만성 혈액투석 환자에서의 대사성 산혈증과 음이온차의 양상

손정일(Chong Il Sohn),김병훈(Byoung Hun Kim),신진호(Jin Ho Shin),양석철(Suck Chul Yang),박용수(Yong Soo Park),한동수(Dong Soo Han),안명주(Myung Ju Ahn),손주현(Ju Hyun Sohn),이인홍(In Hong Lee),김순길(Soon Kil Kim),이정희(Jung Hee Lee 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Objectives: The aim of the present study is to evaluate the prevalence of the various patterns of metabolic acidosis and anion gap among chronic hemodyalysis patients. Methods: Analysis of predialysis arterial blood gases and anion gap patterns was performed in 67 stable chronic outpatient hemodialysis patients(>1 year) with acetate buffer. Blood samples were drawn from the arterial line of the atreriovenous fistula for determination of blood electrolytes, chemistries, and analysis of blood gases at the beginning of hemodyalysis. Results: The degree of metabolic acidosis was mild to moderate with mean pH 7.33±0.039. 82% of a total 67 patients had pH between 7.30 and 7.39 with 18% of them between 7.20 and 7.29. Simple as mixed metabolic acidosis was shown in 49 of 67 patients(73%) and 18 of 67 patients(27%), respectively. In comparison of both groups, the group with mixed metabolic acidosis had significantly lower pH(7.29±0.04 vs 7.34±0.03, p<0.001) with higher pCO₂(38.5±3.4, p<0.005) and anion gap(19.6±4.1 vs 17.6±2.9, p<0.05). The classical high anion gap of end stage renal disease (range, 16 to 29 mEq/L) was also noted in 20 of 67 patients(30%). The linear regression analysis between anion gaps and total serum carbon dioxide contents (TCO₂) didn't show any significant correlation in all patients as well as the two subdivided groups with high and normal anion gap. Furthermore, only 13 of 67 patients(20%) were included between 80 and 120% in the ratio of delta anion gap(ΔAG) over delta TCO₂(dTCO₂). Therefore, the majority of hemodialysis patients (80%) showed the discrepancy between the degrees of d AG and ΔTCO₂. The analysis of unmeasured cations(K, Ca) and anions(albumin, phosphate) in the calculation of anion gap(Na ?Cl ?HCO₃) between two groups of high and normal anion gap of all patients as well as 49 patients of simple metabolic acidosis didn't reveal any discernible contributions to the changes of anion gap. Conclusion- This study therefore showed that the mixed acid-base balance and normal anion gap metabolic acidosis is not an exception in chronic stable hemodialysis patients. Also, the impact of hemodialysis in end stage renal disease patients seemed to lead the changes in values of unidentified anions besides fixed mineral acids and/or in those of unrecognized ionic equivalents of plasma constituents.

만성 C형간염 환자에서 페그인터페론 알파 2a에 의해 반복적으로 발생한 지방층염

송준석 ( June Seok Song ),손주현 ( Joo Hyun Sohn ),정재윤 ( Jae Yoon Jeong ),민지희 ( Ji Hee Min ),최원석 ( Won Seok Choi ),김원중 ( One Zoong Kim ),표주연 ( Ju Yeon Pyo ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.5

Pegylated interferon alpha (PEG-IFN-α) is widely used to treat chronic hepatitis C in combination with ribavirin. Many adverse effects of PEG-IFN-α, such as hematologic, psychologic, dermatologic, immunologic, and other abnormalities, have been reported, and some serious adverse events lead to PEG-IFN-α treatment discontinuation. For very rare adverse events such as panniculitis, there are no established guidelines on whether to continue PEG-IFN-α treatment. Published reports on panniculitis induced by PEG-IFN-α 2a are sparse. Herein we report a case of repeated occurrences of panniculitis in a patient with chronic hepatitis C, leading to treatment cessation. (Korean J Gastroenterol 2016;67:272-276)

