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민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),한동수(dong Soo Han),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),이선영(Sun Young Yi),이미화(Mi Hwa Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
Etiologic diagnosis is important in the management of a patient with acute pancreatitis. Early differentiation of gallstone pancreatitis from nongallstvne pancreatitis by imaging methods is often difficult. The objectives of this study are to assess valucs of clinical and laboratory data in establishing gallstone as an etiology of pancreatitis and to analyze endoscopie retrograde clholangiopancreato- grophy (ERCP) findings of gallstome panrreatitis. Age, sex, serum alkaline phosphatase, aminotransferase (SGPT), amylase, lipase, and total bilirubin levels were significantly clifferent (p < 0.05, chi square) between gallstone and nongallstone groups. The item which favor gallstone pancreatitis are age.50 years, female sex, amylase>1000 IU/ml, lipase 3000 IU/ml, SGPT-100 IU,/L, alkaline phosphatase2400 IU/L, and total bilirubin 2.5 mg, dl. It was found that, those who had more than 4 of above factors (21 cases) were more likely to have gallstone pancreatitis (15 cases, 71.4%). ERCP findings of 22 patients with gallstone pancreatitis were analysed. l5 cases (68.2%) had common bile duct stones, of which 9 had undertaken endoscopic sphincterotomy and removal of stones. In conclusion, clinical and biochemical predictive systems for presence of gallstones in acute pancreatitis may have useful roles in evaluation of etiology in acute pancreatitis and in planing early interventional treatment. ERCP and endoscopic sphinctivotomy in gallstone pancreatitis are safe and effective diagnostic and therapeatic measures.
정상적인 위내시경 소견을 보이는 사람의 위점막 조직에서 cagA 유전자 존재의 의의
민영일(Young Il Min),김해련(Hae Ryun Kim),양석균(Suk Kyun Yang),홍원선(Weon Seon Hong),정훈용(Hwoon Yong Jung),남승우(Seung Woo Nam),박주상(Ju Sang Park),강경훈(Gyeong Hoon Kang),윤광희(Kwang Hee Youn),이미헌(Mi Hun Lee),고진규(Jin K 대한소화기학회 1998 대한소화기학회지 Vol.31 No.6
Background/Airns: It becomes clear that clinical manifestation of H. pylori infection has marked diversity mainly due to the strain diversity of H. pylori and host susceptibility. Many attempts have been made to identify the pathogenic strains of H. pylori, and have shown that the strain with the gene coding for cagA may be a pathogenic strain. To determine the role of cagA gene in the developrnent of gastroduodenal diseases, it is important to test cagA gene in gastric tissues without gross abwrmality. Methods: In a total of forty-seven persons without abnormal gastroscopic findings, the prevalence of H. pylori was determined by polymerase chain reaction (PCR), CLO test, culture, and histological examination. Genomic DNA was amplified by PCR using the primer specific for the 109-bp product of 16S rRNA gene of H. pylori. The prevalence of cagA gene was examined in 37 persons who were positive in PCR for 16S rRNA gene of H. pylori. The PCR product using primer set specific for cagA gene was a 350-bp sized and represented mid-region of cagA gene. Resnlts: Thirty-two (68.1%) out of 47 persons were infected by H. pylori. Thirty-seven (78.7%) persons showed positive PCR result for H. pylori. The cagA was identified in 28 (75.7%) among 37 H. pylori positive persons. Conclusions: The high prevalence of cagA gene in H, pylori-infeced gastric mucosa was observed in the persons with no specific gross abnormality in gastroscapic examination. These results indicate that the expression of cagA gene is common in H. pylori infected gastric mucosa in Korea. To canfirm the cytotoxie activity, the further studies using other primers are needed. (Korean J Gastroenterol 1998;31:731-739)
급성 췌장염의 중증도 판정에 있어서 임상적 기준 ( Ranson 기준 ) 과 방사선학적 ( CT ) 기준의 비교 검토
