Cytochrome P450 2E1 유전자의 다형성이 알코올성 간경변증 환자의 간손상에 미치는 영향

고문수(Moon Soo Koh),이정열(Jeong Yeol Lee),주민하(Min Ha Joo),전만조(Man Jo Jeon),노희종(Hee Jong Noh),김진봉(Jin Bong Kim),김동준(Dong Jun Kim),김정아(Jung A Kim),정영화(Young Hwa Chung) 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Background : There is an individual variation in the hepatic injuries following alcohol abuse, which may be partly caused by the diverse activities of enzymes participating in the degradation of alcohol. Polymorphism of cytochrome P450 2E1 (CYP2E1) gene has been reported to affect the degradating activity of the enzyme, which may be eventually associated with the severity of alcoholic liver disease. In this study we were to evaluate the effects of genetic polymorphism of CYP2E1 on hepatocellular injury or fibrosis. Methods : We analyzed the relationship of CYP2E1 genotypes to the biochemical and clinical characteristics as well as TGFβ1 expressions in a total of 33 patients (M:F=32:1) with advanced alcoholic liver cirrhosis. CYP2E1 genotypes were determined by RFLP using RsaI and PstI. The amounts of serum TGFβ1 were measured by ELISA (TGFβ1 ELISA system, Promega, USA). Results : Out of 33, 23 (70%) had the CYP2E1 of genotype A and all of the remaining 10 (30%) were type B; there was no one who had type C. The serum albumin levels of patients with type A of CYP2E1 gene were lower than those with type B (p=0.01); the Child-Pugh scores were also higher in patients with type A than B (p=0.03). However, there was no difference between the two groups in the serum AST, ALT, γ-GTP and bilirubin levels. The patients expressed similar amount of serum TGFβ1 regardless of their CYP2E1 genotypes. Conclusion : Our data indicates that the most common genotype of CYP2E1 is type A (70%) in patients with advanced alcoholic liver cirrhosis in Korea. It is also suggested that patients with genotype A of CYP2E1 may be associated with more advanced alcoholic liver cirrhosis compared to those with type B.(Korean J Med 60:222-227, 2001)

폐쇄성 황달을 동반한 간세포암 환자에서 담관조영소견의 분석

송일한(Il Han Song),고문수(Moon Soo Koh),최호순(Ho Soon Choi),이성구(Sung Koo Lee),정영화(Young Hwa Chung),김명환(Myung Hwan Kim),이영상(Yung Sang Lee),서동진(Dong Jin Suh),민영일(Young Il Min) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: Jaundice is present in 19-44% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The mechanisms of jaundice are associated with cirrhosis, tumor infiltration into the hepatic parenchyma, and bile duct obstruction. Causes of obstructive jaundice secondary to bile duct obstruction in HCC are bile duct invasion of tumor, tumor thrombi, blood clot of hemobilia, and direct bile duct compression of tumor or metastatic lymph n3e. Methods: To evaluate levels and causes of bile duct obstruction in HCC patients with obstructive jaundice and to assess its survival according to causes of obstructive jaundice, we performed retrospective study, from March 1992 to June 1994, with HCC patients with obstnictive jaundice who under- went endoscopic retrograde cholangogiraphy and/or percutaneous transhepatic cholangiography. Results: The commonest level of bile duct obstruction was common hepatic duct(35.3%), followed by common bile duct(23.5%). The causes of obstruction type were tumor invasion(58.8%), tumor thromhi(29.4%), blood clot with hemobilia(5.97o), and bile duct compression hy tumor (5.9%), in order. The level of bile duct obstruction in most cases of tumor invasion was common hepatic duct while in cases of tumor thrombi, common bile duct was the frequent site. There v:as no difference in levels and types of bile duct obstruction according to tumor types of HCC. The su.rvival period of patients with tumor thrombi was significantly longer than that of patients with bile duct invasion(p0.05). Conclusions; HCC involving bile duct will be found frequently with increased use of direct cholangiograpy. The commonest type of bile duct obstruction in HC'C was duct invasion, so aggressive and adequate treatment for HCC may be useful in management of bile duct obstruction. (Korean J Gastroenterol 1996;28: 101 - 110)

관동맥의 내피세포의존성 혈관이완에 대한 마그네슘의 영향

송재관(Jae Kwan Song),고문수(Moon Soo Koh),염광섭(Kwang Seoup Yeoum),이진오(Jhin Oh Lee),강태웅(Tae Woong Kang),서정돈(Jung Don Seo),이영우(Young Woo Lee),서석효(Suk Hyo Suh),김기환(Ki Whan Kim) 대한내과학회 1990 대한내과학회지 Vol.39 No.4

