Dual Probe 를 이용한 24 시간 보행성 식도 pH 검사에서 근위부 전극 위치에 따른 Laryngopharyngeal Reflux Disease 진단의 문제점

안진광(Jin Kwang An),김광하(Gwang Ha Kim),김정렬(Jeong Yeol Kim),주형준(Hyung Jun Chu),강대환(Dae Hwan Kang),송근암(Geun Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

목적 : Dual probe을 사용한 24시간 보행성 식도 pH 검사 중 근위부 전극 위치는 하부식도괄약근 상연 5 cm 상방에 원위부 전극을 정한 후에 이차적으로 결정된다. 하지만 개인별 식도 길이 차이 때문에 근위부 위치는 상부식도, 상부식도괄약근, 하인두에 각각 위치하게 된다. 현재 laryngopharyngeal reflux disease (LPRD)의 진단에 있어 다양한 진단기준이 있으며, 위치에 따른 어느 하나의 기준에 따라 일률적으로 적용시키는 것은 상기와 같은 이유로 문제점이 있다. 이에 본 연구에서는 각 부위에 따른 진단기준을 각각의 환자에게 달리 적용시키는 것이 일률적 진단기준에 비해 차이가 있는지 알아보고자 하였다. 대상과 방법 : 본원에 2001년 5월부터 8월까지 24시간 보행성 식도 pH 검사를 받은 76예를 대상으로 하였다. 환자들에게서 식도내압검사를 토대로 근위부 전극과 상부식도괄약근의 상관관계에 따라 상부식도, 상부식도괄약근, 하인두에 위치한 군으로 나누어 각 부위별로 일률적 진단기준을 적용하여 LPRD를 진단한 경우와 실제 환자들의 부위에 따른 진단기준을 각각 적용하여 LPRD를 진단한 경우를 비교 분석하였다. 결과 : 상부식도 진단기준 (A)을 일률적으로 적용시켰을 때 76예 중 3예 (3.9%)에서 LPRD가 진단되었으며 상부식도괄약근 진단기준 (B)으로는 14예 (18.4%), 하인두 진단기준 (C)으로는 29예 (38.2%), 각각의 부위별 진단기준 (D)으로 개별적으로 적용하였을 때에는 21예 (27.6%)로 D와 A, D와 B, D와 C 사이에 유의한 차이가 있었다 (p value=0.001, 0.035, 0.005). 결론 : Dual probe를 사용한 24시간 보행성 식도 pH 검사에서 LPRD의 진단을 위해서는 식도내압검사를 시행할 때 상부식도괄약근의 위치도 같이 파악하여 각각의 환자들에서 근위부 전극과 상부식도괄약근의 위치 관계를 고려하여 그 환자에 맞는 LPRD 진단기준을 적용시키는 것이 바람직하다. Background : The diagnostic criteria of laryngopharyngeal reflux disease (LPRD) is defined differently according to the location of the proximal pH probe: upper esophagus, upper esophageal sphincter (UES) or hypopharynx. Clinically the location of proximal probe is determined by the location of distal probe, which is usually fixed on 5 cm above the lower esophageal sphincter. This study was performed to evaluate the difference in the diagnosis of LPRD between the results from considering the location of the proximal probe and not considering it. Methods : This study consisted of 76 patients performed esophageal manometry and 24 hour ambulatory pH monitoring of esophagus using the dual probe. According to location of the proximal probe, the patients were divided into 3 groups : upper esophagus, UES and hypopharynx group. Firstly, we used the diagnostic criteria not considering the location of the probe concordantly in all 76 patients : criteria of the upper esophagus, UES and hypopharynx respectively. And then, we used the diagnostic criteria considering the location of the proximal probe. The results were compared. Results : When the diagnostic criteria of upper esophagus was used, 3.9% (3/76) was diagnosed as LPRD. In the case of UES and hypopharynx, 18.4% (14/76) and 38.2% (29/76) was diagnosed as LPRD. When the diagnostic criteria considering the location of the proximal probe was used, 27.6% (21/76) was diagnosed as LPRD. Significant difference was found between the result considering the location of the probe and 3 results not considering it (p<0.01). Conclusion : It is thought to be appropriate to use the diagnostic criteria considering the location of the proximal probe for the more accurate diagnosis of LPRD.(Korean J Med 62:390-395, 2002)

