A Case of Non-alcoholic Chronic Pancreatitis Showing Characteristic Imaging Features

Differentiation between chronic pancreatitis and pancreatic cancer is often difficult. Some special types of chronic pancreatitis such as ‘non-alcoholic duct-destructive chronic pancreatitis' and ‘chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct' seem to be pancreatic cancer, but show imaging features characterized by the absence of parenchymal atrophy, significant ductal dilatation proximal to the site of stenosis, and the absence of extrapancreatic spread. Recognition of these special types of chronic pancreatitis prior to a definite treatment is important to avoid an unnecessary pancreatic resection. Recently, we experienced a case of non- alcoholic chronic pancreatitis in a 80-year-old man presenting with obstructive jaundice. His radiologic features were similar to those of non-alcoholic duct-destructive chronic pancreatitis. Recognition of this special type of chronic pancreatitis prior to a definitive treatment enabled us to manage this patient optimally. (Kor J Gastroenterol 2000;35:826 - 831)ope

Type of Electric Currents Used for Standard Endoscopic Sphincterotomy Does Not Determine the Type of Complications

Background/Aims: The blended current is usually used for endoscopic sphincterotomy (EST) to minimize bleeding. The pure cutting current may induce less edema of the ampulla and therefore result in less injury to the pancreas theoretically. The aim of this study was to evaluate effects of electric currents used on the development of serum pancreatic enzyme evaluation, clinical pancreatitis or bleeding after EST. Methods: One hundred and eighteen consecutive patients who underwent EST with standard papillotome alone for the treatment of choledocholithiasis were reviewed. All EST had been performed by two endoscopists whose experience on EST was similar: one uses "blended current"(BC group, n=74), while the other uses "pure cutting current" (PC group, n=44). Results: Baseline clinical, laboratory, and procedural parameters were similar in both groups. The incidences of hyperamylasemia and hyperlipasemia were similar between two groups. There was no significant difference in the incidence of clinical pancreatitis between two groups (BC 6.8% vs PC 0.0%, p=0.1557). All episodes of pancreatitis were mild. No episodes of significant bleeding occurred after EST. The incidences of sepsis, cholangitis and perforation were also not different between two groups. Conclusions: Development of complications after standard EST such as hyperamylasemia, clinical pancreatitis, and bleeding may not depend on the electric current used.ope

『프로테스탄트 윤리와 자본주의 정신』에 나타난 `막스 베버의 칼빈주의`에 대한 고찰

학위논문(석사)--서울대학교 대학원 :종교학과,2003.Maste

Molecular analysis of mutations in the polymerase gene of hepatitis B virus during antiviral treatment

