조직학적으로 증명된 위 평활근육종의 임상적 고찰

서광식(Kwang Sik Seo),이병석(Byeng Seok Lee),김석현(Seok Hyun Kim),김성걸(Seong Gul Kim),김진희(Jin Hee Kim),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

N/A Objectives : Gastric leiomyosarcomas are uncommon, represent 1 to 3% of primary malignant neoplasms of the stomach and variable in clinical outcomes. This paper is a retrospective study of the clinical behaviour, histopathologic features and prognostic factors. Methods : Between January 1990 and August 1996, the records of nine patients with primary gastric leiomyosarcoma treated at Chung-Nam National University Hospital were reviewed for clinical presentations and histopathologic feature. The statiscal analysis with SAS system was employed for evaluation of prognostic factors. Results: 1) The median age of the patients was 53.4 years with even age distribution from 31 to 76 years. The male and female ratio was 1.25 to 1. 2) The common symptoms were abdominal pain(67%), bleeding(22%) and indigestion(11%). 3) The locations of the tumor was body(56%) and fundus(44%). The growth pattern of the tumor was mostly submucosal(67%). 4) The average size of tumors was 11cm (6-18cm). 5) The central ulcer on the tumor showed 100%. The endoscopically and preoperative diagnosed leiomyosarcoma with endoscopic biopsy was 33%. 6) The low grade tumors were 7 cases and high grade was 1 in eight resected primary gastric leiomyosarcomas. 7) The overall resectability was 89%. The resected cases had no lymph node metastasis. Chemotherapy and radiotherapy was done 5 cases and 1 case, respectively in patients with high mitotic number, large size and distant metastases. 8) The follow-up period was 4 to 49 months and 3 patients were died. Two of 3 died patients were initially diagnosed stage IVA and 1 patient was stage II with very large size (18cm). The average survival time of 3 died patients was 37 months. 9) The two patients from surgically resected eight cases were recurred at liver and peritoneum and died 11 months and 31 months recurrence, respectively. Conclusion : The advanced stage and recurred case has short survival time but the more many cases and longer follow-up periods should be need to identify for prognostic factors and the effective postoperative adjuvant therapy should be studied for high risk patients.

위선종과 위암에서 면역조직화학적 염색을 이용한 p53 단백 발현율의 비교

김진희(Jin Hee Kim),서광식(Kwang Sik Seo),김성걸(Seong Gul Kim),임의혁(Euyi Hyeog Im),육은주(Eun Ju Yook),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),이충식(Choong Sik Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

N/A Backgrounds: The mutation of p53 gene and p53 protein accumulation is discovered in dysplasia of stomach and gastric cancer. We compared p53 protein expression rate with gastric adenoma and gastric cancer using the immunohistochemical stain and tried to know the correlation of the malig- nant potential of gastric adenoma with p53 protein expression. Methods: We obtained 52 tissues from 22 gastric cancers and 30 gastric adenomas. Accumulation of p53 protein was detected by immunohistochemistry using Anti-Human p53 monoclonal antibody(Pab 1801; Pharmingen). Results: p53 immunoreactivity was detected in 33.3% of gastric adenomas and in 59.l% of gastric cancers. But, threre was no significant difference between two groups(p=0.065). The rate of p53 expression according to various stages, differentiations, cell types in gastric cancers was not significantly different. Also, p53 expression rate according to cell types, size in gastric adenomas showed no significant difference. Conclusions: We suggest that mutation of the p53 gene is an early event in stomach tumorigenesis. But there is to be required more research about the correlation of the malignant potential of gastric adenoma with p53 protein expression. (Korean J Gastroenterol 1995;27: 509 - 516)

당뇨병 백서의 간세포에서 Glucokinase 활성도 및 유전자 발현에 대한 인슐린의 영향

강성이(Sung Yi Kang),서광식(Kwang Sik Seo),팽정령(Jeong Ryung Paeng),우정택(Jeong Taek Woo),김성운(Sung Woon Kim),양인명(In Myung Yang),김진우(Jin Woo Kim),김영설(Young Seol Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi) 대한내과학회 1994 대한내과학회지 Vol.47 No.2

