담도 및 췌장 악성종양에서의 CA19-9의 진단적 가치에 대한 평가

명승재(Sung Jae Myung),최승목(Sung Mok Choi),김은옥(Eun Ok Kim),최호순(Ho Soon Choi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),민영일(Young Il Min),류진숙(Jin Sook Ryu) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3

N/A Background/Aims: The CA19-9 is a tumor marker used for gastrointestinal tumors, especially pancreatic cancer and biliary tract malignancy. However, it was also reported that there are some CA19-9 positive parients with benign diseases. The aim of this study is to evaluate the diagnostic value of CA19-9 in malignant and benign pancreaticobiliary diseases. Methods: Serum CA19-9 levels were measured by radioimmunoassay in 514 patients (biliary diseases: 154, pancreatic diseases: 96, others: 264) who visited Asan Medical Center from February 1993 to February 1994. Results: The positive rates(>37U/ml) of CA19-9 were 67.3% and 47.9% in malignant and benign biliary diseases, 69.6% and 14.8% in malignant and benign pancreatic diseases, 21.3% and 20.0% in other malignant and benign diseases, respectively. The value of CA19-9 in benign biliary disease was significantly more elevated in the patients with cholangitis (median 65.5 U/ml) than patients without cholangitis (median 17.0 U/ml)(p0.01). In patients with benign and malignant biliary diseases, there was a positive correlation between CA19-9 and parameters representing biliary obstruction(alkaline phosphatase and bilirubin). In 7 patients with gallstone disease CA19-9 levels were significantly decreased after stone removal(p( 0.05). Follow-up levels of CA19-9 in 35 patients with biliary malignancy were also decreased after treatment(curative resection in 30 patients, chemotherapy in 2 patients, radiotherapy in 2 patients and management of cholangitis in 1 patient, respectively)(p(0.05). Sensitivity of CA19-9 at a cutoff value of 37 U/ml in pancreatic cancer was 69.6%, biliary malignancy 67.3%. Specificity in pancreatic cancer was 85.2%, biliary malignancy 52.1%. Positive predictive value in pancreatic cancer was 92.3%, biliary malignancy 65.3%. Conclusions: The measurement of CA19-9 can be used as an adjunctive test in the differential diagnosis of malignant and benign pancreaticobiliary diseases. On interpretation of an increased value of CA19-9 in these patients we should consider various conditions such as cholangitis or biliary obstruction with false positive value. (Korean J Gastroenterol 1995;27:347 - 355)

간경변증 환자에서 Lupus anticoagulant 및 Anti-cardiolipin antibody의 양성율

김홍자(Hing Ja Kim),이성순(Sung Soon Lee),최승목(Sung Mok Choi),김석균(Suk Gyun Kim),정영화(Young Hwa Chung),이영상(Yung Sang Lee),서동진(Dong Jin Suh),서을주(El Ju Suh),지현숙(Hyun Sook Chi) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Anti-phospholipid antibody syndrome(APS) is clinical syndrome of venous and arterial thrombosis, recurrent fetal losses and thrombo-cytopenia, which are associated with lupus anticoagulant(LA) and/or anti-cardiolipin antibody(aCL). There are some repors about the prevalence of LA and aCL in liver cirrhotics, but enough data are not available in Korean literature, and the menaing of positiveness of t4ese antibodies has been elusive. So, to know the prevalence and clinical meaning of these antibodies in liver cirrhotics in Korea, this study was performed. Methods: Ninety-one patients with liver cirrhosis requiring admission were randomly selected. LA was tested by combination of LA-aPTT, kaolin clotting time and platelet neutrali- zation method, and aCL by ELISA using Imu]yse ACA kit. Clinical data including etiology and severity of liver disease were analysed. Results: Positive rates of LA and aCL were ]6.5% (15/91) and 34.1%(31/91), respectively. 5 out of 91 (5.5%) patients had both anribodies. There were no corre]ations between the positivity of LA and aCL and age,sex, and etiology of liver disease, but the chance to have severe li ier disease (Child class C) was higher in LA positive patients than negative patients(10/15, 66.7% vs 23/76, 30.3%, p=0.001). 5 out of 41 (12.2%) positive cases seemed to have symptoms and signs of possible APS. 4 out of 41(9.8%) had possible primary illnesses other than liver cirrhosis. Conclusions: About one third of cirrhotics requiring admission and treatment had LA and/or aCL, but only few of positive patients were likely to be symptomatic. Severe liver disease(Child class C) could be a risk factor for LA positivity. (Korean J Gastroenterol 1996; 28:669-676)

