위장질환에 따른 H.pylori 감염빈도와 검사방법의 비교분석

김대현,조재현,금민수,최성곤,이창형,탁원형,권영오,김성국,최용환,정준모 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : H. pylori가 위장관 질환의 병인에 깊은 관련이 있어 이의 적절한 진단 및 치료가 중요하게 대두되고 있다. 이에 저자들은 소화기 증상을 주소로 내원한 환자들을 대상으로 내시경 검사를 실시하여 H. pylori검출을 위한 CLO검사, IgG 항체검사 및 H&E 염색 등을 시행하여 각 질환별로 H. pylori 감염의 양성율을 알아보고 검사법에 따른 민감도 및 특이도를 그 유용성에 대하여 조사하였다. 대상 및 방법 : 1996 4월에서 8월까지 경북대학교병원에 소화기증상을 주소로 내원한 총 313명의 환자를 대상으로 내시경 검사를 실시하여 H. pylori 검출을 위한 CLO 검사, IgG 항체검사, 조직염색 검사를 실시하였다. 결과 : 전체 대상 환자수는 313명이었고 연령별 분포는 16세부터 80세 까지 다양하였으며 그중40대, 50대, 60대가 각각 69예(22%), 73예(23.3%), 65예(20.8%)로 전체 환자중 66%를 차지하였다. 남녀비는 2.07 대 1로 남자가 많았다. 대상환자의 평균나이는 52±15세였고, 전체 대상환자에서 H. pylori 양성군과 음성군의 평균나이는 각각 50±15세, 54±15세 였고, 궤양환자군에서 H. pylori 양성군과 음성군사이의 평균나이는 각각 49±14.8세, 55±13.8세로 나타났다. 각 질환별분포는 위염이 72명(23%), 십이지장 궤양이 85명(27.2%), 위궤양이 80명(25.6%), 위암이 20명(6.4%), 비궤양성 소화불량이 13명(4.2%), 기타가 43명(13.7%)이었으며, H. pylori 감염 양성율은 위염이 71%, 십이지장 궤양이 86.8%, 위궤양이 58.3%, 위암이 75%, 비궤양성 소화불량이 75%였으며 특히 유문륜 궤양에서는 100%의 양성율을 보였다. 소화성 궤양군과 비궤양군에서의 H. pylori 양성율을 비교해 본 결과 궤양군에서는 73.1%, 비궤양군에서는 72%로 통계학적으로 차이는 없었다(P=0.91). 소화성 궤양환자에서 출혈이 동반된 군과 동반되지 않은 군에서의 H. pylori 양성율을 비교해 본 결과 출혈이 동반된 군에서의 양성율은 54.5%였고, 출혈이 동반되지 않은 군에서는 77.5%의 양성율을 보여 출혈이동반되지 않은 군에서 통계학적으로 유의하게 높았다(P=0.014). 나이에 따른 양성율을 알아본 결과 50세 이하에서는 78.5%였고, 50세 이상에서는 67.5%로서 양성율이 낮았으나 통계학적으로 유의성은 없었다(P=0.052). 각 검사법에 따른 민감도 및 특이도는 전체 환자중에서는 CLO검사가 88.9%, 96.1%, IgG항체검사 90.8%, 58.5%, H&E 염색검사 86.9%, 79.2%로서 민감도는 비슷하게 나왔으나 CLO검사는 상대적으로 특이도가 다른 검사법에 비해 높았다. 궤양군에서의 CLO검사의 민감도와 특이도는 92.0%, 95.6%였고, 비궤양군에서의 민감도와 특이도는 84.3%, 96.8%로서 비궤양군에서는 CLO검사의 민감도는 약간 낮았다. 나이에 따른 CLO 검사의 민감도 및 특이도는 50세 이하에서는 91.5%, 93.1% 였고, 50세 이상에서는 86.3%, 97.9%로서 50세 이상에서는 상대적으로 CLO검사의 민감도가 낮았다. 결론 : 본 연구에서는 위장질환에 따른 H. pylori 양성율을 알아보았는데, 다른 보고에서 처럼 높게 나왔으며, 진단 방법으로 사용한 CLO검사, IgG항체 검사, 조직염색검사 등은 모두 비교적 높은 예민도를 나타냈고, 그중 CLO검사가 간편하고 경제적이라는 면에서 임상적으로 유용한 검사로 여겨지나 상대적으로 CLO검사의 민감도가 낮은 비궤양성 질환과 50세 이상의 환자군에서는 CLO검사 외에 다른 검사방법을 병행함으로써 H. pylori의 진단율을 높일 수 있을 것으로 사료된다. Background: Gastric colonization by Helicobacter. pylori is common among patients with peptic ulcer and gastritis. And various diagnostic tests are available in confirming H. pylori infection. The aim of this paper is to estimate the prevalence of H. pylori infection in Gastroduodenal disorders and compare the sensitivity and specificity of the most widely available tests. Methods: A total of 313 patients were tested for H. pylori infection by IgG Ab, CLO test and H&E stains. Results: The prevalence of H. pylori infection was significantly higher in duodenal ulcer(86.8%) than in gastric cancer(75%), gastritis(71%) and gastric ulcer(58.3%)(P=0.009). The sensitivity and specificity of each test was as follows: CLO test(88.9%, 96.1%), IgG Ab test(90.8%, 58.5%), H&E stain(86.9%, 79.2%). Sensitivity of CLO test in peptic group was 92.0%, whereas in non-peptic group, it was 86.3%. Sensitivity of CLO test in age under 50 was 91.5%, that over 50 it was 86.3%. Conculsions: There is a strong association between H. pylori and gastrointestinal disorders. CLO tests have relatively high sensitivity and specificity, especially in peptic group and younger age(below 50 yr)group. But in those patients in which CLO tests are less sensitive (age>50 or non-peptic group), more than one test may be necessary to diagnose the presence of the organism.

