고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

생약제제인 이공산(異功散)의 Cisplatin 유도 신장독성 보호 및 항산화 효과

Lee, Kyung-Tae,Ahn, Kyoo-Seok,Chang, Sung-Goo,Oh, Soo-Myung,Jung, Jee-Chang 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Kyung-Tae Lee, Kyoo-Seok Ahn¹, Sung-Goo Chang², Soo-Myung Oh²and Jee-Chang Jung²¹College of Pharmacy, ²Oriental Medicine and ³College of Medicine, and East-West Medical Reserch Institute, Kyung Hee University, Seoul, Korea. Preventive and Antioxidative Effects of Crude Drug Preparation(E-kong-san) on Cisplatin Induced Nephrotoxicity. Proceedings of International Symposium on East-West Medicine, Seoul. 201-211, 1999. -Nephroprotective effects of a crude drug-prearation (E-kong-san) were determined from cisplatin on rabbit kidney proximal tubule and human renal cortical cells by MTT assays and sustained glucose consumption on ciplatin-induced human renal cortical tissue. Levels of creatinine and blood ure nitrogen(BUN) in serum after administration of cisplatin(0.75mg/kg,i.p.) to E-kong-san(0.75g/kg/day,p.o.)-pretreated rats were markedly lower compared to those of cisplatin-treated rats. Moreover, the administration of E-kong-san significantly inhibited the loss of body weight of cisplatin injected rts. These findings suggest that E-kong-san on the cisplatin induced nephrotoxicity led us to investigate whether the effect of this water extract was a result of anti-oxidation. E-kong-san showed strong free radical scavenger activities on 1,1-dipheny1-2picrylhydrazil(DPPH) radical and xanthine/xanthine oxidase(XOD) generated superoxide anion radical(O2-). We further studied the effects of E-kong-san on lipid peroxidation in rat liver microsomes induced by enzymatic and nonenzymatic methods. E-kong-san exhibited significant inhibition on both ascorbic acid/Fe2+and ADP/NADPH/Fe3+ induced lipid peroxidation in rat liver microsomes. Based on these results, we suggest that-E-kong-san attenuate the cisplatin induced cytotoxicity and its mechanism can be eplained by antioxidant.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

위의 유암종과 선종의 병발 1례

장재식,강혁주,이중현,서영범,윤병구,김용섭,이구,서정일,양창헌,이창우,김정란,윤환중 東國大學校醫學硏究所 2000 東國醫學 Vol.7 No.-

유암종은 전신에 퍼져 잇는 장크롬친화성 세포에서 기원하는데 위의 유암종은 비교적 드문 질환으로 모든 유암종의 1.9~2.2%에 해당하며 위에 발생하는 종양의 1% 미만에서 보고되고 있다. 유암종은 일반적으로 증상이 비특이적이고 면역조직화학검사에 의해서 진단되기 때문에 과거에는 드물게 발견되었으나 최근 내시경 기기 및 술기의 발전과 검사 빈도의 증가 및 면역조직화학검사의 발달로 진단율이 증가 추세에 있으며, 드물지만 유암종에서 선암과 공존하는 예들이 보고되고 있다. 저자들은 심와부 동통을 주소로 내원한 70세 남자 환자의 상부위장관내시경 검사에서 위체상부의 대만곡에서 0.4×0.4 cm 크기의 중간 함몰을 가진 Yamada 1형의 용종과 함께 전정부의 전벽에서 0.8×0.5 cm 크기의 융기된 점막 소견을 보여 조직학적으로 각각 위유암종 및 위선종임을 확진한 후 내시경적 용종 절제술로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body. These tumors are composed of variable numbers of cells that contain endocrine granules in their cytoplasm, which can be identified by immunohistochemistry and electron microscopy. Gastric carcinoid tumors are relatively rare tumor, the reported incidence being 1.9~2.2% of all carcinoid tumors and less than 1% of all gastric tumors. Sometimes, composite carcinoid tumors and adenocarcinoma is reported. We experienced a case of the coincidence of carcinoid tumor and adenoma at the other site of the stomach in a 70 year old male patient. Gastrofiberscope showed 0.4×0.4 cm sized Yamada type I polyp with central depression on the greater curvature of the proximal body and 0.8×0.5 cm sized focal slightly elevated mucosa on the anterior wall of the antrum. The endoscopic biopsy specimens revealed carcinoid tumor and tubular adenoma with moderate atypism, respectively. The carcinoid tumor and adenoma were removed by endoscopic polypectomy. According to the follow-up gastrofiberoscopy after 7 month later, both lesions were nearly normal mucosa except whitish atrophic change after polypectomy.

