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.

진성 복압성 요실금 환자에서 복강경하 방광경부현수술의 유용성: 타술식과의 비교 연구

김용태,엄민식,이석영,신관희,서정원,윤석중,이상철,김원재 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 진성 복압성 요실금의 치료법으로서 복강경을 이용한 Burch 수술을 타수술법과 비교하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 진성 복압성 요실금을 주소로 본원 비뇨기과에서 수술을 시행받은 44명의 환자를 수술법별로 분류하여 수술법에 따른 성공률, 수술 시간, 입원 기간 및 합병증의 빈도를 비교 분석 하였다. 결과: 전체 환자에서 수술 성공률은 86.4% 였으며 이들 중 복강경을 이용한 Burch 수술군에서는 성공률이 100% 이었다. 복강경을 이용한 Burch 수술군은 타수술군에 비하여 입원 기간이 짧았다. 복강경을 이용한 Burch 수술군은 합병증이 매우 경미하였으며 전체 환자의 31.8%에서 단기간의 배뇨곤란을 호소하였으나 장기간의 배뇨곤란은 없었으며 슬링 수술군에서는 3례(16.7%)에서 심한 절박성 요실금을 호소하였다. 결론: 복강경을 이용한 Burch 수술은 높은 치료 성공률과 낮은 합병증의 빈도를 나타내어 진성 복압성 요실금의 치료에서 매우 우수한 수술법으로 사료된다. Purpose: We performed this study to investigate the usefulness of laparoscopic Burch colposuspension as a treatment of genuine stress incontinence compare to other anti-incontinence operation. Materials and Methods : We analyzed success rate, operation time, admission day, and complication rate of various anti-incontinence operations in 44 genuine stress incontinence patients who have been received operation in our hospital. Results : Overall success rate was 86.4%, but laparoscopic Burch coposuspension showed 100% success rate. Laparoscopic Burch colposuspension required shorter admission day compared to other anti-incontinence oparations. Complication rate was lower in laparoscopic Burch colposuspension group. Short-term voiding problems were identified in 31.8% of total patients but 3 patients(16.7%) who have received sling operation complained severe urge incontinence. Conclusion : Laparoscopic Burch colposuspension is considered as an effective surgical method for genuine stress incontinence due to high success rate and low complication rate.

정향 수침액에 의한 아나필락시의 억제 효과

신태용,김상현,이석봉,엄동옥,임종필,이은희,김형민 우석대학교 의약품개발연구소 1996 藥學硏究誌 Vol.1 No.-

The current study evaluates the capacity of Caryophylli Flos water extract(CFWE) to regulate immediate allergic reaction by control of histamine release. CFWE was found to exhibit a ingibitory activity on the compound 48/80-induced anaphylaxis. CFWE inhibited the serum histamine release induced in anaphylaxis by compound 48/80. CFWE was also showed a dose-depent activity on the conpound 40/80-induced histamine release from the highly purified population of Alcian Blue-positive peritoneal mast cells. This result suggest that CFWE may be useful for the prevention and treatment of allergy related disease.

Kudzu Leaf Extract Suppresses the Production of Inducible Nitric Oxide Synthase, Cyclooxygenase-2, Tumor Necrosis Factor-Alpha, and Interleukin-6 via Inhibition of JNK, TBK1 and STAT1 in Inflammatory Macrophages

Eom, Seok Hyun,Jin, So-Jung,Jeong, Hee-Yeong,Song, Youngju,Lim, You Jin,Kim, Jong-In,Lee, Youn-Hyung,Kang, Hee MDPI 2018 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.19 No.5

<P>Kudzu (<I>Pueraria montana</I> var. <I>lobata</I> (Willd.) Sanjappa & Pradeep) is a perennial leguminous vine, and its root and flower have been used for herbal medicine in Asia for a long time. Most dietary flavonoids are reported to be concentrated in its root, not in its aerial parts including leaves. In this study, we investigated whether kudzu leaf and its major constituent, robinin (kaempferol-3-<I>O</I>-robinoside-7-<I>O</I>-rhanmoside) possessed anti-inflammatory activity. To test this hypothesis, we used peritoneal macrophages isolated from BALB/c mice and stimulated the cells with lipopolysaccharide (LPS) or LPS plus interferon (IFN)-γ. Compared with kudzu root extract, its leaf extract was more potent in inhibiting the production of inducible nitric oxide synthase (iNOS), cyclooxygenase-2, tumor necrosis factor-α, and interleukin-6. Kudzu leaf extract decreased LPS-induced activation of c-Jun N-terminal kinase (JNK) and TANK-binding kinase 1(TBK1) with no effects on nuclear factor-κB and activator protein 1 transcriptional activity. Also, kudzu leaf extract inhibited LPS/IFN-γ-induced signal transducer and activator of transcription 1 (STAT1) activation partly via an altered level of STAT1 expression. Robinin, being present in 0.46% of dry weight of leaf extract, but almost undetected in the root, decreased iNOS protein involving modulation of JNK and STAT1 activation. However, robinin showed no impact on other inflammatory markers. Our data provide evidence that kudzu leaf is an excellent food source of as yet unknown anti-inflammatory constituents.</P>

