간세포암종 환자에서 간동맥색전술후 혈청 Angiogenin , bFGF 및 EGF의 상승

이숭환(Soong Hwan Lee),조용현(Yong Hyeon Jo),김병훈(Byoung Hun Kim),김홍주(Hong Ju Kim),이창화(Chang Hwa Lee),이재영(Jae Young Lee),남승우(Seung Woo Nam),백인규(In Kyu Paik),박찬현(Chan Hyun Park),이동후(Dong Hoo Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: Angiogenesis, the induction of the formation of blood vessels, is critical to the development, progression, and metastasis of animal and human tumors. Tumor cells may produce factors which either induce or inhibit angiogenesis and that the onset of angiogenic activity is determined by the balance of these factors may be generalizable to other tumors. Hepatocellular carcinoma is hypervascular tumor and transcatheter arterial embolization(TAE) is widely used to treat patients with unresectable hepatocellular carcinoma. To evaluate changes of angiogenic factors after TAE for hepatocellular carcinoma, we investigated serum angiogenin, bFGF and EGF at the pre-TAE and the post-TAE among the seven patients with hepatocelluar carcinoma. Methods: Angiogenin, bFGF and EGF concentrations in sera were measured at pre-TAE and 3 days after TAE by employing ELISA. The statistical analysis was evaluated by Student's t-test. Results: 1) Angiogenin concentration at pre-TAE and post-TAE was 197.57+28.82ng/ml(mean+standard error) and 225.89>32.06ng/ml, respectively(p=0.022). 2) bFGF concentration at pre-TAE and post-TAE was 6.71+1.83 pg/ml and 21.68+5.58 pg/ml, respectively(p=0.036). 3) EGF concentra- tion at pre-TAE and post-TAE was 195.09+40.29 pg/rnl and 258.11+36.12 pg/ml, respectively (p=0.014). No correlation, however, was present among angiogenin, bFGF, and EGF at both of pre-TAE and post-TAE state. Conclusions: These results indicate that certain angiogenic factors, such as angiogenin, bFGF, EGF, were increased significantly at post-TAE in comparison to pre- TAE, which may reduce the therapeutic effect of TAE for hepatocellular carcinoma. We suggested that the tissue injury/destruction associated with ischemia by hepatic artery embolization are generally considered to represent a fundamental stimulus for angiogenesis in post-TAE. Therefore, suppression of angiogenesis at post-TAE may be important in improving survival for the patients with hepatocellular carcinoma since tumor growth and metastasis are angiogenesis-dependent. (Korean J Gastroenterol 1996; 28:391 - 401)

만성 B형 간염 바이러스 표면항원 보유자의 징병검사 기준에 대한 고찰

이숭환 ( Soong Hwan Lee ),배종엽 ( Jong Yub Bae ),안병철 ( Byeong Cheol Ahn ),배순철 ( Soon Chul Bae ),정경섭 ( Kyung Sup Chung ),손정일 ( Jeong Il Son ),나현재 ( Hyun Jae Na ) 국군의무사령부 2000 대한군진의학학술지 Vol.31 No.1

대량 출혈을 동반한 공장의 Dieulafoy 병변 1 예

이항락(Hang Lak Lee),윤병철(Byung Chul Yoon),변태준(Tae Jun Byun),한호(Ho Han),전운현(Woon Hyun Jun),박준용(Joon Yong Park),이숭환(Soong Hwan Lee),은창수(Chang Soo Eun),이오영(Oh Young Lee),전용철(Yong Chul Jun),한동수(Dong Soo Han) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. However, it is clinically important in that it can be associated with recurrent and massive gastrointestinal bleeding. The bleeding results from an abnormal large submucosal artery. On endoscopy, a small mucosal defect with a protruding vessel or fresh clot may be visualized if the patient is actively bleeding. In most cases, the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, but similar lesions have been described in the antrum, duodenum, colon, and rectum. In particular, jejunal Dieulafoy's lesion is extremely rare. We experienced one case of recurrent and massive bleeding from a proximal jejunal Dieulafoy's lesion, which was confirmed by the pathologic examination of the resected specimen. (Korean J Gastroenterol 2002;39:123-127)

HBV - bDNA 음성 만성 B 형 간염 바이러스 보유자의 간조직검사 소견과 임상적 특징

노병주(Byung Joo Roh),이숭환(Soong Hwan Lee),한성희(Sung Hee Han),조승철(Seung Chul Cho),손주현(Joo Hyun Sohn),이동후(Dong Hoo Lee),기춘석(Choon Suhk Kee) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.6

