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김인수(In Soo Kim),문석준(Seok Jun Moon),박현진(Hyun Jin Park),김동조(Dong Jo Kim),손행종(Haeng Jong Sohn),이무용(Moo Yong Rhee),박건욱(Keon Uk Park),최락경(Rak Kyeong Choi),유병희(Byung Hee Yu),문성수(Seong Soo Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: The construction and maintenance of vascular access are essential in patients with end stage renal disease(ESRD) on chronic hemodialysis. So, the complications of vascular access are significant causes of morbidity and inadequacy of hemodialysis. The current study was undertaken to provide an estimate of the magnitude of the problem of access-related morbidity and to explore the relationship of sex, age, and underlying cause of renal failure as risk factors for vascular complications. Methods: We observed vascular access-related hospitalization, access complications, and sex, age, and underlying cause of renal failure as risk factors on 167 ESRD patients who have received maintenance hemodialysis between January 1983 and June 1993 at the National Medical Center. A univariate survival analysis of time to vascular access-related hospitalization was carried out for each of the risk factors under study, that is, sex, age, and underlying cause of renal failure. Kaplan-Meier survival curves were generated for categorized levels of each variable and compared using the log rank test. Results: 1) The vascular access-related hospitalization occupied 16.5% of all hospital stays and the mean length of hospital stays was 12.4 days. 2) The thrombosis occurred in 82.8% of all access complications. The formation of new vascular access was performed in 69.0% of vascular access-related morbidity. 3) The cumulative 1 year, 2 year, 3 year, 5 year, and 10 year survival rates of vascular access were 89.2%, 83.8%, 75.5%, 67.2%, and 53.2%, respectively, The cumulative survival rate of vascular access in women was lower significantly than in men. It was also lower significantly in diabetics than in other diseases including glomerulonephritis. But, age was not statistically correlated with vascular access survival. Conclusion: The complications of vascular access cause increase in hospitalization among ESRD patients, and women and diabetics apperar to be at particularly high risk. Additional studies on the risk factors for vascular access morbidity are needed to manage vascular access more carefully in ESRD patients on chronic hemodialysis.
간 , 담도 및 췌장 : 간 지방변성에 있어서 말단 간 세정맥 ( Terminal Hepatic Venule ) 주변 섬유화의 정도와 그 의의에 관한 연구
박찬일(Chan Il Park),문성수(Seong Soo Moon) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2
N/A Fatty change of the liver is a histological finding caused by various diseases such as chronic alcoholism, obesity, diabetes mellitus, malnutrition and certain hepatotoxic drugs, and is sometimes accompanied by fibrosis around the terminal hepatic venules (FTHV), which is commonly observed in alcoholic liver disease, especially in alcoholic hepatitis. Investigations on FTHV have been concerned with the prognostic value, but its diagnostic value in pathology have been relatively overlooked. Although FTHV is observed not infrequently in chronic alcoholics, if not severe in degree, the typical features of alcoholic hepatitis seem to be relatively rare in Korean people. The present study was undertaken to evaluate the degree and significance of FTHV in fatty liver due to various etiologies, and also the diagnostic value for prediction of alcoholic etiology was assessed. Ninty cases of needle-biopsied liver specimens which showed more or less fatty change of the liver were collected, and their clinical and patholgical findings were analyzed. The following results were obtained. 1) Among 90 cases 34(37.8%) were alcoholic liver diseases and 56(62.2%) were non-alcoholic fatty livers. Alcoholic liver diseases included 20 cases of alcoholic fatty liver, 5 cases of alcoholic hepatitis and 9 cases of alcoholic cirrhosis. Nonalcoholic fatty liver included 16 cases of obesity, 10 cases of diabetes mellitus, 1 cases of malnutrition, 9 cases of chronic viral hepatitis and 20 cases of fatty liver of uncertain etiology. 2) The serum gamma-glutamyl transpeptidase (GGT) level was increased in 88.2%, SGOT in 59.1 %, SGPT in 84.1%. The increased SGOT level was more frequently observed in alcoholic liver disease than in non-alcoholic fatty liver. The serum (GT level was more elevated in alcohlic fatty liver than in non-alcoholic fatty liver. 3) The hepatic steatosis was mild in 41 cases (45.6%), moderate in 27 cases (30.0%) and severe in 22 cases (24.4%). 4) FTHV of the liver was grade 0 in 17 cases (18.9%), grade 1 in 35 cases (38.9%), grade 2 in 21 cases (23.3%) and garde 3 in 17 cases (18.9%). The percentage of grade 3 FTHV was significantly higher in alcoholic hepatitis than in chronic viral hepatitis with steatosis. 5j The grade of F1 HV was not significantly correlated with the degree of steatosis. And there was no significant difference in the liver function tests and serum lipid levels according to the grade of FTHV. In summary, there was no correlation between the grade of FTHV and laboratory data or the degree of steatosis. There was no significant difference of the grade of FTHV between alcholic liver disease and non-alcoholic fatty liver patients with simple steatosis, but the prevalence of severe FTHV ivas significantly higher in alcoholic hepatitis.