약물 중독 시 위 세척에 의한 산 - 염기 평형 및 전해질의 변화

윤형란(Hyung Ran Yun),손동현(Dong Hyun Sohn),이창범(Chang Bum Lee),이재웅(Jae Woong Lee),양석철(Suck Chul Yang),한동수(Dong Soo Han),손주현(Ju Hyun Sohn),김순길(Soon Kil Kim),김호중(Ho Jung Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: There is little information on the imbalance of electrolyte and acid-base metabolism associated with gastric lavage in acute drug intoxication patients. This study was aimed to analyze the acid-base and electrolyte abnormalities associated with gastric lavage in acute drug intoxication patients. Methods: We studied 24 acute drug intoxication patients who had performed gastric lavage with 10 liters of 0.9% NaC1. Electrolyte parameters and arterial blood gas analysis were carried out before and after gastric lavage. Results: After gastric lavage, acidosis was reduced in general. But there was no significant change in pH (7.34±0.02 vs. 7.38±0.15, p=NS). In acid-base balance, the mixed form of metabolic acidosis and respiratory acidosis was reduced from 7 to 2 cases, and the simple form of respiratory acidosis was reduced from 3 to 1 case. In contrast, normal form was increased from 5 to 7 cases and the simple form of metabolic acidosis was increased from 2 to 6 cases. In electrolyte parameters, serum sodium was reduced significantly (145±1.0 mEq/L vs. 141±0.8 mEq/L, p<0.01), but there was no case of significant hyponatremia (<135mEq/L). Bicarbonate level (20±1.1 mEq/L vs. 22±0.9 mEq/L, p< 0.05) and anion gap (19±1.6 mB vs. 13±1.3 mEq/L, p< 0.01) showed significant change. But, blood levels of potassium (3.6±0.1 mEq/L vs. 3.8±0.1 mEq/L, p=NS), chloride (106±0.6 mEq/L vs. 106±0.6 mEq/L, p=NS) and F'aCO2 (36±1.mmHg vs. 37±1.5 mmHg, p=NS) were no significant change before and after gastric lavage. Conclusions: Gastric lavage with 10 liters of 0.9% NaC1 in acute drug intoxication patients did not show clinically significant changes in electrolytes and acid-base balance.

응급 내과환자의 저나트륨혈증

정자헌(Ja Hun Jung),손동현(Dong Hyun Sohn),박준용(Joon Yong Park),오광택(Kwang Taek Oh),한동수(Dong Su Han),양석철(Suck Chul Yang),손주현(Ju Hyun Sohn),김순길(Soon Kil Kim),김호중(Ho Jung Kim) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: Hyponatremia is the most common finding of electrolyte disorder in patients admitted to medical ward. It is suggested that the prognosis of patients with hyponatremia is worse than that with normal sodium concentration in morbidity and mortality. We performed the study to evaluate the incidence and cause of hyponatremia in inpatients admitted to medical ward via emergency room with prospective study. Methods: Hyponatremia was defined as a serum sodium concentration equal to or less than 134 mEq/L. A total 225 medical patients were prospectively studied for 45 days. Other chemistry and electrolytes of blood and urine were determined within 24 hrs following admission. Results: 1) Of medical inpatients through emergency room, hyponatremia was detected in high frequency (16%) and mild hyponatremia (125-134 mEq/L) was showed in 90% or more. 2) The most common cause of hyponatremia was decreased effective circulating blood volume group (76%), and its common underlying disease was liver disease. 3) Compared to other groups, the group with decreased effective circulatory volume showed significant decrease in spot urine sodium concentration, fractional excretion of uric acid and serum creatinine concentration. 4) There was no correlation between serum concentration of hyponatremia and other parameters associated with it. As it was corrected, no significant simultaneous changes on BUN and serum uric acid concentration was noted. Conclusion: Interpretation of this data depend on not decreased circulatory volume but also other compounding factor as production and excretion of which is related to underlying variable disease.

소화기 ; 만성 간질환에서 펜넬의®무작위, 이중맹검, 다기관 제4상 임상시험

김형준 ( Hyung Joon Kim ),이준성 ( June Sung Lee ),이현웅 ( Hyun Woong Lee ),김문영 ( Mun Young Kim ),남순우 ( Soon Woo Nam ),손주현 ( Ju Hyun Sohn ),조세현 ( Se Hyun Cho ),윤승규 ( Seung Gyu Yoon ),양진모 ( Jin Mo Yang ),박충기 ( 대한내과학회 2014 대한내과학회지 Vol.86 No.2

