Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

크론병에 대한 CoPPLX의 방어효과에 대한 연구

이호학,김유림,문창기,이재일,양병윤,김종수,이정민,정재혁,안석진,박상준,김윤권,김소연,김영중,조민구,최영자,장성조 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.1

외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

돼지 우리 깔집용 왕겨에서의 Ochratoxin A 검출

이문한,박진봉,박응복,이영재,신광순,박종명,남궁선,조준형,박근식,권택석,이재구 한국수의공중보건학회 1992 예방수의학회지 Vol.16 No.1

Low doses of ionizing radiation suppress doxorubicin-induced senescence-like phenotypes by activation of ERK1/2 and suppression of p38 kinase in MCF7 human breast cancer cells

신재식,우상혁,이형찬,홍승우,유두현,홍석일,이왕재,이명석,진영우,안성관,진동훈,박인철 Sookmyung Women's University Research Institute of 2010 여성과 건강 Vol.6 No.1

자궁내 태아사망의 임상적 고찰

이권해,이정재,조현철,이석민,이임순,이해혁,김권대,이순곤,남계현 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Objective: This study was designed to evaluate diagnosis and complication, prognosis during clinical study of cases of intrauterine fetal death. Methods and materials: This is a clinical study of 56 cases of the intrauterine fetal death among 8064 deliveries at Seoul Sunchunhyang university hospital during 5 years from January, 1994 to December, 1998. Results: The incidence was 0.7%. The age distribution of mothers was 18 - 44 years and was highest in the 25 - 29 years range(46.4%). The parity was the most highest in the nulliparous group(51.8%). The most common gestational weeks was 20 - 28 weeks gestational period(46.4%), and most common presentation was cephalic(73.5%). The most common weights of the intrauterine fetal death was from 5,00gm to 1,000g(48.2%). The mode of the most common delivery was the induction of delivery(57.2%). The etiologic factors were: unknown(42.9%), preeclampsia(17.9%), chorioamnionitis(14.3%), congenital anomaly(12.5%), abruptio placenta(7.1%), cord complication(3.6%), placenta previa, death of one for twin. There were 2 cases of maternal complication(DIC, Uterine atony). Conclusion : Intrauterine fetal death should be diagnosised early and treated properly to reduce risk of the maternal complication.

8-hydroxyguanine이 전립선비대증 발생에 미치는 효과

이재원,이석영,이형래,이상철,김용태,김원재 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2

연구목적: 전립선비대증은 노화현상에 의해 발생하는 질환으로서 임상적으로 주로 50세 이상에서 증상이 나타난다. 산소 라디칼은 DNA의 염기에 다양한 손상을 미칠 수 있다. 산소 라디칼에 의한 DNA의 변화에는 여러 가지 형태가 있으며 이러한 변화들 가운데서 guanine이 8-oxoguanine (8-hydroxyguanine, oh8Gua)으로의 수산화(hydroxylation) 반응은 가장 흔히 관찰되는 형태로서 노화 및 만성 퇴행성 질환, 기타 여러 질환의 중요한 병인으로 인식되고 있다. 세포에 유해한 영향을 주는 oh8Gua의 생성으로부터 유전자를 보호하는 수복효소 중 8-oxoguanine-DNA glycosylase (OGG1)가 주된 역할을 하는 것으로 알려져 있는데 이 효소를 생산하는 유전자인 hOGG1은 사람마다 유전자형이 다르다. 따라서 본 연구에서는 전립선비대증이 노화와 관련된 hOGG1 유전자형에 따라서 발생에 차이가 있는지를 조사하였다. 대상 및 방법: 충북대학교 병원에서 전립선비대증으로 진단 받고 입원하여 경요도전립선절제술을 받은 환자로 병리 조직학적으로 전립선비대증이 확인된 81명을 환자군으로 하였으며, 충청북도내 10개 군에서 50세 이상의 건강한 성인 남자 764명을 대상으로 실시한 전립선 무료검진에서 경직장 초음파 검사상 전립선 크기 20 gm 이하, 국제 전립선 증상 점수(IPSS) 7점 이하, 요속 10 ㎖/s 이상, 전립선 특이 항원(PSA) 4.0 ng/㎖ 이하인 81명을 대조군으로 설정하였다. 이들에서 채취한 혈액에서 genomic DNA를 얻은 후 PCR-SSCP (polymerase chain reaction-single stranded conformation polymorphism), 직접 염기서열분석(direct DNA sequencing) 및 RFLP (restriction fragment length polymorphism)를 통해서 두 군 사이의 hOGG1 유전자의 다형성을 분석하였다. 결과: 대조군에서 codon 326형은 Ser326Ser형이 12례(14.8%), Ser326Cys형이 51례(63.0%), Cys326Cys형이 18례(22.2%)였으며 전립선비대증 환자군에서는 Ser326Ser형이 15례(18.5%), Ser326Cys형이 34례(42.0%), Cys326Cys형이 32례(39.5%)로 두 군 사이에 통계적인 유의성이 관찰되었다(p=0.022). 또한 Cys326Cys형과 나머지(Ser326Ser, Ser326Cys)형으로 나누어 시행한 통계 분석에서도 대조군에서는 각각 18례(22.2%), 63례(77.8%)였으며 전립선비대증 환자군에서는 32례(39.5%), 49례(60.5%)로 통계적인 유의성이 관찰되었다(p=0.017, OR=2.286, 95% CI=1.149-4.546). 결론: hOGG1 유전자의 형태와 전립선비대증의 발생과는 밀접한 관련이 있었다. 즉 hOGG1 Cys326Cys형을 가진 사람에서 전립선비대증이 발생한 가능성이 높을 것으로 사료된다. Purpose: 8-oxoguanine DNA glycosylase (OSS1) rapairs DNA by removing 8-oxoguanine (oh8Gua), a highly mutagenic oxidative DNA adduct. Recently, the human gene for OGG1 (hOGG1) was cloned and several genotypes have been reported. However, the implications of such genotypes in benign prostatic lyperplasia have not been demonstrated. To assess the involvement of hOGG1 associated with the aging process on the developing of BPH, we analyzed the genetic polymorphisms of hOGG1. Materials and Methods: We studied the hOGG1 gene polymorphisms in 81 cases of BPH and 81 cases of normal controls. We performed the SSCP, PCR-based restriction fragment length polymorphism (RFLP) and direct sequencing to characterize the genetic polymorphisms of hOGG1 in both BPH patients and controls. Results: We found two polymorphic sites. A serine326/cysteine polymorphism at codon 326 (1a type) in exon 7 was associated with an exchange of amino acid. Another polymorphic site at codon 324 (1b type) in exon 6 was silent. We found that the distribution of hOGG1 genotypes in BPH patients (Ser326Ser type 18.5%, Ser326Cys type 42.0% and Cys326Cys type 39.5%) was significantly different from that in controls (14.8%, 63.0% and 22.2%, respectively) (p=0.022). Homozygosity for the Cys326Cys genotype significantly increased the risk of developing BPH, with the odds ratio (OR) being 2.286 (95% confidence interval [CI]=1.149-4.546) Conclusion: Our results suggest that the hOGG1 Cys326Cys genotype might play a important role in the development of BPH.

Low doses of ionizing radiation suppress doxorubicin-induced senescence-like phenotypes by activation of ERK1/2 and suppression of p38 kinase in MCF7 human breast cancer cells

신재식,우상혁,이형찬,홍승우,유두현,홍석일,이왕재,이명석,진영우,안성관,진동훈,박인철 Sookmyung Women's University Research Institute of 2010 여성과 건강 Vol.6 No.1