조기 위암에서 근위부 위절제술과 위 전절제술의 비교

김은미 ( Eun Mi Kim ),정현용 ( Hyun Yong Jeong ),이엄석 ( Eom Seok Lee ),문희석 ( Hee Seok Moon ),성재규 ( Jae Kyu Sung ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),노승무 ( Seung Moo Noh ),송규상 ( Kyung Sang Song ),신경 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Background/Aims: The purpose of this study was to evaluate clinical outcome of proximal and total gastrectomy regarding reflux esophagitis, nutritional state, and anemia in early gastric cancer. Methods: 94 patients with early gastric cancer were included from January 2001 to January 2007 at Chungnam National University Hospital. Of whom 40 patients (31 men and 9 woman) had proximal gastrectomy (PG) and 54 patients (44 men and 10 woman) had total gastrectomy (TG). We reviewed all their medical and surgical record with surveying for gastrointestinal symptoms and reflux symptoms over the phone. Results: There were no significant differences between basic, surgical, and histopathologic characteristics. Bile reflux symptoms and heart burn symptoms were more common and severe in the TG group. The incidences of endoscopically detected reflux esophagitis were about 60% in the TG group and about 30% in the PG group. The hemoglobin levels were significantly higher in the PG group after the operation and were gradually decreased in the TG as the time went. The levels of laboratory variables such as total protein, albumin, and total cholesterol were lower in the TG group than in the PG group after the operation. However, stoma stricture after operation developed in the PG group more often than in the TG group, and esophageal balloon dilatations were performed more frequently in the PG group. Conclusions: PG is favorable for proximal early gastric cancer in terms of reduced reflux esophagitis, anemia, and malnutrition except the stricture at esophagogastrostomy site. (Korean J Gastroenterol 2009;54:212-219)

출혈성 소화성 궤양 환자에서 재출혈의 위험인자 및 재출혈률

서승원(Seung Won Seo),김연수(Yeon Soo Kim),문희석(Hee Seok Mun),박기오(Ki Ho Park),이엄석(Eom Seok Lee),김선문(Seon Mun Kim),양현웅(Hyeon Woong Yang),나병규(Byung Kyu La),성재규(Jae Kyu Seong),이병석(Byung Seok Lee),정현용(Hyun Yong 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Background/Aims: Bleeding from peptic ulcer is a common and serious complication. Endoscopic therapy is effective in hemostasis of active bleeding. However, rebleeding occurs in 10-30% of patients with bleeding peptic ulcer, and is an important factor associated with mortality. In this study, we analyzed risk factors and rate of rebleeding in patients with bleeding peptic ulcer. Methods: We analyzed 194 patients with peptic ulcer bleeding between June 1995 and May 1998. We retrospectively analyzed the rebleeding risk factors by reviewing medical records and telephone interviews. Results: Rebleeding of peptic ulcer occurred in 43 patients (22.2%). Cumulative rebleeding rate was 12.1% after 1 month, 15.2% after 6 months. The cumulative rebleeding rates at 1, 2, and 3 years were 16.2%, 19.4% and 20.9%, respectively. On the basis of an univariate analysis of clinical and endoscopic findings, significant predictive factors for rebleeding were history of peptic ulcer bleeding (p=0.002), use of NSAIDs (p=0.08), endoscopic stigmata of recent hemorrhage (p=0.000), and presence of shock (p=0.002). In multivariate analysis, history of peptic ulcer bleeding (odds ratio, OR=9.12), use of NSAIDs (OR=7.91), endoscopic stigmata of recent hemorrhage (OR=0.37), and presence of shock (OR=3.83) were independent risk factors of rebleeding. Conclusions: Rebleeding rate of peptic ulcer is 20.6% during 3 years of follow-up and important risk factors of rebleeding are history of peptic ulcer bleeding, use of NSAIDs, endoscopic stigmata of recent hemorrhage, and presence of shock. (Korean J Gastroenterol 2002;39:101-107)

Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

인터페론 치료에 반응이 없었던 예들을 포함한 만성 B형 간염 환자에서 lamivudine의 단기 치료 효과

이상우,이엄석,김선문,서승원,양현웅,성재규,이승민,이병석,김남재,이헌영 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

The efficacy and safety of lamivudine administration according to the presence or abscence of past history of interferon treatment were studied in 22 patients with chronic active hepatitis B who were diagnosed at ChungNam National Univerity Hospital. Nine of these patiens were no responders to interferon treatment. The change of HBV DNA, serum ALT and HBeAg values was analyzed during 12 weeks of lamivudine treatment. The results were as follow : 1. The mean values of HBV DNA and serum ALT were significantly reduced from 1793 9 to 2.0 pg/ml and from 202.5 to 36.3 IU/L after lamivudine treatment (p<0.001). The mean reduction rates of serum HBV DNA and serum ALT were 99.7% and 70.4%. 2. HBV DNA was undetectable in 18 patierits(81.8%) and serum ALT was normalized in 16 patients(68.2%%) after 12 weeks of lamivudine treatment. But there were temporary elevations of serum ALT value comparing to pretreatment value in 5 patients. 3. HBeAg was undetectable in 4 patients(18.1%) and in these 4 patients, anti-HBe was detected after 12 weeks treatment. 4. There was no significant difference of HBV DNA clearance rate and normalization rate of serum ALT between above and below 200 pg/mI group according to pretreatment HBV DNA values(p=0.74, p=0.08). 5. Each clearance rates of HBV DNA in patients without previous interferon treatment and patients with previous interferon treatment were 84.6% and 77.8%(p=0.68). Each clearance rates of HBeAg in patients without previous interferon treatment and with previous interferon treatment were 15.5% and 22.2%(p=0.683). 6. During the treatment periods, adverse effects of lamivudine were negligible in most patients except temporary leukopenia in one patient. Conclusively, lamivudine treatment over the short term period for patients with chronic active hepatitis B was effective in suppression of viral replication and improvement of abnormal serum ALT. Also the efficacy of lamivudine treatment was out of all relation to previous interferon treatment and adverse effects of this drug were negliable. But further study for the efficacy of long term period-lamivudine treatment and appearance of mutant shoud be necessary.