HBsAg 과 HBsAg 가 동시에 출현한 19 예에 대한 임상적 고찰

이남(Nam Lee),변동일(Dong Il Byun),김성근(Sung Kuen Kim),이광래(Kwang Lae Lee),최일균(Il Kyun Choi),최조영(Jo Young Choi),곽정재(Jung Jae Kwack),이상용(Sang Yong Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.4

N/A The usual sequence of events in the serum in response to infection with hepatitis B virus does not include the sustained presence of both HBsAg and it antibody, HBsAb becomes detectable after HRsAb has been cleared from the serum. The presence of HBsAg implies infectivity of the serum, wherase that of HBsAb indicated recovery from HBV infection, immunity from subsequent infection, and noninfectivity of the serum. However, we found and evaluated 19 patients who have had coexistent HBsAg and HRsAb. To study hepatitis B virus maker was done by using RIA technique (Ausria ll and Ausab, Abbott Laboratories, North Chicago, Illinois) The following results were obtained. 1) 2475 Patients with HBsAg positive were 26% in 9501 patients that studied both HBsAg and HBsAb. 19 patients with HBsAg and HBsAb present simultaiously, were 0.076% in 2475 patients with HBsAg positive. 2) HBcAb was positive in all of 14 patients. HBeAg was positive in 4 of 5 patients and HBeAb was negative in all of 5 patients. 3) 2 of 19 patients (10.5%) had liver cirrhosis and 3 of 19 patients (15.8%) had hepatoma at their initial medical evaluation. 4) 10 of 19 patients were positive persistently circulating hepatitis B surface antigen and antibody. The duration of concomitant HBsAb and HBsAb was from 2 to 211 weeks (mean 70.4 weeks) 5) 9 of 10 patients were positive for both HBsAg and HBsAb at their initial medical evaluation, And the presence of HBsAg antedated that of HBsAg and HBsAb simultaneously in one patient of pediatrics for 29 months. 6) Two patients had only HBsAb negative after both HBsAg and HBsAb were found, HBsAb titers of above two patients were significant lower than HBsAb titiers of 19 patients with concomitant HBsAg and HBsAb (HBsAb titer: 1124±174cpm VS 4977±4077cpm, P<0.01) 7) 5 of 10 patients were postivie persistently circulating hepatitis R surface antigen and antibo4y for above 6 months. There were no significant difference in HBsAb titer between above 5 patients and 19 patients with concomitant HBsAg and HBsAb. (HBsAb titer: 6909±4696cpm VS 4977±4007cpm) 8) HBsAb titer of 19 patients with concomitant HBsAg and HBsAb were significant lower than in HRsAb titer of 50 patients with HBsAg (-) HBsAb (+). This result suggest that 19 patients with concomitant HBsAg and HBsAb had relatively lower HBsAb titier. (HBsAg titer: 4977±4007cpm VS 7124±4011cmp, P<0. 05)

호산구성 위장관염의 복막침윤

이배진(Bai Jin Lee),박정영(Jung Young Park),이희영(Hi Young Lee),강효승(Hyeo Seon Kang),이종영(Jong Young Lee),변동일(Dong Il Byun),김형길(Hyung Gil Kim),이수남(Su Nam Lee) 대한소화기학회 1998 대한소화기학회지 Vol.30 No.4

Eosinophilic gastroenteritis is a rare condition of unknown cause characterized by peripheral eosino- philia, eosinophilic infiltration of the gastrointestinal tract, and gastrointestinal symptomatology. Eosinophi]ic gastroenteritis is generally classified according to the layer of gastrointestinal tract involved. Especially, serosal eosinophilic infiltration is the rare,;t form of presentation, and may result in the development of eosinophilic ascites. Herein we repcrt an unusual case of eosinophilic gastroenteritis presenting with peritoneal eosinophilic infiltration diagnosed by a peritoneal biopsy. A 16-year-old woman came to our hospital presenting with abdminal <listensiron and tenderness, vomiting, and diarrhea with marked peripheral eosinophilia. Stool .;pecimens were negative for ova parasites. Biopsy specimens of esophagus, stomach, duodenum, and colon showed nonspecific intlammation but that of the peritoneum showed specific intense e.inophilic infiltration with fibrous band and eosinophilic vasculitis. A diagnosis of serosal eosinophil c gastroenteritis based on c]inical, laboratory, eosinophilic pertoneal fluid and histopathologic data, (:specially the biopsy specimens of the peritoneum. She was treated with corticosteroid and respond d dramatically with a complete resolution of ascites and other G-I symptoms. (Korean J Gastroenterol 1997; 30:547-552)

