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      • 아스피린 유발성 천식환자에서 leukotriene C4 (LTC4) 합성효소 유전자 다형에 관한 연구

        한선애,홍천수,박해심,박중원,유세화,조재연,이상엽,인광호,김선신 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.4

        Background: Aspirin/NSAIDs can release cysteinyl-leukotriene (cys-LTs) into airways and precipitate asthmatic symptoms in aspirin-induced asthma(AIA). It has been reported that there is profound overexpression of LTC₄synthase in their bronchial mucosa, compared to aspirin-tolerant asthma. Objective : We observed whether genetic polymorphism of LTC₄synthase may be predisposed to LTC₄synthase overexpression in AIA. Subject and method: Forty-four AIA patients having positive responses on lysin aspirin bron choprovocation tests and 47 non-aspirin induced asthma (non-AIA) patients having negative challenges and 32 healthy controls were enrlled. The genotypes of the promoter LTC4 synthase gene (A,C transversion) were determined by polymerase chain reaction and restriction frag- ment length polymorphism (RFLP) method. Results : LTC₄ synthase promoter polymorphism (A444C btransversion) was not significantly dif-ferent between non-AIA and AIA patients (p 〉0.05). Conclusion These findings sugest that genetic polymorphism of LTC₄ synthase promoter may not be predisposed to LTC, synthase overexpression in AIA.

      • 기관지천식의 중증도에 따른 안지오테신 전환효서 유전자 다형에 관한 연구

        한선애,이신형,심재정,유세화,조재연,차대룡,이상엽,강세용,강경호,인광호 대한알레르기학회 1998 천식 및 알레르기 Vol.18 No.4

        Background: The angiotensin-converting enzyme (ACE) has a major role in the degradation of bradykinin, tachykinin, substance P which are associated with bronchial hyperresponsiveness and inflammation. The other role of ACE is the genesis of angiotensin II which causes bronchial smooth muscle contraction. The deletion polymorphism of ACE gene(DDtype) may be related to the high serum level of ACE. Objective: We studied to evaluate an association between the insertion /deletion polymorphism of the ACE gene and asthma, and its severity. Materials and methods: Sixty asthmatic patients and 44 healthy controls were enrolled. Severity of asthma was classified by the guideline of NHLBI/WHO workshop. The ACE genotypes of all the subjects were determined by polymerase chain reaction. Results: The distribution of ACE genotypes were not significantly different between healthy controls and asthma group (p)0.05). In asthmatic patients, the genetic polymorphism was similar between different severity groups (p) 0.05). Conchcsion: It is suggested that I/D polymorphism of the ACE gene may not be associated with development of asthma. The severity of asthma may not be influenced by I/D polymorphism of the ACE gene.

      • KCI등재후보

        Successful Treatment of Invasive Gastric Mucormycosis in a Kidney Transplant Recipient

        김형남,한선애,박하열,김현우,홍란,최남규,신민호,윤나라,김현리,정종훈,신병철 대한이식학회 2018 Korean Journal of Transplantation Vol.32 No.4

        Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.

      • KCI등재

        A Case of Methomyl-induced Acute Allergic Tubulointerstitial Nephritis

        김동현,한선애,김형남,신병철,박용진 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.4

        Drug-induced interstitial nephritis is one of the causes of acute kidney injury. Although methomyl is widely used as an insecticide in many countries, methomyl-induced interstitial nephritis has not been reported thus far in the general population. We report a case of a 39-year-old male patient with acute allergic tubulointerstitial nephritis due to methomyl intoxication. He took methomyl 250 mL to commit suicide. He was treated with hemodialysis, but his renal function continued to deteriorate. Kidney biopsy demonstrated mononuclear cell and some eosinophils infiltration into the renal interstitium with tubular invasion. Immediate steroid pulse therapy, appropriate education, and conservative management resulted in gradual restoration of his renal function. This case suggests that methomyl may be a causative allergen inducing acute interstitial nephritis in some patients.

