Alendronate 복용으로 유발된 위궤양 1 예

김병호(Byung Ho Kim),정용희(Young Hee Joung),장영운(Young Woon Chang),민선기(Sun Kee Min),문주영(Ju Young Moon),한요셉(Yo Seb Han),이동근(Dong Keun Lee),동석호(Seok Ho Dong),김효종(Hyo Jong Kim),이정일(Jung Il Lee),장린(Rin Chang) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4

Alendronate (Fosamax), an aminobisphosphonate and a selective inhibitor of osteoclast-mediated bone resorption, is used to treat postmenopausal osteoporosis and Paget's disease. In recent years, reports of severe esophageal injury in patients who took alendronate have evoked attention to the irritant effects of this drug on the mucosa of the upper gastrointestinal tract. We present a case of gastric ulcer caused by alendronate. The patient chiefly complainted of epigastric pain during 14 days. She had taken mefenamic acid for pain control for 3 years and she took once-weekly 70 mg of alendronate for 2 weeks for treatment of osteoporosis before the symptom started. Upper gastrointestinal endoscopy revealed two active gastric ulcers in the low body. The results of rapid urease test (CLO test) and modified Giemsa test for the detection of Helicobacter pylori infection were negative. After withdrawal of alendronate, the symptom resolved completely in one week. Six weeks later, follow-up endoscopy showed complete healing of the ulcer. (Korean J Gastroenterol 2001;38:284-287)

내시경적 정맥류 결찰요법의 단기 치료성적 및 안정성 - 내시경적 경화요법과의 비교 -

김병호 ( Byung Ho Kim ),김효종 ( Hyo Jong Kim ),김영관 ( Young Kwan Kim ),장린 ( Rin Chang ),이정일 ( Joung Il Lee ),동석호 ( Seok Ho Dong ),장영운 ( Young Woon Chang ) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.5

N/A Endoscopic sclerotherapy is an effective method for bleeding esophageal varices, however it is often associated with local and systemic complications which may limit its usefulness. A newly developed endoscopic treatment for bleeding esophageal varices, endoscopic variceal li- gation, which uses small rubber bands to occlude and eradicate the varices, may cause less damage to the esophagus and have no systemic complication theoretically. We compared the effectiveness and safty of the two techniques retrospectively. The patients had proved bleeding from esophageal varix and showed advanced liver cirrhosis. Nineteen patients were treated with ligation, and 20 patients with sclerotherpy. They were followed for a mean of 4 months. Acitve bleeding was controlled by ligation in 2 of 3 patients(67% ) and by sclerotherapy in 3 of 4 patients(75%). The eradication of varices was achieved by ligation in 6 of 14 patients(43 A ) and by sclerotherapy in 10 of 15 patients(67% ). But the mean number of treatments with ligation was lower than that with sclerotherapy(3.4 vs 4.2) ar J than other ligation treatment group(4-5). There was no significant difference in recurrent hernorrhage between two groups. There were one case of pleural effusion and one case of sepsis with acute renal failure in scle- rotherapy treated-patients, whereas none of these complications occurred in ligation treated patients. Two cases of treatment induced bleeding were developed in ligation group. Endoscop- ic variceal ligation has fewer local and/or systemic complications than sclerotherapy. To eradi- cate varices more completely and to achieve denudation of lower esophageal mucosa for pre- vention of recurrent hemorrhage, combination with sclerotherapy would be effective rather than ligation alone.(Korean J Gastroenterol 1994; 26: 765 770)

통상적인 항미토콘드리아항체 검사법에 음성인 원발성 담즙성 간경변증 1예

김병호(Byung Ho Kim),동석호(Seok Ho Dong),김효종(Hyo Jong Kim),이정일(Joung Il Lee),장영운(Young Woon Chang),장린(Rin Chang),임근우(Keun Woo Lim),김희진(Hee Jin Kin\m),남기덕(Ki Deok Nam) 대한내과학회 2000 대한내과학회지 Vol.59 No.1