목적: 펜넬(Pennel(R))은 DDB에 마늘유(garlic oil)를 복합시킨 제제로 혈청 트랜스아미나제(AST와/또는 ALT)가 상승된 만성 간 질환자에서 펜넬의 치료 효과에 대한 유효성을 검증하기 위해 활성대조약인 레가론, 위약군과 비교 평가한 다 기관 제 4상 임상연구를 실시하였다. 방법: 총 11개 병원, 237명의 피험자가 연구에 참여하였다. 이 중 시험약군은 100명, 활성대조군은 102명, 위약군은 35명이었다. 12주간의 치료기간 동안 순응도는 좋았으며 중도 탈락은 없었다. 환자의 연령은 평균 46세, 남성의 비율이 높았다. 치료 전 ALT 값은 91 U/L였으며 66%가 비알코올성 지방간염, 15%가 알코올성 간염, 12%가 만성 C형간염 그리고 7%가 만성 B형간염 환자였다. 결과: 약물 투약 12주째 ALT 정상화 분율은 시험약군이 89명으로 89%, 활성대조군이 19명으로 18.6%, 위약군이 8명으로 22.9%로 나타났다(p < 0.001). 간염의 원인에 따른 분류에서도 시험군에서 통계적으로 의미 있게 ALT 정상화 분율의 비율이 높았다. 치료 전 대비 치료 12주의 ALT는 시험약군에서 평균 85 U/L 감소하였으나 활성대조군은 20 U/L, 위약군은 25 U/L 감소하였다. 항산화 효과 지표인 malondialdehyde(MDA)는 시험약군에서만 1.4 pmol/mg의 호전을 보였다. 하위그룹분석에서 비알코올성 지방간염과, 바이러스성 간염 환자에서 의미 있게 MDA 수치의 호전을 보였다(p < 0.001). 시험약물의 안전성 평가에서도 이상반응의 발생빈도가 위약군에 비해 차이가 없었다. 이상반응의 대부분은 감기, 피로, 설사 및 소화불량 등 grade 1의 경증이었으며 중대한 이상반응은 없었다. 삶의 질 평가 총점수도 시험약군이 치료 12주에 10점 이상 통계적으로 의미 있게 증가하였다(p < 0.001). 결론: 결론적으로 ALT가 상승한 만성 간 질환자를 대상으로 한 12주간의 펜넬 4상 임상 시험의 유효성과 안전성 평가에서 펜넬은 원인 질환과 무관하게 치료 4주 만에 급격한 ALT 수치의 정상화를 유도하였으며 항산화 효과를 보였다. 치료기간 동안 부작용이 거의 없는 안전한 약제로서 순응도가 뛰어났으며, 치료 후 삶의 질이 의미 있게 개선되는 효과를 보였다. Background/Aims: Biphenyl dimethyl dicarboxylate (DDB) combined with garlic oil (pennel) has been used to treat chronic liver disease. A randomized, double-blind, active- and placebo-controlled clinical trial was conducted to investigate the efficacy, safety and quality of life in chronic liver disease patients. Methods: A total of 237 patients with chronic liver disease were randomized into three groups; 100 patients were administered pennel, 102 patients Legalon as an active-control and 35 patients placebo for 12 weeks. The primary endpoint was the rate of alanine aminotransferase (ALT) normalization. We assessed differences in ALT levels and malondialdehyde (MDA) as an oxidative biomarker between 0 and 12 weeks, the improvement in quality of life using a chronic liver disease questionnaire (CLDQ) and the incidence of adverse events. Results: Among 237 patients, there were 157 patients with non-alcoholic fatty liver disease, 36 patients with alcoholic liver disease, and 28 patients with chronic hepatitis B and C. The incidence of ALT normalization at 12 weeks was 89% for the pennel group, 18.6% for the active-control group, and 22.9% for the placebo-control group (p < 0.001). The difference in serum ALT level between 0 and 12 weeks was significantly higher in the pennel group (p < 0.001) and the level of MDA was decreased in the pennel group, statistically (p < 0.001). There was no difference in incidence of adverse events among groups. The pennel group showed significant improvement based on the CLDQ (p < 0.001). Conclusions: Pennel can effectively improve the rate of ALT normalization and the quality of life with a safety profile in chronic liver disease. (Korean J Med 2014;86:179-189)

감염증에서 위점막의 Toll-like Receptor 4 발현

박준용 ( Joon Yong Park ),한동수 ( Dong Soo Han ),김보현 ( Bo Hyun Kim ),강은경 ( Eun Kyung Kang ),이영춘 ( Ying Chun Li ),이항락 ( Hang Lak Lee ),김진배 ( Jin Bae Kim ),손주현 ( Joo Hyun Sohn ),최호순 ( Ho Soon Choi ),강정옥 ( Ju 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