내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

카드뮴폭로후 고환, 신장 및 간장내 카드뮴축적량과 조직손상의 변화

이영구,박정덕,최병선,홍연표,장임원 大韓産業醫學會 1994 대한직업환경의학회지 Vol.6 No.1

To assess the changes of cadmium deposit and histopathologic finding of testis, liver and kidney, different dose of cadmium (Cd) was administerd into male Sprague-Dawley rat(purchased from KIST, Korea Institute of Science and technology) by single intravenous injection. At 12, 24, 48, 168 and 672 hours after Cd injection, tissue cadmium concentration and histopathological change were examined. Cd exposed group showed lesser weight gain than the control. Renal Cd content tended to increase in time-dependent pattern, while hepatic and testicular Cd content tended to decrease. Mean of renal Cd content to hepatic Cd content (Cd K/Cd L) also progressively increased. These results suggest that Cd might be gradually transported to kidney from other organs. In testis and liver, degenerative changes appeared relatively in acute phase. These changes became more pronounced in testis, while less prominent in liver. In kidney, swelling of proximal tubluar cells and thickening of glomerular basement membrane appeared relatively later and these changes were progressively aggravated.

국내 호중구감소성 발열 환자에게 경험적 항진균제로 투여한 Amphotericin B deoxycholate와 Itraconazole 주사제의 비용-확인분석 : 예비보고

