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대장 선종의 위험 인자로 복부 비만 및 인슐린 저항성에 대한 연구
이항락 ( Hang Lak Lee ),손병관 ( Byoung Kwan Son ),이오영 ( Oh Young Lee ),전용철 ( Yong Chul Jeon ),한동수 ( Dong Soo Han ),손주현 ( Ju Hyun Sohn ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3
목적: 대장암은 유전 소인, 흡연, 음주, 식습관 등의 환경인자가 작용하여 발생하며 또한 비만, 고지혈증, 고혈당, 고인슐린 혈증 및 인슐린 저항성이 대장암의 발암과정과 연관이 있다. 다양한 비만 지표를 이용해서 대장 선종과 비만 및 인슐린 저항성과의 연관성을 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2004년 10월까지 한양대학병원에서 검진 목적으로 대장내시경검사와 기타 검사를 시행 받은 환자를 대상으로 전향적으로 환자 대조군 연구를 시행했다. 크기가 0.5 cm 이상이며 조직학적으로 대장 선종이 증명된 50명의 환자를 대상으로 했으며, 대조군은 동일 기간 중 대장내시경검사를 시행 받았으나 특이 병변이 없었던 자로 정했다. 결과: 인슐린, 공복혈당, 총 콜레스테롤, triglyceride, LDL, HDL 수치, 수축기 및 이완기 혈압은 환자군에서 모두 증가되었으나 환자군과 대조군 사이에 유의한 차이는 없었다. HOMA-IR은 환자군에서 인슐린 저항성 수치가 높았으나 통계적인 유의성은 없었다. 그러나 체질량지수, 복부 비만, 체지방, 비만도는 환자군이 대조군 보다 유의하게 높았다. 다변량 분석에서 복부 비만이 가장 의미 있는 위험 인자였으며 체질량지수가 증가함에 따라 대장 선종의 위험도도 증가했다. 체지방, 비만도 역시 중요한 위험 인자였다. 결론: 비만과 대장 선종의 연관성에서 복부 비만이 가장 중요한 위험 인자였으며 복강 내 지방조직이 중요한 역할을 할 것으로 기대한다. 향후 대규모의 환자 대조군 및 코호트 연구가 필요하며 복강 내 지방의 역할에 대한 분자생물학적인 연구가 필요하다. Background/Aims: Abdominal obesity and hyperinsulinemia or insulin resistance are of interest in connection with colon carcinogenesis. We conducted a prospective case controlled study for the evaluation of relationship between abdominal obesity, insulin resistance, and colorectal adenoma. Methods: Fifty patients with colorectal adenoma and fifty healthy subjects were included in this study. Total colonoscopic examinations were performed in all the subjects. Fasting blood sugar (FBS), insulin, homeostasis model assessment (HOMA-IR), triglyceride (TG), cholesterol (CROL), BMI (body mass index), WHR (waist hip ratio), percent body fat (PBF) and obesity degree (OD) were measured. HOMA-IR was considered to represent insulin resistance. Diabetic patients were excluded from this study. Results: There were no differences in sex, serum insulin, FBS, HOMA-IR, TG, CROL between adenoma and control group. Subjects with high BMI, WHR, percent body fat, and obesity were more likely to have colonic adenoma. Multiple logistic regression analysis after adjusting confounding factors, had revealed that WHR was the most important independent risk factor for colon adenoma. Conclusions: Abdominal obesity was most closely related to colonic adenoma. However, insulin resistance was not related to colonic adenoma. A larger case controlled study is needed. (Korean J Gastroenterol 2007;49:147-151)
하부식도 근육층 비후를 동반한 호두까기 식도 환자에서 발생한 Steakhouse 증후군
양선영 ( Sun Young Yang ),이오영 ( Oh Young Lee ),한성희 ( Sung Hee Han ),전대원 ( Dae Won Jun ),노병주 ( Byoung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
Acute esophageal obstruction caused by the impaction of a large bolus of food has been called the `steakhouse syndrome`. Esophageal stenosis is usually found in adults suffering with steakhouse syndrome, but occasionally the syndrome occurs in the absence of any underlying organic abnormality. A 71-year-old male patient had complained of swallowing difficulty after ingesting meat two days previously. We performed endoscopy and found a meat bolus at 30 cm from the incisors, and we so removed the meat with a basket. No pathologic findings were observed endoscopically after the removal of the esophageal meat bolus. The esophageal manometry showed segmental, high amplitude esophageal pressure at the lower esophagus with normal peristalsis. We performed endoscopic ultrasonography with a high frequency catheter and we found thickening of the lower esophageal muscle layer. This case shows that nutcracker esophagus may be the cause of esophageal foreign body impaction and thickening of muscle layer may be associated with the symptom. (Kor J Neurogastroenterol Motil 2005;11:166-169)
혈청 음성 Celiac 병을 의심하는 소장 융모 위축과 연관된 단백상실장병증 1예
한성희 ( Sung Hee Han ),이오영 ( Oh Young Lee ),은창수 ( Chang Su Eun ),노병주 ( Byoung Joo Roh ),손원 ( Won Sohn ),백승삼 ( Seung Sam Baeg ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.1
