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만성 B형간염 환자에서 심한 피부 발진을 보인 라미부딘 부작용 1예
김석배 ( Seok Bae Kim ),서평주 ( Pyoung Ju Seo ),백두산 ( Du San Baik ),윤세영 ( Se Young Yun ),김병하 ( Byung Ha Kim ),신정은 ( Jung Eun Shin ),김홍자 ( Hong Ja Kim ),송일한 ( Il Han Song ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.4
Lamivudine is widely used for the treatment of chronic hepatitis B infection because of it`s remarkable antiviral efficacy and safety. We report a case of severe skin eruption caused by lamivudine. A 47-year-old female was admitted because of jaundice and itching sensation. She was diagnosed as chronic hepatitis B infection a few years ago but did not receive any specific treatment. Laboratory data showed acute deterioration of chronic hepatitis B infection. We prescribed lamivudine as a rescue therapy. Her general condition improved and lab data showed improvement in liver function test thereafter. However, she complained of severe skin eruption and itching sensation a few days after the discharge. We stopped lamivudine because the symptoms did not improve despite the use of anti-histamine. Skin biopsy showed interface dermatitis. After stopping lamivudine, her symptoms improved. However, the skin eruption developed again after lamivudine was restarted. Adefovir was used instead, and the patient did not experience any further skin problems since then. (Korean J Gastroenterol 2006;48:281-285)
서승철 ( Seung Chul Suh ),서평주 ( Pyoung Ju Seo ),박현경 ( Hyun Kyung Paark ),신철민 ( Cheol Min Shin ),조현진 ( Hyun Jin Jo ),김현영 ( Hyun Young Kim ),이상협 ( Sang Hyub Lee ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwa 대한소화기학회 2012 대한소화기학회지 Vol.60 No.6
목적: 대장게실출혈은 하부위장관 출혈의 30-40%를 차지하며 이 중 3-5%에서는 대량출혈로 나타난다. 이번 연구에서는 대장내시경검사를 통해 게실이 확인된 환자들을 대상으로 대장게실출혈의 위험인자에 대하여 후향적으로 알아보고자 하였다. 대상 및 방법: 대장게실증, 대장게실염, 대장게실출혈의 상병명을 통해 확인된 1,003명 중 대장내시경에서 대장게실이 확인된 216명을 대상으로 출혈이 확인되었거나 추정된 환자군과 출혈이 없는 환자군으로 나누어 나이, 성별, 게실 위치에 따른 차이를 비교하였고 동맥경화증 관련 기저질환, 흡연 및 음주 그리고 복용약제 등의 위험인자에 대하여 두 군 간의 차이를 평가하였다. 결과: 216명 중 게실출혈은 35명에서 관찰되었다(16.2%). 평균 연령은 출혈군에서 비출혈군에 비해 유의하게 높았으나 남녀비는 두 군 간에 유의한 차이는 없었다. 두 군에서 모두 우측 대장게실의 비율이 높았으며 게실이 양측성으로 존재하는 경우 출혈 환자의 비율이 더 높았다. 고령, 양측성 게실, 고혈압, 당뇨병, 허혈성 심장질환, 비만이 있을 때 그리고 아스피린, NSAIDs, 칼슘통로차단제의 복용이 출혈과 유의한 관계를 보였다. 다변량 분석에서 아스피린과 양측성 대장게실증이 출혈의 독립적인 위험인자로 나타났다. 결론: 대장게실이 양측에 존재하거나 또는 아스피린을 복용중인 환자에서 대장게실 출혈의 위험성이 증가하므로 이에 대한 주의와 함께 환자에 대한 교육이 필요할 것으로 생각된다. Background/Aims: Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding. The purpose of this study was to evaluate the risk factors for colonic diverticular bleeding diagnosed by colonoscopic examination. Methods: Among the 1,003 patients, who were identified to have colonic diverticulosis including sleeding by diverticulitis and diverticular bleeding coding search, 216 patients had diverculosis, and they were divided into two groups: one with diverticular bleeding, and the other without bleeding. We evaluated the potential risk factors for diverticular bleeding, based on age, gender, location of diverticulum, comorbidities related to atherosclerosis, smoking, alcohol and medications, and compared them between both groups. Results: Among the 216 patients, we observed colonic diverticular bleeding in 35 patients (16.2%). The mean age of the bleeding group was significantly older than that of non-bleeding group. No difference was observed regarding gender ratio. Right colonic diverticula were common in both groups, but there were higher proportion of patients with bleeding in bilateral diverticuosis. Old age, bilateral diverticulosis, presence of atherosclerosis related diseases (hypertension, diabetes mellitus, ischemic heart disease, obesity), use of aspirin, NSAIDs and calcium channel blocker, increased the risk of bleeding. In a multivariate analysis, use of aspirin and bilateral diverticulosis were identified as independent risk factors for colonic diverticular bleeding. Conclusions: Since the patients who took aspirin and/or had bilateral colonic diverticulosis increased the risk of bleeding from divertuculi. As such, caution and education of patients are required.