N/A Introduction: The liver-specific hexokinase isoenzyme, referred to as glucokinase, is thought to play a key reglulatory role in hepatic glucose metabolism. The glucokinase gene is, therefore, of interest both because of its tissue-specific expression and because of the several regulatory processes that can be analyzed. The level of hepatic glucokinase activity appers to be determined essentially by regulation of the rate of enzyme sythesis, with insulin playing a leading role as an inducer. We investigated the role of insulin for the induction of glucokinase in the liver of diabetic rats. Methods: Experimental diabetes was induced by injection of streptozotocin 7 days before the experiment. Regular insulin was given by three days intraperitoneal injection at 8-h interval. The glucokinase mRNA in the liver was estimated by Nothern blot assay, as well as by fluorometric enzyme activity assay. Results: Glucokinase activity was not reduced in the liver of normal fasting rats as compared to normal fed rats. But glucokinase activity was recuced in the liver of daibetic rats as compared to normal rats. In diabetic rats treated with insulin, glucokinase enzyme activity were increased. But glucokinase mRNA expression was only increased in normogycemic diabetic rat with treated with insulin as compared to hyperglycemic rat. Conclusion: These data indicate that insulin stimulates hepatic glucokinase enzyme activity and mRNA expression. But other hormonal or metabolic factors may be contribute to regulation of glucokinase mRNA expressiom.

1996년도 제35차 대한소화기학회 추계학술대회 / 포스터 발표 : 간 ; 대전지역에서 집단적으로 발생한 A 형 간염환자의 실태조사

신경상,김석현,이병석,서광식,김남재,이두용,박성규,최덕례,이헌영 ( Kyung Sang Shin,Seok Hyun Kim,Byung Seok Lee,Kwang Sik Seo,Nam Jae Kim,Doo Yong Lee,Seong Kyu Park,Deok Rye Choi,Heon Young Lee ) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

허혈성 장질환의 임상적 고찰

김진희(Jin Hee Kim),서광식(Kwang Sik Seo),김성걸(Seong Gul Kim),김남재(Nam Jae Kim),정현용(Hyun Young Jeong),이헌영(Heon Young Lee),김영건(Young Kun Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective: Despite increased awareness of the fatality of mesenteric ischemia, the diagnosis seldom is made prior to the onset of gangrene. The multiplicity of etiologic factors, the many varied presentations, and splanchnic vasoconstriction all affect the extent of ischemic injury, adding to the complexity of the clinical problem. Extensive acute processes are still catastrophic illnesses with a high mrotality, but there is a potential for both better diagnisis and therapy with an improved outcome. Discussion of the pathophysiology, diagnosis, and treatment of this entity will be presented. Methods: A Retrospective review of our experience with ischemic bowel disease was made. Ten consecutive clinical cases admitted in ChungNam National University Hospital from October 1990 to April 1994 were observed. Results: 1) We experienced 5 patients with arterial embolic occlusion, 1 patient with venous thrombosis and 4 patients with colonic ischemia. 2) The peak ages were 6th decade and 8th decade. 3) The major clincal symptoms and signs were abdominal pain (100%), abdominal tenderness (70%), melena (70%), nausea (60%), fever (50%), vomiting (40%) and abdominal distension (30%). 4) On laboratory findings, there were leukocytosis (80%) and thrombocytopenia (20%) 5) In plain film, there were ileus (70%), edematous intestinal wall (50%), mucosal edema (30%), thumb printing (10%) and gasless abdomen (10%). Among the 5 cases performed abdominal CT, there were thickening of intestinal wall in 4 cases, narrowing of intestinal lumen in 2 case and ascites in 3 cases. 6) Bowel resections were perfomed in 7 cases and supportive care was performed in 3 cases. 7) The overall mortality rate was 30%, Conclusion: An oggressive approach in patients suspected of having ischemic bowel is indicated if the diagnosis is to be made before necrosis has occurred. A high index of suspicion, early angiography, correction of the underlying cardiac disease, treatment of splanchnic vasoconstriction, surgical revascularization, and resection of gangrenous bowel are necessery if there is to be a significant reduction in the high mortality rates associated with mesenteric ischemia.

고 위험군 급성 담낭염 환자에서 경피적 담낭배액술의 치료 효과

김남재(Nam Jae Kim),이경태(Kyung Tae Lee),이승민(Seung Min Lee),김석현(Seok Hyun Kim),이병석(Byung Seok Lee),서광식(Kwang Sik Seo),김진희(Jin Hee Kim),김성걸(Seong Gul Kim),이헌영(Heon Young Lee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4

N/A Background/Aims: Percutaneous cholecystostomy for decompression and drainage of the gallbladder is indicated when the patient is elderly or suffers from an inflatnmatory process of the gallbladder and is unable to tolerate an operation. To evaluate the role of percutaneous cholecystostomy in the management of acute cholecystitis in the high risk patients, we reviewed our experiences. Methods: Fourteen high risk critically ill patients with acute cholecystitis underwent percutaneous cholecystostomy from January, 1994 to July, 1995 using 8.'7 Fr pigtail catheter under real-time ultrasound and fluoroscopic guidance. Results: The clinical conditions of 14 patients improved after percutaneous cholecystostomy without technical complications. Eight patients subsequently underwent successful elective cholecystectomy after improvement in their medical condition, but one patient who underwent surgery died 10 days after surgery due to gastric varix bleeding which was not related to the gallbladder catheter. The remaining six patients had resolution of acute cholecystitis but did not undergo elective operation because of their poor medical conditions (three in calculous disease) and restoration of gallbladder function(three in acalculous disease). Conclusions: Percutaneous cholecystostomy may be used as an initial life saving procedure for critically I]1 patients with acute cholecystitis, and serves as a definitive procedure for patients considered to be at high operative risk and who have no residual stones. (Korean J Gastroenterol 1997; 29:515-521)