민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),한동수(dong Soo Han),김명환(Myung Hwan Kim),이문규(Moon Kyu Lee),이선영(Sun Young Yi),이미화(Mi Hwa Lee),김미경(Mee Kyung Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
The assessment of severity has a key role in the management of patients with acute pancreatits. A total of 55 patients were enrolled in this study. Ransons cinical severity was determined within 48 hours after admission and radiologic severity was determined based on Balthazar criteria using computed tomography (CT) scan taken not later than 2 hours after admission. The seventy of pancreatitis based on Ransons criteria was mild (0-2 signs) in 39 patients (71%), moderate (3-6 signs) in 10 (18%), and severe ( 7 signs) in 6(11%). with increase in Ranson's score, average days of fasting, hospitali#zation and ICU care were increased. The mortality rate was also increased with CT criteria, the: patients showed mild .;everity in 29 patients (53%) (A:18, B:11). moderate in 20(36%) (C:16, D:4), and severe in 6(11%) (E:6). With increase in CT grade, above mentionr:d clinical parameters were similarly increased When clinical and CT criteria were compared simultaneously, of 39 patients with mild by rlinical rriteria 24 patients were in mild (grade A or B) and remaining 15 patients in moderate (grade C or D) by CT criteria. In 10 clinically moderate patients, 5 were in mild (grade A or B), 3 in rnoderate (grade C or K)) and 2 in severe' (grade E1 by CT critqria. In 6 cIimcally severe patient, were in moderate (grade C or D) and 4 were in severe (grade E) by CT criteria. In conclusion, Ranson's clinical criteria and CT grading were both useful in assessing the clinical course oi acute pancreatitiis. Signaficant statistical correlation was not found between two criteria hut combined prognostic criteria may be more helpful in determination of final outcome of acute pancreatitis.
골수로의 원격전이를 동반한 위장의 저등위 점막연관성 림프조직림프종 2 예
이미헌(Mi Hun Lee),정훈용(Hoon Yong Jung),강경훈(Gyung Hun Kang),장혜숙(Hye Sook Jang),명승재(Seung Jae Myung),양석균(Suk Gyun Yang),홍원선(Won Sun Hong),김진호(Jin Ho Kim),민영일(Young Il Min) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5
Extranodal mucosa-associated lymphoid tissue (MALT) lymphoma constitutes most of the low-grade gastric lymphoma and almost 50% of all gastric lymphoma. The specific recirculation pattern might explain the tendencies of MALT lymphomas to remain localized and to recur preferentially within the gastrointestinal tract. It was known that the rate of gastric MALT lymphoma with bone marrow involvement was low, as less than 10%. We have experienced two patients who presented with nonspecific abdominal pain and dyspepsia. They were diagnosed to have gastric low-grade MALT lymphoma with bone marrow involvement at the time of presentation. The endoscopic findings showed irregular ulcerations. Microscopically, there was monotonous lymphoid infiltration with lymphoepithelial lesions which were consistent with low grade MALT lymphoma. Both patients showed H. pylori-associated chronic gastritis. The results of their bone marrow biopsy showed focal infiltration of neoplastic lymphoid cells. We report two cases of primary gastric low-grade MALT lymphoma with the bone marrow involvement.
졸링거 - 엘리슨 증후군과 동반된 다발성 내분비종 I 형 1 예
이영미(Young Mi Lee),정훈용(Hwoon Yong Jung),최선영(Sung Young Choi),강호형(Ho Hyung Kang),명승재(Seung Jae Myung),양석균(Suk Kyun Yang),홍원선(Weon Seon Hong),김진호(Jin Ho Kim),민영일(Young Il Min) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1
