곰쓸개 복용 후 발생한 육안적 혈뇨와 신유두부 괴사증 1예

김우진,한민석,김수항,박인형,박진석,선제형,홍세인,박옥영,신정현,이숭,신병철 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Renal papillary necrosis occurs most commonly in association with urinary tract infection, diabetes mellitus, sickle cell disease, vascular disease, and analgesic nephropathy. Clinical presentation may be related to symptoms of pyelonephritis such as flank pain, renal colic, hematuria, Proteinuria, recurrent fever. The necrotic tissue may be sloughed off, and the diagnosis can sometimes be made by finding piece of renal medullary tissue in the urine. Pyelography may demonstrate cavities and sinuses in the resion of papillae. Anuria & oliguria can lead to the acute renal failure, and especially prognosis and progress may be affect influenced by urinary infection. We report a case of renal papillary necrosis with ingestion of bear gallbladder. On pyelography, Persistent contrast is diagnostic clue of renal papillary necrosis. This case is not be related to urinary tract infection, but occurred acute renal failure. Expectant treatment was gone.

심낭삼출을 동반한 CREST증후군 1례

윤덕구,박승국,박근용,전영준,이인규,박창호 啓明大學校 醫科大學 1986 계명의대학술지 Vol.5 No.2

CREST syndrome is variant of scleroderma characterized by calcinosis, Raynaud's phenomena, esophageal dysmotility, sclerodactyly & telangiectasia. In the past, it was believed that CREST patients live longer than scleroderma because rare involvement of internal organ, but recently noted that CREST patients may die early by involvement of internal organ. Recently, authors experience one case of CREST syndrome associated with pericardial effusion, herein presenting our experience and literature and reviewed.

악성 점막하 종양과의 구별이 어려웠던 Gastritis Cystica Profunda 1예

선제형,박진석,한민석,김수항,김우진,박인형,이숭,유종선,박찬국 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Gastritis cystica profunda (GCP) is a rare disease characterized by gastric foveolae elongation along with hyperplasia and cystic dilatation of the gastric glands extending into the tissue beneath the submucosa. GCP mainly develops at the gastroenterostomy stoma but can arise in a stomach that has not undergone surgery. The proposed pathogenesis is related to chronic inflammation, ischemia and the presence of a foreign body. GCP may present as a submucosal tumor, Polyp or a giant gastric mucosal fold. Endoscopic ultrasonography (EUS) is an effective diagnostic method for differentiating GCP from protruding and elevated gastric lesions. We report a case of GCP along with the endoscopic and EUS findings that were indistinguishable from a malignant submucosal tumor.

만성 실질성 간질환 환자 혈청에서 Basic Fibroblast Growth Factor 및 Angiogenin 농도의 변동

백인규(In Kyu Paik),이숭환(Soong Hwan Lee),조윤주(Yun Ju Cho),이성희(Sung Hee Lee),김홍주(Hong Ju Kim),남승우(Seung Woo Nam),고희관(Hee Kwan Koh),이창범(Chang Beom Lee),박동일(Dong Il Park),조영중(Yong Jung Cho) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Liver fibrosis by the progression of the chronic process of the liver disease induces deformed microcirculations of the hepatic lobules and this eventually resulted in portal hypertension. Angiogenic stimulant factors are physiologically activated in order to repair the tissue damage. Overexpression of angiogenic factors, however, can stimulate neovascularization as in a formation of the hypervascular tumor that liberates uncontrolled overgrowing of the tumor cells. To elucidate the dynamic changes of the serum concentration of basic fibroblast growth factor(bFGF) and angiogenin in chronic liver diseases, this study is intended to employ an ELISA out of pathologically proven patients. Methods: Sera taken out of the 44 patients with chronic persistent hepatitis(5 cases), chronic active hepatitis(6 cases), liver cirrhosis(19 cases) and hepatocellular carcinoma(14 cases) were tested for bFGF and angiogenin employing Quantikine' ELISA Kits (R & D Systems Inc. Minneapolis, MN) that pathological diagnosis was proven )ater. The statistical analysis was evaluated by students t-test. Results: Serum mean value and standar<I error of bFGF concentration(pg/ml) was 11.851.98 in 19 cases of liver cirrhosis, 9.86+2.35 in 14 cases of hepatocellular carcinoma, 9.48+4.57 in 6 cases of chronic active hepatitis, and 8.29+2.63 in 5 cases of chronic persistent hepatitis. Mean value and standard error of angiogenin concentration (ng/ml) of the sera was 238.92+50.95 in 5 cases of chronic persistent hepatitis, 184.47+12.75 in 6 cases of chronic active bepatitis, 131.36+10.99 in 19 cases of liver cirrhosis, and 211.03+19.08 in 14 cases of hepatocellular carcinoma, respectively. Serum angiogenin concentration in liver cirrhosis was significantly lower than that in chronic persistent hepatitis(p=0.0033(I), and than that in chronic active hepatitis(p=0.018673). Angiogenin concentration in hepatocellular carcinoma was very significantly elevated, when compared with the level of the liver cirrhosis investigated (p=0.000569). Conclusions: These data suppoit that persistent inflammatory insults in chronic hepatitis were compensated by the elevation of angiogenin, but complete fibrosis as in liver cirrhosis showed the depressed level of angiogenin. Again, emerging of the hepatocellular carcinoma is accompanying with the elevated stitnuli of angiogenin for the neovascularization. In contrast, bFGF in this study was statistically not significant but may be related with fibrosis and reconstruction of microvascular system accompanying with progression of chronic parenchymal liver diseases to liver cirrhosis.(Korean J Gastroenterol 1996; 28:806-814)

