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HBV - bDNA 음성 만성 B 형 간염 바이러스 보유자의 간조직검사 소견과 임상적 특징
노병주(Byung Joo Roh),이숭환(Soong Hwan Lee),한성희(Sung Hee Han),조승철(Seung Chul Cho),손주현(Joo Hyun Sohn),이동후(Dong Hoo Lee),기춘석(Choon Suhk Kee) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.6
Background/Aims: It is common in Korea that young men carry HBV-bDNA (branched chain DNA) negative chronic HBsAg, regardless of abnormal aminotransferases. However, histologic findings of these patients were not well-known. The authors studied histologic characteristics of hepatitis activity in these patients and assessed the correlations of aminotransferases and the histologic characteristices of hepatitis activity/fibrosis. Methods: Routine biochemical liver function tests were performed for the 29 young male HBV-bDNA negative chronic HBsAg carriers. Their histologic hepatitis activity/fibrosis was scored. Results: Ninety percent of the patients showed chronic inflammation at liver biopsy, whereas 80% of the parents who had normal aminotransferase showed chronic inflammatory feature in spite of their HBV-bDNA negativity. A significant correlation was found between the levels of aminotransferases and histologic hepatitis activity (lobular activity and portoperiportal activity). The patients with abnormal aminotransferase revealed the higher grade activity than the patients with normal aminotransferase in lobular activity and portoperiportal activity. Conclusions: Most of young male HBV-bDNA negative chronic HBsAg carriers show the histologic characteristics of chronic hepatitis. Some patients could be recovered, but others may show viral replication during their clinical course. (Korean J Gastroenterol 2001;38:419-426)
혈청 음성 Celiac 병을 의심하는 소장 융모 위축과 연관된 단백상실장병증 1예
한성희 ( Sung Hee Han ),이오영 ( Oh Young Lee ),은창수 ( Chang Su Eun ),노병주 ( Byoung Joo Roh ),손원 ( Won Sohn ),백승삼 ( Seung Sam Baeg ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.1
Protein losing enteropathy is described as a diverse group of disorders associated with excessive loss of serum proteins into the gastrointestinal (GI) tract. The etiology of protein losing enteropathy is various. Increased mucosal permeability to protein as a result of cell damage, mucosal erosion, or lymphatic obstruction may develop protein losing enteropathy. Celiac disease is a common cause of protein losing enteropathy associated with small bowel villous atrophy in Europe. We experienced a case of protein losing enteropathy associated with small bowel villous atrophy of unknown origin. A 36-year-old woman was admitted due to chronic watery diarrhea and weight loss. Laboratory findings showed total protein 4.7 g/dL, albumin 2.7 g/dL, cholesterol 100 mg/dL, WBC 6,000/mm3 (lymphocyte 13.6%) with the absence of proteinuria. On esophagogastroduodenoscopic examination, duodenal ulcer scar was noted on the bulb and colonoscopic finding was nonspecific. On small bowel enteroscopy, jejunal and ileal villi was scantly noticed. Small bowel biopsy showed marked villous atrophy. Her symptoms did not improve after supportive care. Gluten free diet was tried because celiac disease could not be ruled out completely. Diarrhea ceased and body weight regained after gluten free diet. (Korean J Gastroenterol 2007;49:31-36)
한국인 만성 B형 간염 바이러스 보유자에서 B형 간염 바이러스 유전자형의 분포
이승환 ( Soong Hwan Lee ),한성희 ( Sung Hee Han ),조승철 ( Seung Chul Cho ),노병주 ( Byung Joo Roh ),손주현 ( Joo Hyun Sohn ),김덕언 ( Duck An Kim ),이동후 ( Dong Hoo Lee ),기춘석 ( Choon Suhk Kee ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
<목적> B형 간염 바이러스의 만성 감염은 무증상 감염, 만성 간염, 간경변, 간세포암 등 다양한 임상 경과를 보이며 바이러스 인자와 숙주 인자, 환경적 요인 등이 이 과정에 중요한 역할을 할 것으로 생각된다. 최근 중국과 일본에서 B형 간염 바이러스 유전자형에 따른 임상 경과에 차이가 있다는 보고가 있다. 유전자형의 분포는 지역적인 차이가 있는 것으로 잘 알려져 있으며 아직까지 한국인 만성 B형 간염 바이러스 보유자에서 B형 간염 바이러스 유전자형에
인후두 역류가 의심되는 환자에서 이중전극 24시간 식도 pH 검사가 유용한가?
