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지속외래복막투석 환자에서 발생한 methicillin내성 Staphylococcus auricularis 복막염
최종욱 ( Jong Wook Choi ),김배근 ( Bae Keun Kim ),황규식 ( Kyu Sig Hwang ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
Although coagulase-negative staphyloccus is the most common organism causing peritonitis in perito-neal dialysis (PD) patients, only one case of PD peritonitis due to Staphylococcus auricularis, the normal flora of external auditory meatus, has been reported over the world. Here we add a case of PD peritonitis caused by methicillin-resistant Staphylococcus auricularis, which was successfully treated with vancomycin. A 79-year-old male PD patient was admitted because of abdominal pain and cloudy peritoneal fluid. At admission, the exit site was clear, and no rebound tenderness was noted although the abdominal wall was diffusely tender. Gram stain of the peritoneal fluid did not reveal any organism, but white blood cell count was 1,210/mm3, with 80% polymorphonuclear cells and 10% lymphocytes. Empirical antibiotic therapy was started with intraperitoneal cefazolin and ceftazidime. Over the next few days, however, the peritoneal fluid was still turbid and showed an elevated cell count. Then, the result of peritoneal fluid culture identified that the organism was oxacillin-resistant Staphylococcus auricularis. Thus the antibiotics were switched into vancomycin, and intraperitoneal vancomycin 1 gm was administered three times at 5 days` intervals to achieve completely clear peritoneal fluid. Staphylococcus auricularisshould be considered as a new potential skin organism causing PD peritonitis.
윤재희 ( Jae Hee Yun ),강종명 ( Jong Myung Kang ),김경수 ( Kyung Soo Kim ),김승현 ( Seung Hyun Kim ),김태환 ( Tae Hwan Kim ),박용욱 ( Yong wook Park ),성윤경 ( Yoon Kyoung Sung ),손주현 ( Joo Hyun Sohn ),송병주 ( Byung Joo Song 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3
Objective: Few studies have examined the impact of chronic diseases on populations using a comprehensive health-related quality of life (HRQOL) in Korea. We assessed HRQOL of patients with 16 common chronic diseases. Methods: We interviewed patients with chronic diseases (n=980) and healthy control (n=288) using two HRQOL measurements: Korean Medical Outcome Study Short Form-36 (KSF-36) and Korean EuroQol-5 Dimensions (KEQ-5D), and questions on sociodemographic and clinical characteristics. Results: Each illness had a distinctive profile. Among disease groups, the KSF-36 global health score was highest in DM and lowest in fibromyalgia. The KSF-36 physical component summary score was highest in DM and lowest in osteoarthritis. The KSF-36 mental component summary score was highest in hypertension and lowest in fibromyalgia. The KEQ-5D utility score was highest in DM and lowest in fibromyalgia. The KEQ-5D visual analog score was highest in DM and lowest in liver cirrhosis. In correlation analysis, the KSF-36 physical component summary, mental component summary and five domains in KEQ-5D were well correlated with each others. Conclusion: Health related quality of life in Korean patients with chronic disease is lower than healthy control. Patients with hypertension and DM registered the two highest scores in global health but patients with fibromyalgia reported the worst health experience in global health. We can compare the profiles of the groups and determine the relative impact on the patients of the various diseases and these data will provide a baseline of the current health related quality of life of individuals suffering from a variety of conditions.
정성수(Sung Soo Jung),심종걸(Jong Geol Shim),한동수(Dong Soo Han),오기영(Ki Young Oh),김성윤(Seong Yoon Kim),김인순(In Soon Kim),박찬현(Chan Hyun Park),강종명(Chong Myung Kang),박한철(Han Chul Park),곽진영(Jin Young Kwack) 대한내과학회 1989 대한내과학회지 Vol.37 No.1
N/A Cyclosporine treated renal transplants are known to develop hyperuricemis more frequently than azathioprine treated patients. We examined the outpatient records of all patients transplanted between April 1978 and June 1988, in whom the allograft functioned for at least one year. We did this study to determine the frequency of hyperuricemia in the renal transplants and predisposing factors. The results were as follows: 1) The serum uric acid concentration in patients in the cyclosporine treated group (8.53±2.26 mg/dl; n=33) was significantly higher than that of the azathioprine treated group (6.74±1.43mg/dl; n=24) (p<0.005). 2) The serum uric acid concentration in patients using diuretics (7.83±1.50mg/dl; n=8) was significantly higher than in those not using diuretics (6.19±1.05 mg/ dl; n=16) in the azathioprine treated group (p<0.01). 3) The serum uric acid concentration in patients using diuretics (9.95±1.74mg/dl; n=12) was significantly higher than in those without diuretics (7.59±1.97 mg/dl; n=21) in the cyclosporine treated group (p<0.005). 4) The serum uric acid concentration in patients using diuretics and azathioprine was significantly lower than that in those using diuretics and cyclosporine (p<0.05). 5) Among the patients not taking diuretics, the serum uric acid level was significantly higher in the cyclosporine treated group than in the azathioprine treated group. We conclude that there is an increased incidence of hyperuricemia in renal transplants treated with cyclosporine. This effect is thought to be due to tubular toxicity by cyclosporine. It is recommended that routine measurement of the uric acid level be done in renal transplants using cyclosporine and that diuretics be avoided in patients taking cyclosporine.
