• 대한수의학회지
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• 제40권2호
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• pp.213-220
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• 2000

Experimental induction of apoptosis by bacterial lipopolysacchardie is useful for understanding the role of apoptosis cell death in clinical endotoxin shock or septic shock. Thirty three mice were injected intraperitoneally with D-galactosamine (20mg) and lipopolysac-charide ($5{\mu}g$) per mouse. Five to eight mice per each experimental group were sacrificed at 6, 12, 24, 48 and 72 hrs post administration. The cells with apoptotic bodies in H-E stained sections were investigated histologically. Development of the apoptotic bodies in livers was observed in 11 of 33 mice (33.3%). These cells were diffusely or collectively appeared only in liver but not observed in kidney, thymus and spleen. Mean percentage of the cells with apoptotic bodies in the livers were 0.32, 4.34 and 5.50% respectively at 6, 12, and 24 hrs post administration. But percentage of these apoptotic cells were fairly less in 48 and 72 hrs post administration. The percentages of cells with 3 to 9 apoptotic bodies per cell were 70~90% of all apoptotic cells. The cells with more apoptotic bodies than limit number at 12 to 72 hrs post administration were belived to be necrosed. The percentage of positive cells by TUTNEL methods were 0.00~0.08, 0.00~052, 1.63~4.18, 12.41~20.21 respectively at control, 6, 12 and 24 and less than 0.01% at 48 and 72 hrs. The above results suggest that development of liver cell apoptosis by lipopolysaccharide ($5{\mu}g$) and D-glatosamine (20mg) was less at 6 hrs and markedly increased at 12 to 24 hrs and then was fairly less at 48 and 72 hrs post administration.

• Tuberculosis and Respiratory Diseases
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• 제69권6호
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• pp.469-473
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• 2010

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Journal of Chest Surgery
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• 제17권4호
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• pp.762-774
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• 1984

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

• Journal of Microbiology and Biotechnology
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• 제24권8호
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• pp.1133-1142
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• 2014

Interleukin-32 (IL-32) is a cytokine and inducer of various proinflammatory cytokines such as $TNF{\alpha}$, IL-$1{\beta}$, and IL-6 as well as chemokines. There are five splicing variants (${\alpha}$, ${\beta}$, ${\gamma}$, ${\delta}$, and ${\varepsilon}$) and IL-$32{\gamma}$ is the most active isoform. We generated human IL-$32{\gamma}$ transgenic (IL-$32{\gamma}$ TG) mice to express high level of IL-$32{\gamma}$ in various tissues, including immune cells. The pathology of sepsis is based on the systemic inflammatory response that is characterized by upregulating inflammatory cytokines in whole body, particularly in response to gram-negative bacteria. We investigated the role of IL-$32{\gamma}$ in a mouse model of experimental sepsis by using lipopolysaccharides (LPS). We found that IL-$32{\gamma}TG$ mice resisted LPS-induced lethal endotoxemia. IL-$32{\gamma}$ reduced systemic cytokines release after LPS administration but not the local immune response. IL-$32{\gamma}TG$ increased neutrophil influx into the initial foci of the primary injected site, and prolonged local cytokines and chemokines production. These results suggest that neutrophil recruitment in IL-$32{\gamma}TG$ occurred as a result of the local induction of chemokines but not the systemic inflammatory cytokine circulation. Together, our results suggest that IL-$32{\gamma}$ enhances an innate immune response against local infection but inhibits the spread of immune responses, leading to systemic immune disorder.

• Tuberculosis and Respiratory Diseases
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• 제62권4호
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• pp.308-313
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• 2007

