십이지장과 공장으로 전이된 원발성 편평성 폐암종

이문희(Moon Hee Lee),홍성표(Sung Pyo Hong),현인규(In Gyu Hyun),이진(Jin Lee),손주현(Joo Hyun Sohn),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김이수(Lee Su Kim),최원진(Won Jin Choi),최철순(Choi Chul Soon) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

Benign and malignant tumors are rarely encountered in the small intestine. Moreover small bowel metastases arising from the lung carcinoma are very unusual. Previous studies reported that the most common metastatic site of lung carcinoma was the esophagus and the most common histologic type was the squarnous cell carcinoma type. This case was duodenal and jejunal metastases from squamous cell carcinoma of the lung. The patient in this case com- plained of hematemesis and presence of movable mass in the lower left abdomen. N odular ul- cerative mass on the duodenal bulb was found by duodenoscopy, and an endoscopic biopsy re- vealed squamous cell carcinoma. A bronchoscopic biopsy determined squamous cell carcinoma of the lung. Abdominal exploration confirmed multiple metastases on duodenum, two sites of jejunum and Douglas pouch. So we report the case of multiple small bowel metastases from primary squamous lung carcinoma. (Korean J Gastronterol 1994; 26: 191 196)

위장관형 탄저병 2예

김철홍(Cheol Hong Kim),박철수(Cheol Soo Park),이문희(Moon Hee Lee),계세협(Sea Hyub Kae),이진(Jin Lee),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3

Anthrax is an acute bacterial infection caused by Bacillus anthracis, which is a spore-forrning, aerobic, Gram-positive bacillus. It occurs most frequently in herbivores when they are foraging for food in areas contamioated with spores of Bacillus anthracis under appropriate climatic conditions. Humans become infected when spores of Bacillus anthracis are introduced into the body by contact with infected animals or contaminated animal products, insect bites, inhalation, or ingestion. The disease occurs primarily in three forms; cutaneous, respiratory and gastrointestinal. Bacillus anthracis bacteremia can develop in any form of anthrax and is fatal in almost all cases. We experienced two cases of human gastrointestinal anthrax, which resulted frorn consumption of contaminated meat. Here we report 2 cases of human gastrointestinal anthrax with a brief review of literature. (Korean J Gastroenterol 1997;29:404-410)

간경변증 환자의 수분 전해질 평형 및 신기능에 있어서 혈청 Endothelin - 1 의 역할

이진(Jin Lee),박철수(Cheol Soo Park),박철희(Cheol Hee Park),계세협(Sea Hyub Kae),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김호중(Ho Jung Kim),기춘석(Choon Suhk Kee) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: It has been recently known that endotheUn-1 is a potent vasoconstrictor. The purpose of the present study was to clarify the possible correlation of endothelin-1 with other vasoactive neurohormonal activities and its effects on fluid- electrolyte balance and renal function in patients with liver cirrhosis. Mcthods: In 35 patients of liver cirrhosis with (n=19) and without (n=16) ascites and in 12 normal controls, plasma and urine levels of endothelin-1 were measured by specific radioimmunoassay, and serum sodium, serum albumin and other blood chemistries, renal functions with creatinine clearance, urinary sodium excretion, plasma renin activity, plasma aldosterone and plasma norepinephrine were measured at the same time. Results: The plasma endothelin-1 level was significantly higher in ascitic group than nonascitic group (mean±SD; 16.4±10.6 VS. 7.5±4.1pg/mL, p=0.0000), and there was no significant difference in plasma endothelin-1 level between nonascitic group and normal controls(4.8±1.9pg/mL). The urine endothelin-1 level also was significantly higher in ascitic group than non-ascitic group (140.3±74.3 VS. 58.5±37.4 pg/mL, p=0.0000), there was no significant difference in urine endothelin-1 level between nonascitic group and normal controls (19.5±112pg/mL). In patients with cirrhosis, the plasma endothelin-1 concentration showed significant negative correlation with creatinine clearance (r=-0.55), serum albumin (r=-0.56%) and serum sodium concentrtion (r=-0.62), and significant positive correlation with plasma renin activity (r=0.63), plasma aldosterone (r=0.68) and norepinephrine (r=0.70). The factors that influence on plasma concentration of endothelin-1 were plasma norepinephrine (p=0.0000), serum sodium (p=0.0169), plasma aldosterone (p=0.0176), serum albumin (p=0.0213) and plasma renin activity (p=0.0329) in statistically significant order. Conclusion: The elevated plasma endothelin-1 level along with the increased activity of other neurohormonal substances including plasma renin, aldosterone and norepinephrine induces sodium and water retention in decompensated liver cirrhosis. Thus, the plasma endothelin-1 level seems to have an important role in the development of functional renal impairment in decompensated liver cirrhosis by inducing renal vasoconstriction.

