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하희근,김민기,정병오,김주인,이혁표,최수전,염호기,김영주 인제대학교 1998 仁濟醫學 Vol.19 No.2
기관 골형성증은 기관 및 주기관지 점막하층의 골성 및 연골성 조직 형성을 특징으로 하는 비교적 드문 질환으로 질환의 기원은 아직 분명하지 않고 다양한 동반 질환들이 보고되고 있으며 국내에서는 늑막 삼출 1예와 폐렴 1예 등이 동반질환으로 보고된 적이 있다. 저자들은 호흡곤란을 주소로 내원한 54세 남자 환자에서 좌하엽의 공동성 활동성 폐결핵을 동반한 기관 골형성증 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Tracheopathia Osteoplastica(TO) is a rare benign disease first described in 1855. This disease is characterized by the presence of osteocartilaginous lesions in the submucosa of the trachea and bronchi without any relation to trachial rings. TO is usually not involved posterior menbranous portion of tracheobronchial tree. The mechanism of its occurrence remains controversial. In the past, most of the cases were not usually diagnosed until autopsy. The sparsity of previously reported cases of TO possibly reflects a lack of awareness of this entity rather than its true incidence. However, with the advent of new pulmonary diagnostic techniques including bronchial endoscopy with pathological examination and thoracic imaging techniques, TO can be recognized antemortem. We describe a case of TO involving the trachea in 54-year old man associated with pulmonary tuberculosis and diagnosed by fiberoptic bronchoscopic biopsy. We review the clinical and pathologic feature of this rare disease.
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B형 만성 간질환 환자들의 간조직내 HBV precore 돌연변이종에 관한 관찰
정정명,이상욱,김석주,하희근,김민기,박영홍 인제대학교 1998 仁濟醫學 Vol.19 No.1
HBV의 C 유전자 영역에는 두 개의 개시 codon이 있는데 앞쪽 개시 codon에서 HBeAg이 합성되고 뒤쪽 개시 codon으로부터 HBcAg가 합성된다. 그리고 이 두 개의 개시 codon 사이를 precore 유전자 영역이라 명명하는데 이 부위에서 HBeAg의 합성과 분비를 나타낸다. 따라서 이 precore 유전자 영역에 변이종이 발생되면 이 영역이 비활성화되고 결과적으로 HBV의 증식은 지속되나 HBeAg의 생산이나 표현은 되지 않을 가능성이 있다. 그리고 이러한 사실은 실제 anti-HBe가 양성인데도, 혈중에 HBV DNA가 고농도로 존재하며, 비전형적인 간염을 나타낸 환자들에서 precore 영역의 염기서열을 분석한 결과 이 유전자 부위에 변이가 있음이 증명되고 있다. HBV precore 변이증에 대한 연구는 현재 세계적으로 진행되고 있으나 아직도 질병과의 관계는 확실히 알려져 있지 않다. 따라서. 저자들은 우리나라의 HBV precore 변이종의 양상과 질병과의 관계를 파악하기 위하여 본 연구를 시행하였다. 그 결과 우리나라의 경우 HBV precore 변이종의 양상은 첫째, 염기서열 1896의 G가 A로 치환된 변이종이 주종을 나타내고 있으며. 둘째, 이 1896변이종은 precore의 다른 유전자 부위에 변이를 동반하는 경향이 높으며, 셋째, HBV precore 변이종은 모든 B형 만성 간질환에서 발생될 수 있을 것으로 사료되나. 간세포암이나 간경변증과 같은 중한 간질환과의 관계에 대해서는 향후 계속적인 연구가 필요할 것으로 사료된다. Aims : In order to determine the relationship between the HBV precore mutant and the severity of liver disease in Korea, we performed liver biopsies in patients with HBV associat ed chronic liver disease and compared the types of HBV precore mutation and histologic findings in the same limier tissue. Method : HBV DNA in liver tissues was amplified by polymerase chain reaction(PCR). The precore mutants were detected by the direct sequencing for them. Results : 1.Total of 59 cases (43 males, 16 females) were studied and the age ranged from 19 to 72 years with a mean age of 36.3 years. The subjects were composed of 26 cases with chronic active hepatitis, 8 with chronic persistent hepatitis, 3 wish chronic lobular hepatitis, 9 with minimal changes, 5 with cirrhosis and 8 with hepatocellular carcinoma. 2.The HBV precore mutants were found in 27 cases(45.8%) and all mutations were G to A changes at nucleotide 1896, creating a stop codon at codon 28. However, 15 cases among 27 mutants of 1896 also had mutation at different precore regions ; one case at 1937, 3 cases at 1840, 6 cases at 1846, 2 cases at 1856 and 3 cases at 1899. respectively. Also, all HBV precore mutants were combined with wild type HBV sequence. 