(A) study on the immunoglobulin in serum and bile in cases of biliary system diseases

의학과/박사[한글] 면역현상은 전신면역과 국소면역기전으로 대별되며 근래 국소면역기전에 대한 여러가지 시도라 관심이 증가되고 있다(Tomasi등 1980, Gilliland 1982). 국소면역기전에는 여러가지 인체분비액내의 면역글로부린과 보체가 관계되며 분비액의 종류에 따라 면역글로부 린들의 농도도 다르다(Delacroix와 Vaerman 1983). 본 연구에서 조기위암 및 대장암 환자를 대조군으로 하고 담낭염군, 폐쇄성황달 환자중 담도염 동반군과 비동반군을 실험군으로 하여, 개복수술시 혈청, 담낭액, 담도액과 폐쇄성 황달환자에서, 혈청과 동시에 T-tub e를 통하여 담도액을 수술후 3일, 6일에 채취하고 immunodiffusion plate를 이용하여 IgG, IgA, IgM, C^^3 c, C^^4 를 측정한 후, 통계적으로 분석하여 이들을 상호비교하고 문헌고찰하였다. 담낭액은 검사치가 각 군간에서 통계학적 의미가 없었으며, 혈청과 담도액은 통계학적으로 의미있는 차이가 있었다. 면역글로부린중 IgA와 보체중 C^^3 c의 농도차이가 통계학적 의의가 있었다. 폐쇄성황달과 염증정도에 따라 혈청내 IgA, IgG, IgM은 증가되고 담즙 내에서는 감소되는경향을 보였고, 보체의 변화는 뚜렷하지 않았다. 황달과 염증이 수술후 완화됨에 따라서 혈청내에서 IgA는 의의있게 감소하고 담도액내에서는 증가함을 보였으며, 이는 황달과 염증완화와 직접관계가 있는 것으로 생각된다. C^^3 c, C^^4 는 혈청내에서 의의있게 증가되고 특히 C^^3 c는 담도액에서도 의의있계 증가되었다. 본 연구에서는 수술후 정상회복된 환자에서의 결과이고 사망에 까지 이른 환자는 아니었으므로, 추후 이런 환자에서도 측정하여 상호 비교 관찰한다면, 임상적으로 더욱 가치있는 연구가 될 것이며, 폐쇄성화농성 담낭염의 예후를 안정하는데 좋은 검사방법이 될 수 있을 것으로 생각된다. A Study on the Immunoglobulin in Serum and Bile in Cases of Biliary System Diseases Eui Suk Koh Department of Medical Science The Graduate School, Yonsei University (Directed by Prof. Choon Kyu Kim, M.D.) It is well known facts that systemic and local immune reatcions take place in case of infection. (Tomasi et at, 1987; Gilliland, 1982). There are several immunoglobulin and comptement secretions with varying degree of its concentrations according to pathologic conditions (Delacroix and Vaerman, 1983). Immune reactions are multiple. This experiment was undertaken to determine immunoglobulin and complement concentration in various biliary disease conditions. Materials and methods ; As a relative control early stages of cancer(stomach 5 cases and colon 2 cases) were chosen. Experimental groups are divided into group Ⅰ, Ⅱ, and Ⅲ. Group Ⅰ was made up only gall-bladder disease (13 cases) and group Ⅱ had obstructive jaundice with cholangitis (17 cases) and group Ⅲ had obstructive jaundice without cholangitis(16 cases). Sample collections were made from blood, gall-bladder and common bile duct at the time of exploration. In group Ⅱ and Ⅲ, T-tube was placed in the common bile duct and T-tube bile was collected at postoperative 3rd and 6th day along with blood sample. Immunoglobulin G, A and M, complement C^^3 c and C^^4 amounts were measured by immunodiffusion method and ccmpared between three groups. Result: 1. IgA and C^^3 c concentration difference had statistical significance between groups. IgA concetration was increased in serum, but decreased in bile in cases of biliary disease Complement activation seems to be more active in the alternative pathway rather than classical pathway. 2. The determination of immunoglobulin and complement concentration in bile and serum had significance to measure humoral defense ability for an icteric patient with inflammation. 3. It was noted that there was reciprocal trend in the quantitative change between serum and bile IgA in the recovery phase of jaundiced patient with inflammation that was to say. IgA concentration was decreased in serum and increased in the bile with statistical significance. 4. C^^3 c and C^^4 concentration increased significantly in serum, particularly C^^3 c concentration was increased in biliary tract bile in recovery phase. 5. It can be concluded that the changes of immunoglobulin and complement concentration measurement in serum and bile might be a good prognostic indicatior in cases of obstructive jaundice with inflammation. [영문] It is well known facts that systemic and local immune reatcions take place in case of infection. (Tomasi et at, 1987; Gilliland, 1982). There are several immunoglobulin and comptement secretions with varying degree of its concentrations according to pathologic conditions (Delacroix and Vaerman, 1983). Immune reactions are multiple. This experiment was undertaken to determine immunoglobulin and complement concentration in various biliary disease conditions. Materials and methods ; As a relative control early stages of cancer(stomach 5 cases and colon 2 cases) were chosen. Experimental groups are divided into group Ⅰ, Ⅱ, and Ⅲ. Group Ⅰ was made up only gall-bladder disease (13 cases) and group Ⅱ had obstructive jaundice with cholangitis (17 cases) and group Ⅲ had obstructive jaundice without cholangitis(16 cases). Sample collections were made from blood, gall-bladder and common bile duct at the time of exploration. In group Ⅱ and Ⅲ, T-tube was placed in the common bile duct and T-tube bile was collected at postoperative 3rd and 6th day along with blood sample. Immunoglobulin G, A and M, complement C^^3 c and C^^4 amounts were measured by immunodiffusion method and ccmpared between three groups. Result: 1. IgA and C^^3 c concentration difference had statistical significance between groups. IgA concetration was increased in serum, but decreased in bile in cases of biliary disease Complement activation seems to be more active in the alternative pathway rather than classical pathway. 2. The determination of immunoglobulin and complement concentration in bile and serum had significance to measure humoral defense ability for an icteric patient with inflammation. 3. It was noted that there was reciprocal trend in the quantitative change between serum and bile IgA in the recovery phase of jaundiced patient with inflammation that was to say. IgA concentration was decreased in serum and increased in the bile with statistical significance. 4. C^^3 c and C^^4 concentration increased significantly in serum, particularly C^^3 c concentration was increased in biliary tract bile in recovery phase. 5. It can be concluded that the changes of immunoglobulin and complement concentration measurement in serum and bile might be a good prognostic indicatior in cases of obstructive jaundice with inflammation.restrictio

