증례 / Billroth II 수술 후 발생한 소장의 세균과다증식에 의한 흡수장애 1예

강태영(Tae Young Kang),은창수(Chang Soo Eun),이정익(Jeong Ik Lee),최창렬(Chang Ryeol Choi),정청일(Chung Il Jeong),전용철(Yong Cheol Jeon),한동수(Dong Soo Han),이오영(Oh Young Lee),윤병철(Byung Chul Yoon),함준수(Joon Soo Ham),이민호(M 대한소화기학회 2001 대한소화기학회지 Vol.37 No.2

A large number of disorders have been associated with proliferation of enteric microorganisms in the small intestine. Billroth II partial gastrectomy is one of the factors that can develop bacterial overgrowth of small intestine. This bacterial overgrowth can lead to malabsorption or disturbed metabolism of intestinal contents. Many cases of bacterial overgrowth after partial gastrectomy have been reported in America and European literature. However, no case has been reported in Korea. Here, we describe a 44-year-old male patient with malabsorption who compalined of abdominal discomfort and peripheral edema. He had a history of Billroth II operation due to perforated gastric ulcer which had occurred 10 years before visiting our hospital. Jejunal biopsy was performed for differential diagnosis. In the aspirated jejunal fluid culture, >105 organisms/mL were observed. After sensitivity based antibiotics therapy, clinical improvement was observed and he recovered well. (Korean J Gastroenterol 2001;37:137-140)

간내담관암에 동반된 종양 색전에 의한 폐쇄성 황달

최호순(Ho Soon Choi),박준용(Joon Yong Park),은창수(Chang Soo Eun),조윤주(Yun Ju Cho),손영우(Young Woo Sohn),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),전용철(Yong Chul Jun),윤병철(Byeong Chul Yoon),함준수(Joon Soo Ham),이민호(Min Ho 대한소화기학회 2000 대한소화기학회지 Vol.36 No.1

Tumor emboli of intrahepatic cholangiocarcinoma in bile duct rarely cause obstructive jaundice. Intraductal tumor embolus is associated with advanced stage of tumor within the liver, and shows poor prognosis and brief survival. However, jaundice by tumor embolus from intrahepatic cholangiocarcinoma must be distinguished from jaundice by common cause, which can be palliated safely and effectively. A patient presented with 1-month history of jaundice and epigastric pain. On cholangiography, polypoid filling defect was observed in the common hepatic duct, which had dilated proximal intrahepatic bile duct and mass shadow on the left lobe of liver. Tumor resection, embolectomy, and bile duct decompression were performed and the obstructive jaundice was relieved. Tumor embolus from intrahepatic cholangiocarcinoma was confirmed intraoperatively and pathologically as the cause of bile duct obstruction. In this report, we describe the rare case of obstructive jaundice by tumor emboli from intrahepatic cholangiocarcinoma with a review of literatures. (Kor J Gastroenterol 2000;36:110 - 116)

췌장의 낭성종양 2예

박경근(Kyung Geun Park),이옥찬(Ock Chan Lee),함준수(Joon Soo Ham),이민호(Min Ho Lee),이동후(Dong Hoo Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4

Cystadenomas of the pancreas are uncommon tumors accounting for 5 to 15 percent of pan- creatic cystic lesions with less than 300 exarnples of this entity having been reported in the lit- erature. Cystadenomas are subdivided into microcystic adenoma(serous cystic adenoma) and mucinous cystic adenoma, the former does not appear to have any malignant potential, while the latter has to be considered as potentially malignant. Microcystic adenoma occurs in elderly patients, is twice as common in wornan, and originates from any location in the pancreas. In contrast, rnucinous cystic adenoma prevails in middle aged woman and is located most fre- quently in the body and tail of the pancreas. The tumors are discovered by chance during in- vestigation for causes of the pains. In some cases, the cyst may compress adjacent structures but a palpable mass is uncommon findings. The diagnosis may be suspected clinically, on ultra- sonography, computed tomography and endoscopic retrograde cholangiopancreaticography. We report each case of microcystic adenoma and mucinous cystic adenoma of the pancreas in 31 years old female and 57 years old female with a review of the literatures. (Korean J Gas- troenterol 1994; 26: 751 757)

췌장 낭종성 종양으로 오인되었던 부신 기원의 신경절성아세포종

박석규(Suck Kyu Park),최호순(Ho Soon Choi),조윤주(Yun Ju Cho),김홍주(Hong Joo Kim),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),전용철(Yong Chul Jun),이오영(Oh Young Lee),윤병철(Byung Chul Yoon),함준수(Joon Soo Ham),이민호(Min Ho Lee) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.4

