직장 Dieulafoy 병변으로 다량의 혈변을 보인 1 예

김태영;이상헌;김지현;배영환;정은주;김승만;지삼룡;설상영 인제대학교 2011 仁濟醫學 Vol.32 No.-

Dieulafoy’s lesion is very rare cause of gastrointestinal bleeding, Deiulafoy’s lesion is exposure of non ulcerative, abnormally large tortuous, thick- walled artery in the muscularis mucosa through a small submucosal defect. It is usullay found on stomach antrum and lesser curvature side of the proximal body, and possibly found on any sites throughout whole gastrointestinal tract, but rarely on rectum. The principal of treating Dieulafoy’s lesion was the surgical resection of lesion, but recently remarkable advances in endoscopic technique make endoscopic approach more popular. We report a case of rectal Dieulafoy’s lesion successfully treated with endoscopic hemoclipping in an elderly female patient.

간세포암의 고주파 열치료 후 천자침 경로를 통한 전이 1례

조영완,박석주,진한영,김준영,이재익,강명주,박정하,윤정희,박성재,지삼룡,이연재,이상혁,설상영 인제대학교 2006 仁濟醫學 Vol.27 No.-

Radiofrequency ablation(RFA), as a form of minimally invasive therapy for hepatocellular carcinoma, has become an important treatment modality. Because of limitation of surgery, RFA has become standard therapy for hepatocellular carcinoma in some situations. But there are some complications of RFA such as bleeding, infection, hematoma, adjacent organ thermal damage including intestinal perforation, needle track seeding, and so on. There are few reports in the literature that systematically evaluate the incidence of needle tract seeding and its associated risk factors. And only 2 cases of needle tract seeding of hepatocellular carcinoma after RFA were reported in Korea. We report a case of needle tract seeding of hepatocellular carcinoma after RFA.

바터 팽대부에 생긴 유암종 1예

강명주,지삼룡,박석주,이재익,조영완,김준영,박성재,박은택,이연재,이상혁,설상영,배상균 인제대학교 2006 仁濟醫學 Vol.27 No.-

Carcinoid tumors have been reported in a wide range of organs but most commonly involve the lungs, bronchi and gastrointestinal tract. Within the gastrointestinal tract, appendix is the most common location for carcinoid, followed by the distal small intestine, the rectum, and the stomach. Among these, primary involvement of the ampulla of Vater is extremely rare. We report a case of carcinoid tumor of ampulla of Vater. A 62-year-old man presented with epigastric soreness. Gastroduodenal endoscopy showed hyperemic bulging mass on ampulla of Vater and diagnosed as carcinoid tumor by histologic finding, with immunohistochemical study. In ^(111)In-octreoscan, tumor had regional lymph node metastasis, but no evidence of distant metastasis. Pancreatoduodenectomy with lymph node dissection was performed.

