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신이식 후 초기의 적절한 Tacrolimus 치료 농도
민상일(Sang-Il Min),김성엽(Seong Yup Kim),안상현(Sang Hyun Ahn),정진구(Chin Koo Chung),민승기(Seung-Kee Min),하종원(Jongwon Ha),김상준(Sang Joon Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Immunosuppressive regimen based on reduced-dose Tacrolimus (TAC) is widely accepted in the field of renal transplantation. However, optimal targetsfor TAC whole blood trough concentrations during the early period after kidney transplantation remain uncertain. Methods: A total of 184 consecutive adult renal transplant recipients with triple immunosuppression (TAC/Mycophenolate/corticosteroid) were included in this study. According to the trough level of TAC at day 7 after transplantation, patients were classified as low TAC concentration (LT, <10 ng/㎖, n=85), intermediate TAC concentration (IT, 10∼15 ng/㎖, n=75), and high TAC concentration (HT, >15 ng/㎖, n=24) groups. Rate of acute rejection, graft function and side effects of TAC within 1 yr after transplantation were evaluated. Results: There was no difference in trough concentrations of TAC at 2 weeks, 1 month, 3 months, 6 months and 12 months after transplantation among the three groups. Significantly higher incidence of acute rejection within 2 weeks after transplantation was observed in LT group compared with IT and HT groups (17.4%, 5.6% and 4.8%, respectively, P=0.037). HT patients showed significantly better estimated glomerular filtration rates until 6 months after transplantation than IT and LT patients (75.5±24.8 vs. 63.8±12.8 and 64.3±15.2 ㎖/min at 6 months, P=0.03). There was no significant difference in TAC toxicity in terms of post-transplant diabetes and renal toxicity. Conclusion: Short-term high TAC exposure immediately after kidney transplantation may provide lower incidence of acute rejection and better restoration of graft function compared with low or intermediate TAC exposure.
쥐의 허혈성 하지 모델에서 VEGF를 함유한 Nanoparticle의 투여 효과
안상현(Sang Hyun Ahn),민상일(Sang-Il Min),김성엽(Seong Yup Kim),민승기(Seung-Kee Min),양한광(Han-Kwang Yang),김상준(Sang Joon Kim),하종원(Jongwon Ha) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.4
Purpose: Vascular endothelial growth factor (VEGF) is one of the factors regulating angiogenesis. For angiogenesis, the local concentration of VEGF has to be maintained. Because of its short half-life, VEGF has been conjugated with nanoparticles. Some nanoparticles, such as poly (lactic-co-glycolic acid (PLGA)) or polyethylenimine (PEI) are commonly used in this field, but have weak points such as faster release than expected and cell toxicity. We investigated the effect of core/shell nanoparticles including lecithin lipid cores in the ischemic hindlimb model. Methods: Mice were anesthetized and a region of the common femoral artery and vein was ligated and excised. Hindlimb ischemic mice (n=28) were divided randomly into four groups: Control group (normal saline, n=7), mouse VEGF group (mVEGF, n=7), nanoparticle including mVEGF group (N-mVEGF, n=7), and nanoparticle/hydrogel mouse VEGF group (NH-mVEGF, n=7). The drug was injected postoperatively into the thigh muscle of the ischemic limb. Perfusion, capillary number and H&E stain were assessed 28 d after treatment. Results: The capillary number increased in N-mVEGF and mVEGF group (P=0.026). Improvements of ischemic limb perfusion were inferior in N-mVEGF, NH-mVEGF groups (P=0.006) compared to other groups. Mice received N-mVEGF, NH-mVEGF treatment showed significant inflammation in the H&E staining. Conclusion: Sustained VEGF delivery via core/shell nanoparticle with lecithin core did not show improved perfusion rate despite an increase in capillary number. Furthermore, vacuolization and induction of inflammation requiring a different composition of nanoparticle should be tested.
