신원성 전신 섬유증

안원석 ( Won Suk An ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1

B 형 간염 표면항원 양성인 막성증식성 사구체신염 3 형 환자의 임상상

안원석(Won Suk An),김기현(Ki Hyun Kim) 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: 만성 B형 간염 바이러스 감염은 막성 신병증(이하 MN), 막성증식성 사구체신염 I형(이하 MPGN I)과 MN과 MPGN I의 조직소견을 동시에 나타내는 막성증식성 사구체신염 III형(이하 MPGN III)을 유발한다. 저자들이 경험한 혈청 HBsAg양성자에서 발생한 MPGN III 환자의 임상상을 보고하고 이를 MN과 MPGN I 환자의 소견과 비교 분석하고자 하였다. 방법: 대상은 1990년 3월부터 2001년 2월까지 동아대학교 병원 내과에서 사구체 신질환을 의심하여 신생검을 시행한 환자 중 혈청 HBsAg 양성이면서 검사소견 및 임상소견상 전신성 홍반성낭창등의 다른 자가면역질환의 동반이 없는 MPGN III 환자 6명의 임상 소견을 MN 8명, MPGN I 19명과 비교 분석하였다. 결과: 연령은 MPGN III군 28.7세로 MN군 43.7세, MPGN I군 44.4세 보다 낮았다(p<0.05). 남녀비는 MPGN III군은 모두 남자였으며 MN군 6:2, MPGN I군 17:2로 3군 모두 남자에서 호발하였다. 신증후군 범위의 단백뇨를 보인 증례는 MPGN III군 6예 중 4예(66.7%)로 MN군 8예 중 6예(75%)보다 약간 낮았으나 MPGN I군 19예 중 5예(26.3%)보다 유의하게 높았다(p<0.05). 혈청 HBeAg양성을 보인 증례는 MPGN III군 6예 중 5예(83.3%)로 MPGN I군 19예 중 16예(84.2%)와 유사하였으며 MN군 8예 중 5예(62.5%)보다 많았다. SGOT가 증가한 증례는 MPGN III군 6예 중 5예(83.3%)와 MPGN I군 19예 중 14예(73.7%)는 MN군 8예 중 4예보다 많았다. SGPT가 증가한 증례는 MPGN III군 6예 중 5예(83.3%)는 MPGN I군 19예 중 10예(52.6%)와 MN군 8예 중 4예(25%)보다 많았다. 혈청 C3가 감소한 증례는 MPGN III군 6예 중 4예(66.7%)로 MPGN I군 19예 중 13예(68.4%)와 유사하였고 MN군 8예 중 3예(37.5%)보다 많았다. 결론: MPGN III 환자는 신증후군 범위의 단백뇨 발생의 빈도는 MN과 가깝고 혈청 C3치의 저하와 SGOT/SGPT 증가는 MPGN I과 유사한 임상 소견을 나타낸다. Background: It is well known that chronic hepatitis B virus infection can commonly cause membranous nephropathy (MN), membranoproliferative glomerulonephritis type I (MPGN I), and rarely, membranoproliferative glomerulonephritis type III (MPGN III), which has the combined pathologic findings of MN and MPGN I. We report the clinical findings of MPGN III in patients with positive serum hepatitis B virus surface antigen. Methods: The clinical findings of six MPGN III patients were investigated retrospectively to compare with those of eight MN and nineteen MPGN I patients with positive serum hepatitis B virus antigen. Results: The mean age of MPGN III cases (29.7 years) was younger than that of MN (43.7 years) and MPGN I cases (44.4 years)(p<0.05). Males were predominant in all groups and the male/female ratio was 6:0 in MPGN III, 6:2 in MN, 17:2 in MPGN I group. The cases of nephrotic range proteinuria (4 out of 6 (66.7%) in MPGN III and 6 out of 8 (75%) in MN group) were more frequent than the 5 out of 19 (26.3%) found in the MPGN I group (p<0.05). The cases of HBe antigenemia were 5 out of 6 (83.3%) in MPGN III, 16 out of 19 (84.2%) in MPGN I and 5 out of 8 (62.5%) in the MN group. The cases of increased SGOT level were 5 out of 6 (83.3%) in MPGN III, 14 out of 19 (73.7%) in MPGN I and 4 out of 8 (50%) in the MN group. The cases of increased SGPT level were 5 out of 6 (83.3%) in MPGN III, 10 out of 19 (52.6%) in MPGN I and 2 out of 8 (25%) in the MN group. The cases of decreased serum C3 level were 4 out of 6 (66.7%) in MPGN III, 13 out of 19 (68.4%) in MPGN I and 3 out of 8 (37.5%) in the MN group. Conclusion: Patients with MPGN III show similar clinical findings to both the nephrotic proteinuria of MN patients and the decreased serum C3 level and increased SGOT/SGPT of MPGN I patients. (Korean J Med 63:126-133, 2002)