간질환 환자 혈청에서 ELISA를 이용한 angiogenin 측정의 평가

권기운,이숭환,이성희,김홍주,이창화,김병훈,백인규,박동일,박성수,이동후 대한간학회 1996 Clinical and Molecular Hepatology(대한간학회지) Vol.2 No.1

Backgroud:Liver fibrosis by the progression of the chronic processes of the liver diseases induces deforrned microcirculations of the hepatic lobules. And this eventually resolted in portal hypertension. On the other hands, angiogenic stimu4nt factors are physiologically activated in order to repair the tissue damage. Overexpression of angiogenic factors, however, can stimulate neovascularization as in a fonnation of the tumor that liberates uncontrolled overgrowing of the tumor cells. Methods: To elucidate the dynamic changes of the serum concentration of angiogenin in chronic liver diseases, this study is intended to employ an ELISA in 44 pathologically proven patients. Quantikiae_(TM) human angiogenin kit (R & D,systems Inc. Mmneapolis, MN) was used for this investigation. Results:Mean value and standard error of angiogenin concentration (ng/ml) of the sera was 238.92+ 50.95 in 5 cases of chronic persistent hepatitis, 184.47+ 12.75 in 6 cases of chronic active hepatitis, 131.36+ 10.99 in 19 cases of liver cirrhosis, and 211.03+ 19.08 in 14 cases of hepatocellular carcinoma, respectively. Serum angiogenin level in the liver cirrhosis was significantly lower than in chronic persistent hepatitis(p=0.00336), and than in chronic active hepatitis(p=0.018673). Angiogenin concentration in hepatocellular carcinomas was significantly higher than the level of the liver cirrhosis investigated(p=0.00569). Conclusions:These data support that persistent inflammatory insults in the chronic hepatitis were compensated by the elevation of angiogenin but complete fibrosis as in liver cirrhosis showed the depressed level. And emerging of the hepatocellular carcinoma is accompanied by the elevated stimuli of angiogenin for the neovascularization.

만성간질환에서의 혈청 procollagen 1/3 propeptides 농도비 측정의 의의

유용걸(Yong Keol Yoo),이숭환(Soong Hwan Lee),김병훈(Byoung Hun Kim),조영중(Young Jung Cho),백인규(In Kyu Paik),유병무(Byeong Moo Yoo),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),최호순(Ho Soon Choi),이동후(Dong Ho 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Most of Ihe chronic liver diseases of variable etiologies are accompanied by a pathobiochemical reaction So-called fibrosis. Liver fibrosis was recently recognized as all the complexity of dynamic changes of the hepatic extracellular matrix(ECM). And ECM consists of four major components: collagen, glycoprotein such as fibronectin and laminin, proteoglycan, and elastin. Among these, collagen I and III are the representatives of disproportion of synthesis and degradation in conjunction with fibrogenesis. To elucidate the clinical significance of procollagen propeptide I(PICP) and III(PIIINP) measurements among the sera out of patients with chronic liver diseases, radioimmunoassay 4vas employed in this investigation. Methods: Sera tested were obtained from pathologically-proven 54 patients; 4 cases of fatty liver, 11 cases of chronic persistent hepatitis, 13 cases df chronic active hepatitis, 15 cases of liver cirrhosis and 11 cases of hepatocellular carcinoma. All:the patients except 4 cases of fatty liver were shown positivity of HBsAg. PICP and PIIINP radioimmunoassay kits(Farmos Diagnostica, Oulunsalo, Finland)were purchased for this study. ResOlts: PICP concentration (mean+standard error) was highest in liver cirrhosis (280.06>39,83 pg/L). PICP in liver cirrhosis was significantly elevated in cornparison to that (109.30+14.58) in fatty:liver(p=0.045), that (122.22>10.26) in chronic persistent hepatitis (p=0.003), and that (158.59>21.58) in chronic active hepatitis(p=0.016), PICP in hepatocellular carcinoma was decreased to 1'94.05+ 29.89. Similarly, PIIINP concentration revealed highest level in liver cirrhosis(17.29+3.58 pg/L). This value was significantly higher than that of chronic persistent hepatitis(5.12+0.59)(p=0.008). Contrarily to these results, concentration ratio of PICP/PIIINP was high in fatty liver (29.27>6.29) and chronic persistent hepatitis (25.04+2.00), These value were statistically higher than that of chronic active hepatitis (17.632.67) (p=0.043). PICP/PIIINP ratio in liver cirrhosis (21.58+3.29) showed no statistical difference. Conclusions: On the basis of these data, it is suggested that the elevation of PICP and PIIINP in the sera of the patients with chronic liver diseases means emerging the liver cirrhosis. And the ratio of these markers can be helpful in differential diagnosis of chronic liver diseases. (Korean J Gastroenterol 1996; 28:815-823)

