식도정맥류환자에서의 (食道靜脈瘤患者) 식도운동에 (食道運動) 관한 연구

김정용(Chung Young Kim),송인성(In Sung Song),최규완(Kyoo Wan Choi),정영화(Young Hwa Chung),이영상(Yung Sang Lee),전형식(Hyung Sik Jun) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.2

N/A Esophageal motility was studied in 14 control cases and 14 cases with esophageal varix, using low compliance pneumohydraulic capillary infusion system. 1) There was no difference in lower esophageal sphincter pressure between control and varix group (20.0+-l8.3mmHg and 19.8+- 5.7mmHg, respectively), but low esophageal peristaltic pressures were decr eased in varix group (51.0+-34.1mmHg) comparing with those in control group. (76.4+-16.4mmHg) (p<0. 05). The decrease of low esophageal peristaltic presure in varix group had no relation with varix grade or age distribution. 2) The lower esophageal peristaltic pressures were increased significantly after metoclopropamide administration in control (from 76.4+-16.4mmHg to 101.2+-21.6mmHg) and varix group (from 51.0+-34.1mmHg to 70.1>38.6mmHg), but the change of lower esophageal sphincter pressure was not significant.

갑상선기능항진증의 간소엽중심부 간세포손상의 진단적 평가를 위한 isocitrate dehydrogenase 활성도 측정

최원범(Won Bum Choi),정영화(Young Hwa Chung),정성애(Sung Ae Jung),송병철(Byung Cheol Song),김정아(Jeong A Kim),김정원(Jung Weon Kim),송일한(Il Han Song),장우영(Woo Young Chang),송영기(Young Kee Shong),이영상(Yung Sang Lee),서동진(Don 대한내과학회 2000 대한내과학회지 Vol.58 No.2

N/A Background : The zonal differentiation of hepatic necrosis is important in the aspect of treatment, follow-up and prognosis of patients. The purpose of this study was evaluating the clinical usefulness of serum isocitrate dehydrogenase (ICDH) as a marker of centrilobular hepatic necrosis in patients with hyperthyroidism. Methods : We determined the serum ICDH and alanine aminotransferase (ALT) activities in 56 patients with hyperthyroidism, 16 patients with chronic viral hepatitis, and 17 normal controls. Results : The activities of serum ICDH were significantly higher in patients with hyperthyroidism than those of patients with chronic viral hepatitis or normal control (p<0.01), even though those of serum ALT were higher in patients with chronic viral hepatitis (p<0.01). The ratio of serum ICDH and ALT activities were markedly different between the patients with hyperthyroidism and chronic viral hepatitis (p<0.001). There was a significant correlation between the serum ICDH and ALT activities in patients with hyperthyroidism as well as in those with chronic viral hepatitis (p<0.05). In patients with hyperthyroidism, the serum ICDH levels were more significantly correlated with serum triiodothyronine (T3) than thyroxine (T4) levels. In a patients with hyperthyroidism and elevated ALT levels, the serum ICDH activity decreased progressively and was normalized ultimately, as serum ALT level and thyroid function were normalized with antithyroid medication. Conclusion : The serum ICDH or ratio of serum ICDH and ALT activities might be useful clinically in differentiating the centrilobular from periportal hepatic necrosis, and following up the degree of hepatic necrosis in patients with hyperthyroidism.(Korean J Med 58:189-196, 2000)

