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식도정맥류에 대한 내시경적 정맥류 결찰요법 후 재출혈 및 재발과 연관된 위험인자들
이석호,이규택,김재준,백승운,최문석,이종균,이준혁,고광철,이풍렬,오성윤,이종철,최규완 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1
Background/Aims: Rebleeding and recurrence of varices are frequent problems following endoscopic variceal ligation (EVL). However, few data are available on the risk factors associated with rebleeding and recurrence. Our aims were to elucidate the clinical feaNres and risk factors associated with rebleeding and recuuence. Methods: One-hundred and eight patients who had undergone EVL due to bleeding esopltageal varices were included in the study. EVL was performed with the Stiegman-Goff Endoscopic Ligator at 2 week intervals until the varices are eradicated or reduced to grade 1 without red color sign (defined as successful EVL), followed by gastroscopy every 3 months. Rebleeding was defined using the descriptions from the Second Baveno International Consensus Meeting, in 1995. Recurrence was defined as increments of varices to grade 2 or greater or appearance of red color sign on follow-up examinations. The Kaplan-Meier method was used to determine the rebleeding and recurrence rate. The Log-rank lest and Cox regression lest were used for univariale and multivariate analysis of risk factors, respectively. Results: 1) The most common cause of rebleeding within 2 weeks from the EVL was esophageal ulcer (50%); whereas, the most common cause of rebleeding after 2 weeks was recurrent varices (38%). 2) In univariate analysis, persistence of esophageal ulcer at 2 weeks after the first EVL was associated with rebleeding (p=0.01); whereas, age, Child class, grade and extent of varices, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p >0.05). Persistence of esophageal ulcer at 2 weeks after the first EVL was associated with rebleeding also in multivariate analysis (relative risk 5.87, p=0.01). 3) In univariate analysis, grade (p=0.01) and extent (p=0.01) of varices were related to recurrence; whereas, age, Child class, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p >0.05). In multivariate analysis, grade of varices was the only risk factor associated with recurrence (relative risk 3.76, p=0.01). Conclusions: 1) Persistence of esophageal ulcer at second week after the first EVL was associated with rebleeding. 2) Frequent follow-up endoscopic examinations are necessary in patients who present with high grade of vaces since risk of recurrence is high even after successful EVL.
Yun Lyul Lee,Hyeok Yil Kwon,Hyung Seo Park,Hyoung Jin Park 대한생리학회-대한약리학회 1997 The Korean Journal of Physiology & Pharmacology Vol.1 No.1
<P> Aim of this study was to investigate if pancreatic polypeptide (PP) reduced the insulin action via the intra-pancreatic cholinergic nerves in the isolated rat pancreas. The pancreas was isolated from rats and perfused with intra-arterial infusion of modified Krebs-Henseleit solution containing 2.5 mM glucose at a flow rate of 1.2 ml/min. Simultaneous intra-arterial infusion of insulin (100 nM) resulted in potentiation of the pancreatic flow rate and amylase output which were stimulated by cholecystokinin (CCK, 14 pM). These potentiating actions of insulin on the CCK-stimulated pancreatic exocrine secretion were completely abolished by administration of rat PP. Vesamicol, a potent inhibitor of vesicular acetylcholine storage, and tetrodotoxin (TTX) also significantly reduced the combined actions of insulin and CCK. Administration of carbamylcholine, an acetylcholine agonist, completely restored the vesamicol- or TTX-induced inhibition of the potentiation between insulin and CCK. Also rat PP failed to attenuate the restoring effect of carbamylcholine. Electrical field stimulation (15-30 V, 2 msec and 8 Hz) resulted in a significant increase in the pancreatic flow rate and amylase output in voltage-dependent manner. Effects of electrical field stimulation were augmented by endogenous insulin. Rat PP also suppressed the pancreatic exocrine secretion stimulated by electrical field stimulation. These observations strongly suggest that PP inhibits the potentiating actions of insulin on CCK-stimulated pancreatic exocrine secretion by suppression of the intra-pancreatic cholinergic activity in the isolated rat pancreas.
