융모상피암의 (絨毛上皮癌) 소장전이에 (小腸轉移) 의한 대량 장출혈 (腸出血) 2예

정재복,문영명,강진경,김기환,최흥재 ( Jae Bock Chung,Yong Myung Moon,Jin Kyung Kang,K Whan Kin,Heung Jai Choi ) 대한소화기학회 1980 대한소화기학회지 Vol.12 No.1

Choriocarcinoma may occur with or without any gynecological symptoms and commonly presents with a variety of medical proolem resulting from metastasis in the lungs, central nervous system, or alirnentary tract. However choriocarcinoma presenting with massive intestinal bleeding is very rare. We have presented two cases of unusual choriocarcinoma presenting with massive intest- inal bleeding due to metastasis.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : B형 간염 바이러스에 의한 각종 간질환에서 말초혈액단핵구 2 ` , 5 ` - Oligoacenylate Synthetase ( 2 ` , 5 ` - AS ) 의 활성도

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Yong Myung Moon),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김경희(Kyung Hee Kim),이관식(Kwan Sik Lee),임대순(Dae Soon Lim) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1

N/A We studied clinical significance of 2'.5'-AS activity in PBMC in HBs Ag positive liver disease and the relation between the anti-viral effect and 2'5'-AS activity in PMBC after interferon administration in chronic active hepatitis. 2'.5'-AS activity in PBMC was determined in 51 patients with HBsAg positive liver disease (acute hepatitis; 10, chronic persistent hepatitis; 10, chronic active hepatitis; 25, liver cirrhosis; 6) and in 10 healthy adult controls. 1) 2'.5'-AS activity in PBMC was in healthy controls, 508.2 +- 123.5 fmole/lhr/lml lysate, where as in patients with acute hepatitis, it was 1250.5 +- 790.5 fmole/1hr/1ml lysate, 862.1 +- 432.0 fmole/1hr/ 1ml lysate in chronic persistent hepatitis, 862.6 +- 432.0 fmole/lhr/lhr/lml lysate in chronic active hepatitis, 699.8 +- 222.6 fmole/lhr/lml lysate in liver cirrhosis. 2) The level of 2'.5'-AS activity in PBMC during acute exacerbation of chronic active hepatitis was 1264 +- 494 fmole/lhr/lml lysate, where as in patients without acute exacerbation, it was 693 +- 398 fmole/lhr/lml lysate. 3) In 9 patients with chronic active hepatitis treated with HuIFN-B, the pretreatment 2'.5'-AS activity in PBMC who became negative for HBV DNA and HBeAg at 6 months after interferon treatment was higher than in patients who did not become negative. In conclusion, in vivo interferon system is activated during acute viral hepatitis and acute exacerbation in chronic hepatitis and that measurement of 2'.5'-AS activity could be used to evaluate in vivo state of the interferon system and to predict the result of interferon treatment.

간장 ( 肝腸 ) 및 담도 ( 膽道 ) : 만성 B 형 활동성 간염 환자에서 Prednisolone 이탈요법후의 베타인터페론 병용투여의 치료효과

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Yong Myung Moon),이상인(Sang In Lee),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),김경희(Kyung Hee Kim),신준한(Joon Han Shin) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A To evaluate the efficacy of a short course of prednisolone withdrawl followed by human B- interferon (HuIFN-B) treatment with chronic active hepatitis B(CAHB), 32 patients with peritoneoscopic liver biopsy proven CAHB were randomized to receive a 3 week tapered course of prednisolone followed by HuIFN-B or HuIFN-B alone. All patients were HBeAg positive and two groups were comparable with respect to age, sex and biochemical and histologic data. Interferon was administered in a dose of 6.0*10 IU per day for I week and 3.0*10 IU per day for successive 3 weeks by intravenous drip infusion. Treatment side-effects occurred in all treated patients but the treatred patients all tolerated and concluded treatment without serious side effects enough to give up the trials. The seronegative and seroconversion rates for the patients treated with prednisolone withdrawl+ HuIFN-B were 50.0% (10 cases out of 20) and 45.0% (9cases out of 20) respectively at last follow up after the treatment. These rates were apparently higher than seronegative rate of 25.0% (3 cases out of 12) and seroconversion rate of 16.7% (2 cases out of 12) in patients treated with HuINF-B alone. Sustained loss of serum HBV DNA & normalization of serum ALT was maintained in 65% (13 cases out of 20) at 6 month after steroid withdrawl+HuIFN-B treatment. Comparison of responders (n=9) to non-responders in patients with steroid withdrawl+ HuINF-B treatment indicated that there was no significant difference in age, sex and pretreatment ALT levels and HBV-DNA values. In conclusion, these results suggest that a short course of prednisolone withdrawl followed by HuINF-B can be more effective than HuIFN-B alone for the selected patients with HBeAg positive CAHB.