Background/Aims: It is common in Korea that young men carry HBV-bDNA (branched chain DNA) negative chronic HBsAg, regardless of abnormal aminotransferases. However, histologic findings of these patients were not well-known. The authors studied histologic characteristics of hepatitis activity in these patients and assessed the correlations of aminotransferases and the histologic characteristices of hepatitis activity/fibrosis. Methods: Routine biochemical liver function tests were performed for the 29 young male HBV-bDNA negative chronic HBsAg carriers. Their histologic hepatitis activity/fibrosis was scored. Results: Ninety percent of the patients showed chronic inflammation at liver biopsy, whereas 80% of the parents who had normal aminotransferase showed chronic inflammatory feature in spite of their HBV-bDNA negativity. A significant correlation was found between the levels of aminotransferases and histologic hepatitis activity (lobular activity and portoperiportal activity). The patients with abnormal aminotransferase revealed the higher grade activity than the patients with normal aminotransferase in lobular activity and portoperiportal activity. Conclusions: Most of young male HBV-bDNA negative chronic HBsAg carriers show the histologic characteristics of chronic hepatitis. Some patients could be recovered, but others may show viral replication during their clinical course. (Korean J Gastroenterol 2001;38:419-426)

만성간질환에서의 혈청 procollagen 1/3 propeptides 농도비 측정의 의의

유용걸(Yong Keol Yoo),이숭환(Soong Hwan Lee),김병훈(Byoung Hun Kim),조영중(Young Jung Cho),백인규(In Kyu Paik),유병무(Byeong Moo Yoo),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),최호순(Ho Soon Choi),이동후(Dong Ho 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Most of Ihe chronic liver diseases of variable etiologies are accompanied by a pathobiochemical reaction So-called fibrosis. Liver fibrosis was recently recognized as all the complexity of dynamic changes of the hepatic extracellular matrix(ECM). And ECM consists of four major components: collagen, glycoprotein such as fibronectin and laminin, proteoglycan, and elastin. Among these, collagen I and III are the representatives of disproportion of synthesis and degradation in conjunction with fibrogenesis. To elucidate the clinical significance of procollagen propeptide I(PICP) and III(PIIINP) measurements among the sera out of patients with chronic liver diseases, radioimmunoassay 4vas employed in this investigation. Methods: Sera tested were obtained from pathologically-proven 54 patients; 4 cases of fatty liver, 11 cases of chronic persistent hepatitis, 13 cases df chronic active hepatitis, 15 cases of liver cirrhosis and 11 cases of hepatocellular carcinoma. All:the patients except 4 cases of fatty liver were shown positivity of HBsAg. PICP and PIIINP radioimmunoassay kits(Farmos Diagnostica, Oulunsalo, Finland)were purchased for this study. ResOlts: PICP concentration (mean+standard error) was highest in liver cirrhosis (280.06>39,83 pg/L). PICP in liver cirrhosis was significantly elevated in cornparison to that (109.30+14.58) in fatty:liver(p=0.045), that (122.22>10.26) in chronic persistent hepatitis (p=0.003), and that (158.59>21.58) in chronic active hepatitis(p=0.016), PICP in hepatocellular carcinoma was decreased to 1'94.05+ 29.89. Similarly, PIIINP concentration revealed highest level in liver cirrhosis(17.29+3.58 pg/L). This value was significantly higher than that of chronic persistent hepatitis(5.12+0.59)(p=0.008). Contrarily to these results, concentration ratio of PICP/PIIINP was high in fatty liver (29.27>6.29) and chronic persistent hepatitis (25.04+2.00), These value were statistically higher than that of chronic active hepatitis (17.632.67) (p=0.043). PICP/PIIINP ratio in liver cirrhosis (21.58+3.29) showed no statistical difference. Conclusions: On the basis of these data, it is suggested that the elevation of PICP and PIIINP in the sera of the patients with chronic liver diseases means emerging the liver cirrhosis. And the ratio of these markers can be helpful in differential diagnosis of chronic liver diseases. (Korean J Gastroenterol 1996; 28:815-823)

