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.

여성 생식기 콘딜로마 병변에서의 In Situ Hybridization에 의한 Human Papillomavirus DNA의 검색

서광선,강동욱,이증훈 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

The in situ hybridization technique, using digoxigenin labeled human papillomavirus(HPV) probes was applied to the detection of HPV DNA types 6 and 11. on paraffin sections of 24 condylomatous and malignant lesions of the uterine cervix, vagina, and vulva were used. They consisted of 9 condyloma acuminata, 10 flat condylomatous lesions associated with cervical intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma(SCC), and 5 noncondylomatous lesions. The HPV DNA probes were stained mainly stained in the loilocytotic nuclei of the superficial portion of the epithelium. The underlying normal, dysplastic, and carcinoma cells were negative. Seven(77.8%) out of 9 condyloma acuminata and 4(57.1%) of 7 CIN Ⅰ/Ⅱ cases were positive for HPV 6 or 11. However, 2 cases of CIN Ⅲ and 6 cases of invasive SCC were negative, irrespective of the presence of koilocytosis. Thus, it was concluded that HPV types 6 and 11 are more commonly associated with benign condylomatous and low grade intrapithelial lesions than high grade lesions and SCC.

IgA 신병증의 임상 및 병리학적 고찰

이강욱,최영환,신영태,노흥규,서광선 충남대학교 의과대학 지역사회의학연구소 1986 충남의대잡지 Vol.13 No.1

Twenty eight cases of primary IgA nephropathy were diagnosed and studied in the Department of Internal Medicine, Chungnam National University Hospital over a period of 49 months from June 1981 to July 1985. The results were summerized as follows: 1. These cases represented 45.2% of patients with primary glomerular diseases undergoing renal biopsy and immunofluorescent studies during the same period. 2. There were 20 males and 8 females. They were 15 to 54 years old and the average age was 29.1. 3. The main symptoms were loin pain, gross hematuria, myalgia, fatigability and generalized edema in 18, 15, 12, 12, and 4 cases, respectively. Upper respiratory tract infection symptoms were presented in 50% of the cases of all patient just before and during the course of disease. 4. Proteinuria was observed in 27 cases and hematuria was seen in 23 cases, Among hematuria, the gross hematuria was observed in 15 cases. Hypoalbuminemia and hypercholesterolemia was presented in 4 cases with generalized edema. Serum BUN and creatinine were elevated in 3 cases with marked decreased Creatinine Clearence in 3 cases (Ccr<50ml/min). 5. The light microscopic findings showed mainly mesangial proliferative glomerulonephritis and focal and segmental glomerular sclerosis in 11 and 7 cases, respectively. Immunofluorescent microscopic findings disclosed diffuse mesangial deposit of IgA in all cases. IgG, igM, C3 and fibrinogen deposits were observed in mesangium in 5, 4, 20, and 7 cases, respectively.

신장조직 손상의 진행에 있어서 Renin-Angiotensin System 의 역할에 관한 연구

이강욱,송정헌,강민규,황평주,김종학,나기량,서광선,박정규,신영태 대한신장학회 2001 대한신장학회잡지 Vol.20 No.3

내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

성인 막성신병증의 임상적 고찰

양종오,이상주,박기현,장윤경,이강욱,서광선,신영태 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

Membranous nephropathy (MN) is a glomerular disease characterized by diffuse thickening of the glomerular basement membrane without significant mesangial proliferative change and is usually manifested by the nephrotic syndrome. To evaluate the clinical and pathologic characteristics of this disease in adults, we analyzed 65 patients with primary membranous nephropathy who were diagnosed at Department of Internal Medicine, Chungnam National University Hospital from February 1986 to February 2001. The results are as follows: 1) Of total 96 patients with membranous nephropathy, 67.7% was primary MN. Hepatitis B-associated MN and lupus MN were 22.9%, and 9.4%, respectively. Median duration of follow-up was 35.1 months(0.3∼177) in primary MN, 49.6 months(2.5∼103) in lupus MN, and 35.6 months(0.5∼108) in hepatitis B-associated MN. 2) Mean age of the patients with primary MN at the time of diagnosis(43.3 years) was significantly higher than that of lupus MN(30.4 years) and HBV-associated MN(36.2 years). Male to female ratio of primary MN was 1.03:l. 3) At the time of diagnosis, 89.2% of primary MN was presented with nephrotic syndrome. Twenty seven percent of patients showed hypertension. Hematuria was found in 58.5% of primary MN patients. Azotemia was noted in 3.1 %. 4) Global sclerosis, tubular atrophy and interstitial fibrosis were noted in 39.8, 16.1 and 11.3% of primaty MN, respectively. IgG and C3 were deposited on the glomerular capillary loop in 92.7% and 29% of primary MN patients. There was no significant correlation between the electron microscopic pathologic stage and clinical findings. 5) Of 56 patients with primary MN followed more than 6 months, 50(90.9%) patients were treated with prednisolone, cyclophosphamide or cyclosporin. Complete remission was obtained in 29 patients(51.8%), partial remission in 6 patients(10.7%), and no response in 18 patients(32.1%). Of 6 patients who were not treated with immunosuppressive drugs, 3 patients showed spontaneous complete or partial remission. Three patients who did not show clinical improvement progressed to end-stage renal failure. There were no significant clinical difference including renal pathology at the time of diagnosis between the patients who showed complete or partial remission and patients who did not. In conclusion, it was difficult to predict the long-term prognosis of primary MN at the time of diagnosis, clinically. The response to therapeutic modality would be the most important to predict long-term prognosis of primary MN.

