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정상범위의 간기능검사치를 갖는 만성 B 형간염 보유자에서 간조직검사와 혈청 4 형 콜라겐치의 비교
송명준(Myung Jun Song),김경곤(Kyoung Gon Kim),신요식(Yo Sig Shin),황남철(Nam Cheol Hwang),박상준(Sang Joon Park),김윤권(Yun Kwon Kim),김소연(So Yon Kim),김영중(Young Jung Kim),조민구(Min Koo Cho),이권전(Gwon Jun Lee) 대한내과학회 2002 대한내과학회지 Vol.63 No.1
목적 : 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자에서 조직학적인 판단을 할 때 경피적인 간생검이 주로 사용되고 있다. 그러나 간생검은 침습적이며 검체 채취상의 오차 및 환자의 거부감에 따른 반복시행의 어려움이 있다. 최근 간 섬유화의 정도와 혈청 Ⅳ형 콜라겐치의 연관성이 있음이 알려짐에 따라 저자들은 간생검의 결과와 혈청 Ⅳ형 콜라겐치의 관계를 연구함으로써 조직소견을 예측하고 감별함에 있어 임상적으로 유용한지 알아보고자 하였다. 대상 및 방법: 임상적인 증상이 없는 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자 31명의 전투경찰을 대상으로 간생검을 시행하여 병리조직학적 소견에 따라 3개의 군으로 분류하였고 각각은 병리학회에서 제안한 기준에 의거하였다. 간생검 당일 아침에 혈액을 채취한 후 Ⅳ형 콜라겐치 (정상치:5 ng/mL 이하)를 측정하여 조직소견과의 관계를 분석하였다. 결과: 총 31예의 대상환자 중 조직소견이 정상인 A군 13명 (41.9%), 섬유화는 없으면서 조직학적 이상이 있는 B군 11명 (35.5%), 섬유화가 있는 C군 7명 (22.6%)이었다. 혈청 Ⅳ형 콜라겐치는 A군에서 3.53±0.57 ng/mL, B군에서 3.56±1.17 ng/mL, C군에서 3.99±0.88 ng/mL이었고, 각 군간에 수치의 상승이 있었으나 유의하게 높지는 않았다 (p>0.05). 조직학적 이상이 보인 경우는 18명 (Group B and C)으로 평균 collagen수치는 3.73±1.06 ng/mL이었고, 섬유화가 없는 경우는 24명 (Group A and B)으로 평균 collagen수치는 3.55±0.88 ng/mL이었고, 각각 A군과 C군과 비교하여 유의성이 없었다 (p>0.05). 결론: 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자의 경우 조직학적 변화를 알고자 할 때 조직학적인 변화에 따라 Ⅳ형 콜라겐치의 상승은 있으나 유의성이 없어 조직소견을 대변할 수는 없으며 간생검이 가장 유용한 검사라고 생각된다. Background: We compared the results of liver biopsy and the levels of serum type Ⅳ collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type Ⅳ collagen in predicting the progression of histopathological findings. Methods: Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type Ⅳcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. Results: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type Ⅳ collagen levels of Group A, B and C were 3.53±0.57 ng/mL, 3.56±1.17 ng/mL and 3.97±0.88 ng/mL, respectively. The average of serum type Ⅳ collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p>0.05). The averages of serum type Ⅳ collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73±1.06 ng/mL and 3.55±0.88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p>0.05). Conclusion: In chronic hepatitis B carriers with normal LFT findings, levels of serum type Ⅳ collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.(Korean J Med 63:29-35, 2002)
활동성폐결핵 환자의 치료에 따른 67Gallium 폐주사의 음전시기의 의의 ( 제 2 보 )
이숭구(Sung Ku Lee),이윤하(Yoon Ha Lee),김진곤(Jin Gon Kim),서대원(Dae Won Soe),장태종(Tae Jong Jang),김윤권(Yun Kwon Kim),김소연(So Yon Kim),박병익(Byong Yik Park),이권전(Gwon Jun Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.2
N/A Objectives: In the treatment of active pulmonary tuberculosis, it is difficult to determine when the active tuberculosis has became inactive. (67)Gallium lung scan is known to be useful in the diagnosis of active pulmonary tuberculosis. The grade of Galliumuptake, the time of loss of uptake and the relation to the stability of tuberculous lesion in the chest radiograph were followed to define the possibility of making early decision when active pulmonary tuberculosis became inactive Metheds: In 31 patients with active pulmonary tuberculosis, (67)Galliurn lung scan and chest radiograph were followed serially from June 1991 to October 1993. (67)Gallium lung scan and chest radiograph were followed serially from June 1991 to October 1993, (67)Gallium lung scan was performed 48 hours after intravenous injection of 3mCi of (67)Gallium citrate and classified into 4 grades according to the degree of up- take. Results: 1) In patients with active pulmonary tuberculosis, the grade of Gallium uptake in lung scan was proportional to the severity of lesion in chest radiograph. 