한국 노인 환자에서 소화성궤양의 임상적 특징

유기동 ( Ki Dong Yu ),김나영 ( Na Young Kim ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwang ),김진욱 ( Jin Wook Kim ),이동호 ( Dong Ho Lee ),정숙향 ( Soo Hyang Jeong ),이광혁 ( Kwang Hyuck Lee ),이형석 ( Hyung Suk Lee ),곽경 대한내과학회 2006 대한내과학회지 Vol.71 No.5

목적: 노인에서 소화성궤양의 특징은 흔히 임상양상이 비전형적이며, 크기가 크고, 깊은 거대궤양이 다발성으로 나타나며, 갑작스런 대규모 출혈이나 천공으로 발현할 수 있다. 하지만 국내에서는 노인에서의 소화성궤양에 대한 연구가 거의 없는 실정이다. 이에 노인 소화성궤양에서의 임상적 특징과 병인으로서 H. pylori와 NSAID가 차지하는 비중, 그 밖에 제3의 인자로 작용할 수 있는 흡연 및 궤양을 초래할 수 있는 만성질환의 동반여부 등을 알아보고자 하였다. 방법: 277명의 환자(65세 이상: 138명, 65세 미만: 137명)을 대상으로 하여 주증상 및 궤양의 위치, 크기, 출혈유무, 8주내 완치여부, H. pylori 감염유무, H. pylori 제균성공여부, 흡연 및 음주(1주일에 3회 이상), 동반된 만성질환여부, 아스피린복용, NSAID, 스테로이드사용유무 등에 대해서 후향적으로 조사하였다. 결과: 고령군에서는 위궤양이 십이지장궤양에 비하여 유의하게 많았으며, 출혈을 포함한 증상의 차이는 없었고, 단일궤양보다는 다발성 위궤양이 많았으며, 크기가 1 cm 이상인 경우가 유의하게 많았고, 궤양에 대한 치유속도는 8주가 지나도 완치가 안된 경우가 비고령군에 비해 유의하게 많았다. 병인으로 H. pylori가 양성인 경우는 고령군에서 유의하게 낮았으며, 위궤양군에서는 차이가 없었고, 십이지장궤양군에서는 약 51%로 비고령군에 비해 통계학적으로 유의하게 양성율이 낮았다. 고령군에서 NSAID의 사용이 많았으며 내시경상 출혈양성과는 유의한 관계를 보였으나, H. pylori 양성이나 아스피린사용과는 유의한 관계가 없었다. H. pylori 양성군에서 제균요법을 시행하고 박멸이 확인된 환자는 전체적으로 68.3%였으며, 양 군 간에 차이는 없었으나, 제균에 실패한 환자는 고령군에서 유의하게 많았다. 소화성궤양의 병인을 각각의 영향을 독립적으로 간주하였을 때, H. pylori가 병인일 가능성은 고령군과 비고령군에서 각각 57.7%, 77.0%였고, NSAID나 아스피린이 병인으로 작용했을 가능성은 13.1%, 1.4%였으며, 흡연이 병인으로 추정되는 군은 5.1%, 7.2%였고, 만성질환에 동반된 합병증으로 생각할 수 있는 환자는 10.2%, 1.4%였다. 결론: 고령에서의 소화성궤양은 비고령군에 비하여 치유속도가 느리고, 병인으로서 H. pylori의 역할은 상대적으로 낮으며, 특히 십이지장궤양군에서 절반에 불과하였다. 오히려 NSAID와 아스피린이 중요부분을 차지하였으며, 동반된 만성질환과 관련되어 발생하였다. 그러나 출혈을 포함한 증상의 차이는 없었다. 추후 대규모의 분석적이고 전향적인 연구가 필요하겠다. Background: The incidence of peptic ulcer has decreased in the general population, but it has increased for the geriatric patients worldwide. The aim of the study is to determine the age-related characteristics of peptic ulcer patients. Methods: A total of 277 patients (195 men and 82 women), who were diagnosed with peptic ulcer from May 2003 to Dec 2004, were analyzed retrospectively. The clinical characteristics of peptic ulcer were compared between the two groups, that is, 138 elderly (= 65 yrs) and 139 non-elderly (= 50 yrs) patients. Results: Peptic ulcer in the elderly were located more atypically (high body and the greater curvature side of the mid and low body), the lesions were large and healed slowly. In the elderly group, 50.7% of the ulcers were gastric and 36.2% were duodenal. On the other hand, in the non-elderly group, 30.2% and 57.6% of the ulcers were gastric and duodenal, respectively. There was no difference of the main symptoms between the two groups. For endoscopically bleeding ulcer, the use of NSAID was statistically significant (p=0.006) only for the elderly group. The presence of Helicobacter pylori was less common in the elderly group than in the non-elderly (57.7% vs 77%, respectively, p=0.001). In the case of gastric ulcer, the rate of H. pylori infection was similar between the two groups (62.9% vs 73.8%, respectively, p=0.233). In contrast, in the case of duodenal ulcer, H. pylori infection was less common for the elderly patients than in the non-elderly patients (51% vs 77.5%, respectively, p=0.002). Conclusions: For the elderly patients with peptic ulcer in Korea, the role of H. pylori was relatively less important that it was for the non-eldery group. On the contrary, NSAID, aspirin and combined chronic illness seem to contribute to ulcer. Bleeding peptic ulcer was discovered in both groups with no significant difference in the occurrence rate.(Korean J Med 71:501-510, 2006)

