가토에서 실험적으로 유발된 겸상 사구체 신염에 관한 Gd-DTPA 조영 증강 후의 역동적 신 자기공명영상

양익,정수영,이열,이경원,원미숙,이일성,이관섭,노정우,전노원,김현태,박문향,Yang, Ik,Chung, Soo-Young,Lee, Yul,Lee, Kyung-Won,Won, Mi-Sook,Lee, Eil-Seoung,Lee, Kwan-Sup,Noh, Jung-Woo,Chun, Roh-Won,Kim, Hyun-Tae,Park, Moon-Hyang 대한영상의학회 1998 대한영상의학회지 Vol.38 No.2

Purpose: The purpose of this study was to evaluate the utility of Gd-DTPA-enhanced dynamic MRI (DMRI) in earlydiagnosis and the assessment of disease processing in experimentally-induced crescentic glomerulonephritis (CGN)in rabbits. Materials and Methods: In six rabbits, CGN was induced by an injection of anti-glomerular basementmembrane Ab. A time-signal intensity curve (TSC) was obtained from DMRI on the day before, and at 1, 4, 7, 15, 45and 113 days after the induction of CGN. Sequential renal biopsies and blood sampling (serum creatinine) wereperformed on the same days, and the results of DMRI and TSC, were compared. Results: In normal kidneys, sequentialDMRI demonstrated the intratubular passage of Gd-DTPA as an inwardly migrating, thin, dark, band pattern. On days1 and 4, the thin dark band appeared but was poorly defined and TSC revealed a delay in peak time. On days 7 and15, movement of the band was seen to be weak and slow, and there was no centripetal migration. The maximal signalintensity of TSC was delayed, and the curves declined very slowly. On days 45 and 113, the dark band pattern wasvery weak and slow, and again there was no centripetal migration. Conclusion: GD-DTPA-enhanced DMRI may be ofvalue in the evaluation of disease processing and the severity of CGN.

발작성 야간혈색소뇨증 : 1예의 MR, CT 소견

양익,정수영,박해정,이열,전노원,노정우,Yang, Ik,Chung, Soo-Young,Park, Hai-Jung,Lee, Yul,Chun, Rho-Won,Noh, Jung-Woo 대한영상의학회 1995 대한영상의학회지 Vol.33 No.5

발작성 야간혈색소뇨증은 매우 드문 용혈성 빈혈로 MR 소견이 보고되기전까지는 특징적인 방사선학적 소견에 대하여 별로 알려져 있지 않았다. 그러나 최근 MR과 CT의 특 징적 소견이 외국 문헌에는 보고된 바 있으나 국내 보고는 없어 MR 및 CT 소견을 보고한 다. 암적색 혈뇨와 만성 빈혈증상으로 반복 수혈후 발작성 야간혈색소뇨증으로 진단된 61세 여자 환자로 복부 MR의 T1, T2 강조영상에서 신피질은 신수질과 비교해 특징적인 저신호 강도를 보였으며 이러한 저신호강도 부위는 조영제를 사용치 않은 CT에서 신피질의 증가된 음영과 일치하였다. 다량 수혈에 의한 혈철증으로 간은 MR에서 저신호강도를 보였고 비장 은 정상이었으며 또한 조영전 CT 상 비장과 비교해 증가된 간 음영을 볼 수 있었다. Paroxysmal nocturnal hemoglobinuria(PNH) is a rare, acquired disease involving multiple hematopoietic celllines. Characteristics of PNH are intrinsic hemolytic anemia, iron deficiency anemia and venous thrombosis. Wereport a case of PNH with characterostoc MR and CT findings. The signal intensity of renal cortex was lower thanthat of medulla on both T1- and T2- weighted MR imaging. On T2 weighted MR images, the liver showed very lowsignal intensity but the signal intensity of the spleen was normal. On precontrast CT the attenuation of renalcortex was higher than that of renal medulla and the attenuation of liver was higher than that of the spleen.These findings of MR imaging and CT were the result from the deposition of hemosiderin in the cells of proximalconvoluted tubules and transfusional hemosiderosis of liver.

