위장관 ; 위내시경검사에서 간과된 진행성 위암의 특징

성인경 ( In Kyung Sung ),김영춘 ( Young Choon Kim ),윤중원 ( Jung Won Yun ),서현일 ( Hyun Il Seo ),박동일 ( Dong Il Park ),조용균 ( Yong Kyun Cho ),김홍주 ( Hong Joo Kim ),박정호 ( Jung Ho Park ),손정일 ( Chong Il Sohn ),전우규 ( 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5

Background/Aims: Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination. Methods: We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months. Results: Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma. Conclusions: Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered. (Korean J Gastroenterol 2011;57:288-293)

변비의 분류와 치료

성인경 ( In Kyung Sung ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.1

Constipation is a common symptom affecting 2-27% of general population in Western countries. According to a population-based study on bowel habits in a Korean community, the prevalence was 16.5% for self-reported constipation and 9.2% for functional constipation. There is a broad range of causes for constipation. There are three subtypes in functional constipation, although overlap is not uncommon. Physiologic studies such as colonic transit test, anorectal manometry, balloon expulsion test, and defecography can be helpful in further evaluating and classifying functional constipation. Slow transit constipation is characterized by prolongation of transit time throughout the colon, caused by either myopathy or neuropathy. Functional defecation disorder is characterized as an inability to initiate defecation following the urge to do so, a feeling of incomplete evacuation, tenesmus, excessive straining or manual evacuation. Normal transit constipation is the most common subtype and characterized by constipation occurring in the presence of normal colonic transit time and normal defecatory function. It is important for clinicians to choose appropriate treatment for constipation which are most efficacious for the individual patient. Most patients with functional constipation respond to laxatives, but a small proportion may be resistant to this treatment. In patients with functional defecation disorder, biofeedback is helpful. Sacral nerve stimulation may be helpful in some patients with slow transit constipation. Patients who are resistant to all the conservative modalities may require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit time is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent defecatory disorder. (Korean J Gastroenterol 2008;51:4-10)

비궤양성 소화불량증 환자에서 십이지장위 역류의 역할에 관한 연구

성인경(In Kyung Sung),이종철(Jong Chul Rhee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

N/A Backgieund/Aims: Delayed gastric emptying has been considered primary mechanism for the pathogenesis of non-ulcer dyspepsia(NUD). And duodenogastric reflux(DGR) could be involved in the pathogenesis of non-ulcer dyspepsia. But there is some controversy surrounding the role of DGR in NUD. The objective of the present prospective study was to investigate the prevalence of DGR, a possible correlation between DGR and dyspeptic symptoms and the association between DGR and delayed gastric emptying in NUD patients. Methods: Cholescintigraphy with technetium 99m 0- diisopropyl iminodiacetic acid(DISIDA) was used to study duodenogastric reflux in 105 patients with NUD and in l l normal controls. Also, in order to identify the gasric emptying rate in patients with NUD, a gastric emptying scan using solid test meal(Tc-99m-tin-colloid labeled chicken liver) was performed. Symptoms were quantified using a clinical score. Results: DISIDA scanning revealed abnorma1 findings in l(9%) of l 1 of normal controls and 31(30%) of lOS patients with NUD. The gastric emptying time of solid meal was delayed in 55(52%) of 105 patients with NUD. In the SS patients with delayed GET, DGR positive were lO(l8%) and in the 50 patients with normal GET, DGR positive were 21(42%)(p<0.05). In the 31 patients with DGR positive, patients with delayed gastric emptying were 10(32%), and in the 74 patients with DGR negative, patients with delayed gastric emptying were 45(60%). The mean symptom score was not significantly different between the patients with DGR positive and negative(8.9 ' 3.6 vs 8.3 ' 3.6). The frequency of DGR in total patients with NLJD was about 30%. And the frequency of DGR in patients of NUD with normal GET was 42%, comparing with 9% in controls(p<0.05). Conclusion: Duodenogastric retlux may be involved in the pathogenesis of non-u1cer dyspepsia with normal gastric emptying time. (Korean J Gastroenterol 1995;27:159 - 166)