원저 : 제2형 당뇨병 동물모델에서 항 혈관내피세포 성장인자(Anti-Vascular Endothelial Growth Factor (VEGF)) 투여 시 췌장에 대한 효과

김지원 ( Ji Won Kim ),함동식 ( Dong Sik Ham ),박헌석 ( Heon Seok Park ),안유배 ( Yu Bai Ahn ),송기호 ( Ki Ho Song ),윤건호 ( Kun Ho Yoon ),유기동 ( Ki Dong Yoo ),김명준 ( Myung Jun Kim ),정인경 ( In Kyung Jeong ),고승현 ( Seung Hy 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.3

연구배경: 대표적인 당뇨병성 합병증인 당뇨병성 신증과 망막병증은 공통적으로 혈관내피세포성장인자(Vascular endothelial growth factor, VEGF)가 합병증의 발생에 중요한 역할을 하는 것이 알려져 있으나 항 VEGF 치료가 췌도나 베타세포에 직접적으로 어떠한 영향을 주는지는 거의 알려진 바가 없다. 이에 당뇨병성 합병증 치료를 목적으로 하는 항 VEGF 치료가 췌장과 당뇨병의 경과에 미치는 영향을 관찰하고, 당뇨병이 진행되면서 나타나는 췌도 및 베타세포의 변화에 있어서 VEGF의 역할을 규명하고 치료에 응용하고자 하였다. 방법: 이에 당뇨병 동물모델인 db/db mouse에 12주간 VEGF 수용체 type 2 antagonist (ATWLPPR, 5 mg/kg)를 복강 내 투여하여 혈당의 변화와 함께 췌장의 면역염색을 통하여 베타세포 질량 및 췌도의 형태적인 변화를 관찰하고 VEGF의 췌도 내 발현 및 혈관신생 정도를 평가하였다. 결과: 12주간 항 VEGF peptide를 투여한 결과, 복강 내당부하검사 시 db/db mouse에 비해 항 VEGF 투여군에서 현저한 고혈당을 보였으며 고혈당이 심해지면서 항 VEGF 투여군에서 체중의 증가가 적었다. 췌장의 무게(db/dm vs. db/db vs. anti-VEGF group, 0.321±0.05 vs. 0.206±0.13 vs. 0.158±0.12 g) 및 베타세포 질량(db/dm vs. db/db vs. anti-VEGF group, 4.08±0.1 vs. 3.77±0.2 vs. 2.89±0.2 mg, P<0.05) 역시 db/db군에 비해 항 VEGF군에서 더 감소되었다. 또한 정상 췌도에 비해 당뇨병이 발생한 군에서 췌도 내 VEGF 발현이 증가되었으나, 항 VEGF 투여시 췌도 내 VEGF 단백의 발현이 감소하였고(db/dm vs. db/db vs. anti-VEGF group, 3.63±2.86 vs. 6.60±3.56 vs. 2.74±1.55%, * P<0.05) 췌도의 크기가 감소하였으며, 췌도 내 섬유화 진행이 더 심하게 관찰되었고(db/dm vs. db/db vs. anti-VEGF group, 3.37±1.51 vs. 13.96±3.20 vs. 16.99±4.96%, * P<0.05) 췌도 내 내피세포의 증식이 더 감소되어 있었다. 결론: 제2형 당뇨병 동물모델에서 혈관내피세포 성장인자(VEGF)는 정상 췌도보다 당뇨병이 발생한 췌도에서 발현이 증가되므로 당뇨병의 발병 기전과 관련이 있을 것이며, 베타세포의 증식 및 췌도 변형에 중요한 역할을 하므로 당뇨병의 치료에도 응용할 수 있을 것으로 생각되고, 당뇨병성 미세혈관 합병증의 치료나 예방을 목적으로 제2형 당뇨병모델에 항 VEGF를 투여할 경우 고혈당 상태를 더 악화시키고 베타세포 증식을 억제하며 췌도 파괴를 가속화 시키므로, 항 VEGF 치료 시 이에 대한 충분한 고려가 필요할 것이다. Background: Vascular endothelial growth factor (VEGF) is associated with the development of diabetic complications. However, it is unknown whether systemic VEGF treatment has any effects on the pancreatic islets in an animal model of type 2 diabetes mellitus. Methods: Anti-VEGF peptide (synthetic ATWLPPR, VEGF receptor type 2antagonist) was injected into db/db mice for 12 weeks. We analyzed pancreatic islet morphology and quantified beta-cell mass. Endothelial cell proliferation and the severity of islet fibrosis were also measured. VEGF expression in isolated islets was determined using Western blot analysis. Results: When anti-VEGF was administered, db/db mice exhibited more severe hyperglycemia and associated delayed weight gain than non-treated db/db mice. Pancreas weight and pancreatic beta-cell mass were also significantly decreased in the anti-VEGF-treated group. VEGF and VEGF receptor proteins (types 1 and 2) were expressed in the pancreatic islets, and their expression was significantly increased in the db/db group compared with the db/dm group. However, the elevated VEGF expression was significantly reduced by anti-VEGF treatment compared with the db/db group. The anti-VEGF-treated group had more prominent islet fibrosis and islet destruction than db/db mice. Intra-islet endothelial cell proliferation was also remarkably reduced by the anti-VEGF peptide. Conclusion: Inhibition of VEGF action by the VEGF receptor 2antagonist not only suppressed the proliferation of intra-islet endothelial cells but also accelerated pancreatic islet destruction and aggravated hyperglycemia in a type 2 diabetes mouse model. Therefore, the potential effects of anti-VEGF treatment on pancreatic beta cell damage should be considered. (Korean Diabetes J 33:185-197, 2009)

급성기 노인전문병동에 입원한 노인성 질환 환자에서 관찰되는 빈혈의 임상적 의의

김은일 ( Eun Il Kim ),서예원 ( Ye Won Suh ),정수현 ( Su Hyun Jung ),김은영 ( Eun Young Kim ),김혜영 ( Hye Young Kim ),박명숙 ( Myung Sook Park ),유기동 ( Ki Dong Yu ),김광일 ( Kwang Il Kim ),김철호 ( Cheol Ho Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1