Effect of rainfall events on soil carbon flux in mountain pastures

Jeong, Seok-Hee,Eom, Ji-Young,Lee, Jae-ho,Lee, Jae-Seok The Ecological Society of Korea 2017 Journal of Ecology and Environment Vol.41 No.11

Background: Large-scale land-use change is being caused by various socioeconomic problems. Land-use change is necessarily accompanied by changes in the regional carbon balance in terrestrial ecosystems and affects climate change. Therefore, it is crucial to understand the correlation between environmental factors altered by land-use change and the carbon balance. To address this issue, we studied the characteristics of soil carbon flux and soil moisture content related to rainfall events in mountain pastures converted from deciduous forest in Korea. Results: The average soil moisture contents (SMC) during the study period were 23.1% in the soil respiration (SR) plot and 25.2% in the heterotrophic respiration (HR) plot. The average SMC was increased to 2.1 and 1.1% in the SR and HR plots after rainfall events, respectively. In addition, saturated water content was 29.36% in this grassland. The soil water content was saturated under the consistent rainfall of more than $5mm\;h^{-1}$ rather than short-term heavy rainfall event. The average SR was increased to 28.4% after a rainfall event, but the average HR was decreased to 70. 1%. The correlation between soil carbon flux rates and rainfall was lower than other environmental factors. The correlation between SMC and soil carbon flux rates was low. However, HR exhibited a tendency to be decreased when SMC was 24.5%. In addition, the correlation between soil temperature and respiration rate was significant. Conclusions: In a mountain pasture ecosystem, rainfall induced the important change of soil moisture content related to respiration in soil. SR and HR were very sensitive to change of SMC in soil surface layer about 0-10-cm depth. SR was increased by elevation of SMC due to a rainfall event, and the result was assumed from maintaining moderate soil moisture content for respiration in microorganism and plant root. However, HR was decreased in long-time saturated condition of soil moisture content. Root has obviously contributed to high respiration in heavy rainfall, but it was affected to quick depression in respiration under low rainfall. The difference of SMC due to rainfall event was causative of a highly fluctuated soil respiration rate in the same soil temperature condition. Therefore, rainfall factor or SMC are to be considered in predicting the soil carbon flux of grassland ecosystems for future climate change.

Characteristics of accumulated soil carbon and soil respiration in temperate deciduous forest and alpine pastureland

Jeong, Seok-Hee,Eom, Ji-Young,Park, Ju-Yeon,Lee, Jae-Ho,Lee, Jae-Seok The Ecological Society of Korea 2018 Journal of Ecology and Environment Vol.42 No.1

