대장암에서 Prostaglandin의 역할

명승재 ( Seung Jae Myung ),김인화 ( In Hwa Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.5

Colon cancer is one of the major leading causes of cancer-related deaths in the Western countries. In Korea, the incidence of colon cancer is increasing due to changes in environment and lifestyle such as diet. Chemoprevention strategy using non-steroidal anti-inflammatory drugs (NSAIDs) has been under intensive clinical and epidemiological research as these drugs suppress colorectal cancer. The best known targets of NSAIDs are cyclooxygenase (COX) enzymes, which convert arachidonic acid to prostaglandins (PGs) and thromboxane. Among these PGs, prostaglandin E2 (PGE2) can promote tumor growth by binding its receptors and activating signal pathways which control cell proliferation, migration, apoptosis, and angiogenesis. Therefore, COX inhibition is promising approach for chemoprevention of colorectal cancer. However, the prolonged use of COX-2 inhibitors is associated with unacceptable cardiovascular side effects. Thus, new targets involved in PGs metabolism are under investigation. 15-hydroxyprostaglandin dehydrogenase (15-PGDH), a key metabolic enzyme of PGE2, was up-regulated in normal colonic epithelium, but decreased in colon cancer. Recent findings suggest that 15-PGDH is involved in the neoplastic progression of initiated colonic epithelial cells. Also, new players related with PGs metabolism including prostaglandin transporter (PGT) and microsomal prostaglandin E synthase (mPGES) were reported to play a role in colorectal cancer development. This review presents current knowledge about the role of prostaglandins and associated proteins in colorectal cancer development and progression. (Korean J Gastroenterol 2008;51:274-279)

급성 B형 간염의 회복 후 말초혈액 단핵구에서의 HBV DNA 검출

명승재(Seung Jae Myung),이영상(Yung Sang Lee),김형건(Hyung Gun Kim),이근찬(Geun Chan Lee),박능화(Neung Hwa Park),정영화(Young Hwa Chung),서동진(Dong Jin Suh) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Background/Aims: Negative seroconversion of HBsAg with the appearance of anti-HBs and normalization of serum transarninase level have been generally accepted as an evidence of a cure of hepatitis B, and viral clearance. However, there are growing evidences that the hepatitis B virus (HBV) genome persists after those events. HBV DNA could be detected from the serum, peripheral blood mononuclear cells (PBMC) and liver tissue by sensitive PCR method, even when HBsAg is undetectable from the serum during the course of chronic hepatitis B. The aim of this study is to demonstrate whether HBV might persist in the circulation after complete serologic and clinical recovery from acute hepatitis and its clinical manifestations implications. Methods: We tried to detect HBV DNA from the serum and PBMC of 24 healthy individuals (male 16, female 8) with a history of self-limited acute hepatitis B infection using the PCR-Southern hybridization. Results: The mean duration from the onset of acute hepatitis to the time of sampling was 19+11 months, and HBV DNA was undetectable from sera of the individuals with PCR and Southern hybridization. HBV PCR was performed after the separation of PBMC and DNA isulation. HBV DNA was amplifiable in 4 of 24 individuals (17%). By Southem hybridization, HBV DNA was confirmed in 4 positive samples. The duration from the onset of acute hepatitis to the sarnpling time in positive group was 7.0 3.2 montks, and was significantly shorter than DNA negative counterpart (21.5 10.5 months)(p<0.01). Conclusions: Hepatitis B virus DNA can persist in peripheral blood mononuclear cells after resolution of acute hepatitis, and it may persist only for a certain period after clearance of virus in the serurn. The role of HBV DNA in PBMC should be elucidated in the future. (Korean J Gastroenterol 1997; 29:74-84)

변비의 진단: 체계적인 문헌고찰

명승재 ( Seung Jae Myung ),이태희 ( Tae Hee Lee ),허규찬 ( Kyu Chan Huh ),최석채 ( Suck Chei Choi ),손정일 ( Chong Il Sohn ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.5

To diagnose constipation accurately in self-reported constipated patients is very important not to miss organic disease and prevent therapeutic abuse. To investigate the etiology of functional constipation is also important to determine the therapeutic modality of constipation. In this systemic review, the clinical usefulness of symptom evaluation, diagnostic tests to rule out organic and systemic disease, and functional tests to discriminate underlying pathophysiology in the diagnosis of constipation were discussed. No specific symptoms or tests were available to predict organic versus functional constipation or differentiate slow transit constipation versus evacuation disorder. Therefore, collaborative studies are necessary to determine the pathophysiology of this disorder. (Korean J Gastroenterol 2010;55:316-324)

대장 종양과 장 염증: C-Reactive Protein은 종양 예측인자로 개발될 수 있을 것인가?

