혈청 Alpha - Fetoprotein치가 높으면서 ( 400ng / ml 이상 ) 간초음파상 종괴소견이 없는 만성간질환 환자에서 s - ALT 및 s - AFP 치 비교관찰의 진단적 의의

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),최병인(Byung Ihn Choi),김나영(Na Young Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3

N/A In practice, we sometimes encounter the patients with chronic liver disease (CLD) who showed serum alpha-fetoprotein (AFP) above 400 ng/ml and no mass lesion in the liver on ultrasonogram. We enrolled 58 such patients, on whom abdominal CT and hepatic angiography were performed to determine the accompanying rate of superimposed HCC. The initial serum ALT level and the subsequent changes of serum AFP levels of the patients with superimpoaed HCC were compared to those of the CLD patients without superimposed HCC to investigate the usefulness of these tests as simple and noninvasive diagnostic tool, which might replace the expensive and invasive tests such as abdominal CT and hepatic angiography. Among 58 patients enrolled, 27 patients (46.6%) were complicated by superimposed HCC, while 31 patients (53.4%) were CLD patients without superimposed HCC. The sensitivity and specificity of serum ALT level below 87 IU/L ( * 3 of upper normal limit) for the detection of HCC were 85.2% and 80.6%, respectively. Out of 31 CLD patients uncomplicated by HCC, the subsequent AFP levels in 24 decreased in a month by 50%. In contrast, 10 CLD patients compIicated by HCC whose subsequent serum AFP levels were checked, showed elevation or no-change of AFP levels, but not decreased at all in a month. We conclude that more than half of the CLD patients with serum AFP above 400 ng/ ml and no mass lesion in the liver on ultrasonogram had not been complicated by HCC, and the initial ALT level and the subsequent serum AFP in 2-4 weeks will be useful as simple and noninvasive exclusion diagnostic tool for the differentiation of CLD complicated by HCC.

우리나라 원발성 (原發性) 간암 (肝癌) 환자에서의 B 형 간염 (肝炎) 바이러스 감염상과 (感染像) 간경변증의 (肝硬變證) 병발 (倂發) 빈도

김정룡(Chung Young Kim),정현채(Hyun Chae Jung) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.1

N/A For the purpose of obtaining the more reliable prevalence rate of HBV infection and of evaluating the causal relationship of HBV infection and underlying liver cirrhosis to the etiology of primary liver cancer in Korea, peritoneoscopy which is the most valuable tool to confirm the diagnosis of liver cirrhoisis and the radioimmunoassay for the serological markers of hepatitis B virus, which is the most sensitive for the detection, were performed in 302 patients with primary liver cancer who were admitted to Seoul National University Hospital and diagnosed by physical and laboratory findings (including serum a-FP), liver scan and radiological methods (including sonography, aMominal CT and angiography), The results were summarized as following: 1) Of 302 patients with primary liver cancer, serum HBsAg was detected 237 patients (78.5%), anti-HBs and/or anti-HBc in 60 patients (19.9%) anti-HBs (single or with anti-HBc) in 25 patients (8.3%) 2) With peritoneoscopy and biopsy under the direct vision, underlying cirrhosis was found in 247 patients (81.8%), chronic hepatitis in 28 patients (9.3%), normal liver in 27 patients (8.9%) besides the findings of primary liver cancer. 3) Liver cirrhosis was found in 213 patients (89.9%) among the 237 patients with HBsAg(+) primary liver cancer, in contrast to 34 patients (52.3%) among the 65 patients with HBsAg(-) primary liver cancer. 4) Serum HBsAg was found positive in 213 patients (86.2%) among the 247 patients with primary liver cancer complicated from underlying liver cirrhosis. Of 27 patients with primary liver cancer complicated from underlying normal liver, serum HBsAg was positive in 10 patients (37.0%), In conclusion, it is highly suggested that chronic hepatitis B virus infection and cirrhosis, especially chronic HBV infection, are closely related to the etiology of primary liver cancer in Korea and that negativity of serum H BsAg in patients with primary liver cancer can be used as one of the prognostic factors in operability and post operative complications.