목적: 노인 환자에서 흔히 관찰되는 빈혈과 노인의 신체적인 기능, 정서적인 기능, 영양상태와의 상관관계를 알아보고 빈혈의 동반 유무가 급성 질환으로 입원한 노인 환자의 예후에 영향을 미치는 가를 알아보고자 본 연구를 수행하였다. 방법: 2004년 5월부터 2005년 4월까지 분당 서울대학교 병원 급성기 노인전문 병동에 입원한 431명의 환자 중 의학적 평가, 기능평가, 영양상태평가, 인지기능평가, 정서상태 평가 등을 포함한 노인 포괄평가가 가능한 환자 308명을 대상으로 입원 당시 혈색소치와 포괄적 노인평가 항목과의 통계적 분석을 시행하였으며 환자의 입원 기간 및 입원 기간 중의 노인 증후군의 발생 빈도를 비교하였다. 결과: 빈혈군이 정상군에 비해 보다 고령이고 남성이 많았으며 영양 결핍과 기능 의존 상태인 특성을 관찰할 수 있었다. 이러한 특성으로 인해 빈혈군에서 입원기간 중 섬망의 발생이 보다 많았고 입원 기간의 유의한 연장이 관찰되었다. 그러나 입원 기간에 영향 미치는 여러 인자 중 빈혈이 독립적인 위험 인자인지를 알아보기 위한 다변량 분석에서 유의한 상관관계는 없었다. 결론: 빈혈은 신체적인 기능, 영양 상태와 밀접한 상관관계가 있으며 전반적인 환자의 상태를 반영해 주는 지표로 생각되나 그 자체가 독립적으로 환자의 입원 기간을 연장시키는 위험인자는 아닐 것으로 생각된다. 향후 노인 환자에서 빈혈의 임상적 의의와 그 치료적 접근에 관해서는 추가적인 임상연구가 수행되어야 할 것으로 생각된다. Background: Anemia is a common medical problem among the elderly; it is more frequent with advancing age. Anemia has been associated with adverse outcomes such as hospitalization, disability and mortality. However, the clinical significance of anemia in frail elderly patients, especially those admitted to acute care units, has not been investigated. Methods: From May 2004 to April 2005, 308 patients 65 years of age or older, admitted to the Acute Elderly Care Unit at the Seoul National University Bundang hospital, were enrolled in the current study. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. Clinical and laboratory evaluations were carried out to determine the prevalence and etiology of the anemia. Results: Anemia (Hb < 13 g/dL in male, < 12 g/dL in female) was identified in 149 patients (48.4%). The leading cause of anemia was anemia of chronic disease (N=75, 50.3%). Comparison between the anemic group and a control group was performed. Anemic patients were older, male, had an impaired functional status as well as a poor nutritional status. Moreover, the development of delirium was more frequent in the anemic group compared to the control group (11.0% vs 20.7%, p=0.021). In addition, the duration of hospitalization was significantly increased in patients with anemia (12.97±1.24 vs 18.07±1.77, p=0.019). However, in the multiple regression analysis, the presence of anemia did not affect the length of hospitalization as an independent factor. Conclusions: Anemia is common in frail elderly patients and has been associated with a poor clinical outcome. Although anemia was not an independent risk factor in the elderly patients, the anemia was associated with multiple co-morbidities, disability and frailty. Therefore, the presence of anemia in the elderly requires active investigation and management. (Korean J Med 72:44-51, 2007)

대장직장암에서 예후인자로서 DCC 단백질의 역할

이만재,유기동,손현화,정재용,김양수,김태균,서영선,박유환,정춘해,이미자,박종,오윤경 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.2

Purpose: Even though the entire resection is only option for primary cure in case of the localized colorectal cancer. However, recurrence rate is relatively high(30%). The evaluation for chromosome 18 long arm status in the patients who have stage II colon cancer gives a important information about a prognosis and evaluation of the patients. This study was undertaken to evaluate the possible prognostic role of the expression of deleted in colorectal cancer (DCC) protein in the patients with stage II colon cancer. Materials and Methods: The present study analysed 22 patients with stage II &II (AJC TNM 1992 classification) colorectal adenocarcinoma who were admitted to the Chosun University Hospital between March 1989 and February 1992. Clinicopathologic parameters including age, sex, TNM stage, adjuvant chemotherapy, location and tumor differentiation and DCC status were examined. Results: The survival rate of the patients expressing DCC was found to be significantly higher in the patients in whom the DCC was expressed, while 4 (18%) in the other who had not the expression of DCC(P= 0.044). Although the patients with the stage II of the TNM stage have a better prognosis than those with stage III (P=0.046), no significant difference was found between these two groups in terms of the eastern cooperative oncology group (ECOG) performance status of patients (P= 0.525). Conclusion: when the expression of DCC protein is negative in patients with colon cancer staged II need a more aggressive treatments like in the patients with staged III colon cancer and thereafter the more exact operative method is required identifying the expression of DCC protein using the frozen biopsy during operation and thereafter the consideration for the chemotherapy and radiation therapy will be possible.