위,십이지장궤양에 대한 Sodium Alginate(Lamina-G^ⓡ)의 치료효과

서광식,이병석,이경태,이승민,김석현,김진희,김남재,이헌영 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Background : Lamina-G has been in the ulcer bleeding and peptic ulcer patients. Lamina-G is a novel antiulcer agent that enhances the mucosal defensive mechanism and hemostatic effect. This paper is to assess the clinical therapeutic effectiveness and any possible side effect of the Lamina-G. Methods : To evaluate the effect of Lamina-G on peptic ulcer disease, Lamina-G was orally administered 240cc at first two days and then 40cc three times for 6-8weeks to 18 patients with benign peptic ulcer disease. Initial diagnosis, follow up gastrofiberscopic observation was done for these peptic ulcer disease. Results : Subjective symptoms were remarkably improved in 94.4% of study group and 100.0%(control group). The rates of ulcer healing were 72.2% of study group and 70.0% of control group. No clinical side effects had been noticed. Conclusion : These results indicate that oral administration of Lamina-G is effective and safe treatment for the peptic ulcer disease with or without bleeding.

당뇨병 백서의 간세포에서 Glucokinase 활성도 및 유전자 발현에 대한 인슐린의 영향

강성이,팽정령,서광식,안규정,우정택,김성운,양인명,김진우,김영설,김광원,최영길 경희대학교 유전공학연구소 1993 遺傳工學論文集 Vol.5 No.-

목적 당대사의 조절 상태에 따른 생체 변화를 분자 수준에서 이해하고자 식이 조건을 달리한 정상 백서와 화학적으로 유도된 당뇨병 백서의 간조직에서 혈당수준과 인슐린치료 정도에 따라 나타나는 글루코키나제 활성도 및 유전자 발현을 분석하였다. 방법 스트렙토조토신 정맥투여 후 당뇨병의 유발을 확인하고, 인슐린을 1일 3회 3일간 복강내로 투여하여 상태를 안정시킨 후, 인슐린 투여군은 인슐린 투여 6시간이내에 그리고 인슐린 비투여군은 24시간 후 단두하여 채혈하고 복강을 열어 간조직을 채취하였다. 채취한 간조직에서 글루코키나제 활성도는 인산화된 포도당에서 NADH의 형성을 형광분광계로 측정하였으며, 글루코키나제 유전자 mRNA발현은 Northern 분석법을 이용하였다. 성적 정상 백서에서 공복상태와 식이를 섭취한 경우에 간조직의 글루코키나제 효소의 활성은 차이가 없었으나, 글루코키나제 유전자 mRNA 발현은 증가되었다. 당뇨병이 유발된 백서의 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현은 정상 백서에 비하여 낮았다. 인슐린 투쳐 후 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현이 증가되었고, 특히 혈당이 정상화된 경우에서 글루코키나제 유전자의 mRNA 발현이 증가도었다. 결론 인슐린에 의한 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA을 증가를 볼수 있었다. 당뇨병 백서에서 인슐린 투여 후에 혈당조절이 안된 경우 간조직의 글루코키나제 유전자의 mRNA 발현이 증가가 없는 것으로 보아 글루코키나제 mRNA의 발현에는 인슐린 이외의 다른 요소가 관여할 것으로 생각된다. The liver-specific hexokinase isoenzyme, referred to as glucokinase, is thought to play a key reglulatory role in hepatic glucose metabolism. The glucokinase gene is, therefore, of interest both because of its tissue-specific expression and because of the several regulatory processes that can be analyzed. The level of hepatic glucokinase activity appears to be determined essentially by regulation of the rate of enzyme synthesis, with insulin playing a leading role as an inducer. We investigated the role of insulin for the induction of glucokinase in the liver of diabetic rats. Experimental diabetes was induced by injection of streptozotocin 7 days before the experiment. Regular insulin was given by three days intraperitoneal injection at 8-h interval. The glucokinase mRNA in the liver was estimated by Nothern blot assay, as well as by fluorometric enzyme activity assay. Glucokinase activity was not reduced in the liver of normal fasting rats as compared to normal fed rats. And glucokinase activity was reduced in the liver of diabetic rats as compared to normal rats. In diabetic rats treated with insulin, glucokinase enzyme activity were increased. But glucokinase mRNA expression was only increased in normoglycemic diabetic rat with treated with insulin as compared to hyperglycemic rat. These data indicate that insulin stimulates hepatic glucokinase enzyme activity and mRNA expression. But other hormonal or metabolic factors may be contribute to regulation of glucokinase mRNA expression.

