Indomethacin 이 말기 신부전증 환자의 자율신경계 기능에 미치는 영향에 관한 연구

하성규(Sung Kyu Ha),한대석(Dae Suk Han),주현영(Hyung Young Ju),김형직(Hyung Jik Kim),구철회(Chul Hoe Koo),김문재(Moon Jae Kim),이호영(Ho Yung Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.2

N/A The authors studied autonomic nervous system fucntion in 63 patients with uremia and 56 normal control subjects. Among these, automonic nervous system function was evaluated in 11 normal control subjects, 18 hemodialysis patients and 6 CAPD patients before and after indomethacin administration. The results were as follow: 1) The valsalva ratio and heart rate variation ratio were significantly lower in CRF group than normal control group (p<0.05); however, there was no statistically significant differences among CRF patient group (p<0.l). 2) The change of diastoloic blood pressure after orthostasis was significantly lower in CRF group than normal control group (p<0.05). The heart rate was more rapid in normal cantrol group, hemoidalysis patients group and CAPD patient group than predialysis patient group (p<0.05). 3) The change of blood pressure after hand grip exercise was lower in predialysis (p<0.05), The degree of increase in heart rate was lower in predialysis patients than normal control group. 4) Although the valsalva ratio and heart rate variation ratio seem to improve after indomethacin administration, they were not statistically significanct (p<0.1), The change of heart rate in response to valsalva maneuver after indomethacin administration was not sign-ficiant (p<0.1). 5) The change in blood pr re and heart rate before and after indomethacin administration were not statistically significant (p>0.05). However, there was significant increase in systologic and diastolic blood pressure in CAFD patients with hand grip exercise after indomethacin administration (p<0.025). In summary, the function of ANS in patients with CRF was significantly reduced than the normal control group. Although, the function of ANS seemed to improve slightly after indomethacin administration in patients with CRF, the results were not satatistically significant, The prostaglandin has been proposed to play a role in ANS dysfunction. However, the results of this study does not seem to support this theory. Futher studies would be required in odrer to show the role of prostaglandin in ANS dysfunction in patients with CRF.

개의 기관근 수축성에 미치는 GABA의 효과

구철회,권오철,최은미,이광윤,김원준 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.2

개의 기관 평활근에서 GABA수용체의 존재여부를 검정하고, 아울러 GABA와 diazepam의 작용기전을 추정해보기 위하여 다음과 같은 실험을 하였다. 개의 기관을 절재하여 4℃의 Tyrode 영양액내에서 폭 2mm 길이 15mm의 수평 근절편으로 만들었다. 기관근 절편은 양끝을 견사로 결찰하여 1ml의 Tyrode 영양액이 함유되어 있는 적출근편실험조내에서 등척성 장력을 측정하여 polygraph에 그 수축력을 묘기하였다. 실험조내의 영양액의 온도는 37℃로 유지시키고, 95%산소와 5% 이산화탄소의 혼합 기체를 공급하여 pH를 7.4로 유지하였다. 실험조 내에 장치된 두 개의 백금선 전극을 통하여 전기장자극을 가하고 전기장자극유발 수축에 대한 GABA와 diazepam 및 GABA 수용체 길항제들의 상호작용을 관찰하였다. GABA와 diazepam은 기관지 절편의 수축반응을 같은 양상, 같은 정도로 유의하게 억제하였다. GABA와 Diazepam에 의한 수축억제작용은 수용체 봉쇄제인 bicuculline에 의해서는 유의하게 길항되었으나 수용체 봉쇄제인 δ-Aminovaleric acid 에 의해서는 전혀 영향을 받지 않았다. 이상의 결과로 보아 본 실험의 조건하에서 개의 기관 평활근에는 수용체가 존재하여, GABA와 diazepam은 말초형의 수용체에 작용하여 콜린성신경지배에 의한 기관근 수축을 억제한다고 사료된다. This study aimed to investigate the existence of GABA receptor and the mechanisms of action of GABA and diazepam on the trachealis muscle isolated from dog. Horizontal muscle strips of 2mm×15mm were prepared from canine trachea, and isometric myography in isolated muscle chamber bubbled with 95/5%-O₂/CO₂ at 36℃, at the pH of 7.4 was performed. Muscle strips contracted responding to the electrical field stimulation (ESP) by 2∼20 Hz, 20 msec, monophasic square wave of 60 VDC GABA and diazepam suppressed the EFS-induced contractions to the similar extent, significantly. (p〈0.05) Bicuculline, a receptor antagonist blocked both GABA-and diazepam-inhibitions; but DAVA, a receptor antagonist did not affect either of them. These results suggest that in the canine trachealis muscle, there may be only receptor, and GABA and diazepam inhibit the contractility via receptor.

