만성 혈액투석 환자에서의 대사성 산혈증과 음이온차의 양상

손정일(Chong Il Sohn),김병훈(Byoung Hun Kim),신진호(Jin Ho Shin),양석철(Suck Chul Yang),박용수(Yong Soo Park),한동수(Dong Soo Han),안명주(Myung Ju Ahn),손주현(Ju Hyun Sohn),이인홍(In Hong Lee),김순길(Soon Kil Kim),이정희(Jung Hee Lee 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Objectives: The aim of the present study is to evaluate the prevalence of the various patterns of metabolic acidosis and anion gap among chronic hemodyalysis patients. Methods: Analysis of predialysis arterial blood gases and anion gap patterns was performed in 67 stable chronic outpatient hemodialysis patients(>1 year) with acetate buffer. Blood samples were drawn from the arterial line of the atreriovenous fistula for determination of blood electrolytes, chemistries, and analysis of blood gases at the beginning of hemodyalysis. Results: The degree of metabolic acidosis was mild to moderate with mean pH 7.33±0.039. 82% of a total 67 patients had pH between 7.30 and 7.39 with 18% of them between 7.20 and 7.29. Simple as mixed metabolic acidosis was shown in 49 of 67 patients(73%) and 18 of 67 patients(27%), respectively. In comparison of both groups, the group with mixed metabolic acidosis had significantly lower pH(7.29±0.04 vs 7.34±0.03, p<0.001) with higher pCO₂(38.5±3.4, p<0.005) and anion gap(19.6±4.1 vs 17.6±2.9, p<0.05). The classical high anion gap of end stage renal disease (range, 16 to 29 mEq/L) was also noted in 20 of 67 patients(30%). The linear regression analysis between anion gaps and total serum carbon dioxide contents (TCO₂) didn't show any significant correlation in all patients as well as the two subdivided groups with high and normal anion gap. Furthermore, only 13 of 67 patients(20%) were included between 80 and 120% in the ratio of delta anion gap(ΔAG) over delta TCO₂(dTCO₂). Therefore, the majority of hemodialysis patients (80%) showed the discrepancy between the degrees of d AG and ΔTCO₂. The analysis of unmeasured cations(K, Ca) and anions(albumin, phosphate) in the calculation of anion gap(Na ?Cl ?HCO₃) between two groups of high and normal anion gap of all patients as well as 49 patients of simple metabolic acidosis didn't reveal any discernible contributions to the changes of anion gap. Conclusion- This study therefore showed that the mixed acid-base balance and normal anion gap metabolic acidosis is not an exception in chronic stable hemodialysis patients. Also, the impact of hemodialysis in end stage renal disease patients seemed to lead the changes in values of unidentified anions besides fixed mineral acids and/or in those of unrecognized ionic equivalents of plasma constituents.

심한 호산구 증가증을 동반한 류마티스 관절염 1예

손정일 ( Chong Il Sohn ),김명곤 ( Myeong Kon Kim ),이기창 ( Kee Chang Lee ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ),정화순 ( Wha Soon Chung ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