연구배경: 패혈증에서 Nitric oxide 스테로이드 호르몬은 혈역학적 변화와 염증반응에 관여하는데 이 두 인자는 서로 상관성이 있는 것으로 알려지고 있다. 하지만 실제 환자에서 서로의 상관성이나 임상적 의의는 연구가 부족한 실정이다. 방법: 패혈증 환자 26예와 대조군 14예를 대상으로 혈중 총 NO와 혈중 코티졸 농도를 측정하였고 이어서 제 3, 5, 7병일에도 연속적으로 측정을 하였다. 결과: 패혈증 환자군에서 초기 혈중 코티졸 및 총 NO 농도는 대조군에 비하여 유의하게 증가하였고 경증 패혈증에 비하여 중증 패혈증 환자군에서 유의하게 높았다. 초기 혈중 총 NO의 농도는 APACHE II 점수, 정맥혈 lactate 농도와 상관성이 있었다. 패혈증의 시간의 경과에 따라 혈중 NO 농도는 제 1병일, 제 5병일, 제 7병일에 혈중 코티졸의 농도와 유의한 상관성이 있었다. 결론: 패혈증 환자들에서 혈중 NO와 코티졸 농도는 증가되어 있었으며, 경과에 따라 서로 유의한 상관성이 지속되었다. 상호작용기전에 대하여는 추가적인 연구가 필요할 것이다.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1992년도 제1회 신약개발 연구발표회 초록집
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• pp.28-28
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• 1992

브라디키닌은 체내에서 강력한 혈관 확장 작용을 일으키는 autacoid(local hormone)로서 혈압의 항상성 유지, 모세혈관 투과성 증진, 염증 및 통증 반응 등에 관여하고 여러 장관 평활근을 수축시킨다. 또한 septic 혹은 endotoxic shock의 여러 원인 물질로도 생각되어진다. 최근 rhinovirus로 인한 감기의 제증상 원인 물질로도 브라디키닌이 주목을 받고있다. 이와같이 브라디키닌온 다양한 질병에 있어 중요한 원인 물질로 여겨지므로 브라디키닌 길항제들은 한두 질병의 치료제로 개발될 가능성이 높음이 강력히 제시되고 있는 실정이다. 이의 개발을 위해서 브라디키닌 수용체에 대한 연구는 필수적이라고 할 수 있다. 본 연구는 두 부분으로 나누어 진행중인데 첫째, 이제까지 보고된 브라디키닌 길항 물질들은 대부분이 브라디키닌의 특정 아미노산 잔기를 치환시킨 펩타이드 유도체로서 이들을 경구 투여시 peptidase어 의하여 쉽게 분해되고 또한 부분적인 효능제 활성을 갖는 불리한 점을 감안하여, 비펩타이드성 브라디키닌 길항제를 개발할 목적으로 한방 및 민간에서 자주 사용되어온 생약중에 브라디키닌 작용에 선택적 길항효과가 있는 물질을 검색한 바 활성을 보인 황금으로부터 작용 성분을 추적중에 있다. 둘째, 브라디키닌 수용체를 순수하게 분리 정제하기 위한 첫 단계로서 이 수용체의 결합시험(binding assay) 방법을 확립하고 더불어 여러 조직내(흰쥐의 여러 기관, 토끼 및 사람의 신장)의 브라디키닌 수용체의 분포를 파악하는 일이다. 횐쥐 조직의 실험 결과로부터 신장에 브라디키닌 수용체가 많이 분포함을 확인되었고 향후 토끼 신장으로부터 동수용체를 분리하고자 한다. 또한 토끼 신장의 근위세뇨관일차배양세포을 이용하여 브라디키닌의 신장에서의 작용기전도 살펴보고 있다.+}$, $Na^{+}$, NH$_{4}$$^{+}$ 및 H$^{+}$) 수용액 메디움에서의 Cd(II), Mg(II) 및 Zn(II)의 Dowex 1-X8, Cl$^{-}$ 수지에 대한 흡착은 역시 어떤 메디움에서도 Cd(II) 흡착이 제일 크며, 다음이 Zn(II) 이고 착이온을 형성않는 Mg(II)이 제일 작았다. 한편 메디움 종류별 D값의 크기순위는 H$^{+}$>K$^{+}$> $Na^{+}$>NH$_{4}$$^{+}$이였다. 메디움의 종류에 따라 D값의 차이가 나는 것은 금속이온의 착이온 형성과 금속이온의 용액내에서의 이온종의 상태와 관련이 있다고 생각된다. 마. MCl(M:K$^{+}$, $Na^{+}$, NH$_{4}$$^{+}$ 및 H$^{+}$)과 MNO$_{3}$ 용리액에 의한 Cd(II), Mg(II) 및 Zn(II)의 용리는 예상한 바와 같이 MCl에서 작은 Dv 값을 갖는데, 이것은 CdCl$_{4}$$^{2-}$ 착이온을 형성하거나 ZnCl$_{4}$$^{2-}$ , ZnCl$_{3}$$^{-}$같은 이온과 MgCl$^{+}$, MgCl$_{2}$같은 이온종을 형성하기 때문인것 같다. 한편 어떠한 용리액에서던지 NH$_{4}$$^{+}$의 경우

