철결핍성 빈혈환자의 내원시 검사 소견

강한걸,신석균,최소연,김현수,송영구,서형찬,김효철 아주대학교 1996 아주의학 Vol.1 No.2

저자들은 철결핍성 빈혈 환자들의 내원시 검사소견을 관찰하여 이들의 특성 및 진단에 유용한 지표를 찾고 아울러 혈청 내 철의 정도를 반영할 수 있는 적혈구지수가 있는 지 알아보고자 1994년 1월부터 1996년 1월까지 아주대학교 부속대학병원 혈액종양내과에 내원하여 Coulter STK A2를 통해서 얻은 적혈구지수와 혈청 철, 혈청 총철결합능력, 혈청 ferritin을 측정하여 진단된 IDA환자 130례를 대상으로 다음과 같은 결과를 얻었다. 1) 전체 환자의 평균연령은 36.3±11.6세였으며 12세에서 65세까지의 연령분포를 보였다. 2) 전체 환자의 혈색소는 8.0±2.0 g/㎗이었고, 헤마토크리트 26.0±5.4%, MCV 68.8±11.3 fl, MCH 21.8±4.6 pg, RDW 18.5±4.0%, 혈청 철 25.0±15.1 ㎍/㎗, 혈청 총철결합능력 422.0±62.7 ㎍/㎗, ferritin 6.7±2.3 ㎍/㎗이었다. 3) 환자들이 호소하는 증상들은 월경과다가 36.9%, 현기증이 34.6%, 만성두통 32.3%, 만성피로 17.7% 그리고 소화기계 장애가 16.9%를 나타내었다. 4) 빈혈의 주요 원인으로서는 월경과다가 75례(57.7%), 위십이지장 궤양이 18례(13.8%), 사춘기/임신으로 인한 철의 요구량 증가가 19례(14.6%)였으며 치질로 인한 출혈이 11례(8.5%)이었고 원인불명이 17례였다. 5) 대상환자들을 혈색소치 9.0 g/㎗를 기준으로 하여 두 그룹으로 분류하였으며 혈색소가 9 g/㎗이상인 경한 빈혈 그룹에서 혈색소와 MCV는 유의한 상관관계(r=0.6584, p<0.05)가 있었으며, 혈색소가 9 g/㎗ 미만인 중한 빈혈 그룹에서 혈색소와 MCHC가 유의한 상관관계(r=0.4305, p<0.05)를 나타내여 경한 빈혈에서는 MCV가 중한 빈혈에서는 MCHC가 의미가 있음을 시사하고 있다. 5) RDW와 MCV는 두 그룹 모두에서 반비례 관계를 보였지만, 빈혈이 경한 그룹에서는 통계적으로 유의한 상관관계(r=-0.2985, p<0.05)를 보였고, 빈혈이 중한 환자그룹에서는 통계적으로 상관관계(r=-0.1208, p<0.05)가 유의하지 않아서, IDA 초기에는 MCV와 RDW가 의미가 있겠지만 중한 빈혈인 경우에는 의미가 없음을 보여 주었다. 6) 새로운 지표 MCV/RDW 비값이 fe/TIBC 포화도와 상당히 유의한 양의 상관관계(r=0.4763, p<0.005)가 있었고 5.1 이하인 경우에는 85.4%의 민감도로 IDA를 진단할 수 있겠다. 이상의 결과에서 혈청 철의 생화학적 지표에 앞서 단순한 일반 혈액검사에서 MCV/RDW를 계산함으로써 IDA의 선별검사로 사용할 수 있으며 5.1 이하의 범위에서 IDA를 진단을 한다면 85.4%의 민감도로 예측할 수 있다. To evaluate the laboratory findings in patients with iron deficiency anemia(IDA) at initial presentation and to define useful screening tests such as RBC indices and markers of serum iron, we studied 130 patients with the diagnosis of IDA who visited Ajou University Hospital from July 1994 to January 1996. The results of the study are as follows; 1) The mean age of IDA patients were 36.3 ±11.6 years old and ranged from 12 to 65 years old. 2) The mean laboratory values at initial visits were hemoglobin 8.3±2.0 g/dl, hemalocrit 26.0±5.4%, mean corpuscular volume 68.8±11.3 fl, mean corpuscular hemoglobin 21.8±4.6 pg, RDW 18.5±4.0%, serum iron 25.0±15.1 ㎍/dl, TIBC 422.0±62.7 ㎍/dl and serum feiritin 6.7±2.3 ㎍/dl. 3) Frequent symptoms and signs were menorrhagia(36.9%), dizziness(34.6%), headache(32.3%), easy fatigability(17.7%) and G-Ⅰ trouble(16.9%). 4) Frequent causes of IDA were menorrhagia in 75(57.7%) cases, gastrointestinal ulcer in 18(13.8%) cases, increased demand for iron due to pregnancy and growth spun in 19(14.6%) cases, hemorrhoidal bleeding in 11(8.5%) cases. 5) When patients were divided into two groups(Hb≥9 g/dl as mild, Hb<9 g/dl as severe anemia), the group with Hba.9 g/dl showed a significant correlation between hemoglobin and MCV(r=0.6584, p<0.05). However, in the group with Hb<9 g/dl, there was a significant correlation between hemoglobin and MCHC(r=0.4305, p<0.05). 5) Negative correlation was observed between MCV and RDW in both groups, <although statistically significant in the mild group(r=-0.2985, p<0.05) but not significant in the severe group(r=-0.1208, p>0.05)> indicating more microcytic in RBC index and anisocytosis in RBC shape. 6) MCV/RDW ratio was correlated significantly with Fe/TIBC saiuration(r=0.4763, p<0.005) and MCV/RDW ratio of less than 5.1. This is lo be the most sensitive index in the diagnosis of IDA, sensitivity 85.4% in both mild and severe groups. In conclusion, in addition to serum iron markers, MCV, MCHC and RDW have been used as screening tests and prediction for IDA. We suggest that the ratio of MCV/RDW(fl/%) less than 5.1 is one of the most sensitive index in screening and diagnosing IDA with 85.4% sensitivity rate.

