담낭절제술과 대장암과의 상관관계

은창수,함준수,김기찬,조윤주,전용철,이오영,한동수,손주현,최호순,윤병철,이민호,이동후,기춘석,박경남 (Chang Soo Eun,Joon Soo Hahm,Ki Chan Kim,Yoon Joo Cho,Yong Chul Jun,Oh Young Lee,Dong Soo Han,Joo Hyun Sohn,Ho Soon Choi,Byoeng Chul Yoon,Min Ho 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: It has been suggested that cholecystectomy can be related with the developmen of colon cancer and altered bile acid metabolism after cholecystectomy may be an important facto in the carcinogenesis. Thus, we have conducted a retrospective case-control study to clarify the relationship between cholecystectomy and subsequent development of colon cancer. Methods: We compared the incidence of previous cholecystectomy in 424 patients with colon cancer who had treated in our clinic during the period of 1983 to 1997 and in 424 age- and sex-matched controls Results: There was no significant difference in a prevalence of cholecystectomy and gallstones between colon cancer patients and controls (Cholecystectomy: odds ratio=1.17, 95% confidence interval=0.39-3.51; Gallstone: odds ratio=1.27, 95% confidence interval=0.73-2.21). The prevalence of cholecystectomy and gallstones was a little high in right-sided colon cancer group, but there was no statistically significant difference between right and left colon. Conclusions: The present study showed that there was no statistically significant association between cholecystectomy and colon cancer. To clarify whether colon cancer is associated with cholecystectomy or gallstones, further study with large sample size and a prospective study of the incidence of colon cancer afte cholecystectomy are proposed. (Kor J Gastroenterol 1999;33:823 - 830)

만성 간 질환에서 경직장 Thallium-201 간 스캔의 임상적 의의 및 방사능 분포 양상

박문승(Moon Seung Park),박근태(Geun Tae Park),김진배(Jin Bae Kim),윤병철(Byoeng Chul Yoon),최호순(Ho Soon Choi),함준수(Joon Soo Hahm),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),조석신(Seok Shin Cho) 대한소화기학회 1998 대한소화기학회지 Vol.30 No.4

Background/Aims: Quantification of the portosystemic shunt is important for properly managing the patients, predicting prognosis and adjusting dosages of oral iirugs for chronic liver disease. In this study, we evaluate the clinical significance of tha]lium-'.!01 liver scan for chronic liver diseases mainly in the aspects of radioactivity distribution. MethndIs: From February 1991 to April 1994, 54 patients with chronic liver disease(25 patients with chi anic active hepatitis, 22 Child A cirrhotics, and seven Child B cirrhotics) underwent the scan. The shunt index(H/L ratio) was determined and was classified into three groups according to the patterns of distributioo of radioac- tivity performed in them(Type I: normal, Type II: filling defect in the liver with or without extra hepatic radioactivity, Type III: extrahepatic radioactivity only) Results: The shunt index in cirrho- tics was higher than chronic active hepatitis(0.56+-0.38 vs 0.35+-024 p<0.05). In terms of patterns of distribution of radioactivity l3 patients among 14 patients with type I(93%) were patients with chronic active hepatitis, 14 patients among 25 patients with type II(56%) were cirrhotics and the remaining were patients with chronic active hepatitis. 14 patients among 15 patients with type Ill were cirrhotics. In terms of shunt indices according to the patterns of distribution of radioactivity the shunt index of type III was higher than that of type II and that of type II was higher than type I(0.79+-0,40:0.39+-0.29 p<0.01, 0.39+-0.29:0.21+-0.14 p<0.05). Conclusions: Determination of the shunt index using a per rectal thalliurn-201 liver scan wa:> a useful method for quantifying the porto- systemic shunt noninvasively and it can differentiate chroruc active hepatitis from cirrhosis. Considering that the graver the chronic liver disease is, that moie frequent type III is, we assume that transformation from type I to type III indicates a progres. Ion of chronic active hepatitis to cirrhosis. (Korean J Gastroenterol 1997; 30:495-502)

간동맥 화학색전술 치료를 받은 간세포암 환자의 예후와 혈청 α1 - Antitrypsin 과의 관계

손정일(Chong Il Sohn),황선호(Seon Ho Hwang),박문승(Mun Seung Park),이오영(O . Young Lee),윤병철(Byoeng Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),서흥석(Heung Suk Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