간세포암 환자에서 DNase , RNase 및 Rnase inhibitor 측정의 의의

계세협(Sea Hyub Kae),정유선(Yoo Sun Chung),장현주(Heon Ju Jang),정선화(Sun Wha Jung),김용태(Yong Tae Kim),강승식(Seung Sik Kang),이진(Jin Lee),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),유재영(Jae Young Yoo) 대한내과학회 1998 대한내과학회지 Vol.54 No.5

N/A Objective Activities of nucleases (acid DNase and neutral RNase) and RNase inhibitor 1mown to be involved in carcinogenesis and suppression of cancer were determined in cancer tissue, serum and ascitic fluid of patients with hepatocellular carcinoma and were compared with those of the controls. Also studied were nucleases and RNase inhibitor isolated from hepatocellular carcinoma tissue and ascitic fluid of the cancer patients to evaluate the properties and interactions between them. Method: Activities of nucleases and RNase inhibitor were measured in cancer tissue, serum and ascitic fluid of patients with hepatocellular carcinoma by ultraviolet spectrophotometry. Nucleases and RNase inhibitor were isolated from hepatocellular carcinoma tissue and ascitic fluid of the cancer patients by DEAE-cellulose column chromatography. As controls, normal tissue of the cancer patients, serum of healthy persons and ascitic fluid of cirrhotic patients were used. Result: Activities of DNase, RNase and RNase inhibitor were significantly increased in hepatocellular carcinoma tissue. DNase activity was not detected, RNase activity was increased and RNase inhibitor activity was unchanged in both serum and ascitic fluid of the hepatocellular carcinoma patients. DNase was isolated as a single enzyme and RNase as seven isozymes from the hepatocellular carcinoma tissue. The DNase isolated preferentially cleaved ds DNA over ss DNA and was endonuclease in nature (majority of hydrolytic products of DNA by the DNase were oligodeoxyribonucleotides). Of seven RNase isozymes isolated from the hepatocellular carcinoma tissue, isozyme I exhibited nonsecretory nature of RNase and other six isozymes secretory nature of the enzyme. Activity of RNase isozyme V was greatly increased and the activity of inhibitor complexed with the isozyme V was also increased. RNase in ascitic fluid of the cancer patient was separated into four isozymes, of which isozyme I exhibited mixed form of secretory and nonseretory nature and greatly increased in its activity. RNase isozyme V isolated in the hepatocellular carcinoma tissue was not detected in the ascitic fluid, Conclusion: The use of the nucleases and the inhibitor in the cancer tissue as biochemical markers for the hepatocellular carcinoma was suggested. RNase was released into the body fluid from the cancer tissue and could be used as a diagnostic marker for the hepatocellular carcinoma. An important rale of the DNase in carcinogenesis of the liver was suggested. RNase isozyme V was limited in the cancer tissue and RNase isozyme I and V and inhibitors associated with these isozymes might be involved in carcinogenesis processes, suppression of cancer and maintenance of tocellular carcinoma through their interactions.