Background/Aims: Toll-like receptors (TLRs) represent a pattern recognition receptors with an ability of specific recognition of pathogens. TLRs appear to respond to pathogens and induce NF- kB activation. TLR2 and 4 seem to be related to the initiation of immune response against gram negative and positive bacteria. We investigated the effect of Helicobacter pylori (H. pylori) infection on the expression of TLRs on the gastric mucosa. Methods: For 35 endoscopic gastric mucosa samples, histologic grading of H. pylori infection and inflammatory cell infiltration were performed. The mRNA expression of TLR2, 3, and 4 was examined by RT-PCR. Immunohistochemistry demonstrated the distribution of TLR2 and 4 in gastric mucosal biopsies. Results: H. pylori positive gastric mucosa expressed higher TLR4/GAPDH ratio than H. pylori negative gastric mucosa (p=0.035), while no significant difference in the expression of TLR2 and 3 was detected (p=0.129, p=0.176). The severity of neutrophil infiltration showed a significant positive correlation with TLR4/GAPDH ratio (p=0.045, r=0.342). Immunohistochemistry using anti-TLR4 and anti-TLR2 antibody revealed the expression of TLR4 in the epithelial cells of H. pylori-infected gastric mucosa. Conclusions: H. pylori infection induces TLR4 expression in the human gastric epithelium, which suggests a certain role of TLR4 in the mucosal inflammatory reaction to H. pylori infection. (Korean J Gastroenterol 2003;41:171-176)

창자간막 혈관염으로 처음 발현된 전신홍반루푸스 1예

이건화 ( Gun Hwa Lee ),은창수 ( Chang Soo Eun ),송준석 ( June Seok Song ),오일환 ( Il Hwan Oh ),정석현 ( Suk Hyun Jung ),박혜선 ( Hye Sun Park ),전용철 ( Yong Chul Jun ),손주현 ( Ju Hyun Sohn ),한동수 ( Dong Soo Han ) 대한장연구학회 2012 Intestinal Research Vol.10 No.3

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease that manifests various symptoms. Mesenteric vasculitis (MV) is one of the serious complications of SLE and carries a high mortality rate. Although MV is the main cause for acute abdominal pain in patients with SLE, it is very rare for the pain to be the first clinical manifestation of the disease. A 34-year old female presented with sudden onset abdominal pain accompanied by small intestinal bowel edema observed on abdominal computed tomography. We performed a diagnostic laparoscopy, as vital signs were becoming unstable and the diffuse abdominal tenderness was worsening rapidly. The examination showed a severe jejunal infarction; thus, the patient underwent a small bowel segmental resection. A histological examination revealed multiple, hemorrhagic, small-vessel vasculitis, and later serologic autoimmune markers were consistent with SLE. We suggest that SLE be considered in the differential diagnosis of young females presenting with an acute abdomen and unexplained enteropathy. A surgical approach such as exploratory laparoscopy could be an option in search for the cause. (Intest Res 2012;10:305-308)

점막하 종양으로 오인된 점액성 위선암

김재훈 ( Jae Hoon Kim ),전용철 ( Yong Cheol Jeon ),이길우 ( Gil Woo Lee ),윤지영 ( Ji Young Yoon ),표주연 ( Ju Yeon Pyo ),오영하 ( Young Ha Oh ),한동수 ( Dong Soo Han ),손주현 ( Joo Hyun Sohn ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2

A gastric carcinoma with the endoscopic features resembling a submucosal tumor (SMT) is rare, and reportedly accounting for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A diagnosis of a SMT-like gastric carcinoma is often difficult as the tumors are almost entirely covered with normal mucosa. Furthermore mucinous gastric adenocarcinoma is uncommon histologic subtype of gastric cancer. These tumors are detected mostly in an advanced stage and rarely in an early stage. Early mucinous gastric adenocarcinoma is characterized as an elevated lesion resembling SMT due to abundant mucin pools in the submucosa. Here we report one case of SMT-like mucinous gastric adenocarcinoma, diagnosed by the usual endoscopic biopsy and treated with surgery. (Korean J Gastroenterol 2011;57:120-124)

