고혈당증과 신적출 후 신증의 실험적 흰쥐 모형에서 신사구체의 형태계측학적 연구 - 사구체 경화증의 발달 과정과 기전에 관한 연구 -

심영웅 ( Young Woong Shim ),설미영 ( Mee Young Sol ),이경민 ( Kyeong Min Lee ),최경운 ( Kyung Un Choi ),김지연 ( Jee Yeon Kim ),이진숙 ( Jin Sook Lee ),박도윤 ( Do Youn Park ),이창훈 ( Chang Hoon Lee ),서강석 ( Kang Suek Suh ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

목적 : 당뇨병의 가장 흔한 합병증의 당뇨병성 신중에서 현저한 조직 변화인 사구체의 섬유화와 이와 유사한 조직 소견을 보이는 다른 질병들과의 관련성 및 섬유화 기전의 기전의 일단을 밝히기 위하여 연구를 시행하였다. 방 법 : 당뇨병성 신증과 신 조직 일부 소실 후 발생하는 신 적출 후 신증, 생리적 노령화로 인한 사구체 섬유화 등에서 섬유화가 일어나는 시기와 부위, 섬유화의 정도와 시간 경과에 따른 변화 등을 조사하기 위하여 실험 동물 모형을 이용하여 형태계측학적 연구를 하였다. 수컷 Sprague-Dowley (이하 S-D) 흰쥐에 streptozotocin을 꼬리 정맥으로 투여하여 당뇨병성 신증 모델을 만들고, S-D 백서의 우측 신장을 절제하여 과여과 모형을 만들었다. 시술 후 일정 기간이 지난 후 시기별로 희생시켜 Sirius red 염색 표본을 만들어 시구체 단면적과 실질의 섬유화 정도를 측정하고, 전자현미경으로 얻은 사구체 소견에서 메산지움 기질의 면적, 사구체 기저막의 두께, 근위우곡세뇨관 기저막의 두께 등을 조사하였다. 이들에서 질병 시기에 따른 변화, 두 실험군 사이의 차이, 정상 대조군 및 생리적 노화 대조군과의 차이 등을 분석하였다. 결 과 : 당뇨병성 신증 모델에서 사구체 단면적은 실험8주 이후 24주까지 전 예에서 정상 대조군에 비해 크기가 의의있게 증가하였고 신 실질과 사구체 내의 섬유화는 실험 2주 째부터 대조군에 비해 의의있는 교원질 양의 증가가 있었다. 사구체 기저막은 streptozotocin 투여 1주에 희생시킨 군에서도 의의있는 두께의 증가가 있었고, 세뇨관 기저막도 3주에 측정한 군에서부터 현저한 두께의 증가가 있었다. 우측신 절제를 시행한 모형에서 사구체 평면적은 실험 7주군에서 커진 소견이 나타났고 16주 이후의 군대에서는 현저한 크기의 증가 소견이 있었다. 신실질과 사구체의 교원질 염색 소견에서 2주 이후 전 기간에 걸쳐 교원질 양의 증가가 있었고, 사구체 기저막과 세뇨관 기저막 두께는 술 후 2주에 희생시킨 군부터 두께가 의의있게 증가하였다. 생리적 노화과정을 거친 군에서도 사구체의 섬유화가 나타났는데 당뇨병 모형과 신적출 모형에 비해 그 정도는 덜하였다. 당뇨병 모형과 신적출 모형 사이의 사구체 조직 변화는 실험 기간이 긴 군들에서 사구체 평면적의 크기, 교원질 양의 증가, GBM과 TBM의 두께 등이 두 군 모두 현저한 증가를 보였고 신적출 모형에서 실험 최종 기간이 같지 않아 실험 수치의 비교가 의미가 없을 것으로 생각된다. 결 론 : 이상의 성적에 의거하면 신사구체와 간질의 섬유화, GBM과 TBM의 두께 증가는 당뇨병성 신증만의 특징적인 조직 변화는 아니고 신 실질 일부 소실이 일어나는 사구체 질환에서 공통적으로 일어나는 소견이다. 그러므로 본 연구의 대상이 된 당뇨병성 신중, 신적출 후 신증, 그리고 생리적 노화 과정 등에서 공통적으로 나타나는 사구체 모세관의 혈역동학적 변화가 사구체의 섬유화에 병인기전을 밝히는데 중요한 요소가 될 것으로 사료된다. Objective :Diabetic nephropathy and ablation nephropathy are characterized by sclerotic processes in the glomeruli. To elucidate the site, degree and time-honored changes of glomerular sclerosis, morphometric analysis was performed using the experimental animals models. Methods : The animals used were male Sprague-Dowley rats and separated into 4 groups as young mormal control, old control, streptozotocin-injected group, and right nephrectornized group. Chronologically kidney specimens were obtained after each treatment and processed to evaluated histologic changes. To evaluated the glomerular area, interstitial fibrosis and glomerular tuft fibrosis, the kidney specimens were fixed in Buin`s