중증 간경변환자에서 공복 및 식후 혈청 Gastrin 치의 변동

박승국(Soong Kook Park),강영우(Young Woo Kang),송영성(Young sung Song),이인규(In Gyu Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.3

N/A Increased incidence (5-40%) of peptic ulceration in the patients with liver cirrhosis has been observed but the pathogenesis has not been clarified. The liver eliminates more than 90% of short gastrin peptides. This study was conducted to investigate the changes of serum gastrin concentration in patients with liver cirrhosis. Fifteen patients with advanced liver cirrhosis and 12 normal control subjects were randomly selected for this study, and the gastrin concentration of each subject was measured at fasting, 15, 45, 90 and 120 minutes after ingestion of 200 ml of commercial milk. The following results were obtained. 1) In the normal control group, the postprandial serum gastrin concentration increased significant- ly at 15, 45 minutes and reached its peak level at 45 minutes. In the patients with advanced liver cirrhosis, it increased significantly at 15, 45, 90 minutes and reached its peak level at 90 minutes. 2) Compared with that of normal control group, postprandial secretory response was blunt signifi- cantly (p<0.01) at 15, 45 minutes in the patients with advanced liver cirrhosis but there was no significant difference in peak level. 3) There was no significant difference in fasting and postprandial serum gastrin concentration between ulcer group and non-ulcer group in the patients with liver cirrhosis.

간경화증, 암성 복막염 및 결핵성 복막염 환자의 혈청과 복수내의 Immunoglobulin, 보체 및 Fibronectin치에 관한 연구

박승국,김인산,윤덕구,이두룡,강영우,안성훈,허정욱,조준승 대한감염학회 1989 감염 Vol.21 No.1

Spontaneous bacterial peritonitis is more frequently developed in cirrhotic ascites than noncirrhotic ascites. To evaluate antibacterial activity of cirrhotic ascites, authors analysed immunoglobulin, C3, C4 and fibronectin level in normal ascites, cirrohotic ascites, cancerous and tuberculous ascites and compared its level between cirrhotic ascites and non cirrhotic ascites. The protein content was 1.8gm% in liver cirrhosis and 4.3gm% in normal control and protein content of cirrhotic ascites was significantly lower than normal control, but there was no statistically significant difference in cell count and differential count. Serum Ig G, Ig A and Ig M were 1792 mg%, 485 mg% and 219 mg% respectively in liver cirrhosis and these values were statistically significantly low compare to carcinomatous peritonitis except Ig G but had no statistically significant different compared to tuberculous peritonitis. Ascites Ig G, Ig A and Ig M were 350 mg%, 102 mg% and 37 mg% respectively in liver cirrhosis and statistically significantly low compared to normal and tuberculous ascites but only Ig M was significantly lower than cancerous peritonitis. Ascites to serum ratio of IgG, IgA, IgM, C3 and C4 were 0.20, 0.24, 0.17, 0.09 and 0.19 respectively in liver cirrhosis and statistically significantly lower than cancerous peritonitis and tuberculous peritonitis. Fibronectin level of serum, ascites and ascites to serum ratio in liver cirrhosis were 311μgm/cc, 99μgm/cc and 0.28 respectively, although these values were lower than cancerous peritonitis and tuberculous peritonitis there was no statistically significant means.

