장출혈을 동반한 회장의 림프종

김성걸(Seong Gul Kim),최지영(Jee Young Choi),임의혁(Euyi Hyeog Im),김진희(Jin Hee Kim),육은주(Eun Ju Yook),김병호(Byeong Ho Kim),성자원(Ja Won Sung),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

Primary small intestinal lymphomas are a hetorogenous group of tumors ortginating from the lymphoid cells of the mucosa and submucosa of the small bowel. The ileum and jejunum are most frequently affected, whereas duodenal involvement is less common. There is a himodal age distribution with peak incidences below the age of 10 and in the fifth and sixth decados, with a slight male prodominance. And it is very difficult to diagnose until the dovelopment of any complications such as obstruction, perforation ancl hemorrahage because of the insidious onset of disense and relative inaccuracy of the diagnostic tools as in all the small bowel tumor. Optimal treatment choices for lymphoma remain controversial. Surgical resection, in many cases, is considered the first line of defense. Primary malignant lymphoma of the small intestine has poorer prognosis due to the delay of the diagnosis than any other extra-intestinal malignancy, but has the better prognosis than any other small intestinal malignancy. The histologic type, the extent of the intestinal disease, and the prosence or absence of extraintestinal involvement are the important factors in prognosis. Patients with resectable disease typically have a 40/r, to 507r, S-year survival. Recently the authers diagnosed the primary small intestinal lymphoma associated with a large amount of bleeding confirmed by intraoperative biopsy. So we report this case with the review ot literatures. (Korean J Gastroenterol 1995;27:251-255)

소화기암에서 조직내 Carcinoembryonic Antigen 측정치와 DNA 배수성과의 관계에 대한 연구

정현용 ( Jeong Hyeon Yong ),김병호 ( Kim Byeong Ho ),성자원 ( Seong Ja Won ),허승식 ( Heo Seung Sig ),이기천 ( Lee Gi Cheon ),이헌영 ( Lee Heon Yeong ),김영건 ( Kim Yeong Geon ),노승무 ( No Seung Mu ),윤완희 ( Yun Wan Hui ),장일성 대한내과학회 1993 대한내과학회지 Vol.44 No.2