solution, paraffin-embedded and 2 ㎛ sections were Sirius red stained. To study the mesangial area, mesangial matrix area, glomerular basement membrane, and tubular basement membrane, the specimens were fixed in 2,5% glutaraldehyde, epon-embedded, double-stained and examined under the transmission electron microscope. All the specimens were analyzed morphometrically using the Image Pro Plus software. The obtained morphometric data were statistically analyzed to evaluate the differences of fibrotic processes and degree between experimental groups. Results : Diabetic group revealed statistically significant increase of glomerular area from 8th week after streptozotocin injection to 24th week of experimental date. The parenchymal fibrosis and glomerular tuft fibrosis was prominent from the 2nd week of injection and steadily increased until the end of experimental date. The thickness of glomerular basement membrane was significantly increased even at the first week of injection and the tubular basement membrane also increased in thickness at the 3rd week of experiment. Ablation nephropathy model made by right nephrectomy showed increased glomerular area at the 7th week of ablation and the degree were intensified after 16th week of experimental date. The amount of stainable collagen in the renal parenchyme and glomerular tuft increased in the second week kidney sample and steadily increased thereafter until the end of experimental date. The increase of thickness of GBM and TBM also started to appear at the second week of operation. The old control also revealed fibrosis but the degree was less than the diabetic and ablation groups. Both diabetic and ablation nephropathy groups exhibited extensive increase of glomerular area, stainable collagen, thickness of GBM and TBM at the end of experimental date and the ablation group revealed more extensive evidences of fibrosis without statistical significance. Comparison between the experimental groups were meaningless because the duration of the experimental manipulation was not the same. Conclusion: Glomerular and renal interstitial sclerosis and thickening of GBM and TBM are not the specific lesions of the diabetic glomerulopathy and are the common histologic changes occur in the kidney of partial parenchymal loss of any etiology. And it is suggested by this study that the common hemodynamic change involving the diabetic nephropathy, ablation nephropathy and physiologic aging is one of the important pathogenetic factors of glomerular sclerosis.