이진욱(Jin Wook Yi),정인목(In Mok Jung),이태승(Taeseung Lee),민승기(Seung-Kee Min),민상일(Sang Il Min),박양진(Yang Jin Park),하종원(Jongwon Ha),정중기(Jung Kee Chung),김상준(Sang Joon Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Acute ischemia of the arm is uncommon compared with events in the leg and much less attention has been paid to the management of acute arterial thromboembolism of the upper extremities. The aim of this study was to evaluate the clinical aspects and treatment outcomes of acute upper extremity thromboembolism. Methods: From January 2007 to March 2010, seven patients underwent the management of upper extremity thromboembolism in three Seoul National University (SNU)-affiliated hospitals. We retrospectively reviewed the medical records. Results: The mean age was 64.6 years (range 48∼93 years) and 4 patients (57.1%) were female. Distribution of the thromboembolism were 4 in brachial, 1 in axillary plus brachial, 1 in ulnar and radial, and 1 in axillary artery, respectively. Time from symptom onset to presentation was 3.5 days (range 1∼10 days). Primary treatment modality were Fogarty catheter embolectomy in 3 cases, bypass surgery in 1 case, and urokinase thrombolysis in 2 cases. A patient without symptoms was treated conservatively. Patients receiving primary thrombolytic therapy underwent surgical approach due to recurred thromboembolism during admission. In our 11.2 months of mean follow-up, there was recurrence but 1 patient died from cerebral infarction after 1.5 year of discharge. Conclusion: In this study, functional outcome of acute upper extremity ischemia following appropriate treatments was excellent. Key features of treatment are shortening the time interval of diagnosis to primary treatment, proper anticoagulation, and treatment of underlying conditions. Larger-volume, long-term results and meta-analysis of upper extremity thromboembolism are required to establish standardized treatment in Korea.
정인목(In Mok Jung),한소리(So Rhee Han),최금희(Keum Hee Choi),권유진(Yujin Kwon),이태승(Taeseung Lee),민승기(Seung-Kee Min),박양진(Yang Jin Park),정중기(Jung Kee Chung),하종원(Jongwon Ha),김상준(Sang Joon Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Although progenitor cells may contribute to intimal hyperplasia (IH) after arterial injury, positive contribution of IH is variable with type of injury or cells. This study was designed to examine whether differentiated muscle derived stem cells (MDSC) attenuate IH in rat. Methods: MDSCs were retrieved using preplate techniques from rat calf muscle and MDSCs (preplate 6th culture fraction, pp6) were exposed to VEGF (50 ng/㎖) for endothelial differentiation prior to injection. Male rats were divided into two groups (cell treated vs. control) and underwent carotid balloon injury with 2-Fr catheter. The virus containing Green fluorescent protein (GFP) gene was transfected into cells for monitoring. Cells (5×10?) were indwelled into carotid artery for 30 minutes after injury and then blood flow was restored. Arteries were harvested at various intervals (1, 2 and 4 weeks) after injury. The intima to media thickness ratio (IMTR) was calculated with morphometric analysis. Results: Endothelial surface markers such as VE-CADHERIN were strongly expressed on differentiated MDSCs. At 4 weeks after injury, IH was predominantly observed in control group compared to cell treated group. The intensity of GFP was strongly observed at 1 week and declined at 4 weeks in carotid artery wall at MDSC group. CD31(+) endothelial cells were observed at MDSC group compared to control. The mean IMTR in cell treated groups were significantly lower than control at 2 weeks (P=0.005) and 4 weeks (P≤0.001). Conclusion: Our study demonstrates that MDSCs therapy promotes re-endothelialization and leads to attenuation of IH after balloon injury in rat.
김민영,김상준,허승,하종원,정중기,안문상,민승기 대한혈관외과학회 2001 Vascular Specialist International Vol.17 No.1
Purpose: Takayasu arteritis is an inflammatory arteriopathy which predominantly affects young females and involves the aorta and its major branches. There is little information on reconstructive arterial surgery for Takayasu arteritis. We aim to evaluate the effectiveness and safety of the operation performed for symptomatic Takayasu arteritis. Method: Eighteen patients (5 men and 13 women) with Takayasu arteritis treated surgically from 1985 to 1999 at Seoul National University Hospital were reviewed. Result: Hypertension was the main symptom in our patients. Four paitients initially underwent medical treatment. Eighteen patients have undergone 21 vascular procedures for the occlusive arteria1 disease. Surgical indications included renovascular hypertension (17), cerebrovascular insufficiency (3), and extremity ischemia (1). Twelve patients with renovascular hypertension treated by unilateral or bilateral aortorenal bypass. Six patients have undergone renal autotransplantation. Aorto-aortic bypass was performed in 4 abdominal aortic coarctation. Two patients with cerebrovascular ischemia were treated by aortocarotid bypass. One patient with upper extremity and cerebrovascular ischemia have undergone femoroaxillary bypass and axillovertebral bypass. There were no postoperative mortality or morbidity except acute renal failure in one patients with full recovery. Revision of the initial reconstruction has been required for recurrent renovascular hypertension in two patients. All patients except two showed beneficial effect after procedures for renovascular hypertension. Conclusion: Surgical treatment of symptomatic Takayasu arteritis is highly effective and safe. Symptomatic improvement and excellent long-term graft patency can be expected after arterial reconstrucion. Considering their young age, aggressive surgical intervention is needed in the patient with Takayasu arteritis.