박현경,이동호,서승철,서평주,김나영,정숙향,김진욱,황진혁,박영수,이상협,신철민 대한소화기내시경학회 2011 Clinical Endoscopy Vol.44 No.1
Background/Aims: The purpose of this study was to evaluate the efficacy and tolerability of dual therapy consisting of esomeprazole and amoxicillin as a rescue therapy for Helicobacter pylori infection. Methods: From December 2009 to August 2010, 21 patients who experienced two consecutive eradication failures were included. They received esomeprazole (40 mg, b.i.d.) and amoxicillin (1,000 mg, b.i.d.) for 14 days as a third eradication regimen. Compliance and side effects were determined from an interview. H. pylori status was evaluated using the ^(13)C urea breath test at least 6 weeks after treatment. Results: The mean age of the patients was 59 years and included 52% males. Indications for treatment were functional dyspepsia (61.9%), peptic ulcer disease (28.6%), and gastric adenoma (9.5%). H. pylori was eradicated in 14 of 21 (66.7%) patients. Minor side effects were reported in three of the 21 patients (14.3%). These side effects consisted mainly of nausea and epigastric discomfort. Conclusions: A 2-week course of dual therapy failed to show satisfactory results in third-line H. pylori eradication, but it was very safe and tolerable. Therefore, dual therapy constitutes an encouraging empirical strategy for the elderly and infirm patients with multiple previous eradication failures.
기도 상피세포에서 Formoterol과 Budesonide 병합투여가 전사활성과 Interleukin-8 분비에 미치는 효과
김동민 ( Dong Min Kim ),서평주 ( Pyung Joo Seo ),강명수 ( Myung Soo Kang ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.1
Background: Recent clinical studies have shown that the combination of inhaled long acting β2 agonist with inhaled glucocorticoid results in better asthma control than higher doses of glucocorticoids alone. Objective: The present study was designed to investigate whether the long acting β2 agonist (formoterol) or glucocorticoid (budesonide) modulates the transcriptional activity and release of interleukin (IL)-8, and the combination of these two drugs influence transcriptional activity and release of IL-8. Method: The effect of formoterol alone and in combination with budesonide, upon tumor necrosis factor-alpha (TNF-α) stimulated human bronchial epithelial cells were investigated. Transcriptional activity was assessed by luciferase assay, and IL-8 was measured by ELISA. Result: Transcriptional activity and release of IL-8 induced by TNF-α were markedly decreased by budesonide alone, and was weakly affected by formoterol alone. The combination of budesonide with formoterol showed a significant additional suppressive effect on transcriptional activity and release of IL-8 induced by TNF-α. The combination effect of lower doses budesonide with formoterol was superior to higher doses of budesonide alone on the suppression of TNF-α-induced IL-8. Conclusion: The combination of budesonide with formoterol significantly inhibits TNF-α-induced IL-8 secretion compared to higher doses of budesonide alone. The combination of glucocorticoids with β2 agonists is an effective therapeutic strategy in asthma management. (Korean J Asthma Allergy Clin Immunol 2006;26:64-69)