Background: For various reasons such as agricultural and economical purposes, land-use changes are rapidly increasing not only in Korea but also in the world, leading to shifts in the characteristics of local carbon cycle. Therefore, in order to understand the large-scale ecosystem carbon cycle, it is necessary first to understand vegetation on this local scale. As a result, it is essential to comprehend change of the carbon balance attributed by the land-use changes. In this study, we attempt to understand accumulated soil carbon (ASC) and soil respiration (Rs) related to carbon cycle in two ecosystems, artificially turned forest into pastureland from forest and a native deciduous temperate forest, resulted from different land-use in the same area. Results: Rs were shown typical seasonal changes in the alpine pastureland (AP) and temperate deciduous forest (TDF). The annual average Rs was $160.5mg\;CO_2\;m^{-2}h^{-1}$ in the AP, but it was $405.1mg\;CO_2\;m^{-2}h^{-1}$ in the TDF, indicating that the Rs in the AP was lower about 54% than that in the TDF. Also, ASC in the AP was $124.49Mg\;C\;ha^{-1}$ from litter layer to 30-cm soil depth. The ASC was about $88.9Mg\;C\;ha^{-1}$, and it was 71.5% of that of the AP. The temperature factors in the AP was high about $4^{\circ}C$ on average compared to the TDF. In AP, it was observed high amount of sunlight entering near the soil surface which is related to high soil temperature is due to low canopy structure. This tendency is due to the smaller emission of organic carbon that is accumulated in the soil, which means a higher ASC in the AP compared to the TDF. Conclusions: The artificial transformation of natural ecosystems into different ecosystems is proceeding widely in the world as well as Korea. The change in land-use type is caused to make the different characteristics of carbon cycle and storage in same region. For evaluating and predicting the carbon cycle in the vegetation modified by the human activity, it is necessary to understand the carbon cycle and storage characteristics of natural ecosystems and converted ecosystems. In this study, we studied the characteristics of ecosystem carbon cycle using different forms in the same region. The land-use changes from a TDF to AP leads to changes in dominant vegetation. Removal of canopy increased light and temperature conditions and slightly decreased SMC during the growing season. Also, land-use change led to an increase of ASC and decrease of Rs in AP. In terms of ecosystem carbon sequestration, AP showed a greater amount of carbon stored in the soil due to sustained supply of above-ground liters and lower degradation rate (soil respiration) than TDF in the high mountains. This shows that TDF and AP do not have much difference in terms of storage and circulation of carbon because the amount of carbon in the forest biomass is stored in the soil in the AP.

전환기의 통신시장 효율화를 위한 정보통신정책의 고찰

박석희 ( Seok Hee Park ),엄석진 ( Seok Jin Eom ) 한국정책학회 2006 韓國政策學會報 Vol.15 No.2

Effect of precipitation on soil respiration in a temperate broad-leaved forest

Jeong, Seok-Hee,Eom, Ji-Young,Park, Joo-Yeon,Chun, Jung-Hwa,Lee, Jae-Seok The Ecological Society of Korea 2018 Journal of Ecology and Environment Vol.42 No.6

Background: For understanding and evaluating a more realistic and accurate assessment of ecosystem carbon balance related with environmental change or difference, it is necessary to analyze the various interrelationships between soil respiration and environmental factors. However, the soil temperature is mainly used for gap filling and estimation of soil respiration (Rs) under environmental change. Under the fact that changes in precipitation patterns due to climate change are expected, the effects of soil moisture content (SMC) on soil respiration have not been well studied relative to soil temperature. In this study, we attempt to analyze relationship between precipitation and soil respiration in temperate deciduous broad-leaved forest for 2 years in Gwangneung. Results: The average soil temperature (Ts) measured at a depth of 5 cm during the full study period was $12.0^{\circ}C$. The minimum value for monthly Ts was $-0.4^{\circ}C$ in February 2015 and $2.0^{\circ}C$ in January 2016. The maximum monthly Ts was $23.6^{\circ}C$ in August in both years. In 2015, annual precipitation was 823.4 mm and it was 1003.8 mm in 2016. The amount of precipitation increased by 21.9% in 2016 compared to 2015, but in 2015, it rained for 8 days more than in 2016. In 2015, the pattern of low precipitation was continuously shown, and there was a long dry period as well as a period of concentrated precipitation in 2016. 473.7 mm of precipitation, which accounted for about 51.8% of the precipitation during study period, was concentrated during summer (June to August) in 2016. The maximum values of daily Rs in both years were observed on the day when precipitation of 20 mm or more. From this, the maximum Rs value in 2015 was $784.3mg\;CO_2\;m^{-2}\;h^{-1}$ in July when 26.8 mm of daily precipitation was measured. The maximum was $913.6mg\;CO_2\;m^{-2}\;h^{-1}$ in August in 2016, when 23.8 mm of daily precipitation was measured. Rs on a rainy day was 1.5~1.6 times higher than it without precipitation. Consequently, the annual Rs in 2016 was about 12% higher than it was in 2015. It was shown a result of a 14% increase in summer precipitation from 2015. Conclusions: In this study, it was concluded that the precipitation pattern has a great effect on soil respiration. We confirmed that short-term but intense precipitation suppressed soil respiration due to a rapid increase in soil moisture, while sustained and adequate precipitation activated Rs. In especially, it is very important role on Rs in potential activating period such as summer high temperature season. Therefore, the accuracy of the calculated values by functional equation can be improved by considering the precipitation in addition to the soil temperature applied as the main factor for long-term prediction of soil respiration. In addition to this, we believe that the accuracy can be further improved by introducing an estimation equation based on seasonal temperature and soil moisture.