이동건,송영구,유진홍,최수미,최정현,박선희,신완식 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : 진균감염이 점차 증가되고 있고 이를 치료하기 위한 비용 역시 증가하고 있지만 국내에서는 비용분석에 대한 연구가 거의 없는 실정이다. 본 연구에서는 호중구감소성 발열 환자에게 경험적 항진균제로 amphotericin B deoxycholate (ABV)혹은 정맥내 itraconazole (ITZA)을 투여할 때의 약물경제학적 측면을 후향적으로 비교해보고자 하였다. 재료 및 방법 : 같은 반응률을 보인다고 가정한 비용-확인분석 모델을 이용하여 가톨릭대학교 조혈모세포이식센터에서 혈액종양으로 항암치료 혹은 조혈모세포이식을 시행한 환자를 대상으로 자료를 수집하였다. 항진균제 투여에 대한 정보는 기존에 출판된 논문 및 학회 심포지움자료를 참고하였고, 논문에서 얻지 못한 정보는 가톨릭대학교 성모병원 의무기록실, 정보지원팀, 진료비관리팀의 협조를 받아 2003년 6월 1일부터 11월 30일까지의 자료를 분석하였다. ITZA에 대한 자료는 2003년 11월 제한적으로 1차 약제로 사용할 수 있게 되었던 때의 자료와 경험을 참조하였다. 결과 : 320명의 환자 중 149명(46.5%)에서 경험적 항진균제를 사용하였고 평균 투여일수는 ABV 17.0일, ITZA 9.8일이었다. 이상반응 발현율은 ABV 54%, ITZA 5%였다. ABV 투여환자 중 11명 (7.4%)에서 혈액투석을 평균 6.5일간 시행하였다. ITZA 투여시 간독성으로 혈장분리반출술, 인공간 등이 필요한 경우는 없었다. 경험적 항진균제를 ABV로 시작한 군(ABV군)은 1인당 1,229,495원, ITZA로 시작한 군(ITZA군)은 1인당 1,434,605원이 소요되어 ITZA군에서 205,110원 (16.7%)이 더 소요되었다. 평균 16일간 항진균제를 사용하여 1일 12,819.4원의 차이가 있었다. 결론 : 비용-확인 분석법에서 ITZA군이 ABV군 비해 하루 12,819.4원의 비용이 더 소요되었다. 비록 ITZA군에서 비용이 더 들었지만 1일 약가차이인 4.7배와 비교하여 많이 감소하여 항진균제의 비용을 1일 약가로 비교하는 것보다는 재원일수, 이상반응 발현율 등을 고려하는 총입원비용으로 약물경제학을 비교하는 것이 더 합당할 것으로 사료된다. 그 외에 환자의 예후, 삶의 질, 사회적 간접비용 등을 고려하는 전체적인 약물경제학을 비교하는 잘 계획된 전향적 연구가 추가로 필요하겠다. Background : The increasing incidence of systemic fungal infections and the rising medical cost have focused the need to determine the economic issues of antifungal agents. Nevertheless there have been only few reports about the cost analysis in Korea. We retrospectively investigated to compare the pharmacoeconomic aspects of amphotericin B deoxycholate (ABV) with those of intravenous itraconazole (ITZA) in the empirical treatment of febrile neutropenic patients. Materials and Methods : Through the cost-identification analysis model, on the presumption that two groups would show identical response, we collected data of patients who received hematopoietic stem cell transplantation (HSCT) or chemotherapy in Catholic HSCT center from Jun 1, 2003 to Nov 30, 2003. The literatures about information on antifungal therapy were extensively reviewed. Other unpublished information was provided by information assistant team, cost management team, and medical record unit in the same hospital. Results : Empirical antifungals were given to 149 out of 320 patients (46.5%). The average duration of administration were 17.0 days for ABV and 9.8 days for ITZA. The rates of adverse events were 54% and 5% for ABV and ITZA, respectively. Eleven (7.4%) patients given ABV received hemodialysis for 6.5 days in average. Among patients given ITZA, none developed hepatotoxicity requiring plasmapheresis or artificial liver. It cost 1,229,495 won/patient for the ABV group (starting ABV as empirical antifungal agent) and 1,434,605 won/patient for the ITZA group (starting ITZA as empirical antifungal agent) which was 16.7% more expensive than ABV group. When we compare the average daily cost for 16 days, the ITZA group spent 12,819.4 won/patient/day more than the ABV group. Conclusion : The cost-identification model in this study revealed that ITZA group cost more than ABV group. However, the difference in expense decreased when 1 day-cost was compared (4.7 times greater than ABV). It would be more reasonable to consider the total cost of anti-fungals during the hospitalization rather than 1 day cost in considering pharmacoeconomics. Well designed prospective study considering prognosis of patients, quality of life, and indirect social cost should be warranted.

太谿穴의 臨床 活用에 대한 文獻考察

구성태,송문영,강정묵,김용명,박보라,이은석,홍정아,김경식,손인철 한국전통의학연구소 2003 한국전통의학지 Vol.13 No.1

Literally, the mean of Tae-gye is highest brook. And on the basis of the acupuncture theory, Tae-gye point is the Soo earth point and source point of the Kidney Channel as well. In addition, Tae-gye point is one of the Yang-Returning Nine points. We were trying to study bibliographically on the Tae-gye point because Tae-gye point can be used very broadly across the symptoms in the theoretical aspect described above. As a results, we found out that according to the classical books of acupuncture, Tae-gye point is entering point of the Meridian Water as a source point and can be used at both Kidney-Sufficient Syndrom and Kidney-Deficient Syndrom. And Tae-gye can be applied to the disease of kidney or bladder that is urogenital symtoms, Also, Tae-gye is an useful option of tooth-ache, asthma, indigestion, constipation, edema etc whose cause is related with decrease of Kidney ki.

