횡격막상부 식도게실과 동반된 식도 아칼라지아

황성준 ( Seoung Joon Hwang ),박효진 ( Hyo Jin Park ),조준식 ( Jun Sik Cho ),이상인 ( Sang In Lee ) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

Epiphrenic diverticulum is a relatively rare condition resulting from mucosal herniation through the muscular wall of the esophagus. This pulsion diverticulum is often associated with abnormal esophageal motility such as esophageal achalasia. Although pneumatic dilatation is recommended as the initial treatment for patients with esophageal achalasia, some authors caution against the use of pneumatic dilatation when esophageal achalasia is complicated by epiphrenic diverticulum. A 49-year old female patient was admitted due to progressive dysphagia for both solid and liquid foods, and weight loss and frequent vomiting. She suffered from Heller`s myotomy due to esophageal achalasia 8 years prior. She was diagnosed as having recurrent esophageal achalasia with epiphrenic diverticulum due to incomplete myotomy, using esophagography, esophagogastrodudenoscopy, esophageal manometry, and esopahgeal transit scan. The patient was successfully treated with pneumatic balloon dilatation, and her symptoms markedly improved.(Korean J our nal of Gastr ointestinal Motility 2002;8:185-190)

급성 췌장염의 진단에 있어서 Urinary Trypsinogen-2 Dipstick 검사의 유용성

황성준 ( Seoung Joon Hwang ),정준표 ( Jun Pyo Chung ),김영균 ( Young Gyun Kim ),송대훈 ( Dae Hoon Song ),이재성 ( Jae Sung Lee ),백승석 ( Seung Seok Baek ),김도연 ( Do Yun Kim ),이덕용 ( Dok Yong Lee ),정연수 ( Yon Soo Jeong ) 대한소화기학회 2004 대한소화기학회지 Vol.43 No.6

Background/Aims: The clinical usefulness of urinary trypsinogen-2 dipstick test is still in controversy. We evaluated the usefulness of urinary trypsinogen-2 dipstick test in patients with acute pancreatitis. Methods: Urinary trypsinogen-2 dipstick test was prospectively performed in 50 patients with acute pancreatitis, 50 patients with non-pancreatic abdominal pain, and 50 healthy controls. Results: On admission, urinary trypsinogen-2 dipstick test was positive in 36 of 50 patients with acute pancreatitis (sensitivity, 72%) and in 4 of 50 patients with non-pancreatic abdominal pain (specificity, 92%). On the other hand, it was all negative in controls. The sensitivity and specificity of serum lipase were 78% and 94%, respectively. At 24 hours after admission, the positive rate of urinary trypsinogen-2 dipstick test rose from 72% to 94% (p=0.02). The results of urinary trypsinogen-2 dipstick test was positive in 14 of 15 patients with severe pancreatitis and 22 of 35 patients with mild pancreatitis according to the criteria by Atlanta International Symposium, 1992. Conclusions: Urinary trypsinogen-2 dipstick test is comparable to serum lipase in diagnosing acute pancreatitis. Delayed measurement and severe pancreatitis are more likely to yield positive results with urinary trypsinogen-2 dipstick test. Thus, we suggest that the cut-off value of urinary trypsinogen-2 dipstick test should be lowered to increase its sensitivity. (Korean J Gastro-enterol 2004;43:364-369)

증례 : 경피경간적 담낭 배액술로 완치된 급성 기종성 담낭염 1예

이상훈 ( Sang Hun Lee ),황성준 ( Seoung Joon Hwang ),이세준 ( Se Joon Lee ),백용한 ( Yong Han Baeg ),이상인 ( Sang In Lee ),이광훈 ( Kwang Hun Lee ),이동기 ( Dong Ki Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

Emphysematous cholecystitis is an unusual variant of acute cholecystitis caused by gas-forming organisms. It is characterized by the presence of gas in the gall bladder lumen, wall or pericholecystic tissues. It is thought to be a rare but life-threatening disease with high morbidity and mortality rates than those for other types of acute cholecystitis. Management of emphysematous cholecystitis is surgical removal of gallbladder. Recently, percutaneous cholecystostomy drainage is employed in patients with complications such as perforation and in those who have high surgical risk. It is demonstrated to lower the surgical mortality rates, but it still does not obviate the need for surgical removal of the gallbladder. Percutaneous cholecystostomy may be used for definite therapeutic procedure of emphysematous cholecystitis and we report a case of emphysematous cholecystitis that was cured by the percutaneous cholecystotomy without surgical procedure. (Korean J Med 69:S777-S781, 2005)

십이지장 제 2부에서 점막 백색 변조의 의의 -위 기능면에서-

양태영 ( Tae Yeong Yang ),윤홍선 ( Hong Sun Yoon ),김민수 ( Min Su Kim ),황성준 ( Seoung Joon Hwang ),박효진 ( Hyo Jin Park ),박찬일 ( Chan Il Park ) 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

