알콜성 간질한에 동반된 알콜성 만성 체장염

박의련(Eui Ryun Park),이동기(Dong Ki Lee),이상철(Sang Cheol Lee),김영경(Young Kyung Kim),김준명(Jun Myeung Kim),박성진(Sung Jin Park),홍사준(Sa Joon Hong),권상옥(Sang Ok Kwon) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

N/A Objectives: The aim of this study was to investigate the prevalence of alcoholic chronic pancreatitis in alcoholic liver disease and the relationship between the degree of pancreatitis and the pathologic type of alcoholic liver disease. Methods: We reviewed ERCP in 68 patients with alcoholic liver disease who were clinically suscepted as alcoholic chronic pancreatitis. Alcoholic liver disease was diagnosed by liver biopsy and alcohol history. Alcoholic chronic pancreatitis was diagnosed by ERCP and grouped by severity according to Anacker and Loffler`s classification, Results: Pancreatic duct changes suggesting alcoholic chronic pancreatitis were present at ERCP in 31.5% of the biopsy-confirmed alcoholic liver disease. There was no correlation between the histopathologic classification of alcoholic liver disease and the severity of alcoholic chronic pancreatitis. Conclusion: In alcoholic liver disease, the possibility of alcoholic chronic pancreatitis should always be considered.

간경변증에 동반된 특발성 세균성 복막염의 재발빈도 및 예견인자

백순구(Soon Koo Baik),권상옥(Sang Ok Kwon),박의련(Eui Ryun Park),김준명(Jun Myeong Kim),이용규(Yong Gyu Lee),최윤종(Yeun Jong Choi),김일희(Il Hoi Kim),이동기(Dong Ki Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objectives: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in u large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. Method: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. Results: The incidence of SRP was 21.8% (68 cases) and showed 80.9% in male, 19.1% in female. Seven- teen (25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrant SBP. Conclusion: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein ≤1.0 g/dl, prothrombin time 45% may not be a sensitive predictor of recurrent SBP.

비장에 이식된 간세포의 조직학적 특성과 알부민 유전자의 발현

권상옥(Sang Ok Kwon),이동기(Dong Ki Lee),김준명(Jun Myeong Kim),박의련(Eui Ryun Park),심광용(Kwang Yong Shim),정필호(Phil Ho Jung),조미연(Mee Yon Cho),허만욱(Mann Uk Hur) 대한내과학회 1997 대한내과학회지 Vol.53 No.4

N/A Background: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. Methods: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. Results: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. Conclusions: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.

유전 의심성 비용종증 대장암의 빈도와 임상적 특성

양석균(Suk Kyun Yang),명승재(Seung Jae Myung),정훈용(Hwoon Yong Jung),홍원선(Weon Seon Hong),김진호(Jin Ho Kim),심기남(Ki Nam Shim),최재원(Jae Won Choe),김해경(Hae Kyung Kim),박무인,이미헌(Mi Hun Lee),김동일(Dong Il Kim),박의련(Eui Ryun 대한내과학회 2001 대한내과학회지 Vol.60 No.6

N/A Background: The current diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) is dependent on a detailed family history based on the Amsterdam criteria proposed by the International Collaborative Group on HNPCC (ICG-HNPCC) in 1990. On recognizing the shortcomings of the ICG-HNPCC criteria, the Korean Hereditary Colorectal Cancer Registry (a subdivision of the Korean Hereditary Tumor Registry) designated the term uspected HNPCC for families who do not fullfill the criteria of the ICG-HNPCC but in whom a genetic basis for colon cancer is strongly suggested. The present study was designed to determine the frequency and define the clinical characteristics of suspected HNPCC. Methods: We analysed the clinical characteristics of 42 suspected HNPCC patients and their family members and compared these characteristics with that of 1,692 non-hereditary colorectal cancer patients. Results : The frequency of suspected HNPCC was 2.4% in our study. The mean age of suspected HNPCC patients at the time of diagnosis was 45.1±9.6 years and that of non-hereditary colorectal cancer patients was 57.4±11.9 years. The incidence of synchronous colorectal cancers in HNPCC was 7.1% and that of non-hereditary colorectal cancers was 0.9%. In suspected HNPCC families, 18 patients had extracolonic malignancies and the stomach cancer was the most common (55.5%). Conclusion : The frequency of suspected HNPCC among total colorectal cancer cases was 2.4% in our study. Tumors in suspected HNPCC differed from non-hereditary colorectal cancers in an early age of onset.(Korean J Med 60:507-513, 2001)

류마티스관절염 환자에서 β-cyclodextrin-piroxicam의 치료 효과

박의련,이수곤 최신의학사 1995 最新醫學 Vol.38 No.1

출혈성 소화성 궤양의 장기 재발률

심기남,정훈용,양석균,홍원선,박의련,박무인,김해련,민영일 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2

