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담즙내 Deoxycholate가 Immunoglobulin G가 콜레스테롤 핵화에 미치는 영향
권계숙(Kye Sook Kwon),신용운(Yong Woon shin),김영수(Young Soo Kim),김진주(Jin Ju Kim),조영업(Young Up Cho),김원곤(Won Gon Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6
N/A Rackground/Aims: Gal]stones are now considered to be the aggregated expression of a metabo]ic disease of liver (lithogenic bi]e), nucleation (a kinetic event), crystallization in gel matrices (stasis) ;md gallbladder dysmotility (increased residence time). To evaluate the role of biliary deoxycholate and Immunoglobulin (Ig) in the cholesterol lithogenesis. 1) Comparing the biliary Ig (IgG, IgA & IgM) concentrations in pati<nts with and without gallstones. 2) Correlating the level of biliary immunoglobulins witb the nucleation time of gallbladder(GB) bile. 3) Comparing the biliary deoxycholate(DCA)/cholate(( A) ratio and nucleation time in patients with & without gallstones. Methods: 12 (3B bile samph.s (6 cholesterol stones, 6 contro]s) were collected by needle aspiration <>f the CiB at the operati<m Hiliary Ig concentrations were measured using Rate-Nephelometry (Kallestad QM300). Biliary t>I]e acicL composition was analyzed using HPLC. Nucleation time was determined hy polarizing niicroscopic observation of cholesterol crystals (daily fc>r 21 days). Results: Hiliary IgG concentration in gallstone group was significantly higher than control group (55.9 I 17.6mg/dL vs 6.9 + 3.3mg/dL, p<0.05) but IgA and IgM concentrations were not different .etween gallstone group a,id control group. Biliary DCA/CA ratio in gallstone group was significantly higher than control group (0.42 + 0.12 vs 0.13 + 0.05, p<0.05). And, nucleation time m gallstone group was significantly shorter than control group (2.8 days vs 2l days, p<0.05). Conclusions: Vatients with cholesterol gallstones have a higher biliary IgG concetration and DC.A/CA ratio. There were I:iverse correlations between nucleation time and IgG concentration and lC!1/CA ratio. J'his study suggests that biliary IgG and DCA may play an important role in the p,thovc.:iesis of cholestero1 ,allstone formation.(Korean J Gastroenterol 1996; 845-852)
김화숙(Wha Sook Kim),김범수(Pum Soo Kim),정석(Seok Jeong),심미란(Mi Ran Sim),양문희(Moon Hee Yang),김성연(Sung Yeon Kim),권계숙(Kye Sook Kwon),조현근(Hyeon Geun Cho),김형길(Hyung Gil Kim),신용운(Yong Woon Shin),김영수(Young Soo Kim) 대한내과학회 2002 대한내과학회지 Vol.62 No.6
Congenital solitary nonparasitic cysts of the liver are rare condition in all age groups. Since 1856, only approximately 900 cases having been reported in the world literature. Epidermoid cysts of the liver are extremely rare type of congenital nonparasitic hepatic cysts, characterized by a fibrous wall entirely lined with stratified squamous epithelium, but lacking hair or skin appendages. This condition has yet to be reported in Korea. Because they have a potential for malignant transformation, it is important to totally resect the epidermoid cyst of the liver. Recently, we experienced a case of 44-year-old female patient with epidermoid cyst of the liver, which condition was complicated by a secondary infection. For this patient, an enucleation of entire cyst was performed. Given the rarity of this case, the following is a report of this case and a review of the relevant literature.(Korean J Med 62:661-665, 2002)
Billroth II 위 절제술을 시행받은 환자에서 담관석 치료를 위한 경피경간 담도내시경쇄석술 후 발생한 급성담관염을 동반한 수입각증후군 1예
김성현 ( Seong Hyun Kim ),권계숙 ( Kye Sook Kwon ),정석 ( Seok Jeong ),이돈행 ( Don Haeng Lee ),민경선 ( Kyung Sun Min ),이진우 ( Jin Woo Lee ),신용운 ( Yong Woon Shin ),전용선 ( Yong Sun Jeon ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.2
Afferent loop syndrome is a rare complication which can occur in patients with Billroth II gastrectomy. Bile and pancreatic juice is congested at afferent loop in the syndrome. This syndrome can progress rapidly to necrosis, perforation, or severe sepsis, and therefore early diagnosis and swift surgical intervention is important. But, cases of endoscopic or percutaneous transhepatic drainage have been reported when surgical management was inappropriate to proceed. We report a case of afferent loop syndrome accompanying acute cholangitis developed after percutaneous transhepatic cholangioscopic lithotripsy for the retrieval of common bile duct stone in a patient who underwent Billroth II gastrectomy due to early gastric cancer. There was no other organic cause. We treated afferent loop syndrome successfully by performing balloon dilation of afferent loop outlet.
