Alien Hand 징후를 보인 1예

정항재,박형국,이광호 대한신경과학회 1990 대한신경과학회지 Vol.8 No.2

복막 투석중인 만성 신부전 환자의 혈압 조절에 관한 연구

정항재,배성화,박준범,조규향,김영진,도준영,윤경우 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2

Background and Methods: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). Results: The results were as follows; 1) All patients received an antihypertensive drug before PD. but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis. mean artcrial pressure(MAP) was significantly decreased for the first 3 months, and this lasted for 1 year. and antihypertensive drug requirpments were significantly decreased continuously up to 9 months(p<0.05). 3) After changing the modality from hemodialysis to peritoneal dialysis, MAP(mmHg. from 107 0±4.5 to 98.6±8.8, p<0.05), antihypertensive drug requirements(from 5.6±2.6, to 2.0±2.5, p<0.01) and erythropoietin dosages(Uint/week, from 4600±2660 to 2000±1630, p<0.05) were decreased. 4) Multiple logistic regression analysis showed that MAP(p<0.01) and daily ultrafiltration volume(p<0.05) can contribute to the determination of antihypertensive drug requirements. However the relationship between antihypertensive drug requirements and PET results or dialysis adequacy indices(weekly Kt/V, weekly creatinine clearance) was not revealed. Conclusion: In conclusion, the prescription of antihypertensive drugs should be considered according to daily ultrafiltration volume, especially during first year after initiating PD, and follow-ups for over a year may be needed.

저나트륨혈증을 급속교정후 발생한 Central Pontine and Extrapontine Myelinolysis 3예

정항재,신현길,이광호,조용욱,배원경,김대호 대한내과학회 1993 대한내과학회지 Vol.44 No.6

저자들은 심한 저나트륨혈증을 급속히 교정하고 난 후 강직성 사지마비와 구음장애, 연하곤란 등의 가성구마비 징후를 보이고, MRI상 뇌교 및 다른 여러부위에 광범위하게 고음영병변을 보인 3명의 Central pontine and extrapontine myelinolysis 환자들을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Central pontine and extrapontine myelinolysis(CPM) is clinically charaterized by quadriplegia, pseudobulbar palsy, and consciousness change, usually following rapid correction of hyponatremia, but the exact mechanism of the pathophysiology remains obscure. Pathologic study reveals well-circumscribed areas of myelin loss sparing neurons and axons in pons and extrapontine region. Vascular changes and inflammation are absent. In the past, the diagnosis of CPM has generally been made on the basis of autopsy findings, but at the present, magnetic resonance imaging has made it possible to make the diagnosis before autopsy for the detection of pontine and extrapontine lesions. We report three cases of central pontine and extrapontine myelinolysis associated with typical clinical symptoms following rapid correction of hyponatremia. MRI showed high-signal areas in basis pontis, bilateral thalamus, caudate nucleus, and putamen.

하벽심근경색 환자에서 잠재적 우심실 기능 부전의 평가에 있어서 우심실 Tei Index의 유용성

정항재,홍그루,천경아,조인호,강지훈,배준호,박종선,신동구,김영조,심봉섭 한국심초음파학회 2005 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.13 No.1

Background:Recognition of ischemic right ventricular (RV) dysfunction in the course of inferior wall left ventricular (LV) acute myocardial infarction is important in clinical practice. The Doppler Tei index is useful for estimating global cardiac function. However, the clinical usefulness of RV Tei index to diagnose subclinical RV dysfunction has not been investigated. The purpose of this study was to assess the clinical value of RV Tei index for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have definite ECG changes at right precordial leads. Methods:The study population consisted of 22 consecutive patients (male 10, average age 57±12) with acute inferior myocardial infarction who did not have specific ST segment changes at right precordial leads. RV Tei index was measured by Doppler echocardiography and RV ejection fraction (EF) was measured by multigated blood pool (MUGA) SPECT. We defined subclinical RV dysfuntion as estimated RA pressure was ≥10 mmHg (group 1) by right heart catheterization. Results:In patients with RV dysfunction, RV Tei index was significantly increased compared with those who did not have RV dysfunction (0.51±0.22 vs 0.35±0.18, p<0.05). RVEF by MUGA blood pool SPECT was significantly decreased in patients with RV dysfunction (35±11% vs 47±12, p<0.05). Conclusion:RV Tei index is simple and useful non-invasive method for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have typical ECG changes at right precordial leads. 배경 및 목적: Tei index는 수축기와 이완기를 포함한 전반적인 심장의 좌심실기능 평가에 있어서 비침습적이고 재현성이 뛰어난 인자로 유용하게 사용되어지고 있다. 우심실 기능 부전이 동반된 급성 하벽부 심근경색증 환자에서 병원 내 사망률과 이환율이 높다. 따라서 급성 하벽부 심근경색증 환자에서 우심실 기능의 조기 파악은 환자의 예후와도 밀접한 연관성이 있다. 이 연구의 목적은 심전도상 우흉부유도 (right precordial leads)에서 ST분절의 변화가 없는 급성 하벽부 심근경색증 환자에서 잠재적 우심 기능저하의 평가에 있어서 우심실 Tei index의 유용성을 보고자 하였다. 대상 및 방법: 2003년 7월부터 2004년 7월까지 영남대학병원 응급실로 내원한 급성 ST 상승 하벽부 심근경색증환자 중 우심실 흉부유도상 ST 분절의 변화가 없는 22명(남자 10명,평균 연령은 57±12세)의 환자들을 대상으로 하였다. 우심도자술에서 우심방압이 10 mmHg 이상으로 상승된 환자를 1군, 10 mmHg 미만인 군을 2군으로 나누었으며, 각 군에서 Doppler 심초음파를 이용하여 측정한 우심실 Teiindex를 비교하였다. 관상동맥 중재술 시행 후 24시간 이내에 MUGA blood pool SPECT를 시행하여 우심실 구혈율을 측정하였다 결 과: 우심방압이 10 mmHg 이상으로 증가된 환자에서 우심방압이 10 mmHg 미만인 환자에서 보다 유의하게 우심실 Tei index가 증가되어 있었으며(0.51± 0.22 vs 0.35± 0.18, p<0.05), MUGA blood pool SPECT로 측정한 우심실 구혈율은 우심방압이 증가된 잠재적 우심 부전 환자에서 유의하게 감소되어 있었다(35±11% vs 47±12%, p<0.05). 결 론: 우심실 Tei index는 급성 하벽 심근경색 환자에서 심전도상 특징적인 변화가 없는 잠재적 우심 기능 부전의 평가에 있어서 비침습적인 검사 방법으로 유용하게 사용되어질 수 있을 것으로 사료된다.

