변비를 주소로 내원한 특발성 거대대장

김홍주 ( Hong Joo Kim ),이준행 ( Joon Haeng Lee ),손희정 ( Hee Jung Son ),김영호 ( Young Ho Kim ),이풍렬 ( Poong Ryul Lee ),김재준 ( Jae Joon Kim ),조은윤 ( Eun Yoon Cho ) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

The condition of an idiopathically dilated colon appears to be clinically heterogenous, very uncommon, and subsequently often poorly managed. Recently, one case of idiopathic megacolon presented by constipation was investigated. The patient was abruptly constipated 6 months prior to the hospital visit. The results of a barium enema and colonoscopy were nonspecific. On plain abdominal radiographs, the ascending and transverse colon were markedly dilated, and the descending colon was not visible. During the conservative management, which included laxative and prokinetic medication, the clinical symptoms and the colonic dilatations on plain radiographs were reduced, and discharged. After that however, repetitive admissions due to abdominal distension and constipation ensued, and therefore a total colectomy was performed in order to improve the patient`s quality of life.(Kor ean J our nal of Gastrointestinal Motility 2002;8:191-196)

기능성 소화불량증 환자에서 mosapride의 상부 위장관 증상 및 위배출능에 대한 효과

지상원 ( Sang Won Ji ),박효진 ( Hyo Jin Park ),이풍렬 ( Poong Ryul Lee ),이오영 ( Oh Young Lee ),김동기 ( Dong Ki Kim ) 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1

목적: Mosapride는 5-HT4 수용체 작용제로서, dopamine D2수용체 차단작용이 없는 새로운 위장관 운동촉진제이다. 본 연구에서는 기능성 소화불량증 환자에서 mosapride가 상부 위장관 증상 및 고형식의 위배출능에 미치는 효과를 알아보고자 하였다. 대상 및 방법: 3개의 3차 의료기관에 내원한 기능성 소화불량증 환자를 무작위 배정하여 시험약 mosapride 5mg과 대조약 domperidone 10 mg을 하루 3회, 2주간 투약하였고, 약물 투여 전후로 고형식의 위배출능, 자각증상을 평가하였다. 결과: 총 81명의 환자 중에서 75명이 2주간의 투약을 완료하였다. 자각증상 개선도 평가에서 중등도 효과 이상을 나타낸 비율은 mosapride 군이 84.6%, domperidone 군이 80.6%로 두 약물 모두 높은 개선 효과를 나타냈으며, 두 치료군 간에 유의한 차이는 없었다. 고형식 섭취 120분 후 mosapride 투여 전후의 위배출능은 각각 76.8±16.4%, 82.4±13.5%였으며( p=0.0023), domperidone 투여 전후의 위배출능은 각각 76.5±13.9%, 83.0±10.7%였다( p=0.0022). 그러나, 두 치료군 간에 위배출능 변화량에 대해서는 유의한 차이는 없었다. 안전성 평가에서 mosapride 군에서는 최소한 한 건 이상의 이상반응을 보고한 환자 비율이 11.9%로 domperidone 군(42.1%)에 비해서 유의하게 낮았으며(90% CI=-0.46~-0.15), 임상증상 이상반응, 혈액검사, 심전도 검사, 그리고 활력징후에 있어서도 임상적으로 유의한 변화를 유발하지 않았다. Domperidone 군은 39.5%에서 혈청 prolactin치의 상승이 있었다. 결론: Mosapride는 국내의 기능성 소화불량증 환자의 치료에 있어서 안전하면서도 유용하게 사용될 수 있는 위장운동 촉진제로 생각된다. Backgr ound/Aims: Mosapride is a new, prokinetic, 5-HT4 agonistic agent free of dopamine D2 receptor antagonist properties. The aim of this study was to evaluate the effects of mosapride on upper GI symptoms and gastric emptying in patients with functional dyspepsia. Methods: Eighty-one patients were randomly allocated to treatment with mosapride (5 mg t.i.d) (n=42) or domperidone (10 mg t.i.d) (n=39) in a single-blind, prospective, multicenter study. The changes in gastric emptying and symptom severity score after 2-week treatment were evaluated for the treatment efficacy. Results: The proportion of patients with symptom improvement more than 50% after medications was 84.6% in the mosapride-treated group and 80.6% in the domperidone-treated group, and this difference was not significant ( p=0.6426). In both groups, gastric emptying measured at 120 minutes after test meal was significantly accelerated after 2-week treatment compared with that of baseline. However, there was no significant difference between te two groups after 2-week treatment. Mosapride was well tolerated, and no serious adverse events were observed. Conclusions: Mosapride is a safe and useful drug for the treatment of patients with functional dyspepsia. (Kor J Neurogastr oenter ol Motil 2004;1:27-34)

