p-ANCA 연관 신염의 임상적 고찰: 단일 임상기관 연구

강혁주 ( Hyeock Joo Kang ),박선희 ( Sun Hee Park ),박자용 ( Ja Yong Park ),신용봉 ( Yong Bong Shin ),김찬덕 ( Chan Duck Kim ),탁우택 ( Woo Taek Tak ),이정호 ( Jeong Ho Lee ),김용림 ( Yong Lim Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

Background/Aims: We evaluated the clinical characteristics and prognostic value of the clinical, laboratory, pathologic features, at time of diagnosis, and the renal survival of patients with ANCA (anti-neutrophil cytoplasmic antibody)-related nephritis. Method: We retrospectively analyzed 17 patients who were diagnosed with ANCA-related nephritis at a single center. The risks of progression to ESRD or death according to the clinical parameters, the ANCA pattern and the renal pathologic findings were evaluated. Results: The major symptoms were hematuria (100%), proteinuria (100%), uremic symptoms (41.2%), edema (35.5%), upper respiratory symptoms (29.4%) and oliguria (23.5%), which were not correlated with renal survival. All the patients showed a p-ANCA pattern. The BUN level (p=0.032) and GFR (p=0.023) at the time of diagnosis were different between the improved and the progressed patients in terms of renal function. The pathology indices were not predictive factors of both renal and patient survival. Eight patients (47.1%) were treated with steroid IV pulse, 4 (23.5%) with steroid IV pulse and cyclophosphamide IV pulse, 2 (11.8%) with steroid IV pulse, cyclophosphamide IV pulse and plasma exchange, and 2 (11.8%) with steroid IV pulse and plasma exchange. Fourteen patients (82.4%) needed hemodialysis. There were 3 (17.6%) disease-related deaths, 13 patients (76.5%) reached ESRD and 4 (23.5%) showed recovery of renal function. The mean percent of patients who survived was 80.2% and the mean percent of renal survival was 33.3% at the 1st and 3rd year, respectively. Conclusions: Poor renal function at presentation was associated with a high risk for disease progression, but age, gender, the clinical patterns of presentation and the pathologic findings were not associated with the prognosis. Early diagnosis and treatment seems to be essential to improve the renal outcomes.(Korean J Med 74:523-530, 2008)

위암종 및 위암종의 전구병변에서 p27Kip1 의 발현

김남일(Nam Il Kim),강혁주(Hyeock Joo Kang),정희철(Hee Chul Jung),김성자(Sung Ja Kim),이구(Goo Lee),서정일(Jeong Il Suh),이창우(Chang Woo Lee),이규춘(Kyu Chun Lee),김한식(Han Sik Kim),장태정(Tae Jung Jang),양창헌(Chang Heon Yang) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

Background : The cyclin-dependent kinase inhibitor p27Kip1 is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27Kip1 was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27Kip1 in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. Methods : p27Kip1 were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. Results : Gastric cancers showed significantly decreased expression level of p27Kip1 when compared with non-neoplastic lesions and adenomas. Labeling index of p27Kip1 were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27Kip1 when compared with advanced gastric cancers. In gastric cancers, p27Kip1 labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. Conclusion : We suggest that p27Kip1 may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.(Korean J Med 62:396-404, 2002)

복막투석환자에서 발생한 보디텔라 관련 재발성복막염

원기범 ( Ki Bum Won ),김준섭 ( Joon Seup Kim ),하경임 ( Gyung Yim Ha ),강혁주 ( Hyeock Joo Kang ),탁우택 ( Woo Taek Tak ),이정호 ( Jeong Ho Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

기초 연구 : 삼투질 농도와 당질코르티코스테로이드가 복막 내 제1형 수분통로 발현에 미치는 영향

김성자 ( Sung Ja Kim ),탁우택 ( Woo Taek Tak ),이준엽 ( Jun Yeop Lee ),강혁주 ( Hyeock Joo Kang ),김미나 ( Mi Na Kim ),박성주 ( Seong Joo Park ),이정호 ( Jeong Ho Lee ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.4

