만성신부전환자에서 혈장 단백 C 및 S 의 임상적 의의

이귀순(Kwi Soon Lee),하성규(Sung Kyu Ha),박종훈(Chong Hoon Park),서정건(Jung Kun Seo),이호영(Ho Yung Lee),한대석(Dae Suk Han),송경순(Kyung Soon Song) 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: Patients with chronic renal failure have increased hemorrhagic tendency due to an uremic platelet dysfunction and complications from anticoagulants used in hemodialysis. They are also prone to have thrombotic complications in the cerebral vessels, coronary arteries and A-V fistula, due to hypercoagulability from changes in various factors. Recently, deficiencies in plasma protein C and S, which are physiological anticoagulants, have been reported to cause thrombosis. In chronic renal failure, plasma protein C and S activities are known to be decreased. Methods: In the present study, activities and antigen concentrations of plasma protein C and S, as well as AT-III activities were investigated in three groups; the normal control group, the predialysis group of chronic renal failure patients treated conservatively, and the hemodialysis group. The findings were analyzed for their relationship to hypercoagulability. Results: 1) The activities of plasma protein C, S and antithrombin-III were significantly lower in the predialysis chronic renal failure group as compared to the control. Antithrombin-III concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly lower than those of the control group. But, protein C antigen concentrations in the hemodialysis group assayed immediately prior to dialysis were significantly higher than those of the control group. There was no significant difference between these groups in plasma protein C activities, and plasma protein S activities and antigen concentrations. 2) In the hemodialysis group, antithrombin-III activities, antigen concentration and activities of plasma protein C were significantly higher than after dialysis as compared to those before the dialysis. 3) There were no significant difference in plasma protein C, S and antithrombin-III activities and plasma protein C and S antigen concentrations in hemodialysis patients between with and without thrombosis at arterio-venous fistula site. However, plasma protein C and antithrombin-III activities were significantly lower in those with thrombosis as compared to those of the normal control group. There were no significant difference in plasma protein C and S activities and antigen concentrations in those without thrombosis as compared to those of the normal control group. 4) There were no significant diffrences in plasma protein C, protein S and antithrombin-III activities and antigen concentrations in dialysis patients with and without recombinant erythropoietin treatment. 5) There were no significant correlations between serum creatinine and creatinine clearance, and plasma antithrombin-III, protein C and protein S activities and antigen concentrations in predialysis group. Conclusion : These results suggest that the decrease in plasma antithrombin-III, protein C and S could be the factors causing hypercoagulability in chronic renal failure patients, and the decreased activities of these factors may return to normal by dialysis. In the hemodialysis group, there were no significant diffrences in plasma protein C and S and antithrombin-III activities and antigen concentrations between the group which showed clinical thrombosis and the group which did not. However, in those who had thrombosis, plasma protein C and antithrombin-III activities are significantly lower than the control group. Administration of recombinant human erythropoietin does not appear to affect the activities of plasma protein C and S and antithrombin-III. In predialysis chronic renal failure patients, there was no significant relationship between renal function and plasma protein C and S and antithrombin-III.

원발성 경화성 담관염 ; 증례보고 및 국내문헌 고찰

서정건(Jung Kun Seo),정준표(Jun Pyo Chung),조현근(Hyeon Geun Cho),이귀순(Kwi Soon Lee),이관식(Kwan Sik Lee),전재윤(Chae Yoon Chon),강진경(Jin Kyung Kang),박인서(In Suh Park),김기황(Ki Whang Kim),김호근(Ho Geun Kim),이상인(Sang In Lee 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A We experienced a case of primary sclerosing cholangitis(PSC) in a 40-year-old female who complained of jaundice and pruritus. Marked elevation of serum alkaline phophatase level, typical beaded appearance and pruned-tree appearance on endoscopic retrograde cholangiography, together with a finding of chronic obliterative fibrosing cholangitis on sono-guided gun biopsy specimen of the liver led to a confirmative diagnosis of PSC. The patient responded to ursodeoxycholic acid (UDCA), but was reluctant to treatment and died of hepatic failure 7 months later. PSC is a very rare disease in Korea. So far, only 5 cases including our present case have been reported in the Korean literature. Male-to-female ratio was 2:3 and the median age was 40(27-80 years old). Ulcerative colitis was associated in one case. Four cases involved both intra, and extrahepatic bile ducts and one case was reported to be confined in the intrahepatic bile ducts. Fatality was in 3 cases, 20 days, 36 days, and 7 months after the initial presentaion, respectively. The causes of death were acute cholangitis and sepsis in two, and hepatic failure in one. We herein report a case of PSC and clinical charateristics of the reported cases in Korea, and review the literature with an emphasis on UDCA treatment in PSC.