Zollinger-Ellison syndrome (ZES) is characterized by recurrent peptic ulcer and diarrhea caused by gastric acid hypersecretion due to gastrinoma. Approximately, one third of patients with gastrinoma have multiple endocrine neoplasia type I (MEN-I). The diagnosis of gastrinoma is difficult, although it can be cured by surgery after localization. Recently, the somatostatin receptor scintigraphy (SRS) was reported to be more sensitive than any other tumor-localization methods. We report a case of ZES with metachronous MEN-I. A 47-year-old woman had peptic ulcer disease with its complications and recently developed diarrhea. Her serum gastrin level was markedly elevated (1,098pg/mL) but the results of conventional imaging tests were negative. We confirmed the presence of gastrinoma by the selective intraarterial secretin injection and portal vein sampling. Then, the tumor was eventually located by SRS under the diagnosis of ZES. She underwent a Whipple`s operation with the compatible pathologic findings of gastrinoma. She was confirmed to have parathyroid hyperplasia and MEN-I during follow-up. (Korean J Gastroenterol 2002;39:50-54)
박선미(Sun Mi Park),김해련(Hae Ryun Kim),민영일(Young Il Min),박건춘(Gun Chun Park),유은실(Eun Sil Yu) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1
Early gastric cancer(EGC) is defined as gastric cancer confined to mucosa or submucosa re- gardless of lymph node metastasis. But lymph node metastasis affects the prognosis of pa- tients with EGC. And nowadays with increasing interest in endoscopic non-operative treat- ment such as laser therapy or strip biopsy, it is necessary to predict nodal metastasis in pa- tients with EGC. A total of 249 cases of EGC were reviewed post operatively according to their size of lesion, macroscopic classification, depth of invasion and cellular differentiation to identify the fac- tors for nodal metastasis in EGC which act as limitation of radical endoscopic treatment. Out of 805 curative resections for gastric adenocarcinoma frorn July 1989 to Jan 1993 in our institute, there were 249 cases of EGC(30.1%). Sex ratio of EGC was 1.8: 1 and ratio of EGC limited to mucosa to that of submucosal involvement was equal (1: 1). Proportion of EGC ac- cording to macroscopic classification was 20.3% of elevated type ( I, I + lIa, Iia, Iia+ Ilb, Iia + Iic), 5.9% of flat type (II b) and 73.8% of depressed bype (Iic, Lic+ Itl, III, III+ LI b, Iic+ Lia, II b + Iic). Out of 249 cases of EGC, there were 36 cases of lymph node metastasis (14.5%). The frequency of nodal rnetastasis of EGC limited to mucosa and submucosa was 5.9% (7/119) and 21.2k(25/118) respectively. The size of mucosal cancer was less than 2cm in 4cases of de- pressed type out of 7 cases of nodal metastasis while with cases of submucosal involvement, the size of lesion could not effect the frequency of nodal metastasis. The frequency of nodal metastasis in EGC limited to mucosa according to macroscopic classification was 11.1% of ele- vated type, 0% of flat type, 5.3% of depressed type and frequency of nodal metastasis in submucosal involvement was 23.3%, 0% and Z2.5% respectively. There was no significant dif- ference in frequency of nodal metastasis according to cellular differentiation. Though the frequency of nodal metastasis is much lower in EGC limited to mucosa than in cases of submucosal involvement, nodal metastasis is found in mucosal cancer especially in cases with small depressed type. Therfore it is suggested that radical endoscopic treatment be not always safe even in less than 1cm sized EGC limited to mucosa, and this type of treat- ment should be selectively considered in cases with small flat or elevated type of mucosal cancer.(Korean J Gastroenterol 1994;26: 56-62)
내시경적 유두부 괄약근 절개술로 치유된 Gallstone Pancreatitis 1예
김명환,조원경,이미화,이성구,민영일 ( Myung Hwan Kim,Won Kyung Joh,Mi Hwa Lee,Sung Koo Lee,Young Il Min ) 대한소화기학회 1992 대한소화기학회지 Vol.24 No.4
A 70-year old man was admitted due to acute pancreatitis. On endoscopic retrograde cholangiogram, bulging ampullar was seen. Endascopic sphincterotomy (EST) with needletype papillotome was done and impacted stoine was then exposed. After removal of the stone, we inserted nasobiliary tube for drainage of infected bile. We present a case of gallstone pancreatitis with impacted stone treated by endoscopic sphincterotomy.
