성인 급성 신부전의 원인 및 예후인자 분석

구영선,장윤경,양종오,강민규,황평주,김종학,나기량,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Acute renal failure is a frequent complication in hospitalized patients and is strongly related to the mortality. The Clinical outcome and prognostic factors of acute renal failure(ARF) have been analyzed by many authors. The present study describes the etiologic and clinical aspects, as well as other factors related to mortality. All the patients suffering from acute renal failure admitted during the period of January 1993 - August 1998 were included in the study. The average age of the patients was 52±17 years and mortality rate was 24%. The causes of acute renal failure were hemorrhagic fever with renal syndrome(HFRS), sepsis, renal hypoperfusion, urinary tract obstruction, acute tubular necrosis, etc. The etiology of ARF was a significant prognostic factor on mortality in ARF. Other significant prognostic factors were oliguria, organ failure, use of vasoconstrictors, hypotension, serum bicarbonate, premorbid conditions, sepsis, neurologic complications, gastrointestinal bleeding. On the other hands, operation, sex, anemia, thrombocytopenia, hypoalbuminemia, BUN, serum creatinine, and hyperkalemia were not significant factors for the mortality. We conclude that major prognostic factors of acute renal failure arc premorbid conditions, sepsis and multiorgan failure, and they are responsible for persistent high mortality of acute renal failure despite of advances of medical care.

抗히스타민劑의 吸光度比法에 의한 定量

李允中,李康春,李東宣,李振九 成均館大學校 1980 論文集 Vol.28 No.-

The absorbance ratio method was applied to the quantitative determination of antihistamines, such as chlorpheniramine maleate(CPM), carbinoxamine maleate(CBM) and diphenhydramine hydrochloride. The influences of indicator and solvent concentration on the precision and accutacy of determination were investigated. And it was found that the effects of temperature and wavelength was negligible in case of averaging conditions. The standard deviations for three antihistamines tested were within 0.13%. As the results, the determination of antihistamines could be carried out easily, rapidly and accurately by the absorbance ratio method.

전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.

진행 위암환자에서 Lymphokine-Activated Killer (LAK) 활성의 저하

홍원선,김영환,송재관,강윤구,이진오,강태웅,김정룡 대한내과학회 1990 대한내과학회지 Vol.38 No.3

Natural killer(NK) and lymphokine-activated killer(LAK) activities were determined in 31 patients with unresectable stomach cancer before and immediately after chemotherapy with 5-fluorouracil, adriamycin and mitomycin C(FAM) and 31 healthy volunteers. The major purposes of the study were focused on whether peripheral blood lymphocytes(PBL) in stomach cancer patients had a similar ability in the generation of LAK activity to those in healthy volunteers and what the effect was of chemotherapy with FAM on the generation of LAK activity. LAK cells were generated in vitro by culturing human PBL with 100 U/㎖ of recombinant human interleukin-2(rH-IL-2) for 72 hours. K562(human myelogenous leukemia cell line) and MKN-45(human stomach adenocarcinoma cell line) were used as target cells for NK and LAK activities. NK activity against K562, a sensitive line, was significantly depressed in patients with stomach cancer compared with that in healthy volunteers(p<0.01). However, LAK activity against K562 was similar to that of the controls. Age, sex and performance status(ECOG 0-2 and 3-4) did not have an influence on both NK and LAK activities. LAK activity was significantly higher than NK activity, either against K562 or MKN-45, in both healthy volunteers and patients with stomach cancer(p<0.001). NK and LAK activities against MKN-45, a NK-resistant line, in patients with stomach cancer showed significantly lower levels than those in healthy volunteers. We also analyzed the effect of chemotherapy with FAM on NK and LAK activities, with no suppression of NK and LAK activities being observed. In this study, we have demonstrated that PBL of stomach cancer have a reduced ability to generate LAK activity in response to rH-IL-2. However, LAK activity generated from PBL receiving chemotherapy with FAM was similar to that of PBL without chemotherapy.

