포스터 전시 : 만성 B형 간염과 mannose-binding lectin gene 유전자 다형성

임선교,정재연,황일란,홍소희,이기명,윤승규,유병무,함기백,김진홍,조성원 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

배경/목적: B형 간염 바이러스(HBV) 감염 후 자연 경과를 결정짓는 요인은 알려져 있지 않으나, 숙주의 면역 반응이 관련될 것으로 여겨지고 있다. Mannose-binding lectin (MBL)은 보체계 활성에 관여하는 단백으로 숙주의 면역반응에 중요한 역할을 한다. 본 연구는 B형 간염의 임상 경과와 MBL 유전자 다형성과의 상관성을 알아보고자 하였다. 대상과 방법: 2002년 3월부터 2002년 9월까지 아주대학교병원에 내원한 498명을 대상으로 MBL 유전자 codon 54 부위의 single nucleotide polymorphism (SNP)를 single nucleotide primer extension assay를 이용하여 측정하였고, SNP stream 25K기종을 이용한 전자동화 분석을 시행하였다. 대상 환자들은 간염 경과에 따라 4군으로 분류하였다. 1군; 바이러스 제거군 (n=126, HBsAg음성, Anti-HBc 및 Anti-HBs양성), 2군; HBeAg 음성 건강 보균자군 (n=58, HBsAg양성, HBeAg 음성, 혈청 transaminase 지속적 정상), 3군; 만성 간염 (n=239, HBsAg양성, 혈청 transaminase 정상 상한치 2배 이상 상승 병력), 4군; 간경변증 (n=75). 결과: (1) MBL 유전자 codon 54 부위의 genotype의 분포는 다음과 같다. 1군(바이러스 제거군); GG / GA / AA = 55.6% / 41.3% / 3.2%. 2군(HBeAg 음성 건강보균자군); GG / GA / AA=67.2% / 29.3% / 3.4%. 3군; GG / GA / AA=63.6% / 32.6% / 3.8%. 4군; GG / GA / AA=66.7% / 32.0% / 1.3%. (2) HBV 감염 후 바이러스 제거군(1군)과 만성화군(chronicity; 2군, 3군, 4군)에서 GG genotype 과 A-allele carrier(G/A, A/A)로 분류했을때 바이러스 제거군에서 55.6% / 44.4%, 만성화군에서 64.8% / 35.2%로 양군간에 차이를 보이지 않았다. (3) HBV 만성화군에서 건강보균자군(2군)과 간질환진행군(3군, 4군)을 비교하였을때 MBL 유전자 codon 54 부위의 genotype은 간질환 진행과 연관성이 없었다.(건강보균자군; GG: 67.2%, A-carrier:32.8%, 간질환진행군; GG:64.3%, A-carrier:35.7%)(p=0.166). 결론: MBL 유전자 codon 54 부위의 유전자 다형성은 HBV의 만성화나 간질환 진행과 무관하였다. 향후 만성 B형 간염과 MBL 유전자 다형성과의 관계의 정립을 위한 지속적인 연구가 필요하리라 생각된다.

Recent development of innovative resection methods for gastric neoplasms using hybrid natural orifice transluminal endoscopic surgery approach

임선교 소화기인터벤션의학회 2017 International journal of gastrointestinal interven Vol.6 No.3

There have been an evolutionary development with respect to the resection modality for the treatment of the gastric neoplasms such as gastric subepithelial tumors (SETs) or early gastric cancers (EGCs). Hybrid natural orifice transluminal endoscopic surgery (hybrid NOTES) played a central role in the process of development. In the earlier period, the non-exposure type hybrid NOTES such as laparoscopy and endoscopy cooperative surgery (LECS), endoscope-assisted wedge resection (EAWR), and laparoscopy-assisted endoscopic full-thickness resection (LAEFTR) has been introduced by several investigators. However, a concern about a spillage of gastric content including the tumor cells has been continuously raised among the clinicians. Accordingly, the non-exposure type hybrid NOTES such as combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), non-exposed endoscopic wall-inversion surgery (NEWS), and hybrid neo-endoscopic full-thickness resection (hybrid neo-EFTR) have been developed to the clinicians. Although most of studies about hybrid NOTES for the treatment of the gastric neoplasms have a small number of patients and require further validations, those are enough to receive our attention. Here, we describe and summarize the development process of the innovative resection methods for gastric neoplasms using hybrid NOTES approach.