『素問· 逆調論』에 대한 硏究

김화창,김종호,천상묵,서대선,김명수,금경수 한국전통의학연구소 2002 한국전통의학지 Vol.12 No.1

A Study on the Youkjoron(逆調論) of the So Moon(素問) one of the classic book of oriental medicine, was carried out analytically for the right comments. The principal ideas abtained summerized as follows: The unbalance between Eum(陰) and Yang(陽) The unbalance between Su(水) and Wha(火) The Yuk Ga(肉苛) which is caused by the unbalance of the Young Wi(營衛) The Asthma(喘息) which is caused by the unbalance of the Viscera(臟腑)

Ascorbic Acid와 2-Methoxyestradiol에 의한 내분비선 장애물질의 제거효율

성대동,이성식,최금찬,성낙창 동아대학교 환경문제연구소 2000 硏究報告 Vol.23 No.1

The removal efficiency of an environmental endocrine disrupter, 1,l-bis (4-chlorophenyl)-2,2,2-trichloroethane(CPT) has been studied using L-ascorbic acid(ACA) and 2-methoxyestradiol(MSD). l,l-Bis(4-chlorophenyI)-2,2,2-trichlorcethyl anion(CPT^( θ)) is formed by treatment of OH- ion to l,l-bis(4-chlorophenyl)-2,2,2-trichloroethane(CPT), l,l-Bis(4-chlorophenyl)-2,2,2-trichiorcethyl radical(CPT·) yields during the reaction of l,l-his(4-chlorophenyl)-2.2,2-trichloroethyl anion with iodine occurs. A high m v a l efficiency for l,l-bis(4-chlorophenyl-2,2,2-trichlorcethyl radical(CPT·) reveals in the case of L-ascorbic acid(ACA) used more than that of 2-methozyestradiol(MSD). This is in accord with the rate of yielding L-ascorbic acid radical(ACA·) is faster than the one of 2-methoxyestradiol radical(MSD·). The removal efficiency of 1,1-bis(4-chlorophen~l)-2,2,2-trichloroethyl radical(CPT·) is increased with increasing of solvent acidity and solvent hydrogen bonding degree.

폐장 유상피 혈관내피종 1예

김상훈,심대중,금주섭,서원태,임시영,이승세,장운하,오태윤,국신호 대한내과학회 1999 대한내과학회지 Vol.57 No.1

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.

