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)

위식도역류질환 환자의 식이 위험요인 및 삶의 질

양선영 ( Sun Young Yang ),이오영 ( Oh Young Lee ),김혜은 ( Hye Eun Kim ),장유경 ( Yu Kyoung Chang ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),정용건 ( Yong Gun Chung ),조찬호 ( Chan Ho Cho ) 대한내과학회 2006 대한내과학회지 Vol.70 No.6

Background: The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study is to evaluate the dietary habit which is commonly known as risk factor of GERD and the quality of life in GERD patients. Methods: This study enrolled 52 patients (ERD; erosive reflux disease 38, NERD; non-erosive reflux disease 14) as patient group. They were completed the questionnaires about dietary habit and quality of life. All datas were compared with 23 healthy volunteer group who visited same hospital for health screening. Results: Patient group had more dietary risk factors such as unbalanced diet, irregular diet, using lots of sauces, having snacks or meals within 3 hours of bedtime and suffering from epigastric discomfort after alcohol drinking (p<0.05). Patient group preferred to have spicy food, soft drink, coffee and tea, fried food, instant food and noodles (p<0.05). ERD group more frequently had snacks or meals just before sleep, suffered from discomfort after drinking, and preferred to have fried food (p<0.05). GERD patients reported significantly worse scores on 6 SF-36 scales, such as physical function, role limitations-physical, role limitations-emotional, mental health, social function, and general health perception. Conclusions: We found that ERD patients had more snacks or meals within 3 hours of bedtime and fried food. Also, they were suffering from epigastric discomfort after alcohol drinking. Patients with GERD experienced decrements in health-related quality of life compared with the control subjects.(Korean J Med 70:627-635, 2006)

간 이식 후 합병된 담관 원주 증후군에 의한 폐쇄성 황달

백상현 ( Sang Hyun Bak ),최호순 ( Ho Soon Choi ),양선영 ( Sun Young Yang ),전대원 ( Dae Won Jun ),한성희 ( Sung Hee Han ),이항락 ( Hang Lak Lee ),이오영 ( Oh Young Lee ),윤병철 ( Byung Chul Yoon ),함준수 ( Jun Soo Hahm ),이민호 ( 대한소화기학회 2006 대한소화기학회지 Vol.48 No.2

Biliary complication occurs in 6-34% of all liver transplant patients. Although bile leaks and strictures are relatively common, other biliary complications such as T-tube leak, choledocholithiasis, and biliary cast syndrome can also be observed. The biliary cast syndrome describes the presence of casts causing obstruction with its resultant sequelae of biliary infection, hepatocyte damage secondary to bile stasis and ductal damage, all contributing to cholangiopathy. Because the exact timing of cast formation after orthotopic liver transplantation is not consistent, it is difficult to define the true incidence of biliary cast syndrome without long-term follow-up data. Proposed etiological mechanisms include acute cellular rejection, prolongation of cold ischemic time, infection, biliary drainage tubes, and biliary obstruction. The diagnosis of biliary cast syndrome is usually confirmed by endoscopic retrograde cholangiopancreatography. There have been few published articles about biliary casts in Korea. Herein, we report a case of biliary cast syndrome followed by orthotopic liver transplantation. (Korean J Gastroenterol 2006;48:119-123)