3.The relationship between HBV precore mutants and HBeAg status revealed that 9 cases from 31 HBeAg positive (29.0%), and 18 from 28 HBeAg negative or anti-HBe positive (64.3%) were mutants. More frequent mutations were observed in HBeAg negative cases. 4.In analysis of the types of mutants and histopathological findings of liver disease, 16 among 26 chronic active hepatitis (46.2%), 1 among 8 chronic persistent hepatitis (12.5%), 1 among 3 chronic lobular hepatitis (33.3%), 5 among 9 minimal changes (55.6%), 2 among 5 liver cirrhosis (40.0%) and 6 among 8 hepatocellular carcinoma (75.0%) showed precore mutations. Conclusion : The patterns of HBV precore mutants in Korea could be summarized as follows. Firstly, mast of the mutations were composed of G to A change at nucleotide 1896. Secondly. most of the mutants at nucleotide 1896 are associated with simultaneous mutations at another precore regions. Thirdly, although precore mutations can happen in any histologic status of chronic liver diseases, its possible relationships with serious conditions, such as cirrhosis and hepatocellular carcinoma, need further investigation.
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이상혁,정정명,설상영,이연재,정준용,윤혜경,하희근,황희승 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.6
Hamartoma is a very rare congenital tumor. A few cases of hamartomatous pol yps in the stomach were reported. Most of harrurtomatous polyps in the stomach occur in patients of polyposis coli. We have experienced four cases of gastric hamartomatous polyps without polyposis coli. There are some differences between previously reported cases and ours. In our casee, the distribution of age is from fourth to ninth decade, men and women ratio is 1: 1. The number of polyps are one in three cases and two in one case. The size of polyps is from 5mm to 12 mm. The location of polyps are various, but most common in antrum. We have experienced four cases which were different from previously reported ones and report them with a brief review of literatures.
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급성신부전과 특발성 기흉이 발생한 Wegener씨 육아종증 1예
박성재,윤혜경,김영훈,김주인,김양욱,하희근 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5
Wegener's granulomatosis is characterized by necrotizing granulomatosis lesion of the respiratory tract, glomerulonephritis and frequently vasculitis involving other organs. The basic pathophysiologic mechanism of Wegener's granulomatosis is not defined yet. However, it may be suspected an autoimmune disease. We experienced a case of Wegener's granulomatosis which are associated with acute renal failure and pneumothorax. The patient suffered from hemoptysis, fever and cough. Despite antibiotic therapy, symtoms did not improved and multiple varying sized nodules were aggravated on chest roentogenogram and serum creatinine elevated 3.4mg/dl. After diagnosis using video associated thoracoscopic surgery, the patient was treated with cyclophsphamide, glucocorticoid and sulfamethoxasole-trimethoprime. With the combination therapy, the patient felt completely well and chest roentogenogram showed lungs were improved and serum creatinine was normal. The patient was readmitted because of right pleuritic pain and dyspnea 15 day after discharge. The patient was developed a right pneumothorax. The lung was easily expanded by intercostal tube drainage with a one way valve. The patient has been treated as an out-patient with immunosuppressive agents continously.
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