호산구 증가증의 원인은 기생충 감염, 알레르기, 약제, 교원성 질환, idiopatic hypereosinophilic syndrme 등에서 나타나며 류마티스 관절염에서는 약 10%의 환자에서 호산구 증가증을 보인다고 한다. 류마티스 질환에서 호산구 증가증은 류마티스 관절염, 다발성 동맥염 및 혈관염, 유육종증 둥과 연관되고 idiopathic hypereosinophilc syndrme이나 골수 증식성 질환, 호산구성 백혈병 등과 감별을 요하며 집중적으로 추적 관찰해야 한다. 저자들은 53세 여자 환자에서 지속적이고, 심한 호산구 증가증이 동반된 류마티스 관절염 환자를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Eosinophilia is usually accompanied by parasite infestation, allergic condition, drug, collagen disease, and idiopathic hypereosinophilic syndrome. In about 10 to 40% of rheumatoid arthritis patients, peripheral blood reveals eosinophilia. Of the rheumatic disease, eosinophilia may occur in rheumatoid arthritis, sarcoidosis, polyarteritis nodosa and other vascultis. Patient with eosinophilia must be carefully followed up due to possibility of progression to eosinophilic leukemia or myeloproliferative disease. We experienced a case of rheumatoid arthritis with severe eosinophilia for a period of more than one year in a 53 year-old female patient, eosinophil more than 85% in the peripheral blood, but in spite of careful laboratory study, there was no evidence of parasite infestation, allergic disease and malignant condition that may cause eosinophilia. Therefore we concluded that her severe eosinophilia was associated with rheumatoid arthritis itself, and now she is intensively followed up at the outpatient department. We have to look for any malignant transformation during her clinical course. Marked eosinophilia associated with rheumatoid arthritis is very rare, so we report this case with a review of literatures.

이중풍선 소장내시경으로 진단한 Meckel 게실

박정호 ( Jung Ho Park ),손정일 ( Chong Il Sohn ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.1

기능성 소화불량의 증상 발현인자로서 스트레스의 의미

김정욱 ( Jung Wook Kim ),김시영 ( Si Young Kim ),김창섭 ( Chang Sup Kim ),이준행 ( Jun Haeng Lee ),조용균 ( Yong Kyun Cho ),박창영 ( Chang Young Park ),손정일 ( Chong Il Sohn ),전우규 ( Woo Kyu Jeon ),김병익 ( Byung Ik Kim ),정을 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

N/A Pathogenesis of functional dyspepsia consists of motor abnormality, sensory abnormality, and psychologic abnormality. Anxiety, depression, and psychosomatic disorders are well known psychopathologies that lead to dyspepsia, and stress seems to be an additional etiology. The aim of this study is to assess whether stress can cause and/or provoke dyspepsia. Methods: Functional dyspepsia was defined and classified by Rome criteria. SCL-90-R for the detection of psychopathology, measurement of life stress scale by self-administered questionnaire, and measurement of stress coping mechanisms using a multidimensional stress coping scale test were performed in 79 functional dyspeptic patients and 25 normal controls. Results: No significant difference was found in the total amount of stress between functional dyspeptic patients and the normal control. However, the patients were more stressful about issues relating to health and marital relationship among stresses in individual daily life. As the patients become more stressful, they used more negative copingmechanisms such as restraint, fatalism, criticism, religiousness, and negativism. These seem to provoke several psychopathologies including interpersonal sensitivity, depression, anxiety, hostility. However, there was no relationship in the amount of stress, the stress coping mechanism, and psychopathology among the dyspeptic symptoms and subgroups of functional dyspepsia. Conclusion: There was no difference in the total amount of stress between functional dyspeptic patients and the normal control. In some individuals who utilize inadequate coping mechanisms against stress, the stress can provoke dyspepsia. (Kor ean J our nal of Gastr ointestinal Motility 2002;8:146-152)

위장암 : 대장암에서 HER-2/neu 발현에 관한 연구

박동일 ( Dong Il Park ),오석중 ( Suk Joong Oh ),박승하 ( Seung Ha Park ),윤중원 ( Jung Won Yun ),김홍주 ( Hong Joo Kim ),조용균 ( Yong Kyun Cho ),성인경 ( In Kyung Sung ),손정일 ( Chong Il Sohn ),전우규 ( Woo Kyu Jeon ),김병익 ( B 대한소화기학회 2004 대한소화기학회지 Vol.44 No.3

