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신관희,한광희,정원일,이형래,이상철,김원재 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2
연구목적: 장을 이용한 요로전환술을 받은 환자들에게는 여러 가지 대사적 장애에 따른 합병증이 발생하게 되는데 그 중 하나인 요석형성의 위험인자에 대해 대사적 검사를 실시하였다. 대상 및 방법: 장을 이요한 요로전환술을 시행 받은 후 적어도 6개월간 추적관찰이 가능했던 30명(회장 도관술 24명, Mainz pouch 4명, 방광 확대술 2명)을 환자군으로 하였고 요석의 과거력이 없는 건강한 38명을 대조군으로 선정하였다. 요로감염이나 항생제를 투여하는 경우에는 대상에서 제외하였고 식이 제한을 하지 않은 상태에서 24시간 소변을 외래에서 모았다. 소변량, 나트륨, 인, 요산, 크레아티닌, 칼슘, 마그네슘, 수산, 구연산 등의 요검사 항목을 조사하여 환자군과 대조군의 측정치 및 크레아티닌으로 보정한 측정값을 각 성별에 따라 비교하였다. 결과: 혈중 칼슘, 인, 요산, 나트륨, 칼륨, 크레아티닌, 혈액요소질소 (BUN) 등 대부분의 혈중 검사 항목들은 환자군과 대조군 사이에 차이가 없었으나 혈중 단백질 수치만이 차이를 보였다. 23명의 남성 환자에게서 수산의 요 배설량이 대조군에 비해 현저히 높았으며 반대로 구연산과 요산은 대조군에 비해 낮았다 (p=0.006, p=0.001, and p=0.005, respectively). 또한, 남성 환자의 칼슘의 요 배설량은 대조군보다 오히려 적게 나타나 환자군의 칼슘/수산 비가 현저히 감소하였다 (p<0.001). 요중 칼슘, 나트륨, 인 및 요산은 크레아티닌의 농도와 관련성을 보였으며, 오직 수산만이 크레아티닌 보정 후에도 남성 환자군과 대조군 사이에 유의한 차이를 보였다. 한편, 7명의 여성 환자들에게서 대조군에 비해 마그네슘의 배설이 감소한 것 이외에 유의한 차이는 나타나지 않았다 (p=0.04). 결론: 본 연구의 결과로 볼 때 요로전환술을 받은 환자에게 요중 칼슘, 마그네슘, 구연산 등이 요석형성에 영향을 끼치는 인자로 작용하지만, 요중 수산 배설의 증가와 이에 따른 칼슘/수산 비율의 감소가 보다 더 주된 위험 요인이라 할 수 있다. Purpose: The present study was performed to assess the risk factors for urolithiasis in patients receiving urinary intestinal diversion due to certain underlying etiology. Materials and Methods: This study included 30 patients who had undergone various forms of urinary intestinal diversion (24 of ileal conduits, 4 of Mainz continent diversions, and 2 of augmentation cystoplasties) with post-operative duration of at least 6 months and 38 age-matched normal controls. Urine samples (24-hour) were randomly collected on an outpatient basis without any dietary restriction when the patients were free of urinary tract infection or antibiotics. Investigation of urinary analytes comprised urine volume, sodium, phosphorus, uric acid, creatinine, calcium, magnesium, oxalate, and citrate. Data were compared in original values and adjusted values by creatinine in each sex. Results: Almost serum analytes such as calcium, phosphorus, uric acid, sodium, potassium, creatinine, and BUN were not significantly different between patients and controls except protein. In 23 male patients, mean urinary excretion of oxalate was significantly greater than control group and conversely in that of citrate and uric acid (p=0.006, p=0.001 and p=0.005, respectively). Unexpectedly, urinary excretion of calcium in male patients was lower than in control (p=0.002) resulting in significant decrease in the ratio of calcium to oxalate (p<0.001). Among the urinary analytes, excretions of calcium, sodium, phosphorus, and uric acid were significantly correlated with that of creatinine. Oxalate was only different analyte when adjusted by creatinine between male patients and controls. In 7 female patients, decreased excretion of magnesium was observed when compared to control (p=0.04). Conclusions: Our study indicated that urinary intestinal diversion cause increased excretion of urinary oxalate leading to decreased calcium to oxalate ratio, as major metabolic alteration for urolithiasis, although urinary calcium, magnesium, or citrate may take a role.