윤창옥 ( Chang Ok Yoon ),이오영 ( Oh Young Lee ),노병주 ( Byung Joo Roh ),전대원 ( Dae Won Jun ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
목적: 이비인후과 외래에서 인후두 역류증이 의심되는 환자를 진단할 때에 쉽게 이용할 수 있는 역류 증상 점수와 현재 가장 정확한 방법으로 알려져 있지만 시행이 어려운 이중전극 24시간 식도 pH 검사와의 연관성을 알아보고 이중전극 24시간 식도 pH 검사의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 인후두 역류증이 의심되는 증상을 주소로 본원 이비인후과 외래를 방문한 46명의 환자들을 대상으로 역류증상 설문조사와 후두경검사와 이중전극 24시간 식도 pH검사 및 상부위내시경을 시행하였다. 역류증상 설문조사를 통하여 증상의 중증도를 조사하였다. 이중전극 24시간 식도 pH검사에서 후두 역류 횟수와 증상의 중증도 간의 연관성을 조사하였다. 결과: 대상 환자들의 평균 나이는 49.4세, 남자 20명, 여자 26명이었다. 주증상으로는 인후두 이물감과 애성이 14명씩으로 가장 많았고 기타 인후통과 기침 등을 호소하였다. 이중전극 24시간 식도 pH 검사에서 인후두 역류가 있는 군과 없는 군간에 증상 점수가 통계적으로 의미있는 차이를 보였다(10.0점 vs 7.0점; p=0.04). 그러나 역류 빈도와 점수의 중증도와는 통계적인 유의성이 없었다. 인후두 역류증의 진단기준을 프로톤 펌프 억제제 복용 후 50%의 증상 호전으로 할 경우 이중전극 24시간 식도 pH 검사의 민감도와 특이도는 각각 59.4%와 33.3% 였다. 결론: 이중전극 24시간 식도 pH 검사의 낮은 민감도 및 검사상의 어려움이 있다. 따라서 인후두 역류증의 진단과 치료시 역류증상 점수(8점 이상)와 후두경 검사상 후두염이 관찰되면 이중전극 24시간 식도 pH 검사의 시행보다 먼저 경험적인 프로톤 펌프 억제제를 사용하여 증상의 호전 유무를 관찰하고 호전이 없는 경우 이중전극 24시간 식도 pH 검사 등을 시행하는 것이 좋을 것으로 생각된다. 또한 이중전극 24시간 식도 pH 검사의 민감도를 높이기 위한 다른 진단기준의 마련이 필요할 것으로 사료된다. Background/Aims: Ambulatory 24-hour dual probe pH monitoring, the reflux symptom index (RSI), and the reflux finding score (RFS) have been developed to standardize the diagnosis of laryngopharyngeal reflux (LPR). The aims of this study were to evaluate the relationship between the RSI and the ambulatory 24-hour dual probe pH monitoring, and we also wanted to investigate the sensitivity of pH monitoring in those patients with suspected LPR who were diagnosed by an empirical trial with proton pump inhibitor (PPI). Methods: Forty six patients suffering with LPR symptoms were examined using the RSI, a laryngoscope and ambulatory 24-hour dual probe pH monitoring. Results: LPR on pH monitoring occurred in 30 of the patients (65.2%) among those patients who were suspected of having LPR, based on the RSI or the RFS. There was a significant difference in the RSI between the patients with reflux and patients without reflux on the pH monitoring. The sensitivity and specificity of pH monitoring were 59.4% and 33.3%, respectively, based on 50% symptom improvement as determined by a trial with PPI. Conclusions: Ambulatory 24-hour dual probe pH monitoring is still useful, but it has a low sensitivity. Therefore, other diagnostic LPR criteria are needed to increase sensitivity of ambulatory 24-hour dual probe pH monitoring. (Kor J Neurogastroenterol Motil 2005;11:117-122)
과민성 장 증후군 아형에 따른 구불창자 수용성 적응도의 차이
전대원 ( Dae Won Jun ),이오영 ( Oh Young Lee ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),노병주 ( Byung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
목적: 과민성 장 증후군의 병태 생리에 대해 많은 연구가 이루어져 왔으나 아직도 명확히 규명되어 있지 않다. 최근에는 과민성 장 증후군 환자에서 구불창자의 수용성 적응도(accommodation)에 대한 연구보고가 있지만 아직 연구가 미흡하며, 특히 아형에 따른 수용성 적응도의 차이는 알려져 있지 않다. 방법: 위장 증상이 없는 7명의 건강한 대조군(평균연령 36.7세, 남자 4명, 여자 3명)과 로마 II 기준에 의한 15명의 과민성 장 증후군 환자(평균연령 36.8세, 남자 8명, 여자 7명)를 대상으로 하였다. 구불창자에 풍선을 삽입하고 바로스타트(barostat) 를 이용하여 구불창자의 수용성 적응도를 측정 하였다. 시각상사척도를 이용하여 지난 3개월 동안 증상 정도와 주당 평균 배변 횟수를 측정였다. 결과: 15명의 과민성 장 증후군 환자 중 변비형이 8명(남자 2명, 여자6명), 설사형이 7명(남자 6명, 여자 1명)이었다. 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았다(정상 대조군 1.3 ml/s, 과민성 장 증후군 1.0 ml/s, p=0.024). 구불창자 수용성 조절능은 설사형 과민성 장 증후군 환자에서 보다 낮은 경향을 보였다(정상 대조군 1.3 ml/s, 설사형 과민성 장 증후군 0.9 ml/s, p=0.051). 변비형 과민성 장 증후군 환자의 경우 정상대조군(정상 대조군 1.3 ml/s, 변비형 과민성 장 증후군 1.1 ml/s, p=0.081)에 비해 통계적으로 유의한 차이를 보이지 않았다. 구불창자 수용성 조절능은 환자가 호소하는 소화기 증상과 배변횟수와 직접적인 연관성을 보이지 않았으나, 변비형 과민성 장 증후군 환자에서는 배변 횟수와 연관성을 보이는 경향이 있었다(r=0.7, p=0.052). 