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증례 : 류마티스 ; 만성 통풍결절 환자에서 발생한 위장관 아밀로이드증 1예
김세현 ( Sei Hyun Kim ),윤규현 ( Kyu Hyun Yoon ),한우진 ( Woo Jin Han ),한재준 ( Jae Jun Han ),최효진 ( Hyo Jin Choi ),백한주 ( Han Joo Baek ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4
저자 등은 체중감소, 구역, 구토, 설사, 손발의 종창으로 내원한 70세 만성 결절통풍 환자에서 발생한 이차성 위장관 아밀로이드증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. 통풍 환자에서 아밀로이드증의 발생은 매우 드물지만, 조절되지 않은 만성 통풍결절 관절염 환자에서 지속적인 설사, 저알부민혈증이나 부종이 있는 경우 감별 진단으로 고려되어야 할 것으로 여겨진다. Secondary amyloidosis is associated with infectious, inflammatory, or neoplastic disorders. Gouty arthritis, unlike other forms of chronic inflammatory arthritis, is not usually associated with amyloidosis. A 70-year-old man was admitted because of generalized edema, anorexia, and diarrhea. He had been diagnosed with gouty arthritis 12 years earlier and took over-the-counter medication during acute attacks. The physical examination revealed multiple tophi on his ears, right hand, and right foot. No evidence of amyloidosis involving the heart or bone marrow was detected. Biopsy of the antrum, duodenum, ileum, and descending colon showed green birefringence with Congo red stain. Immunohistochemistry was strongly positive for amyloid A. We diagnosed him as having secondary gastrointestinal amyloidosis AA with chronic tophaceous gouty arthritis. Allopurinol was administered and oral prednisolone was increased. However, he died from septic shock 25 days after admission. (Korean J Med 77:531-535, 2009)
골에서 발생한 거대세포종에 특이한 Neutral Ribonuclease의 작용기전에 관한 연구
김성준,김세현,최일용,고재경 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.2
To clarify a role of ribonuclease (RNase) in tumorigenesis for giant cell tumor of bone, a RNase isozyme activated in the tumor tissue was separated, and substrate specificity and mode of action of the isozyme were investigated. Activities of RNase and RNase inhibitor in giant cell tumor tissue of bone showed the highest value with poly C as substrate and lower value with RNA or poly A as substrate. Irrespective of substrate used, RNase and RNase inhibitor activities were markedly increased in the giant cell tumor tissue of bone as compared with those in the control bone tissue, and the positive rate of RNase and RNase inhibitor activities as marker for giant cell tumor were higher, suggesting the possible use of RNase and RNase inhibitor as a biochemical marker for giant cell tumor of bone. RNases in giant cell tumor tissue of bone were separated by a DEAE-cellulose column chromtography into 6 isozymes, of which the RNase isozyme V was greatly increased to be activated. The activated RNase isozyme V exhibited higher activity toward poly C than RNA as substrate, indicating the secretory type of enzyme. The RNase isozyme V hydrolyzed linkages of C-C, A-C and A-U with higher activity and the inhibitor activity complexed with the RNase isozme V was increased markedly. These results indicated that the RNase isozyme V was activated and exhibited to be secretory type of enzyme. Majority of hydrolytic products of poly C by the RNase isozyme V appeared to be oligoribonucleotides, suggesting the isozyme V as an endoribonclease. The present study revealed that the RNase isozyme V was activated and was secretory type of enzyme. The activity of the RNase inhibitor associated with the RNase isozyme V was increased and the isozyme was an endoribonuclease in nature, highly active toward the linkages of C-C, A-C and A-U of ss-polyribonucleotide, suggesting a possible action of the isozyme for suppression of the giant cell tumor of bone.