담도 폐쇄로 인한 담도염 환자에 있어서의 담즙 내 세균에 대한 연구

성인경(In Kyung Sung),이규택(Kyu Taek Lee),이종균(Jong Kyun Lee),김영호(Young Ho Kim),이석호(Seok Ho Lee),송희정(Hee Jung Son),이준혁(Joon Hyoek Lee),이풍렬(Poong Lyunl Rhee),김재준(Jae Jun Kim),고광철(Kwang Chul Koh),백승운(Seung Wo 대한내과학회 1998 대한내과학회지 Vol.55 No.1

has been focused on the Enterococcus due to increasing in incidence of nosocomial infection and resistance to broad range of antimicrobial agents of this organism The purpose of this study was to analyse the bacteriologic features of bile in patients with cholangitis. Methods : Bacteriological examination was made of bile from 356 patients with cholangitis due to biliary tract obstruction, 105 of them with common bile duct stone and 251 of them with malignant disease. Bile specimens were taken during percutaneous transhepatic biliary drainage of endoscopic nasobiliary drainage. The specimens were cultured aerobically and anaerobically and then the anti- biotic sensitivity test was done. Results: The overall positive culture rates was 81.4%. There was significant difference in positive culture rates between the patients with common bile duct stone and the patients with malignant disease,(88.5% vs 78.4%, p<0.05) But there was no significant difference in bacteriological features between the patients with common bile duct stone and the patients with malignant disease. The commonly isolated organisms were Enterococcus (21.6%), E.coli(19.7%), and Klebsiella(17.2%) respectively. The isolation rate of anaerobes were only 2%. The rate of polymicrobial infection was 78.1%. The rates of 3rd cephalosporins-resistant Klebsiella were over 30%. The rate of ampicillin-resistant Enterococcus was 35%. The rate of gentamicin-resistant Enterococcus was 28%. Conclusion : This study shows that 1) many micro- organisms have resistance to a broad range of antimicrobial agents, and 2) the antibiotic coverage against Enterococcus should be considered for the treatment of cholangitis due to the increasing tendency to Enterococcus infection.

비궤양성 소화불량증 환자의 아형분포에 대한 연구

성인경(In Kyung Sung),강인구(In Ku Kang),심승철(Seung Chul Shim),김종필(Jong Pil Kim),이기창(Kee Chang Lee),손정일(Chong Il Sohn),정철헌(Chul Hun Jung),박동일(Dong Il Park),이종철(Jong Chul Rhee) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

Objectives: It has been proposed that patients with non-ulcer dyspepsia can be classified into symptom subgroups. Subgroups were as follows; those with symptoms suggestive of peptic ulceration (ulcerlike dyspepsia), those with gastric stasis (dysmotilitylike dyspepsia), those with gastroesophageal reflux (refluxlike dyspepsia), and the remainder (unspecified dyspepsia). Methods: The study population consisted of 306 patients with non-ulcer dyspepsia admitted to or attending to Hanyang University Hospital from the beginning of Feb. 1990 to the end of August 1992. We evaluated the gastrointestinal symptoms and measured gastric emptying time for 150min using radionuclide scintiscan of an 99mTc-labeled chicken liver. Results: 1) A total of 306 patients with diagnosed to non-ulcer dyspepsia, 54% had dysmotilitylike dyspepsia, 16% had ulcerlike dyspepsia, 2% had refluxlike dyspepsia and 10% had unspecified dyspepsia. 2) A total of 148 non-ulcer dyspepsia patients with normal gastric emptying time, 48% had dysmotilitylike dyspepsia, 19% had ulcerlike dyspepsia, 2% had refluxlike dyspepsia and 10% had unspecified dyspepsia. 3) A total of 158 non-ulcer dyspepsia patients with delayed gastric emptying time, 61% had dysmotilitylike dyspepsia, 14% had ulcerlike dyspepsia, 2% had refluxlike dyspepsia and 9% had unspecified dyspepsia. 4) Dysmotilitylike dyspepia was more commonly present in patients with delayed gastric emptying time than in patients with normal gastric emptying time(p<0.05) 5) There was a slight female predominance (1:1.3 male-female ratio) in non-ulcer dyspepsia patients with normal gastric emptying and peak incidence was 40 to 49 years of age (40%). 6) There was a female predominance (1:1.9 male-female ratio) in non-ulcer dyspepsia patients with delayed gastric emptying and peak incidence was 40 to 49 years of age(42%). 7) A total of non-ulcer dyspepsia patients, 35% had irritable bowel symptoms and the frequency of accompanied irritable bowel symptoms was statistically significant difference between the patients with normal gastric emptying time (46%) and the patients with delayed gastric emptying time (26%)(p<0.01). Conclusion: Among the non-ulcer dyspepsia patients in Korean, dysmotilitylike dyspepsia was most common subgroup and the refluxlike dyspepsia was very rare and 35% had irritable bowel syptoms.