만성 간질환의 진행 정도 평가를 위한 비침습적 검사들의 상관관계와 임상적 의의

박근태,전대원,유영조,최춘식,정진웅,김진배,윤병철,최호순,함준수,박경남,이민호,이재원 (Geun Tae Park,Dae Won Jeon,Young Jo Yoo,Choon Shik Choi,Jin Woong Jung,Jin Bae Kim,Byoung Chul Yoon,Ho Sun Choi,Joon Soo Hahm,Kyoung Nam Park,Min Ho Le 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: We aimed to figure out a correlation of non-invasive tests for the diagnosis o chronic active hepatitis (CAH) or liver cirrhosis (LC). Methods: We measured the levels of serum albumin, bilirubin, alanine aminotransferase (ALT), asparate aminotransferase (AST), cholesterol prothrombin time, ICG-Rmax and shunt index (heart/liver ratio) in 174 patients with CAH and 80 patients with LC (Child A, 73 patients; Child B, 7 patients). A correlation of these values to evaluat the progression to liver cirrhosis was figured out from the multiple regression analysis. Results: There were significant differences between CAH patients and LC patients in the ratio of ALT to AST (ALT/AST, 1.45 ±0.05 vs 0.99 ±0.05), prothrombin time (93.9 ±1.2% vs 77.1 ±2.4%), ICG-Rmax (2.11 ±0.15 vs 1.07 ±0.12) and shunt index (0.21 ±0.00 vs 0.60 ±0.03). The multiple regression analysis of non-invasive tests yielded a formula, Y=3.3431 -0.8160 ×ALT/AST -0.0343 ×prothrom-bin time +2.6963 ×shunt index & p=ey/(ey+1), which can estimate the progression of chronic liver disease. The p value was less than 0.7 in 126 (96.2%) of 131 CAH patients, while 47 (68.1%) o69 LC patients showed p value over 0.7. Conclusions: When the p value mentioned above exceed 0.7, CAH is likely to develop into an early LC. These results suggest that the formula inferred from the multiple regression analysis of non-invasive tests may be used to evaluate the progression of chronic liver disease without the repeat of liver biopsy. (Kor J Gastroenterol 1999;33:799 - 807)

기타 : 디지털 영상 전송 시스템을 이용한 원격진료

함준수 ( Joon Soo Hahm ),변태준 ( Tae Jun Byun ),이항락 ( Hang Lak Lee ),최호순 ( Ho Soon Choi ),고용 ( Yong Ko ),이경근 ( Kyeong Geun Lee ),김선일 ( Sun Il Kim ),김태은 ( Tae Eun Kim ),윤지원 ( Ji Won Yun ),박용진 ( Yong Jin Par 대한소화기학회 2004 대한소화기학회지 Vol.43 No.6

Background/Aims: The growth of technology based on internet protocol has affected on the informatics and automatic controls of medical fields. The aim of this study was to establish the telemedical educational system by developing the high quality image transfer using the DVTS (digital video transmission system) on the high-speed internet network. Methods: Using telemedicine, we were able to send surgical images not only to domestic areas but also to international area. Moreover, we could discuss the condition of surgical procedures in the operation room and seminar room. The Korean-Japan cable network (KJCN) was structured in the submarine between Busan and Fukuoka. On the other hand, the Korea advanced research network (KOREN) was used to connect between Busan and Seoul. To link the image between the Hanyang University Hospital in Seoul and Kyushu University Hospital in Japan, we started teleconference system and recorded image-streaming system with DVTS on the circumstance with IPv4 network. Results: Two operative cases were transmitted successfully. We could keep enough bandwidth of 60 Mbps for two-line transmission. The quality of transmitted moving image had no frame loss with the rate 30 per second. The sound was also clear and the time delay was less than 0.3 sec. Conclusions: Our study has demonstrated the feasibility of domestic and international telemedicine. We have established an international medical network with high-quality video trans-mission over internet protocol. It is easy to perform, reliable, and also economical. Thus, it will be a promising tool in remote medicine for worldwide telemedical communication in the future. (Korean J Gastro-enterol 2004;43:370-375)

1996년도 제35차 대한소화기학회 추계학술대회 / Rhabdomyolysis를 동반한 간 세포암 1예

기춘석(Choon Suhk Kee),김태영(Tae Young Kim),이민호(Min Ho Lee),한동수(dong Soo Han),이오영(Oh Young Lee),윤병철(Byoung Chul Yoon),최호순(Ho Sun Choi),장세진(Se Jin Jang),박경남(Kyoung Nam Park),손주현(Joo Hyun Sohn),김승현(Seung Hyu 대한소화기학회 1996 대한소화기학회 추계학술대회 Vol.1996 No.0

