간세포암 환자에 있어서 AST / ALT 비의 진단적 의의

박병채(Byung Chae Park),안수열(Su Yul Ahn),김영곤(Young Gon Kim),조기범(Gi Beum Cho),김미선(Mi Sun Kim),고용호(Yong Ho Ko),박무인(Mu In Park),우인기(In Ki Woo) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5

N/A To assess the possibility that the measurement in peripheral venous blood of AST/ALT ratios might be helpful in detection of hepatocellular carcinoma (HCC), the AST/ALT ratios were evaluated in 282 cases of chronic active hepatitis (CAH), 59 cases of CAH with early cirrhotic change (CAH with LC), 213 cases of liver cirrhosis (LC), and 220 cases of hepatocellular carcinoma (HCC). The ratio of male to female was 72.9% to 27.1% in HBsAg seropositive groups and 68.8% to 3I.2% in HBsAg seronegative groups, respectively. The mean age was 43.7 years old in HBsAg seropositivity and 49.9 years old in HBsAg seonegativity, respectively. In HBsAg seropositive groups, the AST/ALT ratio was 0.68+-0.30 in CAH group, 0.78+-0.19 in CAH with LC, 1.68+-0 83 in LC, 2.17+- l.60 in HCC. In HBsAg seronegative groups, AST/ALT ratio was 0.71+-0.58 in CAH group. 0.82+-0.31 in CAH with LC, 1.72+-0.87 in LC, 1.95+-1.38 in HCC. AST/ALT ratio was gradually increased according to the progress of the chronic liver disease in both HBsAg seropositive groups as well as negative groups. AST/ALT ratio was significantly (p<0.005) elevated in patients with HCC, being above 2.0, as compared to other groups. AST/ALT ratio in the patients with serum AST>200 units was higher than in those with AST<200 units, and the mean AST/ALT ratio in the HCC patients with AST.> 200 units was significantly higher than in other chronic liver disease. AST/ALT ratio above 3.3, without evidence of circulatory disturbance, was almost entirely restricted to the patients with HCC. In conclusion, since elevated AST/ALT ratio reflects the progress of chronic liver disease from CAH to HCC, a gradual increase in AST/ALT ratio might be a useful marker assessing for detection of HCC.

B형 만성간염 , 간경변증 및 간세포암 조직에서의 Transforming Growth Factor a , Insulin-like Growth Factor 2 및 HBsAg의 발현양상

한병훈(Buung Hoon Han),이상욱(Sang Uk Lee),안수열(Su Yul Ahn),허만하(Man Ha Huh),서진혜(Jin Hye Seo),박병채(Byung Chea Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A N/A

Acinetobacter calcoaceticus-Acinetobacter baumannii 복합군의 Ribotyping에 의한 동정

조동택(Dong-Taek Cho),이제철(Je-Chul Lee),김정민(Jung-Min Kim),신행섭(Haeng-Seop Shin),장희경(Hee-Kyung Chang),안수열(Su-Yul Ahn) 大韓微生物學會 1998 大韓微生物學會誌 Vol.33 No.6

