내시경 점막하 박리술 시행 전 위선종과 점막암종에서 혈청 IL-6, VEGF, CRP의 예측인자로서의 중요성

장진석 ( Jin Seok Jang ),최석렬 ( Seok Reyol Choi ),한상영 ( Sang Young Han ),노명환 ( Myung Hwan Roh ),이종훈 ( Jong Hoon Lee ),이성욱 ( Sung Wook Lee ),정진숙 ( Jin Sook Jeung ),김민찬 ( Min Chan Kim ),손영기 ( Young Ki Son ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

Background/Aims: Endoscopic submucosal dissection (ESD) is commonly used for radical resection of gastric adenoma and mucosal cancer, but there is about 30% of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by ESD. The aim of this study was to clarify the clinical significance of IL-6, VEGF, CRP before ESD. Methods: We investigated the correlation between serum IL-6, VEGF, CRP level and discrepancy rate of gastric neoplastic lesions (10 low-grade dysplasias, 18 high-grade dysplasias, and 25 early gastic cancers). Results: Serum levels of IL-6 in gastric adenoma and mucosal cancer patients were significantly higher than in healthy controls (p<0.05). Especially, serum IL-6 level of high-grade dysplasia patient was significantly higher than low-grade dysplasia and mucosal cancer patients, and the positive rate, sensitivity, and negative predictive value of serum IL-6 levels were higher in high-grade dysplasia patient compared to low-grade dysplasia patient and mucosal cancer patient. Serum levels of VEGF in patients with gastric adenoma and mucosal cancer were significantly higher than healthy controls (p<0.01). Serum levels of CRP in patients with mucosal cancer were significantly higher than in the controls (p<0.05), and the positive rate, sensitivity, and positive predictive value of serum CRP levels were higher in high-grade dysplasia and mucosal cancer patients compared to low-grade dysplasia patient. Conclusions: Serum levels of IL-6, VEGF, and CRP in patients with gastric neoplastic lesions were significantly higher than healthy controls, especially, serum IL-6 level of high grade dysplasia patient was significantly higher than low-grade dysplasia and mucosal cancer patients. (Korean J Gastroenterol 2009;54:99-107)

내시경점막하박리법을 이용한 조기위암과 위선종의 치료

장진석 ( Jin Seok Jang ),이은주 ( Eun Joo Lee ),이성욱 ( Sung Wook Lee ),이종훈 ( Jong Hun Lee ),노명환 ( Myung Hwan Roh ),한상영 ( Sang Young Han ),최석렬 ( Seok Reyol Choi ),정진숙 ( Jin Sook Jeong ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.6

목적: 내시경점막하박리법(endoscopic submucosal dissection, ESD)은 큰 병소를 일괄절제할 수 있다는 장점이 있으나 시간이 오래 걸리고, 출혈과 천공과 같은 합병증의 발생률이 높다. 저자들은 위선종과 조기위암에서 ESD의 치료성적을 분석하여 ESD의 효율성과 안전성에 대해 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2005년 12월까지 동아대 학교병원에 입원하여 위선종 및 조기위암으로 진단되어 ESD을 받은 101명의 환자에서 총 101예의 병변을 대상으로 후향으로 조사하였다. 결과: 1) ESD가 시행된 병변의 평균 크기는 2.58 cm였다. 2) ESD군의 일괄절제율은 90.1%였으며, 이는 병변의 크기가 큰(≥3 cm) 경우에 유의하게 감소하였다. 3) 완전절제율은 83.2%로, 병변 크기에 따른 차이는 없었으나 저도형성이상과 고분화형조기위암에서 특히 완전 절제율이 높았다. 4) 출혈은 41.6%로 응급 수술이 필요할 만큼의 유의한 출혈은 없었고, 내시경 치료로 쉽게 지혈하였다. 5) 재발률은 2.0%였다. 결론: ESD법은 조기위암과 위선종의 치료법으로 효과적이고 비교적 안전한 방법으로 향후 장기적인 추적 관찰이 필요하다. Background/Aims: Endoscopic Submucosal Dissection (ESD) is a new endoscopic mucosal resection (EMR) technique which enables en bloc resection even in large and depressed lesions. The aims of this study were to assess the therapeutic efficacy and the safety of ESD in gastric adenoma and in early gastric cancer (EGC). Methods: We analyzed 101 lesions in 101 patients. ESD with insulated-tipped (IT) knife were performed in 52 adenomas and 49 EGCs from January 2003 to December 2005 in Dong-A University Hospital. Results: The mean size of the lesion was 2.58 cm (0.7-4.5 cm). En bloc resection rate was 90.1% which was influenced by size (p>0.05). Complete resection rate was 83.2% even in large or in malignant tumors (p>0.05). Bleeding after ESD occurred in 41.6%. Tumor recurrence rate was 2.0%. Conclusions: ESD with IT knife is effective for the treatment of EGC and gastric adenoma even in large or in malignant lesions without definite increased risk of complications. (Korean J Gastroenterol 2007;49:356-363)