Lee, Youn-Ri,Lee, Chang-Kwon,Park, Hyo-Jun,Kim, Hyo-Jin,Kim, Jung-Hwan,Kim, Jae-Heung,Lee, Keun-Sang,Lee, Yun-Lyul,Min, Kyung-Ok,Kim, Bo-Kyung Korean Physical Therapy Science 2006 대한물리치료과학회지 Vol.13 No.2
Vascular smooth muscle contraction is mediated by activation of extracellular signal-regulated kinase (ERK) 1/2, an isoform of mitogen-activated protein kinase (MAPK). However, the role of stress-activated protein kinase/c-Jun N-terminal kinase (JNK) in vascular smooth muscle contraction has not been defined. We investigated the role of JNK in the contractile response to norepinephrine (NE) in rat aortic smooth muscle. NE evoked contraction in a dose-dependent manner, and this effect was inhibited by the JNK inhibitor SP600125. NE increased the phosphorylation of JNK, which was greater in aortic smooth muscle from hypertensive rats than from normotensive rats. NE-induced JNK phosphorylation was significantly inhibited by SP600125 and the conventional-type PKC (cPKC) inhibitor Go6976, but not by the Rho kinase inhibitor Y27632 or the phosphatidylinositol 3-kinase inhibitor LY294002. Thymeleatoxin, a selective activator of cPKC, increased JNK phosphorylation, which was inhibited by $G{\ddot{o}}6976$. SP600125 attenuated the phosphorylation of caldesmon, an actin-binding protein whose phosphorylation is increased by NE. These results show that JNK contributes to NE-mediated contraction through phosphorylation of caldesmon in rat aortic smooth muscle, and that this effect is regulated by the PKC pathway, especially cPKC.
Lee, Yun-Lyul,Kwon, Hyeok-Yil,Park, Hyung-Seo,Park, Hyoung-Jin The Korean Society of Pharmacology 1997 The Korean Journal of Physiology & Pharmacology Vol.1 No.1
Aim of this study was to investigate if pancreatic polypeptide (PP) reduced the insulin action via the intra-pancreatic cholinergic nerves in the isolated rat pancreas. The pancreas was isolated from rats and perfused with intra-arterial infusion of modified Krebs-Henseleit solution containing 2.5 mM glucose at a flow rate of 1.2 ml/min. Simultaneous intra-arterial infusion of insulin (100 nM) resulted inpotentiation of the pancreatic flow rate and amylase output which were stimulated by cholecystokinin (CCK, 14 pM). These potentiating actions of insulin on the CCK -stimulated pancreatic exocrine secretion were completely abolished by administration of rat PP. Vesamicol, a potent inhibitor of vesicular acetylcholine storage, and tetrodotoxin (TTX) also significantly reduced the combined actions of insulin and CCK. Administration of carbamylcholine, an acetylcholine agonist, completely restored the vesamicol- or TTX-induced inhibition of the potentiation between insulin and CCK. Also rat PP failed to attenuate the restoring effect of carbamylcholine. Electrical field stimulation (15-30 V, 2 msec and 8 Hz) resulted in a significant increase in the pancreatic flow rate and amylase output in voltage-dependent manner. Effects of electrical field stimulation were augmented by endogenous insulin. Rat PP also suppressed the pancreatic exocrine secretion stimulated by electrical field stimulation. These observations strongly suggest that PP inhibits the potentiating actions of insulin on CCK -stimulated pancreatic exocrine secretion by suppression of the intra-pancreatic cholinergic activity in the isolated rat pancreas.
간암 환자의 술전 검사로서 CTAP와 CTHA 의 유용성
이석호,이규택,김재준,강인구,김승훈,백승운,도영수,이종균,이준혁,고광철,이풍렬,최규완,오성윤,이종철 대한간학회 1997 Clinical and Molecular Hepatology(대한간학회지) Vol.3 No.4
Background / Aims : Combined computed tomography during arterial portography(CTAP) and computed tomography during hepatic arteriography(CTHA) are more sensitive methods compared to conventional spiral CT in detection small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CTHA as a preoperative study of hepatocellular carcinoma for surgical treatment. Methods : Eighty -two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angigraphy were included. CTAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventional spiral CT and angiography. Results : 1)105 nodules were found on spiral CT plus angiography , whereas, 138 nodules found on combined CTAP and CTHA : 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases : 9 cases(10%) with bilobar involvement, and 1 case(1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA : combined CTAP and CTHA were able to find more nodules in 21% of tumor ≤3cm, 27% of tumor with 3- 10cm, and 71% of tumor > 10 am on spiral CT (p=0.03). Conclusion : Compared to spiral CT plus angiography, CTAP and CTHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.
이석호,손희정,이규택,김재준,강인구,백승운,이종균,이준혁,고광철,이풍렬,오성윤,이종철,최규완,오영륜 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.4
Amyloidosis is characterized by deposition of amyloid, which is resistant to proteolysis & phagocytosis, in intercellular spaces & vascular walls. The amyloid deposition provokes dysfunction of an accumulated organ & displays variable clinical symptoms depending upon the involved organ. A diagnosis is rendered through a biopsy of the affected organ, followed by staining using congo red which reveals an apple greenish refractile birefringence via polarizing microscopy. Using an electro-microscopy specific filaments can be found. Amyloidosis is classified into primary amyloidosis, composed of light chain filaments (AL) and secondary amyloidosis, comprised of A protain (AA). The AL type of amyloidosis shows deposition of amyloid in muscularis mucosa & muscularis externa. Priunary amyloidosis on the other hand, is relatively rare. We experienced primary stornach amyloidosis (AL), which was mistaken for stomch cancer.