선암으로 악성 변화된 가족성 용종증 3예

박봉수(Bong Sou Park),박정영(Jung Young Park),이배진(Bai Jin Lee),이정호(Jung Ho Lee),김형기(Hyung Gi Kim),변동일(Dong Il Byun),김형길(Hyung Gil Kim),정동균(Dong Gyoon Jung) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

Familial polyposis is an uncornmon hereditary disease characterized by the appearance of numerous polyps in the large intestine with a high potential for malignant transformation. If the patients were untreated, adenomatous polyp was developed to cancer. Therefore once the diagnosis is made, either total coloectomy or subtotal colectomy should be done as preventive measures. We experienced three cases of familial po]yposis which transformed to adeonocarcinoma. The diagnosis was rnade by familial history, morphologic findings of endoscopy and histologica.l study of the lesions. All of them were performed operative management and postoperative chemotherapy. We report our experiences of follow up of these cases and review with the disease reported in the literature. (Korean J Gastroenterol 1996;28:874 - 878)

일가족에 발생한 골화석증

최웅송(Oung Seung Choi),박정영(Jong Young Park),이배진(Bai Jin Lee),이정호(Jung Ho Lee),김형기(Hyung Gi Kim),최낙현(Nak Hyun Choi),박봉수(Bong Sou Park),김시찬(Si Chan Kim),변동일(Dong Il Byun),김형길(Hyung Gil Kim),정동균(Dong Gyoon 대한내과학회 1994 대한내과학회지 Vol.47 No.6

N/A Osteopetrosis (also called Albers-Schoberg's disease, Marble bones and chalk bones) is a rare hone dysplasia in which, on the basis of a failure of osteoclastic and chondroclastic resorption, the bone become exceedingly dense. Two clinically distinct forms are now recognized and have different patterns of inheritance. The milder form is transmitted as an autosomal dominant trait and the more severe form is transmitted as an autosomal recessive trait. We have experienced a familial osteopertrosis, mother and three siblinges out of six, which was thought to be a autosomal dominant inheritance. We report a case of milder form of osteopetrosis with a review of literature.

High Performance Liquid Chromatography를 이용한 Hemoglobin A1C 측정

변동원,서교일,유명희,김극배 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Hemoglobin AIc(HbAlc) has been known to be an index of long-term glycemic control (6-8weeks), and offers several practical advantages for screening of diabetes mellitus and evaluation of effects of treatment. Authors introduced to measure and investigate HbAlc levels by high performance liquid chromatoraphy (HPLC ; LDC Milton Roy, USA), with cation exchange column, Mono S HR 5/5 (Pharmacia). The results were as follows; 1. The mean HbAlc level in normal adult control group (n=50) was 4.13±0.25% (Mean±S.D). 2. Within-run precisions of HbAlc levels measured by HPLC were 4.39±0.01% (Mean±S.D.), 1.41(C.V.) in normal control, and 8.95±0.02% (Mean±S.D.), 1.65(C.V.) in intermittently treated diabetic patients, and 11.02±0.01% (Mean±S.D.) 2.93(C.V.) in untreated diabetic patients. 3. Between-run precision of HbAlc levels measured by HPLC were 4.35±0.01% (Mean±S.D.), 2.76(C.V.) in normal control, and 8.98±0.01% (Mean±S.D.), 1.22(C.V.) in intermittently treated diabetic patients, and 10.95±0.15% (Mean±S.D.), 3.51(C.V.) in untreated patients. 4. The peak level of HbAlc was obtained in about 9 minutes and the whole program could be completed within 17 minutes. 5. Blood specimens could be stored for as long as 8 days at 4℃ without changes of HbAlc levels. These results suggest that the measurement of HbAlc by HPLC using cation exchange column is so accurate, simple and rapid that the clinical use is more wider.

