만성 C 형 간염 환자에서 인터페론치료에 의한 갑상선질환의 발생

김민대(Min Dae Kim),전익수(Ik Soo jeon),강승수(Seung Su Kang),엄재섭(Jae Sup Eum),손호성(Ho Seung Son),박현용(Hyung Lyong Park),윤병철(Byung Cheol Yun),이상욱(Sang Uk Lee),한병훈(Byung Hoon Han) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.6

Background/Aims: It has been suggested that hepatitis C virus is associated with the autoimmune disease and interferon also induces hepatic and non-hepatic autoimmune reaction. We conducted this study to assess the effect of interferon-alpha (INF-α) on the induction of thyroid autoantibodies and clinical thyroid disease and to know whether the thyroid autoantibodies affect the IFN-α efficacy in patients with chronic hepatitis C. Methods: Twenty-nine patients with chronic hepatitis C were enrolled. Anti-thyroglobulin antibody (ATA), anti-microsomal antibody (AMsA), thyroid stimulating hormone and free thyroxine were measured before, during, and after IFN-α therapy. Results: Two of the 29 patients (6.5%) were positive for ATA and AMsA before IFN-α therapy. Of these two patients, one patient was a woman, who showed hyperthyroidism druing IFN-α therapy. Of the 27 patients who had been negative for ATA and AMsA, one female patient became ATA positive with the development of hyperthyroidism, and 3 male patients became AMsA positive during IFN-α therapy. There was no difference in the efficacy of INF-α therapy between the thyroid autoantibody positive and negative groups. Conclusions: IFN-α therapy induced thyroid disease with high prevalence in the patients with chronic hepatis C. Thus, thyroid status should be checked even in patients without thyroid autoantibodies, especially in woman. Antithyroid autoantibodies seem unlikely to affect the efficacy of IFN-α therapy. (Korean J Gastroenterol 2001;37:436-442)

인두구와 쉰 목소리 환자의 위식도 및 위후두 역류 빈도

박찬원 ( Chan Won Park ),최철웅 ( Cheol Woong Choi ),김광하 ( Gwang Ha Kim ),김경엽 ( Kyung Yeob Kim ),하태인 ( Tae In Ha ),박형열 ( Hyoung Yoel Park ),엄재섭 ( Jae Sup Eum ),박찬호 ( Chan Ho Park ),이선미 ( Sun Mi Lee ),강대환 ( 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1

목적 : 인두구 및 쉰 목소리 같은 만성 인후두 증상이 위식도 역류 질환 및 식도 운동성 질환과 관련이 있다고 알려져 있다. 인두구와 쉰 목소리를 호소하는 환자에서 위식도 역류 및 위인두 역류와의 관계를 후향적으로 조사하고자 하였다. 대상 및 방법 : 인두구와 쉰 목소리를 호소하는 290명의 환자(남자 122명, 여자 168명)를 대상으로 하여, 위내시경검사, 24시간 보행성 식도산도검사 및 식도내압검사를 시행하였다. 내시경 소견, 24시간 보행성 식도산도검사 및 식도 내압 검사 소견을 분석하였다. 결과 : 1) 위산 역류의 전형적인 증상은 51.7% (150/290)에서 관찰되었다. 2) 내시경 검사에서 역류성 식도염은 12.2% (29/236), 식도열공탈장은 5.9% (14/236)에서 관찰되었다. 3) 식도내압 검사에서 비정상 소견을 보이는 경우는 64.8%였으며, 이중 비효과적 식도운동이 가장 많았다. 4) 24시간 보행성 식도산도검사에서 정상 소견은 34.2% (91/266), 위식도역류질 환으로만 진단된 경우는 14.3% (38/266), 위후두역류질환으로만 진단된 경우는 15.0% (40/266), 위식도역류질환과 위후두역류질환 모두로 진단된 경우는 36.5% (97/266)이었다. 결론 : 인두구와 쉰 목소리를 호소하는 환자에서 위식도 역류질환 및 위후두 역류질환의 빈도가 높게 나타났다. 그러므로, 후두경 검사상 정상인 인두구 및 쉰 목소리를 호소하는 환자에서 위식도 역류 및 식도운동질환에 대한 검사를 시행하고 이에 따라 치료적 접근을 하는 것이 바람직 하다고 사료된다. Background/Aims: Globus pharyngeus and hoarseness are common extraesophageal manifestations in the patients with astroesophageal reflux disease. The aim of this study was to evaluate the frequency of gastroesophageal and gastropharyngeal reflux in the patients with globus and/or hoarseness. Methods: From July 2004 to December 2006, we retrospectively analyzed the medical records and the findings from endoscopy, esophageal manometry and ambulatory 24-hour pH monitoring of patients with symptoms of globuspharyngeus or hoarseness. Results: One hundred fifty patients (51.7%, 150/290) complained typical reflux symptoms such as heartburn or acid regurgitation. Two hundred thirty-six patients underwent endoscopy. Reflux esophagitis and hiatal hernia were found in 12.2% (29/236) cases and 5.9% (14/236) cases, respectively. Abnormal esophageal motilities were found on 64.8% of patients showed abnormal esophageal motilitiy tests. Ineffective esophageal motility was the most frequent finding. Two hundred sixty-six patients underwent ambulatory 24-hour dual probe pH monitoring. Of them, normal PH monitoring , GERD only, GPRD only and both GERD and GPRD were 34.2% (91/266), 14.3% (38/266), 15.0% (40/266) and 36.5% (97/266), respectively. Conclusions: In a high proportion of the patients with globus pharygeus and hoarseness, gastroesophageal reflux disease and gastropharyngeal reflux disease were observed.