Marshmallow를 이용한 식도조영술의 의의

서정건(Jung Kun Seo),박효진(Hyo Jin Park),김경철(Kyung Chul Kim),이귀순(Kwi Soon Lee),윤상욱(Sang Wook Yoon),전재윤(Chae Yoon Chon),김기황(Ki Whang Kim),박인서(In Suh Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: In the evaluation of esophageal symptoms, the endoscopy, conventional esophagography using liquid barium and esophageal manometry have been used for the detection of organic and functional esophageal diseases. But some questions were raised that these studies were not capable of reproducing the esophageal symptoms and the manometry was often not a confirmative test in all functional esophageal diseases. So, we performed an esophagography using the semisolid material, marshmallow, and evaluated its clinical usefulness in patients with func- tional esophageal diseases. Methods: We perfonned the endoscopy, conventional esophagography and marshmallow esophagography in 54 consecutive patients with esophageal symptoms(dysphagia, globus symptom and non-cardiac chest pain) and esophageal manometry in 21 patients among them, and compared with asymptomatic, healthy volunteers(n=9). Results: The marshmallow esophagography revealed abnormal hesitation and impaction in 15 patients(45%) with normal conventional esophagography(n=33) and in 4 patients(57%) with normal esophageal manometry studies(n=7). In contrast with these result, all of the conventional esophagography were normal in patients with normal marshmallow esophagography(n=17). In the reproducibility of symptoms, the dysphagia group was greater than another groups(p(0.05) and there was a trend towards a high reproducibility of symptoms in patients who showed the severe grade(p (0.05). The abnormal marshmallow esophagography was correlated with the abnormal peristalsis of conventional esopha- gography and nonspecific esophageal motility disorder of manometry(p(0.05). Conclusions: We found the marshmallow esophagography was rnore sensitive and capable of reproducing the sypmtoms than conventional liquid barium esophagography in the evaluation of the esophageal symptoms, and the marshmallow esophagography is thought to be valuable as one of diagnostic tools for esophageal motility disorders. (Korean J Gastroenterol 1996; 28:303-310)

가공화를 이용한 원예치료가 청소년의 에퍼시에 미치는 효과

김효정(Hyo Jeong KIm), 유양희(Yang Hee Yoo), 이귀순(Kwi Soon Lee), 김경희(Kyung Hee KIm), 양희승(Hee Seung Yang) 인간식물환경학회 2023 인간식물환경학회 학술대회 Vol.2023 No.1

정신과 폐쇄 병동 환경 평가에 영향을 미치는 임상변인 : 치료의 질적 향성을 위한 예비적 연구 The Preliminary Study for Promoting the Quality of Psychiatric Inpatient Treatment

서정석,류은정,이상미,한미희,최귀순,손인기,남범우 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-

Purpose: IS prelminary study was designed to assess the clinical variables influencing on the ward atmosphere in psychiatric closed ward and to promote the quality of psychiatric inpatient treatment. Method: 41 psychiatric inpatients were selected in Chung-ju hospital, Konkuk university. Ward Atmosphere Scale(W AS) was used to evaluate patients' perception of ward milieu. WAS score were compared among subgroups with respect to the clinical variables such as duration of admission, frequency of admission, and diagnosis. Results: Significantly, patients who have hospitalized for 1 month to 2 months reported lower score of WAS and patients who have hospitalized for longer than 2 months reported higher score of WAS. The relationship between educated levels and WAS score was not significant. First admitted patients reported significantly lower score of WAS. Bipolar patients reported significantly higher score of WAS and alcohol related patients reported significantly lower score of WAS. Conclusion: The 1st admitted patients, patients with alcohol problem and educated patients were had less satisfied with psychiatric closed ward. Thus, by considering these factors, more specified therapeutic approach and plan should be conducted.

식도직장으로 전이되어 직장 협착을 유발한 위암 1예 : 증례보고

이상인,박효진,김정환,박인서,이관식,이귀순,변기현 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.6

A 59-year old female was admitted to Yongdong Severance Hospital due to diarrhea and lower abdominal pain lasting for 2 months. She had a previous history of admission for stomach cancer on September 1995. At that time, she underwent total gastrectomy and gastroduodenostomy. The pathology of the specimen revealed a signet ring cell carcinoma of stomach. On admission, computerized tomography revealed rectal wall thickness and no evidence of lymph node enlargement in abdomen and pelvic cavity. Barium enema study showed stricture of rectum. After sigmoidoscopic biopsy, she was diagnosed as a rectal metastasis resulted in rectal stricture and underwent sigmoid loop colostomy. Hence we present a case of gastric cancer with rectal metastasis resulted in rectal stricture.

악성종양에 의한 속발성 식도이완불능증 3예

이상인,박효진,한재호,박인서,이귀순,오수환,김충배 대한소화기학회 1998 대한소화기학회지 Vol.32 No.2

Esophageal achalasia is characterized by failure of the lower esophageal sphincter to relax normally during swallowing and aperistaltic movement of the esophageal body. The characteristics of the secondary achalasia induced by malignancy are similar to tbose of the primary achalasia. So the failurc in recognizing the underlying tumor may delay the diagnosis and treatment of underlying tumor. We experienced three cases of the secondary achalasia induced by malignancy. Clinical features, findings of the esophagogram and esophageal manometry for them were consistent with those of the primary achalasia. We could differentiate the secondary achalasia from the primary achalasia using esophagogastroduodenoscopy and abdominal computed tomogram.