건강성인군에서 Erythromycin 1회 경구투여가 담낭배출능에 미치는 영향

배영환(Young Hwan Bae),윤병철(Byung Cheol Kim),김복근(Bok Keun Kim),이병건(Byung Kun Lee),한병훈(Byung Hoon Han),안수열(Su Yul Ahn),이상욱(Sang Uk Lee),박병채(Byung Chae Park) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Background/Aims: The correction of gallbladder motility defect might be useful in the prevention and treatment of cbolesterol gallstones. Reciently erythromycin has been known to have motilin like effect on the motility of gastrointestinal tract and the galbladder. Therefore we examined whether and to what extent the oral administration of erythromycin combination with a test meal is able to improve gallbladder emptying in normal population by means of real time ultrasonography. Methods: Seventeen healthy volunteers(fifteen men and two women) with a mean(range) age of 28.5(26-31) years were examined by a real time ultrasonogram(Aloka Echo Camera SSD-650, 3.5-MHz transducer). Gallbladder volume was determined after 12 hours fasting, and again 30, 60, 90, 120 and 180 min after beginning the test meal that contained 700 Cal - 55% as carbohydrate, 27% as protein, and the rest as fat. One week later, gallbladder volume was rechecked with the same way as previously after administration of erythromycin at the dose of 500 mg orally 30 min before serving test meal in the same subjects. Results: Fasting gallbladder volume was 19.2 3.3 rnl. Minimal residua] volume, and minimal residual volume % were slightly lower in the procedure of test meal with erythromycin(2.1+0.7 ml, 11.2+ 4.3%) than in the procedure of test meal only(2.9 1.5 tnl, 14.9+7.7%). The time reaching at the minimal residual volume was shorter m the procedure of test meal with erythromycin(104.1 15.0 min) than in the procedure of test meal only(111.2+13.7 min), but these differences were not significant statistically. Residual volume % was lower in the procedure of test meal with erythromycin than in the procedure of test meal only at 30 min(32.9+7.0% vs 50.9+14.3%, respectively, p=0.0001), 60 rnin(18.7 5.1% vs 30.411.1%, p=0.0012), and 90 min(13.9+ 5.4% vs 19.7L-12.8%, respectively, p=0.0357) signi- ficantly, but it showed negligible difference at 120 min(12.9+6.3% v 15.7+7.6%), and no difference at 180 min(39.6+21.8% vs 39.7 14.4%) between these two procedures. Conclusions: Erythromycin showed negligible effect on lowering minimal residual volurne, minimal residual volume %, and the time reaching at the minimal residual volurne simingly, but showed strong effect on gallbladder emptying at 30 minutes, 60 minutes and 90 minutes after test meal.

식도정맥류 출혈시 내시경적 경화요법과 Propranolol 의 병용투여가 재출혈과 생존율에 미치는 효과

이금희(Kuem Hee Lee),이수정(Soo Jeong Lee),문익홍(Ick Hong Moon),장태일(Tae Il Jang),김지호(Ji Ho Kim),안수열(Su Yul Ahn),한병훈(Byung Hoon Han),박병채(Byung Chae Park) 대한내과학회 1995 대한내과학회지 Vol.48 No.3

N/A Objectives: We conducted this study to evaluate the therapeutic efficacy of endoscopic sclerotherapy combined with oral propranolol therapy in the prevention of esophageal variceal rebleeding and in survival rate in patients with liver cirrhosis. Methods: Among the 54 patients involved, 34 patients were treated with the combination therapy using endoscopic sclerotherapy and propranolol and 20 were received sclerotherapy alone. Sclerotherapy was done with ethalnolamine oleate at 7-day intervals untill obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 20~25%. Results ; Of the patients treated with the combination therapy, 69.6%, 56.4% and 25.1% were free from rebleeding at 6, 12 and 24 months after entry, respectively. The corresponding figures in patients treated with sclerotherapy alone were 50.5%, 27.5% and 7.5% respectively. The cumulative percentages of the patients free from rebleeding were significantly higher in the combination therapy group than in the latter group (p=0.022). The cumulative survival rates, at 6, 12 and 24 months, of the patients received the combination therapy were 81.9%, 72.5% and 55.8% respectively. The corresponding survival rates in the patients treated with sclerotherapy alone were 77.5%, 53.2% and 11.2% respectively. The cumulative survival rate in patients recerved the combination therapy was significantly higher than those of the latter group (p= 0.004). The multivariate Cox model individuated the propranolol treatment as an independent prognostic indicator of the death rate, but not for the recurrent bleeding. During this study, no significant adverse effect was observed in both group. Conclusion: The combination therapy using endoscopic sclerotherapy and propranolol has shown to be an effective treatment in the prevention of recurrent variceal bleeding as well as in the prolongation of survival rate in cirrhotic patients. Therefore, this method of treatment may be considered as standard therapy of esophageal variceal bleeding.