Primary biliary cirrhosis is a chronic progressive cholestatic liver disease of unknown cause that usually affects middle-aged women and eventually leads to cirrhosis and liver failure. It is characterized by the progressive destruction of small intrahepatic bile ducts, portal inflammation, and progressive scarring. The diagnosis is made by these characteristic pathologic findings and the presence of antimitochondrial antibody. Immunofluorescence, the most widely used method for determining antimitochondrial antibody, is less sensitive and specific than ELISA or immunoblotting and influenced by observer interpretation. Therefore, it is important to detect anti-M2 antibody, the most specific antibody of primary biliary cirrhosis, by ELISA or immunoblotting when antimitochondrial antibody is not detected by immunofluorescence method which can lead to the incorrect diagnosis as autoimmune cholangitis. We describe a case of primary biliary cirrhosis with antimitochondrial antibody negative by immunofluorescence, anti-M2 antibody positive by ELISA. We confirmed primary biliary cirrhosis by liver biopsy.(Korean J Med 59:85-90, 2000)

Galactosamine으로 급성간부전이 유도된 흰쥐에서 간세포이식의 효과

김병호(Byung Ho Kim),은연기,김효종(Hyo Jong Kim),장영운(Young Woon Chang),장린(Rin Chang),이정일(Jung Il Lee) 대한내과학회 1991 대한내과학회지 Vol.40 No.4

Although the mortality rate following acute hepatic failure is still high, it is possible to recover completely if patients survive. So temporary hepatic support that can sustain life during the period of hepatic insufficiency is important in the treatment of acute hepatic failure. Despite the fact that various therapeutic modalities have been described for treating acute liver failure, none has proven to be clinically useful except for the liver transplantation. But liver transplantation is not used widely because of the difficulty in obtaining cadaver donor organs especially in eastern countries, techinical difficulties, and high cost. As the alternatives to liver transplantaion, several investigators developed various techniques of hepatocellular transplantation, which has significantly enhanced the survival rate in the animal from chemically or surgically-induced acute liver failure. According to the evidence provided by the aforementioned studies, we investigated the efficacy of allogeneic hepatocellular transplantation on the survival rate following galactosamine-induced acute liver failure in the Sprague-Dawley male rat, The results were as follows: 1) In the preliminary study for determining the amount of d-galactosamine HC1 (Sigma), intraper- itoneal injection of 1.3g/kg of galactosamine induced a mortality rate of 75% within 5 days in 12 rats (210~280g). 2) Isolation of hepatocytes was performed by a modification of the method of Seglen, collagenase (Sigma, type I) two-step perfusion technique. The mean number of obtainable total hepatocytes from 7 rats was 2.2 ×108±0.7×108, with an average viability of 50±3%. 3) There was no significant difference in the survival rate between group I, which was administered only galactosamine, and group II, which was treated by intraperitoneal transplantation of 2×107 viable hepatocytes at 51 to 55 hours after administration of galactosamine (33% VS 40%). In conclusion, we couldn't note any improvement of survival after hepatocellular transplantation in rats with galactosamine-induced acute hepatic failure. But this result doesn't mean that hepatocellular transplantation had no effect in the treatment of acute hepatic failure. In the future, we will need further study about our method of hepatocytes isolation to increase the viability of isolated hepatocytes, adequate time of the transplantation after galactosamine administration, and syngeneic hepatocellular transplantation in order to evaluate more exactly the efficacy of hepatocellular transplantation.

심한 성장장애를 보인 Crohn 대장염 1 예

김효종(Hyo Jong Kim),김배영(Bai Young Kim),김병호(Byung Ho Kim),이정일(Joung Il Lee),장영운(Young Woon Chang),장린(Rin Chang),이기형(Kee Hyung Lee),전정열(Jung Youl Chun) 대한내과학회 1991 대한내과학회지 Vol.40 No.2

Growth retardation and delayed sexual maturation occur in 15-30% of adolescents afflicted with Crohn`s disease and social complication of these immaturity are often more debilitating than the gastrointestinal manifestation. The etiology of this abnormal growth had been unknown, and various forms of therapy including surgery had yielded disappointing results. Recently, however, chronic caloric insufficiency has been documented in several reports and nutritional restitution using enteral and parenteral routes reverses growth retardation in these patients, and these nutritional effects on growth may be mediated by somatomedin-C. We recently experienced a case of Crohn`s colitis with growth retardation and delayed sexual maturation in adolescent who underwent surgical resection, so we couldn't confirm the nutritional effect on growth but the patient had no endocrine dysfunction and no history of corticosteroid therapy which had been incriminated as possible causes of growth retardation. We report a case of Crohn`s colitis with growth retardation.