위암세포주에서 Recombinant Human Interferon-r와 Adriamycin의 투여순서가 항암효과에 미치는 영향

홍원선,손영숙,김창민,강윤구,이춘택,김유철,임영혁,남현석,이진오,강태웅 大韓免疫學會 1993 大韓免疫學會誌 Vol.15 No.-

Numerous previous studies, both in vitro and in vivo, have demonstrated that the cytotoxicity can be enhanced by the combination of chemotherapeutic agent and interferons(IFNs) in various types of cancer cells. We have previously reported that combined treatment of MKN-45, human gastric adenocarcinoma cells, with adriamycin(ADM) and recombinant human interferon-r(rh-IFN-r) increased in the cytotoxicity. In this study, the effects of combination timing of rh-IFN-r and ADM on the cytotoxicity against MKN-45 were investigated using MTT assay. MKN-45 was treated with rh-IFN-r and ADM in vitro on three schedules : Treat A ; rh-IFN-r and ADM were treated simultaneously, Treat B ; rh-IFN-r was treated 24 hours after the treatment with ADM, Treat C ; rh-IFN-r was treated for 72 hours and followed by the treatment with ADM. The survival of MKN -45 was inhibited by ADM dose-dependently. 102 and 103U/ml of rh-IFN-r significantly inhibited the survival of MKN-45(% survival : 35.1 ±-1.2% and 34.4 ±1.1% in Treat A and 42.5 ± 2.1% and 45.9-±2.5% in Treat C, respectively). However no difference in the survival was observed between 102 and 103U/ml of rh-IFN-r. Combined treatment with rh-IFN-r and ADM significantly augmented the cytotoxicity at low concentrations of ADM. Combined effects of rh-IFN-r and ADM were evaluated using IC30(,ag/ml) to ADM. IC30s of MKN-45 in Treat A, B and C at 102 U/ml of rh -IFN-r _ were 0.019 -?- 0.003, 0.045 :I:0.001 and 0.054 ± 0.012, respectively, while IC30 of MKN-45 treated with ADM alone was 0.052±0.004. IC30s of MKN-45 in ADM alone group, Treat A, Treat B and Treat C at 103U/ml of rh-IFN-r were 0.047 ±0.003, 0.004 -±0.001, 0.031 ±0.004 and 0.056 0.008, respectively. These results indicate IC30s of Treat A and B were significantly lower than those of ADM alone(p<0.05) and IC30s of Treat A was significantly lower than those of Treat B(p <0.01). IC30s of Treat C, however, were not different from those of ADM alone. From these results demonstrating that cytotoxic effects were increased by the combination of rh-IFN-r and ADM in the order, Treat A > Treat B> Treat C, it can be concluded that the simultaneous administration of rh-IFN-r and ADM may be the most effective method to combine these two therapeutic modalties.

심초음파로 결정된 응급 심낭천자술의 천자부위

김성환,황성오,이강현,조준휘,강구현,문중범,이승환,윤정한,최경훈,김영식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. Methods: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital, Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0 cm was considered as the primary safety factor in determining the Puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. Results: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area In 11 patients(12%), and the right parastemal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31 ±21 mm in patients with the subcostal approach and 21±8 mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intraperical pressure among patient groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach.

H. pylori 제균으로 완전 관해된 위의 고도 MALT 림프종 1예 : a case report

황창연,류민희,강윤구,김태원,장흥문,엄대운,허주령 대한내과학회 2004 대한내과학회지 Vol.66 No.1

위의 저도 MALT 림프종은 H. pylori 제균 후에 60∼90%가 관해를 보이는 것으로 알려져 있으나 고도 MALT 림프종은 H. pylori 제균 만으로는 치료가 부족한 것으로 알려져 있다. 그러나 최근에 위의 고도 MALT 림프종에서도 H. pylori 제균 치료를 통해 관해에 이른 사례들이 보고 되었고, 저자들도 고도 MALT 림프종 환자에서 H. pylori 제균 치료를 통하여 내시경적 및 조직학적 완전 관해에 도달한 증례를 경험하여 이를 보고하는 바이다. Low grade MALT lymphoma of stomach is associated with H. pylori infection in more than 90% of cases, and eradication of H. pylori leads to regression of the low grade MALT lymphoma in 60∼90% of cases. On the contrary, high grade MALT lymphoma is thought to be independent from H. pylori for growth and usually is thought to require antitumor chemotherapy. However, there have been recent reports of high grade MALT lymphoma regressing after H. pylori eradication. We experienced and are reporting a case of high grade MALT lymphoma arising in the background of low grade MALT lymphoma that showed complete regression after H. pylori eradication.