적외선 흡수 분광법에 의한 간내 담석의 성분 분석

김영호(Young Ho Kim),윤용범(Yong Bum Yoon),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim),김용태(Yong Tae Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A Intrahepatic calculi are stones involving the right and left hepatic ducts, and their branches, peripheral to their junction at the hepatic hilum. The incidence of intrahepatic calculi is high throughout East Asia including Korea compaired with the West and the composition of intrahepatic calculi are different from each other in the different geographic areas. Therefore the analysis for the composition of intrahepatic calculi is important to understand the pathophysiology of intrahepatic calculi. However, there is no available data regarding the composition of intrahepatic calculi in Korea. So, we analyzed the compositions of 49 intrahepatic calculi removed through the T-tubes or PTBD tubes by infrared absorption spectroscopy. The principal component of intrahepatic calculi was calcium bilirubinate (48.1%), followed by calcium palmitate (12.5%) and cholesterol (11.1%). Neither calcium carbonate or calcium phosphate was found. The 28.5% of dry weight was not analyzed by infrared absorption spectroscopy. Among the 49 cases, 46 cases were pigment stones and 3 cases were cholesterol stones. By the analysis of the principal component, 45 cases were calcium bilirubinate stones, 3 cases were cholesterol stones and 1 case was a calcium palmitate stone. In conclusion, the major type of intrahepatic calculi in Korea is calcium bilirubinate stone and the presence of cholesterol stones sugested the possibility of dissolution therapy for intrahepatic calculi. Further studies for the unmeasured portion may be required to understand the nature of intrahepatic calculi.

한국인에서의 만성 췌장염의 임상적 특성

김영호(Young Ho Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),박중원(Joong won Park),김용태(Yong Tae Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A The clinical characteristics of 53 patients with chronic pancreatitis were analyzed retrospectively to investigate the clinical aspects of chronic pancreatitis in Korea. Alcohol was the most important cause of chronic pancreatitis (51%). In 30% of the patients the causes were not evident. The most common symptoms were abdominal pain (93%) and weight loss (77%). The levels of serum amylase were elevated in only 37% of the patients even during acute exacerbation. In radiologic studies, pancreatic calcifications were found in 65% of the patients In 12 of the 53 patients, chronic pancreatitis could be dignosed only by ERCP. The most common complications were diabetes mellitus (30%), followed by pseudocyst (28%) and biliary tract obstruction (23%). The most common cause of surgical operations was the inability to differentiate chronic pancreatitis from pancreatic cancer with the conventional diagnostic tools including radiologic studies. In the patients with alcoholic chronic pancreatitis, males occupied the larger proportion, weight loss was more severe, and the degree of hyperbilirubinemia was less than in the patients with idiopathic chronic pancreatitis. Although the patients with idiopathic calcifications were older than the patients without pancreatic calcifications, there was no difference in clinical characteristics between calcific and noncalcific chronic pancreatitis exept the mean age. In conclusian, alcohol is the most important cause of chronic pancreatitis in Korea and the ERCP is very useful for diagnosis of chronic pancreatitis, but the level of serum amylase activity is not.

한국인에 있어서의 간내 담석증의 임상적 특성

김영호(Young Ho Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),김용태(Yong Tae Kim),김주성(Joo Sung Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A The incidence of intrahepatic cholelithiasis is higher in East Asia including Korea, than in the West. There have been several clinical studies on intrahepatic cholelithiasis, but the subjects of those studies were limited to operated patients. In this study we analyzed 263 patients whose intrahepatic duct stones were confirmed not only by operation but also by radiologic studies. Among the patients, the male to female ratio was 1:1.5 and thirty-six percent of the patients had a past medical history of cholecystectomy. Involvement of both intrahepatic ducts was most common (39.5%) and stones were detected more frequently in the left intrahepatic duct (34.6%) than in the right (25.9%). Extrahepatic duct stones were found more frequently in the patients where both lobes were involved than in those with single lobe involvement. Regardless of the presence of acute cholangitis, one or more organisms grew in alniost every bile culture (98%). In the detection of intrahepatic duct stones, the sensitivity of computed tomography or percutaneous transhepatic cholangiography was higher than that of ultrasonography or endoscopic retrograde cholangiopancdeatography. From the above results, we suggest that biliary bacterial infection may play an importent role in the pathophysiology of intrahe- patic duct stones and that bile stasis also may play a considerable role. Further studies on efficient methods to diagnose and evaluate intrahepatic duct stones are needed in the future.