      • 위암에서 E-cadherin과 $\beta-catenin$ 발현과 유전자 돌연변이에 관한 연구

        김광일,박성혜,한선애,채양석,김인선,Kim Kwang Il,Park Sung-Hye,Han Sun-Ae,Chae Yang-Seok,Kim Insun 대한위암학회 2001 대한위암학회지 Vol.1 No.4

        Purpose: When cancer cels invade the stroma, they should be dissociated from the adjacent cells at first. E-cadherin and $\beta-catenin$ constitute an important protein complex associated with cellular adhesion, development, and differentiation, especially in epithelial cells. The role of E-cadherin and $\beta-catenin$ in gastric carcinogenesis were studied. Materials and Methods: The expression of E-cadherin and $\beta-catenin$ in gastric adenocarcinomas by using immunohistochemical staining and the mutation by using polymerase chain reaction- single stranded conformation polymorphism (PCR-SSCP) and sequencing were performed in 40 adenocarcinomas and 5 dysplasia of stomach. Thirteen cases, which had lymph node metastasis, were also included for immunohistochemical staining. Results: Inappropriate cytoplasmic and/or nuclear expression of a E-cadherin-$\beta-catenin$ complex was more frequent in poorly differentiated, diffuse type signet ring cell carcinomas than in well-differentiated, intestinal type adenocarcinomas (P<0.05). However, the expression was not related with clinical stage or lymph node metastasis. Mutation of E-cadherin was detected in 4 cases by using PCR-SSCP, whereas mutation of $\beta-catenin$ was detected in 2 cases. Conclusion: E-cadherin and $\beta-catenin$ seem to be important in gastric carcinogenesis, especially in poorly differentiated diffuse type.

      • KCI등재

        호스피스 병동에서 시행되는 말기 암 환자의 DNR (Do-Not-Resuscitate) 동의

        심병용,홍석인,박진민,조홍주,옥종선,김선영,한선애,이옥경,김훈교,Shim, Byoung-Yong,Hong, Seok-In,Park, Jin-Min,Cho, Hong-Joo,Ok, Jong-Sun,Kim, Seon-Young,Han, Sun-Ae,Lee, Ok-Kyung,Kim, Hoon-Kyo 한국호스피스완화의료학회 2004 한국호스피스.완화의료학회지 Vol.7 No.2

        배경: 보편적으로 호스피스 병동에서 말기 암 환자에 있어서, DNR 동의가 흔하게 취득되고 있다. 그러나 말기 암 환자에 대한 현황과 실태 분석에 관한 국내 연구는 아직 드문 현실이다. 최근 저자 등은 보호자가 DNR 동의를 거부하여 심폐소생술 후 인공호흡기 치료를 시행하여 2개월 간 중환자실에서 치료 후 사망한 환자를 경험하면서 지금 까지 진행된 DNR 동의의 현 실태와 앞으로 시행될 DNR 동의의 보완점을 마련하기 위해 본 연구를 시작하였다. 방법: 2003년 1월부터 6월까지 6개월 동안 성빈센트병원 호스피스 병동에 입원한 말기 암 환자 60명을 대상으로 후향적으로 의무기록과 DNR 동의서를 조사하였다. 대상 환자들의 나이, 성별,진단명, DNR 동의 시간, 사망까지의 시간, DNR 동의에 참여한 보호자, DNR 결정 당시 환자 상태, 사망장소, DNR 결정 당시의 치료와 DNR 결정 전후 치료의 변화 등을 조사하였다. 치료 단계는 3단계로 분류하였다. 결과: 중앙 연령은 66세($31{\sim}93$세) 였고 남자가 31명, 여자가 29명이었다. 폐암 12명, 위암 12명, 담낭암 및 담도암 7명, 대장암 6명, 췌장암 4명, 기타 19명이었다. DNR 동의서에 서명한 사람은 아들이 22명, 배우자가 19명, 딸이 16명, 기타가 3명이었다. 이 중 환자가 DNR 동의서에 동의한 경우는 한 명도 없었다. 60명 중 30명이 입원 시에, 30명은 입원 기간 중에 DNR 동의서에 서명하였다. 입원 기간 중에는 증상의 악화 19명, 활력 증후 변화 4명, 다기관 기능부전 3명, 기타 상태 4명 등으로 DNR이 결정 되었다. DNR 동의 후 사망까지의 시간은 13명이 5일 이내에 사망하였다. 사망 장소는 60명 중 한 명을 제외하고는 모두 본원이었다. DNR이 시행되었을 당시 치료 단계는 2명을 제외하고 1단계였고 2단계와 3단계가 각각 1명씩이었다. 결론: 환자의 존엄성과 권리라는 측면에서 DNR 동의의 환자 참여가 국내에서도 신중하게 고려되어야 하겠다. 또 이를 위해 DNR 동의의 의미, 경과, 동의 철회 등의 사항이 포함된 문서화된 동의서에 의해서 환자와 보호자에게 설명되어야 하겠다. Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

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