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각종 간질환 환자에서 HPLC 를 이용한 요중 Neopterin 치의 임상적 의의
심대석(Dae Seok Shim),이옥재(Ok Jae Lee),김영채(Young Chai Kim),하우송(Woo Song Ha),박순태(Soon Tae Park) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: In vivo, increased level of urinary neopterin was demonstrated in patients with viral, bacterial infection, autoimmune disease, malignancy, cellular graft rejection in transplantation, and AIDS. Increased serum and urinary neopterin levels have been observed in patients with acute hepatitis, chronic hepatitis, and liver cirrhosis. The aim of this study is to evaluate the clinical significance of urinary neopterin in patients with various liver diseases. Methods: Urinary levels of neopterin were measured by HPLC (High Performance Liquid Chromatography) in 66 patients with various liver disease and 12 healthy controls. Results: 1) Urinary neopterin level increased significantly in AH (1217.82±380.97 μmol/mol creatinine), CPH (263.15±70.48 μmol/mol Cr), CAH (307.93±100.65 μmol/mol Cr), LC (276.67±66.67 μmol/mol Cr), HCC (1003.83±289.06 μmol/mol Cr) than control group (136.63±59.05 μmol/mol Cr) (p<0.001). However, urinary neopterin level in ASC or ALD was not significantly different from control group. 2) In AH, urinary neopterin levels significantly correlated with serum AST (r=0.840, p<0.025) and ALT (r=0.817, p<0.025) level. However, in chronic liver disease, there was no correlation between neopterin levels and liver function tests in chronic liver diseases. 3) According to Pugh`s classification, there was no significant differences between three groups, but urinary neopterin levels increased significantly in HCC than LC (p<0.001). Conclusions: Our data suggest that urinary neopterin level reflects cell mediated immunity and may be useful marker to predict the clinical course of the various chronic liver diseases.
담낭신티그라피에 의한 담낭담석증 및 간흡충증 환자의 담낭운동성 분석
정판준(Pan Jun Chung),심대석(Dae Seok Shim),강재황(Jae Hwang Kang),류경렬(Gyeong Yeul Reu),원용환(Yong Hwan Won),박영호(Yung Ho Park),손미정(Mi Jung Son),정순일(Soon Il Chung),이옥재(Ok Jae Lee),김영채(Young Chai Kim) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
N/A Objectives: Abnormal gallbladder motility and bile stasis have been implicated in the pathogenesis of gallstone and bacterial infection, but the cause-and-effect relationship is not established. Among the various methods used to measure the gallbladder motility, cholescintigraphy using 99 mTc-labelled iminoacetic acid is nowadays used widely, which is noninvasive, convenient, and is capable of quantitative analysis of gallbladder motility. To evaluate the gallbladder motility in patients with gallstones and clonorchiasis, the authors analyzed the gallbladder filling and emptying using computer-assisted cholescintigraphy. Methods: The study group comprised 30 patients who were admitted to GNUH, from 1992, October to 1993, August, 20 patients of them had asymptomatic gallbladder stones or clonorchiasis, 10 patients were controls. All patients were studied with abdominal ultrasonography and DISIDA cholescintigraphy. We measured maximum gallbladder filling time, half time of emptying and ejection fraction after ingestion of fatty meal. Results: 1) There was no significant difference in maximum gallbladder filling time between control (52.3±9.3 min) and patients with gallbladder stones (51.5±15.8 min) and patients with clonorchiasis (56.9±10.5 min). 2) Gallbladder emptying time (T1/2) were significantly delayed in patients with gallbladder stones (48.4±16.3 min) and clonorchiasis (40.8±12.9 min), as compared with control (23.0±7.5 min). Conclusion: The gallbladder emptying time using computer-assisted cholescintigraphy in patients with gallbladder stones and with clonorchiasis were significantly delayed, as compared with control.
위 출구 폐색을 초래하여 내시경적 절제술로 치료한 Brunner 선 과오종
김기홍,이옥재,심대석,정기문,장종억 대한내과학회 1998 대한내과학회지 Vol.54 No.1
Brunner's gland hamartomas are rare, benign duodenal tumors. But, they are the commonest hamartomas in the small intestine and believed to represent hyperplasia of Brunner's glands, perhaps in response to excessive gastric acid secretion. Brunner's gland hamartomas are usually smaller than 1cm and asymptomatic, incidental finding during endoscopy or radiographic examination. We report a case of large Brunner's gland hamartoma which prolapsed into gastric antrum and caused gastric outlet obstruction, and was resected by endoscopic polypectomy.