성인 입원 환자에서의 영양치료 관련 합병증: 국내 다기관 연구
설은미 ( Eun-mi Seol ),권계숙 ( Kye Sook Kwon ),김정구 ( Jeong Goo Kim ),김정태 ( Jung-tae Kim ),김지훈 ( Jihoon Kim ),문선미 ( Sun-mi Moon ),박도중 ( Do Joong Park ),박정현 ( Jung Hyun Park ),박제훈 ( Je Hoon Park ),박지영 ( Ji Y 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.1
Purpose: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. Methods: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. Results: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m<sup>2</sup>. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. Conclusion: NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.
위 점막연관림프조직 림프종 관해 후 발생한 조기 위암 1예
서동범 ( Dong Beom Seo ),권계숙 ( Kye Sook Kwon ),박현신 ( Hyun Shin Park ),이돈행 ( Don Haeng Lee ),김형길 ( Hyung Gil Kim ),신용운 ( Yong Woon Shin ),김영수 ( Young Soo Kim ),김준미 ( Joon Mi Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.4
위림프종 관해 후 위선암종이 발생하는 것은 매우 드문 일이다. 최근 위 점막연관림프조직(mucosa-associated lymphoid tissue, MALT) 림프종과 위선암종과의 연관성에 대한 논문들이 발표되고 있으나, 정확한 기전은 알려진 바 없다. 53세 남자 환자가 흑색변을 주소로 내원하여 시행한 상부위내시경 검사에서 위체하부의 대만에 Helicobacter pylori (H. pylori) 양성 MALT 림프종을 진단 받았다. 환자는 H. pylori 제균 치료 후에 항암화학요법 및 방사선요법을 시행 받았다. 환자는 12개월 후에 완전 관해 진단을 받았다. 3년 후 환자는 상복부 통증을 주소로 다시 내원하였다. 상부위내시경 검사에서 이전의 MALT 림프종 반대쪽인 위전정부 근위부에 조기 위암이 발견되어 위부분절제를 시행하였다. 저자들은 이전에 국내에서 보고된 바 없는 위 MALT 림프종 관해 후 발생한 조기 위암 1예를 경험하였기에 문헌고찰과 더불어 보고한다. Metachronous association between gastric lymphoma and early gastric cancer is a rare event. Recent studies have suggested that a relationship exists between gastric mucosa-associated lymphoid tissue (MALT) lymphoma and gastric carcinoma although the mechanism is unknown. Herein, we report a 53-year-old man who visited to our hospital due to melena. Esophagogastroduodenoscopy (EGD) revealed a MALT lymphoma on the greater curvature of lower body. The patient received anti-Helicobacter pylori eradication therapy, followed by 6 cycles of chemotherapy and radiation therapy, and achieved complete remission 12 months after the therapy. Three years later, he revisited our hospital with epigastric pain. EGD revealed an early gastric cancer on the anterior wall of proximal antrum, nearly opposite to the previous lymphoma site, and a partial gastrectomy was performed. To the best of our knowledge, this is the first case report of metachronous MALT lymphoma and subsequent gastric carcinoma in Korea. (Korean J Gastroenterol 2007;49:245-250)
간경변 환자에서 조영 심초음파검사를 이용한 폐내 단락의 빈도 및 임상적 의의
정석(Seok Jeong),배성권(Sung Kwon Bae),권계숙(Kye Sook Kwon),조성욱(Seong Wook Cho),고광근(Kwang Kon Koh),신용운(Yong Woon Shin),조상균(Sang Kyoon Cho),김순혜(Soon Hye Kim),김삼수(Sam Soo Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.5
Objectives: Intrapulmonary vascular abnormalities resulting in right-to-left shunt have been described in patients with severe liver disease, especially advanced hepatic cirrhosis. They result in hypoxemia which is associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Since Rydell and Hoffbauer first described intrapulmonary shunt in a cirrhotic patient in 1956, it has been reported recently that 13 to 47 percent of the end-stage hepatic disease patients have these intrapulmonary vascular abnormalities. Contrast echocardiography (CE) has been proved useful in detecting intrapulmonary shunt, The aim of the study is to determine the prevalence of intrapulmonary shunt by CE in patients with hepatic cirrhosis, and to campare the clinical characteristics of those with and without evidence of intrapulmonary shunt. Methods: We performed CE studies in 24 stable cirrhotic patients without the evidence of severe complications such as massive ascites, upper GI bleeding, and hepatic coma. Clinical information including symptom and sign, results of liver and pulmonary function tests, and arterial blood gas values measured both at the supine and erect position, were analyzed in each group of patients with or without intrapulmonary shunt. Results: Positive CE suggesting intrapulmonary shunt was found in 8 of 2A patients (33.3%). However the degree of relative opacifications were one positive (1+) in all 8 patients, and hypoxemia and its related symptom and sign appeared to be rare. Any of the parameters of liver and pulmonary function test did not show the significant difference between CE-positive and CE-negative group. Conclusion: Only the presence of spider angioma was associated with intrapulmonary shunt among the several clinical signs, which suggests common pathogenesis of both vascular abnormalities.