다발성 결절성 고형질화

김진안,강한걸,김성규 한국의학사 1994 診斷과治療 Vol.14 No.12

위암의 발생부위 및 심달도에 따른 위전도검사(EGG)의 의의

박영숙,이광재,강한걸,김영수,함기백,김진홍,조성원,이상인,조용관,김명욱 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

Gastric slow waves which reflect neuromuscular activity of stomach, are considered to originate from the circular muscle of the stomach or from the interstitial cells of Cajal on the greater curvature near the junction of the proximal and distal gastric corpus. Therefore, it is suggested that the gastric malignancy occurring at some region of the stomach may affect the gastric myoelectrical activity. Scarse information is available about the changes of myoelectrical activity in patients with gastric cancer. This study was aimed at investigaing the effect of gastric cancer on gastric myoelectrical activity according to the location and depth of invasion. Methods: Seventy patients(mean age: 54.9±12.9yr,M:F=44:26) with gastric cancer and seventy normal controls(mean age: 45.9±11.1yr, M:F=34:36) were included. Gastric myoelectrical activity was recorded via abdominal surface electrodes using an ambulatory electrogastrographic recorder (Digitrapper EGG, Syndics, Irving, TX). The record were analyzed based on running spectral analysis. Electrogastrography was recorded for at least 30-min during fasting and then 30-min after solid test meal(700 Cal, protein 32 gm, fat 15 g, carbohydrate 110 gm). Results: 1) The percentage of normal slow waves(2-4cpm) was 87.5±15.8% in early gastric cancer group(19), 95.4±18.9% in advanced gastric cancer group(81) and 91.3±9.9% in control group(70) in fasting state In postprandial state, the percentages were 85.9±12.7% 89.3±13.9% and 89.7±10.2% respectively. 2) In advanced gastric cancer, there was no statistical difference according to cancer location on gastric myoelectrical activity. 3) The power ratio defined as postprandial slow wave amplitude increment, was normal in most patients between early and advanced cancer group and control group. 4) In 11 patients with antral cancer and partial pyloric obstruction, the percentage of normal slow waves was 93.3±10.9% in fasting state and 92.8±11.2% in postprandial state and amplitude of slow waves in fasting state was significantly higher than in antral cancer without obstruction (p<0.05). Conclusions: There was no significant change in pattern of gastric myoelctrical activity in patients with gastric cancer according to the location and depth of invasion. However, the pyloric obstruction by cancer infiltration produced prominent increase of amplitude in slow waves similar to the effect of other benign obstruction.