연구배경 : 소화기암 조직에서 carcinoembryonic antigne (CEA)의 생산 정도를 측정하고, 종양세포의 생물학적인 악성도를 반영하는 것으로 알려진 DNA 배수성을 분석하여 그들 사이의 관계를 파악하고, 임상상 및 병리조직학적인 특성들과의 상호관계를 알아보자 하였다. 방법 : 절제수술이 가능했던 위암 26예와 결장직장암 14예를 대상으로 조직내의 CEa를 추출한 후 방사선면역 측정법으로 농도를 측정하고 유식세포분석기를 이용하여 DNA 함량과 세포주기분석을 시행하였다. 결과 : 1) 정상 위점막의 CEA 농도는 평균 10.2ng/gm이었고, 위암조직의 CEA치는 평균 42.1ng/gm으로 정상점막에서보다 4배이상 높았으며, 암의 병기가 높을수록 높았다. 2) 정상 대장점막의 CEA치는 평균 27.3ng/gm으로 정상 위점막보다 높았고 (p<0.05), 결장직장암 조직의 CEA 농도는 평균 164.0ng/gm으로 정상 대장점막에서 보다 6배, 위암조직보다 4배정도 높았다(p<0.05). 3) 위암 DNA배수성 유형은 56.0%가 2배성을, 44.1%가 이수성을 보였으며, 결장대장암은 25.0%에서 이수성을 보였고, 75.0%는 2배성암이었다. 소화기암에서 수술 후 병기등의 임상상과 이수성의 빈도는 통계학적으로 유의성이 없었다. 4) 위암 조직의 평균 CEA 농도는 DNA배수성 유형상 이수성인 경우가 86.4ng/gm으로서 2배성암의 14.5ng/gm보다 6배가 높았고 (p<0.05), 결장직장암에서는 이수성암이 244.8ng/gm으로 2배성암보다 (161.7ng/gm)높은 경향을 보였다(p<0.05). 결론 : 소화기암 조직에서 carcinoembryonic antigen의 생산은 DNA배수성 유형상 이수성을 보이는 DNA stemline과 밀접한 관계가 있음을 알게 되었다. 조직내 CEa 농도와 DNA배수성 유형이 예후를 판정하는데 지표로써의 가치여부는 대상환자에 대한 추적이 필요할 것으로 사료된다. Background : This study was performed to obtain additional information about intratumor heterogeneity and prognosis of gastrointestinal cancers, as defined by different DNA stemlines in relation to tumor CEA expression na clinicopathologic characteristics. Methods : In 26 patients with stomach cancer and 14 patients with colorectal cancer, carcinoembryonic antigen concentrations in tissue extracts were measured by radioimmunoassay and the DNA ploidy patterns of same specimens were determined by flow cytometry. Result : 1) Mean tissuc CEA concentrations in the normal gastric mucosa of the patients with stomach cancers was 10.2ng/gm. Tissue CEA concentrations (mean 42.1ng/gm) of stomach cancers were 4 times higher than the normal mucosa (p<0.05), significantly correlated to TNM stages. 2) Tissue CEA concentrations (mean 27.3ng/gm) in the normal colonic mucosa of the patients with colorectal cancers were higher levels than normal gastric mucosa (p<0.05). Tissue CEA concentrations (mean 164.0ng/gm) of colorectal cancers were 6 times higher than the colorectal mucosa` and 4 times higher than stomach cancer`s (p<0.05). 3) The incidence of aneuploid pattern in the stomach cancer was 44.0%, and 25.0% in the colorectal cancers. The incidence of aneuploid cancer was not significantly related to clinicopathologic findings. 4) Tissue CEA concentrations of aneuploid stomach cancers (mean 86.4ng/gm) were 6 times higher than diploid cancers (mean 14.5ng/gm) (p<0.05). Aneuploid colorectal cancers (mean 244.8ng/gm) had higher CEA levels than diploid cancers (mean 161.7ng/gm) (p<0.05). Conclusion : The production of carcinoembryonic antigen in gastrointestinal cancers was significantly correlated with aneuploid DNA stemlines. To estimate prognostic values of tissue CEA concentrations and DNA ploidity, follw up for these patients and further studies should be pursued.

간경변증 환자에서 간신티그램을 이용한 Propranolol 투여 전후의 간혈류 변화

김병호(Byeong Ho Kim),서광석(Kwang Suk Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),육은주(Eun Ju Yook),임의혁(Euyi Hyeog Im),성자원(Ja Won Sung),이강욱(Gang Wook Yi),정현용(Hyun Yong Jeong),이헌영(Heon Young Lee),김영건(Young Kun 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Esophageal varix bleeding due to portal hypertension in liver cirrhotics is very emergency state and difficult for management. In spite of many kinds of treatment in esophageal varix bleeding such as medical and surgical methods, but cant be expected of good results. Lebrec report that propranolol is significantly decreased portal venous pressure in 1980. This study analyzed the portal hemodynamics by liver scintigraphy of 38 patients with liver cirrhosis who were proven to have esophageal varices and 10 norrnal subjects. The 19 cirrhotics had taken liver scintigraphy before and after propranolol medication. There were significant difference in HAI(Hepatic Arterial Index) between cirrhotics and normal subjects(64.7k16.5/ vs 31.9+8.3%, p<0.001). There were no significant difference in HAI according to the Childs classification, the type of variceal morphology and the presence of ascites, but the HAI in Child B(68.1%) and C(63.4%) groups were higher than that in Child A group(55.5%). The heart rate decreased significantly after propranolol ( 7.6No./min, p<0.001) and the HAI increased significantly after propranolol (+8.0%, p<0.05). It should be suggested that propranolol is effective in decreasing the portal hypertension by decreasing the portal blood flow. There were no serious complication of propranolol. In conclusion, these results suggest that propranolol could be a potentially useful and safe agent in management and prevention of variceal bleeding by decreasing the portal hypertension and the liver scintigraphy with Tc tin colloid is reasonably a accurate, simple, safe, and rapid method, therefore can be considered suitable for use in the assecement of liver hemodynamics.(Korean J Gastroentero11994; 26: 119-126)