Identrus를 통한 電子式 貿易決濟의 活性化에 관한 硏究

오원석(Oh Won Suk),안병수(An Byung Soo) 한국무역상무학회 2003 貿易商務硏究 Vol.19 No.-

The purpose of this paper is to examine whether the international electronic payment system through IDENTRUS can be active in the future or not. For this purpose, we have reviewed the various aspects of the typical systems : their types, operational mechanisms and actual limitations in real trade. Then we have proceeded to examine the distinguished features of IDENTRUS in terms of operational procedures and characteristics by comparing to other systems. Specially as the preconditions of activation, the possibilities of cost down, time reduction, risk hedging and operational efficiency have been studied. Thus we are not sure that the IDENTRUS will have a position as a main stream in the future electronic payment system, but this system would contribute positively to the establishment of electronic payment system if some functional additions will follow.

사구체신염 환자의 생검조직에서 endothelin - 1 의 발현양상

배성진(Sung Jin Bae),안원석(Won Suk An),나서희(Suh Hee Rha),김성은(Seong Eun Kim),김기현(Ki Hyun Kim) 대한내과학회 2002 대한내과학회지 Vol.62 No.5

목적 : Endothelin-1은 강력한 신혈관 수축작용이 있으며, 체내 Na+ 대사에 관여하고, 세포 실험에서는 메산지움 세포의 분화와 수축을 일으키며 세포외 기질 생산을 자극한다고 보고되고 있다. 이에 저자는 사구체신염 환자의 신생검 조직에 endothelin-1에 대한 면역조직화학염색을 시행하여 endothelin-1과 사구체신염의 세포증식성 변화와의 관계를 구명하고자 하였다. 방법 : 대상은 정상 신기능의 성인 사구체 신질환자 64예였다. 초점성 사구체신염과 미만성 메산지움증식성 사구체신염의 병리소견을 보이는 IgA 신병증, 막성증식성 사구체신염, 연구균감염 후 사구체신염과 국소성 및 미만성 증식성 낭창성신염 등은 증식성 사구체신염군으로 하고, 미세변화 신증후군, 막성신병증 및 미소변화 IgA 신병증은 비증식성 사구체신염군으로 분류하였다. 환자들의 신생검 조직을 anti-endothelin-1 serum으로 avidin-biotin-complex 법에 의한 immunoperoxidase 염색을 하여 endothelin-1의 발현 양상을 비교 분석하였다. 결과 : 증식성 사구체신염군의 생검조직에서 비증식성 사구체신염군에 비하여 사구체 모세혈관 내피세포, 간질내 혈관 내피세포 그리고 세뇨관 상피세포에서 각각 endothelin-1 면역반응이 강하였다. 결론 : 이상의 결과로 endothelin-1은 사구체신염의 세포증식과정이나 세포증식 후의 이차적 손상에 중요한 역할을 할 것으로 보인다. Background: Endothelin-1 has been found to be a potent mitogen in cultured mesangial cells. In addition, the urinary hyperexcretion of endothelin-1 was observed in patients with glomerulonephritis. Methods: The author studied endothelin-1 immunoreactivity in 64 kidney biopsies of patients with various glomerular diseases by immunoperoxidase staining utilizing anti-endothelin-1 serum from the rabbit. Results: A group of Ig A nephropathy with glomerular proliferative change (8 focal glomerulonephritis and 7 diffuse mesangial proliferative glemerulonephritis) and a group of other proliferative glomerulonephritis (11 membranoproliferative glomerulonephritis type I, 5 poststreptococcal glomerulonephritis, 8 focal or diffuse proliferative lupus nephritis) have more prominent endothelin-1 protein expression in the glomerular endothelium, the vascular endothelium and the tubular epithelium than non-proliferative glomerular disease group (12 minimal change nephrotic syndrome, 7 membranous nephropathies, 6 IgA nephropathies with minor glomerular abnormality). Conclusion : These results suggest that endothelin-1 has a potential role in the pathophysiology of proliferative glomerualr diseases.(Korean J Med 62:530-536, 2002)

급성신부전과 현미경적 신석회화증을 동반한 부갑상선암 1예

최윤정 ( Yun Jung Choi ),안원석 ( Won Suk An ),강도영 ( Do Young Kang ),나서희 ( Seo Hee Rha ),김성은 ( Seong Eun Kim ),김덕규 ( Duk Kyu Kim ),김기현 ( Ki Hyun Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1