Objectives: Hepatocellular carcinoma(HCC) has a poor prognosis, and only by early detection, cure can be expected by surgery. With development of chemoembolization therapy, we may expect better survival even in the advanced HCC, There many reports about prognostic factors for HCC treated with TAE. We examined relationship between survivals and prognostic factors especially serum a 1-antitrypsin levels in patients with HCC treated with TAE. Methods: 42 patients who had been diagnosed as HCC by ultrasonography and hepatic angiography from 1987 to 1994 were examined for prognostic factors and their survival. Results: Patient's survival who had a single mass was longer (average 21 months) than that of patients who had diffuse tumor(average 4 months, p=0.005). Patient's survival without portal vein thrombosis was longer (average 16 months) than that of patients with portal vein thrombosis (average 4 months, p<0.001). Serologically, patients with low α-fetoprotein level(AFP<40ng/ml) survived longer (average 14 months) than patients with high AFP level(AFP>400ng/ml, average 4 months, p<0.001). Patients with low αl-antitrypsin level (AAT<300 mg/dl) survived longer (average 14 months) than patients with high AAT level (AAT>300mg/dl, average 4 months, p<0.001). Especially, in HCC with low AFP level (AFP<400ng/ml), patients with low AAT level (AAT<300mg/dl) survived longer(average 21 months) than patients with high AAT level (AAT>300mg/dl, average 14 months, p=0.001). Patients with Child's classification A and B showed no signigicant differences in their survival. Conclusion: Serum AAT level may be an important prognostic index in patients with HCC and especially it may be more valuable in patients who had low serum AFP level.

한국인에서 담석증과 인슐린 및 인슐린 저항성과의 관계

김정미 ( Jung Mi Kim ),이항락 ( Hang Lak Lee ),문원 ( Won Moon ),고동희 ( Dong Hee Koh ),이오영 ( Oh Young Lee ),윤병철 ( Byoeng Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민호 ( Min Ho Lee ),이동후 ( Dong Hoo 대한소화기학회 2007 대한소화기학회지 Vol.50 No.3

Background/Aims: Diabetes is one of the risk factors of gallstone diseases. Many studies found a positive association between insulin and gallstones in individuals with diabetes. However, this association is unclear in non-diabetes. So we conducted a case-control study for the evaluation of the association between gallstone diseases and fasting serum insulin level, insulin resistance in non-diabetic Korean general population. Methods: This study was a prospective case-control study on 118 Korean subjects which included clinical examination, abdominal ultrasound, and blood chemistries. Serum fasting insulin level were determined by radioimmunoassay and concentrations of cholesterol, glucose, and triglycerides by standard enzymatic colorimetric methods. Insulin resistance was determined by the homeostasis model assessment (HOMA-IR). Body mass index (BMI), percentage of body fat, and waist hip ratio were also measured. Results: We studied 118 subjects with no clinical evidence of diabetes mellitus and serum glucose <126 mg/dL. Compared with controls (n=89), cases (n=29) had higher levels of serum insulin, glucose, triglyceride levels, and BMI. In t-test and chi-square test for variables, the association between gallstone disease and serum insulin, HOMA-IR index, and BMI were statistically significant (p<0.05). In multiple logistic regression analysis, gallstone disease risk increased with the level of serum insulin (p=0.024, odds ratio=1.376) and HOMA-IR index (p=0.013, odds ratio=2.006). Conclusions: We suggest that hyper-insulinemia and insulin resistance could be associated with gallstone formation in individuals without clinical diagnosis of diabetes mellitus and with normal serum glucose level. (Korean J Gastroenterol 2007;50:183-187)

만성췌장염과 유사한 췌장두부암 1예

조윤주 ( Yun Ju Cho ),최호순 ( Ho Soon Choi ),김진영 ( Jin Yeong Kim ),이용욱 ( Yong Wook Lee ),한동수 ( Dong Soo Han ),손주현 ( Joo Hyun Sohn ),전용철 ( Yong Cheol Jeon ),윤병철 ( Byoeng Chul Yoon ),함준수 ( Joon Soon Hahm ),이 대한소화기학회 1999 대한소화기학회지 Vol.32 No.5

It is important but difficult to differentiate pancreatic cancer without mass formation, chronic pancreatitis and pancreatic cancer coexisting with chronic pancreatitis. These diseases have similar clinical presentations and markedly overlapping findings in various imaging studies, but have extremely different prognosis and treatment modalities. We report a case of pancreatic head cancer without mass formation. Its clinical features are similar to chronic pancreatitis in the initial studies. However, it turned out to be malignant after 4 months. (Kor J Gastroenterol 1998;32:588-694)

한국인 위암 환자의 p53 Codon 72 및 16-bp 중복 다형성 분석

김정미 ( Jung Mi Kim ),이오영 ( Oh Young Lee ),이춘근 ( Chun Geun Lee ),권성준 ( Sung Joon Kwon ),김경숙 ( Kyung Suk Kim ),문원 ( Won Moon ),고동희 ( Dong Hee Koh ),이항락 ( Hang Lak Lee ),윤병철 ( Byoeng Chul Yoon ),최호순 ( Ho 대한소화기학회 2007 대한소화기학회지 Vol.50 No.5

