혈액 투석막에 따른 말초 혈액 단핵세포의 Interleukin 1 , Iterleukin 6 , Tumor necrosis Factor 생산능에 관한 연구

김영훈(Yeong Hoon Kim),임대건(Dae Geon Lim),조현대(Hyun Dae Cho),김양욱(Yang Wook Kim),박원도(Won Do Park),안재형(Jae Hyung Ahn),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: In order to evaluate the role of these cytokines in biological response induced by blood interaction with hemodialysis membranes. Methodes: We have investigated the IL-1, TNF and IL-6 concentrations in the supernatant of 24-hours cultured peripheral blood mononuclear cells (PBMC) without(spontaneous group) or with broken cuprophan or P1VMA membranes in 9 chronic hemodialyzed patients and 8 healthy controls. The blood samples were drawn before dialysis using following criteria: (a) in last dialytic treatment with PMMA membranes(HDEl), (b) after two weeks of dialytic treatment wih cuprophan membranes(HDE2), Results: In the both of patient group(HDE1 and HDE2) and controls production of IL-l, TNF and IL-6 of PBMC stimulated with cuprophan or PMMA membrane particles was increased compared to those of spontaneous group. IL-1 production of HDE1 stimulated PMMA(99.31±30.15fmol/ml) was significantly higher compared to that of cuprophan(48.43±11.29fmol/ml), TNF production of HDE2 with cuprophan(114.86±38.5lfmoVml) was significantly high compared to that of spontaneous group(52.42±29.94fmol/ml). IL-6 production of HDE2(646.70±103.84fmol/ml) was significantly high compared to that of spontaneous group(385.88±87.03fmoVml). Comparing cytokine production of PBMC, there was a significant correlation between IL-1 and IL-6(r=0.78), IL- 1 and TNF(r=0.78) and TNF and IL-6(r=0,76). Conclusion: Our results show that the interaction of cuprophan or PMMA membranes with blood increase the production of IL-1, TNF and IL-6. We suggest that in patients undergoing routine hemodialysis PBMC are primed by exposure to chronic stimulation.

소간세포암의 경피적 에탄올 주입 요법 효과

임대건,이원식,이옥주,장현정,이연재,이상혁,설상영,정정명,한상석 인제대학교 1996 仁濟醫學 Vol.17 No.3

영상 기술의 발달 및 간세포암 고위험군의 추적 관찰에 의한 소간암의 발견율이 높아져 간세포암의 절제율이 높아지고 있으나, 우리나라 간세포암의 경우에 대부분이 간경변을 동반하고 있어 간 절제 후 간 기능 예비력이 저하됨과 종양의 재발, 종양의 위치, 그리고 환자들의 수술 기피 등으로 인해 절제술이 제한을 받고 있다. 수술적 제한을 받는 소간세포암 10례에서 경피적 에탄올 주입요법(PEIT)을 시행하여 추적 관찰한 후 생존을 분석하고자 하였다. 치료 후 평균 생존 기간은 18.4±10.6개월이고, 1년 생존율은 70%, 2년 생존율은 30%, Child class A군의 평균 생존은 21.4개월, Child class B군의 평균 생존은 13.2개월 이었다. PEIT는 다양한 이유로 간절제술에 제한을 받는 원발성 소간암에서 비교적 안전하고 효과적인 치료법으로 사료되며 정기적인 추적 관찰로 재발 여부를 확인하여 2차 PEIT나 TAE 등의 병용이 필요할 것으로 사료된다. Object : The surgical resection for hepatocellular carcinoma(HCC) wish postnecrotic cirrhosis has been restricted due to poor postoperative functional reserve, the development of new lesion in remained liver and patient's refusal against operation. The aim of this study was to assess the effect of percutanous ethanol injection therapy (PEIT) for the patient with small HCC in whom surgical resection was restricted. Material and Method : The subjects of this study were ten patients who were confirmed as small HCC by ultrasound guided liver biopsy. The mean age of the patients was 53.9 ±7.5 years, the male to female ratio was 9 to 1. HBs Ag was noted in eight cases, Anti-HBs antibody was noted in one case, and only Anti-HBc IgG positive was noted in one case among 10 cases. Five cases were assessed as Child A, four cases were Child B, and one case was Child C. In AFP level, lesser than 350ng/ml was checked in four cases and more than 350ng/m1 was checked in six cases. The average size of tumor was 3.1±0.8cm. Under the guidance of ultrasonography, we punctured the mass with 21-22 guage needle and then injected optimal amounts of the mixture of 99.5% ethanol and 2% lidocaine (ratio of 9:1) until the echogeneisity of tumor was completely changed from hypoechoic to hyperechoic (if need, maximum, 3 puncture were done) as one tome. Above procedure was performed 3-6 tomes repeatedly every 2-3 days as one cycle. We followed up the tumor by abdominal ultrasonography and serum AFP after one month and then every three months. If the regrowth of the tumor was detected or if the development of new lesion was suspected, color Doppler ultrasound, abdominal computed tomography or hepatic angiography was performed. And then we performed the second cycle of PEIT or TAE for the regrowing or new lesion. Results: After the first cycle of PEIT the mean of survival duration was 18.4±10.6 months, one year survival rate was 70% and two years survival rate was 30%. The average duration of survival was 21.4 months in Child A, 13.2 months in Child B, and the maximal duration of survival was more than five years at now. Conclusion : The PEIT was considered relatively safe and effective method for inoperablesmall HCC, but one cycle therapy was not sufficient. We suggest that it is necessary to detech the relapse or regrowing of tumor early by careful observation after PEIT and to per form the combination of second PEIT or TAE.