담도 및 췌장 악성종양에서의 CAl9-9의 진단적 가치에 대한 평가

명승재,최승목,김은옥,최호순,이성구,김명환,민영일,류진숙 大韓消化器病學會 1995 大韓消化器病學會誌 Vol.27 No.3

단클론성 유무가 저등급 위점막연관림프조직형 림프종의 임상양상 및 제균요법 후 초기 조직학적 관해에 미치는 영향

김진호,홍원선,민영일,정훈용,명승재,강경훈,김기락,허주령,최승목,심용희,이숭한,양석군 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Background/Aims: There has been little description about the clinical significance of B-cell monoclonality in primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We investigated the effects of B-cell monoclonality on early response to Helicobacter pylori (H. pylori) eradication therapy in patients with H. pylori-positive low-grade gastric MALT lymphoma. Methods: Twenty-nine patients with H. pylori-positive low-grade gastric MALT lymphoma were consecutively enrolled. We performed diagnostic tests including esophagogastroduodenoscopy (EGD), endoscopic ultrasonography and CT scan for the patients. PCR with PAGE was used to analyse the patterns of immunoglobulin heavy chain gene rearrangement. All 29 patients received H. pylori-eradication therapy. They were then followed up at regular intervals by EGD with biopsy. Results: Fifty-five percent (16/29) showed a single band in PAGE after PCR, suggesting a monoclonal proliferation of B-cell lineage. Regardless of B-cell monoclonality, there was no difference in histologic regression rates after 3 months of eradication therapy. However, the MALT lymphomas with B-cell monoclonality showed more ulcerous lesions (p$lt;0.01) and deeper infiltration of tumor into gastric wall (p$lt;0.05) than those without B-cell monoclonality. Conclusions: These results suggest that PCR-based B-cell monoclonality may not affect early therapeutic response to H. pylori-eradication therapy in gastric MALT lymphoma in spite of the more aggressive histologic morphology.

장결핵의 임상상 : 합병증 발생의 위험인자를 중심으로

김진천,홍원선,민영일,정훈용,하현권,양석균,정성애,유창식,이미화,원선영,김해련,최승목,김해경 대한소화기학회 1998 대한소화기학회지 Vol.30 No.4

Background/Aims: In recent years, the pattern of tuberculosis has been changed, demonstrating that extrapulrnonary tuberculosis appears to be increasing. The aim of this study was to investigate the clinical features to predict the factors related to the development of complications in patients with intestinal tuberculosis. Methods: A total of 95 patients with intestinal tuberculosis treated at the Asan Medical Center from June, 1989 to November, 1995 were included. The clinical characteristics of the patients cured by antituberculous medication alone were compared with those of patients who underwent operation due to complications developed during antituberculous medication. Results: Eighty one patients were treated with antituberculous drugs, among whom 66 patients(81%) were cured by antituberculous drugs alone. The reaining 15 patients(19%) received operations for the complications that developed during antituberculous medication. The median period from the beginning of antituberculous medication to the development of complications was 3 months. There was no significant difference in clinical features between the two groups except the location of the disease. Small bowel was evaluated radiologically in only 30 patients, of whom 15 patients revealed small bowel lesions. Six out of 15 patients(40%) with small bowel lesions had the perforation of bowel, while none of 15 patients(0%) without small bowel lesions experienced it(p$lt;0.05). Conclusions: Intestinal tuberculosis patients having small bowel lesions showed a tendency to develop bowel perforation more frequently than in those without small bowel involvement. However, to draw a definite conclusion whether small bowel involvement is the true risk factor for perforation, a prospective study should be performed.