Recent Trend Changes in Clinical Features, Treatment, and Survival from Korean Patients with Hepatocellular Carcinoma

( Jem Ma Ahn ),( Soon Ho Um ),( Dae Hoe Ku ),( Jung Mi Chang ),( Han Ah Lee ),( Tae Hyung Kim ),( Hyuk Soon Choi ),( Young Kul Jung ),( Eun Sun Kim ),( Bora Keum ),( Ji Hoon Kim ),( Yeon Seok Seo ),( 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: There were limited data regarding recent changes from patients with hepatocellular carcinoma (HCC). Our study aimed to evaluate recent time-trends in etiology, stage, treatment and overall survival in Korean patients with HCC. Methods: We consecutively enrolled 1367 patients who were diagnosed as HCC for the first time in Korea University Anam hospital between 2004.3 and 2015.12. These patients were categorized into four groups based on the date of HCC diagnosis with a 3-year interval as follows: P1, 2004.3 - 2007.2 (n = 321); P2, 2007.3 - 2010.2 (n= 348); P3, 2010.3 - 2013.2 (n = 368); P4, 2013.3 - 2015.12 (n = 330). Results: Over the median 19.0 months of follow-up duration, 68.0% of all patients died. Regarding secular trends from 2004 to 2015, HCC had become diagnosed with better liver function (Child-Pugh stage, P = 0.022). Etiology of HCC were changed; proportion of chronic hepatitis B decreased, while cryptogenic etiology increased (P= 0.004, P = 0.024). The proportion of early stage HCC increased (Barcelona Clinic Liver Cancer staging system, P = 0.001; modified UICC staging system, P = 0.005). More patients tended to receive treatment for HCC other than conservative treatment (P = 0.05); either operation or chemotherapy gradually increased as the first treatment modality, while locoregional therapy decreased (P = 0.012). The 1-, 3-, 5-year overall survival rates also increased from 2004 to 2015 (p < 0.001). Conclusions: Over recent 10 years, HCC had become to be diagnosed at earlier stages with better liver function. In addition, the proportion of chronic hepatitis B in HCC etiology decreased, and operation and chemotherapy were more performed as the first treatment. Thus, the overall survival rates could gradually improve with these changes, which might be derived from advance in treatment as well as improvement of HCC surveillance and wide-spread use of anti-viral therapy.

Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500μm as the Safe Margin?

( Sang Hoon Park ),( Hoon Jai Chun ),( Yong Dae Kwon ),( Bo Ra Keum ),( Yeon Seok Seo ),( Yong Sik Kim ),( Yoon Tae Jeen ),( Soon Ho Um ),( Chang Duck Kim ),( Ho Sang Ryu ),( Ji Hye Lee ),( Yang Seok 대한소화기학회 2008 Gut and Liver Vol.2 No.3

Background/Aims: Endoscopic mucosal resection can cure early gastric cancer. The risk of lymphatic metastasis is related to the depth of submucosal invasion by the mucosal malignancy, with a resection depth of 500 μm generally accepted as a safe cut-off. However, excessive thinning induced by stretching of the resected tissue sometimes preventing a precise diagnosis. We studied the effects of stretching on different layers and sites of gastric tissue. Methods: Porcine stomachs were cut into 2.0×2.0 cm pieces, and pieces from body were stretched to 2.5, 3.0, and 3.5 cm. Pieces from the cardia, body, and antrum were also stretched to 3.0 cm. The thickness of each layer was measured and analyzed statistically. Results: Whole gastric wall and submucosal layers showed gradual thinning, with stretching to 3.5 cm tearing the tissues and resulting in imperfect extension. The submucosa was thinner in body tissue than in cardia and antrum tissues. Stretching to 3.0 cm induced a consistent decrease in submucosal thickness (30-70%). The change in thickness varied widely between individual samples. Conclusions: A resection margin of 500μm might be insufficient for the complete removal of malignancy. Moreover, the thickness of the submucosal layer differs with the gastric site and between individuals. Future studies are needed to confirm the findings in human tissue. (Gut and Liver 2008;2:199-204)

Internal Mammary Lymph Node Irradiation after Breast Conservation Surgery : Radiation Pneumonitis versus Dose­Volume Histogram Parameters

Joo Young Kim(김주영),Ik Jae Lee(이익재),Ki Chang Keum(금기창),Yong Bae Kim(김용배),Su Jung Shim(심수정),Kyoungkeun Jeong(정경근),Jong Dae Kim(김종대),Chang Ok Suh(서창옥) 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.4

