심한 호산구 증가증을 동반한 류마티스 관절염 1예

손정일 ( Chong Il Sohn ),김명곤 ( Myeong Kon Kim ),이기창 ( Kee Chang Lee ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ),정화순 ( Wha Soon Chung ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

호산구 증가증의 원인은 기생충 감염, 알레르기, 약제, 교원성 질환, idiopatic hypereosinophilic syndrme 등에서 나타나며 류마티스 관절염에서는 약 10%의 환자에서 호산구 증가증을 보인다고 한다. 류마티스 질환에서 호산구 증가증은 류마티스 관절염, 다발성 동맥염 및 혈관염, 유육종증 둥과 연관되고 idiopathic hypereosinophilc syndrme이나 골수 증식성 질환, 호산구성 백혈병 등과 감별을 요하며 집중적으로 추적 관찰해야 한다. 저자들은 53세 여자 환자에서 지속적이고, 심한 호산구 증가증이 동반된 류마티스 관절염 환자를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Eosinophilia is usually accompanied by parasite infestation, allergic condition, drug, collagen disease, and idiopathic hypereosinophilic syndrome. In about 10 to 40% of rheumatoid arthritis patients, peripheral blood reveals eosinophilia. Of the rheumatic disease, eosinophilia may occur in rheumatoid arthritis, sarcoidosis, polyarteritis nodosa and other vascultis. Patient with eosinophilia must be carefully followed up due to possibility of progression to eosinophilic leukemia or myeloproliferative disease. We experienced a case of rheumatoid arthritis with severe eosinophilia for a period of more than one year in a 53 year-old female patient, eosinophil more than 85% in the peripheral blood, but in spite of careful laboratory study, there was no evidence of parasite infestation, allergic disease and malignant condition that may cause eosinophilia. Therefore we concluded that her severe eosinophilia was associated with rheumatoid arthritis itself, and now she is intensively followed up at the outpatient department. We have to look for any malignant transformation during her clinical course. Marked eosinophilia associated with rheumatoid arthritis is very rare, so we report this case with a review of literatures.

Mongolian gerbil에서 Helicobacter pylori 감염 후 발생되는 Microsatellite Instability에 관한 연구

박동일 ( Dong Il Park ),김민경 ( Min Kyung Kim ),김재준 ( Jae J. Kim ),유태우 ( Tae Woo Yoo ),박정호 ( Jung Ho Park ),김홍주 ( Hong Joo Kim ),조용균 ( Yong Kyun Cho ),손정일 ( Chung Il Sohn ),전우규 ( Woo Kyu Jeon ),김병익 ( Byung 대한내과학회 2006 대한내과학회지 Vol.71 No.1

목적: H. pylori (HP) 감염성 위염에서 HP는 DNA 손상복구기능에 장애를 유발하여 위 상피세포의 유전자에 발생하는 돌연변이를 축적시켜 위암의 발생 위험을 증가시킬 수 있다. 본 연구는 Mongolian gerbil (MG)animal model을 이용한 in vivo 실험에서 만성적인 HP감염이 위 점막의 MSI를 발생시키는 지 알아보고자 하였다. 방법: 7주된 수컷 MG에 HP CA20 균주를 감염시킨 후 일정한 시점마다 동물을 희생시켜 위를 절제하였다. 위염부위의 위 상피를 미세박리하여 DNA를 추출한 후 Fam이나 Hex로 표지시킨 다섯 가지 gerbil MSI marker를 이용하여 중합효소연쇄반응을 실시한 후 310 genetic analyzer를 이용하여 MSI 분석을 시행하였다. 결과: MSI는 정상부위(식도)에서는 관찰되지 않았고, 위염이 없는 부위에 비해 위염부위에서 빈번히 관찰되었다(p<0.05). 위염부위 중 6예에서는 low level MSI를 1예에서는 high level MSI를 관찰하였다(p<0.05). 결론: 본 연구로 MG에서 만성적인 HP 감염이 MSI유발에 관여함을 입증하였다. 이와 같이 HP는 위상피세포내의 DNA mismatch repair 단백 발현을 저하시켜 위상피세포 유전자에 발생하는 돌연변이의 축적을 유발할 수 있을 것으로 생각한다. Background: During Helicobacter pylori (HP) gastritis, the organisms cause an impairment of DNA repair that results in accumulation of mutations in the genome of epithelial cells and an increased risk of gastric carcinoma. The aim of this study was to determine whether microsatellite instability (MSI) could be induced by chronic HP infection in the Mongolian gerbil model. Methods: Seven-weeks old, specific pathogen-free male Mongolian gerbils were infected with the HP strain CA20. They were sacrificed at the each time points (1, 2, 3, 6, 9, 12 months). Areas of gastritis were carefully microdissected. DNA from tissues was analyzed for the presence of MSI by genomic DNA amplification with five gerbil microsatellite markers per sample. Gerbil markers labelled with Fam or Hex were obtained to perform MSI analysis using the 310 Genetic Analyzer. Results: MSI was more frequent in the area of gastritis than in that of normal (p<0.05). Six showed MSI-low and one showed MSI-high within the area of gastritis (p<0.05). Conclusions: This study shows that chronic HP infection in the Mongolian gerbil induces MSI. This finding indicates that HP infection causes a decrease in DNA MMR proteins in epithelial cells of the stomach that may reach critically low levels, allowing for the accumulation of mutations such as those seen in microsatellite regions.(Korean J Med 71:17-23, 2006)