골아세포 MC₃T₃-E₁의 증식과 기능에 Insulin Like Growth Factor Ⅰ, Ⅱ 및 부갑상선 호르몬이 미치는 영향

윤현구,정호연,양인명,김성운,김진우,김광원,김영설,최영길,서광식 대한내과학회 1992 대한내과학회지 Vol.42 No.1

MC₃T₃-E₁골아세포군을 이용하여 IGF-Ⅰ과 Ⅱ를 투여하고 DNA합성과 골아세포기능을 측정하기 위해 PTH에 대한 C-AMP반응정도, alkaline phosphatase 활성도를 측정하여 다음과 같은 결과를 얻었다. 1) IGF-Ⅰ과 Ⅱ는 모두 DNA합성이 어느 농도까지는 증식효과를 나타내지만 그 이후에는 억제되는 양상을 보였다. 2) PTH에 대한 골아세포의 C-AMP반응으로 증가되었지만 IGF-Ⅰ과 Ⅱ의 투여시 농도변화에 따른 의미있는 변화는 없었다. 3) 본 실험의 조건에서 alkaline phosphatase 활성도는 증가되지 않았다. 이상의 결과로 MC₃T₃-E₁ 골아세포에 IGF-Ⅰ과 Ⅱ는 세포의 증식을 자극하여 PTH는 C-AMP생성을 촉진하는 효과가 있었다. The effect of insulin-like growth factor (IGF) Ⅰ and Ⅱ on cloned MC₃T₃-E₁ cells that had osteoblastic activity was examined by [³H] thymidine incorporation into DNA, cyclic AMP responsiveness to parathyroid hormone (PTH), and alkaline phosphatase activity. IGF Ⅰ and Ⅱ stimulated the growth and proliferation of osteoblastic cells at 20ng/㎖ and 50ng/㎖, respectively. We next examined the effect of IGF-Ⅰ and Ⅱ on the expression of osteoblastic activity. Adenylate cyclase response of PTH to IGF-Ⅰ and Ⅱ-treated cells showed maximal stimulation at 10 and 50㎚PTH, respectively, but IGF Ⅰ and Ⅱ induced limited activity of osteoblastic function. In conclusion, IGF-Ⅰ and Ⅱ were potent stimulators to the growth of osteoblastic cells but did not have an immediate effect on expression of osteoblastic function in this experiment.

갑상선 자극호르몬 - 방출호르몬 유전자의 cAMP 반응부위의 특성

양인명,서광식,정운원,정석원 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.3

We investigated whether the two variant elements of CRE(TGcCGTCA[5'CRE], TGACcTCA[3'CRE]) in the 5'flanking region of the rat TRH gene, which are different from the CRE consensus sequence(5'-TGACGTCA-3') by one base pair, are responsive to cAMP, and whether the one base pair difference is responsible for the degree of cAMP responsiveness of the gene. When CA 77 cells were stimulated with forskolin and isobutylmethylxanthine for 4 hours, the level of TRH mRNA was increased by only two fold. The transient gene expression study using serial 5'deletion of the TRH gene in PC12 cells showed that the region between-113 and-77, which includes 5'CRE, was crucial for the cAMP resonsiveness. When the plasmid, which contains the 30 bp oligonucleotide including either 5'CRE or 3'CRE ligated to the enhancerless RSV promoter, was transfected into PC12 cells, it did not significantly affect not only the basal transcription but cAMP responsiveness. The 65 bp oligonucleotide including both 5'CRE and 3'CRE, however, increased both of the basal transcription and cAMP-stimulated transcription by 2-3 fold. When the sequence of 5'CRE was converted to that of the CRE consensus by replacing one base pair, the cAMP responsiveness was increased by two fold although the basal transcription was not increased. The one base pair mutant of 3'CRE increased both of the basal and cAMP-stimulated transcription by 3-4 fold. These results suggest that there are the two variant CREs in rat TRH gene, which are relatively weak CRE compared to the CREs of other neuropeptide genes and cooperative for the activation of both the basal and cAMP-stimulated transcription. The one base pair difference of the variant CREs from the CRE consensus sequence is responsible for the weak responsiveness to cAMP(J Kor Soc Endocrinol 9: 190-199, 1994).