저자들은 급성신부전 및 고칼슘혈증을 보이는 환자에서 신조직검사상 현미경적 신석회화증을 확인하고 여러 영상학적 진단기술의 조합 및 수술 후 조직학적 확인을 통해 부갑상선암을 진단하여 동측 갑상선 엽절제술 시행 후 19개월간 경과관찰한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Parathyroid carcinoma is a very rare disease in patients with primary hyperparathyroidism. Renal impairment and bone disease in the case of parathyroid carcinoma is common due to hypercalcemia. Renal diseases, including nephrocalcinosis, nephrolithiasis, and renal failure are frequent compared with those of benign parathyroid tumors. Nephrocalcinosis is a disorder of increased calcium content and deposition within renal parenchyma. Most cases reporting parathyroid carcinoma have shown medullary calcinosis on radiologic images, but there has been no definitive report of microscopic nephrocalcinosis which does not have a positive radiologic finding. In the case reported herein, a 50-year-old woman had experienced general weakness and a decline in vision. She had hypercalcemia and acute renal failure and the renal biopsy revealed nephrocalcinosis. The PTH level was elevated (940.47 pg/mL) and the parathyroid tumor was localized based on several radiologic findings. Capsular invasion was noted at the time right parathyroidectomy, indicative of parathyroid carcinoma, thus we carried out ipsilateral thyroidectomy. Hypercalcemia was improved after surgery, but renal function was not improved completely due to microscopic nephrocalcinosis. (Korean J Med 75:122-127, 2008)

특발성 막성신염 환자의 치료에 관한 연구

배성진(Sung Jin Bae),안원석(Won Suk An),박건욱(Geun Wook Park),박희승(Hee Seung Park),김구(Gu Kim),김동수(Dong Su Kim),김광동(Kwang Dong Kim),정재열(Jae Youl Jung),장광열(Kwang Yul Chang),김선택(Sun Tack Kim),김성은(Seong Eun Kim),김 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective .We aimed to compare efficacy of treatment between steroid therapy and steroid-chlorambucil combination therapy in patients with adult-onset idiopathic membranous glomerulonephritis (MN). Methods: A series of 31 biopsy-proved idiopathic MN patients was analyzed retrospectively to estimate effect of treatment with steroid and/or cytotoxic agent. All patients (male 15, female 16, mean age of 37 years old) presented a full-blown nephrotic syndrome (proteinuria >3.0gm/day, serum albumin <3.0mg/dL, edema) at the initiation of treat- ment and were observed for at least 6 months (mean follow up period: 28±23 months). Clinical and laboratory information were obtained at the time of presentation and at last follow up. Each patient was assigned to one of the following protacols. 1) Steroid therapy prednisolone 40 or 60mg/day (single dose) for 16 weeks. 2) Steroid-Chlorambucil combination therapy: for 6 months with three cycles of methylprednisolone pulse therapy (lgm 1V for 3 days), prednisolone 0.5mg/kg/day for 27 days, then chlorambucil 0.2mg/kg/day for 28 days. 3. Cyclophosphamide 2mg/kg/day for 28 days. Results: 1) Final status in total 31 cases irrespective of therapeutic modality were complete remission in 5 (16%) cases, partial remission in 9 (29%) cases, no response in 12 (41%) cases, spontaneous complete re- mission in 1 cases, and spontaneous partial remission in 1 case. 2) After initial steroid therapy (in 25 cases), We observed no response in 17 (68%) case, partial remission in 3 (12%) cases, complete remission in 3 (12%) cases, and spontaneous partial remission in 2 (8%) cases. 3) The combination therapy (steroid and chlorambucil) tried in 10 cases results in 5 (50%) cases of partial remission, 2 (20%) cases of complete remission, 1 (10%) case of spontaneous partial remission, and 2 (20%) cases of no response. 4) During follow up period, renal functional deterioration was absent in any case and final albumin levels were significantly increased (p<0.05). Conclusion: Steroid-chlorambucil combination pro- toco1 is considered to be a more effective treatment with higher rate of overall remission compared to steroid therapy. Idiopathic MN itself seems to have a relatively benign course when considering that renal function was preserved in all cases without progression to chronic renal failure and that a few cases of spontaneous remission could be observed. For the limitation in number of cases and duration of follow up in this study, it needs prospective controlled study of more larger scale with long-term follow up to get a more reliable results.