조기 위암에서 근위부 위절제술과 위 전절제술의 비교

김은미 ( Eun Mi Kim ),정현용 ( Hyun Yong Jeong ),이엄석 ( Eom Seok Lee ),문희석 ( Hee Seok Moon ),성재규 ( Jae Kyu Sung ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),노승무 ( Seung Moo Noh ),송규상 ( Kyung Sang Song ),신경 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Background/Aims: The purpose of this study was to evaluate clinical outcome of proximal and total gastrectomy regarding reflux esophagitis, nutritional state, and anemia in early gastric cancer. Methods: 94 patients with early gastric cancer were included from January 2001 to January 2007 at Chungnam National University Hospital. Of whom 40 patients (31 men and 9 woman) had proximal gastrectomy (PG) and 54 patients (44 men and 10 woman) had total gastrectomy (TG). We reviewed all their medical and surgical record with surveying for gastrointestinal symptoms and reflux symptoms over the phone. Results: There were no significant differences between basic, surgical, and histopathologic characteristics. Bile reflux symptoms and heart burn symptoms were more common and severe in the TG group. The incidences of endoscopically detected reflux esophagitis were about 60% in the TG group and about 30% in the PG group. The hemoglobin levels were significantly higher in the PG group after the operation and were gradually decreased in the TG as the time went. The levels of laboratory variables such as total protein, albumin, and total cholesterol were lower in the TG group than in the PG group after the operation. However, stoma stricture after operation developed in the PG group more often than in the TG group, and esophageal balloon dilatations were performed more frequently in the PG group. Conclusions: PG is favorable for proximal early gastric cancer in terms of reduced reflux esophagitis, anemia, and malnutrition except the stricture at esophagogastrostomy site. (Korean J Gastroenterol 2009;54:212-219)

비혈연간 조혈모세포이식 후 발생한 횡문근 융해증 1예

엄기성,김동욱,민창기,김유진,박윤희,김희제,이석,이종욱,민우성,김춘추 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.2

횡문근 융해증은 다양한 원인에 의해 발생하며 광범위한 임상 및 생화학적 소견을 보이는 사망의 가능성이 있는 증후군이다. 근육통, 혈색소뇨, 혈청 creatinine kinase 활성도의 증가가 흔한 소견이며 전격성 횡문근 융해증은 심한 대사성 이상과 여러 장기의 침범을 동반하게 된다. 심정지, 구획증후군 및 급성 신부전이 주된 합병증으로 치명적인 합병증의 정도는 조기진단과 적절한 치료에 의해 좌우된다. 조혈모세포이식 후의 횡문근 융해증은 드문 합병증이며, 특히 동종 조혈모세포이식 후 면역 억제제를 복용하고 있는 환자에서 지질 저하제를 투여할 필요가 있을 때 지질저하제의 신중한 선택이 필요할 것으로 생각된다. 저자들은 만성골수성백혈병의 비혈연간 조혈모세포이식 후 지질 저하제와 면역억제제의 병용에 의한 횡문근 융해증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Rhabdomyolysis denotes an acute or subacute event that leads to necrosis of striated muscles. The clinical features may vary widely from moderate muscular symptoms to life threatening complications. The etiology of rhabdomyolysis has diversified. The causes include polymyositis, heat stroke, prolonged convulsion, vigorous exercise, trauma, hypokalemia, viral illness, and various kinds of drugs. Myalgia, myoglobinuria and elevated level of serum creatinine kinase are the common features. Fulminant rhabdomyolysis may be associated with severe metabolic disturbances and involvement of the other organ systems. The extent of the life- threatening complications of rhabdomyolysis strongly depends on early diagnosis and adequate therapy. Rhabdomyolysis is a rare complication in patients who underwent hematopoietic stem cell transplantation and the patients usually follow a fulminant course. We describe a case of acute rhadomyolysis developed after allogeneic hematopoietic stem cell transplantation from unrelated donor in a patient with chronic myelogenous leukemia. It was postulated that the cause was concurrent administration of lovastatin to treat hypercholesterolemia and cyclosporine for graft versus host disease prophylaxis. The patient was managed with the maintenance of adequate circulating volume and sufficient diuresis to prevent further renal complications. Rhabdomyolytic acute renal failure was treated with continuous arteriovenous hemodialysis and plasmapheresis. The patient recovered completely from rhabdomyolysis without any sequelae and maintains normal life in remission state of underlying disease.