위 점막 병변의 겸자 생검과 점막절제술 후의 조직 진단의 비교

김지연 ( Jee Yeon Kim ),이시원 ( See Won Lee ),박이천 ( Lee Chun Park ),신중광 ( Jung Kwang Shin ),박남영 ( Nam Young Park ),문원 ( Won Moon ),김규종 ( Kyu Jong Kim ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),장희경 ( Hee Ky 대한내과학회 2006 대한내과학회지 Vol.71 No.6

목적: 위 선종의 정확한 조직학적 진단은 중요한데 이것은 전암성 병변과 국소적 위암과 연관되어 있다는 보고가 있기 때문이다. 그러나 위 선종의 경우 내시경 생검과 점막 절제술로 절제된 조직과의 진단이 일치하지 않는 경우가 관찰된다. 이에 위 선종 및 조기위암으로 의심되는 병변에 대한 내시경 생검과 점막절제술 후의 조직소견의 차이를 내시경 소견에 따라 분석하여 보고자 하였다. 방법: 2002년 5월부터 2004년 8월까지 고신 대학교 복음병원에서 상부 워장관 내시경상 위 선종 또는 조기위암으로 의심되는 병변이 관찰되어 내시경 점막절제술을 시행한 88명의 환자를 대상으로 후향적으로 절제 전 내시경 생검과의 조직소견을 판정하였다. 결과: 내시경 생겁 결과와 점막 절제술 후 조직소견이 일치한 경우가 52예(59.1%)였다. 내시경 생검에서 위염 또는 선종인 71예 중에서 점막절제술 후 선암으로 판명되었던 경우가 13예 있었다. 이렇게 조직 소견이 선암으로 상향 진단된 경우의 내시경 소견은 발적, 함몰형 병변인 경우에서 빈도가 높았다. 결론: 선종이 의심되는 위점막 병연이 관찰된 경우 내시경 생검이 전체 병변의 조직을 반영하기는 어려우므로 특히 발적이 동반되거나, 함몰형 병변인 경우에는 점막절제술 등의 전체 병변 절제를 통한 조직검사를 반드시 시행하는 것이 진단과 치료에 도움이 될 것으로 생각한다. Background: The correct histological diagnosis of a gastric adenoma is important, because an adenoma has been reported to be a precancerous lesion and is associated with focal gastric carcinoma. However, there is some discrepancy between the histology of a forceps biopsy and that of the endoscopic mucosal resection. This study compared the histological findings of a gastric mucosal lesion in the specimens of a forceps biopsy and an endoscopic mucosal resection. Methods: 88 cases of gastric mucosal lesions, which had been removed by the endoscopic mucosal resection, were reviewed retrospectively. All the patients had undergone a forceps biopsy before the endoscopic mucosal resection. The histological findings of the specimens by a forceps biopsy were compared with those by resection. Results: The histological findings were accordant at 52 of the 88 cases (59.1%). Among the 71 cases with adenoma or gastritis in the biopsied specimens. 13 cases (18.3%) were finally diagnosed with gastric cancer in the resected specimens. Among all the gastritis and adenomas determined by the forceps biopsy, the high-risk groups for adenocarcinomas were characterized by the following endoscopic findings: red-colored and depressed lesions. Conclusions: Biopsy specimens may not be representative of the entire lesion. Therefore, an endoscopic resection of a gastric mucosal lesion is needed for making an accurate histological diagnosis and treatment if adenomas such as red-colored or depressed lesions are suspected. (Korean J Med 71:600-608, 2006)

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)

로즈마리산을 함유한 키토산 마이크로캡슐의 제조

박진권 ( Jin Kwon Park ),이동희 ( Dong Hee Lee ),이천일 ( Chun Il Lee ),강기춘 ( Ki Choon Kang ),표형배 ( Hyeong Bae Pyo ),신재섭 ( Jae Sup Shin ) 한국 접착 및 계면학회 2009 접착 및 계면 Vol.10 No.1

