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한국인의 위궤양 및 십이지장궤양 환자에서 Helicobacter pylori 감염 빈도
장명국(Myoung Kuk Jang),김학양(Hak Yang Kim),조병동(Byung Dong Cho),장웅기(Woong Ki Jang),김동준(Dong Jun Kim),김용범(Yong Bum Kim),박충기(Choong Kee Park),신형식(Hyung Sik Shin),유재영(Jae Young You) 대한내과학회 1997 대한내과학회지 Vol.52 No.4
N/A Objectives: Peptic ulcer is the major condition that affect numerous individuals every year. In 1983, Warren and Marshall presented the evidence that H. pylori was associated with gastritis and peptic ulcer. Thereafter, K. pylori infection is thought to be a important factor in the pathogenesis of gastric and duodenal ulcer. In western studies, about 58% to 100% of patients with peptic ulcer disease were infected with H. pylori. But in Korea, there is no study about the prevalence of H. pylori infection in peptic ulcer disease despite of its high prevalence and importance. The aim of this study was to investigate the prevalence of H. pylori infection in case of gastric and duodenal ulcer disease in Korea. Methods - We surveyed the prevalence of H. pylori infection of 1031 patients, who were diagnosed as gastric or duodenal ulcer by gastrofiberoscopy. H. pylori infection was evaluated with Rapid Urease Test(CLO test) and/or histology by Wright-Giemsa staining. Results: 1) Peptic ulcer was more frequently developed in males than females, as the frequency of peptic ulcer was 77% in males, and 23% in females. But in view of the prevalence of H. pylori infection, there was no significant difference between males and females, 73% in males and 71% in females. 2) Gastric ulcer was most common in sixth decade(29.8%), but the prevalence of H. pylori infection was peak in fourth(76%), and fifth decade (73%). 3) Duodenal ulcer was most common in fourth decade(26.3%), but the prevalence of H. pylori infection was peak in teenagers(93%) and third decade(87%). 4) The patients who had both gastric ulcer and duodenal ulcer concurrently were most common in sixth decade(27.9%), but the prevalence of H, pylori infection was peak in third decade(100%). Conclusion: We concluded that the majority of peptic ulcer patients in Korea had H. pylori infection. Particularly, young aged patients had higher H. pylori infection rate than old aged.
최근 3년간 강원도 초·중·고등학생의 HBsAg 양성률 변화에 관한 연구
장명국(Jang Myoung Kuk),이자영(Ja Young Lee),이진헌(Jin Heon Lee),김용범(Yong Bum Kim),김학양(Hak Yang Kim),유재영(Jae Young Yoo) 대한내과학회 2000 대한내과학회지 Vol.58 No.6
N/A Background : Since 1983, vaccination for Hepatitis B virus(HBV) has been recommended for all neonates in Korea. Therefore, significant change of HBsAg positive rate is expected. The objective of this study is to investigate HBsAg positive rate of grade, junior high, and high schoolers in Kangwon Province.Methods : From 1997 to 1999, total 120,220 subjects, who were born in 1981 to 1992, were enrolled in this study. HBsAg and anti-HBs were tested by reversed passive hemagglutination and passive hemagglutination, respectively. If their results had been vague, we perfomed enzyme-linked immunosorbent assay for confirmation. Results : HBsAg positive rate of entire study group was 2.5%(3,045 out of 120,220). Those of schoolboys and schoolgirls were 2.6%(1,567 out of 60,076), 2.5%(1,478 out of 60,144), respectively. Significant statistical difference was not observed in comparison of HBsAg positive rate according to sex(p=0.09). HBsAg positive rate of grade schoolers was 1.4%(676 out of 48,871), which was significantly lower than that of junior high(3.2%, 557 out of 17,577) and high-schoolers(3.4%, 1,812 out of 53,772)(p<0.01). From 1997 to 1999, HBsAg positive rate has significantly decreased from 2.8%(1,434 out of 50,434) to 1.9%(407 out of 20,991)(p<0.01). HBeAg positive rate of HBsAg positive subjects was 62.9%(1,000 out of 1,590). Conclusion : HBsAg positive rate of grade-schoolers in Kangwon province Korea, tended to be lower than that of junior high, or high-schoolers, and is also thought to be lower than that of the past, which was caused by nationwide vaccination programme.(Korean J Med 58:608-615, 2000)
폐렴의 진단에서 정량적 기관지폐포 세척액 배양의 유용성
한태호(Tae Ho Hahn),장명국(Myoung Kuk Jang),김성균(Seong Gyun Kim),이자영(Ja Young Lee),이재명(Jae Myung Lee),김동규(Dong Kyu Kim),최정은(Jeong Eun Choi),모은경(Eun Kyung Mo),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Background: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage (BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. Methods: Study group consisted of 30 epiaodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count (≥11,000/mm³) 3) Fever (≥38.3ºC) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms (ICO). Quantitative culture of BAL fluid was considered positive if colony forming units was more than 1.0×10(4)/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes, Result: Recruited were 22 males and 6 females. The mean age was 57.5±13.5 years (range 25-84), Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia, S. aureus (7 cases) was the most common causative agent and was followed by P. aeruginosa (4), E. cloacae (2), A baumanii (1), H. influenzae (1) and a-hemolytic Streptococcus (1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases (31%) and ICO over 5% in 3 cases (15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2% (16/19). Conclusion: Quantitative culture of BAL fluid was sensive and specific compared to sputum and b1ood culture for the diagnosis of bacterial pneumonia, It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.