인슐린 비의존형 당뇨병 환자에서 혈당 조절에 따른 von Willebrand factor의 변화

임대건,윤혁진,윤철,박정현,강창일 인제대학교 1999 仁濟醫學 Vol.20 No.1

인슐린 비의존형 당뇨병 환자에서 혈당 조절에 따른 von Willebrand factor의 변화

임대건,윤혁진,윤철,박정현,강창일 인제대학교 1999 仁濟醫學 Vol.20 No.1S

인슐린 비의존형 당뇨병 환자에서 고혈당 자체가 혈중 von Willebrand factor의 농도를 증가시키는 지를 확인하고 경구용 약제를 사용한 혈당 조절이 von Willebrand factor 농도를 감소시킬 수 있는 지 확인하기 위해 임상적으로 만성적인 당뇨병의 합병증들이 발생되어 있지 않으나 혈당조절이 불량했던 인슐린 비의존형 당뇨병 환자 33명을 각각 엄격한 혈당 조절을 시행한 Euglycemia군 18명과 당뇨병의 급성 증상들의 완화를 위한 통상적인 혈당 조절만을 시행한 Glycemia 군 15명으로 나누어 3개월간 혈당 조절을 시행하고, 당뇨병이 없는 15명의 대조군과 각각 비교하여 다음과 같은 결과를 얻었다. 1) 연구의 시작 시점에서 측정한 평균 공복 혈당과 당화혈색소치는 Euglycemia 군에서 275.5±87.3mg/dl, 12.4±2.7%였고 Glycemia 군에서 248.3±92.1mg/dl, 11.9±3.2%로 나왔으며, 두 군간에 통계적으로 유의한 차이는 없었다. 2) 연구의 시작 시점에서 측정된 von Willebrand factor 값은 Euglycemia 군과 Glycemia 군에서 각각 평균 163±32%, 172±41%로 측정되어 대조군에서 측정된 평균 121±39%와 비교하여 모두 통계적으로 유의하게 증가되어 있었으나(p<0.05), 두 군간에 유의한 차이는 없었다. 3) 엄격한 혈당조절을 시행한 Euglycemia 군에서 평균 공복혈당과 당화혈색소치는 각각 118.6±11.2mg/dl와 5.8±1.3%로 연구 시작 시점의 측정 치보다는 감소하였고(p<0.05), 통상적인 혈당 조절만을 시행한 Glycemia 군에서는 평균 공복 혈당과 담화혈색소치가 각각 163.9±64.3mg/dl와 8.9±2.7%로 연구 시작 시점의 측정치보다는 감소하였으나(p<0.05). Euglycemia 군보다는 통계적으로 유의하게 높은 수치들을 나타내었다(p<0.05). 4) 연구의 종료 시점에서 측정된 von Willebrand factor 값은 Euglycemia 군에서 평균 132±24%, Glycemia 군에서 평균 146±25%로 모두 연구 시작 시점에서 측정된 각각의 측정치와 비교하면 통계적으로 유의하게 감소하였으나(p<0.05). 두 군간에는 유의한 차이가 없었다. 이상의 결과에서 yon Willebrand factor는 임상적으로 당뇨병의 만성 합병증이 발생되어 있지 않지만 혈당 조절이 불량한 인슐린 비의존형 당뇨병 환자에서 대조군보다 증가되어 있다는 사실과, 경구용 혈당 강하제를 사용한 혈당 조절을 통해 감소된다는 사실을 확인하였다. This study was performed to clarify the hypothesis that hyperglycemia itself can elevate the blood level of von Willebrand factor, and lowering of blood glucose level with sulfonylureas can decrease it. Thirty three patients with non-insulin dependent diabetes milletus without clinical evidences of chronic diabetic complications were randomly assigned intro two groups i.e. euglycemic group in which strict blood glucose control was performed, and glycemic group with acceptable glucose control to improve the clinical symptoms only caused by hyperglycemia itself, Fifteen age-matched control subjects without diabetes mellitus and hypertension were also selected. After three months of blood glucose control with sulfonylureas, repeated blood examinations were done. The results were as following : 1) At the start of this study, mean fasting blood glucose and glycated hemoglobin level were 275.5±87.3mg/dl and 12.4±2.7% in euglycemic group, 248.3mg/dl and 11.9% in glycemic group, respectively. These values did not show statistically significant differences. 2) The mean levels of von Willebrand factor at the start of study were 163±32% in euglycemic group and 172±41% in glycemic groups. These values and not show statistically significant differences. 