의사들의 호스피스 관리에 대한 임상적인 접근

손현화,유기동,서영선,김태균,김양수,정재용,박유환,정춘해,홍승민,전제열,이상운 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.2

Background: Cancer has become the major cause of death in Korea. Doctors who treat terminal cancer come across problems which are too difficult to solve. These problems are related with religious, moral and legal problems. These problems are easy death, patients' or family' s refuse of treatment, practice of cardiopulmonary resuscitation(CPR) in terminal cancer, definition of death and so forth. In Korea, studies related with terminal cancer patients and the doctors who treat them are very rare and the hospice system for terminal cancer patients is not organized yet. Objectives: The aim of this study was to identify the opinions of doctors who treat terminal cancer about these problems. Materials ðod: This study was performed on 90 doctors working at Chosun university hospital, who are divided in to three parts as staff, residents and interns. We used questionares related with the above problems, composed of 19 items and six general characteristics. We could confirm 75 questionaires. Results &onclusion: For the question "ve terminal cancer patients was announced their diagnosis and prognosis?"hat was most important to doctors was patients' opinions and the second was their family' s. For the question "eatment which could prolong the life of terminal cancer patients who are unnconscious is performed?"doctors showed a negative opinion. About the easy death of terminal cancer patients, more than half the doctors showed agreement. The prohibition of CPR in terminal cancer patients was agreed by 40%. For the question about the definition of death in terminal cancer patients 76.1% doctors agreed it was brain death. 85.7% subjects answered that they felt moral enmity in treatment of terminal cancer patients. In Korea, the programs for these problems are very poor, and the results of this study can affect the formation of systems and laws about the terminal cancer patients and the doctor's treatment. National support for terminal cancer patients and the hospice care system is required.

당뇨병성 합병증을 가진 환자에서 혈중 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 朝鮮大學校 附設 醫學硏究所 1998 The Medical Journal of Chosun University Vol.23 No.1