복합 항암요법으로 성공적으로 치료한 동시성 식도암과 위선암

한지선 ( Ji Sun Han ),최석렬 ( Seok Reyol Choi ),장진석 ( Jin Seok Jang ),노명환 ( Myung Hwan Roh ),김대철 ( Dae Cheol Kim ),유승희 ( Seung Hee Ryu ),우수미 ( Su Mi Woo ),형건덕 ( Chien Ter Hsing ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2

Although cases of simultaneous esophagus and stomach cancer have been reported sporadically, there are rare reports of successful treatment using chemotherapy. We report a case of synchronous esophageal and gastric cancer successfully treated using docetaxel and cis-diammineedichloro-platinum (CDDP) combination chemotherapy instead of surgery. A 82-years-old man with anorexia and progressive weight loss was diagnosed with synchronous esophageal and gastric cancer by endoscopy. Both cancers were diagnosed as resectable by the preoperative clinical staging. However, surgery was contraindicated because of severe lung dysfunction. Moreover, he actively refused radiotherapy and endoscopic management. Therefore, the patient was given combined chemotherapy with docetaxel (65 mg/m2) and CDDP (60 mg/m2). The esophageal and gastric lesion completely disappeared on endoscopy, and there were no residual tumor cells on endoscopic biopsy after three cycles of chemotherapy. Metastatic lymph nodes also completely disappeared on the CT scan. The patient received a total of ten cycles of chemotherapy, without severe adverse effects. The patient remained asymptomatic for 18 months after discontinuation of the chemotherapy, without evidence of local recurrence or distant metastasis. Surgery or endoscopic treatment of both esophageal and gastric cancers is desirable, but, if medically inoperable, chemotherapy can be alternative treatment option. (Korean J Gastroenterol 2012;60:113-118)

악성화한 거대 위 융모종

장채령 ( Chae Ryeong Jang ),최석렬 ( Seok Reyol Choi ),조정환 ( Jeong Hwan Cho ),구영훈 ( Young Hun Koo ),한승호 ( Seung Ho Han ),유승훈 ( Seung Hoon Ryu ),이동현 ( Dong Hyun Lee ),장진석 ( Jin Seok Jang ),이종훈 ( Jong Hun Lee 대한소화기학회 2005 대한소화기학회지 Vol.45 No.6

Villous tumors of the stomach are somewhat rare with approximately 100 cases only reported in the literatures and have tendency to undergo malignant transformation as high as 72%. They are frequently multiple and associated with other gasrtrointestinal ne

증례 : 소화기 ; 위에 발생한 사구종양 3예

윤현아 ( Hyun Ah Yoon ),최석렬 ( Seok Reyol Choi ),이종훈 ( Jong Hun Lee ),장진석 ( Jin Seok Jang ),백양현 ( Yang Hyun Baek ),이정민 ( Jeong Min Lee ),김민식 ( Min Sik Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5

사구 종양은 사구체(glomus body)의 변형된 평활근 세포에서 유래하는 양성종양으로 일반적으로 사지 말단에서 발생하나, 위장관의 사구종양은 매우 드문 것으로 알려져 있다. 저자들은 건강 검진 시 우연히 발견된 위 상피하종양을 주소로 내원한 환자에서 내시경 초음파 검사 및 CT 검사 후 수술을 통해 조직학적으로 사구종양으로 확인된 세 증례를 경험하였다. 세 증례 모두 내시경 초음파에서 제 4층에서 국소적 고에코를 보이는 비균질성 저에코 병변이 관찰되었고, CT에서 강한 조영 증강 및 이러한 조영 증강이 지연기까지 지속되는 과혈관 종양의 특징적인 소견을 보였다. 이중 한 증례는 특징적으로 쿠션 양성 소견과 CT에서 석회화 소견을 보였다. 저자들은 세 증례에서 사구종양의 서로 다른 특성을 경험하였기에 보고하는 바이다. Glomus tumors originate in modified vascular smooth muscle cells and are most commonly found in the dermis or subcutis but are rarely observed in the stomach. We report three cases of patients who presented with incidental findings of subepithelial tumors in the stomach. One patient showed a positive cushion sign, and the others showed negative cushion signs. Endoscopic ultrasonography (EUS) demonstrated sharply demarcated hypoechoic tumors with internal hyperechoic spots in the fourth layer of the gastric wall and several hypoechoic halos around the tumors. Contrast-enhanced abdominal computerized tomography (CT) showed homogeneous high enhancement of tumors up to the delayed scan, and one case showed calcification in the tumor. For treatment, laparoscopic wedge resections were performed. Histological and immunochemical analysis of the tumor cells were compatible with glomus tumors. These characteristic findings in EUS and CT seem to be useful for the diagnosis of gastric glomus tumors.

