대장 흑색소증의 임상적 고찰

박인서(In Suh Park),문영명(Young Myoung Moon),정재복(Jae Bock Chung),이상인(Sang In Lee),김원호(Won Ho Kim),이관식(Kwan Sik Lee),정현주(Hyeon Joo Jeong),박효진(Hyo Jin Park),정준표(Jun Pyo Chung),박경아(Kyung Ah Park),남문석(Moon Suk 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

Melanosis coli associated with ingestion of anthraquinone compounds in laxatives is due to accumulation of macrophages containing brown lipofuscin-like pigments in the lamina propria. We analyzed the clinical, endoscopic, and pathologic findings and colonic motor functions of melanosis coli and performed electronmicroscopic study to know the ultrastructural changes of neural elements. We studied 13 cases (mean age 48.1 +- 18.5 years, male to female cases 6:7). The vegetable laxatives containing anthraquinone derivatives, aloe or bisacodyl were used mainly and the mean duration of laxative abuse was l.5 +- 1.2 years. Endoscopically, dark brownish mucosal disoloration showed polyhedral forms divided by fine striae of lighter color. Melanosis was more intense in the more oral part of the bowel. Pathologically, no relationship was found between grade of melanosis and kind of drugs, daily dose, or durat.ion of addiction. Ultrastructural features on nerve structure were ballooning of axon. reduction of nerve specific cell organelles, and increased lysosomal activity. The alterations of these neural elements are assumed to he associated with impaired colonic motility. In conclusion, vegetable laxatives such as aloe, seem to be an important causes of melanosis coli in Korea. melanosis coli have a tendency to damage nerve fibers. We should avoid laxative abuse in order to prevent pragressing to cathartic colon.

췌장암에서 p53 단백발현의 임상적 의의

박인서(In Suh Park),정재복(Jae Bock Chung),박찬일(Chan Il Park),송시영(Si Young Song),이돈행(Don Haeng Lee),이우정(Woo Jung Lee),박영년(Young Nyun Park) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

Background/Aims: Alteration in the p53 tumor suppressor gene are involved in the pathogenesis of diverse human cancer. Immunohistochemical detection of the p53 protein has been strongly correlated with rnutations in the p53 gene. Although p53 overexpression or mutation have been elucidated in a variety of cancers, there has been no study in pancreatic cancer in Korea. The purpose of this study is to evaluate the expression rate of p53 protein in pancreatic cancer. In addition, we attempted to clarify the association between expression of p53 and clinicopathologic features including survival. Methods: Using immunohistochemistry with monoclonal antibody to p53(Zymed Lab. Clone No. BP53-12), we exained 47 formalin-fixed paraffin-embedded tissues of pancreatic cancer(39 intraductal adenocarcinoma, 8 rnucinous adenocarcinoma) for overexpres- sion of p53 gene product. Results: Positive nuclear p53 immunoreativity was detected in 44.6% of pancreatic cancer. No clear correlation was found between p53-positive immunostaining and clinicopathologic features such as age, sex, tumor size, location, histologic type, differentiation of tumor cells and stage of tumnor, etc. The mean duration of survival was 8.6 months in the group of p53 positive and 9.6 months in the group of p53 negative and no difference was noted between two groups. Conclusions: These results suggest that mutation of p53 tumor suppressor gene may play a role in the pathogenesis of pancreatic cancer. However there was no correlation between the presence of p53 overexpression and clinicopathologic features or survival. (Korean J Gastroenterol 1997; 30:98 - 102)

간암세포주를 대상으로 한 체외 복합 항암제 감수성 검사

박인서(In Suh Park),정재복(Jae Bock Chung),김병수(Byung Soo Kim),김주항(Joo Hang Kim),노재경(Jae Kyung Roh),유내춘(Nae Chun Yoo),조재용(Jae Yong Cho),최진혁(Jin Hyuk Choi),임호영(Ho Yeong Lim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