김영채,손미정,김성욱,심대석,원용환,이근홍,김명희,김정렬,이옥재 대한내과학회 1995 대한내과학회지 Vol.48 No.2
The incidence of metastatic uterine choriocarcinoma to the bowel is rare. In general, trophoblastic tumors are highly vascular tumors, metastatic tumors are often hemorrhagic. Metastatic choriocarcinoma to the jejunum is characteized by highly vascular tumor, and superior mesenteric artery angiography demonstrated a hypervascular tumor stain at the terminal branch of the jujunal artery. However, lower intestinal bleeding as a first manifestation of metastatic choriocarcinoma to the jejunum is very rare. We experienced a case of the metastatic choriocarcinoma of jejunum with metastasis to the lung and liver that occurred after hysterectomy of the hydatidiform mole. The patient had suffered from massive lower intestinal bleeding. After the arteriography, resection of tumor and jejunojejunostomy was performed.
김건호,이옥재,신원호,심대석,류경렬,김건용,황일용 대한내과학회 1993 대한내과학회지 Vol.45 No.5
Secondary hemochromatosis is primarily a consequence of the treatment of the anemia of long term hemodialysis patients with frequent blood transfusions, seldom a result of oral or parentral iron therapy. Clinically, iron overload may be a serious problem for some maintenance hemadialysis patients and may be manifested by organ dysfunctions. Diagnosis of iron overload can be established by serum ferritin determination, liver biopsy or bone marrow examination, which correlates closely with total body iron stores. It is important to early detect the iron overload and to ristrict blood transfusions or iron therapy in these patients. We present secondary hemochromatosis in a long term hemodialysis patients with 140 pints blood transfusions for 5 years, confirmed by serum ferritin level, HLA (human leukocyte antigen) test and liver biopsy. We are treating this patient with recombinant human erythropoietin (EPO) in order to reduce the frequency of blood transfusions.
지속성 외래 복막투석 환자에 동반된 음낭 수종 및 간접 서혜부 탈장 1 예
김건호,하우송,이옥재,김성욱,김한모,심대석,황일용,함종렬,안인옥 대한내과학회 1994 대한내과학회지 Vol.46 No.5
Abdominal wall hernia is one of complications on CAPD patients. The incidence of this complication varies from 9.9 to 24% among CAPD patients, with a greater incidence among women and old men. The majority of the reported herniae can be differentiated to be incisional (i.e., in the incision of the implanted catheter), umbilical and inguinal according to their locations. It is necessary that patients on CAPD be examined regularly for symptoms and signs of abdominal hernias. Recently, we experienced a 61-year-old man on continuous ambulatory peritoneal dialysis complained of left scrotal and inguinal swelling and tenderness, which was diganosed as indirect inguinal hernia, left, associated with a hydrocele by transillumination and ultrasonography. A herniorraphy was performed, and his symptoms were subsided.
박은숙,김영채,이근홍,이옥재,최진학,심대석,장정순,홍순찬,고경혁 대한내과학회 1994 대한내과학회지 Vol.47 No.6
A 33-year-old man was admitted because of nausea and vomiting. Radiologic and gastroduodenoscopic studies showed partial obstruction of UGI tract, but could not distinguish benign lesion from malignant in duodenum. The patient underwent explolatory laparotomy for confirmatory diagnosis and treatment. The final diagnosis of pseudolymphoma of duodenum was made. The pseudo-lymphoma was benign tumor, and the etiology was unknown. Of the gastrointestinal tract, stomach is the most common site, and duodenum is very rarely involved. We report a case of pseudolymphoma of duodenum With review of reated literlitures.
김영채,김건호,이원주,최진학,강재황,심대석,함종렬,이근홍 대한내과학회 1992 대한내과학회지 Vol.43 No.5
The Pseudocyst as a sequela to pancreatitis or pancreatic trauma can occur at any site in the abdomen, but its formation within the liver, kidney and spleen is a rare event. In such cases pancreatic fluid enters along the major blood vessels into the parenchyma without digesting the capsule. The complications of intrasplenic pseudocyst are spontaneous rupture, bleeding, secondary infection, splenic artery obstruction with splenic infarct and UGI bleedings due to splenic vein thrombosis. Recently, we experienced a 34-year-old man complained of epigastric and LUQ pain, which was diagnosed as intrasplenic pseudocyst associated with chronic pancreatitis confirmed by ultrasonogram of abdomen, abdominal CT and ERCP. A distal pancreatectomy with Roux-en Y pancreaticojejunostomy and splenectomy were performed, and subsidence of his symptoms was observed. We report this case with a review of relevant literature.