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신영태,황평주,김종학,강민규,구영선,양종오,장윤경,이강욱 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1
CAPD has established itself as an effective method maintaining the patients with end stage renal disease. CAPD peritonitis is one of the most important complication of peritoneal dialysis. We analyzed the incidence, pathogens, and outcome of the peritonitis, of the 95 patients who underwent CAPD at CNUH from January 1993 to July 1998. The result were as follows : 1) A total of 72 episodes of peritonitis occurred during this periods. The incidence of peritonitis were 0.64/patient/year. 2) The first episode of peritonitis was occurred within a year in 75%, within two year in 95.8%. 3) The rate of positive and negative culture were 27.8% and 72.2% respectively. Gram positive organisms were cultured in 60%, Gram negative organisms in 40%. S. aureus were most prevalent organisms(30%). 4) The cure rate were 83.3% in Gram positive organisms and 62.5% in negative organisms. 5) Peritoneal catheter were removed in 18 cases. Among them, 7 cases are due to peritonitis. In conclusion, improved technology and increasing patients' effort to careful management of catheter will reduce the incidence of peritonitis.
일측 요관폐쇄에 의한 실험적 수신증에서 신조직내 MCP-1 및 TNF-α유전자 발현
나가량,황평주,김종학,구영선,강민규,서광선,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2
Early cellular and molecular derangements have been suggested as potential pivotal factors for the development of renal injury, such as interstitial fibrosis after the experimental hydronephrosis. Several recent studies have been demonstrating that one of the initial events taking place in the progressive renal injury process is the mononuclear cell infiltration in the glomeruli and tubulointerstitiuim. In order to evaluate the renal light microscopic findings as well as the renal cortical MCP-1 and TNF-α gene expressions which are modulating inflammatory process and the recruitment of mononuclear cells in many experimental models of renal injury, Sprague-Dawley rats underwent unilateral ureteral obstruction (UUO) and sham operation under the thiopental sodium anesthesia(50 mg/kg intraperitoneal injection). Three and 7 days after surgery, rats were sacrificed. By the competitive RT-PCR, the levels of TNF-α and MCP-1 mRNA in renal cortical tissues were measured. The magnitude of mononuclear cell infiltration and interstitial widening were evaluated by standard point counting method. The level of MCP-1 gene expression was significantly increased in UUO group compared to sham group at 3 and 7 days after surgery(UUO 3 days 8.99 ± 0.45, UUO 7 days 11.2 ± 0.26, sham 3 days 1.00 ± 0.08, sham 7 days 0.94 ± 0.05, p < 0.01, p < 0.01, mean ± SEM, respectively). The level of MCP-1 mRNA at 7 days after surgery was significantly higher than that at 3 days in UUO group. The TNF-α gene expression level of UUO group was also significantly higher than that of sham group at 3 and 7 days after surgery(UUO 3 days 1.73 ± 0.16, UUO 7 days 2.03 ± 0.21, sham 3 days : 1.00 ± 0.06, sham 7 days 1.09 ± 0.03, p < 0.01, p < 0.01, respectively). But there was no significant difference between the levels at 3 and 7 days after surgery in UUO group(p>0.05). On the light microscopic examination, the relative volume of interstitium (RVI) and the total count of infiltrated mononuclear cells(MCC) at 3 and 7 days after surgery in UUO group were also significantly higher than those of sham group(RVI ; UUO 7 days 14.9±1.0%,sham 6.0±0.7%, MCC; UUO 7days 34.0± 1.6, sham 3.7± 0.6, p < 0.01, p < 0.01, respectively). In conclusion, we speculated that the early up-regulation of MCP-1 and TNF-α genes of renal cortical tissue in this experimental hydronephrosis model is closely related to the mononuclear cell infiltration and tubulointerstitial fibrosis.
강민규,황평주,김종학,나기량,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2
Hemorrhagic fever with renal syndrome(HFRS) is an acute viral disease characterized by fever, cardiovascular instabilities, hemorrhagic manifestation and renal failure. Eighty-eight cases of HERS who were admitted to Chung-Nam National University Hospital from July 1988 to December 1997 were analysed from the stand-point of clinical and laboratory findings. The results were as follows. 1. The months of peak incidence were November and December. 2. The most frequent chief complains on admission were fever and chill, abdominal pain, nausea and vomiting, myalgia and headache, respectively. 3. The clinical stage on admission were oligouric(42 cases), febrile(22 cases), hypotensive(5 cases) and diuretic(3 cases) phase, respectively. 4. In laboratory analysis, leukocytosis, thrombocytopenia and proteinuria were observed in most of the case. 5. The infection rate of Leptospirosis and Scrub typhus in 72 HFRS patients was 13.9%(8 cases and 2 cases). 6. The mortality rate was 4.2% anti the cause of death were shock(2cases) and pulmonary hemorrhage(1 case)
신영태,황평주,장윤경,양종호,구영선,강민규,김종학,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1
The crescentic glomerulonephritis is a pathologic term which show glomerular destruction due to crescent composed of cellular and/or fibrotic tissue. If not treated aggressively, clinical picture of renal failure developing over weeks or months. So, it is meaningful to know which factors influence on outcome of this disease. We reviewed renal biopsies which had showed crescent more than half of glomeruli for the period March 1983 to March 1998 at Chugnam National University Hospital. We reviewed these cases about clinical features, laboratory findings, renal biopsy findings, management and outcome of patients retrospectively. We grouped these patients to "progress", improve", and "stable" by change in serum atinine level during follow up periods. The results were as follows : 1) The total numbers of patients were 13, the male patients were 6 and the female were 7. The mean age was 43.7+17. 1years. 2) The causes of crescentic glomerulonephritis were IgA nephropathy(4 patients), systemic lupus erythematosus(2 patients), Henoch-Scho"nlein purpura(1 patient), Wegener's Granulomatosis(1 patient), and primary crescentic glomerulonephritis(5 patients). 3) In outcome of patients, 7 of all patients were progress(53.8%), 1 patient was improve, 5 patients were stable. In disease entity, IgA nephropathy, Henoch-Scho"nlein purpura and primary crescentic glomerulonephritis type 1 have poor prognosis. SLE and Wegener's Granulomatosis 4) Five patients had oliguria. They showed lower hemoglobin level, higher ESR, serum BUN, creatinine and potasseum level, more crescent formation, more severe tubular atrophy and interstitial fibrosis in pathologic findings than non-oliguric patients. But outcome of the patent with or without oliguria was not different. In conclusion, factors indicating poor prognosis of crescentic glomerulonephritis were severe tubular atrophy and interstitial fibrosis in pathology.