레이저 형광법을 이용한 인접면 우식증의 진단

설재헌,오유향,이난영,이상호 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.2

레이저 형광법을 이용하여 초기 인접면 우식증을 탐지할 수 있는지의 여부와 그 탐지 감도를 평가하여 인접면 우식증의 진단에 활용 가능한지의 여부를 규명하기 위하여 사람의 치아를 사용하여 다양한 깊이의 인공우식병소를 유발시키고 이를 가시광선 투과법에 의한 사진, 교익 방사선사진 촬영, 레이저 형광법, 광활성 염료를 이용한 레이저 형광법 등으로 관찰하여 검사법 간의 일치도, 상관관계, 병소 깊이에 따른 광밀도 등을 분석하여 다음과 같은 결과를 얻었다. 1. 탈회시간과 각 검사법들과 일치도 검사에서 사진의 경우 tau-c 값이 0.08로 탈회시간에 따른 사진의 검사 수치가 일치하지 않았으나 교익 방사선사진, 레이저 형광법, 광활성 염료를 이용한 레이저 형광법의 tau-c 값은 각각 0.60, 0.48, 0.64로 일치하는 것으로 나타났다. 2. 탈회시간에 따른 병소깊이와 각 검사법 간의 상관관계는 광활성 염료를 이용한 레이저 형광법(r=0.51), 레이저 형광법(r=0.43), 교익 방사선사진(r=0.35), 사진(r=0.33) 순으로 높았으며 광활성 염료를 이용한 레이저 형광법과 레이저 형광법은 탈회 시간과 상관관계가 있었다(P<0.05). 3. 교익 방사선사진을 기준 검사법으로 한 레이저 형광법과 광활성 염료를 이용한 레이저 형광법의 진단학적 민감도는 각각 67%, 100%였으며 특이도는 57%, 11%로 민감도에 비해 상대적으로 낮게 나타났다. 4. 병소의 깊이에 따른 병소 표면에서의 건전 치질과 우식 치질 사이의 광밀도의 차이(DFR)는 광활성 염료를 이용한 레이저 형광법이 레이저 형광법에 비해 크게 나타났으며(P<O.05) 병소 깊이의 변화에 따른 광밀도 변화는 레이저 형광법의 경우 유의한 변화를 보이는데 반해 광활성 염료를 이용한 레이저 형광법에서는 변화를 보이지 않았다. 이상의 결과를 종합하면, 초기 인접면 우식증의 진단에 있어 레이저 형광법과 광활성 염료를 이용한 레이저 형광법을 교익 방사선사진에 뒤지지 않은 진단능을 가지고 있으나 우식 병소의 정성적인 분석뿐 아니라 정량적 분석이 가능한지의 여부는 향후 더 많은 연구가 필요하리라 사료된다. Artificial carious lesions in various depths were observed with visual examination using light transillumination, bite-wing radiography, laser fluorescence, and dye-enhanced laser fluorescence to determine the reproducibility, correlation of each diagnostic method, diagnostic sensitivity and diagnostic specificity. And optical densities according to demineralized times were measured whether laser fluorescence could be used as a quantitative diagnostic method. The following results were obtained whether laser fluorescence could be used for diagnosis of initial proximal caries. 1. Tau-c values of visual examination was 0.08 which showed lowest reproducibility, and those of bite-wing radiography, laser fluorescence, dye-enhanced laser fluorescence were 0.60, 0.48, and 0.64. respectively which showed relatively high reproducibility. 2. The correlation between demineralization time and each examination was the highest in dye-enhanced laser fluorescence(γ=0.51), followed by laser fluorescence(γ=0.43), bite-wing radiograph(γ=0.35), and visual examination (γ= 0.33). Dye-enhanced laser fluorescence and laser fluorescence showed significant correlation with demineralization time. 3. The sensitivity of laser fluorescence and dye-enhanced laser fluorescence for diagnosing approximal caries based on bite-wing radiography were 67%, 100% and those of specificity were 57%. 11% which showed diagnostic specificity was relatively lower than sensitivity. 4. The difference in optical density(DFR) between sound teeth and carious lesions according to lesion depth was high with dye-enhanced laser fluorescence compared with laser fluorescence. DFR measured with laser fluorescence according to changes in lesion depth was statistically significant but was not statistically significant with dye-enhanced laser fluorescence. Based on these results, laser fluorescence and dye-enhanced laser fluorescence have comparable diagnostic power as bite-wing radiography in early diagnosis of proximal caries.