Primary hepatocellular carcinoma(HCC) is one of the most common malignancies in Korea due mainly to high incidence of chronic hepatitis B virus infection. Most of the HCC are inoperable even at first presentation. So chemotherapy could be one of the major therapeutic modalities, but HCC is seldom chemosensitive. This type of chemoresistance is explainesd by high level of expression of multidrug resistance(MDR) gene and p-glycoprotein. We initiated this study to establish the in vitro model of drug selection and combination for HCC. Three human HCC cell lines and five cytotoxic drugs were used. MTT assays for cytotoxicity test were performed with single chemotherapeutic agent and various two drug combinations. Slot blot analysis for measuring the expression levels or MDR1 RNA was performed and demon strated that 2 HCC lines show moderate to high degree of MDRI expression, The ranges of drug concetration which causes 50% inhibition of the cell lines(IC50) are in the clinically achievable concentrations for the 5-fluorouracil in two HCC lines, and adriamycin in one cell line. Two cell lines which showed positive MDRI exression were resistant to adriamycin. But all three cell lines were sensitive to etoposide irrespective of MDR1 expression. In thelinically achievable concentration ranges those we tested, singnificantly improved cytotoxic effects are demonstrated in combinations of etoposide plus cisplatin, and etoposide plus mitomycin-C out of 10 possible two drug combinations. These data indicate the need for in vivo trials with the combination chemotherapy of etoposide plus cisplatin or etoposide plus mitomycin-C for HCC.

중합효소 연쇄반응법을 이용한 Helicobacter pylori 감염 진단과 cagA와 위염 중증도간의 상관 관계

박인서(In Suh Park),이상인(Sang In Lee),박효진(Hyo Jin Park),박형석(Hyung Seok Park),윤상애(Sang Ae Yoon),유기숙(Kie Sook Yoo),정상수(Sang Su Chung) 대한소화기학회 1998 대한소화기학회지 Vol.31 No.3

Background/Aims: After the identification of Helicobacter pylori as a major cause of gastric and duodenal ulcer, special attention has been paid to this bacterium. The aim of this study is to prove the usefulness of the 16S rRNA polymerase chain reaction (PCR) assay as a diagnostic method of H. pylori infection in the gastric biopsy specimens and to investigate whether the severity of histological gastritis is related to the cagA. Methods: Biopsy specimens were obtained from the gastric antrum of 46 patients with chronic gastritis during endoscopy. Histological examination, CLO test and PCR using 16S rRNA and cagA primer were performed. Results: The 16s rRNA PCR were positive in 27 out of 28 infected patients, and negative in 3 out of 18 not-infected patients. The sensitivity of 16S rRNA test for the diagnosis of H. pylori infection was 96.4% and the specificity was 83.3%. The degree of chronic inflammation and activity were more severe in the H. pylori infected patients than in the not-infected controls (p<0.05). No significant difference in histological parameters was noted between cagA positive and cagA negative groups. Conclusions: The 16S rRNA PCR is a highly sensitive but somewhat less specific test for the diagnosis of H. pylori infection. We suggest that careful cleansing and minimization of the contamination can make PCR clinically useful test. PCR recognition of cagA was not associated with the severity of H. pylori gastritis. (Korean J Gastroenterol 1998;31:281-289)

기능성 소화불량증과 역류성 식도염에서 위배출능 및 위 내 분포의 평가

박인서(In Suh Park),전재윤(Chae Yoon Chon),이관식(Kwan Sik Lee),박효진(Hyo Jin Park),김태일(Tae Il Kim),이종두(Jong Doo Lee),정준표(Jun Pyo Chung) 대한소화기학회 1998 대한소화기학회지 Vol.31 No.4

Background/Aims: Delayed gastric emptying and postprandial antral hypomotility are observed in patients with functional dyspepsia. These gastric motility abnormalities can be also associated with pathophysiology of reflux esophagitis. Thus, we studied intragastric food distribution and gastric emptying to examine food maldistribution in functional dyspepsia and reflux esophagitis. Methods: The patients with functional dyspepsia were categorized by prevalent discomfort patients (Group I, 10) and prevalent pain patients (Group II, 12). These two groups of patients ingested test meal labelled with technetium-99m. Patients with reflux esophagitis (Group IIl, 11) and healthy volunteers (Control, 2) ingested the same meal. Serial images of the gastric area were taken for 90 minutes and parameters of gastric emptying and intragastric distribution were examined for the regions of proximal, distal and total stomach. Results: Parameters of total gastric emptying (T1/2, retention at 30 min and 90 min, total gastric residence) in patients with functional dyspepsia and reflux esophagitis were not significantly different from those of controls. In the group II, all parameters of intragastric distribution were not different from those of controls. However, in the group I, initial activity (75.0%) in proximal gastric area after ingestion was significantly lower than that in controls (86.7%). Food distribution [maximal distal content (41.1%), distal gastric residence (41.1%)] in distal gastric area was significantly higher than that in controls [maximal distal content (28.5%), distal gastric residence (28.8%)]. In the Group III parameters of intragastric distribution are similar to those of the group I . Conclusions: Prevalent discomfort group of functional dyspepsia showed abnormal intragastric distribution of ingested food. On the other hand, they did not show delayed gastric emptying. The group of reflux esophagitis showed similar results. (Korean J Gastroenterol 1998;31:411 - 420)