의학과/박사[한글]배경 및 목적: 만성 B형 간염의 장기간 항바이러스 치료에서 약제내성 변이종의 출현은 치료 실패의 주요 원인이다. 이러한 약제내성 변이종의 출현을 방지하기 위한 단기간 두 약제의 병합치료 효과는 임상에서 적용될 수 있는 새로운 치료 전략이나 아직까지 연구된 바가 없다. 따라서 본 연구는 만성 B형 간염 환자에서 혈액 내 B형간염바이러스(HBV)의 HBV DNA 중합효소 유전자 다양성이 존재하는지 확인하고 항바이러스제 투여에 따른 투약 전과 투약 후 매 12주마다의 각 시점 별 바이러스 변이종 분포의 변화를 조사하고, 항바이러스제의 단기병합요법이 바이러스의 감소 정도와 내성변이종 출현의 방지에 긍정적인 영향을 줄 수 있는 지를 확인하고자 하였다. 방법: 대상 환자는 만성 C형간염바이러스(HCV) 또는 HIV 감염이 없고, 암에 걸린 과거력이 없으며, 만성 B형 간염 치료를 위한 항바이러스제 투여력이 없고, HBsAg양성, HBV DNA 20,000 IU/ml(105copies/ml)이상이며, ALT수치가 정상범위 상한치의 2배 이상인 자로 하였다. 2007년 5월부터 2009년 8월까지 전향적으로 총 40명의 환자들이 클레부딘을 매일 30mg 단독으로 투약하는 군(CLV 단독군;n=20)과 매일 클레부딘 30mg과 아데포비어 10mg을 병합하여 12주간 투약 후 아데포비어는 투여 중단하고 매일 클레부딘 30mg을 지속적으로 유지 투약하는 군(CLV+ADV 병합군; n=20)인 두 군으로 나누어 치료받았다. 분자생물학적 분석을 위해서는 항바이러스제 투약 12주째 HBV DNA수치가 103copies/ml이상인 환자들을 대상으로 CLV 단독군에서 3명, CLV+ ADV 병합군에서 4명, 모두 7명을 선택하였다. 7명의 환자에서 약제 복용 전 시점과 약제 복용 시작한 후 12주마다 간기능검사, HBeAg, anti-HBe Ab, HBV DNA농도를 검사하였다. 약제 내성변이종 검출을 위하여 클로닝 및 염기서열분석방법(각 시점별로 20개의 클론) 및 제한효소분절질량다형성(RFMP)법을 사용하였다. 결과: 약제 투약 전의 두 군 사이에 성별, 나이, ALT수치, HBV DNA 수치는 두 군 사이에 통계학적으로 의미 있는 차이를 보이지 않았다. CLV+ADV 병합군에서 투약 12주, 24주까지의 혈청 HBV DNA는 CLV 단독군과 비교하여 통계적으로 의미 있게 감소하였다 [중앙값, CLV 단독군 vs CLV+ADV 병합군; -2.67 vs -4.11, 12주, p =0.001; -4.15 vs -4.97, 24주, p = 0.036]. 하지만 36주와 48주째까지의 HBV DNA 감소 정도는 통계학적으로 의미 있지 않았다. CLV+ADV 병합군 4명의 클로닝 및 염기서열검사결과를 합한 결과와 CLV 단독군 3명의 클로닝 및 염기서열검사를 합한 결과를 비교한 결과 투약 전에 발견되었던 rtV191I변이가 12주에서 관찰되었으나 24주째는 관찰되지 않았다. 두 군 모두에서 투약 12주째와 24주째에 rtR153Q, rtS223A, rtI224V변이가 발견되었다. 24주 째 두 군 모두에서 rtI91L, rtP109S, rtT118N, rtN121I, rtI122L, rtQ130P, rtS135Y, rtK149Q, rtR153Q, rtI163V, rtI187V, rtS223A, rtI224V 변이들이 발견되었다. CLV 단독군의 증례 1 환자에서 rtA181T+rtV191I변이가 치료시작 24주째 클로닝 및 염기서열검사, 및 RFMP 검사에서 발견되었고, rtA181T+rtV191I 변이가 36주째 RFMP 검사로 발견되었다. CLV 단독군의 증례 3 환자에서 rtI163V변이가 치료전, 치료 12주째, 치료 24주째에 클로닝 및 염기서열검사로 발견되었다. CLV 단독군의 증례 3 환자에서 치료 48주째 바이러스돌파현상이 발생하였을 때 시행한 RFMP검사에서 rtM204I변이가 발견되었다. CLV+ADV 병합군의 증례 4 환자는 치료시작 12주째 rtA181T+rtV191I변이가 RFMP 검사로 발견되었고 치료 48주째 RFMP검사로 rtV173L+rtA181T+rtV191I+rtM204I+rtM204V변이가 발견되었다. CLV+ADV 병합군의 증례 5 환자는 치료 24주째와 48주째에 RFMP 방법으로 rtA181T변이가 발견되었다. CLV+ADV 병합군의 증례 6 환자는 치료 24주째 RFMP검사에서 rtA181T변이가 발견되었다. CLV+ADV 병합군의 증례 7 환자는 치료 24주와 치료 36주째 RFMP검사에서 rtV191I+rtM204I변이가 발견되었다. 결론: 만성 B형 간염 치료를 위한 단기간의 항바이러스제 병합요법(CLV+ADV)은 단독요법(CLV)에 비해 효과적인 혈청 HBV DNA 감소를 유도하였다. 하지만 병합요법에도 불구하고 항바이러스 억제 효과가 충분하지 못했던 경우에는 단독요법과 마찬가지로 바이러스 유전자내에 다양한 변이 양상을 보였다. CLV 단독군의 환자에서 바이러스돌파현상이 발생했을 때 L-nucleoside analogue약제들의 내성변이로 알려진 rtM204I변이가 발견되었다. CLV단독군에서 다약제 내성변이인 rtA181T변이도 발견되었다. CLV+ADV 병합군에서는 rtM204I변이, rtA181T변이, rtV173L변이와 동반된 rtM204V변이가 발견되었고, 아데포비어 내성변이인 rtN236T변이는 발견되지 않았다. 향후 이러한 변이들이 임상적으로 의미 있는 항바이러스 내성 발생 및 치료 효과와 직접적인 연관이 있는지에 대한 확인이 필요할 것으로 생각된다. [영문]Background and aim: The development of drug-resistant mutations during a long-term antiviral therapy is a major cause of the failed treatment of chronic hepatitis B. The short-term combination therapy using two drugs to prevent such drug-resistant mutations is a new treatment strategy, but no research has been conducted about its effect. So, the purpose of this study is: to see what variety of viral quasispecies of HBV exists in HBV DNA polymerase in chronic hepatitis B patients; to examine any changes of the distribution of viral mutations every 12 weeks before and after antiviral drug administration; to check