흰쥐에서 TNBS 로 유발된 염중성대장염의 병태생리에 관한 연구

김나영(Na Young Kim),김재준(Jae Jun Kim),송인성(In Sung Song),김정룡(Chung Yong Kim),김우호(Woo Ho Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.1

N/A Objectives: The etiology and pathogenesis of ulcerative colitis and Crohn's disease(inflammatory bowel disease (IBD)) are still unknown although intensive research has been carried out in this area. A major limitation to this area has been the relative paucity of relevant animal models. The aims of this study are, first to establish the appropriate animal model for studying for IBD, and second to find out the chemical mediators involving the pathophysiology of IBD. Method: In the first study for establishing an animal model of IBD, 1 ml of 4% acetic acid was instilled into the lumen of the colon of 8 rats, and 1.2 ml of trinitrobenzene sulfonic acid (TNBS, 25 mg/ml) m 50%(v/v) ethanol was instilled into the lumen of the colon of the 16 rats; on the other hand, 1.2 ml of phosphate buffered saline (PBS) was instilled into the lumen of the colon of the 4 control rats. The gross and microscopic finding of the colon was observed 4Shrs, 1wk, 2wks, 4wks later after the instillation of each material. In the second study, PG₂, LTB₄ and specific activities of superoxide dismutase (SOD), catalase, xanthine oxidase were measured in the colon mucosa of 29 rats 48hrs, 2wks, 4wks after the instillation of 1.2 ml of TNBS (25 mg/ml) in 50% ethanol (v/v), and in the mucosa of 10 control rats 4wks after the instillation of 1.2 ml of FBS. Results: 1) In the first study the gross finding of the control group was all normal, and the acetic acid group showed mild focal hyperemia in 48hrs, 1wk, 2wks after instillation. On the other hand, the TNBS group of 48hrs showed black necrosis up to 7 cm from the anal verge in all 4 rats, in the TNBS group of 1wk, 1-1.5 cm sized active ulcerations, in the group of 2wks, 0.2-1 cm sized shallow ulcerations were scattered, and in the group of 4wks, healing to scar stage ulcerations were found. 2) The microscapic finding of the control group was all normal, and the 4% acetic acid group of 48hrs and 1wk showed infiltration of acute inflammatory cells; all rats of 48hrs and 1wk groups showed infiltration of acute inflammatory cells; all rats of 2wk and 4wk groups showed normal finding except mucosal ulceration in the one rat of two after 2wks. On the other hand, all of the 4 rats of 48hr TNBS group showed very severe acute inflammation, which resolved with appearance of chronic inflammation around the deep ulcer in 1wk later. Two weeks later, chronic inflammation became prominent, and 4wks later, chronic inflammation further progressed with fibrosis. 3) In the second study for studying pathophysiology of IBD caused by TNBS, the mean PGE₂ level of the control group was 289.9 pg/mg mucosa, and that of 4Shr TNBS group was 382.2 pg/mg mucosa without statistical significance. The mean PGE₂ level of 2wk and 4wk TNBS groups were 650.4 pg/mg mucosa and 710.4 pg/ mg mucosa, respectively, which were significantly higher than that of the control group. 4) The mean LTB₄ level of the control group was 4.4 pg/mg mucosa, and those of 48hr, 2wk, 4wk TNBS groups were 44.6 pg/mg mucosa, 106.6 pg/mg mucosa, and 52.8 pg/mg mucosa, respectively, which were all significantly higher than that of the control group. 5) The Cu, Zn SOD activity of the 48hr TNBS group was 0.47 unit/mg protein and this was significantly lower than that of control group, 9.37 unit/mg protein. Those of 2wk and 4wk TNBS groups were 1.84 unit/mg protein and 5.85 unit/mg protein, respectively. The Mn SOD activity of contro1 group was 0.79 unit/mg protein, and that of 48hr TNBS group was 0.57 unit/mg protein without statistical significance. However, those of 2wk and 4wk TNBS groups were 5.58 unit/mg protein and 3.69 unit/mg protein, respectively, which were significantly higher than that of the control group. 6) The catalase activity of the 4Shr TNBS group was 1.32 unit/mg protein and this was significantly lower than that of control group, 2.95 unit/mg protein. Those of 2wk and 4wk TNBS groups were 2.08 unit/mg protein and 2.52 unit/mg protein, and they had no