가족성 선종성 용종증 환자에서 수술 후 발생한 복강내 유건종 1예

박인서(In Suh Park),김원호(Won Ho Kim),송시영(Si Young Song),이세준(Se Joon Lee),조용석(Yong Suk Cho),박용범(Yong Beom Park),권기환(Ki Hwan Kwon),양우익(Woo Ick Yang) 대한소화기학회 1998 대한소화기학회지 Vol.31 No.5

Desmoid tumors are histologically defined as fibromatosis occuring in the musculoaponeurotic soft tissue. They rarely metastasize, but often behave as malignant tumors in the clinical setting because of frequent recurrence and local invasion. Desmoids occur more commonly in association with familial adenomatous polyposis (FAP) than with any other disease, ranging in frequency from 4% to 13% in patients with FAP. In patients with FAP, desmoids often appear after total colectomy as descrete masses in surgical scars of the abdominal wall or as infiltrating fibroblast sheets within the abdominal mesentery or retroperitoneum. Intra-abdominal or mesenteric desmoids pose a serious management problem because of their propensity to surround and compress major blood vessels and viscera. Recently we experienced a ease of desmoid tumor associated with FAP after tatal colectomy. This is the first case in Korea and thus, we report it with review of the literatures. (Korean J Gastroenterol 1998;31:707-712)

만성 간질환 및 원발성 간세포암 환자의 혈청 α1 - Antitrypsin 표현형의 변화

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),문영명(Young Myung Moon),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),김원호(Won Ho Kim),임대순(Dae Soon Yim),함기백(Ki Baik Hahm),신용준(Yong 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

In parallel with the discovery of nev alleies inceasing the complexity of the Pi system, technical refinements have made the classification of an individual with respect to his Pi system relativeiy simple. Isoelectrofocusing in polyacrylamide gels is advantageous method in analyzing pisystem because of ease of performance, high resolution and reproclucibility. Most individuals have the PiMM phenotype resulting in normal plasma a1-antitrypsin (a,-AT) levels. The classical a1-AT deficiency is designated as Pizz in its homogygous form and has 15% of normal plasma a1-AT level, which is known to be associated with increased risk of cirrhosis and primary liver cancer But there is stilJ debate as the cause of this associated liver disease. This study is aimed to know the distribution and contribution of structural variants of a1-AT in South Korean patients with chronic liver diseases inr.uding hepatocellular carcinoma. One hundred thirty nine patients with chronic liver diseases or hepatocellular carcinoma were studied. Rlood sarnples were taken frorn each. Phenotypes of a1-AT were determined by electrofocusing in polyacrylamide gel electrophoresis. The results obtained were as folloas, None of the cases showed deficiency or null variant of a1-AT in patients with chronic liver diseases, hut two cases with hepatocellular carcinoma showed MS phenotype. About half of the cases with chronic liver disease and hepatocellular carcinoma showed homologcius polymorphism of a1-AT phenotype suballeles such as M1M1. M2M2 and M3M3. The distribution of the structural variants of a1-AT phenotype in patients with chronic liver diseases and hepatocellular carcinoma were in order as tollows; M1M1 (51.8%), M1M2(24.5%), M2M2 (7.9%), M3M3 (6.5%), M1M3, (5.8%),M3M3 (2.2%) and M1S (1.3%). In con, lusion, none of the cases with chronic liver diseases showed deficiency or null typed structural variants of a1-AT, but there were two cases with MS phenotype among the 39 patients with hepatocellular carrcinoma. Therefore, genetically determined a1-AT. deficiency seems to be not etiological]y important in South Korean patients with chronic liver disease.