정상성대의 초음파소견:역동적 검사

이성문,우성구,김정식 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.2

임상적으로 후두부에 병변이 없는 지원자 27명을 대상으로 성대의 초음파소견을 분석해본 결과 진성대는 저에코로, 가성대는 고에코로, 성인대는 진성대의 자유연에서 고에코의 선으로 보였으며 갑상연골, 피열연골등은 고에코의 구조물로 나타나 초음파영상에서 정상 해부학적 구조를 잘 볼 수 있었다. 뿐만아니라 역동적 검사를 통해 진성대 및 가성대의 움직임을 실시간영상으로 확인할 수 있었는데 진성대는 평상호흡상태에서 흡기시와 호흡중지상태의 중간정도에 위치하였으며 흡기시에는 외전, 호흡중지상태에서는 내전운동을 보였고 그 움직임은 항상 대칭적이었다. 가성대는 진성대와는 달리 호흡중지상태에서도 기도를 완전히 폐쇄시키지 못함을 알 수 있었으며 가성대의 움직임은 항상 진성대의 움직임과 일치하였다. 현재로서는 후두병변의 진단에 있어 초음파의 역할이 확립된 것은 아니지만, 앞으로 CT나 MR과의 비교연구가 계속되어진다면 후두병변의 진단 및 병기결정에 있어 중요한 역할을 하게될 것이라 기대된다. In diagnosis and staging of laryngeal pathology, CT has been used as a method of choice, and a recent study showed that MR is more sensitive and specific than CT. High-resolution ultrasound is not a routine examination in laryngeal disese, however, several studies using ultrasound insisted the usefulness of the ultrasound in evaluation of laryngeal disease. We analized dynamic sonographic findings of the vocal cords in 27 healthy volunteers. Length of the true vocal cords, distance of rima glottids, distance between two false cords were measured in quiet breathing, deep inspiration, breath holding, and Valsalva manuever state. We also evaluated change of the vocal cord shape during phonation True vocal cords are hypoechoic, false vocal cords are hyperechoic, and vocal ligaments are hyperechoic in free margin of the true cords. The thyroid cartilage shows hyperechoic cortical margin with variable inner echogenicity. The arytenoid cartilages are indentified as echogenic dots. During quiet breathing, postion of the true cords is intermediate between deep inspiration as echogenic dots. During quiet breathing, position of the true cords is intermediate between deep inspiration and breath holding. Vocal cords are adducted during breath holing, and abducted in deep inspiration state. Movement of the vocal is always symmetrical. We concluded that ultrasound is a potentially useful technique for examination of the vocal cords. Comparative studies between sonography and CT and MR is necessary to determine the role of sonography.

한국인의 항파상풍 항체 역가

구홍두,최옥경,장석준,정구영,이정운,김승호 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Inspite of immunization, TETANUS remains a disease with a high morbidity and mortality rate. Tetanus has been still occurred more frequently in developing countries where immunization programs are inadequate. In Korea, there is a routine immunuzation schedule with diphtheria, pertussis, and tetanus(DPT) vaccines at 2,4,6 month after birth at 18 month. But further prophylactic programs are not exist. Moreover, we have usually used only passive immunization, tetanus antitoxin, as a prophylactic regimen for injured patients instead of guidelines of Center for Disease Control. The purpose of this study was to assess the baseline tetanus immunity state and to suggest the proper immunization schedule and adequate prophylactic guideline for injured patients in Korea. One hundred thirty one trauma patients from emergency department of Severance hospital from September to November of 1993 were included. Antietanus antibody titers of the patients were analyzed by ELISA assay. The mean antitetanus antibody titer was 0.728 ±0.236IU/mL. The titers were diminished rapidly with age. In pediatric group(age under 15), the mean titer was 3.251 ±0.426 IU/mL and in geriatric group(age over 64), the mean titer was 0.007 ±0.002 IU/mL which was below the minimal protective antibody titer(0.01 IU/mL). While all of the pediatric patients have protective antibody titer, only 69.2% of young adults(15-39, n=65), 56.7% of adults(40-64, n=30), and 57.2% of geriatrics(>65, n=14) have protective antibody titer. Our results suggest that tetanus prophylaxis is unnecessary in the age under 14. In other age groups, however, our data strongly support the need of prophyulaxis.