담도질환의 진단 및 치료에 있어 첨형 ( Needle Knife ) Papillotome을 이용한 내시경적 유두부 절개술의 유용성
김명환,이미화,이선영,정성훈,이성구,민영일 ( Myung Hwan Kim,Mi Hwa Lee,Sun Young Yi,Sung Hoon Jung,Sung Koo Lee,Young Il Min ) 대한소화기학회 1992 대한소화기학회지 Vol.24 No.6
Needle knife papillotomy was first introduced for impacted papillary stones. At present the use of needle knife papillotome has been extended to include attempted biliary access after failure of conventional techniques or initation of sphincterotomy in patients with Billroth II gastrectomy. During 3 years, we performed endoscopic sphincterotomy with needle knife papillotome in 45 patients. The indication for the use of needle knife papillotome was periampullary tumor (n=10), papillary impacted stone (n=7), Billroth II gastrectomy (n=6), difficult cannulation with normal- appearing papilla or papillitis (n=13), periampullary,diverticula (n=4), for precut (n=4) and for biopsy (n=1). Common bile duct access was successful after needle knife papillotomy in 40 (89%) out of 45 patients. Complications were duodenal perforation (n=2), cholangitis (n=2) and pancreatitis (n= 1), and they were managed successfully by medical treatment. In conclusion, it is thus clear that needle knife papillotomy is a helpful procedure with acceptable and not prohibitive risk. It may be used by experienced endoscopists only to increase the success rate of common bile duct access after failure of conventional method.
원발성 간내 담석에 대한 각종 접촉성 용해제의 용해 효과
김명환(Myung Hwan Kim),임미경(Mi Kyeong Rim),김태형(Tae Hyeoung Kim),유병무(Byeong Moo Yoo),서동완(Dong Wan Seo),정훈용(Hwoon Yong Jung),이성구(Sung Koo Lee),민영일(Young Il Min),박광민(Kwang Min Park),이영주(Young Joo Lee),이승규(Su 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5
Background/Aims: Often it is difficult to remove intrahepatic stones completely. Thus, to study for development of contact solvent for dissolution of primary intrahepatic stones has clinical irnplication. The aim of this study is to compare the dissolution effect of various contact so]vents for dissolution of primary intrahepatic stones. Methods: Tbe contact solvents we used were ethylenediaminetetraacetic acid(EDTA), dimethylsulfoxide(DMSO), N-acetylcysteine, taurocholic acid and methyl tert-butyl ether(MTBE). The dissolution effect of intact gallstone was evaluated until 24 hours by dry weight and the diameter of residual stone. The intrahepatic stones were obtained from patients with brown stones(n=15) and rnixed stones(n=15). Results: In brown stone the dissolution effect of DMSO was the most superior by residual stone weight(57.2% of initial weight). However, in mixed stone EDTA was the most superior (37.9% of initial weight). The smallest diameter(p 2mm) of residual stone after dissolution was obtained by DMSO in both brown and mixed stones. Conclusions: Although our results have shown the partial dissolution effect of intrahepatic stones by contact solvents, significant decrease of tbe stone size was also observed. By diminishing the size and the weight of the stones, the improvement of stone removal rate and the shortening of the treatment period may be expected.(Korean J Gastroenterol 1996;28: 705 - 713)
황일란(Il Ran Hwang),김정원(Jung Won Kim),박선미(Sun Mi Park),김해련(Hae Ryun Kim),민영일(Young Il Min) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1
Background/Aims: Primary gastric non-Hodgkins lymphoma is rare and represents a minority of 1-7% of all gastric malignancy. Prognosis and early diagnosis remains important. Methods: We analysed clinical and endoscopic findings in 27 patients with primary gastric non-Hodgkins lymphoma between June 1989 and July 1994 at the Asan Medical Center. Results: The prevalence of primary gastric lymphoma occupied 1.2% of all gastric cancers. The most frequent chief complaint was epigastric pain(74%), followed by postprandia] epigastric discomfort (19%), abdominal mass(15%) and gastrointestinal bleeding(11%). Initial endoscopic findings suggested gastric lyrnphoma in 6 cases(22%), advanced gastric cancer in 14 cases(52%) and benign gastric ulcer in 2 cases(7%). The macroscopic type of 15 cases(56%) was ulcerative, while 5(19%) were superficial, 5(19%) giant mucosal fold, and 2(6%) polypoid. Pathologic findings of initial endoscopic biopsy specimens in 18 operated cases were gastric lymphoma in 7 cases, atypical lymphocyte infiltration in 3 cases, adenocarcinoma in 4 cases and ulcer or erosion in 3 cases. Conclusions: A definite diagnosis of primary gastric non-Hodgkins lymphoma was difficu]t to be confirmed by endoscopic examination and biopsy. Recognition of specific endoscopic findings with a high index of suspicions is essential for early diagnosis, and multiple biopsies with/without submucosa are required. (Korean J Gastroenterol 1996;28: 11 - 18)