복막투석 환자에서 시범적 현장교육이 복막염 예방에 미치는 영향

이용국 ( Yong Kook Lee ),이준엽 ( Joon Yeop Lee ),김준섭 ( Joon Seup Kim ),최재혁 ( Jae Hyeuk Choi ),강혁주 ( Hyeock Joo Kang ),신성준 ( Sung Joon Shin ),탁우택 ( Woo Taek Tak ),김경수 ( Kyung Soo Kim ),이정호 ( Jeong Ho Lee ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

편평상피세포암과 동반된 소세포폐암에서 발생한 항이뇨호르몬 분비이상 증후군 ( SIADH ) 1 예

윤병구(Byung Gu Yoon),장재식(Jae Sik Jang),유석동(Seok Dong Yoo),구정태(Jung Tae Gu),이영실(Young Sil Lee),이창화(Chang Hwa Lee),천우정(Woo Jung Chun),정희철(Hee Churl Jung),강혁주(Hyeock Joo Kang),서영범(Young Beom Suh),이창우(Chang 대한내과학회 2001 대한내과학회지 Vol.61 No.5

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the term applied to arginine vasopressin (AVP) excess associated with hyponatremia without edema in the absence of physiologic or pharmacologic stimuli to AVP secretion. SIADH is associated with various conditions such as malignant tumors, infection, central nervous system disorders, and different pharmacological agents. The patient was 73-year-old female. She was admitted to the hospit al because of persistent cough, dizziness, gener al weakness and confusion. On admission, her serum osmolality was 253 mOsm/kg, urine osmolality was 416 mOm/ kg, and urine Na concentration was 159 mEq/ L. Her Chest X- ray and CT scan of lung showed about 4×3.5 cm sized mass at posterior basal segment of left lower lobe of the lung, and CT-guided percutaneous needle aspiration revealed small round cell with clusters of malignant squamous cells. She was treated by salt restriction, hypertonic saline infusion and demeclocycline. We planned chemotherapy for advanced combined lung cancer, but she was discharged because of poor general condition and associated pneumonia without cancer chemotherapy. We report a r are case of SIADH in small cell cancer of lung combined with squamous cell cancer of lung.(Korean J Med 61:562-566, 2001)

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.