증식성 위용종에 발생한 고분화 선암 1 예

지삼룡(Sam Ryong Jee),최석렬(Seok Reyol Choi),유승훈(Seung Hoon Ryu),박은희(Eun Hee Park),장진석(Jin Seok Jang),이종훈(Jong Hun Lee),한상영(Sang Young Han),신우원(Woo Won Shin) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.3

The hyperplastic gastric polyps comprise approximately 75% of all gastric epithelial polyps. However, coincidental gastric carcinoma has been rarely reported, being found in 1.5%-2.1% of patients with hyperplastic polyps. The size and the pathology of polyps seem to be important in the application of endoscopic removal. We present a 58-year-old female with well differentiated adenocarcinoma arising from a 1.0cm-sized hyperplastic polyp in the stomach. On the gastroscopic examination, five polyps were noted and their sizes ranged from 0.3cm to 1.0cm. She underwent the endoscopic polypectomy with snare or strip biopsy. Microscopically, focal cancerous change was observed in the largest one (1 cm size, Yamada’s type IV) on the greater curvature of the lower body. (Korean J Gastroenterol 2001;38:207-210)

위암 재발부위에 따른 종양표지자의 양성률

장진석,이성욱,이종훈,노명환,한상영,김민찬,정갑중,최석렬,Jang, Jin-Seok,Lee, Sung-Wook,Lee, Jong-Hun,Roh, Myung-Hwan,Han, Sang-Young,Kim, Min-Chan,Jeong, Gap-Jung,Choi, Seok-Reyol 대한위암학회 2005 대한위암학회지 Vol.5 No.4

목적: 위암과 관련하여 특이한 종양표지자가 없음에도 불구하고 위암의 재발과 관련하여 AFP, CEA, CA19-9등의 유용성에 대한 몇 가지 보고가 있었다. 하지만 이런 연구의 유용성에 대해서는 아직까지 논란의 여지가 있는 것이 사실인데 저자는 CEA, AFP, CA19-9 등 3 가지 종양표지자를 이용하여 단일검사, 병합검사의 양성률을 구하고, 특히 재발부위에 따른 특정 종양표지자의 양성률을 알아보았다. 대상 및 방법: 조직학적으로 위선 암으로 확진되어 근치적 절제술을 받은 환자로서 수술 전과 술 후에 CEA, CA19-9, AFP의 3가지 종양표지자의 검사가 추적 가능하였던 환자 중 재발한 환자 52명을 재발부위별로 종양표지자의 단일 및 병합양성률을 조사하였다. 혈 청 AFP, CEA, CA 19-9의 검사치가 각각 10 ng/ml, 5 ng/ml, 35 u/ml 이상일 때 양성으로 판정하였다. 추적 관찰 중 재발유무는 위내시경 및 생검, 전산화 단층촬영, 흉부 X선 촬영, 골주사 등으로 진단하였다. 결과: 재발된 환자 52명의 재발 당시의 종양표지자의 양성률은 AFP 31%, CEA 52%, CA 19-9 46%였다. 병합양성률은 AFP/CEA 67%, AFP/CA 19-9 60%, CEA/CA 19-9 73%이었다. 재발 시 병합검사의 양성율이 단일검사보다 유의하게 높았다. 재발부위에 따른 단일검사 양성률은 복막의 경우 CA 19-9가 79%, 간의 경우 CEA가 90%로 의미 있게 증가되었다. 결론: 술 전에 종양표지자가 상승된 경우에서는 재발율이 높았으며 재발부위와 관련하여 간의 경우 CEA,복막의 경우 CA 19-9가 의미 있는 양성률을 보였다. Purpose: There are several reports suggested the usefulness of serum tumor markers, AFP, CEA and CA19-9 as prognostic factors or indicators for recurrence in gastric cancer. This clinical study was peformed to evaluate positive rate of tumor markers according to site of recurrence in gastric cancer. Materials and Methods: From the database of patients who underwent radical gastrectomy for gastric cancer between January 1999 and January 2004, 52 patients who showed recurrence were included in this retrospective study. Serum levels of tumor markers were measured at the time of preoperative diagnosis of the gastric cancer and at the time of postoperative recurrence during follow up, respectively. Results: The overall positivity of tumor markers at the time of recurrence was found to be significantly higher than that of prior to surgery in the recurred group for the single test as well as the combination tests. For the peritoneum, the most common recurrent site, the positivity of CA19-9 was higher at the time of recurrence. And the significant positivity of CEA at the time of recurrence was detected in the liver cases. Conclusion: Having a preoperative positive tumor marker may identify the patient as having an increased chance of a recurrence. Although tumor markers continue to have limited diagnostic significance in gastric cancer, CA19-9 may be useful as a predictor for peritoneal recurrence of the gastric cancer, and CEA for recurrence to liver.