Background/Aims: Bleeding from a peptic ulcer is one of the common and serious complications associated with the rate of reported mortality, which ranges from 5% to 10%. Endoscopic therapy is effective in controlling active bleeding and reducing the emer-gency surgery, the immediate mortality rate and the incidence of early rebleeding. But few recent studies have documented the long-term recurrent bleeding rate after discharge in patients with bleeding peptic ulcers. The aim of this study was to determine the long-term recurrent bleeding rate and factors predisposing to recurrent bleeding. Methods: Eighty-eight patients with bleeding peptic ulcers discharged after medical treatment between Dec. 1990 and Jul. 1992 were included in this study and retrospectively followed up with medical records and telephone interviews. The end point of follow-up was recur-rent hemorrhage, surgery for treatment of ulcer complication, or death. Results: By July 1997, retrospective follow-up was available in 76 patients. Recurrent bleeding occurred in 23 patients (30.3%) with bleeding peptic ulcers and the median follow-up period was 69 months (range, 1 ∼79 months). The estimated cumulative recurrent bleeding rate after 1, 2, 3, 4, 5 and 6 years was 11.8%, 14.5%, 19.9%, 24.2%, 27.2% and 34.2%, respectively. There was no difference between the recurrent bleeding group and the non-recurrent bleed-ing group according to age, sex, prior NSAIDs use, previous history of bleeding or pepticulcer, site of ulcer, stigmata of recent hemorrhage at initial examination, method of treatment and amount of transfusion. Conclusion: Recurrent bleeding occurred in one-third of patients with bleeding peptic ulcers after 6 years of follow-up and one-third of recurrent bleeders rebled within 1 year. The factors predisposing to recurrent bleeding in the long-term follow-up could not be found. Therefore, further studies designed to identify factors predisposing to recurrent bleeding are needed and the evaluation of Helicobacter pylori status in bleeding pepic ulcer is needed because Helicobacter pylori is an important factor of peptic ulcer recurrence.

흡연력을 고려한 궤양성 대장염 발생과 충수 절제술 사이의 상관 관계

남승우,양석균,정훈용,심기남,조병동,김승용,박의련,홍원선,민영일 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.1

대장내시경 전처치제로서 Sodium Phosphate 와 Polyethylene Glycol 용액의 전향적 비교 분석

이헌경,김승용,홍원선,민영일,정훈용,김해련,정성애,김석균,심기남,양석균,박의련,조문경 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3

Background/Aims: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. Methods: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. Results: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium (+3.0±3.0 mEq/L), potassium (-0.3±0.3mEq/L), calcium (-0.5±0.5 mg/dL), phosphorus (+3.9±2.2 mg/dL) and osmolarity ( +10.1±9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP (-2.2±2.3 kg) than with PEG (-1.2±2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p$lt;0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p$lt;0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p$lt;0.01). Conclusions: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

공터키안을 동반한 쉬한 증후군에서 그레이보스 병이 병발된 2예

최윤종,정춘희,박의련,김홍승,신영구 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.4

The empty sella syndrome is characterized by obesity, frequent pregnancy, headache and high blood pressure, but its exact cause remains unknown. Usually the incomplete diaphragmatic sella has been considered as the cause of the empty sella syndrome, but some authors recently have suggested that the antipituitary antibody way be related to development of pituitary atrophy and the pituitary empty sella syndrome, and thus it may be clinically useful as screening test for the empty sella syndrome. We experienced two empty sella syndromes associated Graves disease and applied the antipituitary antibody as the diagnostic tool of the empty sella syndrome. But none of this two patients had antipituitary antibody and we report these cases with reviews of literatures. (J Kor Soc Endoerinol 11:517~522, 1996)

칼시토닌 분비를 동반한 갈색세포종 1예

송창호,정춘희,박의련,원영준,신영구,이미덕,강성준,변주원,최윤종,조미연 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.3

Pheochromocytoma is a catecholamine producing turnor and raise with less than 0.1% of hypertensive patients. It is developed, most commonly, in sporadic pheochromocytoma or multiple endocrine neoplasia type 2. Therefore, when hypercalcitoninemia is found in a patient with pheochromocytoma, the possibility of multiple endocrine neoplasia type 2 or the ectopic secretion of calcitonin must be considered. Recently we experienced a 45 year old male patient with sporadic pheochrornocytoma. He also had hypercalcitoninemia and normocalcemia. After the removal of pheochromocytoma, serum calcitnnin level returned to normal. Secretion of calcitonin was confirmed by immunohisto- chemical stain(J Kor Soc Endocrinol 11:343-347, 1996).