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간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 만성 B 형 활동성 간염에서 단기 Prednisolone과 ARA - AMP 병용 요법의 효과
장린(Rin Chang),김병호(Byung Ho Kim),장영운(Young Woon Chang),이정일(Joung Il Lee),김효종(Hyo Jong Kim),강흥선(Heung Sun Kang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4
N/A The purpose of treatment of chronic hepatitis R virus (HBV) infection is the complete elimination of HBV and reduce the risk of further hepatic damage and hepatocarcinogenesis. Immune stimulation provided by corticosteroid withdrawal may be associated with a temporary loss of hepatitis B virus markers in patients effected by chronie active hepatitis B (CAHB). It is possible that an association of antiviral drugs with corticosteroid play a therapeutic role in CAHR. Twenty-Six patients with biopsy-proven, HBeAg and HBV-DNA positive CAHB were treated with prednisolone (PDL) withdrawal [40 mg/day for 4 weeks without tapering, orally] followed in sequence by 2-week rest interval and ARA-AMP [500 mg/day for 4 weeks, intravenously]. The followig results were obtained; 1) The treetment with short-term PDL and ARA-AMP showed dramatic decline in the titer of HAV-DNA. 2) In 13 of 26 patients (50%), partial response, in 6 of 26 patients (23%), complete response were observed at the end of treatment. 3) Partial responders were unstable, and 11 of 13-partial responders (85%) showed reappearance of HBV-DRA during follow-up period. 4) In 4 of 6 complete reaponders (67%), reappearance of HBeAg was observed. Two became seronegative for HBeAg by additional 4wk injection of ARA-AMF but another two became nonresponder in spite of ARA-AMI. 5) Responders showed significantly higher ALT values than nonresponders at two weeks after PDL treatment. 6) After mean follow up of 14.8 months, over,all response rate was 23%. In conclusion, the combination of short-term prednisolone and ARA-AMP in the treatment of chranic hepatitis B was effective in suppressian of HBV-DNA during treatment and shortly after treatment period. But long-term suppressive effect in HBV-DNA and effect in seroconversion of HReAg might be unsaitlsfactory. The larger, randomized, controlled trials using a similar approach is needed.
장린(Rin Chang),김병호(Byung Ho Kim),장영운(Young Woon Chang),이정일(Jung Il Lee),김효종(Hyo Jong Kim),동석호(Seok Ho Dong),강성이(Sung Yi Kang) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6
N/A Gastrin is trophic to the normal gastric and colonic mucosa and stimulates the growth of the stomach and colon cancer that possess the gastrin receptor. Plasma gastrin has been reported to be elevated among patients with colorectal cancer. Whether fasting plasma gastin concentrations are high in patients with stomach or colon cancer is controversial. We therefore studied the effect of food on plasma gastrin concentrations in patients with stomach or colorectal cancer and control subjects. Fasting plasma gastrin concentrations were higher in patients with colorectal cancer than in control subjects, but statistically not significant. There was no significant difference between the postprandial plasma gastrin concentrations of the patients with colorectal cancer and those of control subjects. Fasting and postprandial plasma gastrin concentratios in patients with colorectal cancer did not show significant difference between the patients with metastasis and without metastasis. Also, we showed that there was no significant elevation of fasting,and postprandial plasma gastrin concentrations in patients with stomach cancer compared with the control subjects, Fasting and postprandial plasma gastrin concentrations in patients with stomach cancer did not show significant difference between the patients with metastasis and without metastasis. In conclusion, the results of these studies suggest that gastrin has no significant role in the gastric and colorectal carcinogenesis. But the possibility that the stomach and colon cancer in different geographic location have differcnt. biologic characteristics couldn't be excluded.
