대장암 환자에서 C-Reactive Protein의 임상적 의의

박성철 ( Sung Chul Park ),진윤태 ( Yoon Tae Jeen ),이광균 ( Kwang Gyun Lee ),김주형 ( Juhyung Kim ),현종진 ( Jong Jin Hyun ),김은선 ( Eun Sun Kim ),박상훈 ( Sanghoon Park ),금보라 ( Bora Keum ),서연석 ( Yeon Seok Seo ),김용식 ( Yo 대한장연구학회 2009 Intestinal Research Vol.7 No.2

Background/Aims: C-reactive protein (CRP) is a general marker of inflammation and increased CRP level is reported in several cancers. It has been reported that CRP is an independent factor predicting survival in colorectal cancer patients, although this claim is still under debate. The aim of this study was to investigate the association between CRP and the characteristics of colorectal cancer patients. Methods: One hundred eighty-four patients diagnosed with colorectal cancer between January 2007 and January 2009 were included. The patients with active infectious diseases, other tumors, cardiovascular disease, or inflammatory bowel disease were excluded. The CRP levels of colorectal cancer patients were compared with the control group comprised of 175 healthy adults with a normal colonoscopy. Results: The median CRP in the colorectal cancer patients (3.36 mg/L) was higher than the control group (0.48 mg/L). There was a significant correlation between CRP and the stage of colorectal cancer (p<0.001). CRP was increased significantly in Dukes’ stage D. CRP had a significant correlations with the CEA and CA 19-9 levels, the ESR, and the white blood cell count, and an inverse correlation with albumin. The CRP level in colon cancer patients was higher than rectal cancer patients (p=0.032). There were no significant difference in the CRP according to metastatic sites, such as the liver and peritoneum. Conclusions: Serum CRP levels were higher in patients with colorectal cancer and high CRP level is a predictor of advanced disease. (Intest Res 2009;7:93-99)

사례보고 : 산괴불주머니에 의한 급성 독성간염 1예

강현석 ( Hyun Seok Kang ),최혁순 ( Hyuk Soon Choi ),윤태정 ( Tae Jung Yun ),이광균 ( Kwang Gyun Lee ),서연석 ( Yeon Seok Seo ),연종은 ( Jong Eun Yeon ),변관수 ( Kwan Soo Byun ),엄순호 ( Soon Ho Um ),김창덕 ( Chang Duck Kim ),류호 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

산괴불주머니라는 약초에 의한 급성 독성간염의 1예를 보고하고자 한다. 환자는 상기 약초를 다려 먹은 후 황달이 발생하여 입원하였으나 약초로 인한 간손상이라고는 생각하지 않아 병력 청취 시 말하지 않았고, 결국 원인 규명은 이루어지지 못한 채 간손상이 호전되어 퇴원하였다. 그러나 퇴원 후 약초 재복용으로 인해 간손상이 악화되면서 비로소 복용 사실을 언급하였고 약인성 독성간염으로 확진하게 되었다. 약인성 간손상에서 복용 약물의 인지가 늦어지면 진단이 늦어질 뿐 아니라 재발의 가능성이 높아지므로 약물 사용력에 대해 보다 세밀한 조사가 필요할 것으로 생각한다. Herbs are widely used as treatments for various symptoms. However, several herbs have been reported to be inducers of liver injury. We report herein a case of hepatotoxicity induced by Corydalis speciosa Max. A 37-year-old male complained of jaundice and mild abdominal discomfort. A thorough history was taken, and laboratory investigation, diagnostic imaging studies, and percutaneous liver biopsy sampling were conducted to determine the cause of liver injury. An accurate cause was not revealed. We administered supportive management for acute cholestatic hepatitis of unknown origin, after which his symptoms disappeared and serum aminotransferase levels decreased gradually to near normal levels. However, at 2 months after discharge, the symptoms and the elevation of aminotransferase levels recurred. At that time he told us that he had repeatedly but unintentionally eaten a herb called “Hwang-geun cho”(Corydalis speciosa Max.). Thus, we diagnosed his case as herbal hepatotoxicity. (Korean J Hepatol 2009;15:517-523)

만성 간질환 환자에서 간 섬유화 평가에 대한 간 탄력도 측정의 유용성

김은선 ( Eun Sun Kim ),서연석 ( Yeon Seok Seo ),이광균 ( Kwang Gyun Lee ),박상훈 ( Sanghoon Park ),권용대 ( Yong Dae Kwon ),금보라 ( Bora Keum ),김용식 ( Yong Sik Kim ),진윤태 ( Yoon Tae Jeen ),전훈재 ( Hoon Jai Chun ),김창덕 ( Ch 대한내과학회 2008 대한내과학회지 Vol.74 No.3