N/A After the historical discovery of a soluble vasodilating substance from the vascular endothelium (endothelium-derived relaxing factor, EDRF), impaired EDRF-mediated vasorelaxation is discussed as one of the main pathogenic mechanisms of coronary artery spasm. Recently, some clinical reports that hypomagnesemia may be implicated in the induction of coronary artery spasm were presented, although there are controversial reports on the effects of the extracellular magnesium ion on endothelium-dependent vasorelaxation. Isometric contraction-relaxation was recorded in the transverse strips of porcine coronary artery to clarify the exact effects of Mg2+ on tension-development by a vasoconstrictor agent and on endothelium-dependent vasorelaxation and to predict a possible mechanism of hypomagnesemia in the induction of coronary artery spasm. The results of our study were as follows: 1) Vasoconstrictor activity of PGF2α was significantly more attenuated in the endothelium-intact transverse strips of porcine coronary artery than in the endothelium-denuded strips. 2) Lowering the magnesium concentration enhanced the vasoconstrictor activity of PGF2α while a marked reduction of isometric tension was observed with the elevation of magnesium concentration. 3) Bradykinin-induced endothelium-dependent vasorelaxation is a dose-dependent manner which was completely abolished with the pretreatment of hemoglobin. 4) Endothelium-dependent vasorelaxation of bradykinin was markedly inhibited by lowering the extracellular calcium ion concentration. 5) Change of the extracellular magnesium ion concentration did not alter the IC50 (inhibitory concentration of bradykinin causing a 50% inhibition of the maximum contraction) values of bradykinin-induced endothelium dependent vasorelaxation. From these results it is concluded that if magnesium deficiency is implicated in the induction of coronary artery spasm, the main mechanism would be direct enhancement of responsiveness of the vascular smooth muscle to the vasoconstrictors. Further study with a bioassay system and more various stimulators of EDRF secretion is necessary for exact clarification of the effects of Mg2+ on endothelium-dependent vasorelaxation.

B형 간염 예방접종 효율에 관한 연구 - 한 농촌지역에서의 혈청학적 표지자에 대한 분석

송관욱(Kwan Uk Song),김훈(Hun Kim),고문수(Moon Soo Koh),장웅기(Woong Ki Chang),김동준(Dong Jun Kim),박충기(Choong Kee Park),유재영(Jae Young Yoo),최보율(Bo Yool Choi) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

N/A Background : The objectives of this study are to determine the positive rate of HBV serologic markers and infection rate, and to evaluate the efficiency of hepatitis B vaccination. Methods : Study subjects included 905 persons in 1988-1989 and 744 persons in 1993-1994 living in typical rural communities in Korea. Three serologic markers(HBsAg, anti-HBs, anti-HBc) were tested by radio-immunoassay(RIA). Supplemental informations were collected by self-administered questionnaire and interview on age, sex, history and frequency of vaccination. Results : 1) Among non-vaccinees, HBsAg, anti-HBs, anti-HBc positive rates and infection rate in 1993-1994/1988-1989 were 5.4%/6.5%, 49.1%/45.9%, 48.3%/44.1% and 60.6%/54.5% respectively. The infection rate showed a trend of continuous increase as the age increased, while statistically significant increase was seen over age 20. 2) Overall vaccination rate was 18.1% in 1988-1989 and 37.9% in 1993-1994, showing statistically significant increase in vaccination rate. The rate in younger age groups were higher than in older groups in 1988-1989, but there was no difference by age groups in 1993-1994. Among vaccinees, anti-HBs only positive group occupied 42.7% in 1988-1989 and 41.3% in 1993-1994. HBs Ag negative and anti-HBc positive group occupied 26.2% in 1988-1989 and 36.73% in 1993-1994. Conclusion : 1) Among non-vaccinees, HBsAg positive rate was decreased, but the hepatitis B infection rate was not decreased. 2) The test for selection of eligible person of vaccination and education program for completion of vaccination schedule must be reevaluated to improve the efficiency of hepatitis B vaccination. (Korean J Med 57:994-1005, 1999)

주문맥침범이나 원격전이가 있는 간세포암 환자에서 Cisplatin 간동맥투여 및 전신적 알파인터페론 병합요법의 효과

송일한(Il Han Song),정영화(Young Hwa Chung),고문수(Moon Soo Koh),이영상(Yung Sang Lee),이문규(Mun Gyu Lee),성규보(Kyu Bo Sung),오용호(Yong Ho Aoh),서동진(Dong Jin Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