당질코르티코이드 수용체를 통한 INS-1 세포의 인슐린 분비와 합성
양주연,김희진,강명수,송탁호,정인국,서평주 대한당뇨병학회 2006 Diabetes and Metabolism Journal Vol.30 No.6
-Background: Glucocorticoids play important roles in the regulation of glucose homeostasis. It is well known that glucocorticoids reduce hepatic and peripheral tissue sensitivity to insulin, but the roles of glucocorticoids on insulin secretion and synthesis in pancreatic beta cells are still unclear. We have investigated the direct effects of glucocorticoids on insulin secretion and synthesis in rat insulinoma (INS-1) cells.Methods: Insulin content and 11.2 mM glucose-stimulated insulin secretion (GSIS) were measured in INS-1 cells after culture with or without 1 μM dexamethasone (DEX). Preproinsulin mRNA levels were analyzed by real-time RT-PCR and normalized to the internal control. Effect of RU486 on DEX-induced inhibition of GSIS and preproinsulin mRNA synthesis was evaluated. Results: Insulin content of INS-1 cells cultured in RPMI containing 11.2 mM glucose in the presence of DEX was not different from that of control cells. After 1-h preincubation in 2.8 mM glucose, basal insulin secretion from cells treated with DEX did not differ from that of controls, but GSIS was significantly reduced in the cells treated with DEX in comparison to control cells. The expression of preproinsulin mRNA relative to beta-actin mRNA was also lower in the cells treated with DEX. Glucocorticoid receptor antagonist improved DEX-induced inhibition of GSIS and preproinsulin mRNA synthesis. Conclusion: DEX inhibited GSIS and preproinsulin mRNA synthesis in INS-1 cells. Glucocorticoid receptor antagonist ameliorated the reduced GSIS and preproinsulin mRNA synthesis induced by DEX. (J Kor Diabetes Assoc 30:428~434, 2006) 연구배경: 당질코르티코이드가 간의 포도당신합성을 증가시키며 근육과 지방조직에서 포도당 흡수를 억제하고 지방분해를 증가시키는 인슐린저항성에 대한 연구는 잘 알려져 있다. 그러나 당질코르티코이드가 췌장베타세포의 인슐린 분비와 합성에 미치는 영향에 대해서는 아직 명백히 밝혀져 있지 않다. 본 연구는 덱사메타손에 노출된 INS-1 세포에서 인슐린 함량과 포도당 자극 대한 인슐린 분비와 preproinsulin mRNA 합성을 알아보고 RU486에 의한 당질코르티코이드 수용체 억제가 덱사메타손에 의한 인슐린 분비와 합성 장애에 미치는 효과를 관찰하였다.방법: INS-1 세포를 배양한 후 덱사메타손과 vehicle을 함유한 배지에서 각각 배양한 후 세포 내 인슐린 함량과 포도당 자극에 의한 인슐린 분비를 측정하였으며 real-time역전사 중합효소 연쇄반응을 이용하여 preproinsulin mRNA 발현을 조사하였다. RU486을 이용하여 당질코르티코이드 수용체 억제제가 덱사메타손의 작용에 미치는 영향을 관찰하였다. 결과: 덱사메타손에 노출된 INS-1 세포와 대조군에서 단위세포 단백질량으로 환산한 세포 내 인슐린 함유량은 차이가 없었다. 덱사메타손에서 배양한 INS-1 세포의 2.8 mM 포도당 농도에서의 기저 인슐린 분비는 대조군과 차이가 없었으나 11.2 mM 포도당 자극에 의한 인슐린 분비는 대조군에 비하여 유의하게 감소되어 있었으며 덱사메타손에 배양한 INS-1 세포의 preproinsulin mRNA 합성이 감소되어 있었다. RU486에 의한 당질코르티코이드 수용체 억제는 덱사메타손의 포도당 자극에 의한 인슐린 분비능 저하와 preproinsulin mRNA의 합성 저하를 감소시켰다.