if the short-term combination therapy of antiviral drugs has positive effects on the decrease of virus and the prevention of development of drug-resistant mutations. Methods: The eligible patients had positive HBsAg, with serum HBV DNA levels higher than 20,000 IU/ml(105copies/ml) and serum ALT levels twice higher than the upper limit of normal level. Exclusion criteria included co-infection with hepatitis C or human immunodeficiency virus; evidence of malignancy history; previous exposure to any nucleoside analog that is active against HBV. Between May 2007 and August 2009, a total of 40 chronic hepatitis B Background and aim: The development of drug-resistant mutations during a long-term antiviral therapy is a major cause of the failed treatment of chronic hepatitis B. The short-term combination therapy using two drugs to prevent such drug-resistant mutations is a new treatment strategy, but no research has been conducted about its effect. So, the purpose of this study is: to see what variety of viral quasispecies of HBV exists in HBV DNA polymerase in chronic hepatitis B patients; to examine any changes of the distribution of viral mutations every 12 weeks before and after antiviral drug administration; to check if the short-term combination therapy of antiviral drugs has positive effects on the decrease of virus and the prevention of development of drug-resistant mutations. Methods: The eligible patients had positive HBsAg, with serum HBV DNA levels higher than 20,000 IU/ml(105copies/ml) and serum ALT levels twice higher than the upper limit of normal level. Exclusion criteria included co-infection with hepatitis C or human immunodeficiency virus; evidence of malignancy history; previous exposure to any nucleoside analog that is active against HBV. Between May 2007 and August 2009, a total of 40 chronic hepatitis B Background and aim: The development of drug-resistant mutations during a long-term antiviral therapy is a major cause of the failed treatment of chronic hepatitis B. The short-term combination therapy using two drugs to prevent such drug-resistant mutations is a new treatment strategy, but no research has been conducted about its effect. So, the purpose of this study is: to see what variety of viral quasispecies of HBV exists in HBV DNA polymerase in chronic hepatitis B patients; to examine any changes of the distribution of viral mutations every 12 weeks before and after antiviral drug administration; to check if the short-term combination therapy of antiviral drugs has positive effects on the decrease of virus and the prevention of development of drug-resistant mutations. Methods: The eligible patients had positive HBsAg, with serum HBV DNA levels higher than 20,000 IU/ml(105copies/ml) and serum ALT levels twice higher than the upper limit of normal level. Exclusion criteria included co-infection with hepatitis C or human immunodeficiency virus; evidence of malignancy history; previous exposure to any nucleoside analog that is active against HBV. Between May 2007 and August 2009, a total of 40 chronic hepatitis B patients were prospectively assigned to receive 30mg of clevudine once a day (CLV group; n=20) or 30mg of clevudine and 10mg of adevofir a day for 12 weeks and 30mg of clevudine once a day after 12weeks(CLV + ADV group; n=20). For a molecular analysis, a total of 7 