3) In euglycemic group with strict blood glucose control using sulfonylureas, mean values of fasting blood glucose and glycated hemoglobin after 3 months were 118.6±11.2mg/dl and 5.8±1.3%. These values revealed statistically significant decrease compared wish the values at the start of study(p<0.05). In glycemic group with acceptable glucose control, the mean values of fasting blood glucose and glycated hemoglobin after 3 months were 163.9±64.3mg/dl and 8.9±2.7%, respectively. These values skewed statistically significant decrease compared with the values at the start of study(p<0.05). But between were groups, there were no statistically significant differences. 4) The mean levels of von Willebrand factor at the end of study were 132±24% in euglycemic group and 146±25% in glycemic group. Each value revealed statistically significant decrease compared with the mean values at the start of study(p<0.05). But there were no significant differences between these two groups. From the above results, it may be concluded that the levels of von Willebrand factor in poorly controlled non-insulin dependent diabetic patients without clinically apparent chronic diabetic complications are increased. And blood glucose control using sulfonylureas can significantly decrease the mean value of von Willebrand factor in these patients.

만성 B형 간염에서 알파 인터페론의 치료 효과

정정명,임대건,이원식,최봉기,장윤식,이연재,이상혁,설상명,최하진 인제대학교 1996 仁濟醫學 Vol.17 No.2

1991년 1월부터 1993년 12월까지 인제의대 부산백병원에서 6개월 이상 HBsAg 및 HBeAg 양성이며 간조직 검사상 만성간염을 보인 환자들(활동성;26례, 지속성;3례)을 대상으로 알파 인터페론 치료시 혈청 전환 및 간기능 정상화율과 인터페론 투여에 따른 효과에 대해 분석하여 보았다. In order to evaluate the therapeutic efficacy and safety of recombinent alpha-interferon, we studied 29 patients proven to have chronic hepatitis B(CAH : 26 cases, CPH : 3 cases) through biopsy from January 1991 to December 1993. All patients were seropositive for HBeAg and HBsAg, and recieved alpha-interferon with tonal dosage up to 120 million units. The results were as follows ; 1) HBeAg sero-conversion rate was 51.7%(Total 15 cases including 3 cases in chronic per-sistant hepatitis group), and all these patients have showed normalized transaminase levels continously. 2) In response group, the serum transaminase level began to decrease at average 4.7th week after initiation of interferon. But in non-response group, the serum transaminase level began to decrease at 2nd to 4th week transiently after interferon, and then increased again. 3) Several adverse effects were noted during interferon treatment. General ache and myalgia were most common(65.5%), followed by fever and chillness(37.9%), headache(37.9%), leukopenia(17.2%) etc. But they were relatively tolerable. 4) Peripheral blood leukocyte counts showed slight reduction within 1 week after initiationof interferon treatment but rapidly recovered to normal level within 5 days after temporary withdrawal. And after completion of interferon treatment, no significant differences were remained compared with initial level. With these results, it suggests that α-interferon therapy may be effective and safe in chronic hepatitis B. However, further study will be required in non-responsive group thereafter.