HBeAg 양성 만성 B형 간염에 대한 인터페론 치료의 장기 추적관찰 -원발성 간세포암 발생률을 중심으로-
최대로 ( Dae Ro Choi ),장명국 ( Myoung Kuk Jang ),문한국 ( Han Kook Moon ),김성만 ( Seong Man Kim ),이준호 ( Jun Ho Lee ),이자영 ( Ja Young Lee ),김경호 ( Kyung Ho Kim ),박준용 ( Joon Yong Park ),이진헌 ( Jin Heon Lee ),김학양 ( H 대한내과학회 2005 대한내과학회지 Vol.69 No.2
목적 : 만성 B형 간염환자에서 인터페론 알파 치료가 간염의 진행과 생존에 미치는 장기적 영향에 대한 자료는 부족하다. 저자들은 HBeAg 양성 만성 B형 간염 환자에서 인터페론 알파 치료가 환자의 임상적 결과와 생존에 영향을 미치는 인자들에 대해 평가하기 위하여 본 연구를 시행하였다. 방법 : 1988년 1월부터 2000년 12월까지 한림대학교 강동성심병원에서 생화학, 혈청학, 영상검사 및 간 조직 생검으로 확진된 HBeAg 양성, 만성 B형 간염환자 중에서 인터페론 치료를 받은 98명의 환자를 대상으로 하였다. 인터페론 투여 종료 후 1년 이내에 HBeAg이 최소 2회 이상 연속으로 소실된 경우를 지속적 반응군으로 정의하였다. 직접 환자와 전화하거나 환자의 의무기록을 검토하여 자료를 확인하였으며, 치료 후 추적 조사가 되지 않는 환자들은 한국중앙암등록본부의 데이터베이스의 자료를 이용하여 확인하였다. Kaplan-Meier 방법을 이용하여 누적 생존율 및 간세포암의 누적 발생률을 확인하였다. 결과 : 대상 환자는 남자 78명, 여자 20명이었고, 평균연령은 32.4±10.7세였으며, 평균 추적기간은 92.0±45개월이었다. 총 98명의 환자 중 38명(39%)에서 초기 반응을 보였으나, 12명에서 재발하여 지속적 반응을 보인 경우는 26명(27%)이었다. 6명(6%)에서 간세포암 발생이 확인되었으며, 연령(39세 이상)이 높은 군에서 유의하게 간세포암 발생률이 높았다(p<0.001). 간부전, 정맥류 출혈 등 간 질환과 관련된 사망은 9명(9.2%)이었으며 양군간 생존율에는 유의한 차이가 없었다. 결론 : HBeAg 양성인 만성 B형 간염을 인터페론으로 치료했을 때, 지속적인 반응이 유지되는 환자군에서 생존기간이 연장되고, 간세포암 발생이 감소하는 경향을 보였으나 통계학적인 유의성은 없었다. 그러나 인터페론 치료 시작 당시의 나이가 많은(39세 이상) 환자군에서 간세포암 발생 위험이 높은 것을 확인하였다. 향후 인터페론 반응군에서 통계학적으로 유의한 생존기간 향상 및 간세포암 발생률 감소를 확인하기 위해서는 더 많은 환자군에서 장기간의 추적 연구가 필요할 것으로 생각된다. Background : Data on the long-term effects of interferon alpha (IFN) treatment on disease progression and mortality in patients with chronic hepatitis B (CHB) are limited. To evaluate factors that influence clinical outcome and survival, we performed a follow-up study on hepatitis B e antigen (HBeAg) positive CHB patients treated with IFN. Methods : A total of 98 patients with biopsy-proven HBeAg-positive CHB were treated with IFN- between 1988 and 2000 and followed. Data were collected by review of medical record, direct contact, or using database from Korea Central Cancer Registry. Sustained response (SR) to treatment was defined as HBeAg loss within 12 months after the end of IFN therapy and maintenance of HBeAg negativity for at least 3 years. We tried to find the factors associated with SR, hepatocellular carcinoma (HCC) incidence and survival. We also compared the cumulative rate of HCC and survival between SR group and non-sustained response (NSR)/nonresponder group. Results : The mean IFN dose was 375±205 mega units. Mean follow-up was 92.0 months (SD 45 months). Twenty-six patients (27%) had sustained response to IFN treatment, although transient response was seen in 39% (38 out of 98 patients). Nine patients died of liver-related causes (hepatic failure, variceal bleeding) during follow-up. There were no significant differences of clinical outcomes such as survival and HCC incidence between responders and nonresponders (p=0.18, p=0.10, respectively). However, HCC developed in 6 patients, all of whom were nonresponders with an age older than 39 years. Conclusion : Age of 39 years and above at the time of IFN treatment might increase the risk of developing HCC. Therefore, interferon should be applied at the younger age to prevent HCC in patients with HBeAg-positive CHB.(Korean J Med 69:150-156, 2005)