만성 실질성 간질환 환자 혈청에서 Basic Fibroblast Growth Factor 및 Angiogenin 농도의 변동

백인규(In Kyu Paik),이숭환(Soong Hwan Lee),조윤주(Yun Ju Cho),이성희(Sung Hee Lee),김홍주(Hong Ju Kim),남승우(Seung Woo Nam),고희관(Hee Kwan Koh),이창범(Chang Beom Lee),박동일(Dong Il Park),조영중(Yong Jung Cho) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Liver fibrosis by the progression of the chronic process of the liver disease induces deformed microcirculations of the hepatic lobules and this eventually resulted in portal hypertension. Angiogenic stimulant factors are physiologically activated in order to repair the tissue damage. Overexpression of angiogenic factors, however, can stimulate neovascularization as in a formation of the hypervascular tumor that liberates uncontrolled overgrowing of the tumor cells. To elucidate the dynamic changes of the serum concentration of basic fibroblast growth factor(bFGF) and angiogenin in chronic liver diseases, this study is intended to employ an ELISA out of pathologically proven patients. Methods: Sera taken out of the 44 patients with chronic persistent hepatitis(5 cases), chronic active hepatitis(6 cases), liver cirrhosis(19 cases) and hepatocellular carcinoma(14 cases) were tested for bFGF and angiogenin employing Quantikine' ELISA Kits (R & D Systems Inc. Minneapolis, MN) that pathological diagnosis was proven )ater. The statistical analysis was evaluated by students t-test. Results: Serum mean value and standar<I error of bFGF concentration(pg/ml) was 11.851.98 in 19 cases of liver cirrhosis, 9.86+2.35 in 14 cases of hepatocellular carcinoma, 9.48+4.57 in 6 cases of chronic active hepatitis, and 8.29+2.63 in 5 cases of chronic persistent hepatitis. Mean value and standard error of angiogenin concentration (ng/ml) of the sera was 238.92+50.95 in 5 cases of chronic persistent hepatitis, 184.47+12.75 in 6 cases of chronic active bepatitis, 131.36+10.99 in 19 cases of liver cirrhosis, and 211.03+19.08 in 14 cases of hepatocellular carcinoma, respectively. Serum angiogenin concentration in liver cirrhosis was significantly lower than that in chronic persistent hepatitis(p=0.0033(I), and than that in chronic active hepatitis(p=0.018673). Angiogenin concentration in hepatocellular carcinoma was very significantly elevated, when compared with the level of the liver cirrhosis investigated (p=0.000569). Conclusions: These data suppoit that persistent inflammatory insults in chronic hepatitis were compensated by the elevation of angiogenin, but complete fibrosis as in liver cirrhosis showed the depressed level of angiogenin. Again, emerging of the hepatocellular carcinoma is accompanying with the elevated stitnuli of angiogenin for the neovascularization. In contrast, bFGF in this study was statistically not significant but may be related with fibrosis and reconstruction of microvascular system accompanying with progression of chronic parenchymal liver diseases to liver cirrhosis.(Korean J Gastroenterol 1996; 28:806-814)

궤양성 대장염 환자와 혈액투석 환자 및 정상대조군의 다면적 인성검사 ( MMPI ) 특성 비교

김홍주(Hong Joo Kim),조영중(Young Joong Cho),이숭환(Soong Hwan Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),김호중(Ho Joong Kim),박경남(Kyung Nam Park),조연규(Yun Gyoo Cho) 대한내과학회 1998 대한내과학회지 Vol.54 No.2

N/A Objectives: For many years, inflammatory bowel disease has been thought to have a strong psychosomatic component, but recent prospective studies show no evidence of correlation between various psychologic factors and the disease activity. However, chronic renal disease still places unique stresses on the hemodialysis patients, with consequent emotional reactions. The aims of this study are to investigate the psychologic factors of ulcerative colitis and hemodialysis patients using MMPI scales, which are objective psychological test, thus give aid to psychological understanding of these patients. Methods: We investigated 23 ulcerative colitis patients in remission followed at outpatient department of Hanyang University Hospital and 35 patients receiving hemodialysis between June, 1994 and August, 1995. Twenty students were selected for normal control group. We utilized T-score of each MMPI scale for analyzing characteristics of each group and regard T-score over 70 or below 40 as abnormal. Results: The average T-scores of each MMPI scale in ulcerative colitis, hemodialysis patients 8r normal control group were within normal range between 40 and 70, except for T-score of Es scale in hemodialysis patient group(34.5). The results of comparison between each MMPI scale of two patients & normal control group were as follows. 1) L scale was significantly elevated in ulcerative colitis & hemodialysis patients group compared with that of normal control group. F scale was significantly elevated in hemodialysis patients compared with that of ulcerative colitis patients & normal control group (p<0.01). 2) Hs(p<0.01), D, Pt(p<0.05) and Sc(p<0.01) scales were significantly elevated in hemodialysis patients compared with those of ulcerative colitis patients normal control group. 3) Es scale was significantly lower in hemodialysis patients compared with that of ulcerative colitis patients & normal control group(p<0.01). Conclusion: The result presented in this study reflects emotional disturbances, functional impairment, stressful life condition, excessive hypochondriacal thinking, depressed mood and egocentrie tendency of hemodialysis patients campared with ulcerative colitis patients & normal control group. This result also reflects the projective tendency, hostility, difficulty in rapport formation, psychologic disturbance, obssesive and rigid personality, anxiety and retiredness of hemodialysis patients compared with ulcerative colitis patients & normal control group. On the other hand, we can't find any statistically significant differences between ulcerative colitis and normal control group.

