Gyu Kim),정운태(Woon Tae Jeong),정현채(Hyun Chae Jung),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: We perforrned this experiment to investigate the effect of thyroid hormone on the ]actase activity of rat small intestine by observing the change of lactase level according to the application of thyroid hormon: during fasting. Methods: Forty five male Wistar rats weighing about 260 gram were divided into three groups. The rats of control group(n=5) were sacrificed at 0 hour. The rats of first group(n=20) were starvated with intraperitoneal injection of 0.01 M NaOH 0.1 cc/100 gm body weight daily. The rats of second group(n=20) were starvated with intraperitonea] injection of triicdothyronine(T3) 30 ug disso]ved in 0.01 M NaOH 0.1 cc/100 gm body weight daily. The rats of first and second group were sacrificed at 12 hour, 1 day, 3 day, 5 day respectively, After sacriticing we measured T3 and free T4 level in serum, and intestinal lactase activity from three equally divided segments of removed small intestine. Ancl lactase mRNA were also measured. Results: The T3 and free T4 levels decreased in the NaOH injected groups, especially 3 day or 5 day groups, and T3 level increased in all the thyroid horrnone injected poups but free T4 level decreased. Lactase activity of proxima! Intestine was elevated with fasting, but not elevated in T3 application group. Lactase activity of middle and distal intestine showed similar changes. There was no statistically significant corre1ation between lactase activity and rnRNA level. Con< lusions: Lactase activity is controlled by thyroid hormone. Lactase expression may be regulated at the posttranscription level. (Korean J Gastroenterol 1996; 28:7S7-797)

대장상피세포에서 Interleukin-10 유전자 전달의 CXC 케모카인에 대한 억제 효과

이국래 ( Kook Lae Lee ),김찬규 ( Chan Gyoo Kim ),김병관 ( Byeong Gwan Kim ),장동경 ( Dong Kyung Chang ),이동호 ( Dong Ho Lee ),김주성 ( Joo Sung Kim ),정현채 ( Hyun Chae Jung ),이연 ( Yeon Lee ),박종상 ( Jong Sang Park ),송인성 ( 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: Cytokine plays an important role in initiation and continuation of inflammatory bowel disease. However, cytokine protein has some limitation as a therapeutic tool because of low bioavailability, poor pharmacokinetics and chemical instability. Thus, we studied the effect of interleukin 10 (IL-10) gene transfection on murine colon cancer cell line by using non-viral gene carrier. Methods: Therapeutic gene and plasmid was pCAGGS mouse IL-10 and gene carriers were polyethyleneimine (PEI) and 3β[L-ornithinamide-carbamoyl] cholesterol (O-chol). After IL-10 gene transfection, we measured the level of IL-10 in supernatant of cultured CT-26 cells. The chemokine cytokine-induced neutrophil chemoattractant (KC) and macrophage inflammatory protein (MIP)-2, which were treated with lipopolysaccharide (LPS) or tumor necrosis factor-alpha (TNF-α), were measured after IL-10 gene transfection. Results: The IL-10 values were increased significantly by using PEI, but not by using O-chol. The KC and MIP-2 values were increased when LPS or TNF-α were treated. When PEI was used, KC and MIP-2 values increased by LPS or TNF-α were decreased. When O-chol was used, the KC values increased by TNF-α were decreased but those treated by LPS were not decreased, and the MIP-2 values were not decreased. Conclusions: After IL-10 gene transfection in colon cancer cell, IL-10 cytokine was efficiently expressed. The increased chemokine values by LPS or TNF-α were suppressed by IL-10 gene transfection, but which was not constant because of carrier efficiency. (Korean J Gastroenterol 2003;41:447-455)

Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study

Dong Seok Lee,Gin Hyug Lee,Sang Gyun Kim,Kook Lae Lee,Ji Won Kim,Ji Bong Jeong,Yong Jin Jung,Hyoun Woo Kang 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.5

Background/Aims: We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism foruse training endoscopists. Methods: An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. BetweenMarch 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-relatedfactors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts. Results: Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator hadseveral benefits, including better marking of the target lesion’s limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulnessof the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforationrate decreased after 4 sessions (12 procedures). Conclusions: We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performingreal-time ESD procedures in patients.