식도 운동장애를 동반한 횡격막상부 식도 게실증 3예

박인서(In Suh Park),강진경(Jin Kyung Kain),김충배(Choong Bai Kim),박효진(Hyo Jin Park),문병수(Byung Soo Moon),이천균(Chun Kyun Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

Three patients with epiphrenic diverticula were reviewed with foci on esophageal dysfuntion and its relation to treatment. All cases were identified by bariurn esophagogram and confirmed by endoscopy. Manoetric studies of esophagus documented as diffuse esophageal spasm-like disorder in 1 case, and nonspecific motor disorder in 2 cases. One case was managed surgically, and the other 2 were treated conservatively. We found that epiphrenic diverticulum were associated with esophageal motility disorders. Treatment should be considered to focus on associated motility disorders as well as a diverticulum. (Korean J Gastroenterol 1997;29:687-693)

증례 : 복강 내 종양으로 오인된 미소 위유암종의 림프절 전이 1예

이지숙 ( Jee Suk Lee ),김규종 ( Kyu Jong Kim ),고지호 ( Ji Ho Ko ),박이천 ( Lee Chun Park ),문원 ( Won Moon ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

위유암종은 드문 질환으로 전체 원발성 위종양의 0.3%, 전체 유암종의 2% 이하로 알려져 있고, 대부분 무증상이다. 그러나 최근 들어 위내시경 검사의 시행이 빈번해지고 면역조직검사의 발달로 이들의 발견 빈도가 점차 증가하고 있는 추세이다. 위유암종은 크게 세 가지 형태로 분류되며, 산발적으로 발생하는 제3형의 경우 공격적인 임상상을 가지고 전이가 잘되는 것으로 알려져 있으나, 크기가 1.0 cm 이하인 미소 위유암종의 경우 일반적으로 전이는 극히 드물다. 저자 등은 연고지 병원에서 우연히 발견된 복강 내 종물을 주소로 내원한 42세 여자의 상부 위내시경 검사에서 약 0.8 cm 크기의 미소 위유암종을 발견하여 내시경적 절제술을 시행한 후 복강 내 종물에 대한 외과적 절제에서 이들이 위유암종의 림프절 전이로 확인된 1예를 경험하였기에 문헌고찰과 함께 보고한다. Gastric carcinoid tumors have been regarded as rare neoplasms, accounting for just 0.3% of all gastric tumors and fewer than 2% of all carcinoid tumors. Recently, there has been an increase in the number of reported studies of gastric carcinoid tumors with the widespread use of gastroscopy and improvements in immunohistochemical methods. Gastric carcinoid tumors are classified into three types. For type III gastric carcinoids not associated with hypergastrinemia, which tend to be larger and demonstrate a biologically more aggressive behavior with metastasis, and also for sporadic lesions, excision with regional lymph node clearance has been recommended. Tumors that are less than 1cm in size are called minute carcinoids, which seldom give rise to regional lymph node metastasis, except in rare cases. We report here a rare case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass in a 42-year-old woman. Furthermore, we review the available literature on this entity. (Korean J Med 72:411-414, 2007)

증례 : 다발성 식도 소세포암 1예

박무인 ( Moo In Park ),장희경 ( Hee Kyung Chang ),박선자 ( Seun Ja Park ),박이천 ( Lee Chun Park ),김규종 ( Kyu Jong Kim ),서정아 ( Jeong Ah Seo ),문원 ( Won Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

소세포암의 원발 부위는 대부분 폐와 기관지이며 드물게 타액선, 인후두, 식도, 위, 대장, 직장, 전립선, 자궁경부 등에서 발생할 수 있다. 식도의 원발성 소세포암은 매우 드물어 전체 식도암의 약 0.8~2.4%를 차지한다. 국내에서는 지금까지 약 20예 정도의 원발성 식도 소세포암이 보고되었는데 이 중 다발성으로 발생한 증례는 없었다. 저자 등은 2개월 간의 연하곤란을 주소로 내원한 61세 남자의 상부 위내시경 검사에서 다수의 식도 종괴가 발견되어 조직생검을 시행한 결과 소세포암으로 확인된 1예를 경험하였기에 문헌고찰과 함께 보고한다. The extra-pulmonary sites of a small cell carcinoma are the salivary glands, pharynx and larynx, esophagus, stomach, pancreas, colon, rectum, skin and cervix. Primary small cell carcinoma of the esophagus is extremely rare with an incidence ranging from 0.8~2.4% of all esophageal malignancies. There have been approximately 20 cases reported in the Korean literature thus far. However, there has not been a reported case of multiple small cell carcinoma of the esophagus. We report a case of multiple small cell carcinoma of the esophagus in a 61-year-old man who presented with a 2 month-history of progressive dysphagia with a review of the relevant literature. (Korean J Med 72:406-410, 2007)