구연 : 혈액종양 ; 골수이형성증후군의 임상상 및 치료성적에 대한 연구

임선교,이승원,예영민,신도현,박준성,최진혁,임호영,김효철 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

이중풍선 소장내시경으로 진단된 폐암의 공장 전이

임선교,신성재,고경현,최승준,최정우,이기명,김진홍 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.1

폐암의 소장 전이는 0.2∼0.5% 정도로 드물게 발견되며, 대부분 무증상이나 출혈, 복통, 장폐색, 천공 등 다양한 양상으로 관찰될 수 있다. 소장 출혈이 의심될 때 최근 개발된 캡슐내시경과 이중풍선 소장내시경(DBE)을 시행함으로써 이전의 검사들보다 진단율이 높아졌다. DBE는 고화질의 영상 및 조직검사로 좀더 명확한 진단이 가능할 뿐만 아니라 겸자공 크기가 2.8 mm인 치료용 내시경의 개발로 보다 다양한 치료 술기가 가능해졌다. 만약 18FDG-PET/CT에서 소장 전이가 의심되는 소견이 발견된다면 조직 진단을 위해 DBE를 고려해 볼 수 있다. 저자들은 폐암으로 진단 받은 39세 여자 환자가 혈변을 주소로 내원하여 DBE를 시행하여 비소세포성 폐암의 소장 전이를 진단한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Metastasis from lung cancer to the small bowel is rare and this accounts for 0.2% to 0.5% of all the cases of metastasis from lung cancer. In most cases, the patients are asymptomatic and they can show signs of bleeding, intestinal obstruction, perforation and so on. A better diagnostic approach to the small bowel has recently been made possible through capsule endoscopy and double balloon enteroscopy (DBE), and they have a higher diagnostic rate for small bowel bleeding compared with that of the previous diagnostic tests. DBE makes it possible to diagnose precisely due to the high quality endoscopic images and biopsy specimens. In addition, therapeutic DBE with a 2.8 mm channel enables performing more kinds of therapeutic procedures than diagnostic DBE with a 2.2 mm channel. If small bowel metastasis is suspected on 18FDG-PET/CT, then DBE can be considered for making a pathologic diagnosis. We report here on a case of small bowel metastasis from non small cell lung cancer in a 39-year-old woman who complained of hematochezia and we review the relevant literature.

Epigenetic change의 변화에 따른 발암 위험율 예측도

임선교,신도현,김종수,임태영,이기명,여말희,이지현,함기백,조성원,김진홍 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1

상부위장관에서 발생한 천공 또는 누공에 대한 내시경 치료법

임선교 대한상부위장관ㆍ헬리코박터학회 2024 Korean Journal of Helicobacter Upper Gastrointesti Vol.24 No.1

Perforations or fistulas in the gastrointestinal tract constitute serious emergencies and are associated with high morbidity and mortality rates. Such lesions, occurring in the esophagus, stomach, and duodenum, may arise from noniatrogenic causes (e.g., peptic ulcers, corrosive insults, trauma, malignant tumors) and iatrogenic causes (e.g., endoscopic procedures and surgeries). A prompt diagnosis and an appropriate management strategy are crucial for early recovery before secondary complications occur that may be induced by infection and/or chemical damage from gastric acid or bile. Various endoscopy-based treatment modalities have been developed and play pivotal roles in the management of upper gastrointestinal perforations and fistulas. Through-the-scope clips, self-expanding metallic stents, over-the-scope clips, endoscopic suturing devices, and endoscopic vacuum therapy have significantly improved the success rates associated with treating these types of lesions. However, choosing the optimal modalities that lead to good patient prognoses depends on the lesion characteristics, such as its size, duration, location, and surrounding tissue condition. Thus, gastrointestinal endoscopists have to regularly master and incorporate new endoscopy-based treatment approaches for these complicated conditions.