성인 건강 검진자에서 위식도역류 증상의 빈도

전성국(Seong Gook Jeon),손정일(Chong Il Sohn),김지은(Jee Eun Kim),박기호(Ki Ho Park),황일순(Il Soon Whang),김은주(Eun Joo Kim),박창영(Chang Young Park),김병익(Byung Ik Kim),전우규(Woo Gyu Jeon),정을순(Eul Soon Chung),이풍렬(Poong Lyu 대한내과학회 2000 대한내과학회지 Vol.58 No.2

N/A Background : Gastroesophageal reflux disease (GERD) is considered to be less common in the Orient compared to the West, but epidemiological data on GERD in Korea are rare. The aim of this study was to determine the prevalence of symptoms of gastroesophageal reflux in routine check-up subjects. Methods : We analyzed 2243 subjects (male 716, female 1527; age range 20-69 yr) visited health promotion center for routine check-up. Subjects were given a validated self-reported questionnaire, which measured the presence, duration and severity of typical symptoms (heartburn, acid regurgitation); and the presence of atypical symptoms. At least weekly symptoms of heartburn and/or acid regurgitation were characterized as the definition of GERD. Results : The prevalence of heartburn for at least monthly, at least weekly and at least daily episodes was 6.2%, 3.4% and 3.1%, respectively. The corresponding figures for acid regurgitation were 6.1%, 2.1% and 0.7%. The prevalence of GERD was 8.5%, and was more common in female (p<0.01). Sixty eight percent of subjects with GERD reported the symptoms as having been present for less than 5 years. Seventy four percent of subjects with GERD reported these symptoms to be mild to moderate in severity. Heartburn and acid regurgitation were significantly associated with dyspepsia, chest pain, dysphagia and globus sensation (p<0.01), but not with hoarseness or chronic cough. Conclusion : The prevalence of heartburn and/or acid regurgitation experienced at least weekly is 8.5% in routine check-up subjects. Heartburn and acid regurgitation were associated with epigastric pain, chest pain, dysphagia and globus sensation.(Korean J Med 58:145-151, 2000)

지방간에 대한 혈청 r-glutamyl transferase ( GGT ) 의 진단적 유용성 및 다른 인자와의 상관관계

최권(Kwon Choi),김병익(Byung Ik Kim),조용균(Yong Kyun Cho),박창영(Chang Young Park),손정일(Jung Il Sohn),전우규(Woo Kyu Jeon),김향(Hyang Kim),정을순(Eul Soon Chung),금동극(Dong Geuk Keum),이화영(Hwa Young Lee),이상종(Sang Jong Lee) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

N/A Background : Gamma-glutamyl transferase(GGT) has found wide application as a diagnostic test in hepatobiliary disease, and has been used as the best single marker of alcohol intake. In spite of the wide use of GGT in clinical practice, knowledge concerning the distribution and the determinants of this risk factor in the normal population is spared in Korea. We tried to obtain a better evaluation of specificity of serum GGT by analysis of a large population of health examination. Methods : GGT was measured in 17,140 males aged 17-86 years and 12,125 females aged 18-90 years screened in a health survey program. Results : In multiple regression analyses, serum GGT level showed strong positive association with fatty liver, body mass index, serum levels of AST, ALT triglyceride, uric acid, alkaline phosphatase, systolic blood pressure, and diastolic blood pressure, and weakly positive association with serum levels of creatinine, total cholesterol, and fasting blood sugar. In females, menopause were positively associated with GGT. Conclusions : An elevated serum GGT levels is a strong indicator of hepatobiliary dysfunction or fatty liver. However, proper interpretation of a serum GGT elevation should be carefully considered in correlation with clinical data and laboratory findings. (Korean J Med 57:1006-1013, 1999)