심장이식후 발생한 대장기종 ( Pneumatosis Cystoides Intestinalis )

이천균(Chun Kyun Lee),송시영(Si Young Song),이용찬(Yong Chan Lee),장병철(Byung Chul Chang),문영명(Young Myung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

Pneumatosis cystoides intestinalis(PCl) is a rare disease of undetermined etiology which is characterized by multiple gas-filled cysts in the wall of the small or large intestine or both. It is associated with various medicosurgical conditions including organ transplantation. Fewer than 50 cases of PCI occurring after organ transplantation including 4 cases of cardiac transplantation have been reported in the world literatures. We report a 47-year-old man of PCI who suffered from right lower quadrant abdomina) pain for 1 week. He was taken heart transplantation due to acute myocardiac infarction and ischemic cardiomyopathy 1 year ago. On plain abdominal X-ray revealed the multiple clustered localized collections of gas in the ascending and hepatic flexure of colon. Co]onoscopy showed the typical finding of PCI, which was multiple variable size protruding masses which apperared as round, soft, and somewhat bluish colored cysts. After the puncture of the above cystic mass using endoscopic injection needle, we can observe the deflation of the above ass. This is the first case in Korea. (Korean J Gastroenterol 1995;27: 732 - 737)

만성 간질환 및 원발성 간세포암 환자의 혈청 α1 - Antitrypsin 표현형의 변화

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myung Moon),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),임대순(Dae Soon Yim),함기백(Ki Baik Hahm),신용준(Yong 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

N/A In parallel with the discovery of nev alleies inceasing the complexity of the Pi system, technical refinements have made the classification of an individual with respect to his Pi system relativeiy simple. Isoelectrofocusing in polyacrylamide gels is advantageous method in analyzing pisystem because of ease of performance, high resolution and reproclucibility. Most individuals have the PiMM phenotype resulting in normal plasma a1-antitrypsin (a,-AT) levels. The classical a1-AT deficiency is designated as Pizz in its homogygous form and has 15% of normal plasma a1-AT level, which is known to be associated with increased risk of cirrhosis and primary liver cancer But there is stilJ debate as the cause of this associated liver disease. This study is aimed to know the distribution and contribution of structural variants of a1-AT in South Korean patients with chronic liver diseases inr.uding hepatocellular carcinoma. One hundred thirty nine patients with chronic liver diseases or hepatocellular carcinoma were studied. Rlood sarnples were taken frorn each. Phenotypes of a1-AT were determined by electrofocusing in polyacrylamide gel electrophoresis. The results obtained were as folloas, None of the cases showed deficiency or null variant of a1-AT in patients with chronic liver diseases, hut two cases with hepatocellular carcinoma showed MS phenotype. About half of the cases with chronic liver disease and hepatocellular carcinoma showed homologcius polymorphism of a1-AT phenotype suballeles such as M1M1. M2M2 and M3M3. The distribution of the structural variants of a1-AT phenotype in patients with chronic liver diseases and hepatocellular carcinoma were in order as tollows; M1M1 (51.8%), M1M2(24.5%), M2M2 (7.9%), M3M3 (6.5%), M1M3, (5.8%),M3M3 (2.2%) and M1S (1.3%). In con, lusion, none of the cases with chronic liver diseases showed deficiency or null typed structural variants of a1-AT, but there were two cases with MS phenotype among the 39 patients with hepatocellular carrcinoma. Therefore, genetically determined a1-AT. deficiency seems to be not etiological]y important in South Korean patients with chronic liver disease.

Western Blot Kit (Helicoblot 2.0^TM)을 이용한 Helicobacter pylori 감염의 혈청학적 진단: Helicobacter phenotype에 따른 질환양상의 비교

이용찬,김범수,박효진,정재복,문영명,강진경,박인서 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.31 No.4

담관의 다발성 유두종에서 병발된 선암

조용석,강진경,박인서,문영명,전재윤,정재복,송시영,유효민 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.4

Multiple biliary papillomatosis are extremely rare, fifty one cases have been reported in the literature. Clinical symptoms are associated with obsructive jaundice and cholangitis. Malignant transformation into adenocarcinoma had been described. We report a case of multiple papillomatosis in the entire biliary ductal system with malignant transformation, in which endoscopic retrograde cholangiopancreatography and peroral choledochoscopy showed multiple polypoid lesicons. The endoscopic sphincterotomy and the intraductal biopsy confirmed the histologic diagnosis of multiple papillomatosis and adenocarcinoma.