혈청지질이 담석형성에 미치는 영향에 관한 연구

홍성준(Seong Jun Hong),구양훈(Yang Hun Koo),배영환(Young Hwan Bae),한병훈(Byung Hoon Han),지상근(Sang Keun Ji),김기환(Ki Hwan Kim),안수열(Su Yul Ahn),이상욱(Sang Uk Lee),박병채(Byung Chae Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: A number of studies have shown an increased prevalence of gallstones in patients with coronary heart diseases. Since it has also been known ihat the high density lipoprotein cholesterol(HDL-C) is an important protective factor against coronary artery diseases, one may speculate the possibility that HDL-C may play a role in preventing the gallstone formation, so we tried to identify this role of HDL-C. Methods: We analysed 165 patients who received cholecystectomy due to cholecystitis with gallstones. Their serum lipid profiles and body mass index(BMI) were measured and compared with normal control persons. We adjusted the age and sex distribution in normal control group to the patient group. Results: Among 165 cases, the prevalences of whitish yellow stones, brown pigmented stones and dark pigmented stones were '21.2%, 60% and 18.2%, respectively. In the patients group, the mean age was 53.7+11.5 years and the ratio of male to fema]e was 1:1.6. BMI was significantly higher in the patient group(24.7+ 7.5kg/m )as compared to normal control group(21.9 ' 5.6kg/m, p<0.005). No differences were observed in the serum level of total cholesterol, triglyceride(TG), HDL-C, low density lipoprotein cholesterol(LDL-C), and the ratio of HDL-C to total cholesterol between the patient and control group. However, tbe old aged group, more than 50 years showed that the serum level of HDL-C, HDL-C/total cholesterol were significantly higher than in the group of normal population(48.3+ 18.0mg/dL, 0.30+0.12) than in tbe patient group(43.4+13.3mg/dL, 0.26 0.09, p<0.005), and obese persons(BMI>25kg/m ) showed that their levels were significantly higher in the normal population group(53.0+9.5mg/dL, 0,30+0.08) than in the group of gallstone patients(43.3+ 1.7mg/dL, 0.24>0.07, p<0.005) also. Conclusions: Decreased serum level of HDL-C, HDL-C/total cholesterol might be a causative factor of gallstone formation in the obese or old aged group. (Korean J Gastroenterol 1996; 2S:683 - 6S9)

담도암에 대한 임상적 고찰

안수열,임학,문미경,최영식,차태준,서승연,구자영,박병채 대한내과학회 1992 대한내과학회지 Vol.42 No.2

We assessed 79 cases of chloangiocarcinoma which was diagnosed histologically at Kosin General Hospital and Kim Hae Gospel Hospital from 1986 to 1990 and the results are as follows; 1) More than half of all patients were beyond sixth decade, the ratio of male to female was 2:l and 2.8:1 in intra and extrahepatic cholangiocarcinoma, respectively. 2) Prevalence rate of clonorchiasis was 30%, 18.4% in intrahepatic and extrahepatic cholangiocarcinoma, respectively, and prevalence rate of clonorchiasis in intrahepatic cholangiocarcinoma was markedly higher than that (19.6%) of general population in Pusan, Kyungnam area. 3) The predominant symptoms were general weakness (90.0%), abdominal pain (53.3%), jaundice (46.7%) in intrahepatic cholangiocarcinoma, and in extrahepatic cholangiocarcinoma, jaundice was the most frequent symptom (75.5%). 4) Of the 11 patients with distant metastases in in trahepatic cholangiocarcinoma, the most common site of metastases was abdominal lymph nodes (91 .O%) followed by liver (36.4%), peritoneum (27.3%) and kindey (18.2%). 5) Serum CEA level was more than 10ng/㎖ in 66.7% of intrahepatic cholangiocarcinoma and 26.5% of extrahepatic cholangiocarcinoma which suggested that serum CEA level may be more useful in the diagnosis of intrahepatic cholangiocarcinoma than extrahepatic cholangiocarcinoma. Serum CA 19-9 level was more than 37 U/㎖ in 80.0% of intrahepatic cholangiocarcinoma and 67.3% of extrahepatic cholangiocarcinoma. 6 ) Of the 11 patients with distant metastases in intrahepatic cholangiocarcinoma. 9 patients (81.8%) had serum CEA levels of more than 60ng/㎖, and 5 of 19 patients (26.3%) with localized tumor showed CEA levels of more than 60 ng/㎖, the difference between these two groups was statistically significant (p< 0.05).