증례 : 급성 췌장염 환자에서 복강동맥 협착과 동반하여 발생한 비장경색의 1예

김진건 ( Jin Gun Kim ),임동혁 ( Dong Hyuck Lim ),한봉준 ( Bong Jun Han ),표승일 ( Seung Il Pyo ),이숭환 ( Soong Hwan Lee ),김인숙 ( In Sook Kim ),전의용 ( Eui Yong Jeon ) 대한내과학회 2006 대한내과학회지 Vol.71 No.2

비장경색이 급성 췌장염의 합병증으로 발생된 보고는 드물며, 아직까지 복강동맥 협착과 연관되어 비장경색이 발생된 보고는 없다. 췌장염에서 비장 경색의 발생은 비장 혈관의 혈전에 의한 폐색에 의한 것으로 알려졌다. 그러나 급성 췌장염(특히 두부) 환자에서 비장색을 동반한 경우 가능한 원인으로 복강동맥 협착을 고려해 봐야 할 것이다. 본 증례에서 비장경색의 기전으로 협착후방 확장부의 혈전 형성, 혹은 췌장 두부 동맥으로부터 비장 동맥으로의 비정상적 역류에 의한 것으로 생각된다. 저자들은 급성 췌장염의 병력을 가진 환자에서 혈관조영 술상 발견된 무증상 복강동맥 협착이 비장경색과 연관 되는 1예를 경험하였기에 보고하는 바이다. Prevalence of splenic infarction developed during acute pancreatitis is extremely rare. However, we recently experienced a case of 42-year-old woman who developed splenic infarction during acute alcoholic pancreatitis. There were sustained subjective symptoms and no resolution of image despite of conservative management, so we performed angiography to confirm whether vascular lesion existed or not. We found the significant celiac artery stenosis due to compression by median arcuate ligament and no visible thrombus. We report an unusual case of splenic infarction developed during acute recurrent pancreatitis possibly related with celiac artery stenosis.(Korean J Med 71:198-202, 2006)

만성 간질환 환자에서 혈소판감소증과 혈청 Thrombopoietin 의 관계

조용균(Yong Kyun Cho),김병익(Byung Ik Kim),구은실(Eun Sil Koo),김시영(Si Young Kim),김창섭(Chang Seop Kim),박창영(Chang Young Park),손정일(Chong Il Sohn),전우규(Woo Kyu Jeon),정을순(Eul Soon Jung),이숭환(Soong Hwan Lee),이동후(Dong H 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Background/Aims: The major origin of thrombocytopenia in liver cirrhosis is attributed to enlarged spleen. In order to determine the influence of thromboprotein (TPO) on the origin of thrombocytopenia in liver disease, we measured serum TPO levels in patients with chronic liver diseases. Methods: The study included 18 controls, 26 patients with chronic viral hepatitis, 35 patients with viral liver cirrhosis, and 28 patients with alcoholic liver cirrhosis. We determined their serum thrombopoietin levels by ELISA. Results: The TPO levels of patients with chronic viral hepatitis (147.9 ± 40.9 pg/mL) was significantly higher than those in patients with viral cirrhosis (95.9 ± 50.0 pg/mL), alcoholic cirrhosis (100.8 ± 43.5 pg/mL) or controls (108.1 ± 41.7 pg/mL). In the patients with viral and alcoholic liver cirrhosis, TPO showed a significant positive relationship with prothrombin time (ρ=0.4315, p=0.011 vs ρ=0.4171, p=0.030) and albumin (ρ=0.4939, p=0.003 vs ρ=0.4852, p=0.010). However, TPO levels had a significant inverse relationship with Child-Pugh score (ρ=-0.6151, p=0.000 vs ρ=-0.4658, p=0.014). Conclusion: Serum TPO levels were elevated in patients with chronic viral hepatitis by compensatory mechanism. Along with hypersplenism, low TPO production may play a role in the development of thrombocytopenia in patients with liver cirrhosis, but further studies are needed. (Korean J Gastroenterol 2002;39:108-113)

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.