Recent development of innovative resection methods for gastric neoplasms using hybrid natural orifice transluminal endoscopic surgery approach

임선교 소화기인터벤션의학회 2017 Gastrointestinal Intervention Vol.6 No.3

There have been an evolutionary development with respect to the resection modality for the treatment of the gastric neoplasms such as gastric subepithelial tumors (SETs) or early gastric cancers (EGCs). Hybrid natural orifice transluminal endoscopic surgery (hybrid NOTES) played a central role in the process of development. In the earlier period, the non-exposure type hybrid NOTES such as laparoscopy and endoscopy cooperative surgery (LECS), endoscope-assisted wedge resection (EAWR), and laparoscopy-assisted endoscopic full-thickness resection (LAEFTR) has been introduced by several investigators. However, a concern about a spillage of gastric content including the tumor cells has been continuously raised among the clinicians. Accordingly, the non-exposure type hybrid NOTES such as combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), non-exposed endoscopic wall-inversion surgery (NEWS), and hybrid neo-endoscopic full-thickness resection (hybrid neo-EFTR) have been developed to the clinicians. Although most of studies about hybrid NOTES for the treatment of the gastric neoplasms have a small number of patients and require further validations, those are enough to receive our attention. Here, we describe and summarize the development process of the innovative resection methods for gastric neoplasms using hybrid NOTES approach.

폐출혈을 동반하지 않은 항사구체 기저막 항체질환

임선교 ( Sun Gyo Lim ),김정은 ( Jeong Eun Kim ),이종우 ( Jong Woo Lee ),이동훈 ( Dong Hun Lee ),임승관 ( Seung Kwan Lim ),박인휘 ( In Whee Park ),조현경 ( Hyeon Kyeong Cho ),김흥수 ( Heung Soo Kim ),신규택 ( Gyu Tae Shin ),임현이 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Anti-glomerular basement membrane antibody mediated rapidly progressiv glomerulonephritis is a rare autoimmune disease. It is characterized by acute renal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 ng/dL, Hb was 10.2 g/bL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & Ciq deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal : <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.

소화불량 환자의 진단 과정

임선교 ( Sun Gyo Lim ) 대한내과학회 2017 대한내과학회지 Vol.92 No.5

Nodular lymphoid hyperplasia of the stomach in a patient with multiple submucosal tumors

전자영,임선교,김장희,이기명,조성란,한재호 대한혈액학회 2013 Blood Research Vol.48 No.4

Nodular lymphoid hyperplasia of the stomach is a rare lymphoproliferative disorder. Here, we report a 38-year-old man who presented with multiple submucosal tumors of the stomach. Histologically, the lesions were characterized by multiple discrete submucosal nodules of lymphoid cells. The infiltrates between the lymphoid follicles were composed mainly of medium-sized lymphoid cells with abundant clear cytoplasm, as well as a few large cells with vesicular nuclei. The gastric mucosa exhibited multifocal lymphoid ag-gregates and some of the epithelial cells were infiltrated by small lymphocytes mimicking lymphoepithelial lesions. Histopathology was consistent with mucosa-associated lym-phoid tissue lymphoma. However, the infiltrating lymphoid cells were positive for CD2, CD3, CD5, and CD7. In addition, polymerase chain reaction analysis of the im-munoglobulin heavy chain and T-cell receptor gene rearrangements demonstrated polyclonality. This case was diagnosed as reactive lymphoid hyperplasia of the stomach.