급성 담낭염에 대한 내과적 치료의 역할

강성원,조한래,한설해,박현주,정인성,홍선미,김성걸,이헌영 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

In 58 patients who were admitted to department of internal medicine, ChungNam national university hospital from January 1989 to March, 1993. We evaluated for medical treatments and the following results were obtained. 1) The ratio of male and female was 1 : 1 and mean age of the patients was 57.4 years. 2) At arrival on hospital, the most common clinical symptom was pain in right upper quadrant and epigastrium(93.1%), the remainders were fever and chill(79.3%), nausea(51.7%) and vomiting(36.2 %) in order of frequency. 3) The most common physical findings was tenderness on the right upper quadrant and epaigastrium(98%), the remainders were jaundice(50%) and palpable gall bladder(13.8%) in order of freguency. 4) In laboratory examination, elevated levels of ESR(82.8%), leukocytosis(67.2%), elevated levels of AST(62.0%), ALT(50.0%), serum total bilirubin(51.7%) and alkaline phosphatase (43.1%) were noted. 5) The mean period of NPO was 3.9 days and the mean hospital period was 13.5 days. 6) The rates of combined complications in patients with acute cholecystitis were 17.2%; these are gall bladder empyema(5.2%), hydrops(5.2%), perforation(3.4%), sepsis(3.4%) and intestinal obstruction (1.7%). 7) In 96.6 percent of 58 cases, the symptoms of acute cholecystitis were improved by conservative management. 8) The mean follow-up period was 25.5 months and the recurrence rate was 10% during this period.

정상과 갑상선 종양조직에서 사람 IGF-I 유전자의 발현

김성운,장현하,박상미,김덕윤,우정택,양인명,김진우,김영설,김광원,고석환,홍성화,최영길 경희대학교 유전공학연구소 1993 遺傳工學論文集 Vol.5 No.-

Many of the growth-promoting properties of growth hormone(GH) are mediated by insulin-like growth factor-I(IGF-I), a highly conserved circulating 70-amino acid peptide. Recent studies have shown that multiple mechanisms influence IGF-I gene expression, including transcription from two promoters, alternative RNA splicing, and variable polyadenylation. In thyroid tissue, thyroid stimulating hormone(TSH) and IGF-I are the most possible candidates for follicular cell proliferation and hypertrophy. Actually IGF-I had autocrine and paracrine effect for tissue growing. We prepared thyroid tumor tissue mRNAs using single step method for detecting IGF-I levels according to different tissues, i.e., thyroid adenoma or papillary thyroid carcinoma. We used Northern blot analysis for IGF-I mRNA and RNase protection assay (RPA) for IGF-I transcription start sites. For Northern blot, we used whole human IGF-I cDNA as a DNA probe and for RPA, we used IGF-I exon 1 containing noncoding promoter 1 as a riboprobe. We got good RNA bands from Northern blot analysis around 1 kb (IGF-IA) and 7.5 kb (IGF-IB) region. To clarify the amount of both IGF-IA and IB mRNAs, we measured autoradiographied signal of IGF-I mRNAs bands using densitometer. In IGF-IA signals, there's no change among liver and thyroid tissues, but in case of IGF-IB mRNA bands, the signal was markedly increased in thyroid carcinoma tissues than that of normal thyroid tissue (85% vs 14%). In the study of RPA, all thyroid tissues used the same transcription start sites as those of liver's. We concluded that that this different regulation of IGF-I mRNA was originated from tissue specificity. That meant some tissue specific transcription factor/s were related to tissue IGF-I expression.