목적: HER-2/neu 단백은 상피성장인자 수용체와 구조가 거의 일치하기 때문에 정상 세포의 성장과 증식 과정에 관여한다. 유방암에서 HER-2/neu의 과발현은 나쁜 생존율을 예상할 수 있는 예후인자일 뿐 아니라 항암화학요법이나 호르몬요법에 잘 반응하지 않는 등 치료에 대한 반응을 예측할 수 있는 인자이며 HER-2/neu에 대한 단일클론 항체인 Herceptin(R)은 림프절에 전이된 유방암 환자에서 장기 생존율을 향상시켜 임상에서 활발히 사용되고 Background/Aims: The HER-2/neu protein is involved in normal cell proliferation and tissue growth because it is extensively homologous and related to epidermal growth factor receptor. As a prognostic marker, HER-2/neu is used to forecast the clinical cour

Mongolian gerbil에서 Helicobacter pylori 감염 후 발생되는 Microsatellite Instability에 관한 연구

박동일 ( Dong Il Park ),김민경 ( Min Kyung Kim ),김재준 ( Jae J. Kim ),유태우 ( Tae Woo Yoo ),박정호 ( Jung Ho Park ),김홍주 ( Hong Joo Kim ),조용균 ( Yong Kyun Cho ),손정일 ( Chung Il Sohn ),전우규 ( Woo Kyu Jeon ),김병익 ( Byung 대한내과학회 2006 대한내과학회지 Vol.71 No.1

목적: H. pylori (HP) 감염성 위염에서 HP는 DNA 손상복구기능에 장애를 유발하여 위 상피세포의 유전자에 발생하는 돌연변이를 축적시켜 위암의 발생 위험을 증가시킬 수 있다. 본 연구는 Mongolian gerbil (MG)animal model을 이용한 in vivo 실험에서 만성적인 HP감염이 위 점막의 MSI를 발생시키는 지 알아보고자 하였다. 방법: 7주된 수컷 MG에 HP CA20 균주를 감염시킨 후 일정한 시점마다 동물을 희생시켜 위를 절제하였다. 위염부위의 위 상피를 미세박리하여 DNA를 추출한 후 Fam이나 Hex로 표지시킨 다섯 가지 gerbil MSI marker를 이용하여 중합효소연쇄반응을 실시한 후 310 genetic analyzer를 이용하여 MSI 분석을 시행하였다. 결과: MSI는 정상부위(식도)에서는 관찰되지 않았고, 위염이 없는 부위에 비해 위염부위에서 빈번히 관찰되었다(p<0.05). 위염부위 중 6예에서는 low level MSI를 1예에서는 high level MSI를 관찰하였다(p<0.05). 결론: 본 연구로 MG에서 만성적인 HP 감염이 MSI유발에 관여함을 입증하였다. 이와 같이 HP는 위상피세포내의 DNA mismatch repair 단백 발현을 저하시켜 위상피세포 유전자에 발생하는 돌연변이의 축적을 유발할 수 있을 것으로 생각한다. Background: During Helicobacter pylori (HP) gastritis, the organisms cause an impairment of DNA repair that results in accumulation of mutations in the genome of epithelial cells and an increased risk of gastric carcinoma. The aim of this study was to determine whether microsatellite instability (MSI) could be induced by chronic HP infection in the Mongolian gerbil model. Methods: Seven-weeks old, specific pathogen-free male Mongolian gerbils were infected with the HP strain CA20. They were sacrificed at the each time points (1, 2, 3, 6, 9, 12 months). Areas of gastritis were carefully microdissected. DNA from tissues was analyzed for the presence of MSI by genomic DNA amplification with five gerbil microsatellite markers per sample. Gerbil markers labelled with Fam or Hex were obtained to perform MSI analysis using the 310 Genetic Analyzer. Results: MSI was more frequent in the area of gastritis than in that of normal (p<0.05). Six showed MSI-low and one showed MSI-high within the area of gastritis (p<0.05). Conclusions: This study shows that chronic HP infection in the Mongolian gerbil induces MSI. This finding indicates that HP infection causes a decrease in DNA MMR proteins in epithelial cells of the stomach that may reach critically low levels, allowing for the accumulation of mutations such as those seen in microsatellite regions.(Korean J Med 71:17-23, 2006)