간 혼수를 동반한 간세포암종 환자의 뇌척수액 Ribonuclease 기질특이성에 관한 연구

변동일,김동권,이용성,고재경 한양대학교 의과대학 1996 한양의대 학술지 Vol.16 No.1

Activity of ribonuclease (RNase) was determined with olycytidylate (poly C) and RNA as substrate in the cerebrospinal fluid(CSF) of patients with hepatocellular Carcinoma with coma. RNase and proteins in the CSF of patients with hepatocellular carcinoma were isolated and purified y a DEAE-cellulose column chromatography and high perormance liquid chromatography (HPLC). Substate specificity for the purified RNase activated in the CSF of the cancer patient was determined to evaluate the possible role of the RNase in car5cinogenesis. Activity of RNA measured with poly C and RNA as substrate and ratio of RNA/poly C for the RNase activity in the csf were increased significantly in the hepatocellular carcinoma, but were unchanged in the liver cirrhosis. The positive rate of the RNAse activity in the CSF as a marker for hepatocellular carcinoma was high, suggesting the use of the RNase activity in the CSF as a marker for hepatocellular carcinoma. Proteins and RNases in the CSF of the patient with hepatocellular carcinoma were separated into 7 protein peaks and 5 RNase isozymes(isozyme Ⅰ, Ⅳ-Ⅶ), of which two peak proteins and one RNase isozyme(isozyme Ⅰ) were specific to the hepatocellular carcinoma. The Rnase isozyme Ⅰ purified from the CSF of the cancer patient was a major isozyme of the RNase isozymes isolated, was activated and was higher in ratio of RNA/poly C for the RNase activity, exhibiting more of nonsecretory RNase nature than that from the CSF of the control. The RNase isozyme Ⅰ fraction in the Csf of the patient with hepatorcellular carcinoma was separated by a HPLC into four subpeaks, of which cubpeak Ⅰ-3 exhibited RNase activity. The RNase isozyme Ⅰ (Ⅰ-3) purified from the CSF of the patient with hepatocellular carcinoma showed the highest activity toward poly AC as substrate, the degree of activity being decreased toward poly ACU and C, AU, CI, CIU, CU, RNA, poly U in order. No activity was observed with poly A, G, AG and GU. The substrate specificity toward the RNAse isozyme Ⅰ from the CSF of the cancer patient appeared to be different from that of the control in that relative activity toward RNA, poly U, CI, AC, AU, CIU aand ACU over poly C was higher in the isozyme from the CSF of the cancer patient than in the isozyme from the CSF of the control. The result indicated that the RNASE isozyme Ⅰ from the CSF of the cancer patient was different in nature from the isozyme from the CSF of the control. Observations that in the CSF of the patient with hepatocellular carcinoma with hepatic coma, (1) five RNase isozymes were isolated, (2) of which one isozyme (isozyme Ⅳ) was specific to hepatocellular carcinoma, (3) the RNase isoyzme Ⅰ isolated as a major enzyme was activated and (4) the substrate specficity of the isozyme in the CSF of the cancer patient was different from that in the CSF of the control, suggested that the RNase isozyme Ⅰ in the CSF of the cancer patient might be involved in carcinogenesis processes of hepatocellular carcinoma.

항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

파괴성 관절병증으로 나타난 갑상선 기능저하증 1 예

이배진,변동일,김형길,정동균,최낙현,박정영 대한내과학회 1996 대한내과학회지 Vol.51 No.1

Hypothyroidism in frequently overlooked in the elderly because many of its symptoms are attributed to the normal aging process, Hypothyroidism may be accompanied by rheumatic syndromes such as neuropathy, myopathy, and arthropathy with chronic joint effusion. Because these symptoms are correlated with severity and durations of the hypothyroid state, early diagnosis may prevent severe articular sequelae. We experienced a case of primary hypothyroidism presenting with destructive arthropathy and thyroid replacement therapy was followed by longterm improvement.

무증상 T파 역위의 수술과 관련된 심전도 변화

최일균,변동일,이종영,이상용,정덕자,최조영,이정균 한양대학교 의과대학 1989 한양의대 학술지 Vol.9 No.2

Cardiac arrhythmias during operation have been increased because the number of patients with cardiovascular disease, especially symptomatic or asymptomatic ischemic heart disease, has increased and cardiac arrhythmias can be a warning that the patient is under physiologic or anesthetic distress and that rapid correlation is necessary. To reduce the operation risk is major concern and preliminary screen is important as one of cardiac origin risk, the role of silent myocardial ischemia must be evaluated. But there has been rare studies for the ECG abnormalities during operation related to T wave inversion on preoperative ECG. In order to investigate the frequency, duration, relation to the site of inverted T wave and characteristics of arrhythmia or ST-T change, we started this study. Preoperative ECG had been performed to 1,872 patients who were prepared general anesthesia, there were 48 patients (2.56%) of only T wave inversion without accompanying symptoms of ischemic heart disease. We observed the 48 patients with ECG monitoring in operation room from anesthetic induction to recovery, but could not observe any electrocardiological abnormalities especially ST-T changes or arrhythmias compared with preoperative ECG except one case (2.1%) of sinus bradycardia. And the amplitude of inverted T wave was not shown statistically significant changes between preoperative ECG and intraoperative or postoperative ECG. It is concluded that there will be no problems in the anesthetic procedure for the operation in the patients with asymptomatic T wave inversion and will be no need to postpone the operation for performing the other studies to confirm ischemic heart disease. So ECG monitoring may be more important in the patients with asymptomatic T wave inversion during general anesthesia for operation.

난소또는 고환적출 흰쥐에서 이중에너지 방사선 흡수 계측법을 이용한 골밀도 변화에 대한 연구

이명렬,변동원,서교일,유명희,나수균,김극배 대한골대사학회 1996 대한골대사학회지 Vol.3 No.1