장기적인 Captopril 투여가 백서 소장 점막의 Angiotensin Converting Enzyme 활성도에 미치는 영향

김나영(Na Young Kim),김웅(Woong Kim),안준석(Zoon Seog Ahn),양석균(Suk Kyun Yang),이풍렬(Poong Lyul Rhee),정현채(Hyun Chae Jung),이효석(Hyo Suk Lee),윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Angiotensin-converting enzyme (ACE, c-terminal dipeptidyl carboxypeptidase) plays a key physiological role in the regulation of blood pressure through conversion of angiotensin I to angiotensin II and inactivation of bradykinin. Although this enzyme has been mainly found in vascular endothelial cells, recently it has been identified as a prominent mucosal brush border membrane bound enzyme in the small intestine and is estimated to take part in the digestion and absorption of dietary protein. The authors designed the following experiment to investigate the effect of long-term captopril administration, which is used broadly as an antihypertensive agent and is an active site specific ACE inhibitor, to mucosal ACE specific activity in rat small intestine. Twenty-three 215 g average weight rats were divided into three groups; the control group, consisting of 9 rats, was not fed with captopril; the second group, consisting of 9 rats, was fed with 2.5 mg/kg captopril dissolved in distilled water; and the third group, consisting of 5 rats, was fed with 12.5 mg/kg . The rats were killed by decapitation and the isolated small intestines were divided into three segments of equal length from the Treitz ligament to the terminal ileum, After the mucosal homogenate was obtained from each segment, ACE specific activities and the stable marker enzymes known for the brush border membrane (aminopeptidase N, dipeptidyl aminopeptidase IV, alkaline phosphatase) were assayed. The results were as follows; 1) ACE specific activities were highest in the middle segment and lowest in th distal segment, and there was no difference in ACE specific activities between the control group and 2.5 mg/kg or 12.5 mg/kg captopril treated groups (p>0.05). 2) There was no difference in aminopeptidase N, dipeptidyl aminopeptidase IV, and alkaline phosphatase specific activities between the control group and captopril treated groups (p>0.05). We concluded that mucosal ACE specific activities in rat small intestine were not inhibited by long-term captopril administration, and that the estimated role of rat intestinal ACE in the digestion and absorption of dietary protein would not be altered by long-term captopril administration.

NSAID 에 의한 IEC18 세포독성 및 그 기전

김나영(Na Young Kim),송인성(In Sung Song),김정룡(Chung Yong Kim),김용식(Yong Sik Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.6

N/A Objectives: It is known that the NSAID can cause the ulcerative lesion on the small intestine but the precise pathophysiology was not established yet. This study was done to observe whether the NSAID has toxic effect on the small intestinal cell and if it has cytotoxicity, to investigate its mechanism. Method: To observe the toxic effect of five NSAIDs (indomethacin, sulindac, aspirin, ketoprofen, ibuprofen) upon the IEC18 cells originated from the ileum of the rat, the MTT method was used, and to investigate its mechanism, ATP ratio (ATP in each NSAID divided by ATP of control) was meseared. Results: 1) Among the five NSAIDs, the cytotoxicity of indomethacin was most conspicuous that the IEC18 cell survival rate was 0% in 300㎍/ml of indomethacin. The survival rate for sulindac and ketoprofen decreased in proportion to the concentration up to 600㎍/ml where the survival rate was 5.7% and 15.8%, respectively. For ibuprofen, there was no change in cell survival rate up to 200㎍/ml, while in 400㎍/ml the survival rate was reduced to 4.1% For aspirin, the survival rate was strikingly high (53.5%) even in 1000㎍/ml. 2) The addition of PGE2 to the NSAIDs resulted in no significant changes in the cell survival rate. 3) The addition of prednisolone to NSAIDs resulted in the increase of the survival rate by less than 6.2% for indomethacin, sulindac, and aspirin, On the other hand, the addition of the prednisolone of 2.5㎍/ml increased the survival rate by 16.2% and 21% respectively for ketoprofen of 400㎍/ml and ibuprofen of 300㎍/ml. 4) The ATP ratios measured 3days after application of NSAID to IEC18 cells were found to be 52%, 37%, 34% and 42%, respectively for indomethacin of 200㎍/ ml, sulindac of 300㎍/ml, ketoprofen of 500㎍/ml and ibuprofen of 300㎍/ml, all of which showed the strong toxicity. On the other hand, the ATP ratio was found to increase up to 163% after application of aspirin of 600㎍/ml, which showed the relatively weak toxicity. Conclusion: From these results, each of the 5NSAIDs shows a different level of toxicity from one another, and the impairment of oxygen metabolism, which can be seen from the reduced ATP ratios, may be suggested as an important mechanism of cytotoxicity.