진행병기 소세포폐암 환자에서 Irinotecan, Cisplatin의 복합화학요법

강혁주,장대영 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.1

소세포폐암은 전체 폐암 중 15%를 차지하고, 가장 나쁜 임상경과를 보이며 치료하지 않는 경우 2~4개월의 중앙 생존치를 나타낸다. 다른 조직형의 폐암보다 진단 당시에 더 널리 퍼져있지만 항암화학요법과 방사선요법에는 더 잘 반응하는 경향을 보인다. 최근 일본을 중심으로 ironotecan/cisplatin의 병합 요법이 기존의 etoposie/cisplatin 보다 효과적이라고 보고되고 있으나, 용법과 용량에 대해서는 논란이 많다. 본 연구는 국내 환자들을 대상으로 하여 부작용이 적으며, 효과적인 용법과 용량을 결정하기 위해 진행병기 소세포폐암 환자에게 4주 간격으로 3주간 irinotecan을 투여하는 임상연구를 시행하였다. 조직학적이나 세포진검사상 확인된 진행병기의 소세포폐암 환자로 신체 검사나 방사선학적 검사로 최대 직경이 2 cm 이상 측정 가능한 병변이 있는 18세 이상 75세 이하의 19명을 대상으로 하였다. 선정 기준은 일상 신체활동도 2 이하, 백혈구 3,000/μL 이상, 중성구 1,500/μL 이상, 혈소판 100,000/μL 이상이면서, 적절한 간기능 및 신기능을 가진 환자로 하였다. 투약 방법은 irinotecan 60 mg/m²을 90분 동안 정주하며, 1일째, 8일째와 16일째 반복 투여하고, cisplatin은 60 mg/m²을 생리 식염수 섞어 1시간에 걸쳐 1일째 정주하며 이를 4주마다 반복하였다. 평가 가능한 15명의 환자에서 전체 57주기의 복합 항암 화학요법이 시행되었으며, 완전 반응은 1명 (6.7%), 부분 반응은 8명 (53.3%)으로 전체 반응률은 60.0% 였다. 전체 15명 환자의 중앙 생존 기간은 37주 이었다. 심각한 부작용으로는 백혈구 감소증이 21.1%에서 나타났고 비혈액학적 부작용으로는 오심과 설사가 24.6%와 22.8%에서 동반되었다. 진행병기 소세포폐암 환자에게 4주 간격으로 3주간 irinotecan을 투여하는 방법은 부작용의 빈도가 높고, 전체 용량을 완전히 투여하기가 어려웠던 점을 고려할 때 적절한 용량과 투여 방법을 정하기 위한 전향적인 대조군 연구가 필요하다. Small-cell lung cancer (SCLC) accounts for approximately 15% of lung cancer and is a particularly aggressive form of lung cancer characterized by a poor prognosis, rapid tumor growth, and early metastasis. The purpose of the present phase I1 study is to evaluate the antitumor efficacy and toxicity of the combination of irinotecan and cisplatin in patients with extensive disease SCLC. Eligibility criteria included ECOG performance status < or = 2; age 18-75 years; adequate bone marrow, liver, and renal function; measurable or evaluable disease; no previous systemic chemotherapy (prior radiotherapy an@or surgery were allowed), no other previous or concurrent malignancy; no peripheral neuropathy. Treatment consisted of irinotecan 60 mg/m2 on days 1, 8, and 15 and cisplatin 60 mg/m²on days 1, every four weeks, for six courses. RESULTS: Nineteen patients (median age 60 years, range 35-75) entered the trial, fifteen were evaluable for response, toxicity and survival. Patients received a median of 3 treatment cycles (range 1-6). Overall response rate was 60% (9 of 15) of patients; complete response rate was 6.7% (1 of 15) of patients; partial response rate was 53.3% (8 of 15) of patients. Median survival was 37 weeks. Toxicity was relatively well tolerated. The most frequent moderate-to-severe toxicity (21.1% of patients) was grade 3-4 neutropenia. The most frequent non-hematologic toxicity was nausea and diarrhea. In summary, irinotecan and cisplatin is an active combination in patients with extensive disease small cell lung cancer. Only 1 patient received the full dose of chemotherapy without skips or delay. So, the optimal dose and schedule should be investigated through the randomized controlled trials.