모틸린에 의한 사람 위 평활근의 수축 기전에 관한 연구

심상군(Sang Goon Shim),이종철(Jong Chul Rhee),이풍렬(Poong Lyul Rhee),최규완(Kyoo Wan Choi),전성국(Sung Kook Jeon),강동묵(Tong Mook Kang),엄대용(Dae Yong Uhm),이종석(Jong Seok Lee),성인경(In Kyung Sung),김현서(Hyun Seo Kim) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1

Background/Aims: Motilin is an intestinal peptide that stimulates the contraction of gut smooth muscle. A discrepancy exists between the in vivo (neurally mediated) and in vitro (direct action on a smooth muscle receptor) mechanisms of motilin action in many species. We investigated in vitro mechanisms of motilin action on human gastric smooth muscle. Methods: Antral cirular muscle strips of the surgical tissue obtained during gastrectomy, were used to measure contractile force and electrical activity. Dispersed muscle cells were used to measure L-type Ca2+ current and electrical activity. Results: Motilin of 1-100nM contracted smooth muscle in a concentration-dependent manner. Motilin-induced contractions were unaffected by tetrodotoxin or atropine treatment. Nifedipine or Ca2+-free bath solution blocked motilin (10nM)-induced contractions. Low concentration of motilin (1nM) resulted in an increase in acetylcholine (0.1~100M)-induced contractions. By patch clamp recording technique, motilin (1 or 10nM) did not modify the L-type Ca2+ current, but motilin-induced membrane depolarization was detected. Erythromycin also contracted smooth muscle with membrane depolarization but verapamil inhibited the contraction. Conclusions: These results suggest that motilin contracts smooth muscle through a direct action on smooth muscle receptor and Ca2+ influx through the L-type Ca2+ channel, which is due to membrane depolarization, also mediates motilin-induced contractions. (Korean J Gastroenterol 2002;39:4-12)

극소 저체중 출생아에서 뇌실 내 출혈의 중증도 관련 위험 요인과 신경발달학적 예후

천미경 ( Mi Kyung Cheon ),염숙경 ( Sook Kyung Yum ),문청준 ( Cheong Jun Moon ),윤영아 ( Young Ah Youn ),김소영 ( So Young Kim ),성인경 ( In Kyung Sung ) 대한주산의학회 2014 Perinatology Vol.25 No.4