폐색성 담관질환자의 장투과성의 변화

김정욱 ( Jeong Wook Kim ),전우규 ( Woo Kyu Jeon ),장세경 ( Sae Kyung Chang ),이정안 ( Jung Ahn Lee ),박동일 ( Dong Il Park ),조용균 ( Yong Kyun Cho ),성인경 ( In Kyung Sung ),손정일 ( Chung Il Sohn ),김병익 ( Byung Ik Kim ),김은정 대한내과학회 2004 대한내과학회지 Vol.67 No.6

목적 : 장관장벽 이상은 폐색성 담관질환에서 발생하며 장내세균전위나 장관내독소혈증과 같은 감염성 합병증을 유발 한다. 본 연구에서는 폐색성 담관질환에서 장관장벽 이상과 임상양상과의 관계를 알아보았다. 방법 : 건강대조군 18명, 양성질환에 의한 폐색성 담관질환자 20명, 악성질환에 의한 폐색성 담관질환자 21명에서 장투과성 검사를 실시하였으며 질환군간 차이와 각종 임상양상과 연관성을 비교하였다. 장투과성 검사는 51Cr-EDTA (51Cr-ethylen Background : Gut barrier dysfunction occurs in experimental models and humans of obstructive biliary disease. This phenomenon promotes infectious complications including bacterial translocation and intestinal endotoxemia. The aims of this study were to ex

활동성 궤양성 대장염 환자에 있어서 도플러 초음파의 유용성

정수석(Soo Suk Jung),조용균(Yong Kyun Cho),박정식(Jeong Sik Park),김시영(Si Young Kim),김창섭(Chang Seop Kim),손정일(Chung Il Sohn),박창영(Chang Young Park),김병익(Byung Ik Kim),정을순(Eul Soon Jung),박해원(Hae Won Park),전우규(Woo K 대한소화기학회 2002 대한소화기학회지 Vol.39 No.3

Background/Aims : An increase in splanchnic blood flow in both artery and vein has been observed in activeulcerative colitis (UC). Doppler ultrasonography (US) is a non-invasive evaluation method of splanchnic arterialinflow in superior mesenteric artery (SMA). This study was undertaken to assess the usefulness of Doppler Usin detecting changes of the hemodynamic variables in patients with UC. Methods: Twenty-two patients with UC(14, active UC; 8, inactive UC) were studied, and compared with 14 matched healthy subj ects. Flow velocity,resistance index (RI), and pulsatile index (PI) of the SMA were evaluated by Doppler US. Results: Peaksystolic velocity was significantly higher in patients with active UC than in patients with inactive UC and control (178±53 m/sec vs. 117±15 m/ sec, 111±24 m/ sec; p<0.05). The PI of SMA was significantly lower inpatients with active and inactive UC than in control (1.58±0.53, 1.7±0.52 vs. 2.9±0.44; p<0.05). Minimaldiastolic velocity and RI of the SMA were not significantly different among three groups. Conclusions: Peaksystolic velocity of SMA reflects the activity of the disease in patients with UC. Doppler US in patients with UC is an important non-invasive, readily available method to evaluate the activity of the disease and predict itsrecurrence. (Korean J Gastroenterol 2002;39 :192-197)

알코올 및 바이러스성 간경변증에서 세균성 감염 빈도의 비교

박정식(Jeong Sik Park),조용균(Yong Kyun Cho),이은정(Eun Jung Rhee),정수석(Soo Suk Jeong),김시영(Si Young Kim),김창섭(Chang Seop Kim),박창영(Chang Young Park),손정일(Chung Il Sohn),전우규(Woo Kyu Jeon),김병익(Byung Ik Kim),정을순(Eul 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background: Liver cirrhosis may be considered one of the most common cause of acquired immunodeficiency. Alcohol abuse may be predisposing factor to infections in patients with liver cirrhosis, so we compared the rate of spontaneous bacterial peritonitis (SBP) and other bacterial infections in alcoholic and viral liver cirrhosis. Methods: We studied 188 patients who had been diagnosed with liver cirrhosis from January 1995 to June 2000 and evaluated the frequency of bacterial infections (SBP, pneumonia, urinary track infection, bacteremia, infectious colitis) retrospectively according to cause and degree of cirrhosis. Results: Among 188 patients (alcoholic 76, viral 112), 64 patients (34%) presented with bacterial infection at hospitalization, 33 (43%;33/76) of 64 subjects were alcoholic and 31 (28%;31/112) of 64 subjects were viral liver cirrhosis. The rate of bacterial infections was higher in alcoholic liver cirrhosis than viral cirrhosis (p<0.05). The rate of SBP and other bacterial infections were more frequent in patients of Child-Pugh class C than in those of Child-Pugh class A and B (p<0.01, p<0.05) respectively. Patients of alcoholic liver cirrhosis were more susceptible to bacterial infection than those of viral liver cirrhosis with Child-Pugh class A/B (p<0.05), but no difference was noted in patients of Child-Pugh class C (p>0.05). Conclusion: This results suggest that the rate of bacterial infections are more common in alcoholic than viral liver cirrhosis in relatively early stage and it may be influence the prognosis of liver cirrhosis.(Korean J Med 62:159-164, 2002)

