성인에서 발생한 지방성 폐렴의 임상적 고찰

현재근 ( Jae Geun Hyun ),이종헌 ( Chong H. Rhee ) 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6

한국 성인에서 발생한 자가면역성 간염의 임상적 고찰

현재근 ( Jae Geun Hyun ),백승운 ( Seung Woon Paik ),이준혁 ( Joon Hyoek Lee ),고광철 ( Kwang Cheol Koh ),김지은 ( Jee Eun Kim ),최문석 ( Moon Seok Choi ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae Jun Kim ),이종철 ( Jong Chul Rhee 대한소화기학회 1999 대한소화기학회지 Vol.33 No.5

Background/Aims: Although autoimmune hepatitis (AIH) is common in western countries, only sporadic cases have been reported in Korea. The aims of the study were to analyze the clinical and histological features and to examine clinical course of AIH in Korea. Methods: One-hundred and ninety-seven patients with chronic liver disease of unknown etiology were screened with anti-nuclear antibody (ANA) and anti-smooth muscle antibody (SMA). Fourteen (7.1%) patients had either antibodies and only 11 (5.6%) of them met the criteria suggested by the International Autoimmune Hepatitis Group as definite or probable. The clinical, laboratory and histologic features of these eleven cases were reviewed. Results: The mean age was 53.5 (31 -73) years and all of the patient were female. The level of globulin and IgG were elevated in 63.6% and 75% of the patients respectively. ANA and SMA were positive in 54.5% and 72.7% of the patients, respectively. Eigh (72.7%) of the patients showed severe inflammation in liver biopsy. Among 8 patients who received immunosuppressive therapy, seven patients (87.5%) showed initial response, and biochemical and serologic remissions were achieved in 5 (62.5%) and 2 (25.0%) patients, respectively. Conclusions: AIH seems to be partly responsible for chronic liver disease of unknown etiology in Korea. AIH should be suspected in female patients with chronic liver disease of unknown etiology, especially in case of hypergammaglobulinemia. (Kor J Gastroenterol 1999;33:653 - 661)

Helicobacter pylori 양성 소화성 궤양 환자에서 구연산 라니티딘 비스무스 제제 4주일 투여를 기본으로 한 삼제 병합요법의 효능에 관한 전향적 연구

박동일(Dong Il Park),김재준(Jae Jun Kim),임윤정(Yun Jeong Lim),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),김영호(Young Ho Kim),손희정(Hee Jung Son),이풍렬(Poong Lyul Rhee),백승운(Seung Woon Paik),이종철(Jong Chul 대한소화기학회 2000 대한소화기학회지 Vol.36 No.4

Background/Aims : We performed this study to assess the safety and efficacy of 1-week or 2-week course of triple therapy based on 4 week administration of ranitidine bismuth citrate (RBC) in eradicating Helicobacter pylori (H. pylori) infection. Methods : Fifty patients with gastric or duodenal ulcer were confirmed of having H. pylori infection. They were prospectively randomized to receive one of the following regimens: RBC 400 mg (4 weeks), amoxicillin 1g (1 week), clarithromycin 500 mg (1 week) twice daily or RBC 400 mg (4 weeks), amoxicillin 1g (2 weeks), clarithromycin 500 mg (2 weeks) twice daily. Histology and CLO test were performed to identify H. pylori positivity before randomization. Four weeks after completing the antibiotic therapy, the 13C-urea breath test (UBT) was performed to detect H. pylori in all cases. Results : Of the 25 patients of 1-week treated group, 19 patients underwent 13C-UBT. The eradication rate on per protocol analysis was 100% (19/19), and the eradication rate on intention-to-treat analysis was 76% (19/25). Out of the 25 patients of 2 week-treated group, 17 patients underwent 13C-UBT. The eradication rates on per protocol analysis and intention-to treat analysis were 100% (17/17) and 68% (17/25). There was no difference in H. pylori eradication rate between the two groups. Conclusions: One-week course of triple therapy based on 4-week administration of RBC was well tolerated and effective in eradicating H. pylori infection. (Kor J Gastroenterol 2000;36:465 - 472)

혈관침범이 의심되는 췌장암 환자에서 절제 가능성과 생존율 분석

박동일(Dong Il Park),이종균(Jong Kyun Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),이규택(Kyu Taek Lee),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),최규완(Kyoo 대한내과학회 2000 대한내과학회지 Vol.58 No.6

Background : One of the major limitations of curative resection in pancreatic cancer patients is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were (1) to assess the clinical value of contrast enhanced spiral CT in predicting the resectability and survival of pancreatic cancer patients with suspicious vascular invasion and (2) to assess the influence of curative resection on survival in these patients.Methods : Forty cases of the pancreatic cancer patients who were suspected of having involvement of adjacent large vessels and subsequently underwent operation with curative intent were enrolled in this study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, type and number of vessel involved. Survival rate was compared between curative and palliative resection groups. And survival was also compared between resected and non-resected groups. Results : Of the 40 patients with adenocarcinoma of the pancreas, 14 patients had curative resections, and 26 patients had palliative resections. The probability of curative resection was higher in patients with segment length less than 2 cm, compared with those with more than 2 cm. However, there was no difference in survival between two groups. There were no differences of resectability and survival according to the degree of encasement, type and number of vessel involved. There were no difference in survival between curative and palliative resection groups, and between resected and non-resected groups. Conclusion : A survival benefit is not achieved by curative resection in pancreatic cancer patients with vascular invasion. So other non-operative treatments should be considered as effective tools prior to resection in these patients.(Korean J Med 58:651-656, 2000)