Protein losing enteropathy is described as a diverse group of disorders associated with excessive loss of serum proteins into the gastrointestinal (GI) tract. The etiology of protein losing enteropathy is various. Increased mucosal permeability to protein as a result of cell damage, mucosal erosion, or lymphatic obstruction may develop protein losing enteropathy. Celiac disease is a common cause of protein losing enteropathy associated with small bowel villous atrophy in Europe. We experienced a case of protein losing enteropathy associated with small bowel villous atrophy of unknown origin. A 36-year-old woman was admitted due to chronic watery diarrhea and weight loss. Laboratory findings showed total protein 4.7 g/dL, albumin 2.7 g/dL, cholesterol 100 mg/dL, WBC 6,000/mm3 (lymphocyte 13.6%) with the absence of proteinuria. On esophagogastroduodenoscopic examination, duodenal ulcer scar was noted on the bulb and colonoscopic finding was nonspecific. On small bowel enteroscopy, jejunal and ileal villi was scantly noticed. Small bowel biopsy showed marked villous atrophy. Her symptoms did not improve after supportive care. Gluten free diet was tried because celiac disease could not be ruled out completely. Diarrhea ceased and body weight regained after gluten free diet. (Korean J Gastroenterol 2007;49:31-36)
궤양성 대장염과 유사한 양상을 보인 살모넬라 대장염 1예
손병관,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1
Salmonella species have recently been shown to involve the colon in a fashion resembling ulcerative colitis by radiographic and endoscopic appearance. The presentation of Salmonella colitis is usually similar to that of ulcerative colitis; and often leads to delayed or inappropriate management. Furthermore, Salmonella infection and inflammatory bowel disease (IBD) can coincide in the same patient. Salmonella colitis in the setting of undiagnosed underlying IBD can present a diagnostic dilemma for the clinician. We report a case of Salmonella colitis in which the radiographic and colonoscopic findings were similar to those of ulcerative colitis.
전용철,한동수,이민호,박근태,장세진,최호순,이오영,함준수,기춘석,손주현,박경남,윤병철 대한소화기학회 1998 대한소화기학회지 Vol.31 No.3
Background/Aims: Colonic mucosal lesions akin to mucosal changes in portal hypertensive gastropathy have been observed occasionlly in patients with portal hypertension. However the exact prevalence of these lesions, their relationship to the severity of the liver disease and their associations with gastric mucosal changes is still unclear. The present study assesses the prevalence of rectal varices and colonopathy and factors associated with them in liver cirrhosis. Methods: Thirty one cirrhotic patients and 40 controls underwent endoscopic examinations of upper and lower gastrointestinal tract. Results: Colonic mucosal changes were observed in 16 patients (51.6%) while 0 in control group. They included increased vascularity (12/16, 75.0%), spider like lesion (4/16, 25.0%), nonspecific colitis lesion (1/16, 6.3%). Rectal varices were observed in 2 patients (12.5%) but they were not observed in the controls. Pathologic finding in patients with increased vacularity showed dilatation and increase of vessels (5 of 6 patients), but there was no abnormal finding in patients with spider like lesion (0 of 3 patients). The colonic mucosal changes were not associated with the Child's grade of cirrhosis, the grade of esophageal varices, the presence of gastric varices, the history of bleeding or the patient's experience of ligation therapy. However, cirrhotic patients with portal hypertensive gastropathy had higher prevalence (70.6%) of colonic mucosal change than the patients without it (28.6%, p$lt;0.05). Conclusions: Colonic mucosal changes occur frequently in patients with portal hypertensive gastropathy. However, the prevalence of rectal varices is lower in these patients.