복막 평형 검사에 영향을 주는 인자 및 시행시기에 관한 분석

정항재,조규향,박준범,배성화,김영진,도준영,윤경우 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4

The peritoneal equilibration test(PET) is used as a tool for determining the characteristics of the peritoneal membrane. Initial PET is recommended at least 1 month after peritoneal dialysis, but PET after 1 month may be difficult to perform on an out- patients basis. Two standard PETs(D/P4Cr) were performed in 60 CAPD patients(DM:non DM=22:38). Initial PETs, within one week after starting CAPD and follow up PETs, at least 3 months after CAPD were performed. The initial PET values were compared with subsequent PET values. Clinical data (age, sex, body surface area, BMI, presence of diabetes mellitus, ascites) and laboratory indices(serum albumin, dialysate creatinine clearance, KT/V, protein catabolic rate) were compared with the results of the PETs. In initial PET result, there was negative correlation between D/P4Cr and serum albumin(r=-0.522, p$lt;0.001 N=60). There was no significant difference between initial and follow up(mean±S.D.:8.84±5.2months after CAPD) D/P4Cr(0.68±0.14 vs 0.68±0.13). But with pge of time, delta D/P4Cr and delta serum albumin were also negatively correlated (r=-0.459, p$lt;0.001). According to the linear regression analysis, the factor significantly associated with D/P4Cr was serum albumin(coefficients -0.111). In conclusion, serum albumin level is the most important predictor of the peritoneal membrane transport characteristics, and it seems that the timing of PET does not matter, rather the changes of with time are strongly correlated with the changes of the serum albumin level.

복막 투석 환자에서 도관 관련 감염 및 복막염에 대한 Mupirocin 과 Catheter Revision 의 효과

정항재(Hang Jae Jung),도준영(Jun Young Do),윤경우(Kyung Woo Yoon),박준범(Jun Bum Park),조규향(Kyu Hyang Jo),김정미(Jung Mi Kim),최준혁(Jun Heuk Choe),김영진(Yeung Jin Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Background: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Methods : We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started me-dications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results : The total follow-up was 2401 patient months(pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus(MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them im-proved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse(The mean duration : 14.0 months) The rates of ESI were more reduced after using mupi-rocin than before(l per 12.7 vs 34.0 pt.mon, p<0.01). Conclusion: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

특별강연 및 일반연제 발표 : 복막 투석 환자에서 복막염시 한외 여과에 미치는 인자에 대한 분석

정항재 ( Jeong Hang Jae ),조규향 ( Jo Gyu Hyang ),박준범 ( Park Jun Beom ),김영진 ( Kim Yeong Jin ),도준영 ( Do Jun Yeong ),윤경우 ( Yun Gyeong U ) 대한신장학회 1999 춘계학술대회 초록집 Vol.18 No.2

MRI상 다발성 병변을 보인 Neuro-Behcet병 1예

박형국,정항재,조상걸,이광호 순천향대학교 1990 논문집 Vol.13 No.3

We describe a case of Neuro-Behcet's disease with recurrent meningoencephalitis in which MRI showed multiple high-signal lesions in the thalamus, frontal and parietal lobes, and brainstem on T2-weighted image. Treatment with prednisolone was acompanied by marked improvement of the patient's clinical status.

복막 투석 환자에서 복막 평형 검사에 영향을 미치는인자로 혈청 알부민에 대한 연구

배성화,정항재,박준범,김영진,도준영,윤경우 대한신장학회 1998 춘계학술대회 초록집 Vol.1998 No.-

임신오조에 수반되어 발생한 Wernicke증후군 1예의 MRI소견

박형국,정항재,백근섭,이광호,김대호 대한신경과학회 1990 대한신경과학회지 Vol.8 No.1