• Journal of Gastric Cancer
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• 제18권1호
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• pp.37-47
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• 2018

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

• 대한유전성대사질환학회지
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• 제16권3호
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• pp.148-154
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• 2016

요소 회로 대사 이상은 요소 합성에 관련된 효소의 결핍으로 인해 발생하는 질환으로, ornithine과 carbamylphosphate로부터 citrulline을 생성하는 과정에 관여하는 효소인 OTC 결핍증이 가장 흔하다. OTC 결핍증은 ammonia, glutamate, glutamine, alanine 등의 축적되면서 고암모니아 혈증 및 고글루타민 혈증으로 인한 신경학적 증상이 나타나게 되며, 근긴장 저하, 호흡 부전, 경련, 기면, 혼수로 진행하여 사망에 이르게 된다. 저자들은 생후 4일 경부터 구토와 함께 의식의 저하를 보인 환자에서 직열 질량 분석법을 통해 OTC 결핍증을 진단하였고, 증상 발생 31시간 만인 생후 118시간 째에 지속적 정정맥 혈액여과(continuous venovenous hemofiltration, CVVH)을 적용하여 고암모니아 혈증을 치료하였다. 또한 직접염기서열분석법을 통해 780번과 781번 염기 사이에 CAGGCAGTGT가 삽입되는 변이(c.780_781insCAGGCAGTGT (p.Ile261Glnfs*35))를 발견하였다. 환자는 4일 간의 CVVH 이후 혈중 암모니아 농도와 의식이 호전되어 생후 53일 째 퇴원하였으나, 생후 12개월 경 좌측 대퇴골의 골절과 골수염이 발생하였고, 이후 패혈증 쇼크, 고혈당, 다발성 장기부전으로 사망하였다. 이에 저자들은 OTC 결핍증 환자에서 CVVH 치료 및 패혈증과 당뇨를 경험하였고, 유전자 검사에서 이전에 보고된 바 없는 새로운 변이를 확인하였기에 증례를 보고하는 바이다.

• Journal of Chest Surgery
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• 제45권4호
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• pp.236-241
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• 2012

Background: Prolonged usage of extracorporeal membrane oxygenation (ECMO) may induce multi-organ failure. This study is aimed to evaluate prognostic factors in the patients with ECMO. Also, the prognosis of ECMO with Kidney Injury Network Scoring system is studied. Materials and Methods: From May 2005 to July 2011, 172 cases of ECMO were performed. The cases of perioperative use of ECMO were excluded. Renal failure patient and younger than 15 years old one were also excluded. As a result, 26 cases were enrolled in this study. Male patients were 15 (57.7%), and mean age was $56.57{\pm}17.03$ years old. Demographic data, ECMO parameters, weaning from ECMO, and application of continuous renal replacement therapy are collected and Acute Kidney Injury Network (AKIN) scores were evaluated just before ECMO and day 1, day 2 during application of ECMO. Results: Venoarterial ECMO was applied in 22 cases (84.6%). The reasons for applications of ECMO were cardiac origin in 21 (80.8%), acute respiratory distress syndrome in 4, and septic shock in 1 case. Successful weaning from ECMO was achieved in 15 cases (57.7%), and survival discharge rate was 9 cases (34.6%). Mean duration of application of ECMO was $111.39{\pm}54.06$ hours. In univariate analysis, myocarditis was independent risk factors on weaning failure. Using the receiver operating characteristic curve, level of hemoglobin on 24 hours after ECMO, and base excess on 48 hours after ECMO were showed more than 0.7. AKIN score was not matched the prognosis of the patients with ECMO. Conclusion: In our study, the prognosis of the patients with myocarditis was poor. Hemoglobin level at first 24 hours, and degree of acidosis at 48 hours were useful methods in relating with prognosis of ECMO. AKIN scoring system was not related with the prognosis of the patients. Further study for prognosis and organ injury during application ECMO may be needed.