FK506 처리 흰쥐에서 신장 및 혈관 조직 산화질소 함량 감소
정권(Kwon Jung),김수완(Soo Wan Kim),이종은(Jong Un Lee),백윤웅(Yun Woong Paek),염충호(Chung Ho Yeum),나명윤(Myong Yun Nah),김남호(Nam Ho Kim),강종명(Chong Myung Kang),최기철(Ki Chul Choi) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
N/A The present study was aimed at investigating whether FK506 alters the regulation of nitric oxide(NO) system. Male Sprague-Dawley rats were treated with FK506(1 mg/kg/day, i.m.) for 3 weeks. Control group was without treatment of FK506. Plasma levels and urinary excretion of NO metabolites(nitrite/nitrate, NOx) were measured. The protein expression of NO synthases(NOS) and tissue contents of NOx were determined in the kidney and thoracic aorta. The aorta was also examined of its changes in isometric tension in responses to acetylcholine and sodium nitroprusside. The arterial pressure did not significantly differ between FK506-treated and control groups. Plasma NOx levels remained unaltered, while urinary NOx excretion was significantly decreased in FK 506-treated group. Tissue contents of NOx were significantly decreased, although the expression of ecNOS and iNOS proteins was significantly altered neither in the kidney nor in the aorta. Acetylcholine-induced relaxation of the isolated aortic ring was significantly attenuated, whereas sodium nitroprusside-induced relaxation was not significantly affected. These results suggest that FK506 decreases the tissue contents of NO, without significantly affecting the expression of NOS.
이형접합제 PiMZ 및 α1 - Antitrypsin 결핍을 보인 간경변증
기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이민호(Min Ho Lee),안명주(Myung Ju Ahn),고윤석(Youn Suck Koh),함준수(Joon Soo Ham),이종철(Song Chul Lee),강종명(Jong Myung Kang) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
In 1969, Sharp described the first cases of aplhai-antitrypsin deficiency disease in children with juvenile liver cirrhosis. Since then, this inborn error has been recognized as one of the more common factors in cirrhosis of infancy and childhood, especially in Caucasians of Northern Europeans. PiZZ phenotype is the only one associated with liver disease, there have been a few rescent reports of cirrhosis in heterozygous patients. We experienced a case of 24-year-old male patient who was diagnosed as liver cirrhosis by biopsy but had no defintie causes of liver cirrhosis. The laboratory findings were compatible with liver cirrhosis. By biopsy, the liver is composed of variable sized, micro and macronodules. Dense fibrous tissue encase these nodules. The hepatocytes are strongly positive granules and diastase resistant. Pi phenotype was Pi MIZ by IEF (immunoelectric Focusing) method and the plasma alphai- antitrypsin level is lower than normal.