지속성 외래 복막투석 환자의 복막염

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.

사람폐암세포주 (PC-14)에서 Cyclosporin A에 의한 Adriamycin 내성의 극복

김영환,홍원선,송재관,강윤구,이진오,강태웅,김건열,한용철 대한내과학회 1990 대한내과학회지 Vol.38 No.3

Cyclosporin A and verapamil were tested using MTT assay to evalute the modification effect on the resistance to adriamycin in a human lung cancer cell line(PC-14) and its resistant subline(PC-14/A). PC-14/A was derived by the continuous exposure of PC-14 to incremental concentrations of adriamycin. PC-14/A was 2.5 times more resistant to adriamycin in terms of ICso than PC-14. Cyclosporin A alone, at a concentration of 2.5㎍/㎖, inhibited the growth of PC-14 to 68.3%. 2.5㎍/ ㎖ and 5.0㎍/㎖ of cyclosporin A showed an increase in the cytotoxicity of adriamycin (p<0.01) with 5.0㎍/㎖ being greater than 2.5㎍/㎖(p<0.01). Excluding the direct cytotoxic effect, however, cyclosporin A did not increase in the sensitivity of PC-14 to adriamycin but only showed an additional cytotoxic effect with adriamycin. Verapamil (up to 6.0㎍/㎖) did not inhibit the growth of PC-14. 3.0㎍/㎖ of verapamil did not increase the cytotoxic effect of adriamycin. The combination of cyclosporin A and verapamil with adriamycin enhanced the cytotoxicity of adriamycin, but the result was similar to that of cyclosporin A with adriamycin. 5.0㎍/㎖ of cyclosporin A modified the adriamycin resistance of PC-14/A(SR, 3.2). However, 3.0㎍/㎖ of verapamil did not significantly reverse the adriamycin resistance of PC-14/A. The modified effect of the combination of 5.0㎍/㎖ of cyclosporin A and 3.0㎍/㎖ of verapamil was similar to that of 5.0㎍/㎖ of cyclosporin A alone in PC-14/A. These results demonstrate that cyclosporin A has an additional cytotoxic effect with adriamycin in PC-14 and PC-14/A and has overcome the acquired resistance to adriamycin in PC-14/A. They also suggest that cyclospoin A may have the therapeutic potential in the treatment of human lung cancer.

연부조직육종의 수술후 방사선 치료결과

김연실(Yeon Shil Kim),장홍석(Hong Seok Jang),윤세철(Sei Chul Yoon),유미령(Mi Ryeong Ryu),강기문(Ki Moon Kang),정수미(Su Mi Chung),김훈교(Hoon Kyo Kim),강용구(Yong Koo Kang) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.4