중증 감염증에 대한 Mobactam의 임상효과

손정일,최일영,정태준,최태열 대한감염학회 1993 감염 Vol.25 No.2

Mobactam,a new synthetic monobactam, was administered to 27 aptients with severe infections. Clinical evaluations were made after monotherapy according to UTI criteria, as excellent in 5 patients, moderate in 14 patients and poor in 8 patients. Overall clinical effectiveness rate was 70.4%. For those who did not completely cured with mobactam monotherapy (22 patients), addition of ceftriaxone brought 18 more patients including 11 cure patients in clinical effectiveness group. Antibiotic sensitivity tests was performed using 96 gram-negative strains isolated from patients in intensive care units. Mobactam has shown sensitivity of 78% to Pseudomonas spp. which was comparable to amikacin and superior to other available antibiotics tested. For Klebsiella pnaeumoniae, mobactam was the most effective and the prevalence of resistant strains. Overall, mobactam was an effective antibiotic for eradicating gram-nega tive bacilli such as Pseudomonas spp., Klebsiella spp., Enterobacter spp., and Proteus spp. Based on this results, we conclude that mobactam can be safely used as a primary antibiotic in patients with severe infections.

아급성 갑상선염양 증후군을 갖는 갑상선유전분증

김정호,김인순,안유헌,유용걸,김목현,손정일,고영혜,윤석남 대한내과학회 1994 대한내과학회지 Vol.47 No.4

Amyloidosis is a disease of unknown cause characterized by the accumulation of an amorphous, proteinaceous material in various organs and tissue of the body. We had recently experienced a 31-year-old man presented with subacute thyroiditis like symptoms, diarrhea and proteinuria. He had tender, diffuse, firm goiter, low normal limit of thyroid function, and increased erythyrocyte sedimentation rate. On the basis of history, clinical settings, and laboratory findings, the diagnosis of subacute thyroiditis was initially made. Steroid therapy resulted in dramatic improvement of thyroid symptoms, Histological examinations of the patient's thyroid gland, colon and kidney revealed amyloid deposition. Retrospectively, we concluded that amyloid depasition in thyroid gland, colon, and kidney was secondary to ankylosing spondylitis from which he had suffered for 14 years. He has achieved clinical improvement with steroid and thyroid hormone replacement therapy and being followed-up. In conclusion, when patients with clinical features of subacute thyroiditis have an unusual course, the possibility of thyroid amyloidosis should be considered.

Helicobacter Pylori 에 대한 혈청 lgG 항체가와 내시경 및 조직병리소견과의 연관성

김시영,박창영,박은미,조용균,전우규,정을순,이상종,김병익,김창섭,박범준,손정일,금주섭,금동극,이화영 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.1

Baekgronnd/Alms:In dinical practlce, among the technique tg defe4ed Heticobacter pylori (H. pylori) infaction IgG serological test is noninvasive, safe, quick, widely available, and inexpensive. We studied that whether the titers of anti-g. pylori IgG antibody were correla0d with endoscopic finding, and the degree of microscopic gastric damage and H. pylori density in dyspeptic patients. Methods: Gastric biopsy specimens were obtained in IGP patiens with H. pylori infec5on undergoing upper gastric endoscopy. The titers of serum IgG antibodies to H pylori were measured by enzyme immumoassay. Macrpscopic gastric damages and. Histologic pylori were scored by the Sydney system. Resnlts: Bndoscopic findings showed no significant association with H. pylori antibody titers (p=0.111). There was significant correlation between H pylori antibody titers and lymphocyte infiltration (p 0.002), neutrophil infiltration (p=0.002), H, pylori density (p=0.000I), respectively. There was no significant correlation between 8 py4ri antibody titers and atropy (p=0. 142), irrtestinal metaplasia (p=0.368), respectivelp. Conclnsions: H. pylori antibody titer has signi6cant association with the H. pylori density, neutrophil and 1ymphocyfe infiltration. The serological test using BIA method is a use5G in detecting H, pylori infection and it may be used as a predictor for the H. pylori density and degree of inflammation.