한국인에서 B 형 간염 바이러스 감염상태와 HLA - DR type 과의 연관성

안상훈(Sang Hoon Ahn),한광협(Kwang Hyub Han),이천균(Chun Kyon Lee),김동기(Dong Kee Kim),강신욱(Shin Wook Kang),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),박기일(Ki Il Park) 대한내과학회 1998 대한내과학회지 Vol.55 No.1

N/A Objectives : The course after hepatitis B virus infection appears not to be related to variations in virulence of the HBV itself and may be influenced by the host immune response, which in turn may be regulated by the major histocompatibility complex. The purpose of this study was to determine whether the clearance of HBV was related to a particular HI& allele in Korean. Methods : We studied total 1372 Korean persons who had visited Yonsei University Medical Center for renal transplantation from January in 1990 to August in 1997. Hepatitis B-virel markers and HLA-DB types were examined by retrospective study. Results . 1) Among 1372 subjects, 924 were male and 448 were female(Mean age, M:37.4yrs, F:38.3yrs). Healthy donors in total subjects were 424. 2) Commonly, HLA-DR4 was most frequent among the total subjects, also in the group of Non-Exposure, Chronic Carrier, Clearance, and Antibody. 3) HLA-DR6 was significantly frequent in the group of Clearance and Antibody compared with the group of Chronic Carrier(p<0.001, RR=3.72 and p<0.001, RR=3.58, respectively). HLA-DR9 was significantly frequent in the group of Chronic Carrier compared with the group of Clearance and Antibody(p<0.001, BR=3.33 and p<0.001, RB=3.32). Results in healthy donors were same as above. 4) HLA-DR13 was significant between the HLA-DR6 subgroups(DB13, DR14! which may influence the clearance of HRU. Conclusion: HLA-DR6(esp, HLA-DR13) may be associated with elimination of HBV as one of the host factors influencing the immune response to HBV and HLA-DR9 with persistent HBV infection.