44 이전 내시경 검사상 간과된 진행성 위암의 내시경 및 임상 소견

신헌섭 ( Hun Sub Shin ),손정일 ( Chong Il Sohn ),김병익 ( Byeong Ik Kim ),전우규 ( Woo Gyu Jeon ),박창영 ( Chang Young Park ),조용균 ( Young Kyun Cho ),이준행 ( Jun Haeng Lee ),김정욱 ( Jung Wook Kim ) 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-

활동성 궤양성 대장염 환자에 있어서 도플러 초음파의 유용성

정수석(Soo Suk Jung),조용균(Yong Kyun Cho),박정식(Jeong Sik Park),김시영(Si Young Kim),김창섭(Chang Seop Kim),손정일(Chung Il Sohn),박창영(Chang Young Park),김병익(Byung Ik Kim),정을순(Eul Soon Jung),박해원(Hae Won Park),전우규(Woo K 대한소화기학회 2002 대한소화기학회지 Vol.39 No.3

Background/Aims : An increase in splanchnic blood flow in both artery and vein has been observed in activeulcerative colitis (UC). Doppler ultrasonography (US) is a non-invasive evaluation method of splanchnic arterialinflow in superior mesenteric artery (SMA). This study was undertaken to assess the usefulness of Doppler Usin detecting changes of the hemodynamic variables in patients with UC. Methods: Twenty-two patients with UC(14, active UC; 8, inactive UC) were studied, and compared with 14 matched healthy subj ects. Flow velocity,resistance index (RI), and pulsatile index (PI) of the SMA were evaluated by Doppler US. Results: Peaksystolic velocity was significantly higher in patients with active UC than in patients with inactive UC and control (178±53 m/sec vs. 117±15 m/ sec, 111±24 m/ sec; p<0.05). The PI of SMA was significantly lower inpatients with active and inactive UC than in control (1.58±0.53, 1.7±0.52 vs. 2.9±0.44; p<0.05). Minimaldiastolic velocity and RI of the SMA were not significantly different among three groups. Conclusions: Peaksystolic velocity of SMA reflects the activity of the disease in patients with UC. Doppler US in patients with UC is an important non-invasive, readily available method to evaluate the activity of the disease and predict itsrecurrence. (Korean J Gastroenterol 2002;39 :192-197)

복부팽만을 주소로 내원한 의인성 거대결장

황상준 ( Sang Jun Hwang ),손정일 ( Chong Il Sohn ),최효선 ( Hyo Sun Choi ),박정식 ( Jung Sik Park ),박정호 ( Jung Ho Park ),김홍주 ( Hong Joo Kim ),박동일 ( Dong Il Park ),조용균 ( Yong Kyun Cho ),전우규 ( Woo Kyu Jeon ),김병익 ( 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

Although only a few of the patients with severe or intractable constipation become candidates for surgical intervention, various surgical procedures for constipation have been developed since the beginning of the 20th century. The most widely accepted surgical procedure for slow transit constipation is currentlya total colectomy with either ileosigmoidal or ileorectal anastomosis. However, various surgical procedures have been tried until now and end-to-end ileosigmoidostomy with exclusion of the entire colon is one of the bypass surgeries. We present here a case of iatrogenic megacolon that presented with abdominal distension as a long term complication of bypass surgery for a patient with severe constipation. (Kor J Neurogastroenterol Motil 2006;12:166-169)

국내 크론병 환자에서 위점막의 Bamboo Joint-Like Appearance에 관한 연구

강문수 ( Mun Su Kang ),박동일 ( Dong Il Park ),박정호 ( Jung Ho Park ),김홍주 ( Hong Joo Kim ),조용균 ( Yong Kyun Cho ),손정일 ( Chong Il Sohn ),전우규 ( Woo Kyu Jeon ),김병익 ( Byung Ik Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6