명승재 ( Seung Jae Myung ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4

만성 가성 장폐쇄 환자의 임상양상과 치료 대책

명승재 ( Seung Jae Myung ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1

단독 전기자극치료로 임상적 호전을 보인 직장 감각능 저하를 동반한 변비 환자 1 예

장혜숙(Hye Sook Chang),명승재(Seung Jae Myung),윤인자(In Ja Yoon),양석균(Suk Kyun Yang),정훈용(Hwoon Yong Jung),홍원선(Weon Seon Hong),김진호(Jin Ho Kim),민영일(Young Il MIn),유창식(Chang Sik Yu) 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2

Patients with intractable constipation often complain of social, physical and psychological stress. Recently, biofeedback therapy is widely used in the management of intractable constipation and improve the defecation act, particularly in cases of constipation associated with pelvic floor dyssynergia. However, some of constipated patients show only decreased rectal sensation and increased rectal compliance on the anorectal function tests. It is unclear whether the decreased rectal sensation is a cause or outcome of constipation and not known how to treat such cases. We recently experienced a 25-year-old female patient who complained of constipation. She had intractable constipation, which made her attempt a suicide. Colon transit time study and defecogram showed nonspecific findings. Her anorectal manometric findings were within normal ranges except rectal sensation and compliance. Rectal volume for desire and urge to defecate, and maximal tolerable volume were markedly increased and compliance was impossible to measure. She was treated by electrical stimulation therapy. After electrical stimulation therapy, her constipation symptoms improved dramatically. Furthermore, the desire and urge volume were decreased and the compliance became calculated. We report this constipation case with decreased rectal sensation and increased rectal compliance possibly treated by electrical stimulation therapy. (Korean Journal of Gastrointestinal Motility 2001;7:245-250)

비만과 대장암

나수영 ( Soo Young Na ),명승재 ( Seung Jae Myung ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.1

Obesity worldwide is constantly increasing. Obesity acts as an independent significant risk factor for malignant tumors of various organs including colorectal cancer. Visceral adipose tissue is physiologically more important than subcutaneous adipose tissue. The relative risk of colorectal cancer of obese patients is about 1.5 times higher than the normal-weight individuals, and obesity is also associated with premalignant colorectal adenoma. The colorectal cancer incidence of obese patients has gender-specific and site-specific characteristics that it is higher in men than women and in the colon than rectum. Obesity acts as a risk factor of colorectal carcinogenesis by several mechanisms. Isulin, insulin-like growth factor, leptin, adiponectin, microbiome, and cytokines of chronic inflammation etc. have been understood as its potential mechanisms. In addition, obesity in patients with colorectal cancer negatively affects the disease progression and response of chemotherapy. Although the evidence is not clear yet, there are some reports that weight loss as well as life-modification such as dietary change and physical activity can reduce the risk of colorectal cancer. It is very important knowledge in the point that obesity is a potentially modifiable risk factor that can alter the incidence and outcome of the colorectal cancer. (Korean J Gastroenterol 2012;59:16-26).

기능성 변비 환자에서 골반저 근실조 환자를 구별해 낼 수 있는 임상적 지표

김대현 ( Dae Hyunn Kim ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),정성희 ( Sung Hee Jung ),장혜숙 ( Hye Sook Chang ),박일권 ( Il Gwon Park ),정훈용 ( Hwoon Yong Jung ),홍원선 ( Weon Seon Hong ),김진호 ( Jin Ho Kim ) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