연구 배경 : 고혈당성에 의한 산화환원반응 이상(가저산소증)이 조절 되지않는 당뇨병의 특징으로 혈관과 신경 기능에 대한 진성 저산소증의 효과와 유사하며, 당뇨 합병증의 병태생리에 중요한 역할을 한다. 고혈당이 있는 인슐린 비의존형 당뇨병 환자에서 인슐린 수준이 정상이듯이, 빈혈이 있는 당뇨병 환자에서 EPO의 농도는 실제 혈색소 농도의 감소비율과 차이가 있을 것이라 추측된다. Friedman 등은 당뇨병성 합병증 원인 인자로 가저산소증(pseudohypoxia) 또는 저산소증(hypoxia)을 제기하였고 이런 인자들이 EPO의 상대적 또는 절대적 결핍에 의한 것임을 보고하였다. 방법 : EPO-Trac^(TM 125)I RIA kit을 이용하여 방사면역측정법으로 EPO 수준을 검사하였다. 전혈 3㎖을 5-10㎖ 시험관에 정맥 채혈하였으며, 용혈과 장기간의 보존을 위하여 원심분리를 즉시 시행하여 혈청을 영하 200C에서 냉동 보관 후 일괄적으로 검사 결과를 얻었다. 결과 : 1996년 9월부터 1997년 2월까지 조선대학교 부속병원 내과에 입원한 2형 당뇨병 환자 63례를 대상으로 하여 다음과 같은 결과를 얻었다. 1) 당뇨병성 합병증이 없는 군과 있는 군간의 혈색소, 혈중 EPO농도의 차이는 유의한 차이가 있었으며 혈색소의 감소율보다 혈중 EPO의 감소율이 더 높았다. 2) 당뇨병성 망막증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으나 혈중 EPO농도는 유의한 차이가 있었다. 증식성군에서만 혈중 EPO의 감소비율이 혈색소에 비해 높았다. 3) 당뇨병성 신증의 유무에 따른 혈색소, 혈중 EPO농도는 유의한 차이가 있었고 혈색소 감소율에 비해 EPO농도의 감소율이 높았다. 신증의 중증도에 따른 혈색소, EPO의 차이는 미세알부민뇨군을 제외하고는 유의한 차이를 보였고 혈색소 감소율에 비해 EPO의 감소율이 더높았다. 4) 당뇨병성 신경병증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으며 EPO농도는 유의한 차이를 보였다. 혈색소와 EPO의 감소비율은 비슷하였다. 신경병증의 중등도에 따른 혈색소와 EPO농도의 변화는 유의한 차이가 없었으나 stage 3에서는 혈색소감소율보다 EPO감소율이 더높았다. 결론 : 당뇨병성 합병증을 가진 환자에서 빈혈의 정도는 대부분 혈청 EPO치의 절대적 감소에 의함을 간접적으로 밝혀낼 수 있었으며 차후 더 많은 대상으로 비교 분석이 필요하리라 사료된다. Background: Hyperglycemic-induced redox(pseudohypoxia) imbalance is a characteristic feature of poorly controlled diabetes that mimics the effects of true hypoxia on vascular and neural functions and plays an important role on the pathogenesis of diabetic complications. As is true for apparently "normal" insulin levels typically found in NIDDM even in the presence of hyperglycemia, a "normal" erythropoietin level in an anemic diabetic subject may be disproportionally low for the actual red cell mass. Therefore, Friedman et al suggested that pseudohypoxia or hypoxia as an etiological factor of diabetic complications are due to absolute or relative erythropoietin deficiency Method: EPO-TracTM 125I RIA kit was used for the quantitative determination of erythropoietin(EPO) in serum by radioimmunoassay. An adequate sample of blood (3ml whole blood) was collected aseptically by venipuncture in a 5~10ml glass tube to yield a minimum of 400 L of serum per assay. The serum was promptly removed from the clot by centrifugation in order to avoid hemolysis. Then to increase its storage time it was frozen at -200C in a nonself defrosting freezer. Finally, tests were undertaken simultaneously Results We studied 63 cases with diabetes mellitus, who were admitted to Chosun University Hospital from September, 1996 to February, 1997 at the Department of Internal Medicine. We defined the control group, as diabetic patients who did not have anemia(<13mg/dl), diabetic complications(retinopathy, nephropathy, neuropathy) and the remainders were defined as the experimental group(we excluded anemic patients, who had secondary causes of anemia and diabetic patients with end stage renal disease)Data were as follow 1) The relationship of Hb and the 24hr urine protein between diabetic patients with and without complications significantly differed(p=0.02, < 0.001 respectively), but the Hb level was poorly related between diabetic patients with and without retinopathy(except in preproliferative, proliferative subgroups) and neuropathy. 