간경변증 환자의 나트륨대사에 있어서 혈장 Renin 및 교감신경활동도의 역할

이진(Jin Lee),최용석(Young Suk Choi),강승식(Seung Sik Kang),정용영(Yong Young Jung),윤석부(Seok Boo Yoon),계세협(Sea Hyub Kae),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김호중(Ho Jung Kim),기춘석(Choon Suhk Kee) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: We studied to determine the changes of sodium metabolism and to evaluate the role of plasma renin and sympathetic activities in liver cirrhosis with hyponatremia. Methods: We performed measurement of serum sodium, serum albumin and other blood biochemistries, creatinine and creatinine clearance, daily urinary sodium excretion, plasma renin and aldosterone, and plasma norephinephrine level for sympathetic activity in 24 cirrhotic patients with (n;8) and without ascites(n; 16) on day 1 after admisson. We checked body weight, serum sodium and creatinine clearance again on day 10 after admission. Results: 1) The serum sodium level of the ascitic group was lower than that of the non-ascitic group(136±1.0 vs. 138±2.4 mEq/L, p<0.01). There were also significant lower values of serum albumin, creatinine clearance and 24hr urinary sodium excreation in the ascitic group as compared with non-ascitic group. 2) The plasma renin activity and norepinephrine level of the ascitic group were higher than that of the non-ascitic group(renin=3.8±1.1 vs. 557±50 pg/ mL, p<0.05). 3) On day 10 after admission, the serum sodium concentration was decreased more prominently to 132±2.6 mEq/L along with significant reduction of body weight and creatinine clearance in the ascitic group, whereas there was no change of serum sodium level in the non-ascitic group, 4) In total 24 patients, a significant positive correlation between serum sodium and albumin concentration(R=0.6, p=0.004) as well as a significant negative correlation between serum sodium concentration and plasma renin activity(R=0.7, p=0.001). Conclusion: These results suggest that changes of serum sodium concentration in cirrhotic pathents correlate closely with changes of renal function related to the presence or absence of ascites, serum albumin level, changes of body weight, increased plasma renin activity and sympathetic activity, and with alteration of sodium and water delivery to the diluting segment of renal tubules.

조기 대장암의 임상적 의의와 치료

곽상택,이진,주상언 한림대학교의료원 1994 人間科學 Vol.18 No.5

Mouse 신장에서 Azide가 반응성 산소에 의한 독성에 미치는 영향

곽상택,권태우,장현정,백광진,권년수,이희성 중앙대학교 의과대학 의과학연구소 1993 中央醫大誌 Vol.18 No.3

An increased production of reactive oxygen species has been postulated as a major pathogenic factor in the tissue damage occurring in high oxygen environment. Azide could enhance the oxygen toxicity by inhibiting superoxide dismutase and catalase, enzymes which remove reactive oxyge species. Mice were treated with azide (8.1 ㎎/㎏ body weight), and placed in a chamber saturated with 100% O_2 for 3, 6, 12, 24, 48 or 72 h. Superoxide radical generation, and activities of xanthine oxidase, superoxide dismutase and catalase in homogenate of the mouse kidney were measured. Superoxide radical generation was enhanced after exposing mice to azide/100% O_2, and reached to a maximum at 24 h. The elevated activity of cytosolic Cu, Zn-superoxide dismutase by the azid/oxygen treatment was sustained up to 12 h. Mitochondrial Mn-super oxide dismutase was slowly induced by the azide/oxygen treatment and was continuously increased until 72 h of exposing 100% o_2, while treatmet with neither azide nor oxygen alone enhanced the enzyme activity. Change of the catalase activity was not observed in the mouse kidney treated with azide and/or 100% oxygen. Xanthine oxidase activity was markedly decreased by the azide/oxygen treatmet. These reslts suggested that superoxide radicals generated in high oxygen tension were originated mainly from mitochondria, not from xanthine oxidase-catalyzed reaction. Thus, mitochondrial Mn-superoxide dismutase was induced to remove the superoxide radicals effectively.