N/A Objectives: Hepatocellular cearcinoma(HCC) patients presenting with vascular involvement or extrahepatic metastasis are usually contraindicated to surgery or chemoebolization, and median survival of those has been reported to be only a few weeks. Recent several studies suggested that certain chemotherapeutic agent or recombinant interferonalpha(rIFN-α) may be useful in a proportion of patients with inoperable HCC. Methods: To evaluate the effect of intraarterial cisplatin infusion and systemic rlFN-α in the treatment of HCC, 68 HCC patients with major portal vein thrombosis or distant metastasis were randomized to three groups: group A(n=19) treated with cisplatin and rIFN-α, group B(n-23) with cisplatin and group C(n=26) with supportive care only. Cisplatin of 2mg/kg body weight was infused transarterially every 8weeks and rIFN-α of 3×10(6) IU/m2 Bady Surface area was administered subcutaneously three times per week. Patients with severe hepatic decompensation(serum bilirubin>3.0 mg/dL, albumin<3.0g/L, prothrombin time<60%), hypersplenism(peripoheral WBC count <3,000/mm3, platelet count<40,000/mm3), uncontrolled ascites, active gastrointerstinal bleeding, cardiac or renal dysfunction were excluded in this study. The effects of therapy were assessed by the changes of tumor size and durations of survival. Results: The partial response rate assessed by the change of tumor size in group A was significantly higher than that in group B(33 vs 14%: p<0.05). 1 year survival rate of group A (27%) was also significantly higher than that of group B (9%) or C (0%) (p<0.05, p<0.01, respectively). Furthermore, median survival period of group A (19weeks) was significantly longer than that of group B(11weeks) or C(5weeks) (p<0.05, p<0.01, resectively). Side effects of combined therapy were flu-like symptoms, gastrointestinal upset, transient elevation of serum creatinine or ALT level, leukopenia, thrombocytopenia, and oral ulcer. However, these were transient and well tolerated by all of the patients. Conclusion. These data suggest that combined therapy of intraarterial cisplatin infusion and systemic rIFN-α administration may be useful in the treatment of HCC patients with major portal vein thrombosis or distant metastasis, in terms of tumor response or prolonging survival period.

투석식 초여과를 이용한 간경변 환자에서의 저항성 복수의 조절

한상진(Sang Jin Han),정의훈(Eui Hun Jeong),백광호(Gwang Ho Baik),윤동석(Dong Seok Yoon),김명빈(Myung Bin Kim),고문수(Moon Soo Koh),구자룡(Ja Ryong Koo),장웅기(Ung Ki Jang),김동준(Dong Jun Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.5

N/A Background: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. Methods: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. Results: The mean ultrafiltration time was 231±28min, ultrafiltrated volume was 5.15±1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5±23.7㎎/dL to 25.7±20.2㎎/dL; serum aldosterone level decreased from 807.3±301.1pg/ml to 431.1±187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67±0.28g/dL to 1.90±1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. Conclusion: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.

돌막창자 병변에 대한 추가 검사와 돌막창자판막 병변과의 상관관계

남지형 ( Ji Hyung Nam ),김재학 ( Jae Hak Kim ),이종호 ( Jong Ho Lee ),최종순 ( Jong Sun Choi ),박정배 ( Jeong Bae Park ),이준규 ( Jun Kyu Lee ),임윤정 ( Yun Jeong Lim ),고문수 ( Moon Soo Koh ),이진호 ( Jin Ho Lee ) 대한장연구학회 2008 Intestinal Research Vol.6 No.2