배양된 쥐 인슐린종 세포에서 성장인자들에 대한 인슐린 유전자의 발현

김성운,양인명,김진우,김영설,김광원,최영길 경희대학교 유전공학연구소 1989 遺傳工學論文集 Vol.1 No.-

인슐린 유전자 발현의 실험실적 모델로서 쥐 인슐린종 세포(RINm5F cell;rat insulinorraceil)를 이용하여 몇 개의 성장인자에 대한 반응을 조사하고 인슐린 유전자의 활성에 관여하는 상황을 이해하고자 인슐린 유전자의 mRNA를 조사하였다. RINm5F 세포는 glucose 와 EGF 등의 성장인자에 대해 세포분화 및 성장에 자극을 받으며 인슐린, IGF-Ⅰ IGF-Ⅱ등에는 영향을 받지 않았다. 따라서 RINm5F TPVHSMS 생체내 췌도 베타세포의 기능을 대변하기는 어려웠으나 각종 성장인자의 세포내 활성양상을 간접적으로 알 수 있었다. Insulin secretion of RINm5F cells can be stimulated by some of the growth factors, however, not in the same manner compared to pancreatic islet beta cells. We observed that insulin superfamily (insulin IGF-Ⅰ, IGF-Ⅱ) were not affected to insulin mRNA of RINm5F cells, but EGF (50ng/㎖) increased insulin mRNA levels, and dexamethasone (300ng/㎖) decreased insulin mRNA levels in RIAm5F cells. So some of growth factors regulated insulin gene at transcription level in RINm5F cells line.

인터넷

한상조,김영설 경희대학교 1996 慶熙醫學 Vol.12 No.3-4

혈당측정기 GlucoDr™ System의 평가

박철영,류미숙,우정택,김성운,김진우,김영설,안규정 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.2

연구배경: 당뇨병 환자에서 엄격한 혈당조절은 환자의 예후와 밀접한 관련이 있다. 혈당조절을 철저히 하기 위해서는 자가 혈당 측정기의 사용이 필수적이라 할 수 있다. 또한 저혈당이 빈번하게 발생하거나, 위험요소가 있는 환자들에게도 유용하게 사용될 수 있다. 이에 저자들은 전기화학감지법의 원리를 이용하여 국내에서 처음 생산된 자가혈당측정기인 GlucoDr™ blood Glucose Testing System(ALL Medicus, Co, Korea)를 현재 국내에서 시판되고 있는 다른 제품과 비교, 평가하여 임상적 유용성을 살펴보고자 하였다 방법: 혈당측정기준장비는 YSI 2300 STAT Plus(YSI Incorporated, USA)를 사용하였으며 GlucoDr™외에 Glucocard(KDK, Japan), Precision QID(Abbott Laboratories, Co, USA), Glucotrend(Roche, USA), Surestep(Lifescan, USA)의 다른 혈당측정기를 같이 평가하였다. 정밀도, 직선성, 비교방법과의 상관관계 평가, 검체량에 따른 영향, 헤마토크리트에 따른 영향, 검사자에 따른 영향, 항응고제에 따른 영향들을 평가하였다. 결과: 본 연구에서의 주된 평가대상인 GlucoDr™의 평가결과, 정밀도를 나타내는 검사 내, 검사 간 변이계수는 8%이내였으며, 45~500mg/dL 범위에서 R²=0.9906, 0.9984 정도의 직선성을 나타내었다. 본 연구에 있어 비교방법으로 이용한 YSI 2300 STAT Plus와의 상관관계 및 정확도는 y = 1.0058x + 0.453, R = 0.9853인 것으로 나타났다. 검체량이나 검사자 및 항응고제에 따른 측정값에는 유의할만한 차이가 없는 것으로 나타났으나, 헤마토크리트가 증가 또는 감소함에 따라 최소 10%에서 최대 26% 가량의 영향을 받는 것으로 관찰되었다. 결론: GlucoDrTM는 국내 사용되는 다른 혈당측정기와 비교하여 유용할 것으로 생각된다. Background: Self-monitoing blood glucose devices are sidely used in monitoring and point-of-care testing for the management of diabetic patients. We performed the present study to evaluate the performance of the GlucoDr™ blood glucose testing system using an electrochemical technique. Method: The GlucoDr™ was evaluated for linearity, precision, comparison of method, the effect of sample volume, hematocrit concentration, reapplication, operator and application methods. Results: The GlucoDr™ showed good linearity for glucose concentrations ranging from 52mg/dl to 475mg/dl(r²=0.971). The single day, and day-to-day, CV were within 8%. Excellent correlation was found between the GlucoDr™ and YSI 2300 STAT Plus(y=1.0058x + 0.453, r²=0.9710). The sample volume, reapplication, operator and application method produced no significant effect on the test result. An overestimation in the glucose values was found with low hematocrit concentrations. There was no significant effect by the anticoagulants, with the exception of citrate. Conclusion: The GlucoDr™ showed good linearity, precision and correlation with the reference method and provided rapid and reliable result for blood glucose levels. Therefore, the GlucoDr™ seems appropriate for clinical use in the management of diabetic patients.