한국에서 분리된 Helicobacter pylori 균주에서의 병리 인자 분포 및 이에 대한 숙주 방어 기전의 분자생물학적 연구

김정목(Jung Mogg Kim),정현채(Hyun Chae Jung),이주영(Joo Young Lee),이경미(Kyung Mee Lee),진영주(Young Joo Chin),김영전(Young Jeon Kim),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: CagA or cytotoxin-positive H. pylori may be associated with gastroduodenal diseases. However, controversies about this association also exist. Moreover, there could be geographic differences in the prevalence of virulence factors such as cagA or cytotoxin. In H. pylori infection, the gastric mucosa shows acute and chronic inflammation. However, the pathogenesis of such as an inflammation by H. pylori is not well elucidated. We performed this study 1) to determine prevalence of the genes of virulence factor such as cagA and cytotoxin in H. pylori, 2) to assess the correlation of their presence with clinical findings, and 3) to test whether the vacuolating cytotoxin of H. pylori could evoke proinflammatory cytokine gene expression in gastric epithelial cells. Methods: 1) The prevalence of the cagA, vacA and adhesin genes in H. pylori strains isolated from Koreans was determined by PCR analysis. 2) H. pylori was cultured in Brucella broth containing 10% fetal bovine serum for 3 days using a shaker in a microaerophilic condition. Cytotoxin assay was performed by determining whether addition of the concentrated culture supernatants is able to cause vacuolization of HeLa cells. 3) After human gastric epithelial cells, Hs746T and AGS were incubated with the culture supernatants containing vacuolating cytotoxin, each RNAs were extracted from the gastric epithelial cells. And then various cytokine gene expression were assessed using RT-PCR. The expressed cytokine transcripts were quantified by RT-PCR and standard synthetic RNA. Among cytokines, IL-8 proteins were also measured by ELISA. Results: 1) More than 95% of H. pylori isolates from Korean adults possessed cagA, vacA and adhesin genes. And 80.6% of H. pylori strains have expressed vacuolating cytotoxicity against HeLa cells within 24 hours. 2) There was no correlation between the virulence factors of H. pylori strains and clinical findings. 3) Cytotoxin-positive culture supernatants also caused vacuolization in gastric epithelial cells, both Hs746T and AGS. 4) Expression of mRNA for proinflammatory cytokines such as IL-1 α, IL-8, MCP-1 and GM-CSF was much more upregulated by vacuolating cytotoxin-positive culture supernatants than cytotoxin-negative ones in both Hs746T and AGS cells. Number of molecules of the expressed IL-8 transcripts was parallel to the amounts of IL-8 protein secreted from gastric epithelial cells. Conclusion : These results suggest that virulence factors of H. pylori may not be factors determining disease entitiy in Korean patients infected with H. pylori. In addition, vacuolating cytotoxin secreted from H. pylori could give rise to vacuolization in gastric epithelial cells as well as induce proinflammatory cytokines from the cells.

한국정상성인의 혈청 및 요 Amylase 치와 췌장질환에 있어서의 진단적 재평가

김정룡 ( Chung Yong Kim ),송인성 ( In Sung Song ),지영일 ( Young Il Chee ) 대한내과학회 1975 대한내과학회지 Vol.18 No.4