상부 위장관내 Helicobacter pylori 감염의 진단법으로서 타액내 특이항체 측정의 유용성
정석(Seok Jeong),신용운(Yong Woon shin),권계숙(Kye Sook Kwon),박기수(Gi Soo Park),김영수(Young Soo Kim),김진주(Jin Ju Kim),주영채(Young Chae Chu) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6
N/A Background/Aims: The measurement of H. pylori antibodies in saliva has been proposed by several investigators as valid test for diagnosis of H. pylori infection. The aim of aur study was to compare the level of sa1ivary H. pylori specific IgG and IgA between H. pylori positive and negative group, and to determine the optimum cut-off value for appropriate sensitivity and specificity of salivary antibody. Methods: 49 dyspeptic patients (35 non-ulcer dyspepsia, 4 duodenal ulcer, 7 gastric ulcer, 3 gastric cancer) underwent upper GI endoscopy with biopsy. Three biopsies were taken from antru: one for rapid urease test, two for histology (Hematoxylin & Eosin, Giemsa stain). The patients were considered to be infected when rapid urease test or histology was positive for H. pylori. 3 ml of unstimulated saliva were obtained frorn each patient before endoscopy and then were centrifuged. The supernatant was diluted 1:4 before testing. H. pylori specific antibodies in saliva were tested with ELISA (G.A.P. test, Bio-Rad, U.S.A.). Results: 1) Salivary H. pylori IgG titer were higher in H. pylori positive than in negative patient (0.13 + 0.09 vs 0.06 + 0.03, p <0.05). 2) In terms of salivary H. pylori IgA titer, there was no difference between H. pylori positive and negative patients. 3) The optimum cut-off value of salivary H. pylori IgG was 0.082 OD and both sensitivity and specifcity were 80% at its cut-off level. Conclusions: The measurement of salivary H. pylori IgG is a convenient, noninvasive and reliable test in the diagnosis of H. pylori infection. (Korean J Gastroenterol 1996; 28:764-769)
급성 호흡곤란증후군 환자에서 발생한 거대세포바이러스 대장염에 의한 장협착
한주영 ( Ju Young Han ),이홍렬 ( Hong Lyeol Lee ),곽승민 ( Seung Min Kwak ),권계숙 ( Kye Sook Kwon ),김경은 ( Gyung Eun Kim ),김준미 ( Joon Mee Kim ),조재화 ( Jae Hwa Cho ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2
Cytomegalovirus (CMV) infection has been described in immunosuppressed individuals such as patients with AIDS, those receiving chemotherapy, and post-transplantation. CMV can cause severe disease either via reactivation of latent virus or via primary infection. In immunocompetent patients, CMV infection is usually transient and does not exhibit many symptoms. The colon is the site most frequently affected by severe CMV disease in immunocompetent patients. Clinically, CMV colitis commonly presents with diarrhea, fever, and abdominal pain. Although some patients recover spontaneously, others suffer from severe complications, such as bowel perforation, severe gastrointestinal bleeding and, rarely, stricture, and surgery is the choice of treatment in these patients. We report a case of stricture of the proximal transverse colon, presenting as a complication of CMV colitis, in an immunocompetent man with acute respiratory distress syndrome. We performed laparoscopic segmental resection of the proximal transverse colon. (Korean J Med 2013;84:284-289)
상부위장관질환과 Helicobacter pylori 독성인자 유전자 아형의 연관성
이진우(Jin Woo Lee),정석(Seok Jeong),김인한(In Han Kim),권계숙(Kye Sook Kwon),최원(Won Choi),이돈행(Don Haeng Lee),조현근(Hyeon Guen Cho),김범수(Pum Soo Kim),김형길(Hyung Gil Kim),신용운(Yong Woon Shin),김영수(Young Soo Kim),최연호(Yo 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2
Background/Aims: Clinical outcome of Helicobacter pylori (H. pylori) infection may be associated with specific virulence-related bacterial genotypes. The present study aimed to assess the relationship between the H. pylori virulence factors such as cagA, vacA, iceA and severity of upper gastrointestinal diseases. Methods: PCR was used to examine cagA, vacA, and iceA genotypes of H. pylori isolates obtained from 92 infected patients with different clinical presentations (14 cases of nonulcer dyspepsia, 26 cases of gastric ulcer, 30 cases of duodenal ulcer, 22 cases of gastric cancer). If sl was positive, DNA sequence was analyzed for its subtype. Results: The positive rate of cagA varies from 78.6% to 96.7% in the clinical subcategories. The positive rates of iceA1 and iceA2 were 88.5% and 0% in patients with gastric ulcer, 86.7% and 3.3% in patients with duodenal ulcer, 72.7% and 13.6% in patients with gastric cancer, and 92.9% and 0% in patients with nonulcer dyspepsia, respectively. No significant difference was found in the prevalence of cagA and iceA among these groups. The vacA genotype slc and ml were predominant in most subjects irrespective of the clinical outcome and we could not find slb and s2 subtypes. The genotype of cagA+ iceAl vacA slc-ml was predominant in Korean H. pylori strains. Conclusions: We could not confirm the previous reports of relationship between the cagA, vacA, iceA status and clinical outcome of patients with upper gastrointestinal diseases. Further study is needed to examine the specificity of H. pylori strains in Koreans. (Korean J Gastroenterol 2001;38:89-97)