N/A PFD is effectively treated by biofeedback therapy. For the definite diagnosis of PFD, defecography, colon transit time study, balloon expulsion testing, and anorectal manometry are needed. However, these methods are of high cost and cause discomfort to patients. Moreover, definite diagnosis cannot be made by a single test due to a high false positive rate. In general, several symptoms linked with problems in defecating, including excessive straining, the sensation of incomplete evacuation, and applying pressure around the anus or the vagina to facilitate defecation, are known to be frequently associated with PFD. The aim of this study was to evaluate whether specific clinical parameters could differentiate patients with PFD from other constipated patients. Methods: An organized questionnaire including 47 questions that contained subjective symptoms, past medical history, and eating habits was designed. The questionnaire was distributed to 132 patients who fulfilled Rome II criteria for functional constipation. Digital rectal examination was conducted by a single gastroenterologist. Results: Among 132 patients, 45 patients were categorized as PFD, 26 patients as slow transit constipation (STC) and 17 patients as normal transit constipation. Among specific questions about constipation, hard stool was more frequently noted in patients with STC than PFD (p<0.05), and the frequency of defecation was lower in patients with STC than PFD (p<0.05). However, the symptoms suggesting difficult defecation were not different between the two groups. The percentage of paradoxical contraction by digital rectal examination was not different between the two groups (PFD: 57.1% vs. STC: 48.0%). Conclusion: The symptoms and signs suggesting difficult defecation could not differentiate PFD from STC and normal transit constipation, although several parameters were different among the three subgroups. Therefore, anorectal physiologic tests are needed for the diagnosis of PFD.(Kor ean J our nal of Gastrointestinal Motility 2002;8:167-176)

골반저 근실조 환자의 직장항문내압검사에 따른 분류와 그 임상적 의의

정성희 ( Sung Hee Jung ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),정훈용 ( Hwoon Yong Jung ),김대현 ( Dae Hyun Kim ),김태훈 ( Tae Hun Kim ),장혜숙 ( Hye Sook Chang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),홍원선 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: The pathophysiology of pelvic floor dyssynergia (PFD) is unclear and heterogenous. The PFD patient could be classified according to several manometric patterns. However, its clinical significance is not known. The aims of this study were to classify PFD patients according to manometric patterns and to evaluate its clinical meaning including response to biofeedback therapy. Methods: Seventy patients (M:F 21:49, mean age 51±18) with PFD who fulfilled Rome criteria were examined with anorectal manometry. These patients were classified into 4 groups according to manometric patterns. The types were defined as follows: Type 1, adequate propulsive force with paradoxical anal contraction (n=49); type II, inadequate propulsive force with inappropriate anal contraction (n=3); type III, adequate propulsive force with failure to relax (n=13); type IV, inadequate propulsive force with failure to relax (n=5). We compared the clinical findings, parameters of manometry, and responses to biofeedback therapy of the 4 groups. Results: Clinical findings including subjective symptoms were not different among the 4 groups. On anorectal manometry, squeezing pressure was low in type II and type IV compared to type I and type III (p<0.05). Only forty patients underwent biofeedback therapy, and there was no difference in the biofeedback response rate among the 4 groups. Conclusions: Pelvic floor dyssynergia could be classified into four groups according to manometric patterns. However, the significance of this classification system is dubious because clinical features including responses to biofeedback therapy are not different among groups. (Korean J Gastroenterol 2003;41:456-464)

항인지질 증후군과 연관된 허혈성 대장염

황창연 ( Chang Yun Hwang ),명승재 ( Seung Jae Myung ),장혜숙 ( Hye Sook Chang ),양석균 ( Suk Kyun Yang ),김태훈 ( Tae Hun Kim ),정훈용 ( Hwoon Yong Jung ),홍원선 ( Weon Seon Hong ),김진호 ( Jin Ho Kim ),민영일 ( Young Il Min ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

There are various causes of ischemic colitis. It can be largely divided into occlusive and non-occlusive causes: thrombus formation in the superior or inferior mesenteric arteies secondary to atherosclerotic vascular lesion is one of the most frequent occlusive causes; hypotensive state due to causes such as hemorrhage is one of common examples of non-occlusive causes. Antiphospholipid antibody is associated with numerous thromboembolic phenomena. We report a case of elderly male who presented with ischemic colitis and was diagnosed as having antiphospholipid syndrome later. He was positive for lupus anticoagulant, showed mesenteric venous thrombosis on abdominal CT, and experienced acalculous cholecystitis during the hospital course. The patient`s clinical, laboratory, and pathologic findings are consistent with ischemic colitis associated with antiphospholipid syndrome. (Korean J Gastroenterol 2003;41:504-508)