위암과 위산도

이상인,박영숙,강한걸,문영수,이광재,홍사준,김영수,함기백,김진홍,조성원 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

Based on the known relation sivp between gastric carcinoma and achlorhydria, gastric juice analysis was performed on 47 patients with gastric carcinoma diagnosed by gastrofiberscopy with gastric biopsy,in order to find the relationship of tumor location, gross findings, gut hormone such as gastrin and somatostatin, serum and gastric juice CEA, gastric juice nitrite and gastric acid secretion. According to gastric acidity, there were no significant differences in age, sex, serum gastrin and somatostatin, serum CEA and gastric juice nitrite. But gastric juice CEA was increased significantly in patients with achlorhydria compared to in patients with normal acidity. In patients with low acidity and achlorhydria, gastric carcinoma was located mainly in the upper stomach compared with tumors in patients with normal acidity, which involved mainly the mid-to-lower stomach. These findings suggest that the location of tumor may be related to gastric acid secretion and achlorhydria was not the causative factor of gastric cancer, but rather a secondary phenomenon of tumor invasion to the gastric acid secreting area.

1996년도 제35차 대한소화기학회 추계학술대회 / 일반연제 : 위장관 ; Experimental colitis 시 reactive oxygen metabolites 및 cytokine 의 변화 - DA-9601 의 효과를 중심으로 -

채보원,함기백,고준호,강한걸,이광재,김진홍,조성원,안병옥,김원배,양중의 ( B . W . Chae,K . B . Hahm,J . H . Ko,H . G . Kang,K . J . Lee,J . H . Kim,S . W . Cho,B . O . Ahn,W . B . Kim,J . I . Yang ) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

대한간학회지 제2차 춘계학술대회 초록집 : 간경변증에 의한 울혈성 위병변에서의 Nitric Oxide Synthase(NOS) 분포 -면역화학검사-

문영수 ( Mun Yeong Su ),강한걸 ( Kang Han Geol ),홍사준 ( Hong Sa Jun ),이광재 ( Lee Gwang Jae ),김영수 ( Kim Yeong Su ),함기백 ( Ham Gi Baeg ),김진홍 ( Kim Jin Hong ),조성원 ( Jo Seong Won ),임현이 ( Im Hyeon I ) 대한간학회 1996 Clinical and Molecular Hepatology(대한간학회지) Vol.2 No.2(S)

극미세 췌관 내시경으로 진단된 점액성 췌관 확장증 1예

문영수,김진홍,김영수,홍사준,조성원,함기백,윤명호,강한걸 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

Mucinous ductal ectasia(MDE) is a newly described entity of mucinous neoplasm of pancreas with characteristic endoscopic and pancreatographic findings. It is charaeterized by a patulous duodenal papilla extruding mucus and a pancreatogram showing dilatation with amorphous filling defects, communication of the mass with the pancreatic duct. MDE is intraductal lesion consisting of dilated $quot;cystified$quot; ducts lined by mucin-producing columnar cells. The lesion is usually located in the head or uncinate process. When the radiographic appearance of the ERCP cannot provide sufficient information for definite diagnosis, additional endoscopic visualization is desirable. With the advent of pancreatoscopy, an endoscopic procedure is now available that has proven to enhance diagnostic accuracy. The 0.8-mm ultrathin pancreatoscope allows macroscopic diagnosis under direct vision. Endoscopic sphincterotomy is not required, and insertion into the pancreatic duct is feasible in most cases with the aid of guidewires. Major indications are unclear filling defects on ERCP, strictures of uncertain origin, and duct cut-offs. A limitation of this procedure are the lack of angulation, insufficient illumination, fragility of endoscopic equipment, and nonspecific findings. In addition, biopsy while directly viewing the lesion is impossible at present. We experienced one case of MDE who presented with the symptom of weight loss. Ultrathin pancreatoscopy was useful for the direct visualization af pancreatic duct in the differential diagnosis of filling defects of main pancreatic duct.

급성 기종성 담낭염 2 예

이광재,김진홍,김영수,이선민,조성원,김영준,윤명호,함기백,이내희,채보원,강한걸 대한내과학회 1997 대한내과학회지 Vol.53 No.3

Emphysematous cholecystitis is an uncommon form of acute cholecystitis characterized by the presence of gas within the wall, lumen of the gall bladder or biliary ducts. Clinically it is very similar to ordinary farm. But since the risk of perforation is five times that expected from ordinary cholecystitis, early diagnosis and appropriate surgical treatment are important. We could diagnose these cases by the simple abdomen, abdominal ultrasound and abdominal CT by the presence of air in the lumen and the wall of the gall bladder. Percutaneous trans hepatic gall bladder drainage (PTGBD) for decompression was used because poor general condition of patients and later, we could successfully perform the cholecystectomy without any complication. We presented two cases of emphysematous cholecystitis with review of the relevant literature on the subject.

