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The Effect of Dialysis Membrane Flux on Amino Acid Loss in Hemodialysis Patients
길효욱,양종오,이은영,이은미,최종순,홍세용 대한의학회 2007 Journal of Korean medical science Vol.22 No.4
We examined whether high flux membranes (HF) may induce a greater loss of amino acids compared to low flux membranes (LF). Ten hemodialysis patients participated in this study. Pre- and post-hemodialysis plasma amino acid profiles were measured by reverse-phase high pressure liquid chromatography for both HF and LF. We measured the dialysate amino acid losses during hemodialysis. The reduction difference for plasma total amino acid (TAA), essential amino acid (EAA), and branch chained amino acid (BCAA) was not significantly different in comparisons between the two membranes. (HF vs. LF; TAA 66.85±30.56 vs. 53.78±41.28, p=0.12; EAA 14.79±17.16 vs. 17.97±28.69, p=0.12; BCAA 2.21±6.08 vs. 4.16±10.98 mg/L, p=0.13). For the HF, the reduction in plasma amino acid levels for TAA and EAA were statistically significant. Although it was not statistically significant, the dialysate losses of BCAA were greater than the reduction in plasma (plasma reduction vs. dialysate loss; HF 2.21±6.08 vs. 6.58±4.32, LF 4.16±10.98 vs. 7.96± 3.25 mg/L). HF with large pores and a sieving coefficient do not influence dialysate amino acid losses. Hemodialysis itself may influence the dialysate amino acid losses and may have an effect on protein metabolism.
Pharmacokinetics of Glutathione and Its Metabolites in Normal Subjects
길효욱,양종오,홍세용,이은영,황수경,정영호,이지원,김형기,김수현 대한의학회 2005 Journal of Korean medical science Vol.20 No.5
To determine the loading and maintenance dosage of glutathione (GSH) for patients suffering from reactive oxygen species (ROS) injury such as acute paraquat intoxi-cation, a kinetic study of reduced GSH was performed in synchrony with that of cys-teine (Cys), cystine (Cys2), and methionine (Met). Human subject’s porticipitation was voluntary. The effective dose of Cys, Cys2, and Met against ROS in fibroblast cells generated by paraquat was assessed using laser scanning confocal microscopy. Both Cys and Met suppressed ROS in a dose-dependent manner at concentra-tions of 1-1,000 M; the concentration required to suppress ROS by 50% was 10 M for Cys and 50 M for Met. Using metabolite kinetics with the assumption that Cys and Met are the metabolites of GSH, expected concentrations of Cys and Met of above 20 and 50 M were estimated when GSH was administered at 50 mg/kg body weights every 205.4 min for Cys and 427.4 min for Met.
원인 불명의 급성 신부전으로 발현된 급성 파라콰트중독 1례
길효욱,양종오,이은영,홍세용,Gil Hyo Wook,Yang Jong Oh,Lee Eun Young,Hong Sae Yong 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
Paraquat, a widely used herbicide, is extremely toxic, causing multiple organ failure in human. Many treatment modality has been used, but now paraquat is very fatal drug. Elimination rate of plasma paraquat seems to be a factor for the survival rate. So early diagnosis and early treatment are very important. Plasma paraquat concentration could be measured by radioimmunoassay. But it is impossible that the test was done at Emergency room and the result was checked immediately. There was relation between plasma paraquat concentrations and urine paraquat concentration. Because of its simplicity and low cost, urine paraquat concentration test is complementary to the plasma concentration measurement. If the patient has psychotic problem or unconscious mental state, and is observed unexplained dyspnea and oral ulcer, urine paraquat test is very important to rule out acute paraquat intoxication. We experienced a patient who was presented as unexplained acute renal failure initially and was diagnosed as paraquat intoxication later.
Diagnostic and Therapeutic Approach for Acute Paraquat Intoxication
길효욱,Jung-Rak Hong,장시형,홍새용 대한의학회 2014 Journal of Korean medical science Vol.29 No.11
Paraquat (PQ) has known negative human health effects, but continues to be commonlyused worldwide as a herbicide. Our clinical data shows that the main prognostic factor isthe time required to achieve a negative urine dithionite test. Patient survival is a 100%when the area affected by ground glass opacity is < 20% of the total lung volume onhigh-resolution computed tomography imaging 7 days post-PQ ingestion. The incidenceof acute kidney injury is approximately 50%. The average serum creatinine level reaches itspeak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain twoconnecting lines from the highest PQ level for the survivors and the lowest PQ level amongthe non-survivors at a given time. Patients with a PQ level between these two lines areconsidered treatable. The following treatment modalities are recommended to preservekidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration,3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a generaloverview on the diagnostic procedure and treatment modality of acute PQ intoxication,while focusing on our clinical experience
Efficacy of Hemocontrol Biofeedback System in Intradialytic Hypotension-Prone Hemodialysis Patients
길효욱,방기태,이소영,한병근,김진국,김영옥,송호철,권영주,김용수 대한의학회 2014 Journal of Korean medical science Vol.29 No.6
We conducted a study to determine whether the hemocontrol biofeedback system (HBS)can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD)patients compared with conventional HD. In this multicenter prospective crossover study,60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (periodA), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBSHD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDHduring 24 HD sessions (14.9 ± 5.8 sessions, 62.1% in period A vs 9.2 ± 7.2 sessions,38.4% in period B1, P < 0.001) and the number of IDH-related nursing interventions in asession (0.96 ± 0.66 in period A vs 0.56 ± 0.54 in period B1, P < 0.001) significantlydecreased in period B1 than in period A. Recovery time from fatigue after dialysis wassignificantly shorter in period B1 than in period A. The patients with higher post-dialysisblood pressure, lower difference between pre- and post-dialysis blood pressure, lessfrequent IDH, and higher pre- and post-dialysis body weight in period A responded betterto HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve thepatient tolerability to HD by reducing the IDH frequency and promoting faster recoveryfrom fatigue after dialysis.
살충제 중독환자에서 혈액관류가 혈중 살충제 농도에 미치는 영향
길효욱,양종오,이은영,홍세용,Gil Hyo-Wook,Yang Jong-Oh,Lee Eun-Yong,Hong Sae-Yong 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1
Purpose: Hemoperfusion is an effective modality of extracorporeal elimination of toxins in acutely poisoned patients. We evaluated the effect of hemoperfusion on plasma concentration of toxins in patients exposed to certain pesticides. Methods: Eleven patients who were acutely exposed to pesticides participated in our study. We measured plasma pesticide concentration from the whole blood obtained by arterial and venous sources by gas chromatography. Results: The plasma concentrations of only 3 patients was measured. Methidation clearance by hemoperfusion was 82.2%, fenitrothion was 23%, and endosulfan was 0% Conclusion: Measurement of plasma organophosphate concentration is not a practical application. Our results suggest that hemoperfusion is applicable in patients with pesticide intoxication according to clinical status.