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( Kwang Hyun Chung ),( Ho Young Lee ),( Yong Jin Jung ),( Hwi Young Kim ),( Ji Won Kim ),( Ji Bong Jeong ),( Byeong Gwan Kim ),( Kook Lae Lee ),( Won Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Assays for hepatitis B surface antigen (HBsAg) quantification are emerging serologic tests which might determine treatment strategy and monitor treatment responses in chronic hepatitis B (CHB) patients. The aim of our study was to evaluate the dynamic changes in HBsAg titers during the natural course of CHB infection, and identify correlations between HBsAg titers and hepatitis B virus (HBV) DNA concentrations across different phases of CHB measured using novel immunoradiometric assay (IRMA). Methods: Serum HBsAg titers and paired HBV DNA concentrations in the different phases of CHB were retrospectively compared from August 2010 to March 2011 by correlation analysis. Phases of CHB were defined on the basis of HBV DNA concentrations, serum hepatitis B e antigen/ antibody status, and serum alanine aminotransferase levels. Additionally, mean HBsAg titers were compared across the different stages of chronic liver disease. Results: In 629 serum samples, mean HBsAg titers were significantly higher in the immune tolerance (ITO) and immune clearance (ICL) phases than in immune control (ICN) and immune escape (IES) phases. Correlations between HBsAg titers and HBV DNA concentrations varied with the CHB phases. Modest correlation was observed in ITO (n=54, r=0.733, p<0.001) and ICL (n=28, r=0.677, p<0.001), and poor correlation in ICN (n=79, r=0.242, p=0.032); however, no significant correlation was seen in IES (n=86, r=0.015, p= 0.894) and the oral nucleos(t)ide analogues-treated group (n= 252). Additionally, the mean HBsAg titers were significantly higher in patients with liver cirrhosis or hepatocellular carcinoma than in patient without liver cirrhosis or hepatocellular carcinoma (21574.7 vs. 4525.5 IU/mL, p<0.001; 16616.4 vs. 3529.6 IU/mL, p<0.001, repectively) and tended to gradually decrease as the 10-year age stratum increased (P for trend<0.001). Conclusions: HBsAg quantification using the IRMA method might be useful to discriminating patients in different phases of CHB and in different stages of chronic liver disease.
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( Kwang Hyun Chung ),( Won Kim ),( Byeong Gwan Kim ),( Ho Young Lee ),( Eunhyo Jin ),( Yuri Cho ),( Ji Yeon Seo ),( Hwi Young Kim ),( Yong Jin Jung ),( Ji Won Kim ),( Ji Bong Jeong ),( Kook Lae Lee ) 대한소화기학회 2015 Gut and Liver Vol.9 No.5
Background/Aims: Quantification of hepatitis B surface antigen (HBsAg) is an emerging serologic test and may be useful for identifying treatment strategies for chronic hepatitis B (CHB). This study aimed to evaluate HBsAg titers during the natural course of CHB and identify correlations between HBsAg titers and hepatitis B virus (HBV) DNA concentrations across different CHB phases measured using an immunoradiometric assay (IRMA). Methods: CHB phases were defined on the basis of HBV DNA concentrations, the presence of hepatitis B e antigen/antibody (HBeAg/Ab) and serum alanine aminotransferase levels. Serum HBsAg titers and paired HBV DNA concentrations in the different phases of CHB were compared using 627 serum samples. Results: Mean HBsAg titers were significantly higher in the immunotolerant (IT) phase and immunoreactive (IR) HBeAg-positive phase than in the low-replicative (LR) and HBeAg-negative CHB (ENH) states. The correlation between HBsAg titers and HBV DNA concentrations was modest in the IT (n=36, r=0.804, p<0.001) and IR (n=48, r=0.773, p<0.001) phases, and it was poor in the LR state (n=116, r=0.289, p=0.002); however, no significant correlation was observed in the ENH state (n=67, r=0.146, p=0.237) or in the oral nucleos(t)ide analogue-treated group (n=267). Conclusions: HBsAg quantification using IRMA might be useful for discriminating different CHB phases and different stages of chronic liver disease. (Gut Liver 2015;9:657-664)