2) Subgroups of patients with diabetic complications had higher 24hr urine protein than patients without diabetic complications, except stage I diabetic neuropathy 3) The EPO level was significantly different between diabetic patients with and without complications. 4) The correlation between EPO and Hb was significantly different, especially in diabetic patients with retinopathy and nephropathy according to severity of diabetic complications, compared with patients who did not have diabetic complications such as retinopathy and nephropathy. Conclusion: We know that anemia induced by diabetic complications is due to relative EPO deficiency than absolute EPO deficiency, and further evaluation and studies are needed on many cases in the future

당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

성인 급성 신부전 환자의 예후인자 분석

정종훈,김영곤,유기동 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4

Background:Acute renal failure(ARF) is characterized by rapid decline in glomerular filtration rate and retension of nitrogenous waste products. This syndrome occurs in approximately 5 percent all hospital admissions and up to 30 percent of admissions to intensive care units. ARF is diagnosed when screening of hospital patients reveals a recent increase in serum BUN(blood urea nitrogen) and creatinine. The mortality rate for ARF is approximate 40-60% and has changed little in past three decades. This lack of improvement in outcome, despite significant advances in medicine. The reasons of high mortality rate is not certain. This study intend to identify prognostic risk factors influencing survivals. Methods:We retrospectively analyzed 60 patients with ARF during 2 years period from Oct. 1996 to Oct. 1998 at chosun university hospital. Multiple factors which may influence mortality were evaluated. Results: 1)Of the 60 patients, 34 were male and 26 were female. The mean age was 55.8±15.9 years. 2)The cause of ARF is Drug, toxin, dehydration, infection, trauma, surgery, urinary tract obstruction, HFRS, rhabdomyolysis and bleeding. 3)Underline disease is observed in 52 case. DM, Hypertension, Malignancy, Pulmonary disease, Liver disease, Renal disease 4)The mortality rate is 31.7%. The major cause of deaths is DIC, infection and hepatic failure. 5)Based on the unpaired t-test, chi-squre analysis, albumin, total bilirubin, hemoglobin, thrombocytopenia, APACHE Ⅱ score, serum sodium, urine creatinine, number of multiple organ failure, cause of acute renal failure, pH, vital sign on admission, sepsis, DIC, oilguria, and hemodialysis were significant factors between survivors and nonsurvivors(p$lt; 0.05). 6)APACHE Ⅱ score on admission is good prognostic factor for patients with acute renal failure (p$lt;0.001). Conclusion:This results suggest that the evaluation of patients symptom, sign, laboratory data, APACHE Ⅱ score is important for patients with acute renal failure. the discriminant score by multiple analysis and APACHE Ⅱ score could relatively predict the mortality of ARF patients. however further evaluation and clinical apply of prognostic factors is required to confirm these results.