급성심근경색에서 Troponin T 와 경색의 크기와의 상관관계

서창희(Chang Hee Suh),김한수(Han Soo Kim),강한걸(Han Geol Kang),신준한(Joon Han Shin),탁승제(Seung Jae Tahk),이승호(Seong Ho Lee),최병일(Byung Il William Choi) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A Objectives: The estimation of infarct size has been important in evaluation of prognosis of the patients who had acute myocardial infarction. The infarct size estimated by the thallium-201 SPECT has been known to correlate with the prognosis of patient. The enzymatic estimation by the total release of creatine kinase isoenzyme MB(CK-MB) has been widely used in estimating infarct size clinically, but inconvienent and not cardiospecific. Recently, serum troponin T, cardiospecific myofibrillar protein, has been used in the diagnosis of acute myocardial infarction, and used in the estimation of reperfusion following myocardial infarction. To assess the role of the late troponin T peak concentration on the estimation of infarct size, this prospective study was carried out. Methods: The patients with acute myocardial infarction who were admitted, within 48hours after the onset of chest pain, to Ajou University Hospital between April 1995 and August 1995 were evaluated. All patients were divided into anterior and inferior infarct and checked serum troponin T and CK-MB serially, and underwent stress Thallium-201 SPECT 1 week after infarction, In each group, we assessed the correlation of the late toponin T peak concentration, the total release of CK-MB, and the infarct size estimated by thallium-201 single photon emission computed tomography(SPECT). Results: 1) The eligible subjects consisted of 22 patients (17 men and 5 women), and age ranged from 29 to 77 years(mean 57.8±12.5 years). 2) The mean arrival time to the hospital after the onset of chest pain was 15.5±13.2 hours. The 19 patients had at least one risk factor for coronaryartery disease. 3) The late troponin T peak concentration and the total release of CK-MB in patients with anterior infarction were not different from those with inferior infarction. The infarct size estimated by the thallium-201 SPECT in patients with anterior infarction was larger than patients with inferior infarction The left ventricular ejection fraction in anterio infarction was lower than inferior infarction. 4) The late troponin T peak concentration ha: positive correlation with the infarct size estimated by the thallium-201 SPECT in the total patients, and both patients with anterior infarction and inferio infarction. 5) The total release of CK-MB correlated with the infarct size estimated by the thallium-20 SPECT in the total patients, and the patients of inferior infarction. Conclusion: The late troponin T peak concentration was more accurate than the total release o CK-MB in the estimation of infarct size. Therefore, when the patient arrived to the hospital less than 48hr after the onset of chest pain, the late troponin T peak concentration is useful in the decision and evaluation of therapeutic intervention and in the prediction of prognosis.

기능성 소화불량증 환자의 위배출시간에 따른 위전도 ( EGG ) 에 관한 연구

박영숙(Y . S . Park),김영수(Y . S . Kim),강한걸(H . G . Kang),함기백(K . B . Hahm),김진홍(J . H . Kim),조성원(S . W . Cho),이상인(S . I . Lee),김옥화(O . H . Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.6

N/A Objectives The aim of this study was to know the clinical significance of electrogastrography(EGG) and to determine the relationship between gastric myoelectrical activity and gastric emptying time in patients with functional dyspepsia. Methods: This study included 10normal subjects and 30patients with functional dyspepsia. They were given scrambled egg with 2mCi 99m Tc-sulfur colloid for measuring gastric emptying time. We measured half time(T1/2) and remnant radio activity at 2hour after meal. Gastric myoelectrical activity was recorded by cutaneous EGG(Synetics, Digitrapper EGG) in 30patients with functional dyspepsia. EGG was recorded for at least 30minutes in fasting state and 30minutes in post prandial state (solid test meal, 618Cal), EGG was analyzed based on the running power spectra. Results: 1) In 10 normal subjects, the mean of gastric emptying time (Tl/2) was 89.0±7.9min and among 30 patients of functional dyspepsia, 14patients (46%) showed delayed GET (delayed GET group) and 16patients (53%) showed normal GET (normal GET grooup) 2) In both patients group, there was no significant difference in the percentage of normal gastric slow waves(2-4cpm) between fasting state and post prandial state. 3) In post prandial state, the ratio of slow wave in normal GET group was significantly higher than that in delayed GET group (95.5±6.2% vs 82.5±14.3%, p<0.05), but in fasting state, there was no significant difference. 4) Normal post prandial amplitude increment (1.5times higher than fasting state amplitude) was seen in 7(50%)cases of delayed GET group and in 13(80%)cases of normal GET gorup, which was statistically significant (p<0.05). Conclusion: Among patients with functional dyspepsia, delayed GET group showed higher ratio of gastric dysrhythmia and abnormal post prandial amplitude change. Electrogastrography seems to have clinical significance in evaluating the explanable cause of functional dyspepsia.