유전학적 불안전성을 보이는 대장암의 발생기전

김효종(Hyo Jong Kim),김윤화(Youn Hwa Kim),정혜전(Heo Jeon Cheong),동석호(Seok Ho Dong),김배영(Bae Young Kim),김병호(Byung Ho Kim),이정일(Joung Il Lee),장영운(Young Woon Chang),장린(Rin Chang),양문호(Moon Ho Yang) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: Multiple genetic alterations in tumor suppressor genes(APC, MCC, DCC, p53) and oncogenes(K-ras) have been implicated in the development of colorectal carcinomas(CRCs). Recently, mutator genes(hMSH2, hMLH1, hPMS1, hPMS2), which are characterized by the development of particular form of genetic instability, termed RER(replication error) was reported in CRCs. It is postulated that RER may be required for multiple genetic alterations in the development of CRCs. But the mode of genetic alterations caused by RER is not certain. To evaluate the mode of genetic alterations caused by RER in multistage carcinogeneis, we compared the frequency of p53 expression, known to be involved in the pathogenesis of CRC, in two groups of tumors. RER(+); those demonstrating RER, and RER( ); those lacking such genetic alterations. Methods: RER test at microsatellite loci; DNA was extracted from normal and tumor tissues using cryostat sectioning method. Purified DNA was subjected to a PCR-based technique in which(CA)n repeat sequence were amplified and RERs were detected when a change in allele length was detected. Immunohistochemical analysis of p53 expression; Deparaffinized section of formalin-fixed tumor tissue samples were immunostained for p53 protein, using a monoclonal p53-specific DO7 antibody. Results: The frequency of RER in sporadic CRC was 40.1%(9/22). P53 expression was observed in 6 of 18 carcinoma(33.3%). The frequency of p53 immunostaining was lower in tumors demonstrating RER(25% vs. 40%). All tumor demonstrating RER at multiple loci did not exhibited p53 immunostaining. Conclusions: These results suggest that RER is likely to play an important role in the pathogenesis of CRCs probably by the different mode of genentic alterations from those lacking RER. (Korean J Gastroenterol 1996;28: 36-46)

8 경피 내시경하 위루술을 시행한 169예의 시행 전 경비위관 거치 기간과 내시경 소견과의 상관관계

김한숙 ( Han Suk Kim ),동석호 ( Seok Ho Dong ),정경환 ( Kyung Hwan Jeong ),채명종 ( Myung Jong Chae ),한요셉 ( Yo Seb Han ),정용희 ( Yong Hee Jeong ),이병욱 ( Byung Wook Lee ),김효종 ( Hyo Jong Kim ),김병호 ( Byung Ho Kim ),장영운 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

음주 및 비음주 간경변 환자에서의 골이영양증

김양수(Yang Soo Kim),김현우(Hyun Woo Kim),김병호(Byung Ho Kim),동석호(Seok Ho Dong),김효종(Hyo Jong Kim),장영운(Young Woon Chang),이정일(Joung Il Lee),장린(Rin Chang) 대한내과학회 1993 대한내과학회지 Vol.45 No.1

Background: Osteopenia has long been recognized as a potential complication of chronic liver disease. Severe osteopenia, regardless of its cause, is a risk factor for the development of fracture, which may contribute to mortality in patients already debilitated by chronic liver disease, However, data an the prevalence and the severity of osteopenia in the patients with liver cirrhosis are scant in Korea. We determined the prevalence of osteopenia in cirrhotic patients and tried to elucidate the mechanism of osteopenia in cirrhotic patients. Methods: In 36 male patients with liver cirrhosis, twenty were nonalcoholics and sixteen were alcoholics. Fifteen male controls matched in age and sex were included in this study group. We determine of the prevalence of osteopenia using the dual energy absortiometry and various hormones and biochemical items relevant to bone metabolism were also measured. Results: 1) Bone density was significantly decreased in both groups of patients 'with liver cirrhosis, nonalcoholics and alcoholics, compared with normal controls (p<0.05). 2) The prevalence of osteopenia of whole body was 20Fo in non-alcoholic cirrhotics and 25% in alcoholic cirrhotics. The most frequent site of osteopenia was lumbar spine in both groups (30%, 31%). 3) The levels of ionized calcium and 1, 25-(OH)2-D3 were significantly decreased in both non-alcoholics and alcoholics compared with controls (p<0.05). Parathyroid hormone didn't show any significant difference between cirhotics and controls, but calcitonin was rather increased in cirrhotics. 4) In cirrhotic patients with osteopenia (whole body), the levels of ionized calcium, 25-OH-D3 1, 25-(OH)2-D3 were significantly decreased compared with non-osteopenic liver cirrhotics (p<0.05). 5) Regional bone density of spine, arm, and pelvis were significantly decreased in osteopenic cirrhotics compared with non-osteopenic cirrhotics. Conclusion: The prevalence of osteopenia was 10-30% in non-alcoholic cirrhotics, 19-31% in alcoholic cirrhotics depending on the site studied and the most frequent site of osteopenia was lumber spine in both groups. Decreased vitamin D and ionized calcium may be one of various pathogenic factors involving the developement of osteopenia in patients with liver cirrhosis, and especially decreased blood level of 25-OH-D3 in cirrhotics suggested that defect of 25-hydroxylation in cirrhotic liver may be partially responsible for decreased vitamin D. However, further studies need to be performed to elucidate the obvious mechanism of osteopenia according to the etiology of chirrhosis, remained liver function and the histologic form of osteopenia.