원발성 항인지질 항체 중후군을 동반한 Budd - Chiari 중후군의 임상상 및 혈관조영상 특성

김경아(Kyoung Ah Kim),정영화(Young Hwa Chung),서동완(Dong Wan Seo),김선희(Seon Hee Kim),추윤호(Yun Ho Chu),고정민(Jeong Min Kho),유빈(Bin Yoo),박철민(Cheol Min Park),성규보(Kyu Bo Sung),이영상(Yung Sang Lee),서동진(Dong Jin Suh) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: Many patients with Budd-Chiari syndrome have no evident etiological factor especially in Asian countries. And various obstructive patterns of inferior vena cava and hepatic veins have been reported suggesting several different causes may be involved. Recently primary antiphospholipid antibody syndrome has been described as a characteristic clinical entity with multiple thromboembolic episodes and typical laboratory features such as serum antiphospholipid antibody, not being associated with any collagen vascular disease. To evaluate the etiological role of primary antiphospholipid antibody syndrome in Budd-Chiari syndrome and clarify the clinical features of Budd-Chiari syndrome patients with primary antiphospholipid antibody syndrome, we analyzed clinical and angiographic. data of 27 consecutive patients with Budd-Chiari syndrome (Age: 47±12 years, M: F=13:14). Methods: We analyzed clinical manifestations and angiographic characteristics of 4 Budd-Chiari syndrome patients with primary antiphospholipid antibody syndrome, comparing to those of 23 without it. Results: Underlying etiological factors were identified only in 6(22%); 4(15%) were associated with primary antiphospholipid antibody syndrome. Most of patients with Budd-Chiari syndrome showed superficial abdominal collaterals, ascites, symmetrical lower leg edema and hepatosplenomegaly with laboratory features of liver cirrhosis, regardless the association of primary antiphospholipid antibody syndrome. However, only out of 4 with primary antiphospholipid antibody syndrome, 2 had asymmetrical lower leg edema with ulcer; 2 complained of unexplained long-standing dry cough, 1 of intermittent fever. In both with lower leg ulcer, thrombotic obstructions of deep veins were identified. Another one with primary antiphospholipid antibody syndrome was proved to have pulmonary hypertension without definite vascular obstruction. All of 4 patients(100%) with primary antiphospholipid antibody syndrome in contrast to only 8 out of 23(35%) without it showed broad obstruction of inferior vena cava and all three hepatic veins(Sugiura type II; p<0.05). Conclusion: These data suggested that primary antiphospholipid antibody syndrome is one of common etiological factors in patients with Budd-Chiari syndrome, and that especially in Hudd-Chiari syndrome patients who present asymmetrical lower leg edema with ulcer, long-standing dry cough, unexplained fever, pulmonary hypertension of unknown cause or broad obstruction of inferior vena cava, the possibility of association with primary antiphospholipid antibody syndrome should be considered.

주문맥침범이나 원격전이가 있는 간세포암 환자에서 Cisplatin 간동맥투여 및 전신적 알파인터페론 병합요법의 효과

송일한(Il Han Song),정영화(Young Hwa Chung),고문수(Moon Soo Koh),이영상(Yung Sang Lee),이문규(Mun Gyu Lee),성규보(Kyu Bo Sung),오용호(Yong Ho Aoh),서동진(Dong Jin Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

N/A Objectives: Hepatocellular cearcinoma(HCC) patients presenting with vascular involvement or extrahepatic metastasis are usually contraindicated to surgery or chemoebolization, and median survival of those has been reported to be only a few weeks. Recent several studies suggested that certain chemotherapeutic agent or recombinant interferonalpha(rIFN-α) may be useful in a proportion of patients with inoperable HCC. Methods: To evaluate the effect of intraarterial cisplatin infusion and systemic rlFN-α in the treatment of HCC, 68 HCC patients with major portal vein thrombosis or distant metastasis were randomized to three groups: group A(n=19) treated with cisplatin and rIFN-α, group B(n-23) with cisplatin and group C(n=26) with supportive care only. Cisplatin of 2mg/kg body weight was infused transarterially every 8weeks and rIFN-α of 3×10(6) IU/m2 Bady Surface area was administered subcutaneously three times per week. Patients with severe hepatic decompensation(serum bilirubin>3.0 mg/dL, albumin<3.0g/L, prothrombin time<60%), hypersplenism(peripoheral WBC count <3,000/mm3, platelet count<40,000/mm3), uncontrolled ascites, active gastrointerstinal bleeding, cardiac or renal dysfunction were excluded in this study. The effects of therapy were assessed by the changes of tumor size and durations of survival. Results: The partial response rate assessed by the change of tumor size in group A was significantly higher than that in group B(33 vs 14%: p<0.05). 1 year survival rate of group A (27%) was also significantly higher than that of group B (9%) or C (0%) (p<0.05, p<0.01, respectively). Furthermore, median survival period of group A (19weeks) was significantly longer than that of group B(11weeks) or C(5weeks) (p<0.05, p<0.01, resectively). Side effects of combined therapy were flu-like symptoms, gastrointestinal upset, transient elevation of serum creatinine or ALT level, leukopenia, thrombocytopenia, and oral ulcer. However, these were transient and well tolerated by all of the patients. Conclusion. These data suggest that combined therapy of intraarterial cisplatin infusion and systemic rIFN-α administration may be useful in the treatment of HCC patients with major portal vein thrombosis or distant metastasis, in terms of tumor response or prolonging survival period.