목적 : 극소 저체중 출생아(very low birth weight infant, VLBWI)에서 뇌실 내 출혈(ntraventricular Hemorrhage,IVH)의 중증도 관련 주산기 요인들을 알아보고, 생존한 VLBWI에서 IVH의 중증도에 따른 신경발달 예후도 알아보고자 하였다. 방법 : 2009년 5월부터 2013년 4월까지 가톨릭의대 부속 서울성모병원 신생아 집중치료실에서 치료받았던 재태 연령 37주 미만의 미숙아로서 출생 체중 1.5 kg 미만인 VLBWI 중 IVH이 확인된 145명을 대상으로 후향적으로 분석하였다. IVH 중증도 관련 요인들을 출생 전 요인, 산과적 요인, 출생 후 요인으로 구분하여 1+2단계 IVH군과 3+4단계 IVH군 간에 통계적으로 유의한 차이가 있는지 알아보았다. 신생아기 사망 26명과 퇴원 후 추적 관찰에서 누락된 11명을 제외한108명을 대상으로 IVH 중증도에 따른 신경발달 예후를 조사하였다. 신경발달 예후는 인지 발달 장애, 뇌성마비, 시각및 청각 장애, 뇌전증 등 중증 신경발달 장애가 있는 경우에 대해서 조사하였다. 중증 신경발달 장애는 108명 중 23명(21.3%)에서 조사되었다. 결과 : 재태 연령과 출생 체중이 중증 IVH 발생과 관련된 출생 전 요인이었다. 낮은 1분 및 5분 아프가 점수, 저혈압/쇼크, 동맥혈 최대 이산화탄소 분압, 동맥과 개존증의 존재, 기흉, 혈소판 감소증, 무호흡 발작, NEC, 중등도 이상의 기관지 폐 형성이상 등이 중증 IVH 발생과 관련된 출생 후 요인이었다. 이들 요인들을 대상으로 다중 회귀분석을 한 결과, 낮은 재태연령과 작은 출생 체중, 저혈압/쇼크가 중증 IVH 발생과 관련된 독립적인 인자였다. 중증 신경발달 장애는 중증 IVH에서 생존한 VLBWI에서 유의하게 빈도가 높았다. 결론 : VLBWI에서 조산 예방과 더불어 중증 IVH 위험 요인인 저혈압/쇼크를 최소화하는 것이 중증 신경발달 장애를최소화하는 방침이다. Purpose : The purpose of this study is to investigate the perinatal risk factors for severity of intraventricularhemorrhage (IVH) in very low birth weight infants (VLBWIs) and to study the following neurodevelopmentaloutcomes depending on the degree of IVH severity. Methods : The retrospective study included 145 VLBWIs who were admitted at Seoul St. Mary’s Hospitalbetween May of 2009 and April of 2013. Prenatal, obstetric and postnatal risk factors for IVH were investigated. VLBWIs were divided into the group of IVH grade 1-2 and IVH grade 3-4. During this study period, 26VLBWIs were died and 11 VLBWIs were lost to followed up, thereby 108 infants were included in the finalanalysis. They were regularly followed up and assessed for presence of major neurodevelopmental impairmentsincluding cognitive impairment, cerebral palsy, visual deficit, hearing deficit, and epilepsy. Among 108 infants,23 (21.3%) patients had neurodevelopmental impairments. Results : The lower gestational age and birth weight were significant prenatal risk factors for severe IVH. Lower Apgar score at 1 and 5 min, hypotension/shock, higher levels of partial pressure of carbon dioxide,presence of patent ductus arteriosus, pneumothorax, thrombocytopenia, necrotizing enterocolitis, andbronchopulmonarydysplasia were significant postnatal risk factors for severe IVH. After multiple logisticregression analysis, gestational age, birth weight, and hypotension/shock were independent risk factors forsevere IVH. The incidence of major neurodevelopmental impairments were also significantly higher inVLBWIs who survived after severe IVH. Conclusion : In addition to preterm birth, minimizing hypotension/shock, the risk factor of severe IVH, isimportant to prevent major neurodevelopmental impairments in VLBWIs.

미숙아의 신생아 경련

박주형(Joo Hyung Park),정인아(In Ah Jung),한지윤(Ji Yoon Han),성인경(In Kyung Sung),이주영(Ju Young Lee),윤영아(Young Ah Youn),이인구(In Goo Lee) 대한소아신경학회 2012 대한소아신경학회지 Vol.20 No.3