patients who had serum HBV DNA levels on week 12 higher than 1.000 copies/ml (3 patients from the CLV group; 4 patients from the CLV + ADV group) were selected. A liver function test and the HBeAg/anti-HBe Ab/HBV DNA levels of 7 patients were examined every 12 weeks before and after treatment. Cloning (20 clones each time) and the RFMP method were used to find drug-resistant mutations. Results: There were no statistically significant differences between the two groups in sex, age, ALT levels and HBV DNA levels before treatment. The degree of HBV DNA reduction in the CLV+ ADV group was better than that of the CLV group on week 12 and on week 24 statistically, but not on week 36 and on week 48. [median, CLV group vs CLV+ADV group]; -2.67 vs -4.11, week 12, p =0.001; -4.15 vs -4.97, week 24, p = 0.036]. The rtV191I mutation was found before treatment and week 12, but not week 24 when the added results of the cloning and sequencing of 4 patients (CLV+ADV group) were compared with the added results of 3 patients (CLV group). The rtR153Q, rtS223A and rtI224V mutations were found on week 12 and on week 24 in both groups. The rtI91L, rtP109S, rtT118N, rtN121I, rtI122L, rtQ130P, rtS135Y, rtK149Q, rtR153Q, rtI163V, rtI187V, rtS223A and rtI224V mutations were found in both groups on week 24. The rtA181T+rtV191I mutation was found in Case 1 patient of the CLV group on week 24 through cloning and sequencing and the RFMP method. Also, the rtA181T+rtV191I mutation was found in Case 1 patient of the CLV group on week 36 by the RFMP method. The rtI163V mutation was found in Case 3 patient of the CLV group before treatment and on week 12 and week 24 by cloning and sequencing. The rtM204I mutation was found in Case 3 patient of the CLV group by the RFMP method when a virologic breakthrough developed on week 48. The rtA181T+rtV191I mutation on week 12 and the rtV173L+rtA181T+rtV191I+rtM204I+rtM204V mutation on week 48 were found in Case 4 patient of the CLV+ADV group by the RFMP method. The rtA181T mutation was found in Case 5 patient of the CLV+ADV group on week 24 and week 48 by the RFMP method. The rtA181T mutation was found in Case 6 patient of the CLV+ADV group on week 24 by the RFMP method. The rtV191I+rtM204I mutation was found in Case 7 patient of the CLV+ADV group on week 24 and week 36 by the RFMP method. Conclusion: The short-term combination therapy for the treatment of chronic HBV using clevudine and adefovir reduced HBV DNA levels more effectively, compared with the clevudine monotherapy. In the case where antiviral effect was not sufficient, despite the combination therapy, a variety of mutations were found within a virus gene, same as in the case of the monotherapy. The rtM204I mutation, known as the mutation of L-nucleoside analogues, was found in the CLV group when a virologic breakthrough developed. The rtA181T mutation, known as the multi-drug resistant mutation, was found in the CLV group. The rtM204I mutation, the rtA181T mutation and the rtM204V mutation accompanied by the rtV173L mutation were found in the CLV+ADV group. The rtN236T mutation, known as a mutation of ADV, was not found in the CLV+ADV group. Further study to check if these mutations are directly associated with the development of clinically significant antiviral drug resistance and the subsequent treatment outcome is needed.ope