급성 췌장염의 시대적 변화

김배영(Bai Young Kim),김효종(Hyo Jong Kim),정형근(Hyung Keun Chung),김영관(Young Kwan Kim),동석호(Seok Ho Dong),김병호(Byung Ho Kim),이정일(Jung Il Lee),장영운(Young Woon Chang),장린(Rin Chang) 대한내과학회 1993 대한내과학회지 Vol.45 No.5

Background: According to the rapid changes in social environment such as increasing alcohol consumption and the marked improvement in diagnostic technique, we expect that there have been major changes in various aspects of acute pancreatitis during the recent 12 years in Korea. Methods: The medical records of 317 patients with acute pancreatitis diagnosed from 1980 through 1992 were reviewed about clinical, laboratory and radiological findings in the three different time period. Results: 1) There has been an increasing incidence in male sex about three folds. 2) There has been an increasing trends in the duration of hospitalization. 3) A significant increase was observed in the proportion of patients with alcoholic pancreatitis in the three different time period; 26.9%, 45.7%, 50.7% respectively. 4) The complication rates have been slightly increased in the three different time period; 46.3%, 47.1%, 59.1% respectively. But, the type of complications has not been changed. 5) There is increasing severity in non-gallstone group, but no significant differences in gallstone group. There is a declining trends in the number of patients with muld severity index, but increasing trend in the number of patients with moderate severity index in non-gallstone group. 6) There was no significant differences in mortality rate. Conclusions: There has been major changes in the etiology ans severity of acute pancreatitis from 1980 through 1992. Especially, significant increase in the proportion of patients with alcoholic pancreatitis was observed in the three differnt time period. These results might be due to socioeconomic changes.

단일 기관에서 경험한 크론병에서 Infliximab의 치료 효과

김연주 ( Yeon Ju Kim ),김정욱 ( Jung Wook Kim ),이창균 ( Chang Kyun Lee ),박현진 ( Hyun Jin Park ),심재준 ( Jae Jun Shim ),장재영 ( Jae Young Jang ),동석호 ( Suk Ho Dong ),김효종 ( Hyo Jong Kim ),김병호 ( Byung Ho Kim ),장영운 ( Y 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5

Background/Aims: Our aim was to assess the long-term data regarding efficacy and safety of infliximab (IFX) treatment for refractory Crohn`s disease (CD) patients in our tertiary teaching hospital. Methods: We have retrospectively analyzed the medical records of 89 CD patients who underwent IFX treatment between March 2003 and February 2011 at Kyung Hee University Hospital (Seoul, Korea). The primary outcome measurements were the rates of initial clinical response (CR) at 10 weeks after the 1st IFX infusion and sustained CR at the end of the follow-up. Overall adverse events related to IFX treatment were also evaluated. Results: The mean (SD) follow-up period of eligible 80 patients was 33.7 (21.9) months. A total of 77 patients (96%) showed initial clinical response, but 8 patients showed loss of response to IFX during the follow-up. Finally, 59 patients (59/77, 76.6%) showed sustained CR at the end of the study. Logistic regression analyses showed that an initial CR at 10 weeks was the independent predictor associated with sustained CR (OR 22.286, 95% CI 2.742-132.717, p=0.001). Overall adverse events reported in 18 patients (18/80, 23.3%), including 3 serious infection (pulmonary tuberculosis and herpes zoster). Conclusions: Treatment with IFX was efficacious and relatively safe for refractory CD patients in Korea. An initial CR at 10 weeks was significantly associated with sustained CR.