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( Kwang Hyun Chung ),( Ho Young Lee ),( Yong Jin Jung ),( Hwi Young Kim ),( Ji Won Kim ),( Ji Bong Jeong ),( Byeong Gwan Kim ),( Kook Lae Lee ),( Won Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background/Aim: Assays for hepatitis B surface antigen (HBsAg) quantification are emerging serologic tests which might determine treatment strategy and monitor treatment responses in chronic hepatitis B (CHB) patients. The aim of our study was to evaluate the dynamic changes in HBsAg titers during the natural course of CHB infection, and identify correlations between HBsAg titers and hepatitis B virus (HBV) DNA concentrations across different phases of CHB measured using novel immunoradiometric assay (IRMA). Methods: Serum HBsAg titers and paired HBV DNA concentrations in the different phases of CHB were retrospectively compared from August 2010 to March 2011 by correlation analysis. Phases of CHB were defined on the basis of HBV DNA concentrations, serum hepatitis B e antigen/ antibody status, and serum alanine aminotransferase levels. Additionally, mean HBsAg titers were compared across the different stages of chronic liver disease. Results: In 629 serum samples, mean HBsAg titers were significantly higher in the immune tolerance (ITO) and immune clearance (ICL) phases than in immune control (ICN) and immune escape (IES) phases. Correlations between HBsAg titers and HBV DNA concentrations varied with the CHB phases. Modest correlation was observed in ITO (n=54, r=0.733, p<0.001) and ICL (n=28, r=0.677, p<0.001), and poor correlation in ICN (n=79, r=0.242, p=0.032); however, no significant correlation was seen in IES (n=86, r=0.015, p= 0.894) and the oral nucleos(t)ide analogues-treated group (n= 252). Additionally, the mean HBsAg titers were significantly higher in patients with liver cirrhosis or hepatocellular carcinoma than in patient without liver cirrhosis or hepatocellular carcinoma (21574.7 vs. 4525.5 IU/mL, p<0.001; 16616.4 vs. 3529.6 IU/mL, p<0.001, repectively) and tended to gradually decrease as the 10-year age stratum increased (P for trend<0.001). Conclusions: HBsAg quantification using the IRMA method might be useful to discriminating patients in different phases of CHB and in different stages of chronic liver disease.
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The Influence of Sour Taste on Dysphagia in Brain Injury: Blind Study
Kwang Lae Lee,김두영,Wan Ho Kim,Eun Joo Kim,Won Seok Lee,Soo Jung Hahn,Min Sung Kang,So Yeon Ahn 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.3
Objective To verify the infl uence of sour taste on swallowing and the presence of refl ex cough when sour material was swallowed in patients with dysphagia secondary to brain injury. Method Fifty dysphagic brain injury patients who underwent videofl uoroscopic swallowing study (VFSS) were recruited. Th e patients who had shown severe aspiration at 2 ml of liquid were excluded. Th e dysphagic patients were given 5 ml each of a sour tasting liquid (SOUR) and a thin liquid barium (LIQUID) in random order. An expert analyzed the result of VFSS by reviewing recorded videotapes. Analysis components consisted of the Penetration-Aspiration-Scale (PAS) score, oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT)and the refl ex cough presence. Results The PAS score for SOUR was significantly lower than the one for LIQUID (p=0.03). The mean OTT for SOUR was significantly shortened compared to that for LIQUID (p=0.03). The mean PTT and PDT were also shortened in SOUR, although the diff erences were not statistically signifi cant (p=0.26 and p=0.32, respectively). Th ere was no signifi cant diff erence between SOUR and LIQUID regarding the presence of refl ex cough (p=1.00). Conclusion Th e sour taste could enhance sensorimotor feedback in the oropharynx, thus lowering the chances of penetration-aspiration caused by shortening of the oropharyngeal passage times. There was no significant diff erence in the presence of refl ex cough produced between LIQUID and SOUR.
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Cyclic Vomiting Syndrome Developed after Stroke
Kwang Lae Lee,Jung In Shin 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.1
Cyclic vomiting syndrome is characterized by recurrent episodes of stereotyped vomiting separated by regular symptom-free periods. We describe a case of cyclic vomiting syndrome developed after stroke, which has not been reported to date. A 69-year-old woman experienced recurrent vomiting following left cerebral infarct. Th e patient’s vomiting pattern was consistent with cyclic vomiting syndrome, and the diagnosis of cyclic vomiting syndrome was established by exclusion of other known disorders which could have resulted in vomiting. She was treated with imipramine hydrochloride and her symptom was well controlled.
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