진성 혈소판증가증에 동반한 Budd - Chiari 증후군 1 예

서봉근(Bong Geun Seo),한상영(Sang Young Han),이종훈(Jong Hun Lee),장진석(Jin Seok Jang),이현수(Hyun Soo Lee),노명환(Myung Hwan Roh),최석렬(Seok Ryeol Choi),신우원(Woo Won Shin) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1

Budd-Chiari syndrome is an acute or subacute obstruction of hepatic venous outflow which causes post-sinusoidal portal hypertension, esophageal varix, and cirrhotic course. Its prognosis is usually poor. The cause and pathogenesis are unclear, but the primary cause is generally thought to be congenital. The main secondary causes are chronic myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, presence of lupus anticoagulant, protein C or protein S deficiency, hypercoagulability due to oral pills, tumor, trauma, and infection. It can be treated by shunt operation, balloon dilatation, stent insertion, or transjugular intrahepatic portosystemic shunt. We report one case of Budd-Chiari syndrome with essential thrombocythemia which has never been reported in Korea. (Korean J Gastroenterol 2002;39:64-67)

포스터 전시 : 위장관 ; Neostigmine을 이용해 치료한 급성 대장 가성폐쇄증 1예

김완수 ( Wan Su Kim ),한상영 ( Sang Yung Han ),배이지 ( Ea Sy Bae ),장진석 ( Se Jun Jang ),최석렬 ( Jin Seok Jang ),신우원 ( Seok Ryeol Choi ),이종훈 ( Woo Won Shin ),김광진 ( Jong Hun Lee ),( Kwang Jin Kim ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

급성 대장 가성폐쇄증은 어떤 기계적 폐색의 원인이 없이 대장이 급격히 확장하는 질환으로 1948년 Ogilvie에 의해 처음 보고되어 Ogilvie`s 증후군이라고 알려져 있기도 하다. 가장 위험한 합병증으로는 자발성 대장천공으로서 약 3%에서 발생하며 사망률은 50%까지 이른다. 이 증후군은 보존적 요법에 대부분 반응을 하나 때론 대장내시경하 감압술 및 수술이 필요하기도 하다. 최근 연구에서 acetylcholinesterase 억제제인 neostig

연구논문 : 공기방울 간농양에서 당뇨군과 비당뇨군의 비교

이창재 ( Chang Jae Lee ),한상영 ( Sang Young Han ),이성욱 ( Sung Wook Lee ),백양현 ( Yang Hyun Baek ),최석렬 ( Seok Reyol Choi ),노명환 ( Myung Hwan Roh ),이종훈 ( Jong Hoon Lee ),장진석 ( Jin Seok Jang ),한진 ( Jin Han ),조수현 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: Patients with diabetes mellitus (DM) are more likely to have a pyogenic liver abscess with gas formation, which is associated with higher morbidity and mortality. The morbidity and mortality in pyogenic liver abscess are also higher in DM patients than in non-DM patients. This study evaluated the morbidity, mortality, and clinical features in patients with gas-forming liver abscesses associated with DM. Methods: Among 379 cases of pyogenic liver abscess excluding malignancy from January 2001 through December 2009, 25 patients treated for pyogenic-gas-forming liver abscesses were reviewed retrospectively. We compared the morbidity, mortality, and clinical findings in patients with pyogenic-gas-forming liver abscesses between DM and non-DM patients. Results: Gas formation was present in 25 (6.6%) of 379 cases with pyogenic liver abscess. DM was combined with gas-forming liver abscesses in 19 cases (76%). The most common organism responsible for the gas formation was Klebsiella pneumoniae (82%). Complications were present in 23 cases (92%) of gas-forming liver abscesses, with pulmonary complications (especially pleural effusion) being the most common (n=14, 61%). Four patients (16%) died of sepsis. Conclusions: Gas-forming liver abscesses are not uncommon in cases of pyogenic liver abscesses and are associated with high morbidity and mortality rates. The clinical manifestations and complications do not differ significantly between DM and non-DM patients.