기능성 소화불량증 환자에서 자율신경 기능 이상과 위배출시간의 연관성

김지은(Ji Eun Kim),이풍렬(Poong Ryul Lee),박동일(Dong Il Park),현재근(Jae Geun Hyun),김영호(Young Ho Kim),심상군(Sang Goon Shim),백승운(Seung Woon Baek),이종철(Jong Chul Lee),최규완(Gyu Wan Choi),김창섭(Chang Sub Kim),성인경(In Gyung 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Background/Aims: Autonomic nerve dysfunction may be responsible for the pathophysiologic mechanisms of various functional gastrointestinal disorders including functional dyspepsia. We evaluated whether the autonomic nerve dysfunction is related with delayed gastric emptying time. Methods: Forty patients (M:F=11:29, mean age=42.9 years) with functional dyspepsia and 14 asymptomatic controls (M: F=6:8, mean age=41.9 years) were enrolled in this study. Autonomic nerve function was measured by a standardized battery of five cardiovascular reflex tests. Gastric emptying time of solid meal was measured by scintigraphic method and expressed as the retention rate at 120 minutes (RR120). Results: RR120 was greater in the patients group than in the controls (48.1±19.7% vs 28.3±14.1%). Definite, severe, and atypical abnormal autonomic nerve functions were observed in 45% (18/40) of the patients group but not in the controls. The controls showed normal or early abnormality (5/14). Autonomic nerve dysfunction was not related to delayed gastric emptying (p=0.42) and there was no significant correlation between the autonomic score and RR120 (p=0.55). Conclusions: Patients with functional dyspepsia had significant autonomic nerve dysfunction, as compared to asymptomatic controls. However, autonomic nerve dysfunction was not related with delayed gastric emptying time.

크론병의 임상적 고찰

류민규(Min Kyu Ryu),김영호(Young Ho Kim),현재근(Jae Geun Hyun),문원(Won Moon),이경수(Kyung Su Lee),이상수(Sang Soo Lee),이준행(Jun Haeng Lee),손희정(Hee Jung Son),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백 대한내과학회 2001 대한내과학회지 Vol.60 No.1

Backgound : Crohn's disease (CD) is a chronic inflammatory disease that has difficulty in treatment due to various complications and frequent recurrence. There have been many studies on the clinical aspects of CD in western countries, however there have been few studies in Korea. We try to perform this study to elucidate the clinical features of CD in Korea. Methods : We retrospectively reviewed the medical records of 62 patients diagnosed as CD in Samsung Medical Center from October 1994 to July 1999 and investigated their clinical features. Results : Male to female ratio was 1.7:1 and the mean age at diagnosis was 29.6 years. The most common symptom was abdominal pain (58%), followed by diarrhea. Perianal lesions were observed in 27 cases (44%) of 62 patients. Fistula was the most common (60%) among the perianal lesions, followed by abscess, fissure, and stricture. Extraintestinal manifestations were observed in 23 cases (37%) of 62 patients. Arthritis was the most common (44%), followed by oral, skin, and ocular lesions. All patients were classified into three groups on the basis of disease extent by the radiologic and endoscopic findings; combined type (66%), colitis alone (23%), and small bowel disease alone (11%). Empirical anti-tuberculous medications were administered to 28 cases (45%) of 62 patients before CD was diagnosed. The presenting features were classified into inflammatory (71%), fistulizing (14.5%), and fibrostenotic (14.5%) type. Operation was performed in 31 cases (50%) of 62 patients during clinical course. The causes of operation were fistulizing complication (48%), fibrostenotic obstruction (32%), and indefinite diagnosis (20%). Conclusion : We noticed little difference in the clinical features of CD in Korea compared to those of western countries. And, intestinal tuberculosis should be considered in differential diagnosis of CD in endemic areas of tuberculosis like Korea.(Korean J Med 60:46-50, 2001)