Neuroblastoma, a tumor of the peripheral nervous system, is the most common extracranial solid tumor of childhood. Neurogenic tumor which includes neuroblastoma is classified into neuroblastoma, ganglioneuroblastoma and ganglioneuroma according to cytologic differentiation. Many cases of ganglioneuroblastoma which is the most rare tumor of neurogenic tumors have been reported during past few decades in U. S and European literature. However, in Korea, only 3 cases of ganglioneuroblastoma in adult have been reported. Recently, we experienced a case of ganglioneuroblastoma which was initially misdiagnosed as pancreatic cystic neoplasm by imaging study. A 27-year-old male patient admitted our hospital with chief complaint of left upper quadrant discomfort and intermittent vomiting. Imaging studies, such as abdominal sonogram, abdominal computed tomography, endoscopic retrograde cholangiopan creatography and angiogram revealed a cystic mass in pancreatic tail portion. The patient underwent mass excision, left nephrectomy and adrenalectomy. Diagnosis of ganglioneuroblastoma of adrenal origin was made on the basis of its histopathologic findings. (Kor J Gastroenterol 2000;36:567 - 572)

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)

이형접합제 PiMZ 및 α1 - Antitrypsin 결핍을 보인 간경변증

기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),안명주(Myung Ju Ahn),고윤석(Youn Suck Koh),함준수(Joon Soo Ham),이종철(Song Chul Lee),강종명(Jong Myung Kang) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

In 1969, Sharp described the first cases of aplhai-antitrypsin deficiency disease in children with juvenile liver cirrhosis. Since then, this inborn error has been recognized as one of the more common factors in cirrhosis of infancy and childhood, especially in Caucasians of Northern Europeans. PiZZ phenotype is the only one associated with liver disease, there have been a few rescent reports of cirrhosis in heterozygous patients. We experienced a case of 24-year-old male patient who was diagnosed as liver cirrhosis by biopsy but had no defintie causes of liver cirrhosis. The laboratory findings were compatible with liver cirrhosis. By biopsy, the liver is composed of variable sized, micro and macronodules. Dense fibrous tissue encase these nodules. The hepatocytes are strongly positive granules and diastase resistant. Pi phenotype was Pi MIZ by IEF (immunoelectric Focusing) method and the plasma alphai- antitrypsin level is lower than normal.

1996년도 제35차 대한소화기학회 추계학술대회 / 식도 운동에서 Raynaud`s Phenomenon의 영향

이민호(Min Ho Lee),기춘석(Choon Seok Kee),김성윤(Sung Yoon Kim),최호순(Ho Soon Choi),배상철(Sang Cheol Bae),함준수(Joon Su Ham),정성수(Sung Soo Jung),한동수(dong Soo Han),윤병철(Byung Chul Yoon),김태환(Tae Hwan Kim),이오영(Oh Young L 대한소화기학회 1996 대한소화기학회 추계학술대회 Vol.1996 No.0

N/A N/A

췌장 외분비 기능검사로서 내시경적 췌관 내 세프레틴 검사 (Intraductal Secretin Test)의 유용성

한동수,이민호,최호순,윤병철,이동후,손주현,조윤주,함준수,전용철,기춘석,박경남,박일규 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3

Background/Aims: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients witd chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation cf the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. Methods: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. Results: When we regarded mean-l.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. Conclusions: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.

담석의 병인 및 담즙검사의 의의에 관한 연구

윤석부,이옥찬,함준수 한양대학교 의과대학 1989 한양의대 학술지 Vol.9 No.1

Two major type gallstones have been described which have different characteristics and etiologies, cholesterol and pigment gallstone. Fromation of cholestrol gallstones depend upon 2 factors, cholesterol superstaturation and nucleation, and it has been proposed that cholesterol gallstones originates from microcrystals of cholesterol. Pigment stones, esp. calcium bilirubinate stones occur most commonly in association with chronic infectious cholangitis that is almost unique to Orient. The pigment is present entirely as unconjugated bilirubte to the formation of pigment stones by producign β-glucuronidase and thus deconjugating bilirubin diglucuronide to unconjugated bilirubin which in turn combines with calcium, leading to stone formation. Bile samples were obtained by Entero-Test, centrifuged and a single drop was immediately examined microscopically, and bacteria isolated from bile were cultured and the β-glucurondase activity were determined. The results were as follows: 1. Total 51 patients were studies; 18 GB stones, 18 CBD stones, and 15 controls. 2. Of the 18 GB stones, 15 (83%) had CMC (Cholesterol Monohydrate Crystal) and 4(22%) of the 18 CBD stones had CMC. (p<0.01 3(17%) of 18 GB stones and 11(61%) of 18 CBD stones had CBG (Calcium Bilirubinate Granule). (p<0.01) 3. No significant difference was found in bacterial incidence between GB and CBD stones. Most frequently isolated bacteria was Escherichia coli and it was more common in CBD stones than in GB stones. (p<0.05) 4. β-glucuronidase activity was found only in CBD stones and was 100% in Escherichia coli. These result suggest that crystalization and β-glucuronidase activity secondary to bacterial infection have an important role in the formation of cholesterol and pigment gallstone, and microscopic bile examination may be helpful in predicting the presence of gallstones.

내시경 결찰술을 이용하여 치료한 위 동정맥 기형 1 예

한동수,이민호,최호순,윤병철,이동후,이오영,손주현,조윤주,함준수,전용철,기춘석,박경남,박석규,손영우,윤경택 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3

Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.