목 적: 방사선 폐렴과 체적­선량 히스토그램(dose­volume histogram, DVH) 변수들 사이의 연관성을 평가하고, 내유림 프절이 포함된 유방암의 방사선치료에서 방사선 폐렴을 방지할 수 있는 실제적인 지침을 제공하고자 한다. 대상 및 방법: 부분유방절제술을 받은 초기 유방암 환자 20명이 본 연구에 포함되었다. 전체 유방, 상부쇄골림프절,내유림프절에 총 28회 50.4 Gy가 조사되었다. 방사선 폐렴은 방사선 영상에서의 폐 변화(radiological pulmonary change; RPC)와 증상이 있는 방사선 폐렴(symptomatic radiation pneumonitis)에 의해 평가되었다. DVH 변수들은 grade<2 RPC와 grade≥2 RPC로 나누어 비교되었다. 이 때, DVH 변수들은 평균 폐 선량(mean lung dose), V10 (10 Gy 이상 받는 폐의 백분율 부피), V20, V30, V40, 그리고 정상 조직 합병증 확률(normal tissue complication probability, NTCP)이다. 결 과: 20명의 환자 중 9명(45%)에서 grade 2 RPC가 발생하였고, 11명(55%)에서는 발생하지 않았다. 1명의 환자에서 grade 1의 증상이 있는 방사선 폐렴이 발생하였다. 단변량 분석에서 DVH 변수 중, NTCP가 두 RPC grade 군 간에 유의한 차이를 보여주고 있다 (p<0.05). Fisher의 정확한 검증(exact test)은 NTCP값 45%가 RPC의 threshold level로서 적합함을 보여준다. 결 론: 본 연구는 NTCP가 유방암의 내유림프절 방사선치료 후 RPC 예측인자 중 한가지로 쓰일 수 있음을 보여준다. 임상적으로 이는 NTCP 45% 이상에서 RPC가 발생하기 용이함을 의미한다. Purpose: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. Materials and Methods: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade <2 RPC and those with grade ≥2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). Results: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher’s exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. Conclusion: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.

Screening of 3 - Hydroxy - 3 - Methylglutaryl - Coenzyme a Reductase Inhibitors In vitro and Its Application to Pullets

Keum-Hee Yeom,Suk-Yeun Hwang,Kyung-Woo Lee,Moon-sook Woo,Sun Park,Dae-Gyu Min,Bong-Duk Lee,Chang-Keun Sung 한국식품영양과학회 1999 Preventive Nutrition and Food Science Vol.4 No.1

The primary objective of these studies was to screen the materials showing inhibitions of HMG-CoA reductase in vitro. The secondary objective was to determine the effect of garlic, lovastatin and copper on cholesterol concentrations in plasma, liver and breast muscle of pullets. In experiment 1, the degree of inhibition of the selective samples on HMG-CoA reductase activity was determined in vitro. The inhibition rate of water soluble garlic extracts, lovastatin and copper to HMG-CoA reductase activity were 51.3%, 87.5%, and 82.0%, respectively. In experiment 2, control diet (basal diet), garlic powder (3% in diet), lovastatin (300 ㎎/㎏ of diet) and copper (200 ㎎/㎏ of diet) were fed to pullets in order to investigate the changes of cholesterol concentration in plasma and tissues. Plasma total cholesterol, and LDL-cholesterol were significantly reduced in pullets fed a diet containing 3% garlic powder. However, copper significantly increased total cholesterol compared to controls and lovastatin did not affect plasma cholesterol concentration. Total cholesterol in liver and breast muscle in pullets were not affected by adding cholesterol-lowering materials to the diets. The data suggests that it is not easy for HMG-CoA reductase inhibitors to reduce cholesterol levels in the body due to complication in cholesterol metabolism. However, garlic administration can lower the levels of plasma cholesterol in pullets.