Hepatopulmonary Syndrome in Poorly Compensated Postnecrotic Liver Cirrhosis by Hepatitis B Virus in Korea

(Jae Ho Lee),(Dong Ho Lee),(Joo Hee Zo),(Tae Ho Kim),(Kook Lae Lee),(Hee Soon Chung),(Cheol Ho Kim),(Sung Ku Han),(Young Soo Sim),(Hyo Suk Lee),(Yong Bum Yoon),(In Sung Song),(Chung Yong Kim) 대한내과학회 2001 The Korean Journal of Internal Medicine Vol.16 No.2

N/A Background : Hepatopulmonary syndrome (HPS) refers to the association of hypoxemia, intrapulmonary shunting and chronic liver disease. But there is no clear data about the prevalence of HPS in postnecrotic liver cirrhosis by hepatitis B virus(HBV), the most common cause of liver disease in Korea. The aim of this study was to investigate the prevalence of HPS in poorly compensated postnecrotic liver cirrhosis by HBV, and the correlation of the hepatopulmonary syndrome with clinical aspects of postnecrotic liver cirrhosis by HBV. Methods : Thirty-five patients underwent pulmonary function test, arterial blood gas analysis and contrast-enhanced echocadiography. All patients were diagnosed as HBV-induced Child class C liver cirrhosis and had no evidence of intrinsic cardiopulmonary disease. Results : Intrapulmonary shunt was detected in 6/35 (17.1%) by contrast- enhanced echocariography. Two of six patients with intrahepatic shunts had significant hypoxemia (PaO2 < 70 mmHg) and four showed increased alveolar- arterial oxygen gradient over 20 mmHg. Only cyanosis could reliably distinguish between shunt positive and negative patients. Conclusions : The prevalence of intrapulmonary shunt in poorly compensated postnecrotic liver cirrhosis by HBV was 17.1% and the frequency of hepatopulmonary syndrome was relatively low (5.7%). ‘Subclinical’ hepatopulmonary syndrome (echocardiographically postive intrapulmonary shunt but without profound hypoxemia) exists in 11.4% of cases with poorly compensated postnecrotic liver cirrhosis by HBV. Cyanosis is the only reliable clinical indicator of HPS of HBV- induced poorly compensated liver cirrhosis. Further studies are required to determine if the prevalence and clinical manifestations of HPS varies with etiology or with geographical and racial differences.

HBV 에 의한 후괴사성 간경화환자들에서 조영 심초음파도를 이용한 폐내 단락에 관한 연구

이재호(Jae Ho Lee),이경미(Kyung Mi Lee),조주희(Joo Hee Zo),이동호(Dong Ho Lee),정경해(Kyung Hae Jung),김원배(Won Bae Kim),이국래(Kook Lae Lee),김철호(Cheol Ho Kim),정희순(Hee Soon Chung) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Background: Liver cirrhosis is a common disease and mainly postnecrotic by the infection of hepatitis B virus (HBV) in Korea, and arterial hypoxemia is not a rare finding in liver cirrhosis. But there were few studies about hepatopulmonary syndrome which is defined as liver dysfunction, hypoxemia and intrapulmonary vascular dilatation, and one of the causes of arterial hypoxemia. Method: We examined the presence of dyspnea and stigmata of chronic liver disease in 35 patients who were diagnosed as Child class C, liver cirrhosis by HBV and had no evidence of intrinsic cardiopulmonary disease at Seoul Municipal Boramae Hospital (from January 1996 to October 1996). To diagnose hepatopulmonary syndrome, contrast-enhanced echocardiography was done for detecting intrapulmonary shunt in association with pulmonary function test, arterial blood gas analysis, chest roentgenogram and EKG. Result: 1) Twenty nine patients (82.9%) complained of exertional dyspnea, and the six from these patients also complained of resting dyspnea. Tachypnea was observed in 15 patients (42.9%/normal respiration rate defined as 12 to 16 per min), while platypnea was not found. 2) Splenomegaly and ascites were universal findings in all while clubbing of finger and cyanosis were observed in only 1 case (2.9%) and 2 cases (5.7%), respectively, and esophageal varix was found in the thirty two (91.4% / grade I in 9, grade II in 20 and grade III in 3 patients). Spider angioma was observed in the twenty one (70.0% among 30 patients). 3) Seven patients (20.0%) showed mild ventilatory defect of restrictive type since forced vital capacity decreased to 65-79% of predicted value. Diffusing capacity for carbon monoxide decreased below 70% of predicted value in 4 patients (11.4%). In addition, there were small amount of pleural effusion in 5 patients (14.3%) and nonspecific arrhythmia in 3 patients (8.6%). 4) Six cases (17.1%) had intrapulmonary shunt, which showed significantly lower arterial oxygen tension (72.2±15.1 vs 90.2±7.4 mmHg, p<0.05) and increased alveolar- arterial oxygen difference (43.1±16.2 vs 22.4±7.4 mmHg, p<0.05). 5) Only the cyanosis had a significant correlation with intrapulmonary shunt. Conclusion - 1) Intrapulmonary shunt was detected by contrast- enhanced echocardiography in the six from 35 cases of Child class C, liver cirrhosis by HBV 2) But only two patients of six positive intrapulmonary shunt patients showed significant hypoxemia (PaO2<70mmHg). Our results suggest that subclinical hepatopulmonary syrdrome may be exist.