Background/Aims: p53 gene plays an important role in cell cycle control in response to DNA damage which may increase the probability of mutations leading to carcinogenesis. The role of p53 gene polymorphisms [codon 72 (exon 4) and 16-bp duplication (intron 3)] as potential markers indicating cancer risk remains inconclusive, and the data on gastric cancer are very limited. The aim of this study was to assess the role of p53 gene polymorphisms in the risk of gastric cancer and in the determination of genetic susceptibility to gastric cancer in Koreans. Methods: We analysed p53 genotypes using a polymerase chain reaction-based restriction fragment length polymorphism assay in a population-based case-control study in 120 gastric cancer patients and 145 cancer-free controls in Koreans. Results: There was no specific genotype of p53 gene polymorphism in the gastric cancer patients compared to cancer-free controls. In p53 codon 72 and 16-bp duplication polymorphisms, the frequency and distribution of genotypes showed no statistical significance (p=0.7125 and p=0.1659). There was no difference in genotype by histologic subtypes, location of lesion, and age. However, the genotypic distribution in the patient subgroups with a history of heavy cigarette smoking of p53 16-bp duplication polymorphism were significantly different from those of cancer-free controls (p=0.0079). Conclusions: The p53 codon 72 and 16-bp duplication polymorphisms were not associated with the increased risk of gastric cancer and did not seem to contribute to gastric cancer susceptibility among Koreans. It is possible that p53 16-bp duplication polymorphism modulates the risk of smoking-induced gastric cancer development in Koreans. In order to clarify the associations between specific genotypes and gastric cancer risk, the evaluations of these polymorphisms in other ethnic backgrounds with larger number of patients would be needed. (Korean J Gastroenterol 2007;50:292-298)

중합효소 연쇄반응 검사를 이용한 헬리코박터 파이로리의 검출 - 기존 진단법과의 비교

박경남(Kyung Nam Park),김태영(Tae Young Kim),최호순(Ho Soon Choi),박준용(Joon Yong Park),한동수(Dong Soo Han),전용철(Yong Cheol Jeon),함준수(Joon Soo Hahm),이용욱(Yong Wook Lee),윤병철(Byoeng Chul Yoon),은창수(Chang Soo Eun),문광호(G 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3

Background/Aims: The detection of Helicobacter pylori (H. pylori) hoth before and after treatment is very important, but conventional methods to detect H. pylori are less specific. The aim of this study was to evaluate the efficiency of polymerase chain reaction (PCR) assay as a diagnostic method of H. pylori infection. Methods: One hundred ninety three patients were included in the study. Their biopsy specimens obtained from gastric antrum and body were submitted to PCR assay, rapid urease test (CLO test), culture, and histological examination. Results: Fifty eight percent (111 out of 193 patients) of the patients had H. pylori infection. The diagnostic sensitivity/specificity of PCR assay, rapid urease test, histological examination, and culture were 98.2%/95.1%, 95.5%/74,4%, 86.5%/98.8%, and 73.9%/100%, respectively. The positive predictive value/negative predictive value of PCR assay, rapid urease test, histological examination, and culture were 96.5%/97,5%, 83.5%/92.4%, 99%/84.4%, and 100%/73.9%, respectively. The highest sensitivity was achieved in the PCR assay, while the highest specificity was obtained in culture. Conclusions: PCR assay was proved to be the most sensitive test with high specificity for the detection of H. pylori. (Kor J Gastroenterol 1998;32:313-319)

궤양성 대장염과 유사한 양상을 보인 살모넬라 대장염 1예

손병관,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Salmonella species have recently been shown to involve the colon in a fashion resembling ulcerative colitis by radiographic and endoscopic appearance. The presentation of Salmonella colitis is usually similar to that of ulcerative colitis; and often leads to delayed or inappropriate management. Furthermore, Salmonella infection and inflammatory bowel disease (IBD) can coincide in the same patient. Salmonella colitis in the setting of undiagnosed underlying IBD can present a diagnostic dilemma for the clinician. We report a case of Salmonella colitis in which the radiographic and colonoscopic findings were similar to those of ulcerative colitis.

담도 배액관 교체 후 발생한 혈담증

박경남,한동수,이민호,최호순,손주현,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Hemobilia is defined as hemorrhage into the biliary tract and occurs when injury or disease cause communication between the biliary tract and blood vessels. The causes of hemobilia are trauma (accidental, iatrogenic), inflammation, gallstone, neoplasm, and vascular lesions. Currently, the mos common cause of hemobilia is trauma. Specially, iatrogenic causes are considered as the mos important. Iatrogenic cause of hemobilia has increased now because invasive procedures such as liver biopsy, biliary drainage (PTBD, ERBD) were popular. We experienced 2 cases of iatrogenic hemo bilia developed after exchange of ERBD stent.

Minocycline Hydrochloride 1회 주입으로 치료된 거대 간낭종 1예

이준수,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수,김용수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Hepatic cysts are usually asymptomatic, and require no treatment, but occasionally they may become large enough to cause symptoms. Aspiration of cystic fluid, surgical intervention, or instillation of various sclerosing agents has been used. Recently, some reports have shown that treatment with minocycline hydrochloride instillation into the cyst produces good results. We experienced a successful treatment of a huge hepatic cyst by instillation of minocycline hydrochloride. After cystic fluid was aspirated, 600 mg of minocycline hydrochloride was instilled into the hepatic cyst, 15 cm in diameter, through the pigtail catheter under ultrasound guidancee. After 2 months, the cyst could not be detected by diagnostic imaging, and no recurrence was observed. We report a case of successful treatment of a huge hepatic cyst with instillation of minocycline hydrochloride.