길 단편소설선 5 : 어느 택시 드라이버의 경우

허철웅 사회평론 1997 사회평론 길 Vol.97 No.5

장형 위암과 선종

허철웅,이상길 대한상부위장관ㆍ헬리코박터학회 2022 Korean Journal of Helicobacter Upper Gastrointesti Vol.22 No.1

Gastric adenoma (dysplasia) is a precursor for gastric cancer and is closely associated with intestinal type gastric cancer. Thus, accurate diagnosis and proper management of gastric adenoma are extremely critical for preventing gastric cancer. The revised Vienna and World Health Organization classifications have categorized gastric adenomas into two types: high-grade and low-grade dysplasia. High-grade dysplasia requires endoscopic resection due to synchronous carcinoma or the high risk of progression to carcinoma. Although the treatment for low-grade dysplasia remains controversial, endoscopic resection is also recommended due to the potential of progression to carcinomas and the unrevealed histologic discrepancies between forceps biopsy and endoscopic specimens. According to the Lauren classification, gastric cancer is categorized into three histologic types: intestinal, diffuse, and mixed types. Intestinal and diffuse types show a distinct difference in their clinical and epidemiological features. The intestinal type, in its pathogenesis, follows the cascade of non-atrophic gastritis, atrophic gastritis, intestinal metaplasia, adenoma, and intramucosal neoplasia (correa cascade). It tends to appear in older ages than diffuse type and show some predominance in the distal portion of the stomach. It is more common in males and is often associated with environmental factors. In this review, the current knowledge of gastric adenoma and intestinal type gastric cancer, together with relevant diagnostic and therapeutic strategies, is discussed.

Clinical Significance and Risk Factors of Asymptomatic Peptic Ulcer Disease

허철웅,김병욱 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6

COMMENTARY

헬리코박터 파일로리 감염 진단의 최신 지견

허철웅 ( Cheal Wung Huh ),김병욱 ( Byung-wook Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.5

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is mandatory for the effective management of many gastroduodenal diseases. Currently, various diagnostic methods are available for detecting these infections, and the choice of method should take into account the clinical condition, accessibility, advantage, disadvantage, as well as cost-effectiveness. The diagnostic methods are divided into invasive (endoscopic-based) and non-invasive methods. Non-invasive methods included urea breath test, stool antigen test, serology, and molecular methods. Invasive methods included endoscopic imaging, rapid urease test, histology, culture, and molecular methods. In this article, we provide a review of the currently available options and recent advances of various diagnostic methods. (Korean J Gastroenterol 2018;72:229-236)

크론병과 유사한 내시경 소견의 거대세포바이러스 대장염

허철웅 ( Cheal Wung Huh ),윤영훈 ( Young Hoon Youn ),정다현 ( Da Hyun Jung ),김도환 ( Do Whan Kim ),고보건 ( Bo Gun Kho ),김지현 ( Jie Hyun Kim ),박효진 ( Hyo Jin Park ),이상인 ( Sang In Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.4

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn`s disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn`s disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn`s disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment. (Korean J Gastroenterol 2012;59:303-307)

위선종의 내시경 치료

허철웅 ( Cheal Wung Huh ),김병욱 ( Byung-wook Kim ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.3

Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the `wait and see` strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma. (Korean J Gastroenterol 2017;70:115-120)

Endoscopic Factors that Can Predict Histological Ulcerations in Early Gastric Cancers

이재신,김병욱,허철웅,Joon Sung Kim,맹이소 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.3

Background/Aims: Predicting histological ulceration in early gastric cancer (EGC) during endoscopic examination is crucial forendoscopists deciding on the treatment modality. The aim of this study was to investigate the endoscopic factors that can predicthistological ulcerations in EGCs. Methods: We retrospectively analyzed patients who underwent endoscopic submucosal dissection (ESD) for EGC. Clinical features andendoscopic characteristics of EGC such as location, histological differentiation, longest diameter, tumor morphology, mucosal break,converging fold, color change, and surface irregularity were reviewed. Histological ulceration was defined based on ESD specimens. Results: A total of 633 EGC lesions from 613 patients were included and histological ulcerations were found in 90 lesions (14.2%). Presence of converging folds, tumor morphology, and color changes on endoscopic examination were related to histological ulcerationin the univariate analysis and converging folds along with color changes were statistically significant factors in the multivariate analysis. Kaplan–Meier analysis showed that patients with histological ulcerations in EGCs tended to have higher marginal recurrence rates. Conclusions: Mucosal breaks are not equivalent to histological ulcerations. Rather, the existence of converging folds and color changesduring endoscopic examination suggest histological ulcerations. Endoscopists should consider these factors when they decide thetreatment modality for EGCs.