기능성 소화불량증 환자에서 Helicobacter pylori 의 유형에 따른 위 조직학적 소견 및 혈청 위펩티드 농도

이상인,박효진,김경철,박인서,이관식,이귀순,윤상애,정준근 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.1

Background/Aims: Clinical isolates of Helicobacter pylori(H. pylori) can be divided into at least two major types. Type I bacteria express VacA(vacuolating cytotoxin) and CagA(cytotoxin-associated antigen), type II bacteria do not exp~ress VacA or CagA. The purpose of this study is to evaluate the changes of gastric histology and serum level of gastric peptides(gastrin and pepsinogen) according to the bacteriological types in H. pylori infection. Methods: In patients with H. pylori-positive functional dyspepsia, we classified the type of infection serologically by detecting IgG antibodies to CagA and VacA. Each patient was also evaluated for the degree of gastric inflammation and serum concentrations of gastrin and pepsinogen(PG). IgG antibodies to these proteins and concentrations of gastrin and PG were detected by using a immuno-blot kit and a radioimmunoassay kit, respectively, from the sera of each patient. From endoscopically biopsied antral specimens, the degree of gastric inflammation was evaluated by scoring inflammatory changes. Results: 1) In 53 patients of functional dyspepsia, 38(72%) cases were H. pylori-positive. From 38 H. pylori-positive patients, it revealed that 16 cases(42%) were infected with type I bacteria(type I subgroup), 7 cases(18%) with type II bacteria(type II subgroup), and all the remaining 15 cases(40%) with CagA+/VacA- bacteria(type III subgroup). 2) The mean value of gastric inflammatory score was highest in type I subgroup, and then type III, type II subgroup and H. pylori-negative group, in decreasing order. The mean score of type I subgroup(5.79±1.37) was significantly higher than the scores from H. pylori-negative group(1.59±0.93, p$lt;0.001) or type II subgroup(4.00±0.90, p$lt;0.05). 3) The serum levels of gastrin were higher in H. pylori-positives than H. pylori-negatives, but there was no significant differences among H. pydori-positive subgroups. The serum levels of PG showed significant differences among H. pylori-positive subgroups. PG-I was significantly higher in type I subgroup(82.7±24.8 ng/ml), compared with type II subgroup(53.2±15.6ng/m1)(p$lt;0.01). PG-II was also significantly higher in type I subgroup (20.2±6.9 ng/ml), compared with type II(12.5±4.2 ng/ml) and type III subgroup(14.7 6.5 ng/ml)(p$lt;0.05). 4) Gastric inflammatory scores did not correlate with. serum levels of gastrin, but it correlated with serum levels of PG-I(r=0.4517, p $lt; 0.05) and PG-II(r=4546, p $lt; 0.05). Conclusions: We could observe that type I infection of H. pylori was associated with most severe gastric inflammation and increased serum levels of PG. Serologic typing of H. pylori infection can be a simple method to predict the severity of infection and may be useful in selecting subjects who need eradication therapy in patients with functional dyspepsia.

기능성 소화불량증 환자에서 미란성 유문전부 변화와 Helicobacter pylori 감염의 의미

이상인,박효진,이홍우,박인서,이귀순,오수환 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.4

Background/Aims: The etiology of funetional dyspepsia remains unknown, with inconclusive evidence for several factors, including abnormal gastroduodenal motility, personal traits, infection of Helicobactor pylori (H. pylori) and erosive prepyloric change (EPC). Therefore, we evaluated the relation between H. pylori or EPC and gastric emptying in patients with functional dyspepsia. Methods: We performed an ultrasonographic gastric emptying test in 18 patients with functional dyspepsia comparing 6 healthy volunteers as the control. The presence of BPC in the stomah was diagnosed by esophogogastroduodenoscopy, and the Helicobacter pylori infection was evaluated using a rapid urease test. Results: The erosive prepyloric change in the antrum was revealed in five patients with dyspepsia. Amang the EPC (+), EPC (-) with dyspepsia, and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. Among the H. pylori (+), H. pylori (-) patients with dyspepsia and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. Conclusions: No association was found between dyspeptic symtoms and the presence of H. pylori infection or EPC. The two factors, Helicobacter pylori infection and erosive prepyloric change, did not affect the gastric motility in functional dyspepsia.

서행성 만성 변비증 환자에서 위 배출능 평가

문윤재,박효진,이귀순,이상인,박인서,김기황 대한대장항문학회 1997 Annals of Coloproctolgy Vol.13 No.4