항결핵약제에 의한 간독성에 대한 임상적 연구

윤용범(Yong Bum Yoon),정영화(Young Hwa Chung),이영상(Yung Sang Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A On the 44 patients who was admitted and diagnosed as toxic hepatitis due to antituberculous agents, the clinical details were reviewed. The results were summerised as following: 1) Male to female ratio was 1:1, and mean age was 34.7. They took at least two or more kinds of hepatotoxic agents, so that one definite cause of hepatotoxicity conldn't be determined. 2) Typical symproms of hypersensitivity such as fever, skin rash or lymphadenopathy were found only 2 patients, and eosionophilia above 500/㎣ was demonstrated in 28.6% of the patients. 3) 18 patients, 4.9% of total, showed severe hepatotoxicity that serum bilirubin was above 2.0 mg %, and 45.5% of the patients had mild hepatotoxicity that serum transaminase levels were belew the fivefolds of the normal range. 4) Severe jaundice, acute renal fai1ure, fever and lymphadenopathy were noted in two patients and were thonght as hepatotoxicity due to intermittent use of rifampin. 5) Readministrations of isoniazid and rifampin were successful in 81.3% and 86.7% of the patients respectively, but 71.4% of retrials of pyrazinamide were failed. No clinical differences were recognized between success and failure groups, but the frequency of eosinophilia was higher in failure group. 6) No differences between icteric and anicteric groups were noted in age, sex, used drugs, past history of drug use, the response to the readministration of the dnigs and frequency of eosinophilia, but the duration of treatment in icteric group was much prolonged in comparison with anicteric group.

만성 B형 간염을 동반한 간경변증 환자에서 라미부딘 요법의 효과 및 안전성

양수현(Soo Hyun Yang),정영화(Young Hwa Chung),정성애(Sung Ae Jung),정석원(Suk Won Jung),송병철(Byung Cheol Song),장우영(Woo Young Chang),이상수(Sang Soo Lee),이한주(Han Chu Lee),이영상(Yung Sang Lee),서동진(Dong Jin Suh) 대한내과학회 2001 대한내과학회지 Vol.60 No.2

N/A Background : Lamivudine has been reported to be effective and safe in the treatment of chronic hepatitis B. However, in patients with advanced liver cirrhosis (LC) who have less hepatic reserve function and so higher chances of serious complications, its outcomes remained to be clarified. We evaluated the effectiveness and safety of lamivudine in patients with LC caused by hepatitis B. Methods : Twenty four patients with HBV-associated LC who had clinical evidence of hepatic dysfunction (Child-Pugh Class A:B:C = 13:7:4) as well as 76 patients with biopsy-proven chronic hepatitis B (CH) as controls were administered with 150 mg of lamivudine orally everyday for at least more than 6 months. Serum HBeAg and HBV-DNA (liquid phase hybridization assay) as well as CBC, prothrombin time and biochemistry were tested sequentially during the follow-up period. Results : All patients in both groups became negative for HBV-DNA in their sera during the treatment. Five out of 24 LC (21%) and 33 (43%) of 76 CH patients were relapsed within the follow-up periods of median 19 and 22 months, respectively (p=0.42). HBeAg seroconversion was observed in 7 of 19 LC (37%) and 25 of 69 CH (36%) patients with positive HBeAg (p=0.52). The hemoglobin, white blood cell and platelet counts were not changed significantly in both groups during the follow-up periods. The prothrombin time, serum cholesterol and bilirubin levels were also not changed significantly during the treatment. All of 76 CH patients had not presented any fatal complication during the follow-up periods. In contrast, 3 out of 4 LC patients in Child-Pugh class C died of serious complications (1 out of 5 relapsers, 2 of 19 persistent responders, p=NS; 1 died of sepsis, 2 of variceal bleeding). Conclusion : Lamivudine therapy may be as effective in patients with LC as in those with CH in terms of the clearance of serum HBV-DNA and the seroconversion of HBeAg. Our data also suggest that the lamivudine therapy is as safe even in decompensated LC as in CH.(Korean J Med 60:131-138, 2001)