신장 ; 혈액투석에서 투석액 칼슘농도와 칼시트리올이 골대사에 미치는 영향
염지연 ( Ji Youn Youm ),김현철 ( Hyun Chul Kim ),이영철 ( Young Chul Lee ),최종욱 ( Jong Wook Choi ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6
목적: 현재 혈액투석에 사용 중인 투석액 칼슘 농도는 1.25mmol/L, 1.5 mmol/L, 1.75 mmol/L로 구분된다. 고칼슘 투석액은 부갑상선호르몬의 분비를 억제시키는 효과가 있으나 고칼슘혈증 위험을 증가시키고, 저칼슘 투석액은 adynamic bone disease을 개선시키는 효과가 있으나 칼슘 평형을 악화시킬 우려가 있으므로 투석액 칼슘 농도의 적절한 선택은 쉽지 않다. 저자들은 표준칼슘 농도인 1.5 mmol/L 투석액을 사용하였을 때 칼시트리올 용량 변화와 아울러 요독성 골질환에 미치는 효과를 평가하고자 하였다. 방법: 투석액 칼슘 농도 1.75 mmol/L로 1년 이상 혈액투석 중인 환자 36명에서 투석액 칼슘 농도를 1.5 mmol/L로 전환 후 1년간 경과를 추적하였다. 투석액 칼슘 농도를 낮추기3개월 전에 측정한 혈청 iPTH 농도에 따라 환자를 1군(iPTH< 150 pg/mL, n=21), 2군(iPTH 150-300 pg/mL, n=7), 3군(iPTH>300 pg/mL, n=8)으로 구분하여 혈청 칼슘, 인, 알칼리포스파타제, iPTH 농도를 3개월 간격으로 측정하였고, 인결합제 및 칼시트리올 용량 변화를 조사하였다. 결과: 투석액 칼슘 농도 1.75 mmol/L 사용 중 1군, 2군 및 3군의 iPTH 농도는 각각 57±48 pg/mL, 191±46 pg/mL, 589±200 pg/mL로 유의한 차이가 있었다(p<0.001). 투석액칼슘 농도를 1.5 mmol/L로 전환 후 1군에서 혈청 iPTH가 12개월에 걸쳐 유의하게 증가하였다(p=0.01). 3개월째부터 증가가 현저하여(57±48 vs. 287±266 pg/mL, p<0.01) 이후증가세를 유지하였다. 그러나 2군에서는 유의한 변화가 없었고, 3군의 혈청 iPTH는 12개월에 걸쳐 유의하게 감소하였는데(p=0.02) 특히 9개월째 감소가 기저치에 비해 낮았다(589±200 vs. 242±246 pg/mL, p<0.01). 혈청 알칼리포스파타제도 혈청 iPTH와 유사한 변화 양상을 보였다. 투석액칼슘 농도를 1.5 mmol/L로 전환한 후 1군과 2군에서 인결합제와 칼시트리올 투여 용량의 유의한 변화는 없었으나, 3군에서 칼시트리올 용량이 6개월째부터 유의하게 증가하였고 (4.4±5.1 vs. 9.6±2.9 μg/month, p<0.05) 나머지 기간 동안증가 추세를 유지하였다. 결론: 혈액투석액 칼슘 농도를 1.75 mmol/L에서 1.5 mmol/L으로 전환한 후 적절한 인결합제와 칼시트리올 투여 용량을 조정하면서 adynamic bone disease와 이차성 부갑상선항진증환자에서 혈청 iPTH 측정치가 호전되는 경향을 보였다. 신성골형성장애가 있는 혈액투석 환자에서 투석액 칼슘 농도 1.5 mmol/L를 선택하는 것이 효과적일 수 있다. Background/Aims: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. Methods: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH<150 pg/mL, n=21; group 2, iPTH 150-300 pg/mL, n=7; group 3, iPTH>300 pg/mL, n=8). Data were collected at 3-month intervals for 1 year. Results: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca × P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p=0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p=0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p=0.001). Conclusions: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately. (Korean J Med 2011;81:751-758)
혈장교환술과 면역억제제 치료로 호전된 항사구체기저막 항체질환
김지현 ( Jee Hyun Kim ),유선진 ( Sun Jin You ),박준성 ( Jun Sung Park ),이창화 ( Chang Hwa Lee ),김근호 ( Gheun Ho Kim ),강종명 ( Chong Myung Kang ),임소덕 ( So Dug Lim ),이종호 ( Jong Ho Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
Anti-glomerular basement membrane disease is a rare autoimmune disease characterized by rapidly progressive renal failure and/or pulmonary hemorrhage. The presence of severe crescentic glomerular inflammation with linear deposition of immunoglobulin G along the glomerular basement membrane is pathognomonic. Because renal function is rapidly and often irretrievably destroyed, many patients require hemodialysis all through their lifetime. We report a case of 33 year(s)-old man who was diagnosed as anti-glomerular basement membrane disease without pulmonary hemorrhage. The patient was treated with pulse methylprednisolone and plasmapheresis followed by oral corticosteroid and cyclophosphamide. His renal function was successfully recovered with early diagnosis and aggressive treatment.