만성 B형 간염 바이러스 감염자에서 YMDD 영역 자연 돌연변이

허정 ( Jeong Heo ),신영민 ( Young Min Shin ),김광하 ( Gwang Ha Kim ),주형준 ( Hyung Jun Chu ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),조몽 ( Mong Cho ),양웅석 ( Ung Suk Yang ),김철민 ( Cheol Min Kim ),장현정 ( Hyun Jung 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

<배경 및 목적> 만성 B형 간염 치료에 뉴크레오사이드 유사체인 라미부딘이 효과적인 항바이러스 제재로 널리 사용되고 있으나, 일정기간 투여 후 라미부딘에 내성을 가지는 B형 간염 바이러스 출현이 문제되고 있다. YMDD 영역 돌연변이가 라미부딘 투여로 인해 2차적으로 발생하는 것인지, B형 간염 바이러스는 역전사에 의해 복제 증식으로 돌연변이가 빈발하며 이것들 중 YMDD 영역 돌연변이가 라미부딘 투여로 적자생존에 의해 우점종이 되는 것인지 아직 분명치

십이지장 게실에서 저류된 캡슐 내시경

김시호 ( Si Ho Kim ),배상수 ( Sang Su Bae ),주형준 ( Hyung Jun Chu ),박지환 ( Ji Hwan Park ),경규천 ( Gyu Cheon Kyung ),안효동 ( Hyo Dong An ),김근 ( Keun Kim ),강은규 ( Eun Gyu Gang ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

Capsule endoscopy is being increasingly recognized as a gold standard for diagnosing small bowel disease, but along with the increased usage, capsule retention is being reported more frequently. We report a case of capsule endoscopy retention in a diverticulum of the duodenal proximal third portion, which we treated by esophagogastroduodenoscopy. A 69-year-old male visited hospital with hematochezia. He had hypertension and dyslipidemia for several years, and was taking aspirin to prevent heart disease. CT and colonoscopy revealed a diverticulum in the third portion of the duodenum, rectal polyps, and internal hemorrhoids. Capsule endoscopy was performed but capsule impaction occurred. The capsule was later detected by CT in the diverticulum. Endoscopy was performed a day later and the capsule was removed using a net. A small bowel series was conducted after capsule removal, and no stenosis was found. The patient fully recovered and no recurrence of hematochezia was observed at his one month exam. This is the first case in Korea of capsule retention in a duodenal diverticulum, with successful removal by endoscopy. (Korean J Gastroenterol 2016;67:207-211)

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)

후천성 면역 결핍증 환자 ( AIDS ) 의 혈액면역학적 특성과 기회감염에 대한 임상적 고찰

남태수(Tae Su Nam),서경수(Keung Su Seo),이경인(Kyong In Lee),김윤성(Yun Seong Kim),홍진희(Jin Hee Hong),김광하(Gwang Ha Kim),정준훈(Joon Hoon Jeong),주형준(Hyung Jun Chu),박승근(Seung Keun Park),성낙현(Nak Hean Seoung),정주섭(Ju Sup 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A The number of persons with HIV infection in Korea have increased steadily, total number of HIV infection in Korea were 478 on August, 1995. To investigate the clinicoimmunologic manifestation of AIDS in Korea, we reviewed complete blood counts (CBC), CD4 counts, serum β2-microglobulin level, opportunistic infections and cause of death for 19 AIDS patients who had been admitted or visited at Pusan national university hospital during the period of January, 1990 to August, 1995. 1) The predominant mode of HIV transmission was heterosexual contact(18), other modes of transmission were homosexual contact(1). Clues of diagnosis of HIV infection were routine occupational health examination(14), and opportunistic infection symptoms such as fever, coughing(4). 2) Mean CD4 cell counts(/mm3) were 53±72 totally, 22±27 for 8 dead patients at mean 2 month before, 91±87 for 7 living patients. There were not significant difference(p>0.05). 3) Serum β2-microglobulin(MG;ug/ml) was measured at 12 patients, mean serum β2-MG level was4.8±7.3 totally, 7.1±10.3 for 6 dead patients at mean 1.3 month before, 2.5±0.4 for 6 living patients. There were not significant(p>0.05). 4) At CBC examination, WBC(/mm3) was 5,932±2,899 totally, 5,452±3,436 for 10 dead patients, 6,500 ±2,221 for 9 living patients(p>0.05). Hb(g/dl) was 11,4±2.8 totally, 9.4±1.8 for dead patients, 13.6±1.8 for living patients(p<0.05). Lymphocyte count(/mm) was 1,255±800 totally, 731±424 for dead patients, 1,838716 for living patients(p<0.05). ESR(mm/h) was 72±47 totally, 97±33 for dead patients, 47±47 for living patients(p<0.05). 5) Opportunistic infections had developed at 14 patients, candidiasis 7, pneumocystis carinii pneumonia 5, tuberculosis 3, cytomegalovirus infection 2, herpes zoster 3, toxoplasmosis 1, cryptococcal infection 2, bacterial pneumonia 5, and herpes simplex l. Malignant lymphoma had developed in 1 patient. 6) Mean survival interval from diagnosis of HIV infection to death was 32.8±19.1 months, and the most common cause of death was pneumocystis carinii pneumonia, and other causes of death were meningitis, bacterial pneumonia and AIDS-wasting syndrome. Based on these results, We concluded that CD4 counts, serum β2-microglobulin level, Hb, total lymphocyte count and ESR in AIDS patients are specific laboratory markers of progression and prognosis of AIDS, the most common opportunistic infection was candidiasis, and the most common cause of death in AIDS patients was pneumocystis carinii pneumonia.