부분 신절제 백서모델에서 Angiotensin Converting Enzyme Inhibitor 및 Angiotensin II ATI 수용체 길항제가 Plasma Renin Activity 및 Angiotensin II level에 미치는 영향

김종학,구영선,강민규,황평주,나기량,이강욱,서광선,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Renin-angiotensin-system(RAS) has been thought to have a pivotal role in renal injury mechanism. Many reports state that the inhibition of RAS prevents the progression of renal disease in 5/6 nephrectomized rats as a typical chronic renal failure model. Angiotensin converting enzyme inhibitor blocks the conversion from Angiotensin I to Angiotensin Ⅱ (A-Ⅱ ), and ATI RA inhibits the action of A-Ⅱ at the level of AT1 receptor. Therefore the PRA and A-Ⅱ level may be influenced independently by each treatment modality with these drugs. In this study, the influence of long term treatment with ACEI or AT1RA in these models on systolic blood pressure, PRA, and A-Ⅱ level was evaluated. Male Sprague-Dawley rats weighing 270-300 grams were anesthesized with thiopental sodium(50 mg/kg) and underwent right nephrectomy and partial(approximately two thirds) infarction of the left kidney by ligation of two-three segmental arterial branches. The rats were divided into four groups : sham group, control group, 5/6 subtotal nephrectomized and ACEI treated group (enalapril 100 mg/L in drinking water), 5/6 subtotal nephrectomized and ATIRA treated group (losartan, 200 mg/L in drinking water). They were treated for twelve weeks. In the twelve weeks, both groups treated with ACEI and AT1RA ingestion demonstrated a significant decrease in systolic blood pressure(165±23 vs. 132±9, mmHg, control vs. ACEI, M±SEM, p<0.05, 165±23 vs. 124±7 mmHg, control vs. ATIRA, M±SEM, p<0.01) compare to the control group. In both group treated with ACEI and AT1RA showed a significant increase in PRA(ACEI ; 7.2±2.9, AT1RA ; 4.7±0.4, control ; 2.7±1.1, sham ; 2.7±1.4, ng/ml/hr, ACEI vs. control and sham, M±SEM, p<0.05). However no significant differences were found in the sham vs. control(p>0.05), and in ACEI vs. control. The plasma A-II level was significantly increased in AT1RA treated group compared to sham and ACEI treated group(2,753±543 vs. 484±169.3, ng/ ml, AT1RA vs. Sham, p<0.01). In conclusion, treatment with ACEI and AT1RA for twelve weeks normalized systolic blood pressure, proteinuria and increased PRA compared to the control group; whereas plasma A-II level was increased only by AT1RA treatment.

혈청 HBsAg 양성인 사구체신염의 임상상 및 신조직 소견

신영태,구영선,강민규,황평주,김종학,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Hepatitis-B-associated glomerulonephritis is one of the immunologically mediated disorders associated with chronic Hepatitis B virus(HBV) infection. The frequency of HBsAg infection has been high in East Asia and it is one of the most important etiologic factors of the secondary glomerulonephritis. We reviewed the clinical and pathologic features of 29 patients with glomerulonephritis and HBs antigenemia, who were admitted to Chungnam National University Hospital from January 1988 to Febuary 1999. The results were as follows : 1) The average age of the patients was 33.8±10.4(mean±SD) and male to female ratio was 3.8. Proteinuria was present in 27 patients(93%), hematuria in 20 patients(69%) and hypertension in 17 patients(59%). Two patients(7%) manifested with renal insufficiency and 8 patients(28%) with nephrotic syndrome. 2) Renal pathology revealed membranous nephropathy(41%), membranoproliferative glomerulonephritis(21%), mesangial proliferative glomeulonephritis(21%), minimal change nephritis (14%) and focal segmental glomerulonephritis(3%). 3) The pathologic findings of liver were chronic active hepatitis(68%), chronic persistent hepatitis(38%) and liver cirrhosis(8%). 4) During the follow-up period(average:49.4 months), 7 patients(68%) presented persistent proteinuria, 5 patients(21%) progressed to renal failure and 2 patients(8%) resolved clinically. 5) The treatment was done with prednisolone to 3 patients, and with alpha-interferon to 3 patients. One patient treated with prednisolone resolved clinically, but this resolution did not coincide with disappearance of the hepatitis B antigens.

신부전증과 폐에 Pseudolyrmphorma를 동만한 원발성 Sjogren 증후군 : Cyclophosphamide와 Prednisolone에 의한 성공적인 치료

강민규,구영선,황평주,김종학,나기량,서광선,이강욱,신영태 대한신장학회 2000 대한신장학회잡지 Vol.19 No.4

전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.