Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

Nitric Oxide에 의한 난소 과립세포의 Apoptosis 조절에 대한 연구

강한승,이석자,김외리,이채관,신창숙,김성태,강성구 인제대학교기초과학연구소 1998 자연과학 Vol.2 No.-

여포의 퇴화가 진행되는 기작에서 apoptotic cell death 와 nitric oxide (NO)의 연관성에 관하여 실험하였다. 난소의 apoptosis는 GnRH에 의해 유도되고 스테로이드에 의해 억제된다. 여포에서 과립 세포의 apoptosis에 대한 호르몬의 영향과 NO 생산효과를 조사하기 위하여 중간크기 (직경 5-6 ㎜)의 여포에서 non-apoptotic 과립세포를 분리하여 스테로이드, GnRH agonist, GNRH agonist+SNP, 그리고 NO 공여체인 SNP를 처리하여 24시간동안 배양하였다. 배양된 과립세포에서 게놈 DNA를 추출하여 apoptotic DNA절편화 경향을 알아보았고, 배양액과 griess reagent를 반응시켜 nitrite 농도를 측정하였다. 스테로이드 호르몬을 처리하였을 때, 대조군에 비해 NO 생성이 다소 증가하였으며 apoptotic DNA 절편화도 억제되었다. GnRH agonist 처리군에서는 apoptotic DNA 절편화가 가속화 양상을 나타내었으며 NO 생성은 다소 감소하였다. 그러나 GnRH agonist+SNP 그리고 SNP 처리군에서는 apoptotic DNA 퇴화가 억제되었으며 NO 농도는 대조군에 비해 현저히 높았다. 위의 실험 결과로 보아 과립세포 분화와 여포성숙과 퇴화과정에서 호르몬과 NO가 밀접한 관련이 있는 것으로 사료된다. To study the regulation of porcine follicular cell apoptosis by steroids, GnRH agonist and nitric oxide, we have analyzed DNA fragmentation, the hallmark of apoptosis, and nitrite production in porcine granulosa cells. In, ovarian apoptosis is induced by GnRH but is prevented by steroids. Apoptosis is confined to the granulosa cells but it was not clear whether apoptosis of granulosa cell was regulated by NO in vitro. So non-apoptotic granulosa cells isolated, grown at 37℃, for 24 hrs, and treated with / without SNP, GnRH agonist, and sterioid, respectively. In cultured granulosa cells were used to extract genomic DNA and culture media was assayed for nitrite concentration. Nitrite production of culture media was increased and apoptotic DNA fragmentation was supressed in SNP treated groups, GnRH agonist+SNP, and estrogen, progesterone. Nitrite concentration in culture media was decreased and apoptotic DNA was induced treated with GnRH agonist. These data suggest that NO production and apoptosis may be involved of granulosa cell differentiation and ovarian follicular atresia by SNP, estrogen and progesterone. Moreover, NO can overcome the granulosa cell apoptosis induced by GnRH agonist.

저장 온도 및 상대습도가 비타민 정제 중 지용성 비타민 함량의 변화에 미치는 영향

김동섭,이재황,김세곤,이동언,박석준,이진희,이강표,최성원,백무열 경희대학교식량자원개발연구소 2007 硏究論文集 Vol.26 No.1

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

The Safety and Efficacy of Daclatasvir and Asunaprevir with Chronic HCV Genotype 1 Infection and Hemodialysis

