식도 궤양 , 급성 담낭염 및 허혈성 대장염의 소견이 현저한 알레르기성 육아 종증 ( Churg - Strauss Syndrome ) 1 예

정숙향(Sook Hyang Jung),김광호(Kwang Ho Kim),남상민(Sang Min Nam),박현철(Hyun Chul Park),추현광(Hyun Kwnag Chu),황일순(Il Soon Whang),김주현(Ju Hyun Kim),전형식(Hyung Sik Jun),박성혜(Sung Hye Park),이상헌(Sang Hun Lee),김호연(Ho Yun 대한내과학회 1993 대한내과학회지 Vol.45 No.3

Churg-Strauss syndrome is a kind of rare systemic vasculitis characterized by peripheral eosinophilia, bronchial asthma and relatively specific pathological findings such as necrotizing vasculitis, eosinophilic infiltration of tissue and/or extravascular granuloma. Clinically multiple organs/systems can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system and gastrointesinal/hepatobiliary tract. Gastrointestinal symtoms were frequently accompanied, but usually mild and easily controllable so that special study for evaluation of the symptoms hardly seemed to be needed. We experienced a case of Churg-Strauss syndrome presenting as esophageal ulcers, acute acalculous cholecystitis and treatment-resistant ischemic colitis in a 24-year-old male patient with acute upper abdominal pain and watery, often bloody diarrhea. He also showed peripheral eosinophilia, bronchial asthma, mononeuritis multiplex, skin rash and arthritis. The patient received high dose corticosteroid, cyclophosphamide and exchange plasmapheresis with resolution of almost all symptoms. But symptoms of ischemic colitis such as abdominal pain and diarrhea are not completely improved in spite of intensive therapy.

연구논문 : C형간염바이러스 유전자형 1b에 감염된 한국인 환자에서 인터페론 감수성 결정 영역의 유전자 돌연변이 양상

진영주 ( Young Joo Jin ),박윤경 ( Yoon Kyung Park ),윤귀준 ( Gui Jun Yun ),이한주 ( Han Chu Lee ),정숙향 ( Sook Hyang Jeong ),김강모 ( Gang Mo Kim ),임영석 ( Young Suk Lim ),정영화 ( Young Hwa Chung ),이영상 ( Yung Sang Lee ),서 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: The treatment response to interferon could differ with mutations in the interferon-sensitivity-determining region (ISDR) in patients infected with hepatitis C virus (HCV) genotype-1b (HCV-Ib). We examined the pattern of ISDR mutations and analyzed whether the number of amino acid substitutions influences the treatment response to peginterferon plus ribavirin in chronic hepatitis or cirrhotic patients infected with HCV-Ib. Methods: The study population comprised 52 patients who visited Seoul Asan Medical Center and Seoul National University Bundang Hospital from January 2006 to December 2008 and who received peginterferon alpha-2a (n=37) or -2b (n=15) plus ribavirin, and whose serum was stored. We analyzed the early virologic response, end-of-treatment response, and sustained virologic response (SVR), and examined the ISDR using direct sequencing. Results: The proportions of patients with ISDR mutation types of wild (0mutations), intermediate (1-3 mutations), and mutant (≥4 mutations) were 50.0%, 42.3%, and 7.7%,respectively, and the corresponding SVR rates were 63%, 50%, and 67% (p>0.05). The SVR rates were 59.4% and 50.0% in patients with <2 and ≥2 mutations, respectively (p>0.05). On univariate analysis, age was the only predictive factor for SVR (p=0.016). The pretreatment HCV RNA titer tended to be lower in those with SVR, but without statistical significance (p=0.069). Conclusions: The frequency of ISDR mutations was low in our cohort of Korean patients infected with HCV-Ib. Therefore, ISDR mutations might not contribute to the response to treatment with peginterferon plus ribavirin.

백서 소장점막의 부위별 Angiotensin Converting Enzyme의 효소 특이활성도차이에 대한 유전적 조절기전에 관한 연구

송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),김재준(Jae Jun Kim),박중원(Joong won Park),윤병철(Byung Chul Yoon),정현채(Hyun Chae Chung),이풍렬(Poong Ryul Lee),임경욱(Kyoung Wook Yim),정숙향(Sook Hyang Chung),유 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Recent reports indicate that angiotensin converting enzyme (ACE) in intestinal mucosa may be involved in protein digestion in vivo. The specific activities of intestinal ACE show regional difference. We performed this experiment to define the level of genetic regulation determining the regional difference of ACE specific activities by the relationship between ACE specific activities and ACE mRNA levels. Small intestines of 3 Wistar rats were removed and divided into 3 segments of equal length. Mucosal homogenate and brush border membrane (BBM) were prepared from scraped mucosa and ACE specific activities were measured in both samples by fluorometric method. Total RNA was extracted by guanidinium thiocyanate and isolated by Cesium chloride,ultracentrifugation. Each 6 ug of isolated RNA was transferred to nitrocellulose membrane by dot and slot apparatus. Northern hybridization with radiolabeled ACE 5 cDNA of mouse was performed and ACE mRNA was detected by autoradiography. The means of ACE specific ar.tivities (uM/ug protein/min) in harnogenate and BBM of proximal intestines were 23.4+- 4.8, 286.3+-80.6, in those of middle intestines were 21.3+-2.0, 211.0+-78.8 and those of distal intestines were 8.2+-1.9, 76.4+-10.7. The means of relative amounts of ACE mRNA in proximal, middle and distal intestines were 75%, 96% and 10% respectively. In linear regression analysis between ACE specific activities of BBM and relative amounts of ACE mRNA, R-value was 0.60 (p<0.05). We concluded that transcription was considered as the level of genetic regulation determining the regional difference of ACE specific activities.