백서 소장점막의 부위별 Angiotensin Converting Enzyme의 효소 특이활성도차이에 대한 유전적 조절기전에 관한 연구

송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),김재준(Jae Jun Kim),박중원(Joong won Park),윤병철(Byung Chul Yoon),정현채(Hyun Chae Chung),이풍렬(Poong Ryul Lee),임경욱(Kyoung Wook Yim),정숙향(Sook Hyang Chung),유 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Recent reports indicate that angiotensin converting enzyme (ACE) in intestinal mucosa may be involved in protein digestion in vivo. The specific activities of intestinal ACE show regional difference. We performed this experiment to define the level of genetic regulation determining the regional difference of ACE specific activities by the relationship between ACE specific activities and ACE mRNA levels. Small intestines of 3 Wistar rats were removed and divided into 3 segments of equal length. Mucosal homogenate and brush border membrane (BBM) were prepared from scraped mucosa and ACE specific activities were measured in both samples by fluorometric method. Total RNA was extracted by guanidinium thiocyanate and isolated by Cesium chloride,ultracentrifugation. Each 6 ug of isolated RNA was transferred to nitrocellulose membrane by dot and slot apparatus. Northern hybridization with radiolabeled ACE 5 cDNA of mouse was performed and ACE mRNA was detected by autoradiography. The means of ACE specific ar.tivities (uM/ug protein/min) in harnogenate and BBM of proximal intestines were 23.4+- 4.8, 286.3+-80.6, in those of middle intestines were 21.3+-2.0, 211.0+-78.8 and those of distal intestines were 8.2+-1.9, 76.4+-10.7. The means of relative amounts of ACE mRNA in proximal, middle and distal intestines were 75%, 96% and 10% respectively. In linear regression analysis between ACE specific activities of BBM and relative amounts of ACE mRNA, R-value was 0.60 (p<0.05). We concluded that transcription was considered as the level of genetic regulation determining the regional difference of ACE specific activities.

말초형 간내담관암의 수술 후 예후에 관한 고찰

이종철,이상수,이종균,이규택,최성호,김재준,최규완,백승운,고광철,이풍렬,심상군,류광현,이준혁,박철근,손태성,여규동 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Background/Aims: Prognostic factors related to the postoperative survival of patients with peripheral cholangiocarcinoma (PCC) are not well documented. The purpose of this study was to evaluate the clinical and pathologic factors that might influence the postoperative survival of patients with PCC. Methods: Twenty-nine patients with PCC underwent laparotomy between September 1994 and September 1999. Fourteen clinicopathologic factors influencing postoperative survival were analyzed in nineteen patients who underwent hepatic resection (resection group). Ten patients had unresectable advanced tumor (unresectable group). Results: In the resection group, the overall 1-, 2-, and 3-year survival rate was 51.4%, 45.0%, and 28.1%, respectively (median survival of 17.6 months). The median survival in the unresectable group was 4.1 months and no patient lived longer than 1 year. In univariate survival analysis, tumor size and perineural invasion were correlated significantly with overall survival. The survival of patients who underwent resection with positive margin was significantly longer than that of the unresectable group. Conclusions: An aggressive surgical approach provides the best chance for long-term survival of patients with PCC. Tumor size and perineural invasion may be considered as prognostic factors for postoperative survival, but a large, long-term study is needed.