혈액투석 환자에서 관상동맥질환의 예측인자로서 단순방사선 촬영상 혈관 석회화 점수들간의 비교

김정민 ( Jung Min Kim ),안원석 ( Won Suk An ),김기현 ( Ki Hyun Kim ),김성은 ( Seong Eun Kim ),손영기 ( Young Ki Son ),정석희 ( Seuk Hee Chung ),오유정 ( You Jeong Oh ),김우재 ( Woo Jai Kim ),김동균 ( Dong Kyun Kim ),배숙향 ( Hyang 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2

Purpose: Vascular calcification (VC) scores on simple plain radiographic films are known to be associated with coronary artery disease (CAD) and mortality. The present study was designed to demonstrate a correlation between VC scores of the hands and pelvis, and feet and lateral lumbar spine on plain radiographs. In addition, we analyzed the usefulness of checking all the plain radiographs for assessment of pre-existing CAD. Methods: We recruited 61 hemodialysis (HD) patients from OO Dialysis Center. We checked the plain radiographic films of the feet, hands, pelvis, and lateral lumbar spine and evaluated VC scores with previously reported methods. We defined CAD based on myocardial scans, echocardiography, or coronary angiography. Results: Positive associations were found between the VC scores of the feet, VC scores of the hands and pelvis, scores of abdominal aortic calcifications (AACs), and CAD. Approximately 30% of patients who had CAD could be missed based on a single VC scoring method. Patients who showed any one finding among the AAC scores >5, VC scores of the pelvis and hands >3 or arterial media calcifications of the feet on plain radiographs had a high sensitivity (93.8%) and a high negative predictive value (96.3%) for the presence of CAD. Conclusion: Each VC score was highly inter-correlated. All three VC scoring methods on plain radiographic films are useful screening tests for the presence of CAD in HD patients.

거대 부신 피질 선종

김덕규,김종성(Jong Seong Kim),안원석(Won Suk An),강도영(Do Young Kang),이주일(Ju Il Lee) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

The benign adrenal cortical adenoma usually secretes cortisol and its size is less than 3 cm in diameter. Though adrenal cortical carcinoma also secretes cortisol and other steroid hormones, its size is usually over 6 cm. We present a huge glucocorticoid producing adrenal cortical adenoma (15 * 11 * 12 cm), which was diagnosed by NP-59 scan and confirmed by sorgery, with a review of the literature.

간세포암의 직경과 위치에 따른 고주파 열치료의 치료효과 및 합병증에 관한 연구

유정남 ( Jung Nam Yoo ),신우원 ( Woo Won Shin ),강기태 ( Ki Tae Kang ),조정환 ( Jung Hwan Cho ),문성훈 ( Sung Hun Moon ),윤욱돈 ( Uk Don Yun ),장채령 ( Chae Ryeong Jang ),이태영 ( Tae Yeong Lee ),안원석 ( Won Suk An ),이종훈 ( Jon 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : Induction of coagulation necrosis by using thermal energy sources such as radio-frequency (RF), microwaves and lasers has recently been as a new, minimally invasive technique for percutaneous tumor ablation. RF ablation is considerd effective and safe for the local control of small HCCs. The aim of this study is to evaluate the therapeutic efficacy and complications according to the diameter and location of the HCC. Methods : Between May 1999 and December 2000, one hundred fifty patients underwent RF thermal ablation in Dong-A university hospital. Among them, forty nine patients were enrolled in this study who have no history of prior other treatment including hepatic resection, TAE, PEI, and chemotherapy, also who have follow-up CT performed at least six months after ablation. The patients devided into two groups, who have small HCC (.3 cm in diameter) and the others. Recurrence rate was also evaluated with spiral CT performd at least six months after treatment. Results : In large HCC group (>3 cm in diameter), the mean follow-up duration was 10.8 months and local recurrence rate was 51.0%?12.4. In small HCC group (.3 cm in diameter), the mean follow-up duration was 12.7 months. Local recurrence rate was 16.2%?8.6 in patients with small HCC. Among one hundred fifty patients underwent radio-frequency thermal ablation, 5 cases of intraperitoneal bleeding, 5 cases of pleural effusion and 3 cases of pneumothorax were observed. In most of cases, the necrotic area of HCC reached to the capsule of liver or located in hepatic dome. Conclusion : Radio-frequency ablation appears to be more effective and safe for the treatment of small HCC than that of large HCC and more attetion must be given to the RF ablation if the tumor is larger than 3cm or located close to the capsule of liver or in hepatic dome. (Korean J Med 63:507-512, 2002) Key Words : Radio - frequency Ablation, Carcinoma, Hepatocellular

이차성 막성신병증의 원인 및 임상경과

이은주 ( Eun Ju Lee ),이상화 ( Sang Hwa Lee ),원종진 ( Jong Jin Won ),유정남 ( Jeong Nam Yu ),안상준 ( Sang Jun An ),정제혁 ( Jae Hyeok Jeong ),나서희 ( Seo Hee Rha ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun 대한내과학회 2005 대한내과학회지 Vol.68 No.4