무증상 대장 용종의 선별 검사로서 분변잠혈검사의 유용성

이상협 ( Sang Huyb Lee ),이경수 ( Kyoung Soo Lee ),이종열 ( Jong Yeul Lee ),지정훈 ( Jeong Hoon Ji ),박주경 ( Joo Kyung Park ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwang ),김진욱 ( Jin Wook Kim ),정숙향 ( Sook Hyang Jun 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6

목적: 최근 분변잠혈검사 양성인 무증상 환자에서 대장 내시경 검사가 대장암의 선별과 진단을 위해 많이 이용되어 대장암 이외의 대장 용종 진단도 늘고 있다. 그러나 무증상 대장 용종에 대한 선별 검사로서 분변잠혈검사의 임상 유용성과 한계는 거의 알려져 있지 않다. 이번 연구에서는 무증상 대장 용종 환자에서 분변잠혈검사가 양성인 환자의 인구학적인 특성과 용종 특성을 살펴 대장내시경 검사 전 대장 용종의 선별 검사로 분변잠혈검사의 유용성과 한계를 알아 보고자 하였다. 대상 및 방법: 2003년 5월부터 2004년 10월까지 분당서울대학교병원에 내원하여 대장암 조기 검진을 위해 대장내시경 검사 이전에 1회의 분변잠혈검사를 받고 대장내시경 검사 후 용종절제술을 받은 환자들을 대상으로 하여, 분변잠혈검사 결과에 따라 용종 양상을 비교하였다. 결과: 분변잠혈검사는 대상 환자 288명 중 32명(11,1%)에서 만 양성이었다. 결과가 양성인 환자에서는 133개 용종이, 분변잠혈검사 결과가 음성인 환자에서는 809개 용종이 절제되었다. 분변잠혈검사 결과에 따라 절제된 용종들을 비교하였을 때, 용종 크기(p=0.02)와 위치(p=0.03)에서만이 유의한 차이가 있었다. 환자 특성을 비교하였을 때 단변량 분석에서 환자 나이(p=0.046), 용종 크기(평균 용종의 크기, p=0.04; 가장 큰 용종의 크기, p<0.01)와 용종 개수(p=0.045)에서는 유의한 차이가 있었지만 성별(p=1.00), 용종 분포(p=0.94), 용종 조직형(p=0.36)에서는 차이가 없었다. 다변량분석에서는 가장 큰 용종의 크기가 20 mm 이상이면 상대 위험도 4.71로 양성 분변잠혈검사와 관련이 있었다. 결론: 분변잠혈검사는 크기가 큰 용종(20mm 이상) 이외의 무증상 용종 환자의 선별 검사로서는 그 유용성에 한계가 있었다. 따라서 대장내시경 검사가 필요한 무증상 용종 환자 선별을 위해 대장내시경 검사 전 분변잠혈검사를 시행하는 것은 유용성이 떨어진다고 생각한다. Background/Aims: Detection of asymptomatic benign colon polyp is increasing because colonoscopy is widely used as a screening and diagnostic method. Fecal occult blood test is usually performed for the selection of patients requiring colonoscopy as well as mass screening for colon cancer. The aim of this study was to investigate the usefulness of fecal occult blood test performed prior to colonoscopy as a screening method of benign colon polyps. Methods: Clinical characteristics of patients with polyps were evaluated according to the fecal occult blood test results in patients who underwent one-day fecal occult blood test and colonoscopic polypectomies from May 2003 to October 2004, retrospectively. Results: A total of 942 colonoscopic poly­pectomies in 288 patients were evaluated. Fecal occult blood tests were positive only in 32 patients (11.1 %). In univariate analysis, there was a significant difference in polyp size (p=0.02) and location (p=0.03) according to the presence of positive fecal occult blood tests. In addition, age of the patient (p=0.046), polyp size (mean, p=0.04; largest, p < 0.01) and the number of polyps (p=0.045) were significantly different. However, in multi­variate analysis, only polyp size larger than 20 ㎜ was significantly related with positive fecal occult blood test with estimated odds ratio of 4.71. Conclusions: Fecal occult blood test has limitations as a screening test in asymptomatic patients with colon polyps, except for colon polyps larger than 20 ㎜ in size. (Korean J Gas­troenterol 2006;48:388-394)

위장의 용종 제거에 쓰이는 여러가지 방법의 비교 연구

정현채,송인성,김재준,최규완,윤병철,김정룡,이풍렬,임경욱,정숙향 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.1

The gastric polyps may be premalignant lesions and they should be removed as possible. The gastric polyps can be remoued by various endoscopic methods. The safety and therapeutic effectiveness of snare polypectomy, neodymium YAG laser therapy and electrocutery were compared in a total number of 106 patients who were diagnosed as benign polyps by means of endoscopic biopsy.Safety was evaluated by the rate of complications such as perforation and bleeding, and therapeutic effectiveness was evaluated by the average numbers of treatment session of each modality. Average numbers of treatment session of snare polypectomy, laser therapy and electrocautery were 1.04, 1.38 and l.44, respectively. Average numbers of treatment session of snare polypectomy were significantly (p$lt;0.05) lower than those of other two methods. Perforation was not occurred in any group. Bleeding rates after snare polypectomy, laser therapy and electrocautery were 17.4%, 1.0% and 3.8%, respectively. Bleeding was significantly (p$lt;0,05) more frequent after snare polypectomy than after other two methods. In conclusion therapeutic effectiveness was best in snare polypectomy but complication was most frequent after snare polypectomy. There was no difference between laser therapy and electrocautery for therapeutic effectiveness and safety. Therfore, laser therapy and electrocautery caa be used for the removal of flat adenoma, alternatively.