배경: 상부 위장관 내시경 검사시 십이지장 제 2부에서 흔히 보이는 분홍색의 점막 색조와는 달리 점막의 백색 변조를 가끔 볼 수 있다. 이에 관한 문헌은 거의 없고 지방을 함유한 대식세포의 침착에 비롯된다는 주장이 있을 뿐이다. 저자들은 백색 변조를 위 기능면에서의 의미와 조직학적인 이상 유무에 대해서 알아 보았다. 대상 및 방법: 십이지장 제 2부에 백색 변조가 있는 기능성 소화불량증 환자(I군) 14명, 백색 변조가 없는 기능성 소화불량증 환자 (II군) 11명, 그리고 상부 위장관 증세가 없으며 백색 변조가 없는 정상 대조군 10명을 대상으로 상부 위장관 증상, 위 배출 시간 및 조직학적 검사 소견을 비교하였다. 결과: I, II군에서 동반 질환, 증상 지수간 유의한 차이는 없었다. 위 배출 시간 [TI/2 (min)]은 I군 147.4분, II군 99.6분, 정상 대조군은 75.8분으로, I군은 각각 II군, 정상 대조군에 비해서 유의한 위 배출 시간의 지연이 있었으며(p<0.05), II군과 정상 대조군 간에는 유의한 차이가 없었다. 세 군간의 유의한 조직학적 차이점은 없었으며 백색 변조된 점막에서 지방을 함유하는 특이적인 소견은 없었다. 결론: 기능성 소화불량증 환자에서 상부 위장관 내시경 검사를 실시할 때 드물게 볼 수 있는 십이지장 제 2부 점막의 백색 변조는 위 기능적인 측면에서 위 배출 시간 지연과 연관이 있음을 알 수 있었다. Background/Aims: A mucosal `whitish discoloration` of the duodenal second portion may be discorvered during esophagogastroduodenoscopy (EGD). This study investigated the gastric functional implication and histological abnormalities of mucosal `whitish discoloration`. Methods: The upper gastrointestinal symptoms, gastric emptying time and histology findings were compared in patients with functional dyspepsia (FD) showing mucosal `whitish discoloration` of the duodenal second portion (group I), FD patients without `whitish discoloration` (group II), and normal controls who have neither symptoms nor `whitish discoloration` (normal controls). Results: There was a significant difference between group I (147.6 min) and group II (99.6 min) or normal controls (75.8 min). However there was no difference between group II and normal controls. There was no histological difference in the three groups. In particular, there was no mucosal infiltration of macrophage in second portion of duodenum. Conclusions: Mucosal `whitish discoloration` of the duodenal second portion, uncommon occurrence in EGD, can be correlated with a delayed gastric emptying time. (Kor J Neurogastroenterol Motil 2006;12:122-126)

건강 자원자에서 위 배출에 미치는 tadalafil의 효과

김민수 ( Min Su Kim ),장진혁 ( Jin Hyuck Chang ),김익성 ( Ek Seong Kim ),황성준 ( Seoung Joon Hwang ),장재훈 ( Jae Hoon Jahng ),김승민 ( Seung Min Kim ),유영훈 ( Young Hoon Ryu ),박효진 ( Hyo Jin Park ) 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.1

목적: 본 교실에서는 건강 자원자에서 phosphodiesterase (PDE) 5형 억제제인 sildenafil이 전체 위 배출능에는 영향이 없었으나 음식물의 위내 분포에는 영향이 있음을 보고한 적이 있다. 이에 sildenafil 보다 작용시간이 긴 것으로 알려진 tadalafil (cialis(R))은 위 배출에 어떠한 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 건강한 남자 자원자 8명(평균 나이 26.4세)을 대상으로 투약 전, tadalafil 투약 30분 후, 투약 24시간 후에 위 배출 주사를 시행하여 전체 위 배출능을 알아보기 위한 지표로서 total T(1/2) (min)을 구하였고, 위내 분포를 알아보기 위한 지표 중 위 근위부에 대해서는 proximal T(1/2) (min)과 검사식 섭취 직후 위 근위부의 방사선량인 initial proximal activity (%)를, 위 원위부에 대해서는 위 원위부에서 가장 높이 기록된 방사선량인 maximal distal content (%)을 구한 다음 tadalafil 효과 및 24시간 후까지 작용 지속 여부를 확인하였다. 결과: 위 배출 주사 결과 투약 전, tadalafil 투약 30분 후, 투약 24시간 후의 total T(1/2) (min), proximal T(1/2) (min), initial proximal activity (%), maximal distal content (%)가 모두 통계학적으로 유의한 차이를 보이지 않았다. 결론: 최근 시판된 PDE 5형 억제제, tadalafil은 위 배출 및 위내 분포에 유의한 영향을 미치지 않음을 확인할 수 있었다. Background/Aims: In a previous study we demonstrated an influence of sildenafil, a phosphodiesterase (PDE) type 5 inhibitor, on intragastric food maldistribution without affecting total gastric emptying. In this we wanted to determine the effect of tadalafil (cialis(R)), which has longer duration of action than sildenafil, on gastric emptying. Methods: Eight male (mean age, 26.4 yrs) healthy volunteers were selected. Total T(1/2) (min) was measured to assess total gastric emptying before, 30 minutes and 24 hours after tadalafil intake. Proximal T(1/2) (min), initial proximal activity (%)-radioactiviy measured in the proximal body of the stomach immediately after food ingestion-, and the maximal distal content (%)-the highest radioactiviy measured in the distal body of the stomach was measured as indicators of intragastric food distribution. Results: There were no significant differences in total T(1/2) (min), proximal T(1/2) (min), initial proximal activity (%) and maximal distal content (%) before and 30 minutes and 24 hrs after intake of tadalafil. Conclusions: The recently launched PDE5 inhibitor, tadalafil, has no significant influence on total gastric emptying or intragastric food distribution. (Kor J Neurogastroenterol Motil 2006;12:31-34)

증례 : 간내 원발 병소가 뚜렷하지 않고 폐전이로 확진된 간세포암종 1예

문희선 ( Hee Sun Mun ),백용한 ( Yong Han Paik ),장진혁 ( Jin Hyuck Chang ),황성준 ( Seoung Joon Hwang ),문종태 ( Jong Tae Moon ),이관식 ( Kwan Sik Lee ),권지은 ( Ji Eun Kwon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1S