궤양성 대장염에서 대장 점막 Mucin의 조직화학적 특성과 Lectin 반응

송근암(Geun Am Song),김태오(Tae Oh Kim),안진광(Jin Kwang An),이준홍(Jun Hong Lee),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Backgrounds : In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. Methods : The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. Results : In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. Conclusions : This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.(Korean J Med 58:532-541, 2000)

9 악성 위출구 협착에 대한 내시경적 금속 인공관 유치의 유용성

김보석 ( B. S. Kim ),문재현 ( J. H. Moon ),권대식 ( D. S. Kwon ),안진광 ( Jin Kwang An ),허정 ( J. Heo ),김광하 ( G. H. Kim ),강대환 ( D. H. Kang ),송근암 ( G. A. Song ),조몽 ( M. Cho ),양웅석 ( U. S. Yang ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

비효과적 식도운동 환자에서의 식도 산청소능

김광하(Gwang Ha Kim),배용목(Yong Mock Bae),정을조(Eul Jo Jeong),문재현(Jae Hyeon Moon),안진광(Jin Kwang An),김진선(Jin Seon Kim),허정(Jeong Heo),강대환(Dae Hwan Kang),송근암(Geun Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2002 대한내과학회지 Vol.63 No.4

목적 : 저진폭 수축파와 연동운동 단절은 식도 내용물의 부적절한 배출과 역류와 연관성이 있어 기능적·임상적 중요성을 가진다. 이런 이유로 비특이성 식도운동장애(NEMD)에서 구분하여 비효율적 식도운동(IEM) 이라는 새로운 진단명이 제시되고 있다. 이에 저자들은 산역류가 있는 IEM 환자에서 식도 산청소능을 조사하고자 하였다. 방법 : 2001년 6월부터 2002년 5월까지 쉰 목소리, 인후 이물감, 흉통 등으로 식도운동검사와 보행성 식도산도검사를 시행 받은 252예 중에서 산역류를 보이는 정상식도운동군 51명(남:여 18:33, 평균 48.0세)과 IEM군 40명(남;여, 16:24, 평균 48.6세)을 대상으로 하여 식도운동검사와 보행성 식도산도검사 결과를 비교분석하였다. 적어도 wet swallow의 30% 이상에서 원위부 식도의 저수축 소견이 관찰되는 경우를 IEM으로 진단하였으며. 식도 산청소능은 원위부 식도 pH가 4 미만인 전체 시간(분)을 총 역류 횟수로 나눈 값으로 정의하여 양군 간에 결과를 비교분석하였다. 결과 : 1) IEM군에서 근위부 식도와 원위부 식도 수축파의 진폭, 하부식도괄약근압은 각각 47.3±21.9 mmHg, 60.0±27.5 mmHg, 18.0±6.7 mmHg로, 정상식도운동군(66.5±22.6 mmHg, 100.3±31.8 mmHg, 29.5±8.4 mmHg)보다 유의하게 낮았다(p<0.05). 2) IEM군에서 전체 검사시간 중, 기립시, 앙와위시 pH 4 미만인 전체 측정시간 백분율은 0.78±1.08%, 1.05±1.55%, 0.42±1.16%로, 정상식도운동군(각각 0.55±0.85%, 0.85±1.31%, 0.14±0.41%)과 유의한 차이는 없었다(p>0.05). 또한, 전체 측정시간 중 pH 4 미만의 역류가 일어난 횟수, 전체 측정시간 중 pH 4 미만의 역류가 5분 이상 일어난 횟수, Demeester 종합점수, 최장역류시간도 양군간에 유의한 차이는 없었다(p>0.05). 3) IEM군에서 앙와위시 식도 산청소능은 0.73±0.64분/회로, 정상식도운동군 0.31±0.29분/회보다 유의하게 증가되어 있었다(p=0.021). 하지만 기립시 식도 산청소능은 IEM군 0.51±0.42분/회, 정상식도운동군 0.41±0.40분/회으로 양군간에 유의한 차이는 없었다(p=0.096). 결론 : IEM군에서 정상식도운동군보다 앙와위시 유의한 식도 산청소능 증가가 관찰되었다. IEM이 위식도역류질환(GERD)에서 흔히 관찰되는 것을 고려한다면, IEM시 보다 더 적극적인 항역류 치료가 필요하며, 차후 GERD의 장기합병증과의 관련성에 대한 연구도 필요할 것으로 보인다. 이러한 상황을 고려해 볼 때 IEM은 NEMD에서 분리하여 독립된 운동질환으로 분류하는 것이 바람직하리라 사료된다. Background : Failed or hypotensive peristalsis, two of the diagnostic criteria for NEMD, correlates with impaired anterograde propulsion and retrograde escape of esophageal contents. The aim of this study was to evaluate esophageal acid clearance (EAC) in patients with ineffective esophageal motility (IEM). Methods : Of 252 patients performing esophageal manometry and ambulatory esophageal pH monitoring, 51 patients with normal motility and acid reflux and 40 patients with IEM and acid reflux were included. Results : The amplitude of peristaltic waves in the proximal and distal esophagus and lower esophageal sphincter pressure was lower significantly in patients with IEM than those with normal motility. Percentage of time of pH<4 in total, upright, and supine period and number of reflux episodes was not different in both. Supine EAC was significantly increased in patients with IEM when compared to those with normal motility. Upright EAC was not different in both. Conclusion : We concluded supine EAC is increased in patients with IEM. Since IEM is frequently associated with gastroesophageal reflux disease (GERD), a more intensive therapy must be needed. We propose IEM can be as a specific entity of primary esophageal motility disorder, especially in patients with GERD.(Korean J Med 63:386-393, 2002)