임신중인 여성에서 발견된 Hepatoblastoma

심영웅(Young Woong Shim),이창환(Chang Hwan Lee),박성민(Sung Min Park),김춘섭(Chun Sup Kim),주기중(Kee Joong Ju),송갑영(Kap Young Song),서기식(Kee Sik Suh),최환주(Hwan Ju Choi) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

Hepatoblastoma is a distinctive tumor of the liver composed predominantly of hepatocytes of varying degree of maturity and occurs mostly in children under the age of 4 years. Hepatoblastoma in the adult is a very rare clinlcal entity. There is no reported hepatoblastoma in the adult in the Korean literature. The usual course of this disease in adults is one of a relavively rapid downhill course and the prognosis is extremely poor. We report a case of hepatoblastoma in a pregnant woman with a review of the literature.

급성신부전의 임상적 고찰 (pp.345-351)

나하연 ( Ha Yeon Rha ),심영웅 ( Young Woong Shim ),김연호 ( Yeon Ho Kim ),박형구 ( Hyung Gu Park ),김지원 ( Ji Won Kim ),이만재 ( Man Jae Lee ) 대한내과학회 1985 대한내과학회지 Vol.28 No.3

각종 간질환 및 수혈 경력 환자에서 C 형 간염 바이러스 항체의 발현 양상

박성민(Sung Min Park),주기중(Kee Joong Ju),이창환(Chang Hwan Lee),심영웅(Young Woong Shim),송갑영(Kap Young Song) 대한내과학회 1993 대한내과학회지 Vol.45 No.2

N/A Background: We studied the prevalence of Hepatitis C viruses in various liver diseases in Korea using recombinant viral antigen (C 100-3) to evaluate its etiological significance and routes of transmission. Methods: A total of 256 patients with chronic renal failure who experienced transfusion or hepatocellular disease were tested for serum HBsAg & Ab, HBcAb, Anti-HCV, AST, ALT and some were performed liver biosy for diagnostic purpose. The 46 cases of acute hepatitis, 78 cases of chronic hepatitis, 25 cases of liver cirrhosis, 30 cases of hepatocellular carcinoma, 15 cases of hemodyalysis patients, 62 cases of hepatitis B virus carrier were studied. Results: 1) There were 1.2% Anti-HCV positive patients among 256 cases. Among them there were 32.0% of liver cirrhosis, 16.7% of hepatocellular carcinoma, 20.0% of hemodialysis patients, 8.7% of acute hepatitis, 11.5% of chronic hepatitis, 4.8% of hepatitis B virus carrier (Table 1). 2) Among 184 cases of HBsAg positive patient, 20 cases (10.9%) were Anti-HCV positive and among 72 cases of HBsAg negative patients, 12 cases (16.7%) were Anti-HCV positive (Table 2, 3). 3) Among 32 cases of Anti-HCV positive patients, 20 cases (62.5%) were HBsAg positive and 12 cases were negative (Table 4). 4) Among Anti-HCV positive and HBsAg negative patients, the higher positive response of Anti-HCV were noted in patients with HBcAb positive and increased AST and ALT (Table 5). 5) Among Anti-HCV positive patients, the 65.4% were related to transfusion or acupuncture (Table 6). Conclusion: This study shows that further research for the development of more sensitive and specific diagnostic method for hepatitis C and thorough follow up study for its routes of transmission are needed.

인슐린종 ( Insulinoma ) 1 예

박종성 ( Jong Sung Park ),나하연 ( Ha Yeon Rha ),김장섭 ( Jang Sup Kim ),심영웅 ( Young Woong Shim ),배광훈 ( Kwang Hoon Bae ),박희두 ( Hee Du Park ) 대한내과학회 1982 대한내과학회지 Vol.25 No.11

전정부 급성위염의 내시경적 관찰 및 병리조직학적 소견

허윤(Yoon Huh),이균태(Gyun Tae Lee),박근수(Keun Soo Park),이승모(Seung Mo Lee),서세웅(Se Ung Seo),심영웅(Young Woong Shim) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1

N/A The author studied on acute gastritis of antrum diagnosed with gastroscopy, for 88 cases who had visited Department of lnternal Medicine, Pusan National University Hospital from July 1982 to June 1983. Detailed studies were made of clinical and endoscopic findings in 88 patients, and histopathologic findings in 15 patients whose biopsies were possible among 88 patients. The results were as follows; 1) The sex distribution of the 88 patients was observed such as 72.7% in male and 2.73% in female with ratio of 2.7: 1(male female). In age distribution, third decade(33. 3%) was most frequent and the remaining was in the following order 4th, 5th, 6th, 7th decade respectively. And acute gastritis of antrum occurred most frequently in December. 2) The suspected causes were drug ingestion in 15.9% stress in 13.6%, alcohol in 10.2% and unknown in 46.6%. 3) Clinical manifestations of 88 cases undergone gastroscopy were abdominal pain(96.6%), nausea(60.2%) and abdominal discomfortness(54.5%). The author clinically classified 88 patients into three types based on endoscopic findings. The frequency of each types was edematous gastritis in 34.1%, hemorrhagic erosive gastritis in 48. 9% and ulcerative gastritis in 17.0% respectively. 4) Endoscopic features were as follows; In edematous type, there observed edema of mucosa and narrowing of the antrum due to marked swelling of the mucosal folds, extending from the antrum up to the region of the angulus. These findings were subsided in 1~2 weeks. In hemorrhagic erosive type, edematous thickening of the mucosal folds were extended from the antrum up to the region of the angulus in addition to hemorrhage and erosion which normalized in 1 week. In ulcerative type, there also observed mucosal edema, erosion and hemorrhage. Hemorrhage was disappeared in 1 week, but one or more ulcerations were observed on antrum. 5) Histopathologic features were as follows; slight edema and hypergjg of the mucosa were observed in the edematous type, showing no other characteristic change. Characteristic changes in hemorrhagic erosive type were hemorrhage, necrosis and neutrophil infiltration. In the early stage of the ulcerative type, the histologic changes were very similar to those in the hemorrhagic erosive type. Ulcer formation was observed on the 4-7th day of the onset.