실험적 허혈성 급성 신부전 모델에 대한 칼슘 길항제의 효과

권영주(Young Joo Kwon),이규백(Kyu Back Lee),권현민(Hyun Min Kyeon),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim),노정우(Chung Woo Noh) 대한내과학회 1989 대한내과학회지 Vol.37 No.4

N/A Recently, much attention has been focused on the role of calcium in mediating or propagating ischemic cell injury. Modifying alterations in cell calcium redistribution or cellular calcium influx with a variety of agents have been beneficial in ameliorating the degree of cell injury in a number of experimental settings. But studies on animal models about ischemic acute renal failure (ARF) produced either by infusion of vasoconstrictors or by interrupting renal artery blood flow have provided conflicting results. The purpose of this study was to evaluate the effect of calcium entry blockers in an ischemic ARF model by the renal artery clamp in rats. Nine cats were anesthetized with pentobarbital sodium (40mg/kg, I.M,) and a tracheostomy, an IV line and a urinary catheter were placed in position. Temperature was maintained at 37.5 degrees C. By an abdominal approach, both renal arteries were isolated. Four cats were used as controls and received saline for 2 hours before bilateral renal artery clamping. Another five cats were treated with verapamil (5㎍/kg/min.) systemically for 2 hours before bilateral renal artery clamping. All nine cats underwent 1 hour of renal artery clamp followed by 3 hours of reperfusion and hydration with saline. Before clamping and after reperfusion, blood and urine were sampled for creatinine, Na and K, and urine volume was measured. The results were as follows: In the control group, the serum creatinine level was 1.28㎍0.33㎎/dl before clamping and increased to 1.63±0.73㎎/dl after clamping; in the experimental group, the serum creatinine level was 1.20±0.33㎎/dl before clamping and increased to 1.75±0.50㎎/dl after clamping. In the control group, the Ccr value was 13.08±9.25ml/min before clamping and decreased to 0.41±0.22ml/min after clamping; in the experimental group, the Ccr value was 6.24±6.18ml/min before clamping and decreased to 0.14±0.09ml/min after clamping. But these results were not significant statistically. Our results suggested that systemic pretreatment with a calcium entry blocker (verapamil) may be ineffective in an ischemic ARF model by renal artery clamping in cats.

혈액투석복수의 특서과 발새기전에 관한 연구 : 혈액투석의 적절도(Kt/V urea) 및 혈청복수알부민농도경사(Serum ascites albumin gradient:SAAG)를 중심으로 Hemodialy sis adequacy(Kt/V urea) and serum ascites albumin gradient(SAAG)

구자룡,양익,채동완,김근호,박규용,노정우,김형직,전로원,육청미,김현태 대한내과학회 2000 대한내과학회지 Vol.59 No.3

Background : The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). Methods : In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. Results : Mean SAAG of HA was $gt;1.1(1.49±0.40) gm/dL, and mean concentration of total protein of HA was $gt;2.5(4.26±0.58) gm/dL. T mean of weekly Kt/Vurea of patients with HA(2.61±0.85) was significantly lower than that of patients without HA(3.48±0.90)(p$lt;0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p$lt;0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p$lt;0.05). Conclusion : It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.(Korean J Med 59:283-289, 2000)

조기위암에 병발한 미세변화 신증후군양 IgA 신병증 1 예 : 국내외 보고 예 고찰

김진철,이상무,구자룡,정성원,김우중,이현순,조성태,윤종우,오흥영,채동완,김근호,노정우,김형직,전로원,육청미 대한내과학회 2001 대한내과학회지 Vol.61 No.3

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgA level and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.(Korean J Med 61:286-292, 2001)

양측성 기종성 신우신염이 동반된 기종성 방광염 1 예

이현숙,구자룡,신미경,김대경,이종민,정문현,전노원,김재삼,노정우,김형직,고경식,김근호,김지현,채동완 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Since the first clinical observation by Kelly and MacCallum, gas-forming infection of the urinary tract has been extensively studied. It is characterized by gas production within the urinary tract. The gas may often pass outside the urinary tract. Patients with this disorder invariably have uncontrolled diabetes mellitus and possibly associated obstructive uropathy. It is usually caused by aerobic bacteria, most commonly Escherichia coli. In the literature, the majority of cases were emphysematous pyelonephritis alone or emphysematous cystitis separately. Bilateral renal involvement associated with emphysematous cystitis is very rarely seen and no case was reported yet in Korea. We report a case of bilateral emphysematous pyelonephritis and emphysematous cystitis which occured in 48-year-old diabetic patient simultaneously. It was caused by E coli The patient was cured by medical management alone.