담관 폐쇄에 의한 백서간의 형태학적변화와 항산화효소 생성량과의 관계

박찬국,김명철,김창욱,김만우,유기동,김영학,이만재,모성환,기근홍 대한소화기학회 1998 대한소화기학회지 Vol.31 No.2

Background/Aims: Obstructive cholestasis has been known to cause heaptic injury, resulting in morphological change in the liver. Rats with biliary obstruction may be believed to be susceptible to oxidative stress and free radical related liver injury by the infiltration of inflammatory cells. Using biliary obstruction in rats, we studied the relationships between morphologic changes and the levels of antioxidant enzymes. Methods: The proximal portion of the common bile duct of Sprague-Dawley rats were ligated with silk. We observed morphological changes, estimated the antioxidant enzymes within the liver tissue, and assayed aspartate aminotransferase, total bilirubin, and alkaline phosphatase within serum at every week for 4 weeks. Results: After biliary obstruction, the activities of superoxide dismutase, catalase, and glutathione peroxidase gradually increased in rat liver. Histologically, proliferation of bile ductules and fibrosis developed 3 to 4 weeks later after ligation of common bile duct. Hepatic lobular destruction and severe portal triaditis were noted 2 weeks later. Conclusions: Due to the increased activities of the antioxidant enzymes after biliary obstruction, it is believed that the oxygen free radicals play an important role in hepatic injury by cholestasis in rats, and that morphological changes may partially result from the release of oxygen free radicals by the inflammatory cells.

A Case of Cedecea davisae Peritonitis in a Liver Cirrhosis Patient

Kim,Tae Weon,Shin,Sung Heui,Chung,Suk Jin,Yu,Ki Dong,Lim,Yong,Park,Young Jin,Kim,Man Woo 대한감염학회 1998 감염 Vol.30 No.1

복막염을 동반한 간경변증을 앓고 있는 49세 남자 환자의 복수로부터 Cedecea davisae가 분리되었다. 환자는 내원하기 15일 전부터 시작된 간경변증에 의한 복부팽창을 주소로 내원한 환자로서 입원후 복부팽창을 치료하던 중 고열, 복부압통과 반동압통 등의 복막염 증세를 보였으며 복수로부터 C. davisae가 분리되었다. 분리된 이 세균은 항생제 감수성 검사에서 cefotaxime, piperacillin과 imipenem에 감수성을 보였고 imipenem 투여 후 환자의 복막염은 효과적으로 치료되었다. 장내세균과에 속하는 이 세균에 의한 감염증은 매우 드물다. 이 보고는 복수로부터 C. davisae를 분리한 최초의 보고이다. Cedecea davisae is a motile, Gram-negative rod in the family Enterobacteriaceae which is positive for lipase, DNase and catalase, and negative for gelatinase and oxidase. This bacterium is rarely isolated in the clinival specimens. We isolated C. davisae from the ascitic fluid of a 49-year old male patient with liver cirrhosis who was diagnosed as acute bacterial peritonitis. Bacterial identification was performed by API 20E and VITEK. Antimicrobial susceptibility test showed that the isolate was susceptible to cefotaxime, piperacillin, and imipenem. Peritonitis of this patient was improved by imipenem therapy. This is the first reported case of peritonitis caused by this organism.