Clinical observation of surgical emergencies in neonates

의학과/석사[한글] 응급수술을 요하는 선천성 기형은 1,000명 출생당 1.5내지 2명에서 발생하는 것으로 되어 있으며 대부분이 출생후 신생시기에 그 증상이 발현되며 진단후 곧 수술로써 교정을 해주지 않으면 사망률이 매우 높은 것으로 알려져 있다. 수술후 예후는 질환의 종류, 증상 발현 시기, 공존기형의 유무 혹은 미숙아의 여부 등에 의하여 크게 좌우되는 것으로 되어 있다. 최근, 수술 전후의 신생아 생리에 대한 지식이 발달되고 또한 진단방법의 개선 및 이에 따른 조기수술, 수술후 수액요법 혹은 경정맥 고영양공급 등의 개발로 이들 신생아 기형의 수술후 합병증 및 사망률이 점차 감소되고 있는 경향에 있다. 저자는 최근 13간 연세대학교 의과대학 의과학교실에서 응급수술을 시행하였던 신생아의 선천성 질환 112예에 대하여 임상적으로 분석 관찰하여 다음과 같은 결과를 얻을 수 있었다. 1. 질환별 발생 빈도는 쇄흉이 35예(31.3%), 선천성 거대 결장증이 23예(20.5%), 선천성 장관 폐쇄증이 21예(18.8%), 염전증을 수반한 중장 이상 회전증이 7예(6.2%), 선천성 횡경막 탈장증이 6예(5.4%), 선천성 식도 폐쇄증이 5예(4.5%), 선천성 복벽 기열이 5예(4.5%), 제대 기저부 탈장증이 3예(2.7%), 대변성 복막염이 2예(1.6%), 환상 취장이 2예(1.6%)로 분류되고 있었다. 2 .전체 대상군에 대한 성별 빈도는 2.1:1로 남아에 호발하고 있었다. 3. 질환별 남녀 성별비는 쇄흉이 2.3:1, 선천성 소장폐쇄증이 2:1, 염전증을 수반한 중장 이상 회전증이 1.3:1, 선천성 횡경막 탈장증이 2:1, 선천성 식도 폐쇄증이 2:1, 대변성 장 폐쇄증이 2:1로 대부분의 질환이 남아에서 호발되고 있었다. 4. 증상 발현시기는 출생후 24시간 이내가 70예(62.6%)로써 가장 많은 빈도를 보이고 있었고, 24시간 후 1주 이내가 30예(26.8%)로 전체대상의 89.4%가 생후 1주일 이내세 증상이 발현되고 있었다. 5. 선천성 병발 기형은 112예중 25예로 22.3%의 비율을 나타내고 있다. 6. 수술후 사망율은 27.7%이었다. 7. 사망원인은 호흡 부전증이 14예(45.1%)로 가장 많은 비율을 차지하고 있었으며, 그 다음으로는 패혈증, 전해질 불균형, 공존 기형에 따른 병발증 등의 순으로 분석되고 있었다. 8. 수술후 예후에 미치는 인자로는 증상 발현시기, 공존기형의 유무, 미숙아의 여부 및 질환의 종류 등으로 분석되고 있었다. [영문] Present report is an analysis of 112 consecutive cases of congenital anomalies requiring emergency operation in neonates seen during the past 13 years, from 1965 to 1977, in the Surgical Department of Yonsei Medical Center. The results were as following: 1. There were 76 boys and 36 girls and, in 89.4% of the patients, their clinical symptoms and signs developed in the first week of life. 2. Imperforate anus, congenital megacolon and intestinal stenosis or atresia constituted 72% of this series. 3. Twenty five cases had one or more associated anomalies, presenting 23.3% in this study, And more than 20% of the patients with esophageal atresia and tracheoesophageal fistuls omphalocele, gastroschisis, and Bochdal다 diaphragmatic hernia had one or more associated anomalies. 4. Thirty one of 112 cases were died after surgery and so 27.7% of mortality rate was recorded. And more than 50% of death occured in the patients with esophageal atresia and tracheoesophageal fistula, gastroschisis, omphalocele, and meconium peritonitis. 5. Pertinent factors, predisposed to death, were presenoe or abscence of associated serious anomalies, prematurity, and onset of symptoms. 6. The major causes of death, in order of frequency, were respiratory insufficiency, sepsis, electrolyte imbalance and associated anomalies.restrictio