메네트리어병 국내 보고 16예의 임상적 고찰

이종철,김영호,이미숙,이순진,손희정,강태욱,이준행,박동일,김재준,최규완,백승운,이풍렬,임윤정,장재권 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.6

Background/Aims: Menetrier's disease is a poorly defined condition that is f unknown origin, characterized by giant folds in the stomach. The histoiogic fentures are foveolar hyperplasia and cystic dilatation of the gland. We presented the characteristic findings of Menetirer's disease in Korea with a review of literatures to understand the Menetirer's disease more precisely, Methods: The sixteen cases of Menetrier's disease was reported in Korea. We analyzed their age, sex, symptoms, signs, laboratory findings and treatments, retrospectively, Results: The average age was 46 years. There were 11 men and 4 women. The most common symptom was epigastric pain (94%). The most common sign were epigastric tenderness (69%) and pretibial pitting edema (63%). Patients were often associated with the hypoalbuminemia (73%). All patients showed hypertrophic folds on either gastrofiberscopy or upper gastrointestinal series, All patients showed foveolar hyperplasia histologically. Three patients were operated to control a massive upper gastrointesinal bleeding. Two patients were operated to control the intractable edema. Two patients were operated to exclude gastrie malignancy, Conclusions: Menetrier's disease showed broad clinical features such as epigastric pain, hypoalbuminemia, massive hematemesis and mimicking gastric malignancy. The giant gastric folds and foveolar hyperplasia were the most commom and important findings in the Menetrier's disease.

상부 위장관 출혈을 동반한 위결핵 1예

이종철,김영호,이상수,문원,박동일,김재준,최규완,백승운,이풍렬,심상군,이경수,성인경,구진하,류봉춘 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.6

Gastric tuberculosis is quite rare and usually combined with pulmonary tuberculosis. Its diagnosis is so difficult as it is often unsuspected, We report a patient with gastric tuberculosis who presented with hematemesis in Korea, Upper endoscopy showed large, deep penetrating ulcer containing an exposed vessel and adherent clot in the body. Gastric biopsies revealed only chronic inflammation and no evidence of granuloma or malignancy. Diffuse mural thickening was noted on abdominal CT. The diagnosis was made postoperatively following gastrectomy for bleeding gastric ulcer. Microscopic examination of resected stomach showed peptic detritus and noncaseating granulomas. However, multiple caseating granulomas with Lagerhan's giant cells were found on the examination of lymph nodes. The patient was treated with antituberculous therapy for 12 months without any complications.

B형 간염 바이러스 감염과 연관된 비대상성 간경변증 환자에서 라미부딘 치료에 의한 Child-Pugh 점수의 호전

이종철,최문석,김재준,최규완,이준혁,백승운,고광철,박상종,이풍렬 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.4

Background/Aims: Lamivudine is an oral nucleoside analogue with potent antiviral activity against HBV inducing normalization of ALT and improvement of necro-inflammation and fibrosis in chronic hepatitis B. But its role in decompensated cirrhosis has not been established. The Child-Pugh score is a reliable and convenient prognostic indicator reflecting liver synthetic function. We evaluated the incidence of any improvement in Child-Pugh score after lamivudine treatment in patients with decompensated cirrhosis. Methods: Twenty-six patients with HBV associated active decompensated cirrhosis showing detectable serum HBV received lamivudine (100 or 150 mg/day) for 6-45 months (median 16). The Child-Pugh score at 6th month of lamivudine treatment was compared with base line score. Results: The Child-Pugh score improved ( 2-point reduction) in 17 (65.4%) patients, was constant in 8 (30.8%), and aggravated ( 2-point increase) in one (3.8%) of 26 patients. HBV DNA was initially cleared in 24 cases (92.3%) but breakthrough developed in 7 (29.2%). HBeAg was lost in 5 (25%) of 20 cases. Initial improvement was maintained in 14 (82.4%) of 17 cases but aggravated with breakthrough in 3 (17.6%). Two of 5 patients waiting for liver transplantation showed marked improvement and were removed from the list. Conclusion: Lamivudine can be an effective treatment for patients with decompensated cirrhosis due to HBV infection, improving the Child-Pugh score in many cases. However, deterioration of liver function associated with DNA breakthrough was an important problem in patients showing initial improvement. (Korean J Hepatol 2000;6:481-487)