( Myeong Jun Song ),( Jung Hyun Kwon ),( Soon Woo Nam ),( Tae Hee Lee ),( Young Woo Kang ),( Ji Woong Jang ),( Seok Hyun Kim ),( Byung Seok Lee5 ),( Sea Hwan Lee ),( Hong Soo Kim ),( Ji Hoon Kim ),( S 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: We aimed to evaluate the efficacy and safety of Daclatasvir (DAV) and Asunaprevir (ASV) in patients with chronic hepatitis C virus (HCV) and chronic renal failure (CRF). Methods: 22 chronic hemodialysis patients with HCV infection at 12 medical centers have prospectively enrolled from Feb, 2016 to Feb, 2017 (NCT02580474). Of those, 9 patients who were followed 12 weeks after treatment ended were included. We evaluated the virological responses at each week 4, 12, 24 and the 12-week sustained virologic response (SVR12). The tolerability and safety of patients were also evaluated. Results: Of these 20 patients, there had no resistance-associated variant of NS5A (NS5A RAVs) and 2 patients showed indeterminate NS5A RAVs. 12 patients (54.5%) completed the 24 weeks treatment of DAV and ASV. 6 patients (27.2%) have continued, but 4 patients discontinued study prior to 12 weeks. Overall, all patients (n=9) achieved SVR12. Virologic response at week 4, 12 and 24 showed 94.4% (17/18), 93.3% (14/15), and 100% (12/12) respectively. DCV and ASV were well tolerated among the majority of patients and discontinuation of the treatment due to adverse events (hypertension, bradycardia, leukemia) was occurred in 3 patients. In two patients with indeterminate NS5A RAVs, one achieved SVR12 but the other showed viral breakthrough and discontinued treatment. Conclusions: In this study, DAV and ASV combination therapy for chronic hemodialysis patients with HCV infection achieved high sustained virological response with few adverse events. Close monitoring of safety and tolerability may be necessary when treating chronic hepatitis C patients with CRF receiving DCV and ASV.

Equisetum arvense L.이 고혈당 쥐의 혈중 포도당 농도에 미치는 영향

이현자,김석환,손기호,강우규,최종원 慶星大學校 環境問題硏究所 1992 環境硏報 Vol.2 No.1

The effect of methanol extract of Equisetum arvense L.(EM) on blood glucose level in streptozotocin-induced diabetic rat and acute toxicity of EM were investigated. Male Sprague-Dawley rats(200∼250g), with free access to commercial rat chow and water, were divided into four groups: Group 1 served as control; Group 2 received STZ only: Group 3 received EM only; Group 4 received pretreatment with EM followed by STZ administration. EM did not affect the normal blood glucose level and LD50 was about 6,250㎎/㎏. EM pretreatment in STZ-induced diabetic rats slightly inhibited Weight loss and water consumption. EM pretreatment in STZ-induced diabetic rats slightly inhibited the rise of serum glucose concentration. Serum transaminase(AST, ALT) and sorbitol dehydrogenase(SDH) were slightly increased by STZ induced changes in the serum glucose level.

랜덤하중스펙트럼하에서 AL 2024-T3 합금판재의 균열진전에 관한 연구

강기경,황영진,이석순 경상대학교 생산기술연구소 2000 生産技術硏究所論文集 Vol.16 No.-

Damage Tolerance Design Concept lessens defects and damages when a aircraft is manufactured and operated. And it make back up plane before the critical crack size using quantitative analysis of the residual defect size, fatigue crack propagation. So residual strength of a structure in damage tolerance range should be proved using analysis and test for endurance of design maximum load. A aircraft are exposed to the various load conditions such as thrust, gravity, lift and so on at the same time. The complicated load condition is the random load rather than the constant amplitude load. In this study, the experimental resu1ts and the theoretical values of residual strength and crack growth rate using the fatigue test for aluminum alloy plates usually being used for the aircraft skin under random load have been compared and considered.

소규모지역에서의 지가 및 인구 분포 특성에 관한 연구 : 부산광역시 북구를 대상으로

이성호,조병렬,강석효 釜山大學校 都市問題硏究所 2003 都市硏究報 Vol.15 No.-

It is important to inquiry into the characteristics of several features which are components of a city in studying. However, it was impossible to analyze the existing inquiries in micro because of the limitation of information. Especially, there were not any examples in small scale area and it was very hard to guess the characteristics of the area using the existing information and systems. I presented micro analysis method in small scale area. It was based on not only the production method of land cost and the density of population using GIS is more advanced than existing, but also compared analysis of each feathers through the Grid analysis.