배 경 : 신생아기에는 뇌의 미성숙으로 인하여 경련이 일생 중 가장 흔히 발생하며, 특히 미숙아에서 경련의 발생 빈도가 높다. 신생아 집중 치료가 발전하면서 미숙아의 생존율이 향상되었지만, 생존한 미숙아들의 신경학적 후유증의 빈도 역시 증가되었다. 이에 저자들은 미숙아로 출생하여 경련을 일으킨 환아들을 대상으로 병력, 임상 양상과 검사 소견을 분석하고 그에 따른 예후를 관찰함으로써 미숙아 경련의 특징과 위험인자들을 알아보고자 하였다. 방 법 : 2009년 3월에서 2012년 2월까지 서울성모병원 신생아 중환자실에 입원한 재태 연령 37주미만으로 출생한 환아 중 경련이 발생한 환아 16명을 대상으로 후향적 조사를 시행하였다. 결 과 : 재태 연령 30주 미만의 환아에서 신생아 경련 발생률이 높았고, 경련의 발생 시기는 생후 1주일 이내가 많았으며, 경련 형태는 비정형적 경련이 많아 일반적인 신생아 경련과 동일하였다. 뇌파검사에서는 75%에서 비정상 소견을 보였는데, 대부분이 간질모양파를 보였고(77.8%) 나머지는 배경파가 억제되어 있었다. 뇌 영상 검사에서는 62.5%에서 이상 소견을 보였는데, 대부분이 뇌실 내 출혈(80%) 이었다. 경련의 위험인자로는 절반의 환아에서 출생 시 가사가 관찰되었고, 주산기 병력을 가진산모인 경우도 43.8%를 차지하고 있었다. 경련을 조절하기 위하여 phenobarbital, phenytoin, 그리고 midazolam을 사용하여 대부분(76.9%)은 조절되었고, 조절 될 때까지의 기간은 평균 4.3±4.2일 이었으나 3명은 사망 시까지 경련이 조절되지 않았다. 항경련제의 투약을 중지할 때까지 걸린 시간은 평균 53.4±28일 이었다. 그리고 추적 관찰 기간 중 경련을 경험한 미숙아의 절반 이상이 정상 발달을 보이고 있었다. 결 론 : 출생 시 가사가 미숙아의 신생아 경련 발생에서 가장 중요한 인자로 생각 되지만 산모의 주산기 병력 역시 신생아 경련 발생과 밀접한 연관성이 있을 것으로 추정된다. 따라서 산모가 주산기 병력이 있는 경우에는 출생 미숙아에 대한 면밀한 관찰과 검사를 통해 경련을 조기에 발견하여 치료할수 있도록 하여야 하며, 이를 위해 뇌파검사가 보다 더 적극적으로 이용되어야 한다. Purpose : Neonatal seizures are the most prominent feature of neonatal neurologic dysfunction, and the lifespan risk for seizures is highest in the neonatal period, especially in preterm infants. This study was aimed to find and analyze the risk factors and clinical profiles of seizures in preterm infants. Methods : Sixteen cases of preterms with seizures were retrospectively reviewed between Mar. 2009 and Feb. 2012. Results : The average gestational age was 30.3±4.1 weeks and 11 patients (68.7%) experienced seizures within 1 week after the birth. Eight cases (50%) had a perinatal asphyxia during the delivery and 7 cases (43.8%) had a history of perinatal maternal illness. Various types of seizures were observed of which subtle seizures were the most common (50%). Electroecephalographies were performed in 12 cases, which showed abnormal findings in 9 cases (75%). Neuroimaging studies were performed in 16 cases and showed abnormal findings in 10 cases (62.5%). Thirteen patients were discharged in the improved state and 3 patients expired. Eight cases had normal outcome, while 3 cases showed developmental delay. Prognosis was unknown in 2 cases due to follow up loss. Conclusion : Neonatal asphyxia is the most important risk factor. Furthermore, infants with a history of perinatal maternal illness appear to be at risk for neonatal seizures. EEG is a sensitive method for assessing seizure activity and prognosis. Monitoring high risk infants with asphyxia and a history of perinatal maternal illness, and early postnatal tracing with EEG is required to detect and manage high risk preterms.

대장 종양에서의 Sonic Hedgehog 단백의 발현

한혜승 ( Hye Seung Han ),이선영 ( Sun Young Lee ),성무경 ( Moo Kyung Seong ),김정환 ( Jeong Hwan Kim ),성인경 ( In Kyung Sung ),박형석 ( Hyung Seok Park ),진춘조 ( Choon Jo Jin ),황태숙 ( Tae Sook Hwang ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: Dysregulation of the hedgehog pathway has been implicated in regeneration and carcinogenesis, leading to the expression of the sonic hedgehog (Shh) protein in gastrointestinal neoplasms. The expression of Shh in colon neoplasms and paired normal colonic mucosa was therefore investigated. Methods: Forty-four colon cancers and 73 colon adenomas that were removed by surgical colectomy or colon polypectomy between August 2005 and August 2006 were included. Colorectal neoplasms and the adjacent normal colon tissue were examined by immunohistochemistry using rabbit polyclonal Shh antibody. Results: Expression of Shh was up-regulated in adenomas and adenocarcinomas of the colon compared to normal colon tissues (p<0.001). The degree of Shh expression was not associated with the size, shape, or, location of the tumor, or as the age and gender of the patient. In normal colonic epithelium, Shh was expressed at the apex of the crypts and in a few basally-located cells. Conclusions: Higher levels of Shh expression in colonic adenoma and adenocarcinoma suggest that Shh is required during epithelial proliferation in the colon. Hedgehog signaling is likely to be associated with early tumorigenesis in colonic neoplasms. (Intest Res 2008;6:19-24)

기능성 소화불량증 환자에서 자율신경 기능장애에 관한 연구

박동일(Dong Il Park),이풍렬(Poong Lyul Rhee),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),김창섭(Chang Sup Kim),장재권(Jae Kwon Jang),심상군(Sang Goon Shim),성인경(In Kyung Sung),김영호(Young Ho Kim),손희정(Hee Jun 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

N/A Background/Aims : The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. Methods : Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. Results : (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. Conclusion: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.