결론: 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았으며 특히 설사형 과민성 장 증후군 환자에서 구불창자의 수용성 적응도가 낮았다. Background/Aims: A contentious issue in medicine is whether or not patients with irritable bowel syndrome (IBS) have abnormal motor physiology, and also whether the sensory and motor physiologies are different between the patients suffering with the various subtypes of IBS. Our aim was to investigate if IBS patients have different sigmoid accommodation compared with the normal controls or if the differences exist in sigmoid accommodation according to the IBS subtype. Methods: Fifteen Rome II positive IBS patients and 7 normal controls were recruited for the study. A sigmoid bag catheter was endoscopically placed, and then bag inflation was performed via a barostat. Sigmoid accommodation was measured by using the rapid phasic distention method. Results: In the IBS patients, sigmoid accommodation (1.0 ml/s) was significantly lower than that of the controls (1.3 ml/s). There were no statistically significant differences in sigmoid accommodation according to the IBS subtype, but the IBS patients with predominate symptoms of diarrhea had a tendency for lower sigmoid accommodation (p=0.051). Gastrointestinal symptoms and stool frequency did not seem to have any correlation with sigmoid accommodation. However, for the IBS patients with predominate symptoms of constipation, the stool frequency tended to be associated with the sigmoid accommodation (p=0.052). Conclusions: Sigmoid accommodation was significantly lower in the IBS patients. The results are generally consistent with the finding that the IBS patients with predominate symptoms of diarrhea exhibit a tendency for lower sigmoid accommodation. (Kor J Neurogastroenterol Motil 2005;11:129-134)
하부식도 근육층 비후를 동반한 호두까기 식도 환자에서 발생한 Steakhouse 증후군
양선영 ( Sun Young Yang ),이오영 ( Oh Young Lee ),한성희 ( Sung Hee Han ),전대원 ( Dae Won Jun ),노병주 ( Byoung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2
Acute esophageal obstruction caused by the impaction of a large bolus of food has been called the `steakhouse syndrome`. Esophageal stenosis is usually found in adults suffering with steakhouse syndrome, but occasionally the syndrome occurs in the absence of any underlying organic abnormality. A 71-year-old male patient had complained of swallowing difficulty after ingesting meat two days previously. We performed endoscopy and found a meat bolus at 30 cm from the incisors, and we so removed the meat with a basket. No pathologic findings were observed endoscopically after the removal of the esophageal meat bolus. The esophageal manometry showed segmental, high amplitude esophageal pressure at the lower esophagus with normal peristalsis. We performed endoscopic ultrasonography with a high frequency catheter and we found thickening of the lower esophageal muscle layer. This case shows that nutcracker esophagus may be the cause of esophageal foreign body impaction and thickening of muscle layer may be associated with the symptom. (Kor J Neurogastroenterol Motil 2005;11:166-169)
HBeAg 양성인 만성 B 형 간염을 가진 젊은 남자 환자에서 조직학적 간염 활성도와 HBV DNA 의 관계
한성희,이동후,이숭환,손주현,기춘석,노병주,신준재,조승철 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.1
Background/Aim: A significant correlation between HBV DNA and liver damage was found in precore mutant strains but there was no significant association between viral replication and liver damage in HBeAg positive patients. Laboratory tests are often requested to predict hepatitis activity (grade) and fibrosis (stage) in HBeAg positive chronic hepatitis B. We assessed ALT, AST, and HBV-branched DNA to find which is the best for predicting hepatitis activity and fibrosis. Methods: Routine biochemical liver function tests and HBV DNA in sera were assessed in 119 young patients positive with HBsAg and HBeAg. The mean age of patients was 21±2 years. All patients were male. By logistic regression analysis the relationships between laboratory data, hepatitis activity, fibrosis, or risk of chronic active hepatitis were analyzed. Results: There was a significant correlation between aminotransferase (AST, ALT) and hepatitis activity/ fibrosis. A significant inverse relationship between the HBV bDNA and hepatitis activty was demonstrated (Pearson's correlation coefficient: lobular activity,-0.305; porto-periportal activity, -0.410). But HBV bDNA was not correlated with severity of fibrosis. AST and HBV bDNA was the important test for predicting the more severe hepatitis activity (lobular activity and porto-periportal activity: score≥3, respectively) Conclusion: The higher AST, but the lower HBV bDNA, in sera shows the more severe hepatitis activity. AST and HBV bDNA could be helpful for assessing the hepatitis activity in young male patients with HBeAg positive chronic hepatitis B if proper reference values are used.(Korean J Hepatol 2002;8:44-51)