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도준영,윤경우,정항재,김병덕,이은영,조규향,박준범,배성화,김영진 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4
Nocardiosis is a rare infection seen most commonly in immunocompromized patients. Most patients have pulmonary involvement, but some develop disseminated infection. A 52-year-old man, treated with immunosuppressive drugs for 3 months after kidney transplantation, developed pulmonary nocardiosis and disseminated infection involving brain, skin, and both uvea. The diagnosis was made by open lung biopsy specimens showing characteristic weak acid fastness with modified Ziel-Neelsen stainig and histologic examination. Immunosuppressive therapy was continued and combination of surgical drainage of brain abscess and chemotherapy with Minocycline were successful. With the increasing number of allograft recipients and concomitant immunosuppression, the possibility of an increase in Nocardia opportunistic infections exists.
도준영 영남대학교 의과대학 2006 Yeungnam University Journal of Medicine Vol.23 No.1
Epithelial to mesenchymal transition (EMT) is and important etiologic factor for the development of peritoneal fibrosis in CAPD patients. Mesothelial cells are main source of trans-differentiated fibroblasts under stress from the bioincompatible peritoneal dialysate. In our study there was no difference in dialysate TGF-β and VEGF between the low and high GDP groups during an initial 12months. However, after adjusting with D-CA125, the low GDPs group showed a significantly lower D-TGF-β/D-CA125 and D-VEGF/CA125 during the initial 12months. Among the adjusted peritoneal growth factors for CA124, VEGF/CA125 and TGF-b/CA125 were factors significantly associated with greater EMT in this study. Adjustment of the peritoneal growth factor for effluent CA125 (surrogate for mass of HPMCs) revealed significant association with EMT suggesting that the fibroblastoid transition from HPMCs could be affected by the amount of intraperitoneal growth factors (TGF-b, VEGF) per unit mass of HPMCs. There was significant improvement in both cell score and D-CA125 at the sixth and 12th months after switching from a high GDPs solution to a low GDPs solution. Use of icodextrin solution in patients who had average peritoneal transport showed not only better systemic effects such as decreased glucose absorption via dialysate but also preservation of the peritoneum, including less EMT and high mesothelial bulk mass. In conclusion, Therapy with low GDP solution including icodextrin may positively impact preservation of the peritoneal membrane integrity and prevention of peritoneal fibrosis with time on PD.