소아 장중첩증의 수술군과 비수술군의 비교 관찰

윤병대,박진길,구철회 최신의학사 1992 最新醫學 Vol.35 No.9

한국형 출혈열 환자에서 동반된 간기능 장애가 그 예후에 미치는 영향

한대석,이은경,김문재,이호영,구철회,주현영 대한내과학회 1986 대한내과학회지 Vol.31 No.3

The prognostic factors of Korean hemorrhagic fever are still not clarified. We evaluated the relationship between liver dysfunction on admission and mortality in 121 patients with Korean hemorrhagic fever admitted at the department of internal medicine, Severance hospital from May, 1g77 to May, 1985 and the following results were obtained. 1) Overall mortality rate in patients with Korean hemorrhagic fever was 10. 7%(13 of 121). 2) The expired patients showed much higher initial SGOT and SGPT level compared to those who survived. 3) Elevated SGOT level was more useful than SGPT level as a poor prognostic index. 4) The expired patients had lower serum albumin level and more prolonged prothrombin time than survived. 5) No differences were seen between two groups in the degree of acidosis, RUN and serum creatinine level. In conclusion, severe hepatic dysfunction should be considered as a poor prognostic index ia patients with Korean hemorrhagic fever.

위암과 동반된 막성신병증 1예

이종인,이은영,김진수,최승옥,심영학,홍순원,이형준,구철회 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1

The relationship between malignancy and membranous nephropathy remains unresolved exactly, but it was suggeste d that nephrotic syndrome can be menifested as a prodrome to underlying malignancy. It has been reported that membranous nephropathy is associated with malignancy, however, a few cases were reported in Korea. We recently experienced a patient with stomach cancer which was detected during the follow-up of the membranous nephropathy. Proteinuria and microsopic hematuria disappeared after subtotal gastrectomy. We concluded that the stomach cancer might be a cause of glomerulonephritis in this case.

정기 혈액투석을 위한 동정맥루 형성 시기에 대한 연구

김미혜,이은영,김진수,최승옥,김명수,구철회,한병근,갈응호,신표진,윤현진 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6

The number of patients and long-term survival rates of chronic renal failure have been increasing since the development of renal replacement therapy. Therefore, continuous follow-up observation on an outpatient basis, vascular access for dialysis and the determination of when to start dialysis have clinical significance associated with the prognosis of these patients. Presently, there is little clinical data about chronic renal failure patients such as, clinical features at initial dialysis, the presence or absence of neph-rologist follow-up, and the types and timing of vas-cular access. The goal of this study therefore was to investigate the clinical features at initial dialysis, presence or absence of follow-up, types and timing of vascular access in 80 patients retrospectively. The results are as below ; 1) The mean age of the patients was 47.8±14.0 years, and there were 47 male and 33 female patients. 2) Seventeen patients(21.3%) had DM as an underlying disease and 63 patients(78.79%) were non-diabetic patients. 3) At the initial dialysis, the diabetic patients had an average BUN of 79.2±29.6mg/dl, average Cr of 7.82.0mg/dl and an average Ccr of 10.0±7.0ml/min. The non-diabetic patients had the following averages ' BUN 118.7±37.9mg/dl, Cr 15.3±6.3mg/dl and Ccr 5.5±4.3ml/min. 4) The initial meeting with a nephrologist prior to dialysis occured as follows : in the diabetic group, 13 patients(76.596) met their nephrologist 12 months before, 3 patients(17.6%) 1 month before, one patient(5.9N) met the specialist one to 3 months before and no one had meeting 4 to 12 month before their dialysis. In the non-diabetic group, 36 patients(63.2%) initially visited a nephrologist 12 months before, 16 patients (28.1%) one month before, 3 patients(5.3%) one to 3 months before and 2 patients(3.5%) had a meeting 4 to 12 months before the first dialysis. 5) The timing of native arteriovenous fistula formation was as follows; In the diabetic group, 10 patients(66.7%) had an A-V fistula constructed immediately upon admission, 2 patients(13.3%) had one constructed one to 3 months before, 2 patients(13.3%) had one made 4 to 12 months before, one patient (6.7%) had a fistula created one week to one month before, and no one had a fistula formed 12 months before their initial dialysis. In the non-diabetic group, 36 patients(69.2%) had an A-V fistula constructed on admission ll patients(21.2%), one week to one month before 2 patients(3.8%), one to 3 rnonths before 2 patients(3.8%), 4 to 12 months before: one patient(1.9%) had the fistula created 12 months before initial dialysis. From these results, we learned that the time interval between either the patient's first meeting with his/her nephrologist or initial referral for renal replacement and vascular access preparation for hemodialysis was much longer than what is currently known. In conclusion, prompt referral to a nephro-logist early in the course of the disease and proper education of the patient by the nephrologist can lead to timely initiation of dialysis at a lower serum creatinine and higher Ccr levels which will reduce mortality, morbidity, and hospital care cost.