목적 : "Bamboo joint-like (BJL) appearance"는 규칙적인 미란이나 고랑이 가로지르는 위체부 소만부와 분문부의 종주하는 두꺼워진 점막 주름으로 크론병과 연관이 있다는 보고가 있어 왔다. 이번 연구에서는 국내 크론병 환자에서 BJL appearance의 발견율에 대해 알아보고자 하였다. 대상 및 방법: 본원에서 진단 받은 크론병 및 궤양성 대장염 환자에 대해 2005년 1월부터 12월까지 상부위장관내시경을 시행하였고, 같은 기간 상부위장관 증상으로 상부위장관 내시경 검사를 받은 비염증 장질환 환자를 순서대로 포함하였다. 검사자 간 차이를 줄이기 위해 모든 내시경 검사는 한명의 내시경의가 시행하였고, 미세 변화 관찰을 위해 0.4% 인디고카민액을 이용한 색소 내시경을 시행하였다. 결과: 21명의 크론병 환자(검사 당시 평균연령±표준편차; 40±15세, 남/여; 13/8), 28명의 궤양성 대장염 환자(42±15세, 21/7), 그리고 685명의 비염증 장질환 환자(49±14세, 354/331)가 포함되었다. 크론병 환자의 상부위장관내시경 소견으로는 미란위염이 52.4% (11/21)로 가장 많았고, 만성표재위염 23.8% (5/21), 만성위축위염 4.8% (1/21), 십이지장 미란이나 궤양 9.5% (2/21), 그리고 9.5% (2/21)는 정상이었다. BJL appearance는 크론병 환자의 47.6% (10/21)에서 발견되어 궤양성 대장염 환자(3.6%, 1.27)나 비염증 장질환 환자(0.1%, 1/685)보다 의미 있게 높은 발견율을 보였다(p<0.001). 크론병 환자에서 BJL appearance의 발견율은 성별, H. pylori 감염 상태, 비엔나 분류에 따른 표현형, 치료 약제, 혹은 상부 위장관 내시경 소견과는 차이가 없었다. 결론: 위체부와 분문부의 BJL appearance는 크론병 진단의 단서가 될 수 있다. Background/Aims: Bamboo joint-like (BJL) appearance is an endoscopic finding characterized by swollen longi­tudinal folds transversed by erosive fissures or linear furrows on the lesser curvature side of gastric body and cardia. It has been reported to be associated with Crohn`s disease (CD). This study was aimed to evaluate the incidence of BJL appearance in Korean patients with CD. Methods: From January to December in 2005, we performed esophagogastroduodenoscopy (EGD) in patients diagnosed as CD and ulcerative colitis (UC) in our hospital. Non-inflammatory bowel disease (IBD) subjects with upper gastrointestinal symptoms who underwent EGD were consecutively enrolled during the same period. One endoscopist performed all the endoscopic exami­nations to avoid inter-observer variation. A dye-spraying technique with 0.4% indigocarmine was used to allow the detection of subtle changes during the endoscopic examination. Results: A total of 21 patients with CD (mean age±SD, 40±15 yr; M/F, 13/8), 28 patients with UC (42±15 yr; 21/7), and 685 non-IBD subjects (49±14 yr; 354/331) were enrolled. EGD findings in CD patients were gastric erosions (11/21), chronic superficial gastritis (5/21), chronic atrophic gastritis (1/21), duodenal erosions or ulcers (2/21), and normal (2/21). Incidence of BJL appearance was significantly higher in patients with CD (47.6%, 10/21) than others (UC, 3.6%, 1/28; non- IBD, 0.1 %, 1/685) (p < 0.0001). Among patients with CD, incidence of BJL appearance was not significantly different according to the sex, status of H. pylori infection, Vienna classification for phenotype, medications or EGD findings. Conclusions: BJL appearance on the gastric body and cardia can be a diagnostic clue to CD. (Korean J Gastroenterol 2006;48:395-400)