혈액투석중인 만성신부전 환자에서 혈압조절의 양상과 투석적절도가 혈압에 미치는 영향

김명빈(Myung Bin Kim),박규용(Ky Yong Park),김근호(Guen Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objective : Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. Methods : The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. Results : The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP <114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. Conclusion : Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.

말기신부전 환자의 혈액투석에 있어서 혈관 성숙기간이 동정맥루 생존율에 미치는 영향

박규용(Ky Yong Park),김근호(Guen Ho Kim),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo),조진원(Jin Won Cho),여미애(Mi Ae Yeo),양형원(Hyung Won Yang),김경희(Kyung Hee Kim),이기성(Ki Sung Lee),전로원 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A Arteriovenous fistula(AVF) has been the most important, primary mode of achieving vascular access for chronic hemodialysis by this time. In general, maturation period over 4 to 8 weeks after operation for the formation of AVF has been recommended for the long-term survival of AVF, and so insertion of central venous catheter without using AVF being matured has been primarily recommended whenever hemodialysis is needed. But not infrequently, serious complications have been reported in association with the insertion and the use of central venous catheter. So earlier use of AVF is regarded as a good method of avoiding serious complications with regard to the insertion and the use of central venous catheter. But early use of AVF has not been generally recommended, for early use of AVF has been regarded to be associated with early failure of AVF. But few studies have reported the correlation between maturation period and AVF survival. And in practice, early use of AVF has already been performed frequently by not a few nephrologists or nurses of dialysis units. So authors tried to examine the correlation between maturation period and AVF survival rate, and to find the validity of early use of AVF if it is regarded usable for the hemodialysis by experienced hemodialysis nurses and nephrologists. Methods : A retrospective analysis using 88 AVF cases which had been created in 85 patients from Oct. 1986 through June 1996, and from which authors could get enough information for this study was done. Authors compared one year survival rates of AVF according to the maturation period, the presence of DM, and condition of AVF assessed clinically by doctors and experienced nurses in hemodialysis units. Also from the cases with AVF obstruction, authors examined the 1st, 2nd, and 3rd year survival rate of AVF according to the maturation period. Results : One year survival rate of AVF with maturation period less than 4 weeks was higher than that with maturation period more than 4 weeks, but there was no statistical significance. One year survival rate, irrespective of the length of maturation period for AVFs, of AVF regarded to be usable and good for hemodialysis was higher than that of AVF regarded to be usable but not good for hemodialysis. In the study with the AVF obstruction group only, one year survival rate of AVF with maturation period less than 4 weeks was higher than that of AVF with maturation period more than 4 weeks but there was no statistical significance. And one year AVF survival rate was higher in non DM group(94.1%) than DM group(60%) regardless of maturation period of AVF(P<0.05). Conclusion : On the contrary to the views that longer maturation period of more than 4 weeks will be necessary for the long-term survival of AVF, our results suggest that shorter maturation period for AVF less than 4 weeks does not necessarily mean early failure of AVF once AVF is regarded to be usable for hemodialysis. So it is suggested that early use of AVF instead of inserting central venous catheter is a reasonable approach for getting an adequate vascular access for hemodialysis in chronic renal failure patients who were subjected to receive hemodialysis on waiting peroid of AVF maturation.

동해 연안역의 박테리아 생산력과 유기물질의 분해능

이기성(Ki Sung Lee),고동규(Dong Kyu Ko),김근호(Guen Ho Kim),이영근(Young Keun Lee),최청일(Chung Il Choi),최영길(Yong Keel Choi) 한국환경생물학회 1999 환경생물 : 환경생물학회지 Vol.17 No.1

Bacterial population, signal compounds of pollution, bacterial productivity, heterotrophic activity and the activities of extracellular enzymes were analyzed four times from July 1994 to April 1995 at Daejin, Galnam, Pohang, and Ulsan in the coastal area of East Sea in order to investigate the state of eutrophication. The population of heavy metal resistant bacteria in Pohang was the highest among all stations. The bacterial populations which could utilize C-P compounds(phosphonate) showed the highest at Pohang that was expected for the industrial and agricultural effluents to inpour. It could be useful as an index of expectation about the influx of industrial sewages and agricultural effluents. The activities of extracellular enzymes for the degradation of organic matter were the highest in the Ulsan Chuyongam, but low in Daejin. These results showed positive relationship with the population of heterotrophic bacteria and bacterial productivity. The ratio of poly-P and DNA in Pohang was the highest, and that in Ulsan, Galnam, and Daejin consecutively, corresponding with the distribution of heterotrophic bacteria. In case of the heterotrophic activities, each of the stations gives difference of seasonal variation in heterotrophic activities. Bacterial productivity seemed to be dependent on seasons; the highest in summer and the lowest in fall and winter. These seasonal variations of bacterial productivity seems to be similar with those of heterotrophic bacteria. It is suggested that the state of eutrophication could be evaluated by the criteria of the population sizes and the productivities of microorganisms, the amount of poly-P, heterotrophic activity, the activities of extracellular enzymes, etc.

급성 뇌교 경색의 임상 연구

장상섭,이형,김지언,이상도,임정근,김근호,박영춘,김태완,김진석 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.1

내인성 뇌교 혈관의 공급 영역에 따라 단독 뇌교 경색은 전측(내측과 외측), 피개, 외측 뇌교경색의 세가지 유형으로 분류할 수 있고 이들의 임상 양상과 국소 해부학적 상관 관계는 일치하였다. 전측 뇌교경색은 주로 피질 척수로를 손상시켜 상하지의 부전 편마비를 일으키며 반수 이상의 환자(59%)에서 피개 징후와 증상을 동반하였다. 피개경색은 현훈, 의식변화, 안 운동장애, 감각장애 및 뇌신경마비같은 피개 증상과 징후가 나타나며 일부(30%)에서 경미한 운동장애가 동반되었다. 단독뇌교 경색은 주로 기저 동맥의 관통 동맥 폐색에 의해 발생하곡 대혈관 질환이나 심 색전증 또한 단독 뇌교 경색의 원인이 되었다. Background : In a pontine infarction, variable neurologic deficits present because the pons is very complicated organ including cranial nerve nuclei and several fiber tracts. It's the aim of this study to clarify the clinicotopographical correlation of isolated acute pontine infarcts. Methods : We studied 33 patients with acute pontine infarct and classified them into three subtypes on the basis of lesion location on MRI. Clinical features, angiographic findings and risk factors were compared. Results : Twelve patients had a ventromedial pontine infarcts, in which clinical findings included dysarthria (N=12), hemiparesis (N=12) and tegmental signs (N=6). Five patients had a ventrolateral pontine infarcts, in which clinical findings included vertigo (N=3), hemiparesis (N=3) and sensory disturbances (N=2). Fifteen patients had a tegmental infarcts, in which clinical findings were vertigo (N=13), eye movement disorders (N=10) such as abducence palsy; inter-nuclear opthalmoplegia, ocular bobbing, and sensory disturbance (N=4). Emboligenic heart disease (N=3/33 9.1%) and sign-ificant stenosis of vertebro-basilar artery (3/16 18.7%) were observed. Summary: Corresponding to territories of intrinsic pontine vessels, isolated pontine infarcts could be classified into three main syndromes. Isolated pontine infarcts were usually due to thrombosis of per-forating arteries, but large artery stenosis and cardioembolism also could be causes of isolated pontirie infarcts.