충수 돌기의 점액낭종으로 야기된 충수 돌기형 장중첩증 1예
김희선 ( Hee Seon Kim ),장명국 ( Myoung Kuk Jang ),문한국 ( Han Kook Moon ),장지선 ( Ji Sun Jang ),김형수 ( Hyung Soo Kim ),조성진 ( Seong Jin Cho ),김학양 ( Hak Yang Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4
저자들은 22세 여자 환자에서 발생한 충수돌기의 양성 점액성 낭종에 의한 장중첩증을 경험하고, 이를 충수돌기 절제술만으로 치료하였다. 이를 문헌 고찰과 함께 보고한다. Intussusception of the appendix is not only extremely rare but also presents with symptoms similar to appendicitis. Therefore, preoperative diagnosis is unusual. On the other hand, appendiceal mucocele refers to obstructive dilatation of the appendiceal lumen caused by mucus. It has been reported in 0.2~0.3% of appendectomy specimens. A 22-year-old woman visited the Emergency Department because of right lower abdominal tenderness with hematochezia. Abdominal CT scan revealed a target sign in the right lower quadrant area that was suggestive of intussusception. The patient underwent emergency surgical reduction of the intussusception and appendectomy. The pathology showed an appendiceal mucocele. (Korean J Med 75:449-452, 2008)
조병동(Byung Dong Cho),오흥국(Heung Kuk Oh),장명국(Myoung Kuk Jang),경태영(Tae Young Kyong),이종민(Jong Min Lee),김용범(Yong Bum Kim),김학양(Hak Yang Kim),박충기(Choong Kee Park),유재영(Jae Young Yoo) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2
N/A Background/Aims: Extrahepatic bile duct(EHBD) carcinoma is a rare tumor among the population of the world and accounts for less than 2% of cancers found at autopsy and about 10% of all biliary duct cancer. To identify the clinical characteristics associated with prognosis and the survival rate by treatment modalities, we reviewed 120 patients with extrahepatic bile duct carcinoma who were diagnosed at the Kangdong Sacred Heart Hospital of Hallym University from June 1987 to October l994. Methods: According to treatment modalities, these patients were divided into 50 cases of the operation group, 47 cases of the non-operative treatrnent group and 23 cases of the no treatment group. The survival rate of these three groups was analyzed according to Cutler-Ederer methods. Results: The most common symptom and sign were jaundice(85.8%) and hepatomegaly (57.5%). The most common site of tumor was the common hile duct(63.3%), followed by the hepatic duct bifurcation(25.8%), the common hepatic duct(9.2%), the cystic duct(0.8%) and tbe diffuse type(0.8%). The median survival was l0.7 months. The survival rate was 76.7% in 3 months, 68.4% in 6 months, 4l.6% in l year, 14.1% in 2 years, and 3.4% in 5 years. According to the treatment modalities, the median survival was l6.3 months in the operation group, 6.3 months in the non-operative treatment group, and 3.5 rnonths in no treatment group. Conclusions: The operation group had a better survival rate than the other group. We conclude that operation offers the best prognosis. The result of this study suggests that early diagnosis and operation prolong survival in these patients. Further studies of adjuvant chernotberapy and radiotapy wi]l be necessary to improve patients survival. (Korean J Gastroenterol 1996; 28:25] 259)