급성 B형 간염의 회복 후 말초혈액 단핵구에서의 HBV DNA 검출

명승재(Seung Jae Myung),이영상(Yung Sang Lee),김형건(Hyung Gun Kim),이근찬(Geun Chan Lee),박능화(Neung Hwa Park),정영화(Young Hwa Chung),서동진(Dong Jin Suh) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Background/Aims: Negative seroconversion of HBsAg with the appearance of anti-HBs and normalization of serum transarninase level have been generally accepted as an evidence of a cure of hepatitis B, and viral clearance. However, there are growing evidences that the hepatitis B virus (HBV) genome persists after those events. HBV DNA could be detected from the serum, peripheral blood mononuclear cells (PBMC) and liver tissue by sensitive PCR method, even when HBsAg is undetectable from the serum during the course of chronic hepatitis B. The aim of this study is to demonstrate whether HBV might persist in the circulation after complete serologic and clinical recovery from acute hepatitis and its clinical manifestations implications. Methods: We tried to detect HBV DNA from the serum and PBMC of 24 healthy individuals (male 16, female 8) with a history of self-limited acute hepatitis B infection using the PCR-Southern hybridization. Results: The mean duration from the onset of acute hepatitis to the time of sampling was 19+11 months, and HBV DNA was undetectable from sera of the individuals with PCR and Southern hybridization. HBV PCR was performed after the separation of PBMC and DNA isulation. HBV DNA was amplifiable in 4 of 24 individuals (17%). By Southem hybridization, HBV DNA was confirmed in 4 positive samples. The duration from the onset of acute hepatitis to the sarnpling time in positive group was 7.0 3.2 montks, and was significantly shorter than DNA negative counterpart (21.5 10.5 months)(p<0.01). Conclusions: Hepatitis B virus DNA can persist in peripheral blood mononuclear cells after resolution of acute hepatitis, and it may persist only for a certain period after clearance of virus in the serurn. The role of HBV DNA in PBMC should be elucidated in the future. (Korean J Gastroenterol 1997; 29:74-84)

내시경적 역행성 췌담관 조영술의 합병증으로 발생한 전격성 담관염

민영일(Young Il Min),김명환(Myung Hwan Kim),이철환(Cheol Whan Lee),정영화(Yung hwa Chung) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

ERCP has gained wide acceptance as a valuable tool for the diagnosis and management of disease of the pancreas and biliary tract. Although cornplications with this procedure are few, infection has been reported to be a major cause of morbidity and mortality. We have cared for one patient with secondary sclerosing cholangitis who had experienced fulminant cholangitis after ERCP in resolving phase of acute pancreatitis. Because of the high mortality rate from septic complications of EFCP it is necessary to administer prophylactic antibiotics and avoid inducing excessively increased bile duct pressure during the procedure and provide effective biliary drainage after procedure.

치료 후 광범위하게 조기 재발한 간세포암종 비수술적 치료 후 광범위하게 조기 재발을 보인 간세포암종

장명국 ( Myoung Kuk Jang ),이한주 ( Han Chu Lee ),임영석 ( Young Suk Lim ),정영화 ( Young Hwa Chung ),이영상 ( Yung Sang Lee ),서동진 ( Dong Jin Suh ) 대한간암학회 2004 대한간암학회지 Vol.4 No.-

간경변증 환자에서 Lupus anticoagulant 및 Anti-cardiolipin antibody의 양성율

김홍자(Hing Ja Kim),이성순(Sung Soon Lee),최승목(Sung Mok Choi),김석균(Suk Gyun Kim),정영화(Young Hwa Chung),이영상(Yung Sang Lee),서동진(Dong Jin Suh),서을주(El Ju Suh),지현숙(Hyun Sook Chi) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Anti-phospholipid antibody syndrome(APS) is clinical syndrome of venous and arterial thrombosis, recurrent fetal losses and thrombo-cytopenia, which are associated with lupus anticoagulant(LA) and/or anti-cardiolipin antibody(aCL). There are some repors about the prevalence of LA and aCL in liver cirrhotics, but enough data are not available in Korean literature, and the menaing of positiveness of t4ese antibodies has been elusive. So, to know the prevalence and clinical meaning of these antibodies in liver cirrhotics in Korea, this study was performed. Methods: Ninety-one patients with liver cirrhosis requiring admission were randomly selected. LA was tested by combination of LA-aPTT, kaolin clotting time and platelet neutrali- zation method, and aCL by ELISA using Imu]yse ACA kit. Clinical data including etiology and severity of liver disease were analysed. Results: Positive rates of LA and aCL were ]6.5% (15/91) and 34.1%(31/91), respectively. 5 out of 91 (5.5%) patients had both anribodies. There were no corre]ations between the positivity of LA and aCL and age,sex, and etiology of liver disease, but the chance to have severe li ier disease (Child class C) was higher in LA positive patients than negative patients(10/15, 66.7% vs 23/76, 30.3%, p=0.001). 5 out of 41 (12.2%) positive cases seemed to have symptoms and signs of possible APS. 4 out of 41(9.8%) had possible primary illnesses other than liver cirrhosis. Conclusions: About one third of cirrhotics requiring admission and treatment had LA and/or aCL, but only few of positive patients were likely to be symptomatic. Severe liver disease(Child class C) could be a risk factor for LA positivity. (Korean J Gastroenterol 1996; 28:669-676)