급성 식도정맥류 출혈 환자에서 Somatostatin과 Vasopressin의 치료효과 비교 : A Prospective Randomized Trial

최병현,문병수,문영명,한광협,전재윤,이관식,정정일,김동기,백용한,이천균 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.4

Background/Aims: Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear. The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. Methods: From March, 1997 to September, 1998, 28 consecutive cirrhotic patients admitted to the Yonsei Medical Center because of active variceal bleeding were included in this trial. The patients were randomized to receive either somatostatin (15 patients) or vasopressin (13 patients) for 48 hours. Results: There were no significant differences between the two treatment groups in relation to Child's classification, amount of bleeding before randomization and units of blood transfused during therapy. Initial control of bleeding was achieved in 13 (86.7%) patients receiving somatostatin and in 10 (76.9%) of those treated with vasopressin. However, two patients in the somatostatin group and two in the vasopressin group bled again during treatment. Therefore complete control of bleeding during the 48 hours of therapy was achieved in 11 (73.4%) patients treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complications associated with each therapy. Vasopressin produced complications in four patients (chest pain in two, hypertension in one and hyponatremia-induced seizure in one) while somatostatin produced minor complication in one patient. Conclusions: This study suggests that somatostatin is efficacious in controlling acute hemorrhage from esophageal varices and has a lower risk of adverse effects than vasopressin.(Korean J hepatol 2000;6;468-473)

위 이소성 췌장의 내시경적 소견

강진경,박인서,문영명,정재복,백용한,박병규,송시영,이용찬,박수진,고준상 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.5

Backgound/Aims: Ectopic pancreas in the stomach is a relatively uncommon abnormality. Although its typical finding on endoscopy was described as a submucosal nodule with central umbilication, it is still difficult to differenciate ectopic pancreas from other pathologies. So we investigated the endoscopic findings of ectopic pancreas in the stomach. Methods: Between Jan. 1987 and Aug. 1998, nineteen patients who underwent gastroendoscopy and were histologically diagnosed as ectopic pancreas by various methods, were encountered at the Department of Internal Medicine, Severance Hospital, Yonsei University. The clinicopathologic records of all the patients were reviewed. Results: The mean age of the patients was 39.3 years old with a male to female ratio of 1:2.8. Endoscopically, seventeen cases (89.5%) were suggestive of submucosal tumors. Submucosal tumors combined with umbilication were in 4 cases (21.1%), with ulceration in 2 cases (10.5%), erosion in 5 cases (26.3%), ulceration and erosion in 1 case (5.3%),and normal mucosa in 5 cases (26.3%) respectively. The size of ectopic pancreas was in the range of 0.8∼3.0 cm, except in one case which measured 6.0 cm. The location of ectopic pancreas was in the antrum in 18 cases (94.7%), and in the angle in 1 case (5.3%). The endoscopic diagnoses were ectopic pancreas in 5 cases (26.3%), submucosal tumor in 12 cases (63.1%), gastric polyp in 2 cases (10.5%). The methods of histologic diagnosis of ectopic pancreas in 3 cases (15.8%) was by endoscopic biopsy, by endoscopic submucosal resection in 10 cases (52.6%), and by operation in 6 cases (31.6%). Conclusions: Ectopic pancreas in the stomach is found in various morphology, presented as submucosal tumors in the antrum. Because histological diagnosis by endoscopic forcep biopsy is difficult in many cases, endoscopic submucosal resection or operation should be considered.

상부 위장관 Stromal Tumor 의 악성 감별진단에 있어서 내시경 초음파 검사의 유용성

강진경,박인서,문영명,정재복,백용한,이용찬,황재하 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.6

Background/Aims: Endoscopic ultrasonography (EUS) has been useful in evaluating submucosal lesions of the upper gastrointestinal tract as well as providing guidelines for therapeutic plans. Large proportions of submucosal tumors are diagnosed as stromal tumors. Most are benign, but a significant proportion of them could be malignant. There are a few reports concerning EUS findings as being predictive of malignancy. The aim of this study was to evaluate specific EUS features favoring malignancy in stromal tumors of the UGI tract. Methods: From January, 1992 to June, 1997, thirty-three cases appeared involving stromal tumors (18 benign, 15 malignant (including 8 STUMP)), and were either surgically (27 cases) or endoscopically (6 cases) resected. Videotapes and photographs were reviewed and EUS features that favored the malignancy were analyzed. Results: The mean age was 49 years old and the male to female ratio was 2 : 1. One out of 11 esophageal stromal tumors was malignant, and the figure was significantly lower than the proportions of malignant tumors of the stomach (61.9%). Among EUS features, tumor sizes greater than 4 cm (p$lt;0.05), cystic spaces inside the tumor mass (p$lt;0.05), and inhomogenous echogenicity (p$lt;0.05) were determined to be independent markers associated with malignancy, whereas multiplicity, contour of mass, shape, focal echogenic foci, and shape of the extraluminal border did not show significant association to the malignancy. Most stromal tumors were benign when all of these features suggesting malignancy were absent. Conclusions: Of the various EUS features of UGI tract stromal tumors, tumor size ($gt;4cm), cystic spaces, and inhomogeneous echogenicity were found to be independent features predicting malignancy. Therefore, EUS is a valuable tool for differentiating the malignant nature of stromal tumors of the UGI tract.