N/A N/A

만성 B 형 간염 환자 간조직의 제 Ⅳ형 Collagen, Laminin, 및 Fibronectin 의 발현과 임상검사 성적과의 비교

김진배 ( Jin Bae Kim ),박근태 ( Geun Tae Park ),황선호 ( Sun Ho Hwang ),박문승 ( Moon Seung Park ),최호순 ( Ho Soon Choi ),윤병철 ( Byoung Chul Yoon ),함준수 ( Joon Soo Ham ),기춘석 ( Chun Suk Kee ),박경남 ( Kyoung Nam Park ),홍 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Background/Aims: Hepatic fibrosis is caused by increased deposition of liver connective tissue components in the intercellular space. This leads to disturbance of intrahepatic blood flow and hind rance of exchange process between blood and cells. We investigated the deposition of extracellula matrix in the liver of patient with HBsAg positive chronic liver disease and the results were compared with those of other liver function tests. Methods: Needle-biopsied specimen was obtained from 31 patients with mild chronicactive hepatitis (CAH), 30 patients with moderate CAH, 19 pati ents with severe CAH, and 18 patients with cirrhosis. Immunohistochemical stains using antibodies were performed for type Ⅳcollagen, fibronectin and laminin. Results: Shunt index which could be measured with Thallium 201 scan was significantly increased according to the degree of stain for type Ⅳcollagen in portal area, especially in severe chronic active hepatitis and cirrhosis group. Pro thrombin time (%) and serum albumin were decreased according to the degree of stain for laminin in lobule. Conclusions: These results suggest that the deposit of type Ⅳcollagen in portal area i a major contributing factor in the development of intrahepatic shunt and the deposit of laminin within Disse' s space may cause impairment of the hepatic function in cirrhosis. (Kor J Gastroentero1999;33:786 - 798)

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)

간장 및 담도 : 간세포암 치료에 있어서 간동맥 색전술의 이용 - 임상경험 24예 -

기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이성구(Sung Koo Lee),이종철(Jong Chul Rhee),유종상(Jong Sang Ryue),최호순(Ho Soon Choi),박민선(Min Sun Park),서흥석(Heung Suk Seo) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

N/A 24 patients with unresectable hepatocellular carcinoma were treated with transcatheter arterial embolization. The results were as followings: 1) The serum levels of AFP were decreased in about 80 percent of the patients with elevated AFP. 2) We found the low density areas in the CT after embolization which meant the effect. 3) Side effects were fever, nausea and vomiting in almost of all patients but subsided within several to ten days.

1 형과 2 형 당뇨모델 흰쥐에서 Chromium Picolinate 의 당내성과 인슐린 감수성에 대한 영향

신현진(Hyun Jin Shin),홍정희(Jeong Hee Hong),고현철(Hyun Chul Koh),신인철(In Chul Chin),최호순(Ho Soon Choi),김태화(Tae Hwa Kim),김동선(Dong Sun Kim),엄애선(Ae Son Om),강주섭(Ju Seop Kang) 한국응용약물학회 2001 Biomolecules & Therapeutics(구 응용약물학회지) Vol.9 No.4

Chromium is an essential nutrient and participates in glucose and lipid metabolism in human beings and animals. The present study was conducted to assess the effects of chromium picolinate (Cr-pic) on glucose tolerance and insulin sensitivity in type Ⅰ and Ⅱ diabetic rats. The experimental groups were type Ⅰ diabetic (streptozotocin-induced: 40㎎/㎏, i.p.) and type Ⅱdiabetic (Goto-Kakizaki rats) models. Each group was subdivided into control, low-dose and high-dose of Cr-pic treated groups. The Cr-pic was orally administered with Cr-pic (100 mg/kg for low dose group and 200㎎/㎏ for high dose group) for 4 weeks. And then we performed intraperitoneal glucose tolerance test (IPGTT) and insulin sensitivity test (ITT). The glucose tolerance test was carried out by injection of glucose (2 g/㎏, i.p.). The peripheral insulin sensitivity test was conducted by injection of insulin (5 units/㎏, s.c.) and glucose. We performed determining of blood glucose concentration at 0, 10, 30, 60, 90, and 120 min using automated glucose analyzer. The plasma insulin concentration was determined by rat insulin EIA kit. Administration of Cr-pic improved weight gain in all groups with higher significant in the low-dose group. There was no significance between the control and the Cr-pic treated groups in the area under the blood glucose curve and serum insulin concentration plots of IPGTT and peripheral ITT in type Ⅰ diabetic rats. But Cr-pic treated groups showed significantly lower levels of the area under the blood glucose curve during IPGTT and ITT and the high-dose group showed less effects compared with the low-dose group in the type Ⅱ diabetic rats. The plasma insulin concentration of both diabetic groups was not influenced by Cr-pic supplementation. We can conclude that chromium picolinate may improve the endogenous and exogenous insulin action and peripheral insulin sensitivity in type Ⅱ diabetic rats.