인슐린 비의존성 당뇨병 환자에서의 식도 운동 이상

이지영,이상원,신성훈,엄재섭,김지연,박무인,박선자,구자영 고신대학교 의학부 2001 高神大學校 醫學部 論文集 Vol.16 No.1

Background The structure and function of the gastrointestinal (GI) tract may be abnormal in patients with diabetes mellitus. These changes in diabetic patients may influence any part of the GI tract from the esophagus to the anus. The loss of gastric tone and motility, the prolonged transit time through the small intestine, and the nocturnal diarrhea in diabetes are widely recognized functional disturbances of the GI tract involving the autonomic nervous system. The esophagus is one other organ of the alimentary tract that is highly innervated by the vagus, but whose functional activity in diabetes has been neglected, relatively. It was the aim of this study to measure the contractile pressure and the pattern of motility of esophagus under physiologic conditions in consideration of the concurrent presence of evident neuropathies (autonomous and peripheral). The present study was designed to explore further whether esophageal motility dysfunction are present in non-insulin dependent diabetes mellitus(NIDDM) patients who do not show apparent symptoms and signs of gastroenteropathy, and to evaluate its relationship with peripheral polyneuropathy. Methods Thirty patients with NIDDM and 40 age-matched normal controls were recruited for this study and esophageal manometry, esophagogram, endoscopy, and nerve conduction velocity test were performed in these patients. Results Compared with controls, NIDDM patients showed significantly lower mean esophageal contractile amplitude and shorter mean contractile duration(P<0.01) on the body portion. The mean contractile velocity was decreased on distal esophageal body (P<0.05). Mean lower esophageal sphincter(LES) pressure of NIDDM was significantly higher than that of controls(p<0.05), and mean duration of relaxation was significantly shorter than that of controls(p<0.05). The abnormal contraction patterns and waves were found in 9 patients with NIDDM, including 6 cases with diminished number of peristaltic contraction, and nonspecific esophageal motility disorder were diagnosed for these patient. In control group, all these abnormalities were absent. In the diabetic patients, esophageal motility test findings had no correlation with the presence of peripheral polyneuropathy and duration of NIDDM. There were some differences of esophageal motility findings between groups of HbAlc>12% and <12%, and between groups of fasting blood sugar>150㎎/㎗ and <150㎎/㎗, but without statistical significance. Conclusion These results indicate that abnormalities of esophageal motility may be present in NIDDM patients who do not show apparent symptoms and signs of gastrointestinal disorder, as evidenced by low mean peristaltic amplitude of body, high mean LES pressure, and diminished number of peristaltic contractions, higher incidence of abnormal contraction patterns and waves in NIDDM group than control group(33% vs 0%), and the correlation between esophageal dysfunction and NIDDM duration or the presence of peripheral polyneuropathy is not found. The cause of these abnormalities of esophageal motility were thought to be vagal nerve damage, but Auerbach's plexus damage may also be important, as shown by high LES pressure, and short duration of LES relaxation.

Cerivastatin과 Cyclosporine을 병용 투약한 신이식 환자에서의 횡문근융해증 1예

신성훈,김민대,강승수,김찬욱,이지영,엄재섭,권성일,김길수,정연순,임학 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Cerivastatin, a kind of statins, is a recently used lipid-lowering drug. which inhibits of hydroxymethylglutarate coenzyme A (HMG-CoA) reductase. The serum concentrations of statins in healthy volunteers are increased by the simultaneous administration of cyclosporine, itraconazole, as well as erythromycin and verapamil and increased risk of myalgia and rhabdomyolysis has been reported after concomitant use of HMG-CoA reductase inhibitors with these drugs. A 57-year-old female kidney transplant recipient admitted because of a dark urine, myalgia and weakness of extremities. Six weeks before admission, the patient has taken cerivastatin 0.3mg daily. Cyclosporine, prednisolone and mycophenolate mofetil were maintained for recent two years. Initial laboratory data showed serum creatinine 1.1mg/dl, AST 235 IU/L, LDH 2,465 IU/L, CPK 1600 IU/L, myoglobin >3,000 ng/ml and cyclosporine 288ng/ml (TDX). Medication of cerivastatin was discontinued, and the patient recovered rapidly with supportive therapy. After eighteen weeks of cerivastatin withdrawal. the drug was represcribed to control the increased lipid levels. The patient showed the same clinical manifestations suggesting rhabdomyolysis following eight weeks of cerivastatin administration. We report a case of rhabdomyolysis associated with cerivastatin and cyclosporine combination therapy in a kidney transplant recipient.