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성인에서 발현된 연쇄상구균 감염 후 사구체 신염의 임상적 , 조직학적 특징
이동원(Dong Won Lee),김용범(Yong Beom Kim),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Youn Rha) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5
목 적 : 연쇄상구균 감염 후 사구체 신염은 연쇄상구균 감염으로 인해 형성된 면역 복합체가 사구체 기저막에 연하여 침착됨으로써 유발되는 면역 질환이다. 학동기 전후 연령의 소아 및 젊은 연령층에서 주로 발생하고 고령층에서는 발생이 드물며 장기적인 예후 또한 차이가 있다. 이에 저자는 성인에서 발생한 연쇄상구균 감염후 사구체 신염에 대한 임상적, 조직학적 고찰을 통해 연령에 따른 특징을 규명하고자 하였다. 방 법 : 1995년부터 1999년까지 부산대학교병원에서 임상적, 조직학적으로 연쇄상구균 감염 후 사구체 신염으로 진단 받은 16세 이상의 환자를 대상으로 하였고 대상군은 25명이었다. 발병 연령에 따라 30세 미만을 청년층으로, 30세 이상을 중년층으로 구분하였고, 조직 검사상 사구체 간질, 내피세포의 증식과 호중구 침착 소견을 보이는 경우를 조기 경증 소견으로, 반월형, 경화성 변화를 보이는 경우를 후기 중증 소견으로 분류하였다. 연령층에 따라 임상적, 조직학적 특성을 비교하였고 T - test를 통해 통계적 유의성을 검토하였다. 결 과 : 중년층에서 신기능 장애, 즉 사구체 여과율 감소의 빈도가 증가하였고, 연령이 증가할 수록 조직 소견상 후기 중증 소견이 통계적으로 유의한 증가를 보였다. 그러나 BUN, serum creatinine, serum albumin, 24 hurine total protein, C3, ASO, IgG, IgA, IgM 등에서는 연령에 따른 유의한 차이를 관찰할 수 없었다. 결 론 : 발병 연령이 증가할 수록 연쇄상구균 감염 후 사구체 신염으로 인한 신기능의 저하가 현저함에 따라, 고령층의 신증후군, 신염 등에서 신기능의 저하를 보이는 경우 연쇄상구균 감염에 대한 조기 진단 및 치료가 향후 신기능의 보존 및 개선에 도움이 될 것으로 생각된다. N/A
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이우철(Woo Chul Lee),이수봉(Soo Bong Lee),김영민(Young Min Kim),홍진희(Jin Hee Hong),성은영(Eun Young Seong),박성민(Sung Min Park),곽임수(Im Soo Kwak),나하연(Ha Youn Rha) 대한내과학회 1998 대한내과학회지 Vol.55 No.3
N/A Objectives: Antiphospholipid syndrome(APS) is characterized by arterial or venous thrombosis, recurrent fetal loss, many neurological deficits, and presence of anticardiolipin antibody(ACA) or lupus anticoagulant(LA). This study was done to know the clinical and serological characteristics of antiphospholipid syndrome. Methods: Clinical and laboratory features of 18 patients with APS who had antiphopholipid antibodies and histories of obstetric events and thrombosis were studied. Results: Of the 18 patients, 4 were male, and 14 were female, and the ages ranged from 19 to 64 years. 11 patients were primary APS. 17 patients had ACAs: ll had IgG ACA; 2 had IgM ACA; 3 had both IgG and IgM; 1 had both IgG and IgA; 1 patient had LA. Antinuclear antibodies were positive(>1:40) in 15 patients, and antis-DNA(>l:10) were present in S patients. Hemolytic anemia was noted in 4 patients with positive in only direct Coomb`s test, and all were secondary APS. Thrombocytopenia(<150,000/mm3) was observed in 14 patients, 9 patients raged between 100,000/mm³ and 150,000/mm³. Initial presentation were vein thrombosis in 7 patients, pulmonary embolism in 3, arterial occlusion in 3, leg ulcer in 1, spontaneous abortion in 2, preeclampsia in 1, preterm labor in 1. Combined diseases were SLE, Sjogren syndrome, idiopathic thrombocytopenic purpura, hypertension. In 7 patients associated with cardiac abnormalities, 3 were mitral regurgitation, 4 were pericardial effusion, l was dilated cardiomyopathy. Venous thrombosis were present in 11 patients, 6 had deep vein thrombosis only, 3 had both deep vein thrombosis and pulmonary embolism Arterial occlusion were present in 4 patients, 3 had small multiple cerebral infarction, 1 had right common femoral ar4mal occlusion. Obstetric complications were present 5 patients of 14 female patients1` 3 had spontaneous abortion, preeclampsia was present in 1 and present labor was present in 1. Conclusions: The clinical and serological features of APS in this study were similar to those of previous reports (Oeffinger et al,1994: Edelman et al., 1995). Treatment with prednisolone, anticoagulants and antiplatelet agents was used. Of the 10 follow-up patients, none had recurrence of thrombotic events.