폐쇄성 황달에서 담도 배액 전후의 Cytokine과 Endotoxin에 대한 연구

강대환 ( Dae Hwan Kang ),허정 ( Jeong Heo ),김광하 ( Gwang Ha Kim ),문재현 ( Jae Hyeon Moon ),권대식 ( Dae Sik Kwon ),김보석 ( Bo Suk Kim ),안진광 ( Jin Kwang An ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ),양웅석 ( Ung Suk Yang 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: Malignant biliary obstruction are associated with high postoperative morbidity and mortality. This study was performed to determine the effect of external and internal biliary drainage on plasma concentrations of cytokines and endotoxin. Methods: Twenly-one patients with malignant biliary obstruction were enrolled in this study. They were devided into two groups, PTBD (percutaneous transhepatic biliary drainage) and ERBD (endoscopic retrograde biliary drainage)groups. Then, plasma concentrations of TNF-α, sTNFr, interleukin 1α (IL-1α), interleukin 6 (IL-6), and endotoxin were measured before and after 1 week in PTBD and ERBD groups. Results: Total bilirubin decreased significantly from 13.3±8.2 to 6.2±4.4 mg/dL after PTBD and 7.0±11.2 to 5.3±4.0 mg/dL after ERBD (p=0.005, 0.007, respectively). Plasma sTNFr in PTBD group was 5.1±1.4 before drainage and remained unchanged 5.5±1.5 ng/mL at one week after drainage (p=0.155). Plasma sTNFr in the ERBD group was 5.9±1.5 and 5.6±1.0 ng/mL before and after biliary drainage, respectivedly (p=0.333). There was no significant difference of sTNFr changes between the PTBD and ERBD groups (p=0.113). Moreover, there was no significant difference in endotoxin changes between the PTBD and ERBD groups (p=0.477). Other cytokines changed insignificantly. Conclusions: Both PTBD and ERBD did not affect significantly plasma concentrations of sTNFr and endotoxin. Although ERBD provides a better quality of life and physiologic benefit, it dose not decrease cytokines and endotoxin associated with high morbidity and mortality in patients with malignant biliary obstruction. (Korean J Gastroenterol 2003;41:493-498)