기능성 소화불량증 환자에서 자율신경 기능 이상과 위배출시간의 연관성

이종철,김영호,김창섭,손희정,박동일,김재준,최규완,백승운,고광철,이풍렬,이문규,김지은,심상군,현재근,성인경,장재권,이경한 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Background/Aims: Autonomic nerve dysfunction may be responsible for the pathophysiologic mechanisms of various functional gastrointestinal disorders including functional dyspepsia. We evaluated whether the autonomic nerve dysfunction is related with delayed gastric emptying time. Methods: Forty patients (M:F=11:29, mean age=42.9 years) with functional dyspepsia and 14 asymptomatic controls (M: F=6:8, mean age=41.9 years) were enrolled in this study. Autonomic nerve function was measured by a standardized battery of five cardiovascular reflex tests. Gastric emptying time of solid meal was measured by scintigraphic method and expressed as the retention rate at 120 minutes (RR120). Results: RR120 was greater in the patients group than in the controls (48.1±19.7% vs 28.3±14.1%). Definite, severe, and atypical abnormal autonomic nerve functions were observed in 45% (18/40) of the patients group but not in the controls. The controls showed normal or early abnormality (5/14). Autonomic nerve dysfunction was not reted to delayed gastric emptying (p=0.42) and there was no significant correlation between the autonomic score and RR120 (p=0.55). Conclusions: Patients with functional dyspepsia had significant autonomic nerve dysfunction, as compared to asymptomatic controls. However, autonomic nerve dysfunction was not related with delayed gastric emptying time.

췌장의 관내 유두상 점액성 종양 -1예 보고-

김지은,고영혜,이회정,김용일,이풍렬 대한병리학회 1996 Journal of Pathology and Translational Medicine Vol.30 No.8

위장의 용종 제거에 쓰이는 여러가지 방법의 비교 연구

정현채,송인성,김재준,최규완,윤병철,김정룡,이풍렬,임경욱,정숙향 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.1

The gastric polyps may be premalignant lesions and they should be removed as possible. The gastric polyps can be remoued by various endoscopic methods. The safety and therapeutic effectiveness of snare polypectomy, neodymium YAG laser therapy and electrocutery were compared in a total number of 106 patients who were diagnosed as benign polyps by means of endoscopic biopsy.Safety was evaluated by the rate of complications such as perforation and bleeding, and therapeutic effectiveness was evaluated by the average numbers of treatment session of each modality. Average numbers of treatment session of snare polypectomy, laser therapy and electrocautery were 1.04, 1.38 and l.44, respectively. Average numbers of treatment session of snare polypectomy were significantly (p$lt;0.05) lower than those of other two methods. Perforation was not occurred in any group. Bleeding rates after snare polypectomy, laser therapy and electrocautery were 17.4%, 1.0% and 3.8%, respectively. Bleeding was significantly (p$lt;0,05) more frequent after snare polypectomy than after other two methods. In conclusion therapeutic effectiveness was best in snare polypectomy but complication was most frequent after snare polypectomy. There was no difference between laser therapy and electrocautery for therapeutic effectiveness and safety. Therfore, laser therapy and electrocautery caa be used for the removal of flat adenoma, alternatively.