사례보고 : 위의 간세포양 샘암종의 간전이 1예

정은형 ( Eun Hyoung Jeong ),김동현 ( Dong Hyun Kim ),마성호 ( Sung Ho Ma ),정의종 ( Eui Jong Chung ),배상수 ( Sang Su Bae ),박아영 ( A Young Park ),주형준 ( Hyung Jun Chu ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.2

기능성 소화불량증과 기능성 변비를 동시에 호소하는 환자에서 주석산 시사프리드의 증상 개선 효과 및 안전성

양웅석(Ung Suk Yang),조중현(Joong Hyean Cho),구자영(Ja Young Koo),이광웅(Kwang Ung Ri),조성락(Seoung Rak Cho),한상영(Sang Young Han),박희욱(Hee Ug Park),송근암(Geun Am Song),주형준(Hyung Jun Chu),김도하(Do Ha Kim),이준상(Joon Sang Le 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.1

N/A Backgrounds/Aims: This study was performed prospectively to evaluate the short - term effect of cisapride tartrate on the frequency and the degree of symptoms in patients with functional dyspepsia and functional constipation. Methods: One-hundred thirty-two patients with a mean age of 44.7 years in men and 43.1 years in women, who presented with symptoms of both functional dyspepsia and functional constipation were recruited, and the frequency and the degree of symptoms corresponding to functional dyspepsia and functional constipation were assessed by an interview in 10 hospitals respectively. In an open, multicenter trial, 132 patients received 10 mg of cisapride tartrate three times a day (TID) for 8 weeks. Patients wrote a defecation diary for 8 weeks and checked symptom scores, which represented the degree of symptoms of dyspepsia and constipation, at the 4th and 8th week. Results: The frequently reported symptoms of functional dyspepsia were epigastric fullness (2.34 0.80), bloating (2.05 0.82), early saety (1.67 0.99), anorexia (1.04 0.95) and nausea (0.94 0.93). The mean defecation frequency per week was 3.07 2.35 and patients showed subjective symptom scores as follows; 97.0 25.26 % in the rate of sense of incomplete evacuation, 1.85 0.73 in the hardness of stool and 1.62 0.57 in difficulty to pass stool. After adminstration of cisapride tartrate in the case of functional dyspepsia, 66.1% of patients at the 4th week and 81.5 % of patients at the 8th week showed good or excellent improvements. In the case of functional constipation, 82.7%of patients also showed good or excellent improvements. Overall improvements of symptoms in both functional dyspepsia and functional constipation were 78.2% at the 8th week. Conclusion: Cisapride tartrate reduced the frequency and the degree of symptoms in functional dyspepsia and functional constipation without significant adverse effects.(Korean Journal of Gastrointestinal Motility 2001;7:36-46)

대장결핵의 내시경적 고찰

김주호,양웅석,송근암,조몽,주형준,고원욱,옥창민,박승근,나산균 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.

내시경적 점막절제술로 치유된 조기 잔위암 1 예

김정훈,이창익,주형준,이진관,허충,조삼권,황만근 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.6

아르곤 플라스마 응고소작술 (argon plasma coagulation)로 치료한 위전정부 혈관확장증 (gastric antral vascular ectasia) 1예

배용목,정을조,허정,김광하,주형준,강대환,조몽,양웅석,이창훈 대한내과학회 2002 대한내과학회지 Vol.63 No.1

Gastric antral vascular ectasia (GAVE) is a rare but important cause of chronic gastrointestinal bleeding. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Many treatment modalities of the gastric antral vascular ectasia exist. One of them, the argon plasma coagulation (APC) is an excellent therapeutic tool. Inactive argon gas is converted to ionized form by means of electrical energy. Ionized argon plasma conducts high frequency electrical energy to tissues and leads coagulation necrosis of tissues. We experienced a case of gastric antral vascular ectasia presenting melena for about one month in a 72-year-old man treated endoscopically in four sessions with argon plasma coagulation.

만성 바이러스 간염 환자에서 간조직 내 아연의 농도

이재승,강대환,문지현,송근암,조몽,양응석,주형준,서경덕,김정렬 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2

Background and Aims - Zinc is an essential, mostly intracellular, trace element which participates in many oxidative or deoxidative reactions and in a protective action on liver cell activity. Plasma zinc levels are known to decrease in patients with liver disease including chronic viral hepatitis. The aim of this study was to reveal whether hepatic zinc concentrations have a correlation with grades of necroinflammation or stages of fibrosis in the patients with chronic viral hepatitis. Methods - This study consisted of 50 subjects (43 chronic hepatitis B, 4 chronic hapatitis C, and 3 cirrhosis). Each specimen of liver tissue was classified with the grade of lobular inflammation, portal/periportal inflammation, and stage of fibrosis according to Scheuer`s method. Hepatic zinc concentration was determined by ICP-Atomic Emission Spectrometry. Results: The mean hepatic zinc concentration in the 50 chronic viral hepatitis patients was 233.66㎍/g dry weight of liver tissue. The hepatic zinc levels were significanty correlated with the grades of portal/periportal inflammation (rs=-0.385, p=0.006), and grades of lobular inflammation(rs=-0.342, p=0.015). The stages of fibrosis were also negatively related (rs=-0.423, p=0.002). The zinc concentrations differed significantly among grades of lobular inflammation (p=0.013) and among stages of fibrosis (p=0.044). Conclusions- Hepatic zinc concentrations showed negative correlation with grades of portal/periportal inflammation, lobular inflammation, and stage of fibrosis in the patients of chronic viral hepatitis. These results suggest that decreased hepatic zinc concentration might be associated with severe hepatic injury and reflect decreased protective activity on liver cell injury.(Korean J Hepatol 2001;7:147-152)