2) The degree of (67)Gallium uptake in serial lung scan waned progressively while antituberculous chemotherapy was continued, and showed in loss of uptake in 83% of patients within 6 months of therapy 3) The loss of (67)Gallium uptake was observed simultaneously in most patients as the lesion in chest radiograph became stable. In 81% of patients, the interval between the time of loss of (67)Gallium uptake and Radiologic stabilization was less than one month. Conclusion : While antituberculous chemotherapy was given, the serial (67)Gallium lung scan might be useful in determining the activity of tuberculous lung lesion and in making earlier decision than chest radiograph. Conclusively, we consider Gallium lung scan as a valuable measure in assessing the effectiveness of antituberculous treatment.
횡문근융해증으로 인한 급성신부전증의 핍뇨기에서 발생한 중증 고칼슘혈증
임수진 ( Im Su Jin ),이승희 ( Lee Seung Hui ),문창기 ( Mun Chang Gi ),정준오 ( Jeong Jun O ),박상준 ( Park Sang Jun ),김윤권 ( Kim Yun Gwon ),김소연 ( Kim So Yeon ),김영중 ( Kim Yeong Jung ),조민구 ( Jo Min Gu ),이권전 ( Lee Gwon 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.6
Hypercalcemia rarely develops in patients with acute renal failure associated with rhabdomyolysis. If hypercalcemia occurs, it happens mostly in diuretic phase and rarely in oliguric phase. Secondary hyperparathyroidism, abnormal metabolism of Vitamin D, immobilization of patient, and release of calcium from injured muscle are considered as possible pathogenetic mechanisms of hypercalcemia in acute renal failure associated with rhabdomyolysis. Among them, dissoultion of calcium from injured muscle into extracellular fluid is accepted as the major mechanism of pathogenesis of hypercalcemia. A twenty year old male patient, combat policeman, developed syncope in the course of regular physical training. He was diagnosed of acute renal failure associated with rhabdomyolysis at the hospital he initially visited. After being subjected to three sessions of acute hemodialysis, he was transferred to our hospital. During the treatment, laboratory test was performed upon his continuous complaints of lower extremity weakness. It showed severe hypercalcemia with plasma calcium level of 17.3 mg/dL. He was in oliguric phase at the time of this severe hypercalcemia. Patient`s lower extremity weakness was gradually improved by hemodialysis using low calcium dialysate. He was discharged after his renal function became normal. He has been followed on regular basis. (Korean J Nephrol 2003;22(6):731-735)
간 스캔상 공간점유병소의 소견을 보인 Budd-Chiari 증후군
이정해,이윤하,서대원,장태종,황인섭,김영중,김소연,이권전 ( Jeong Hae Lee,Youn Ha Lee,Dae Won Seo,Tae Jong Jang,In Shup Hwang,Young Jung Kim,So Yon Kim,Gwon Jun Lee ) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3
A twenty-one-year old man visited our hospital due to abdominal distension for a month. On the physical examination, there was severe abdominal distension with fluctuation and shifting dullness. The routine laboratory results were within normal range. On the Magnetic Resonace angiography, there wasnt any blood flow within the right and middle hepatic vein. So we concluded that the etiologic disease was Budd Chiari syndrome. On the Iiver scan, there was cold area(absence of radiouptake) on entire right lobe of the liver, increased uptake on the bone marrow and showed spienomegaly. This finding was similar to the liver mass occupying right lobe with underlying chronic liver disease. On the previous reports, it is quite uncommon finding that Budd-Chirari syndrome shows lesion like space occupying one on the liver scan. So we report this case with a review of the lit.erature.