주폐자충 폐렴으로 발현된 Felty 증후군 1예

김성호,남대근,문재현,김지홍,김보석,안진광,문태건,안병재,김성일 全南大醫大 2001 전남의대학술지 Vol.37 No.3

Helicobacter pylori 의 내시경적 전파 예방을 위한 내시경 세척 및 소독법의 중요성

강대환,안진광,문재현,송근암,조몽,김도훈,양웅석 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.6

간경변증 환자에서 혈청 Growth Hormone, Insulin-like Growth Factor-1 과 Insulin-like Growth Factor Binding Protein-3 의 임상적 의의

강대환,김도훈,안진광,문재현,양웅석,이준홍,송근암,조몽 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.1

Background/Aims : Although an Insulin-like growth factor-1(IGF-1) and an Insulin-like growth factor binding protein-3(IGFBP-3) have been reported to be valuable indices of nutritional state in cirrhotic patients, there is still a dispute. The controversy may be caused by the fact that most studies included heterogeneous groups of patients such as alcoholic and posthepatitic cirrhosis. The aim of this study was two fold: to evaluate whether the Growth hormone(GH), IGF-1, and the IGFBP-3 are significant or not as valuable indices of hepatic function as well as the nutritional state in hepatitis B or C associated cirrhotic patients. Methods : This study consisted of 36 patients with liver cirrhosis associated with hepatitis B or C. Patients with alcoholic cirrhosis were excluded. The serum GH, IGF-1, and IGFBP-3 were measured while patients were fasting. The variables of liver function and nutritional state included Child-Pugh score, serum bilirubin, albumin, prothrombin time, triceps skinfold thickness(TSF), and midarm muscle circumference (MAMC). The correlation between the variables of liver function or nutritional state and the serum GH, IGF-1, or IGFBP-3 was evaluated. Results : The IGF-1 correlated very well with IGFBP-3 (P$lt;0.001). Both the IGF-1 and IGFBP-3 correlated inversely with Child-Pugh score (P$lt;0.01, P$lt;0.001 respectively). IGFBP-3 correlated very well with the serum bilirubin level as well as the albumin level (P$lt;0.001). Neither the IGF-1 nor IGFBP-3 showed any correlation with TSF or MAMC. Conclusions : Both IGF-1 and IGFBP-3 were clinically significant as indices of hepatic function in the patients with hepatitic B or C associated cirrhosis but neither of them were significant as indices of nutritional state.(Korean J Hepatol 2000;6:52-58)

과혈관성 종양양상을 보인 침윤성 위궤양 1 예

김지홍,이창훈,강대환,안진광,문재현,양웅석,송근암,조몽,주형준,문태건 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.6

정상 혹은 감소된 혈장 ACTH 를 보이면서 IPSS에 의해 진단된 쿠싱증후군 2예

문태건,남대근,문재현,황지윤,김지홍,안진광,손석만,김인주,김용기,김학진,조용구 대한내과학회 2002 대한내과학회지 Vol.62 No.5

Cushing's syndrome results from prolonged exposure to high levels of glucocorticoid hormones. ACTH-dependent Cushing's syndrome accounts for about 85% of endogenous causes. Autonomous pituitary ACTH secretion, called Cushing's disease, is responsible for 80% of these causes, whereas ectopic ACTH secretion is responsible for 20% of them. Appropriate therapy of patients with Cushing's syndrome depends on accurate diagnosis and classification of the disorder. In addition to the history and clinical evaluation, the laboratory evaluation of a patient with Cushingoid appearance is necessary to establish the diagnosis and determine the cause of hypercortisolism. A major problem in the differential diagnosis of ACTH-dependent Cushing's syndrome is distinguishing Cushing's disease from the ectopic ACTH syndrome. Both entities can have similar clinical and laboratory features. In addition, both pituitary microadenoma and ectopic ACTH-secreting tumors may be radiologically occult. Bilateral inferior petrosal sinus and peripheral vein catheterization with simultaneous collection of samples for measurement of ACTH is one of the most specific tests available to localize the source of ACTH production. We report two cases of Cushing's syndrome diagnosed by inferior petrosal sinus sampling associated with normal or low ACTH levels on routine basal hormone assay. -