건강 검진자에서 역류성 식도염의 유병률 및 위험 인자에 대한 환자 -대조군 연구

전성국 ( Seong Gook Jeon ),이풍렬 ( Poong Lyul Rhee ),신명희 ( Myung Hee Shin ),현재근 ( Jae Geun Hyun ),이화영 ( Hwa Young Lee ),손정일 ( Chong Il Sohn ),김재준 ( Jae Jun Kim ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Pa 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Background/Aims: There were few epidemiological data on reflux esophagitis in Korea. The aim o this study was to estimate the prevalence and risk factors of reflux esophagitis in Korea. Methods We examined 8314 subjects (male 4,876, female 3,438, age: 18-83 year) visiting health promotion center for routine check-up including EGD. All of them were given a questionnaire about smoking alcohol consumption, exercise, diet habits, use of drugs and medical history. We estimated the prevalence of reflux esophagitis and performed a case-control study to evaluate the risk factors of reflux esophagitis. We recruited 200 cases with reflux esophagitis and 400 controls without reflux esophagitis on EGD. Results: The prevalence of reflux esophagitis was 3.73% in male and 0.81% in female. The age-adjusted prevalence was 3.19% in male and 1.66% in female. The prevalence in male was significantly higher than that in female (p<0.01). On the monovariate analysis, smoking and body mass index were significantly related with reflux esophagitis (p<0.05). On the multivariate analysis, smoking was a significant risk factor of reflux esophagitis (p<0.05). Conclusions: The prevalence of reflux esophagitis in subjects who had routine check-up was 3.73% in male and 0.81% in female. Smoking is suggested to be a significant risk factor of reflux esophagitis. (Kor J Gastroenterol 1998;32:701 - 708)

기능성 소화불량증 환자에서 자율신경 기능장애에 관한 연구

박동일(Dong Il Park),이풍렬(Poong Lyul Rhee),이용욱(Yong Wook Lee),김지은(Jee Eun Kim),현재근(Jae Geun Hyun),김창섭(Chang Sup Kim),장재권(Jae Kwon Jang),심상군(Sang Goon Shim),성인경(In Kyung Sung),김영호(Young Ho Kim),손희정(Hee Jun 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

Background/Aims : The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. Methods : Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. Results : (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. Conclusion: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.

간세포암의 파열로 인한 혈복강을 가진 환자의 임상 양상 및 생존 기간과 관련 있는 인자

김지은 ( Jee Eun Kim ),이준혁 ( Joon Hyoek Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),최문석 ( Moon Seok Choi ),현재근 ( Jae Geun Hyun ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae Jun Kim ),이종철 ( Jong Chul Rhee 대한소화기학회 1999 대한소화기학회지 Vol.33 No.3

Background/Aims: Hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening condition. This study was aimed to understand the clinical features of patients with ruptured HCC and to evaluate the prognostic factors influencing survival. Methods: Among 624 cases with HCC who visited the Samsung Medical Center from July, 1995 to June, 1997, 30 case (4.8%) were diagnosed as hemoperitoneum due to rupture of HCC. The clinical records and radio logic findings were reviewed retrospectively. Results: The median survival was 23 days (1-150) and the most common cause of death was liver failure (43.5%). The median survival of the patients trea ted by transarterial embolization (TAE) was significantly longer than that of the patients treated con servatively (97 vs. 10 days, p=0.03). In univariate analysis of factors influencing survival, the tumo size (p=0.04) and treatment modality (p=0.03) influenced the survival, whereas Child' s class, presence of portal vein invasion and type of tumor did not. In multivariate analysis, treatment modality wa the only significant factor which influenced the survival (p=0.01). Conclusions: The patients with rupture of HCC showed poor prognosis with median survival of only 23 days and the main cause of death was liver failure. TAE may prolong survival but further prospective studies are needed to prove its role. (Kor J Gastroenterol 1999;33:375 - 383)

국내에서 개발된 대장통과시간 측정용 방사선 비투과성 표지자의 유용성

김지은(Jee Eun Kim),이풍렬(Poong Lyul Rhee),김영호(Young Ho Kim),성인경(In Kyung Sung),박동일(Dong Il Park),현재근(Jae Geun Hyun),이준행(Jun Haeng Lee),손희정(Hee Jung Son),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woo 대한내과학회 2001 대한내과학회지 Vol.60 No.4

Background: Among various methods for measuring colon transit time, radio-opaque marker study is simple, reproducible and economical method. The commonly used marker, Sitzmarks? (Konsyl Pharmaceuticals Inc. Texas) had limitation in it s use due to expensiveness and difficulty in importation. We thought that the new domestic marker comparable to Sitzmarks is necessary and made a Kolomark (Korean colon marker )TM. The comparison of radio-opaqueness and the measurement of colon transit times by two markers were done. Methods: In two 1000 ml beakers, 350 ml of rice-gruel, sever al chicken-bones and ten rings of Sitzmarks? and KolomarkTM were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by Image and the value of pixels were obtained. These were repeated five times. Colon transit times were measured in 60 healthy persons stratified by age, 30 by Sitzmarks? and 30 by KolomarkTM. Results: The mean value of pixel of KolomarkTM was much lower than that of Sitzmarks?. The difference between background or beaker and KolomarkTM was much greater than that of Sitzmarks?. There was no significant difference between colon transit time studied by Sitzmarks? and KolomarkTM. Conclusion: KolomarkTM, a more radio-opaque and cheaper marker than Sitzmarks? will be applied usefully for measuring colon transit time.(Korean J Med 60: 337- 341, 2001)