위궤양에 대한 Teprenone(Selbex^�)의 임상효과

정현용,김병호,성자원,이기천,허승식,이종선,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

The study objective was to assess the ulcer healing effects of Teprenone, stimulator of mucus production, given in dose of 50mg tid. We reviewed 25 cases of gastric ulcer proven endoscopically and treated by Teprenone. The results were follows; 1) The healing rate of gastric ulcer was 72% after 8 weeks treatment. 2) Subjective symptoms such as epigastric pain, belching, nausea, anorexia and vomiting were subsided at 86%. 3) There were not developed any symptoms, signs and laboratory abnormality (CBC, liver funtion test, urinalysis) suggesting side effect of drugs. In conclusion, Teprenone was considered an effective and safe drug in the treatment of gastric ulcer diseases.

내시경으로 확인된 상부소화관 용종의 임상적 고찰

김영건,김병호,성자원,이기천,허승식,이종선,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

From January 1987 to October 1991, we performed 14,333 cases of upper gastrointestinal endoscopy and diagnosed 527 cases with U.G.I polyp. We assesed these 527 cases and obtained following results: 1) The overall incidence of U.G.I. polyps was 3.6%, and there was no sexual difference. The peak incidence was in 6th decades(32.4%). 2) The U.G.I. polyps were located chiefly at stomach(415 cases, 78.7%), among which antrum occupied antrum 43.5%, body 24.0% and funds 5.1%. And the others were esophagus(6.5%) and duodenum(12.3%). 3) The size of U.G.I. polyp was below 1cm in 72.3%, from 1cm to 1.9cm in 20.7% and above 2cm in 7.0%. According to Yamada' classification, type Ⅰ, Ⅱ, Ⅲ and Ⅳ was 31.9%, 51.3%, 13.7% and 3.0%. 4) Histological nature of U.I.G. polyp were hyperplastic polyp(85.8%), adenomatous polyps(9.3%), carcinomatous polyps(3.3%) and etc. The size of neoplastic polyp such as adenomatous polyps(mean 1.0±0.7cm) and carcinomatous polyps(niean 2.0±1.8) were larger man hyperplastic polyp(mean 0.6±0.4) (p<0.05) 5) The gastric polyps were associated with peptic ulcer(7.5%), gastric cancer(3.2%), other malignancy(3.5%), hepatobiliary disease(5.5%), post subtotal gastrectomy(5.5%). And others(75%) werenot associated with specific disease.

내시경으로 진단된 소화성 궤양의 임상적 고찰

김영건,육은주,김성걸,임의혁,성자원,김병호,허승식,이기천,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

A clinical analysis was performed of 3055 pateints with peptic ulcer who were diagnosed with gastroduodenoscopy, in Hospital of Chungnam National University College of Medicine from July 1988 to May 1993. 1) During the period 1988-1993, The proportion of gastric ulcer among peptic ulcer decreased from 47.8% to 42.8%, but that of duodenal ulcer increased from 36.8% to 39.6%. 2) Of the 3055 cases, the number of patients with esophageal ulcer was 98(3.2%), with gastric ulcer 1407(41.6%), with. duodenal ulcer 1104(36.1%), with channel ulcer 149(4.9%), and with combind ulcer 297(9.7%). 3) We observed a peak incidence of peptic ulcer in the 50-69age group, gastric ulcer in the 5069age, duodenal ulcer in the 40-59age group. The ratio of male to female was 3.6 : 1 in peptic ulcer, 4.4 : 1 in gastric ulcer, 3.0 : 1 in duodenal ulcer. 4) The common site was angle in gastric ulcer, and bulb in duodenal ulcer. 5) The active stage was 39.4% of gastric ulcer, and 37.4% of duodenal ulcer, the healing stage was 34.2% of gastric ulcer, and 17.9% of duodenal ulcer, and the scar stage of gastric ulcer was 26.4%, and duodenal ulcer was 44.7%. 6) The size of ulcer was less than 1Cm in 66.7% of gastric ulcer, and in 75.5% of duodenal ulcer, the size of ulcer was greater than 2Cm in 13.2% of gastric ulcer, and in 6.5% of duodenal ulcer. 7) The frequency of multiple ulcer was 29.9% in gastric ulcer, and 16.5% in duodenal ulcer.