급성 악화를 보인 만성 B형 간염의 치료에 있어서 Lamivudine 즉시 투여의 적절성

이천균,서정훈,조용석,원선영,박인서 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: 만성 B형 간염의 급성 악화시 즉시 라미부딘 치료를 하는 것이 합리적인지에 대해 이해가 부족한 바, 이들의 자연경과를 알아보고 라미부딘 투여군의 비교를 통해서 라미부딘 치료의 적절한 시점을 알아보고자 하였다. 대상과 방법: 2000년 3월부터 2003년 5월까지 본원에 내원한 만성 B형 간염 환자 중 혈중 HBV DNA 또는 HBeAg 양성, ALT>400 IU/L인 35명을 대상으로 혈청 HBV DNA, HBeAg, anti-HBe, ALT를 포함한 간기능 검사를 1-3개월 간격으로 측정하였으며 ALT가 재상승한 경우, 100 IU/L 이상시 라미부딘 100 ㎎을 매일 경구 투여하고, 무작위로 선출된 환자에게 내원 당시 즉시 라미부딘을 투여하고 상기의 방법으로 검사를 시행하여 라미부딘의 효과를 비교하였다. 결과: 내원 당시 혈청 ALT가 400 IU/L 이상의 소견을 보인 27명의 환자를 대상으로 항바이러스제를 투여하지 않고 경과 관찰을 시행하였으며 이중 5명의 환자에게서 평균 19개월 추적관찰중 정상 ALT, HBeAg의 음성, HBV DNA의 음성상태가 유지되었고(제1a군) 3명의 환자에서 ALT가 약간 상승하거나 정상이었지만 HBeAg의 자연 음전은 유도되지 않았다(제1b군). 반면, 19명의 환자에서는 평균 5개월 만에 ALT의 재상승 소견을 보여 라미부딘 치료를 시작하였다(제2군). 제1a군과 제2군 사이에서 혈청 HBV DNA의 중앙값은 각각 6.5 pg/mL과 518.1 pg/mL로 제1a군에서 현저히 낮았으며 HBV DNA가 20 pg/mL 이하였던 환자 7명 중 5명(71.4%)에서 자연음전이 유도되었다. 경과 관찰 중 재상승한 환자 19명 중 16명의 환자와 급성 악화로 내원 즉시 라미부딘을 투여한 환자 8명(제3군)을 비교한 결과, 제2군에서는 3군에 비해 치료시 혈청 ALT는 낮고 HBV DNA는 높았으며 첫 내원시보다 오히려 혈중 HBV DNA가 높은 상태에서 라미부딘 치료가 시작되었다. 양군 간의 라미부딘 치료 효과는 2군에서 56.3% (9/16)로 3군의 62.5% (5/8)와 차이가 없었다. 결론: 급성 악화를 동반한 만성 B형 간염 환자의 경우 내원 당시 혈중 HBV DNA가 현저히 낮은 경우는 HBeAg의 자연음전을 기대할 수 있으나, 대부분의 경우 라미부딘의 즉시 치료를 통한 HBeAg의 음전을 시도하는 것이 바람직하다고 생각된다. Background/Aims: It has been unclear whether immediate antiviral therapy or observation under the expectation of spontaneous inactivation of hepatitis B virus (HBV), is more appropriate for the treatment of chronic hepatitis B (CHB) with acute exacerbation. We intended to analyze the short-term natural course of CHB with acute exacerbation and evaluate the efficacy of lamivudine. Methods: We analyzed 35 CHB patients with acute exacerbation (positive HBV DNA or HBeAg and ALT>400 IU/L) between March 2000 and May 2003. We regularly checked serum HBV DNA, HBeAg and liver unction tests including ALT every 1 to 3 months. If ALT was above 100 IU/L during the follow-up period, patients were treated with 100 ㎎ lamivudine orally once a day. We compared the efficacy of lamivudine use between this group and the group provided with immediate lamivudine trial at their first visit. Results: 27 CHB patients with acute exacerbation were observed without immediate lamivudine trial. In 5 of these patients normal ALT, negative HBeAg and HBV DNA were maintained during 19 months (group la). Slightly elevated or normal ALT was maintained without HBeAg seroconversion in 3 patients (group 1b). However, serum ALT flared up above 100 IU/L in 19 patients within 5 months. So, lamivudine was tried on these patients (group 2). The serum HBV DNA was extremely low, being 6.5 pg/mL in group la compared to 518.1 pg/mL in group 2. Spontaneous inactivation of HBV was observed in 71.4% (5/7) of patients with HBV DNA less than 20 pg/mL at the first visit. ALT was lower and HBV DNA was higher in group 2 than the 8 patients who received immediate lamivudine trial at the first visit (group 3). The response rate of lamivudine was similar between group 2, 56.3% (9/16) and group 3, 62.5% (5/8). Conclusions: Spontaneous inactivation of HBV was expected in CHB with acute exacerbation and extremely low level of HBV DNA (less than 20 pg/mL) in a short term follow-up period. Immediate lamivudine therapy might be more appropriate in most CHB patients with acute exacerbation.(Korean J Hepatol 2004;10:22-30)

식도근절개술로 치료한 식도이완불능증에서 발생한 Barrett 식도궤양 1예

박효진,박인서,이천균,송준현 대한소화기내시경학회 1995 Clinical Endoscopy Vol.15 No.3

We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.

소화관 내시경 검사에 의한 감염

이천균,박인서 한국의학사 1997 診斷과治療 Vol.17 No.4