원저 : 늑막염의 임상적 고찰

김춘섭 ( Choon Sup Kim ),주기중 ( Kee Joong Ju ),이창환 ( Chang Hwan Lee ),박성민 ( Sung Min Park ),심영웅 ( Young Woong Shim ),송갑영 ( Kap Young Song ) 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.5

급성췌장염에 대한 임상적 고찰

주기중(Kee Joong Ju),서대홍(Dae Hong Suh),김춘섭(Chun Sup Kim),이창환(Chang Hwan Lee),심영웅(Young Woong Shim),송갑영(Kap Young Song) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6

N/A Diagnostic imaging procedures of the pancreas have been revolutionized in recent years by the introduction of sonography and computed tomography. We compared the previous litera- tures of actue pancreatitis which did not use ultrasonography and computed tomography with the cases which use the imaging technigque as a diagnostic tool and for the early detection of complications. A clinical observation was made on the 175 cases of the acute pancreatitis con- firmed and treated at the Pusan Adventist Hospital as in patients during the 6 years period from March, 1988 to December, 1993. The possible etiologic factors of the disease seen in de- scending order were unknown origin(44.6% ), alcohol(26.9% ), biliary tract disease(9.7% ), overeating(6.9%) and peptic ulcer(6.3/o). The patients complained of upper abdominal pain, nausea, vorniting, fever with chills in order. The most commonly observed physical sign was tenderness in the upper abdomen. In the radiologic studies, we observed pancreatic enlarge- ment(83.6%), phlegmon formation(18.2%) and pseudocyst(9.1%) by the ultrasonic examina- tion and enlargement of pancreas(100%), obliteration of fat plane(76.5%), extrapancreatic phlegmonous mass(29.4% ), ascites(20.7% ) and pseudocyst(14.7% ) using the computed to- mography. The cornplications were phlegmon formation, ascites, pseudocyst, shock, atelectasis, septicemia and acute renal failure. The mortality rate during the hospitalization was in 1.7% and the main causes of death were due to septicemia and renal failure. In conclusion, we observed the frequency of complications of acute pancreatitis were higher than the previous studies because of using the advanced diagnostic imaging tools. (Korean J Gastroenterol 1994; 26: 995--1001)

원발성 경화성 간세포암 1 예

최환주,심영웅,서대홍,김춘섭,송갑영,임홍섭,김충기,이겸철 대한내과학회 1997 대한내과학회지 Vol.53 No.2

Hepatoma is one of the most common malignant disease among cancers that occur in Korea. Recently, according ta developing imaging diagnostic technology and non surgical treatment the hepatoma is easily detected in early diagnosis and appropriate treatment. From this point of view, the histologic pattern of hepatoma is markedly important. This is the first reported case of sclerosing hepatocellular carcinoma, which is characterized by intense fibrosis, in which the tubular neoplastic structures are embedded. The incidence of sclerosing hepatocellular carcinoma is very rare. Therefore the rare histologic pattern of hepatoma might be introduced by many studies and reports. We recently experienced a case of sclerosing hepatocellular carcinoma.

형질 세포성 백혈병 1예

권형각,주영만,천종철,심영웅,송갑영,최환주 大韓血液學會 1990 大韓血液學會誌 Vol.25 No.1