만성 간질환에 대한 DDB(Biphenyl Dimethyl Dicaboxylate)의 임상적 효과

이헌영,임의혁,김성걸,김진희,육은주,성자원,김병호,정형용,강대영,김영건 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

To investigate the effects of short-term administration of DDB(Biphenyl Dimethyl Dicarboxylate) for decreasing elevated serum aminotransferase levels in chronic liver diseases, authors applied 3 capsules of DDB per day at each meal time for 35 patients and compared with 35 patients treated with other conservative management. The following results were obtained. 1. Serum alanine aminotransferase (ALT) levels significantly decreased from 247.1± 180.0 IU/L of pretreatment level to 96.6±126.0 IU/L, 61.1±62.7 IU/L and 38.0±26.8 IU/L after 1, 3 and 6 months of treatment(p<0.05) and effective rates were observed in 60.0%, 71.4% and 88.6% of patients after 1, 3 and 6 months of treatment. 2. Serum aspartate aminotransferase (AST) levels decreased also significantly from 167.8±96.9 IU/L of pretreatment levels to 124.4±155.0 IU/L, 77.9±49.6 IU/L, 60.6± 46.9 IU/L after 1, 3 and 6 months of treatment(p<0.05), but decreasing pattern of serum AST was less significant than that of serum ALT. 3. No significant difference were observed in the serum ALT and AST changes according to the cause and duration of hepatitis. 4. No significant adverse effects were observed in whole patients treated with DDB. It is suggested that small dose administration of DDB is effective for decreasing serum aminotrans ferase levels in chronic liver disease in which other conservative management was not effective.

용종 형태로 발생한 대장의 동정맥 기형 1예

김진희,김병호,임의혁,김영건,이헌영,성자원,김성걸,육은주,정현용 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.4

Arteriovenous malformations occur predominantly in the cecum and ascending colon and is not associated with vascular lesions of the skin, central nerveous system. or lung Arteriovenous malformations involving gastrointastinal tract is often to be found to be cause of the recurrent painless bleeding without specific past history and family history and usually diagnosed by selective mesenteric arteriography or colonoscopy, But because of small size of the lesion and local occurence, diagnosis of the arteriovenous malformation is very difficult. Authors exprienced a case of arteriovenous maltormation in the colon. The patient had a history of repeated gastrointestinal bleeding, and were diagnosed by colonoscopy and were treated with colonoscopic resection.

내시경적 위장관 용종 절제술 148예의 임상적 고찰

김진희,김병호,임의혁,정현용,김영건,이헌영,성자원,김성걸,육은주 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.1

Gastrointesinal polyp is a premalignant lesion, it is recommanded to be removed. Endoscopic polypectomy has long been considered as a safe and effective method for removal of polyps. One hundred forty eight endoscopic gastrointestinal polypectomy were done in 111 patients who visited Chungnam National University Hospital from January in l991 to August in l993, and clinical character including histopathology were evaluated. (continue...)

항암화학요법과 방사선 병합요법으로 완전관해를 보인 위분문부로 벽내전이된 식도암 1예

김진희,김병호,임의혁,김영건,이헌영,성자원,김성걸,육은주,정현용 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.3

Esophageal carcinoma is a rare malignant neoplasm consisting of about 1.5% of the whole gastrointestinal tract neoplasm and has poor prognosis of which survival rate is below 5%. The squamous cell carcinoma of the esophagus could be multicentric in character and may have occured in 9.5-27% of incidence. The most common site is head and neck region. The metastasis of esophageal carcinoma occur through hematogenous, lymphatic spread, direct invasion and rarely intramural metastasis. Of theses, intramural metastasis has been occured in 7-14.3% of incidence and its presence has been regared to poor prognostic factor due to early regional or distant metastasis. Surgery, chemotherapy, radiotherapy alone or combination of these has been used as treatment modalities of esophageal cancer, but combination chemoradiotherapy with or without operation is prefered method than other at present. Authors report a case of esophageal carcinoma showing intramural metastasis to the gastric wall, which had the complete remission with preoperative chemoradiotherapy.