비소세포 폐암환자에서 Docetaxel 투여 중 발생한 아급성 피부 홍반루푸스

신정아 ( Jung Ar Shin ),허철웅 ( Chul Woong Huh ),권지은 ( Ji Eun Kwon ),김형중 ( Hyung Jung Kim ),안철민 ( Chul Min Ahn ),장윤수 ( Yoon Soo Chang ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.5

Drug-induced subacute cutaneous lupus erythematosus (SCLE) is associated with use of the following classes of medications: anti-hypertensives, anti-cholesterolemia, anti-psychotics, and anti-inflammatory drugs. Docetaxel is an anti-neoplastic agent, which is widely used for treatment of non-small cell lung cancer. Few cases of docetaxel-induced SCLE have been reported in the medical literature. Here, we report the case of a 58-year-old female patient who developed drug-induced SCLE after administration of docetaxel. After 4 cycles of chemotherapy with docetaxel and cisplatin, erythematous skin eruptions developed on the patient`s face. Skin biopsies of the eruptions were remarkable for interfacing dermatitis with basement membrane thickening. Immunofluorescent study revealed characteristic features of SCLE, including granular deposition of IgM, C3, and apoptotic bodies along the basement membrane. The skin eruptions resolved gradually after cessation of drug and with the use of topical corticosteroids.

The Effect of Peripheral CRF Peptide and Water Avoidance Stress on Colonic and Gastric Transit in Guinea Pigs

Zahid Hussain,박효진,김혜원,허철웅,이영주 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.4

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common gastrointestinal (GI) diseases; however, there is frequent overlap between FD and IBS patients. Emerging evidence links the activation of corticotropin releasing factor (CRF) receptors with stress-related alterations of gastric and colonic motor function. Therefore, we investigated the effect of peripheral CRF peptide and water avoidance stress (WAS) on upper and lower GI transit in guinea pigs. Dosages 1, 3, and 10 μg/kg of CRF were injected intraperitoneally(IP) in fasted guinea pigs 30 minutes prior to the intragastric administration of charcoal mix to measure upper GI transit. Colonic transits in non-fasted guinea pigs were assessed by fecal pellet output assay after above IP CRF doses. Blockade of CRF receptorsby Astressin, and its effect on GI transit was also analyzed. Guinea pigs were subjected to WAS to measure gastrocolonic transit in different sets of experiments. Dose 10 μg/kg of CRF significantly inhibited upper GI transit. In contrast, there was dose dependentacceleration of the colonic transit. Remarkably, pretreatment of astressin significantly reverses the effect of CRF peptide on GI transit. WAS significantly increase colonic transit, but failed to accelerate upper GI transit. Peripheral CRF peptide significantly suppressed upper GI transit and accelerated colon transit, while central CRF involved WAS stimulated only colonic transit. Therefore,peripheral CRF could be utilized to establish the animal model of overlap syndrome.

단일기관에서의 식도 호산구증가증에 대한 경험

조기원 ( Ki Won Cho ),허철웅 ( Cheal Wung Huh ),정다현 ( Da Hyun Jung ),윤영훈 ( Young Hoon Youn ),박효진 ( Hyojin Park ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

Background/Aims: Esophageal eosinophilia occurs in many conditions, including eosinophilic esophagitis (EoE) and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), which have been increasingly recognized in Western countries. There have been only a few reports in Korea. Here, we evaluated the clinical and endoscopic characteristics of patients with esophageal eosinophilia from our experience. Methods: Nineteen patients were diagnosed with esophageal eosinophilia based on typical symptoms, endoscopic features, esophageal eosinophilia with ≥15 eosinophils/high power field, and response to medication by PPI. Symptoms, endoscopic and pathological findings were evaluated. Results: Of the 19 patients, 2 patients were diagnosed with EoE, 7 patients were diagnosed with PPI-REE, and 10 patients were undetermined due to loss to follow-up. Among these 19 patients, dysphagia was present in 11, and heartburn, dyspepsia and reflux in 8. Sixteen patients had common endoscopic features, such as longitudinal furrows, concentric rings, strictures, and white plaques; however, 3 patients had normal findings. Nine patients underwent endoscopy at the time of follow-up. Two patients had complete resolution, and 3 had partial resolution. However, 4 patients showed no endoscopic changes. All patients showed symptom improvements. Conclusions: The clinical and endoscopic characteristics of both groups in Korea were undistinguishable. However, after treatment, endoscopic findings were different between the two groups. Large-scale studies are warranted to confirm our findings. (Korean J Gastroenterol 2018;72:10-14)