A study on development of oceanographic information service system (V)

한국과학기술연구

Type of electric current used for standard endoscopic sphincterotomy does not determine the type of complication

의학과/석사[한글] 표준 내시경적 유두괄약근 절개술시 사용 전류에 따른 합병증 발생의 비교 목적 : 내시경적 유두괄약근 절개술(endoscopic sphincterotomy, EST)을 시행할 때 사용되는 전류에 따른 합병증의 발생을 비교하여 전류가 EST에 따른 합병증 발생에 미치는 영향을 알아보고자 하였다. 연구방법 : 췌장염, 담관 협착 및 오디괄약근 기능부전이 없으며, 담관 담석증으로 진단받고 이의 제거를 목적으로 EST를 시행 받은 118명의 환자들을 대상으로 임상기록을 검토하였다. 모든 EST는 경험이 비슷한 두 명의 시술자들에 의해 시행되었다. 한 시술자는 74명의 환자들을 대상으로 혼합파(BC)를 사용하였고, 다른 한 시술자는 44명의 환자들을 대상으로 순수 절단파(PC)를 사용하였다. 혈청 아밀라제와 리파제는 시술 전, 시술 후 2시간 및 시술 후 24시간에 측정하였다. 고아밀라제혈증과 고리파제혈증은 EST시행 2시간 후의 각 췌효소의 수치가 정상 범위를 초과한 경우로 하였다. 임상적으로 시술에 따른 부작용을 시술 후 30일 이내까지 후향적으로 평가하였다. 췌장염은 새로운 복통이 발생하거나 기존의 복통이 악화되는 동시에 EST시행 24시간 후에 측정한 혈청 아밀라제 수치가 정상 상한치의 3배를 초과한 경우로 하였다. 결과 : 양 군간의 EST 시행 전의 임상적 요인, 검사실적 요인 및 EST 시술과 관련된 요인들을 비교해 보면 차이가 없었다. 양 군간 고아밀라제혈증 및 고리파제혈중의 발생률 차이는 없었다. 임상적 췌장염은 BC군에서 6.8% 및 PC군에서 0.0%에서 발생하였으나 통계적 유의성은 없었다(p=0.1557). 모든 췌장염은 경증이었고 입원 후 2-3일 내에 퇴원하였다. 출혈은 양 군 모두 발생하지 않았으며, 다른 합병증들도 양 군간에 차이가 없었다. 결론 : EST의 합병증 발생과 사용 전류와는 관계가 없으며, 그 보다는 시술자 요인 이 더 중요한 것으로 생각된다. 핵심되는 말 : 표준 내시경적 유두괄약근 절개술, 순수 절단파, 혼합파 [영문] Background Aim: Although a blended current (BC) is usually used for endoscopic sphincterotomy (EST) to minimize bleeding, a pure cutting current (PC) may induce less edema of the ampulla and therefore less injury to the pancreas theoretically. The aim of the study was to evaluate whether the type of electric current affects the development of serum pancreatic enzyme evaluation, clinical pancreatitis or hemorrhage after EST. Methods: One hundred and eighteen consecutive patients who underwent EST with standard papillotome alone for choledocholithiasis were reviewed. All EST had been performed by one of two endoscopists whose experience of EST was similar; one using ''blended current'' (BC) (n=74), while the other using ''pure cutting current'' (PC) (n=44). Serum amylase and lipase values and peripheral blood hemoglobin levels before and after EST were measured in all patients. Hyperamylasemia (or hyperlipasemia) was defined as increase of serum amylase (or lipase) greater than the upper normal limit (UNL). Pancreatitis was defined as new or worsened abdominal pain and serum amylase at 24 hours after EST greater than 3 × UNL. Results: Baseline clinical, laboratory, and procedural parameters were similar in both groups. The incidences of hyperamylasemia and hyperlipasemia were similar between the two groups. There was no significant difference in the incidence of clinical pancreatitis between the two groups (BC 6.8% vs PC 0.0%, p=0.1557). All episodes of pancreatitis were mild. No significant episodes of bleeding occurred after EST. The incidences of sepsis, cholangitis and perforation were also not different between the two groups. Conclusion: Development of complications after standard EST such as hyperamylasemia, clinical pancreatitis and hemorrhage does not seem to depend on the electric current used. Key Words : endoscopic sphincterotomy, electric current, blended current, pure cutting currentope

A Study on the Max Weber`s Calvinism in The Protestant Ethic and the Spirit of Capitalism

The purpose of the thesis is to elucidate whether the Protestant Reformation, especially its Calvinist branch, have contributed a decisive role for the formation and development of modern capitalism. For more than a century this Question has been the focal point of a scholarly controversy which had its beginning in 1904-5 with the publication by the famous German sociologist, Max Weber, of an article entitled "Die Protestantische Ethik und der Geist des Kapitalimus" (The Protestant Ethic and the Spirit of Capitalism). In his essay Weber proposed the tentative thesis that this crucial element had appeared as a kind of by-poduct of the religious ethics of Calvinism

열린충남 57호-[열린마당]행복도시의 성공적 추진전략과 비전

1. 추진 배경 우리나라 전체면적의 11.8%에 해당하는 수도권에 인구의 절반가량이 살고 있다. 우리나라의 수도권 인구집중도는 현재 49.1%에 이르는데, UN은 이러한 수치가 세계 4위에 해당한다고 발표하였다(UN Report, 2007). OECD에서도 대도시권이 인구 6백만 내지 7백만을 넘어서게 되면 집적으로 인한 효율보다 혼잡과 오염 등으로 인한 비경제효과가 더 크다고 지적한 바 있다. 실제로 삶의 질에 대한 평가에 있어 서울은 세계에서 86위에 머무르고 있다고 보고된 바 있다(Mercer, 2008). -이후 생략1. 추진 배경 2. 추진 현황 3. 현 시점의 진단과 분위기 4. 행복도시의 성공 전략 5. 행복도시의 비