폐경기의 여성에서 발견된 폐임파관 평활근종증 1례

이옥주,임대건,오경석,김주인,이봉춘,최석진,이양행 인제대학교 1996 仁濟醫學 Vol.17 No.1

임파관 평활근종증은 폐, 종격동, 복부 임파계의 평활근의 비전형적인 증식을 특징으로 하는 드문 질환으로, 주로 가임기 여성에서 발견된다. 저자들은 운동시 호흡곤란을 주소로 내원한 52세 폐경기 여성에서 개흉 폐 생검을 통해 폐 임파관 평활근종증 1례를 경험하였기에 관련 문헌 고찰과 함께 보고하는 바이다. Lymphangioleiomyomatosis is a rare disorder characterized by proliferation of smooth muscle cells in the tissues of the lung and lymphatic vessels of the abdomen. The symptoms of LAM are logically explaines by the extent and location of the smooth muscle proliferation. This rare disorder causes serious respiratory impairment and survival is generally less than 10 years. It generally presents during the child hearing years, and this, together with exacerbation with menses and during pregnancy, has suggested some degree of hormonal influence. We experienced a case of pulmonary lymphangioleiomyomatosis in a post menopausal wowan who had suffered from exertional dyspnea, so we report it with a brief review of the literature.

당뇨병 환자의 Recombinant DNA Human NPH 인슐린에 대한 혈당 반응

이재윤,표지수,임대건,강창일 인제대학교 1993 仁濟醫學 Vol.14 No.4

종전에는 당뇨병 환자에게서 동물 인슐린(unpurified insulin of bovine/porcine)을 사용하여 혈당 반응을 연구하였으나, 저자들은 Recombinant DNA Human NPH 인슐린을 당뇨병 환자에게 사용하여 그 혈당 반응과 체중에 따른 변화를 관찰하였다. The blood glucose response to Recombinant DNA Human NPH Insulin in 60 diabetic patients with various body weight was studied and the results were as follows ; 1.The transient response pattern was 6 cases(10.0%), the normal response pattern was 44 cases(73.3%), and delayed response patters was 10 cases(16.7%) 2.The blood glucose response with various body weight showed the most groups that belonged to the normal response pattern but the delayed response pattern was relatively common in overweight and obesity group. In conclusion, the blood glucose response to Recombinant DNA Human NPH Insulin in diabetic patients with various body weight showed the most groups that belonged to the normal response pattern.

대장 흑피증 5례의 임상 분석

김규환,옥승철,이영민,임대건,이상혁,설상영,정정명,최하진 인제대학교 1995 仁濟醫學 Vol.16 No.2

대장 흑피증은 매우 드문 질환으로 anthraquinone 제제의 지속적인 복용과 관련되어 있다고 알려져 있는데 저자 등은 본원에서 대장 내시경을 통한 조직검사나 수술을 통해 확진된 대장 흑피증 환자 5명을 대상으로 그 임상적 특징을 관찰하고 문헌 고찰과 함께 보고하는 바이다. Melanosis coli is the brownish black pigmentation of the colon associated with prolonged ingestion of anthraquinone compounds as laxatives. This condition is so rare that a few cases have been reported in Korea and its pathophysiology has not been understood clearly Many studies have suggested that the brownish discoloration of the colon mucosa is due to accumulation of macrophage containing lipofuscin pigment. We report 5 cases of melanosis coli histologically confirmed by colonoscopic biopsy or by operation from January, 1992 to September, 1994 in this hospital with a review of the literature.