1986 년 춘천지역에서 균주 배양, 분리로 확진된 렙토스피라병 13 예

이수현,조민기,최문기,곽상택,이영천,홍광일,김연근,김교명,김윤원 대한내과학회 1987 대한내과학회지 Vol.32 No.5

We studied the clinical features of 13 patients of confirmed leptospirosis who had been admitted to the Chun Cheon Sacred Heart Hospital, Hallym University, from the end of October to the end of December of 1986. The results were as follows: 1) Most patients were farmers, some were not farmers but living in rural area, and the other patients were living in the city who were exposed to rural environment except one diabetic patient. 2) Blood cultures revealed positive results in all cases, and there was one positive finding on the spinal culture study. 3) At the time of admission, the microscopic agglutination test showed positive result in only 3 cases, and their titers were relatively low. 4) Classifying them with their clinical features, hepatitis type which was the most common was 76.9%, nephritis type was 30.7%, pulmonary type was 23.1%, influenza type was 23.1% and meningitis type was 15.4 %, and these showed mixed pattern which had been overlapped to each other, 5) The ninty percent of hepatitis type were anicteric. 6) The prognosis was excellent and the clinical symptoms and signs were improved with normalization of the laboratory data. In this study, we concluded that hepatitis type was dominant, and this result was quiet different from other domestic reports. The difference in the serovar or geographic character could be responsible for this unique feature. So, we suggest that the study on the serovar of Leptospira should be carried out in detail and the different clinical features according to the geographic distribution of patients should be surveyed more extensively.

담낭결손을 동반한 총담관 대장루 1 예

이진,장현주,강승식,이봉화,곽상택,임해성,정유선,정선화,계세협,주사언 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3

The enterobiliary fistulas are mostly spontaneous and are caused by biliary disease associated with calculi. Review of many series shows that the most common variety of enterobiliary fistulas is a cholecystoduodenal fistula followed by cholecystocolic, cholecystogastric and choledochoduodenal fistula in that order. But very few cases of choledochocolonic fistulae have been reported. We report a case of choledocholithiasis combined with the absence of gallbladder leading to a choledochocolonic fistula, which was confirmed by endoscopic retrograde cholangiography and abdominal exploration in a 63-year-old male patient with complaint of right upper abdominal pain.

알코올성 간질환 환자에 있어서 혈청 Type IV Collagen 측정의 유용성

이진,강승식,박철희,주상언,계세협,장웅기,임창재,곽상택,임해성,정유선 대한소화기학회 1999 대한소화기학회지 Vol.33 No.2

Background/Aims: Serun type IV collagen (IV-C) is known to be related to hepatic fibrosis. This study was performed to evaluate the clinical usefulness of IV-C measurement as an index of hepatic fibrosis in patients with chronic liver diseases, especially chronic alcoholic liver diseases. Methods: The IV-C was measured in 16 cases of chronic persistent hepatitis (CPH) B, 16 cases of chronic active hepatitis (CAH) B, 18 cases of hepatitis B associated liver cirrhosis, 12 cases of alcoholic hepatitis, 18 cases of alcoholic cirrhosis, and 16 normal controls. The concentration of IV-C was determined by one-step sandwich enzyme immunoassay. Results: The concentration of IV-C in vira cirrhosis group (356.4 ±96.1 ng/mL) was significantly (p$lt;0.05) higher than that in the CPH group (121.1 ±47.4 ng/mL), the CAH group (141.5 ±75.5 ng/mL) and normal controls (90.1 ±13.7 ng/mL) The concentration of IV-C in alcoholic cirrhosis group (956.6 ±334.5 ng/mL) was significantly (p$lt;0.05) higher than that in alcoholic hepatitiup (147.5 ±55.5 ng/mL) and normal controls (90.1 ±13.7 ng/mL). The concentration of IV-C in alcoholic liver disease group (632.9 ±478.8 ng/mL) was significantly (p$lt;0.05) higher than that in chronic viral liver disease group (212.4 ±132.8 ng/mL). The concentration of IV-C in alcoholic cirrhosis group (956.6 ±334.5 ng/mL) was significantly (p$lt;0.05) higher than that in viral cirrhosis group (356.4 ±96.1 ng/mL). Conclusions: The IV-C level was no a sensitive index for degree of fibrosis progression in chronic viral liver disease. However, we suggest that it can be a crude marker in monitoring cirrhotic change in chronic hepatitis, especially in alcoholic hepatitis. (Kor J Gastroenterol 1999;33:222 - 231)