스테로이드 저항성 궤양성 대장염 환자에 대한 Cyclosporine A의 치료 효과

이대희(Dae Hee Lee),이준행(Jun Haeng Lee),박동영(Dong Young Park),김윤준(Yoon Jun Kim),황진혁(Jin Hyok Hwang),차성덕(Sung Duk Cha),정운태(Woon Tae Jeong),윤정환(Jung Hwan Yoon),이국래(Kook Lae Lee),이동호(Dong Ho Lee),정현채(Hyun Cha 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: In refractory severe ulcerative colitis patients who are resistant to intravenous corticosteroids and total parenteral nutrition, new medical therapeutic tools that induce rapid remission is required in order that the patients can avoid colectomy. Since 1990, several western groups reported in their well designed studies that cyclosporine A cou)d induce rapid remission at steroid resistant severe ulcerative colitis patients resulting avoidance of colectomy. We tested the effectiveness of intravenous cyclosporine A therapy at steroid resistant severe ulcerative colitis patients in Korea, which has little experiences in the management of steroid resistant severe ulcerative colitis. Methods: Seven patients were included who were refractory to intravenous corticosteroids and total parenteral nutrition of at least 4 weeks duration. Their liver function tests and creatinine clearance tests were all normal. Cyclosporine A were administered by continuous intravenous methods over 6 hours or 24 hours. The starting doses of cyclosporine A were 4 mg/kg. The blood level was monitored by radioimmunoassay with a monoclonal antibody. The doses were adjusted at blood level from 100 ng/ml to 400ng/ml. In one patient cyclosporine A was administered for only 4 days because of rapid aggravation and consequent emergency operation. In another 6 patients cyclosporine A were administered for 14 days. Results: Four patients revealed scores of less than 10 by clinical activity scores system. But, in spite of improvement by scores, 3 patients of above 4 responders exhibited persistent gross hematochezias at frequencies of more than 3 times a day. Therefore operations were recommended in 6 patients. But one patient refused operation and is under OPD follow up with oral cyclosporine A and corticosteroids medications but he exhibits persistent gross hematochezia at a frequency of 3 or 4 tirnes a day. Out of 5 patients who were operated, 4 patients were cured by operations but 1 patient died because of postoperational sepsis. Conclusions: We found that the intravenous cyclosporine A therapy produced some improvement by clinical activity scores in 4 patients out of 7 patients but induced clinical remission of gross hematochezia in only 1 patient. Therefore operation could be avoided in only 1 patient. This result suggests that the response of Korean patients to intravenous cyclosporine A therapy would be different from that of western people. However, many another studies, especially case control studies are required to clarify this possibility and to assign the proper role of intravenous cyclosporine A therapy in the manageent of patients with ulcerative colitis in Korea. (Korean J Gastroenterol 1997; 30:58-65)