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혈액투석 환자에서 중심 정맥 도관의 세균 집락과 균혈증에 관한 연구
김용범(Yong beom Kim),이동원(Dong Won Lee),안승재(Seoung Jae An),정유석(Yoo Suck Jung),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Youn Rha) 대한내과학회 2001 대한내과학회지 Vol.61 No.2
N/A Background : Central venous hemodialysis is often used and is respectively safe in hemodialysis patients. But, many complications have been reported. Peripheral bacteremia after insertion of central venous hemodialysis catheter is a major cause of morbidity. We undertook a prospective study to investigate the colonization of central venous hemodialysis catheter and subsequent related episodes of peripheral bacteremia. Methods : Twenty-nine patients were enrolled ; who had been in hemodialysis program from July, 1999 to June, 2000 in Pusan National University Hospital. Blood cultures were taken from the catheter weekly after insertion. When the result of blood cultures through the central venous catheter became positive, indicating the colonization in the central venous catheter, peripheral venous blood cultures were taken before starting dialysis to detect the peripheral bacteremia. The data were analyzed by Mann-Whitney test. Results : The mean age of patients was 53 years old and a prospective study of 29 central venous hemodialysis catheter was performed. Seven catheters (24%) became colonized on their instrumental surface. The mean time to colonization was 21 days after insertion. The colonizing organisms were Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus. Four catheters (13%) developed peripheral bacteremia with the same organism of colonization in the central venous catheter. The mean time to bacteremia was 19 days after insertion. The organisms of peripheral bacteremia were Staphylococcus epidermidis (n=2), Staphylococcus aureus (1), Enterococcus (1). Bacteremia only occurred when blood drawn through the catheter cultured more than 1000 colony forming units per mL. The risk of subsequent bacteremia is not related to time left in. Conclusion : Bacterial colonization in the central venous catheter often led to bacteremia in hemodialysis patients. The risk of subsequent bacteremia is not related to time left in situ but to degree of colonization. In future, prospective study is needed in more patients.(Korean J Med 61:121-126, 2001)
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말기 신질환 환자에서 심기능 지표들의 혈액 투석에 따른 변화
이동원(Dong Won Lee),김용범(Yong Beom Kim),안승재(Seoung Jae An),정유석(Yoo Suck Jung),곽임수(Ihm Soo Kwak),신영우(Yung Woo Shin),나하연(Ha Youn Rha) 대한내과학회 2001 대한내과학회지 Vol.60 No.6
N/A Background : It is absolutely necessary to evaluate cardiac function at starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. Methods : Twenty patients with end stage renal disease were enrolled , who had been in hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital. They were examined with echocardiography and gated blood pool scintigraphy at starting hemodialysis and after follow-up. The data were analyzed by paired T-test. Results : The patients were 46.2±16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus(n=10), hypertension(7), glomerulonephritis (2) and others(1). The duration of symptoms associated with end stage renal dis- ease and underlying diseases was 3.4±2.6 years, and the duration of hemodialysis was 13.8±7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p<0.05) with no significant changes for LAD, IVS, PWT and EF (p>0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p<0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p<0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p<0.05). And in four cases associated with cardiac diseases without diabetes, there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p<0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p<0.05) as a whole, while increased (5.90%, p<0.05) in the cases associated with diabetes and cardiac diseases. Conclusion : During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore we can expect that adequate hemodialysis -with dry-weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cadiomyopathy. (Korean J Med 60:567-573, 2001)
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균혈증 및 패혈증의 임상 양상 및 예후 인자에 대한 고찰
이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),이동원(Dong Won Lee),김용범(Yong Bum Kim),정주섭(Joo Seop Chung),곽임수(Ihm Soo Kwak),조군제(Goon Jae Cho),나하연(Ha Youn Rha),장철훈(Chul Hun Ch 대한내과학회 1999 대한내과학회지 Vol.56 No.3
N/A Objectives : In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. Methods : We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. Results : 1) Male to female ratio was 1.22 : 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. Conclusion : Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.
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