대장 선종의 위험 인자로 복부 비만 및 인슐린 저항성에 대한 연구

이항락 ( Hang Lak Lee ),손병관 ( Byoung Kwan Son ),이오영 ( Oh Young Lee ),전용철 ( Yong Chul Jeon ),한동수 ( Dong Soo Han ),손주현 ( Ju Hyun Sohn ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3

목적: 대장암은 유전 소인, 흡연, 음주, 식습관 등의 환경인자가 작용하여 발생하며 또한 비만, 고지혈증, 고혈당, 고인슐린 혈증 및 인슐린 저항성이 대장암의 발암과정과 연관이 있다. 다양한 비만 지표를 이용해서 대장 선종과 비만 및 인슐린 저항성과의 연관성을 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2004년 10월까지 한양대학병원에서 검진 목적으로 대장내시경검사와 기타 검사를 시행 받은 환자를 대상으로 전향적으로 환자 대조군 연구를 시행했다. 크기가 0.5 cm 이상이며 조직학적으로 대장 선종이 증명된 50명의 환자를 대상으로 했으며, 대조군은 동일 기간 중 대장내시경검사를 시행 받았으나 특이 병변이 없었던 자로 정했다. 결과: 인슐린, 공복혈당, 총 콜레스테롤, triglyceride, LDL, HDL 수치, 수축기 및 이완기 혈압은 환자군에서 모두 증가되었으나 환자군과 대조군 사이에 유의한 차이는 없었다. HOMA-IR은 환자군에서 인슐린 저항성 수치가 높았으나 통계적인 유의성은 없었다. 그러나 체질량지수, 복부 비만, 체지방, 비만도는 환자군이 대조군 보다 유의하게 높았다. 다변량 분석에서 복부 비만이 가장 의미 있는 위험 인자였으며 체질량지수가 증가함에 따라 대장 선종의 위험도도 증가했다. 체지방, 비만도 역시 중요한 위험 인자였다. 결론: 비만과 대장 선종의 연관성에서 복부 비만이 가장 중요한 위험 인자였으며 복강 내 지방조직이 중요한 역할을 할 것으로 기대한다. 향후 대규모의 환자 대조군 및 코호트 연구가 필요하며 복강 내 지방의 역할에 대한 분자생물학적인 연구가 필요하다. Background/Aims: Abdominal obesity and hyperinsulinemia or insulin resistance are of interest in connection with colon carcinogenesis. We conducted a prospective case controlled study for the evaluation of relationship between abdominal obesity, insulin resistance, and colorectal adenoma. Methods: Fifty patients with colorectal adenoma and fifty healthy subjects were included in this study. Total colonoscopic examinations were performed in all the subjects. Fasting blood sugar (FBS), insulin, homeostasis model assessment (HOMA-IR), triglyceride (TG), cholesterol (CROL), BMI (body mass index), WHR (waist hip ratio), percent body fat (PBF) and obesity degree (OD) were measured. HOMA-IR was considered to represent insulin resistance. Diabetic patients were excluded from this study. Results: There were no differences in sex, serum insulin, FBS, HOMA-IR, TG, CROL between adenoma and control group. Subjects with high BMI, WHR, percent body fat, and obesity were more likely to have colonic adenoma. Multiple logistic regression analysis after adjusting confounding factors, had revealed that WHR was the most important independent risk factor for colon adenoma. Conclusions: Abdominal obesity was most closely related to colonic adenoma. However, insulin resistance was not related to colonic adenoma. A larger case controlled study is needed. (Korean J Gastroenterol 2007;49:147-151)

궤양성 대장염과 동반된 상장간막정맥 및 간문맥 혈전증 1예

전용철,박경남,한동수,김병훈,손주현,안명주,조윤주,송승찬 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3

Thromboembolism is a infrequent extraintestinal complication of inflammatory bowel disease. Especially, portal vein and superier mesenteric vein thrombosis are rare complications of ulcerative colitis and its mortality is invariably fatal. The mechanism of thrombolic complications in inflammatory bowel disease remains enigmatic. Moreover, the clarification of the hypercoagulable state remains elusive. This report describes the case of 27-year-old-female with active ulcerative colitis. The patient revealed portal vein and superior mesenteric vein thrombosis with ascites detected by abdominal ultrasound exammation and computed tomography and successfully treated with combined anticoaulation therapy.