목 적 : 최근들어 연부 조직 육종의 치료방법이 광범위 구획절제에서 사지기능을 보존하는 제한적 수술과 방사선/항암화학요법의 다병용치료로 변환되고 있으며 광범위 수술과 유사한 치료성적을 거두고 있다. 저자들은 수술후 방사선 치료를 시행한 연부 조직 육종 환자를 대상으로 치료 결과 및 실패 양상을 알아보고 관련된 예후 인자를 분석하여 수술 후 방사선치료의 역할을 알아보고자 하였다. 대상 및 방법 : 대상환자는 1983년부터 1994년까지 치료한 60명이었고 모두 추적관찰이 가능했으며 평균 추적기간은 50개월이었다. 원발병소는 상·하지가 35례(58%)로 가장 많았고 체간 12례(20%), 두경부 7례(12%)였으며 병리학적 유형에 따른 구분은 악성섬유구종 14례(23%),지방육종이 10례(17%), 악성신경섬유종 7례(12%) 등 이었다. 전체환자중 6례를 제외하고는 조직학적등급의 분석이 가능했고 grade I, II, III가 각각 27례(45%), 3례(5%), 24례(40%)였다. 수술적 절제는 19례(32%)에서 광범위절제, 36례(60%)에서 변연절제, 5례(8%)에서 국소절제를 시행하였다. 방사선치료선량은 28.8- 80Gy였고 25례에서 방사선치료와 함께 항암화학 요법을 병용하였다. 결 과 : 최종분석 시 실패 양상은 국소재발이 20례(25%), 원격전이 7례(12%), 국소재발과 원격전이를 동반한 경우가 14례(23%)였다. 원격전이한 환자는 구제치료와 상관 없이 모두 사망하였고 국소재발한 환자중 5명이 구제치료에 성공하여 무병생존하였다. 전체환자의 2년 및 5년 국소제어률은 68.0%와 48.7%로 비교적 저조한 결과를 보였다. 국소제어율에 영향을 미친 예후인자는 조직학적 유형, AJCC 병기, 조직학적 등급, 수술의 범위, 수술절연 침범 유무 및 잔존종양 정도, 림프절 전이 유무(p <0.05)였다. 전체 환자의 5년 생존률과 5년 무병생존률은 각각 60.4%, 36.6%였고 평균 생존기간은 89개월이었다. 단변량 분석에 의한 생존률에 영향을 미친 예후인자로는 조직학적 유형, AJCC 병기, 림프절 전이 유무, 조직학적 등급, 수술절연 침범 유무와 잔존 종양 정도 였다. 결 론 : 결론적으로 본 연구 결과 연부 조직 육종에서 제한적 수술과 수술 후 방사선치료로 비록 저조한 국소제어률을 보였으나 사지 절단 혹은 광범위 구획절제와 비교시 유사한 생존률을 얻었다. Purpose : The major goal of the therapy in the soft tissue sarcoma is to control both local and distant tumor. However, the technique of obtaining local control has changed significantly over the past few decades from more aggressive surgery to combined therapy including conservative surgery and radiation and/or chemotherapy. We retrospectively analyzed the treatment results of the postoperative radiation therapy of soft tissue sarcoma and its prognostic factor. Materials and Methods : Between March 1983 and June 1994, 60 patients with soft tissue sarcoma were treated with surgery and postoperative radiation therapy at Kang-Nam St. Mary's hospital. Complete follow up was possible for all patints with median follow up duration 50 months (range 6 - 162 months). There were 28 male and 32 female patients. Their age ranged from 6 to 83 with a median of 44 years. Extremity (58%) was the most frequent site of occurrence followed by trunk (20%) and head and neck (12%). Histologically malignant fibrous histiocytoma (23%), liposarcoma (17%), malignant schwannoma (12%) constitute 52% of the patients. Daily radiation therapy designed to treat all areas at a risk for tumor spread upto dose of 4500-5000 cGy. A shrinking field technique was then used and total 55-65 Gy was delivered to tumor bed. Twenty-five patients (42%) received chemotherapy with various regimen in the postoperative period. Results : Total 4 1 patients failed either with local recurrence or with distant metastasis. There were 29 patients(48%) of local recurrence. Four patients (7%) developed simultaneous local recurrence and distant metastasis and 8 patients (13%) developed only distant metastasis. Local recurrence rate was rather higher than of other reported series. This study included patients of gross residual, recurrent cases after previous operation, trunk and head and neck prima ry. This feature is like ly explanation for the decreased loca l control rate . Five of 29 patients who fa iled only loca lly were salvaged by re- excis ion and/or re- irradiation and rema ined free of disease . Factors affecting loca l control include histologic type , grade, stage , extent of operation and surgica l ma rgin involvement, lymph node metastas is (p <0.05). All 21 patients who fa iled distantly are dead with progress ive disease at the time of this report. Our overall survival results are similar to those of larger series . Actuarial 5 year overall survival and disease fresurvival were 60.4 %, 36.6% respectively. Grade, stage (being close association with grade), residual disease (negative ma rgin, microscopic, gross) were significant as a predictor of survival in our series (p <0.05). Conclusion : Combined surgery and postoperative radiation therapy obtained 5 year survival rate comparable to that of radical surgery.