Helicobacter pylori 감염과 세포증식 및 세포사멸간의 관계

박인서(In Suh Park),이상인(Sang In Lee),이관식(Kwan Sik Lee),정상수(Sang Su Chung),정병천(Byung Chun Chung),박효진(Hyo Jin Pack) 대한소화기학회 1998 대한소화기학회지 Vol.32 No.4

Background/Aims: Many studies have shown that Helicobacter pylori (H. pylori) infection is associated with gastroduodenal diseases. The pathogenic effects of H. pylori are associated with cytokine production, cell cycle progression, cellular proliferation and apoptosis. We performed this study to investigate the effect of H. pylori eradication on gastric mucosal cell apoptosis and proliferation. Methods: Gastroduodenoscopy was performed for 42 cases. Twenty two of them showed H. pylori-positive gastritis and the other 20 cases showed H. pylori-negative normal mucosa. H. pylori infection was assessed by rapid urease test and histology of biopsy specimens from gastric antrum. Ki-67 immunostaining of gastric biopsy specimens was used to measure mucosal cell proliferation in H. pylori positive gastritis before and after therapy. DNA frapnentation with terminal deoxynu- cleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling method was used for a marker of apoptosis. Results: Apoptosis was increased in gastric mucosal epithelium of patients with H. pylori-positive gastritis (p<0.05). H. pylori eradication therapy reduced apoptosis in antral mucosa (p<0.05) and the cell proliferation levels (p=0.051). Conclusions: Induction of apoptosis in gastric epithelium by chronic stimulation of H. pylori could be involved in the pathogenesis of gastroduodenal diseases. (Kor J Gastroenterol 1998;32:427 - 434)

한국인 위암에서 Survivin과 HIAP-1 유전자 발현

박찬진,류승완,김인호,백원기,서성일,서민호,손수상,Park Chan Jin,Ryu Seung Wan,Kim In Hoo,Baek Won-Ki,Suh Seong-Il,Suh Min-Ho,Sohn Soo Sang 대한위암학회 2003 대한위암학회지 Vol.3 No.1

Purpose: Dysregulation of apoptosis may attribute to development of cancer by abnormally prolonging cell viability with accumulation of transforming mutations. Survivin and HIAP (Human Inhibitors of Apoptosis)-1 were recently described as apoptosis inhibitors. Their pathogenic roles in gastric cancer are largely unknown. In the present study, we examined the expression of survivin and HIAP-1 in gastric cancer tissues and cell lines in order to elucidate the roles of survivin and HIAP-1 in the process of gastric carcinogenesis. Materials and Methods: Eight gastric cancer cell lines and five gastric cancer tissues were studied. The expression of survivin and HIAP-1 were evaluated by reverse transcription -polymerase chain reaction (RT-PCR), immunohistochemistry, and Western blot. Results: Western blot and RT-PCR analysis revealed survivin and HIAP-1 expression in all gastric cancer cell lines. Increased expression of survivin and HIAP-1 were found in all cases of gastric cancer tissues compared to normal tissues by Western blot analysis. In immunohistochemical analysis tumor cells were stained with anti-survivin and anti-HIAP-1 antibodies. Cell cycle dependence of survivin expression was preserved in gastric cancer cell lines. Conclusion: The results indicate that increased expression of survivin and HIAP-1 genes may play an important role in gastric cancer.

장중첩증이 (腸重疊症) 동반된 대장지방종 (大腸指肪腫)

박인서 ( In Suh Park ),박찬일 ( Chan Il Park ),이경식 ( Kyung Sik Lee ),김기황 ( Ki Whang Kim ),최흥재 ( Heung Jae Choi ),양주영 ( Joo Young Yang ),박창윤 ( Chang Yoon Park ),윤용광 ( Yong Dwang Yoon ) 대한소화기학회 1982 대한소화기학회지 Vol.14 No.1

Excluding adenomataus polyps, lipomas represent the most common benign tumor of the colon. But lipomas of gastrointestinal tract are rarely encountered, and when seen they are usually an incidental finding at autopsy or operation. When small, these tumors are frequently asymptomatic. Constipation and colicky abdominal pain in wax and wane pattern are frequent symptoms in the larger tumor and intussusception is the main complication of the lipomas. A few hundreds of gastrointestinal lipomas were reported in the world, but only 6 cases of it were found in the literature in Korea. A case of lipomas in colon associated with intussusception in a 36-year-old woman and a brief review of the literature were presented.