당뇨병 백서의 간세포에서 Glucokinase 활성도 및 유전자 발현에 대한 인슐린의 영향

강성이,팽정령,서광식,안규정,우정택,김성운,양인명,김진우,김영설,김광원,최영길 경희대학교 유전공학연구소 1993 遺傳工學論文集 Vol.5 No.-

목적 당대사의 조절 상태에 따른 생체 변화를 분자 수준에서 이해하고자 식이 조건을 달리한 정상 백서와 화학적으로 유도된 당뇨병 백서의 간조직에서 혈당수준과 인슐린치료 정도에 따라 나타나는 글루코키나제 활성도 및 유전자 발현을 분석하였다. 방법 스트렙토조토신 정맥투여 후 당뇨병의 유발을 확인하고, 인슐린을 1일 3회 3일간 복강내로 투여하여 상태를 안정시킨 후, 인슐린 투여군은 인슐린 투여 6시간이내에 그리고 인슐린 비투여군은 24시간 후 단두하여 채혈하고 복강을 열어 간조직을 채취하였다. 채취한 간조직에서 글루코키나제 활성도는 인산화된 포도당에서 NADH의 형성을 형광분광계로 측정하였으며, 글루코키나제 유전자 mRNA발현은 Northern 분석법을 이용하였다. 성적 정상 백서에서 공복상태와 식이를 섭취한 경우에 간조직의 글루코키나제 효소의 활성은 차이가 없었으나, 글루코키나제 유전자 mRNA 발현은 증가되었다. 당뇨병이 유발된 백서의 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현은 정상 백서에 비하여 낮았다. 인슐린 투쳐 후 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현이 증가되었고, 특히 혈당이 정상화된 경우에서 글루코키나제 유전자의 mRNA 발현이 증가도었다. 결론 인슐린에 의한 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA을 증가를 볼수 있었다. 당뇨병 백서에서 인슐린 투여 후에 혈당조절이 안된 경우 간조직의 글루코키나제 유전자의 mRNA 발현이 증가가 없는 것으로 보아 글루코키나제 mRNA의 발현에는 인슐린 이외의 다른 요소가 관여할 것으로 생각된다. The liver-specific hexokinase isoenzyme, referred to as glucokinase, is thought to play a key reglulatory role in hepatic glucose metabolism. The glucokinase gene is, therefore, of interest both because of its tissue-specific expression and because of the several regulatory processes that can be analyzed. The level of hepatic glucokinase activity appears to be determined essentially by regulation of the rate of enzyme synthesis, with insulin playing a leading role as an inducer. We investigated the role of insulin for the induction of glucokinase in the liver of diabetic rats. Experimental diabetes was induced by injection of streptozotocin 7 days before the experiment. Regular insulin was given by three days intraperitoneal injection at 8-h interval. The glucokinase mRNA in the liver was estimated by Nothern blot assay, as well as by fluorometric enzyme activity assay. Glucokinase activity was not reduced in the liver of normal fasting rats as compared to normal fed rats. And glucokinase activity was reduced in the liver of diabetic rats as compared to normal rats. In diabetic rats treated with insulin, glucokinase enzyme activity were increased. But glucokinase mRNA expression was only increased in normoglycemic diabetic rat with treated with insulin as compared to hyperglycemic rat. These data indicate that insulin stimulates hepatic glucokinase enzyme activity and mRNA expression. But other hormonal or metabolic factors may be contribute to regulation of glucokinase mRNA expression.