간세포암에서 간동맥 화학색전요법과 병용한 경피적 가열 생리식염수 주입요법의 치료 효과

이상욱,안수열,한병훈 대한소화기학회 1999 대한소화기학회지 Vol.33 No.4

Background/Aims: Transhepatic arterial chemoembolization (TACE) is an effective means of treating unresectable hepatocellular carcinoma (HCC). However, it is almost impossible to achieve complete necrosis of tumor by TACE. To achieve complete necrosis of large HCC, we tried a new combination therapy; TACE with percutaneous hot saline injection therapy (PSIT). Methods: Ninety patients with HCC (2-9cm) were enrolled in this study. Forty-five patients were treated with TACE alone (Group 1), whereas forty-five patients underwent a single TACE session followed by PSIT (Group 2). The therapeutic effect was analyzed by histological evaluation, angiography, ultrasono-graphy and survival rate. Results: The mean numbers of TACE and PSIT were 1.5 and 3.6 times , respectively. On follow- up biopsy for group 2, complete necrosis of tumor was observed in 33 le-sions. Complete remission (CR) and partial response (PR) were achieved more frequently in group 2 than in Group 1. The median survival period was 9 months in Group 1 and 28.9 months in Group 2 (p$lt;0.05). Treatment modality and Okuda stage had a statistical significance in comparing prognosis. The observed side effects of PSIT were transient mild fever and pain during hot saline injection. Conclusions: The combination therapy of TACE and PSIT appears to be effective in treating patients with unresectable HCC.

면역억제제투여중 발생한 Listeria monocytogences에 의한 뇌막염 2예

임학,안수열,유경무 고신대학교 의학부 1994 高神大學校 醫學部 論文集 Vol.10 No.1

It is well known that Listeria monocytogenes may cause meningitis in the immunocompromised host. We experienced 2 cases of L. monocytogenes meningitis in patients with renal transplant and with systemic lupus erythematosus. The confirmation of diagnosis was made by CSF culture and identification of pathogen. In both cases, third-generation cephalosporins were given before the identification of pathogen but no clinical improvement was found. Following the substitution cephalosporin by ampicillin, one patient died and the other recovered without any CNS complication.

만성 간염환자 혈청에서 B 형 간염 바이러스 Precore/Core 영역 DNA 의 돌연변이

박종욱,서민호,안수열,최병길,윤수정 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Objectives : Causes of diverse clinical sourses of patients with chronic hepatitis B virus(HBV) infection are not fully-known. The host immune response to HBV antigen and the appearance of mutant viruses are believed to be important factors. To determine whether appearance of precore and core mutant viruses are related to the clinical course of the patients, we analysed the entire core region of viral DNA in 7 HBV chronic carriers. Methods : Serum was obtained from 7 patients(3 chronic active hepatitis, 4 CAH with cirrhosis)and pre-C and core region of HBV were amplified by polymerase chain reaction, then directly sequenced. Result : In all 7 HBV DNA there was a point mutation from T to C at nucleotide 2104 of core region, and each DNA also contained 6 to 17 variable point mutations at different nucleotides yielding various amino acid substitution. One of DNA had a point mutation from A to G at nucleotide 1898, converting tryptophan(TGG) to a stop codon(TAG). Two cases of deletion mutations covered C-region segment ranging from nucleotide 2142 to 2306 and one case of deletion covered pre-C region ranging from nucleotide 1815 to 1843. Conclusion : Three out of seven DNA contained mutational sites coincided with known immunodominant T cell epitopes and rest of the mutational sites could also affect the antigenecity of the HBV. Therefore, mutant HBV could after the host immune response, and may modulate the clinical course of infection.