급성 심근 경색 환자에서 재관류 방법에 따른 P파폭과 P파 분산의 변화

최웅길 ( Woong Gil Choi ),김대혁 ( Dae Hyeok Kim ),김기창 ( Gi Chang Kim ),안인선 ( In Sun Ahn ),김수현 ( Soo Hyun Kim ),유형권 ( Hyung Kwon Yu ),권준 ( Jun Kwan ),박금수 ( Keum Soo Park ),이우형 ( Woo Hyung Lee ) 대한내과학회 2007 대한내과학회지 Vol.73 No.5

목적: 급성 심근경색증 환자에서 심방세동은 10~20%의 빈도로 발생되는 흔한 부정맥이다. 최대 P파 폭과 P파 분산은 심방세동의 전기생리학적 특성과 연관된 동성 흥분파의 비균질 전도, 심방내 전도장애와 밀접히 연관된 것으로 알려져 있다. 이 연구의 목적은 급성 심근경색증 환자의 재관류 치료 방법이 최대 P파의 폭과 P파 분산에 대해 미치는 효과를 비교 분석하였다. 방법: 2005년 5월부터 2006년 5월까지 급성 심근경색으로 본원에 내원한 86명의 환자를 대상으로 응급실내원 당시의 모든 환자의 심전도와 일차적 관상동맥 중재술, 혈전용해요법을 시행 받은 환자 군은 치료 2일 후에 지연 관상동맥 중재술로 예정된 환자는 입원 2일 후의 심전도에서 최대 P파 폭과 P파 분산을 측정하여 각 군 간의 차이를 분석하였다. 결과: 일차적 관상동맥 중재술, 혈전용해요법, 지연관상동맥 중재술을 시행한 환자는 각각 28명, 27명 그리고 31명이었다. 일차적 관상동맥 중재술을 시행한 군이 다른 치료전략을 시행한 군에 비해 시술 후 최대 P파 폭과 P파 간격 분산이 다른 군에 비해 유의하게 감소하였으나, 혈전용해요법과 지연 관상동맥 중재술간의 치료후 유의한 차이는 없었다. 혈전용해요법과 지연 관상동맥 중재술을 시행한 경우 경색관련 관상동맥의 개존성이 있었던 군에서 개존성이 없었던 군에 비해 2일 후 P파 분산이 의미있게 감소하였다. 결론: 급성 심근경색증 환자에서 일차적 관상동맥중재술 군이 치료 후 최대 P파 폭과 P파 분산이 의미있게 감소하였다. Background: P wave dispersion (PWD) and P wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the change of the maximal P wave duration (Pmax) and PWD according to the treatment strategy used in patients with an acute myocardial infarction (AMI). Methods: We retrospectively evaluated 86 patients that experienced an AMI. Patients were classified into three groups according to the treatment strategy: primary percutaneous coronary intervention (PCI), thrombolytic therapy, and delayed PCI. ECGs that were obtained from all patients on admission and on the second day were analyzed. The Pmax and minimum P wave duration (Pmin) were measured from a 12-lead ECG. The PWD was calculated as the difference between the Pmax and Pmin. Result: There was no significant difference in the age, gender, medication, coronary risk factor, ejection fraction, left atrial diameter, basal Pmax and PWD among the groups. However, there were significant differences in P max and PWD between the primary PCI group and the other groups on the second day after hospital admission. In the thrombolytic therapy and delayed PCI groups, the PWD was significantly lower in the patients with a patent infarct-related artery (IRA) than in patients without a patent IRA on the second day after hospital admission. Conclusions: These findings suggest that a primary PCI decreased the Pmax and PWD more than thrombolytic therapy or a delayed PCI.(Korean J Med 73:489-495, 2007)

Case Reports : Superior Vena Cava Syndrome Caused by Encircling Soft Tissue

Dae Hyeok Kim,Yong Sun Jeon,Gi Chang Kim,In Sun Ahn,Jun Kwan,Keum Soo Park,Woo Hyung Lee 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.2

Superior vena cava syndrome can occur from benign conditions that might not alter life expectancy. Here we present a case of a superior vena cava (SVC) obstruction caused by soft tissue encircling the SVC, which was strongly suspected of being an unusual focal type of fibrosing mediastinitis. A 39-year-old man with no prior medical history presented with a four-week history of facial plethora, headache and dilated veins of the neck with a dark purple color change on the anterior chest wall. Radiology examinations, including venography, and computed tomography with a 3-dimensional volume-rendering image of the chest, had revealed severe narrowing of the SVC due to tiny encircling soft tissue and collateral vessels. A total occlusion of the SVC occurred as a result of a thrombus that developed within 1 day after the diagnostic SVC angiogram. The patient underwent stent deployment three days after the administration of thrombolytic therapy.