간세포암종 환자에서 간동맥색전술후 혈청 Angiogenin , bFGF 및 EGF의 상승

이숭환(Soong Hwan Lee),조용현(Yong Hyeon Jo),김병훈(Byoung Hun Kim),김홍주(Hong Ju Kim),이창화(Chang Hwa Lee),이재영(Jae Young Lee),남승우(Seung Woo Nam),백인규(In Kyu Paik),박찬현(Chan Hyun Park),이동후(Dong Hoo Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: Angiogenesis, the induction of the formation of blood vessels, is critical to the development, progression, and metastasis of animal and human tumors. Tumor cells may produce factors which either induce or inhibit angiogenesis and that the onset of angiogenic activity is determined by the balance of these factors may be generalizable to other tumors. Hepatocellular carcinoma is hypervascular tumor and transcatheter arterial embolization(TAE) is widely used to treat patients with unresectable hepatocellular carcinoma. To evaluate changes of angiogenic factors after TAE for hepatocellular carcinoma, we investigated serum angiogenin, bFGF and EGF at the pre-TAE and the post-TAE among the seven patients with hepatocelluar carcinoma. Methods: Angiogenin, bFGF and EGF concentrations in sera were measured at pre-TAE and 3 days after TAE by employing ELISA. The statistical analysis was evaluated by Student's t-test. Results: 1) Angiogenin concentration at pre-TAE and post-TAE was 197.57+28.82ng/ml(mean+standard error) and 225.89>32.06ng/ml, respectively(p=0.022). 2) bFGF concentration at pre-TAE and post-TAE was 6.71+1.83 pg/ml and 21.68+5.58 pg/ml, respectively(p=0.036). 3) EGF concentra- tion at pre-TAE and post-TAE was 195.09+40.29 pg/rnl and 258.11+36.12 pg/ml, respectively (p=0.014). No correlation, however, was present among angiogenin, bFGF, and EGF at both of pre-TAE and post-TAE state. Conclusions: These results indicate that certain angiogenic factors, such as angiogenin, bFGF, EGF, were increased significantly at post-TAE in comparison to pre- TAE, which may reduce the therapeutic effect of TAE for hepatocellular carcinoma. We suggested that the tissue injury/destruction associated with ischemia by hepatic artery embolization are generally considered to represent a fundamental stimulus for angiogenesis in post-TAE. Therefore, suppression of angiogenesis at post-TAE may be important in improving survival for the patients with hepatocellular carcinoma since tumor growth and metastasis are angiogenesis-dependent. (Korean J Gastroenterol 1996; 28:391 - 401)

괴사성 간경변증에서의 골이영양증

조성래(Sung Rae Cho),박경아(Kyung Ah Park),여준기(Joon Kee Yoe),박정모(Chung Mo Park),박근용(Geun Young Park),이인규(In Gyu Lee),허정욱(Jeong Wook Hur),안성훈(Sung Hoon Ahn),박승국(Soong Kook Park) 대한내과학회 1994 대한내과학회지 Vol.47 No.6

Objectives: Patients with chronic liver disease are at increased risk to develop metabolic bone disease. Although the etiology of the osteopathy in patients with primary biliary cirrhosis has not been defined, vitamin D deficiency and calcium malabsorption have been suggested as possible pathogenetic factors. In Korea, Patients with postnecrotic liver cirrhosis due to chronic hepatitis B are numerous, however, data on the prevalence and severity of osteopenia in these patient are rare. This study was performed to elucidate the mechanism of osteopenia and to examine its severity in postnecrotic liver cirrhosis. Methods: Thirty four patients with postnecrotic liver cirrhosis and thirty controls matched in age and sex were included in this study group. To obtain bone mineral density of lumbar spines in postnecrotic liver cirrhosis and control groups, measurements and comparisons of following tests were performed: Dual energy xray absorptimetry, serum calcium, serum osteocalcin, and serum 25 (OH) vitamin D. In addition, initial morning urine sample was collected to measure pyridinoline crosslinks. Results: 1) The average bone density of lumbar spines was 1.03±0.03 gm/cm² in postnecrotic liver cirrhosis group and 1.15±0.02 gm/cm² in normal controls (p<0.01). 2) The prevalence of osteopenia in the lumbar spine was 50% in postnecrotic cirrhotics compaired to 13% in controls. 3) The levels of serum calcium, 25 (OH) vitamin D and serum osteocalcin were 2.12±0.04 mmol/L, 7.38±1.00 ng/ml and 1.92±0.18 ng/ml in postnecrotic liver cirrhosis, 2.54±0.05 mmol/L and 21.68±1.90 ng/ml and 3.31±0.31 ng/ml in control group (p<0.05). 4) The levels of urinary pyridinoline crosslinks in postnecrotic liver cirrhosis and control were 82.87±7.50 nM/mM and 43.48±3.52 nM/mM, respectively (p<0.05). Conclusion: This study suggests that the incidence of lumbar osteopenia is more common in postnecrotic liver cirrhosis patients. In addition, its pathogenesis is related to vitamin D deficiency, decreased osteoblastic activity, and increased osteoclastic activity. Further studies including several hormones and histopathology of bones are needed to clearly define the mechanisms of osteopenia in postnecrotic liver cirrhosis.