만성 간질환의 진행 정도 평가를 위한 비침습적 검사들의 상관관계와 임상적 의의
이재원,정진웅,이민호,박근태,김진배,전대원,함준수,유영조,박경남,윤병철,최호순,최춘식 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6
Background/Aims: We aimed to figure out a correlation of non-invasive tests for the diagnosis o chronic active hepatitis (CAH) or liver cirrhosis (LC). Methods: We measured the levels of serum albumin, bilirubin, alanine aminotransferase (ALT), asparate aminotransferase (AST), cholesterol prothrombin time, ICG-Rmax and shunt index (heart/liver ratio) in 174 patients with CAH and 80 patients with LC (Child A, 73 patients; Child B, 7 patients). A correlation of these values to evaluat the progression to liver cirrhosis was figured out from the multiple regression analysis. Results: There were significant differences between CAH patients and LC patients in the ratio of ALT to AST (ALT/AST, 1.45 ±0.05 vs 0.99 ±0.05), prothrombin time (93.9 ±1.2% vs 77.1 ±2.4%), ICG-Rmax (2.11 ±0.15 vs 1.07 ±0.12) and shunt index (0.21 ±0.00 vs 0.60 ±0.03). The multiple regression analysis of non-invasive tests yielded a formula, Y=3.3431 -0.8160 ×ALT/AST -0.0343 ×prothrom-bin time +2.6963 ×shunt index & p=ey/(ey+1)timate the progression of chronic liver disease. The p value was less than 0.7 in 126 (96.2%) of 131 CAH patients, while 47 (68.1%) o69 LC patients showed p value over 0.7. Conclusions: When the p value mentioned above exceed 0.7, CAH is likely to develop into an early LC. These results suggest that the formula inferred from the multiple regression analysis of non-invasive tests may be used to evaluate the progression of chronic liver disease without the repeat of liver biopsy.
한동수,이민호,최춘식,박근태,이오영,기춘석,박경남,정진웅,조윤주,박문승,손주현,윤병철,최호순,권오정,임현철 대한소화기학회 1998 대한소화기학회지 Vol.31 No.2
Intestinal malrotation is a rare disorder typically found in childhood. In adults it is an uncommon disease, and usually presents as bowel obstruction. Occasionally the clinical picture is confusing and the diagnosis of mahotation is not discovered until operation. Intestinal malrotation represents an arrest in the normal counterclockwise rotation of the cecum from the left lower quadrant to the right upper quadrant. The example is nondescent of the cecum, in which this structure remains in the subhepatic position. These are the diagnostic problems of differentiating between acute appendicitis and acute cholecystitis and the difficulty of appendectomy through a lower abdominal incision. In some patients, the cecum that cross the duodenum (Ladd's bands) is often fixed in an abnormal position by dense adhesion. In addition, the colon and the small intestine have a common mesentery with a lack of fixation to the lateral and posterior regions of the abdominal cavity. The usual mechanism of obstruction is adhesive compression of the duodenum and volvulus of the small intestine. Herein we experienced the case with intestinal malrotation associated with Ladd's bands with duodenal compression, presenting with acute abdominal pain and vomiting.
만성 B 형 간염 환자 간조직의 제 Ⅳ형 Collagen, Laminin, 및 Fibronectin 의 발현과 임상검사 성적과의 비교
이민호,박근태,김진배,황선호,최호순,함준수,기춘석,홍은경,박경남,윤병철,박문승,박문향 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6
Background/Aims: Hepatic fibrosis is caused by increased deposition of liver connective tissue components in the intercellular space. This leads to disturbance of intrahepatic blood flow and hind rance of exchange process between blood and cells. We investigated the deposition of extracellula matrix in the liver of patient with HBsAg positive chronic liver disease and the results were compared with those of other liver function tests. Methods: Needle-biopsied specimen was obtained from 31 patients with mild chronicactive hepatitis (CAH), 30 patients with moderate CAH, 19 pati ents with severe CAH, and 18 patients with cirrhosis. Immunohistochemical stains using antibodies were performed for type Ⅳcollagen, fibronectin and laminin. Results: Shunt index which could be measured with Thallium 201 scan was significantly increased according to the degree of stain for type Ⅳcollagen in portal area, especially in severe chronic active hepatitis and cirrhosis group. Pro thrombin time (%) and serum albumin we decreased according to the degree of stain for laminin in lobule. Conclusions: These results suggest that the deposit of type Ⅳcollagen in portal area i a major contributing factor in the development of intrahepatic shunt and the deposit of laminin within Disse' s space may cause impairment of the hepatic function in cirrhosis.