목적: 만성간질환 환자에서 섬유화 진행 정도의 평가는 환자의 치료 및 예후를 결정하는데 매우 중요하다. 섬유화 평가를 위해 간 조직 생검이 가장 좋은 검사법으로 알려져 있으나 비용이 많이 들고 침습적인 검사라는 점 등 몇 가지 문제점이 있어 최근에는 비 침습적 방법을 통한 간 섬유화 측정법들이 시도되고 있다. 본 연구는 이러한 비 침습적 검사법의 하나인 Fibroscan을 통한 liver stiffness measurement(LSM)가 만성간질환 환자에서의 간 섬유화 정도 평가에 유용한가를 평가하기 위해 시행하였다. 방법: 만성간질환으로 간 조직생검을 시행한 93명의 환자를 대상으로 하였다. 간 조직생검 시행 당일 또는 다음날 Fibroscan을 통해 LSM을 측정하였다. 생검 조직의 섬유화 정도는 METAVIR 기준의 간 섬유화 병기에 따라 분류하였다. LSM 결과의 유용성 및 섬유화 정도 평가에 대한 optimal cutoff value를 결정하기 위해 receiver-operating characteristics(ROC) curve 분석을 시행하였다. 결과: 만성간질환으로 간 조직생검을 시행 받은 85명 환자의 연령은 40±13세(중앙값, 40세)였으며 남자가 62명(66.6%)이었다. 만성간질환의 원인은 다음과 같다. 만성 B형 간염, 56명(65.9%) 만성 C형 간염, 19명(22.4%) 지방간질환, 4명(4.7); 자가면역성간염, 3명(3.5%) 기타, 2명(2.4%). 간 조직 생검 결과 F0-1, F2, F3 및 F4에 해당하는 환자는 각각 21명(24.7%), 27명(31.8%), 26명(30.6%) 및 11명(12.9%)이었다. 간조직 생검을 통한 간 섬유화 진행단계는 LSM 결과와 유의한 연관성을 보였다(Kendall`s correlation coefficient: 0.583;p<0.001). 간 조직 생검에서 F2 이상, F3 이상 및 F4 이상에 대한 LSM의 area under ROC curve는 각각 0.871 (95% CI, 0.787-0.956), 0.874 (95% CI, 0.800-0.948) 및 0.894 (95% CI, 0.817-0.970)였다. F2 이상, F3 이상 및 F4 이상에 대한 optimal cutoff value는 각각 6.9, 11.9 및 14.15 kPa였다. 결론: Fibroscan을 통한 LSM 측정은 만성간질환 환자에서 간의 섬유화 정도를 평가할 수 있는 유용한 비 침습적인 방법으로 생각된다. Background/Aims: Accurate assessment of liver fibrosis is very important for predicting the prognosis of patients with chronic liver diseases. Liver biopsy is still considered the gold-standard for assessing liver fibrosis. However, it is an invasive procedure with several limitations such as its questionable outcomes. Recent studies have suggested that liver stiffness measurement (LSM) using Fibroscan is noninvasive and useful for assessing liver fibrosis. This study was performed to evaluate the efficacy of LSM for evaluating liver fibrosis in patients with chronic liver diseases. Methods: We prospectively enrolled 93 patients with chronic liver diseases, as confirmed by liver biopsy. The patients underwent liver biopsy and LSM. The METAVIR liver fibrosis stages of the biopsy specimens were assessed by an experienced pathologist. LSM was performed by Fibroscan. The efficacy of LSM and the optimal cutoff values for assessment of the fibrosis stage were determined by a receiver-operating characteristics (ROC) curve analysis. Results: LSM was well correlated with the fibrosis stage (Kendall correlation coefficient: 0.58; p<0.001). The areas under the ROC curves were 0.871 (95% CI, 0.715-0.924) for the patients with significant fibrosis (F≥2), 0.874 (0.761-0.929) for the patients with severe fibrosis (F≥3) and 0.894 (0.792-0.956) for the patients with cirrhosis (F=4). The optimal LSM cutoff values for F ≥2, F ≥3 and F=4 were 6.9, 11.75 and 14.5 kPa, respectively. Conclusions: LSM was a simple, effective method for assessing liver fibrosis in patients with chronic liver diseases. Its use for the follow up and management of these patients could be of great interest and so further investigation is required. (Korean J Med 74:264-270, 2008)

신장 이식 환자에서 CMV duodenitis 치료 후 병발한 Pneumocystis jirovecii 폐렴 1예

김혜원 ( Hye Won Kim ),김명규 ( Myung Gyu Kim ),우영석 ( Young Seok Woo ),부창수 ( Cang Soo Boo ),조상경 ( Sang Kyung Jo ),김형규 ( Hyoung Kyu Kim ),조원용 ( Won Yong Jo ),이광균 ( Kwang Gyun Lee ),김혜옥 ( Hye Ok Kim ),오초롱 ( C 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5

Solid organ transplant recipients are at increased risk for various opportunistic infections because of their immunocompromised state. Pneumocystis jirovecii (carinii) infection has posed serious problems in these patients which can be life threatening. It has been reported that incidences of Pneumocystis infection have dramatically decreased with the use of prophylactic antibiotics. However, there have been reports that say the risks of Pneumocystis infection are increasing with the use of new immunosuppressive drugs and in presence of preceding immunomodulating infections such as CMV infection which is another common opportunistic infection in transplant patients. There were only a few case reports abroad on Pneumocystis infection following CMV infection in patients who underwent kidney transplantation. In Korea, however, there hasnt been any report of such cases. Herein we report a case of a kidney transplant patient who experienced a serious episode of Pneumocystis jirovecii pneumonia following CMV duodenitis. After adequate mechanical ventilation and use of antibiotics the patient completely recovered without any complications.

A Case of Disseminated Tuberculosis with Miliary Central Nervous System Tuberculoma

Noh, Ji Yun,Heo, Jung Yeon,Lee, Kwang Gyun,Yoon, Young Kyung,Lee, Jacob,Song, Joon Young,Cheong, Hee Jin,Kim, Woo Joo 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Disseminated tuberculosis occurs through lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The exact incidence of disseminated tuberculosis is still unknown and its diagnosis presents a challenge since the symptoms are not specific of the disease. Brain tuberculoma is one of the complications of tuberculosis. The literary review of brain tuberculoma shows that it mainly occurs in the cerebrum and cerebellum, whereas involvement of the brainstem is rare. Recently, we have experienced a case of 46-year-o1d man with fever of 2 months duration who was diagnosed with disseminated tuberculosis with miliary central nervous system (CNS) tuberculomas; brain tuberculomas were found even in the brainstem and the spinal cord. Pulmonary, intestinal, renal, and choroidal involvements were also noted.