결핵 진단에서 38 kD 항원을 이용한 면역크로마토그래피법의 임상적 유용성

강혁주,이영실,김성자,이영현 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.1

연구 목적: 결핵의 진단에는 현재 흥부 X-선 검사와 객담 항산균 도말 및 배양 검사가 가장 널리 이용되고 있지만, 초기의 결핵, 폐외 결핵, 또 객담을 제대로 채취할 수 없는 노인이나 소아 등의 환자에게 있어서의 결핵균 검사에는 한계가 있다. 본 연구는 결핵 진단에서 38 kD 항원을 이용한 면역크로마토그래피법(immunochromatography; ICT)의 임상적 유용성을 알아보고자 하였다. 대상 및 방법: 항산균 도말, 배양 검사 또는 조직 검사로 확진된 폐 및 폐 외 결핵 환자 73명과 대조군 58명을 대상으로 38 kD 항원을 포함한 5가지 항원을 부착한 ICT tuberculosis kit를 이용한 면역크로마토그래피법을 실시하여 다음과 같은 결과를 얻었다. 결과: 1) 결핵군 73명 중 58명과 대조군 58명중 8명이 ICT양성으로 나와 민감도 79.5%, 특이도 86.2%를 보였다. 2) 폐 외 결핵 환자 14명 중 11명(78.6%)이 ICT 양성으로 나타난 반면, 항산균 도말, 항산균 배양 및 중합효소연쇄반응법에서는 각각 3명(21.4%), 4명(28.6%), 6명(42.9%)이 양성으로 나타나 ICT의 양성율이 보다 높았다(p<0.05). 결론: 이상의 결과로 ICT는 신속 간편하면서 항산균 도말, 배양 검사 및 방사선 검사 등과 함께 결핵진단에 보조적 도구로 사용 가능할 것으로 보이며, 특히 객담 항산균 도말 음성 폐결핵, 폐 외 결핵, 객담 및 기타 검체 채취가 어려운 경우 결핵의 조기 진단에 큰 도움을 주리라 생각한다. Background: In the diagnosis of tuberculosis, it is widely used to several methods such as X-ray, AFB smear and culture, but is limited to demonstration of tuberculosis that early stage of pulmonary tuberculosis, extrapulmonary tuberculosis and elderly or children who cannot expectorate. So we had evaluated the clinical significance of serologic detection of antibody to 38kD antigen, which is known as the most specific to the Mycobacterium tuberculosis complex, by immunochromatography Methods: Sera were taken from 73 patients with tuberculosis confirmed by AFB smear, culture or histologic findings, and from 58 controls. Detection of IgG against 38 kD antigen was carried out by immunochromatography using ICT tuberculosis kit (AMAFU) Results: 1. Overall diagnostic sensitivity and specificity in tuberculosis were 79.5% and 86.2%. 2. Among extrapulmonary tuberculosis, 11 out of 14 (78.6%) patients were positive in ICT, but 3 out of 14 (21.4%/0), 4 out of 14 (28.6%) and 6 out of 14 (42.9h) were positive in AFB smear, culture and PCR on samples from the affected fluid (or tissue), respectively. ICT was more detected than other tests (p<0.05). Conclusions: ICT is very rapid, simple and inexpmsive. This assay, combined with AFB smear, culture and X-ray, could provide a more accurate diagnosis of active tuberculosis, especially in the case of smear negative pulmonary tuberculosis, extrapulmonary tuberculosis and who sputum or other specimens study are very difficult.

위의 유암종과 선종의 병발 1례

장재식,강혁주,이중현,서영범,윤병구,김용섭,이구,서정일,양창헌,이창우,김정란,윤환중 東國大學校醫學硏究所 2000 東國醫學 Vol.7 No.-

유암종은 전신에 퍼져 잇는 장크롬친화성 세포에서 기원하는데 위의 유암종은 비교적 드문 질환으로 모든 유암종의 1.9~2.2%에 해당하며 위에 발생하는 종양의 1% 미만에서 보고되고 있다. 유암종은 일반적으로 증상이 비특이적이고 면역조직화학검사에 의해서 진단되기 때문에 과거에는 드물게 발견되었으나 최근 내시경 기기 및 술기의 발전과 검사 빈도의 증가 및 면역조직화학검사의 발달로 진단율이 증가 추세에 있으며, 드물지만 유암종에서 선암과 공존하는 예들이 보고되고 있다. 저자들은 심와부 동통을 주소로 내원한 70세 남자 환자의 상부위장관내시경 검사에서 위체상부의 대만곡에서 0.4×0.4 cm 크기의 중간 함몰을 가진 Yamada 1형의 용종과 함께 전정부의 전벽에서 0.8×0.5 cm 크기의 융기된 점막 소견을 보여 조직학적으로 각각 위유암종 및 위선종임을 확진한 후 내시경적 용종 절제술로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body. These tumors are composed of variable numbers of cells that contain endocrine granules in their cytoplasm, which can be identified by immunohistochemistry and electron microscopy. Gastric carcinoid tumors are relatively rare tumor, the reported incidence being 1.9~2.2% of all carcinoid tumors and less than 1% of all gastric tumors. Sometimes, composite carcinoid tumors and adenocarcinoma is reported. We experienced a case of the coincidence of carcinoid tumor and adenoma at the other site of the stomach in a 70 year old male patient. Gastrofiberscope showed 0.4×0.4 cm sized Yamada type I polyp with central depression on the greater curvature of the proximal body and 0.8×0.5 cm sized focal slightly elevated mucosa on the anterior wall of the antrum. The endoscopic biopsy specimens revealed carcinoid tumor and tubular adenoma with moderate atypism, respectively. The carcinoid tumor and adenoma were removed by endoscopic polypectomy. According to the follow-up gastrofiberoscopy after 7 month later, both lesions were nearly normal mucosa except whitish atrophic change after polypectomy.