Background/Aims: The diagnostic value of terminal ileum (TI) biopsies during colonoscopy remains controversial. This study assessed the clinical characteristics of terminal ileal lesions during colonoscopy to find the affecting factors for the specific investigations in addition to TI biopsies. Methods: Thirty-seven patients (male to female ratio of 1.6, mean age 42.2±12.2 years, range 20-68 years) who had undergone colonoscopy with biopsies of TI at Dongguk University International Hospital from September 2005 to December 2007 were retrospectively studied. We analyzed the characteristics of patients, endoscopic and histopathologic findings, followed by multivariate analysis of those significant variables. Results: Ulcerative lesions were most frequently found in 17 cases (45.9%) and multiple lesions were observed in eight cases (21.6%). Aphthoid shape was evident in 19 cases (51.4%). Eight cases (21.6%) were combined with ileocecal valve (ICV) lesion. On histopathologic examination, nonspecific inflammation was evident in 19 cases (51.4%). The diagnostic yield of TI biopsies was 5.4%. Presence of ICV lesion (p=0.004) and multiple lesions (p=0.027) were associated with clinically significant TI lesion. By multivariate analysis, only ICV lesion was statistically significant (Odds ratio 8.3: 95% confidence interval 1.3-54.1, p=0.026). Conclusions: Not all patients who undergo colonoscopy require intubation of TI. However, a careful examination of ICV could be useful to determine whether intubation of TI would be necessary or not. (Intest Res 2008;6:121-127)

우리나라 담석증의 역학에 관한 연구 ; 전국적 다기관 협동 조사 성적

김명환 ( Myung Hwan Kim ),오희철 ( Hee Choul Ohrr ),정재복 ( Jae Bock Chung ),김창덕 ( Chang Duck Kim ),강진경 ( Jin Kyung Kang ),고문수 ( Moon Soo Koh ),김남재 ( Nam Jae Kim ),김대곤 ( Dae Ghon Kim ),김성국 ( Sung Kook Kim ),김 대한소화기학회 1999 대한소화기학회지 Vol.32 No.5

Background/Aims: To understand the epidemiologic characteristics of gallstone disease in Korea and to evaluate the chronological changes of gallstone disease, the authors performed this prospective nationwide cooperative study. Methods: The subjects were 1,263 patients with gallstone. They were hospitalized at 19 hospitals in Korea from February to July, 1997. The study protocals were recorded on 1,263 patients and gallstones were removed from 1,133 patients and their chemical compositions were analyzed. Results: Among total patients with gallstone, the proportions of patients with gallbladder, common bile duct (CBD) and intrahepatic duct (IHD) stones were 64.0%, 21.9%, and 14.1%, respectively. Male to female ratio was 1 versus 1.3. The gallbladder stones were categorized as cholesterol (58.1%), black pigment (25.2%) and brown pigment (12.1%) stones. The CBD stones were classified into brown pigment (76.1% ), cholesterol (18.4%) and black pigment (3.5%) stones.

염증성 장질환 환자들의 외래 방문 순응도와 치료 약제와의 상관 관계

강윤성 ( Yun Seong Kang ),김소영 ( So Young Kim ),조민호 ( Min Ho Jo ),강현우 ( Hyoun Woo Kang ),이준규 ( Jun Kyu Lee ),임윤정 ( Yun Jeong Lim ),고문수 ( Moon Soo Koh ),이진호 ( Jin Ho Lee ),양창헌 ( Chang Hun Yang ),김재학 ( Jae 대한소화기학회 2013 대한소화기학회지 Vol.61 No.6

증례 : 소화기 ; Fitz-Hugh-Curtis 증후군: 드물지 않은 질환

남지형 ( Ji Hyung Nam ),박정배 ( Jeong Bae Park ),김순애 ( Soon Ae Kim ),김말영 ( Mal Young Kim ),강봉균 ( Bong Kyun Kang ),이진호 ( Jin Ho Lee ),고문수 ( Moon Soo Koh ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

Fitz-Hugh-Curtis (FHC) 증후군은 골반내감염과 연관되어 발생하는 심한 우상복부 통증을 특징으로 하는 간주위염으로 국내의 골반내감염 환자의 증가에 따라 드물지 않게 발생하지만 급성 담낭염 등의 급성 복증과 감별이 어려울 수 있다. 저자들은 복통을 주소로 내원하여 FHC 증후군으로 진단된 8명의 환자를 경험하였다. 젊은 여성에서 우상복부 통증이 있을 경우 감별진단의 하나로 FHC 증후군을 고려하여야 하며, 나선식 전산화단층촬영이 진단에 유용하겠다. Fitz-Hugh-Curtis (FHC) syndrome is hepatitis characterized by severe right upper abdominal pain associated with pelvic inflammatory disease (PID), mimicking the symptoms of acute abdomen, such as in acute cholecystitis. FHC syndrome is becoming more common with the increasing incidence of PID in Korea. We treated eight patients with FHC syndrome, who visited our hospital with right upper quadrant abdominal pain. We emphasize the importance of spiral computed tomography (CT) in the diagnosis of right upper quadrant abdominal pain in sexually active young women. (Korean J Med 77:91-94, 2009)