간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간경변증 환자에서 골이영양증에 관한 연구
민영일(Young Il Min),장린(Rin Chang),김병호(Byung Ho Kim),장영운(Young Woon Chang),이정일(Jung Il Lee),김효종(Hyo Jong Kim),강흥선(Heung Sun Kang),황영희(Young Hee Whang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4
N/A The aim of tbe studywas to investigate the incidence and pathophysiology of osteodystrophy in patiients with pastnecrotic cirrhosis of the liver. Bone changes were meaSured by scanning densitometry. Various hormones and biochemical items which reflect calcium and bone metabolism were also measured. Twenty-one Korean male patients with HRsAg positive postnecrotic cirrhosis and 20 male controls matehed in age ans sex were included in study groups. The results were as follows ; 1) The incidence of ostsopenia in patients with postnecrotic cirrhosis of the liver was 19%. 2) Mean values of 25-OH-D and 1.25- (OH)2D2 were 7.3 +- 4.7 ng/ml and 12.5 +- 10.8 pg/ml respectively in patients with postnecrotic cirrhosis of the liver. Theses values were significantly lower than those of normal controls (28.1 +- 18.0 ng/ml and 29.4 +- 6.5 pg/ml) 3) Levels of ionized calcium were 5.4 +- 0.5 mg/dl and 5.4 +- 0.4 mg/dl in patients with postnecrot corrhosis of the liver and controls respectively. 4) The levels of carboxy-terminal parathyroid hormone were normal in patients with postnecrotic cirrhoeis (412 +- 145 pg/ml,controls: 393 +- 46pg/ml). 5) in patients with osteopenic liver cirrhosis, in spite of extremely low values of 25-OH-D3(24 +- 4.1ng/ml) and 1.25- (OH)2-D3(2.0 +- 0.3 pg/ml), mean serum ionized calcium level (5.9 +- 0.4mg/dl) was higher than those of nonostepenic liver cirrhosis (5.3 +- 0.4 pg/dl)was higher than those of nonos teopenic liver cirrhosis (5.3 +- 0.4 mg/dl) and normal controls (5.4 +- 0.4mg/dl). Inconclusion, vitamin D levels were significantly low in patients with postnectrotic cirrhosis of the liver but ionized calcium levels were maintained in normal range and protean bone changes were observed by scanning densitornetry. A certain portion of the patients (19%) with postnecrotic cirrhosis of the liver showed moderate degree of osteopenia accompained by extremely low levels of serum vitamin D and inappropriately elevated ionized calcium levels in the blood. These relative hypercalcemic changes seem to be related to low levels of estradiol rather than overproduction of parathyroid hormone.
김효종(Hyo Jong Kim),강성이(Sung Yi Kang),김병호(Byung Ho Kim),이정일(Joung Il Lee),장영운(Young Woon Chang),장린(Rin Chang) 대한내과학회 1991 대한내과학회지 Vol.40 No.4
N/A Perforated peptic ulcers are frequently sealed spontaneously by omentum or by adjacent organs, and the associated peritonitis resolves without operation. Several surgeons, nearly 40 years ago, have applied their knowledge of the phenomenon of spontaneous seal to the treatment of the perforated duodenal ulcer and their reported mortality rate was almost half that generally recorded mortality rate for surgical treatment at that time. But despite these encouraging reports of successful non-op treatment of the perforated duodenal ulcer, the conservative treatment had not been gained widespread acceptance. Instead, much of the recent surgical literature concerns not whether patients with perforated duodenal ulcers should have an operation, but whether a definitive operation to heal the ulcer should be performed at the time of perforation. But recently there was a significant advances in ulcer treatment and antibiotic therapy. And also there was a few promising reports of non-op treatment of the perforated peptic ulcers by means of a prospective randomized or selective trial. In this study, we compared the clinical charateristics of emergency operative treatment group with non-op group retrospectively to offer the opportunity to reap- praise the role of the non-op treatment of the perforated duodenal ulcer. Our data suggest that perforated duodenal ulcer can be safely treated non-op when spontaneous seal of the ulcer perforation had occured. Therefore, efforts to induct and maintain the spontaneous sealing by using the initial observation period should be made positively.