장규만(Kyu Man Jang),하기수(Ki Soo Ha),문현창(Hyun Chang Moon),이문철(Moon Chul Lee),유병희(Byung Hee Yu),이홍순(Hong Soon Lee),문성수(Seong Soo Moon) 대한내과학회 1988 대한내과학회지 Vol.35 No.6
N/A Plasma atrial natriuretic peptide (ANP) has been known to be a kind of peptide hormone and to have actions of natriuresis, diuresis and vasodilatation. It has been suggested that plasma ANP may be secreted from the cardiac atrium in response to extracellular fluid volume expansion to maintain blood volume homeostasis, and its level may be raised in volume overloaded conditions, such as congestive heart failure, chronic renal failure and the syndrome of inappropriate antidiuretic hormone secretion. We investigated the effect of fluid removal by sequential ultrafiltration and hemodialysis on circulating plasma ANP in 14 volume overloaded patients with chronic renal failure. The results were as follows: 1) The mean dry weight of patients was 58.3±0.4 kg and the predialytic weight gain was 3.4±0.9 kg. The amount of fluid removal by sequential ultrafilt-ration was 1176±31.7 ml (about 2% of predialytic body weight) and postdialytic weight loss was 3.1±0.3 kg. Systolic and diastolic blood pressures were not significantly changed during sequential ultrafiltration and hemodialysis, Plasma osmolality, BUN and K+ levels were not significantly changed after ultrafiltration but were significantly decreased after hemodialysis. 2) Plasma ANP levels were raised in all patients (mean±SE 205.3±30.7pg/ml, n=l4) compared with healthy contro1s (40.9±4.4 pg/ml, n=16), but showed considerable interpatient variability. 3) Plasma ANP levels fell with fluid removal during ultrafiltration (123.4±4.2 pg/ml, p<0.025) and again as fluid was removed during hemodialysis (88.7±3.1 pg/ml, p<0.05). 4) There was no significant correlation between predialytic weight gain and plasma ANP levels, and between postdialytic weight loss and plasma ANP levels. In conclusion, this study showed that the plasma ANP level was raised as body fluid volume increased in patients with chronic renal failure and fell with fluid removal after dialysis. These findings suggest that changes in body fluid volume play an important role in the regulation of ANP secretion.
조성락(Sung Rag Cho),나산균(San Gyun Rha),문성수(Seong Soo Moon),한규호(Kyu Ho Han),박인철(In Cheol Park),김순관(Soon Kwan Kim),양만석(Man Seok Yang),허갑도(Gap Do Hur),최태룡(Tae Lyong Choi) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
Unilobular atrophy or hypoplasia involving the hepatic lobes is not uncommon on the left side. It is distinctly uncommon on the right, where it probably represents an developmental anomaly if no other etiological factor is demonstrable. So we report a case of hypoplasia of right hepatic lobe.
한국인 집단에서 상염색체 우성 다낭신과 연관된 microsatellite 다형 현상에 관한 연구
문성수,심성한,조상희,김정숙,조율희 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.1
Autosoal dominant polycystic polycystic kidney disease (ADPKD) is one of the most common autosomal dominant diseases and account for 10% of end stage renal disease in Caucasians. To establish the strategy for prenatal and presymptomatic diagnosis of ADPKD three microsatellite markers flanking the PKDI (polycystic kidney disase 1) locus were analyzed in 144 healthy Koreans with themethods of polymerase chain reaction, polyacryalmide gel electrophoresis and silver staining. All the microsatellite markers employed wre (CA)n repeat ploymorphisms. KG8 marker system showed 5 alleles, 120 bp, 122pb, 124bp, 126bp and 130bp with the frequencies of 0.0035, 0.7778, 0.2083, 0.0035 and 0.0069 respectively. In 16AC2.5 marker system 9 alleles (111 bp, 113bp, 115bp, 117bp. 117bp, 119bp, 121bp, 123bp, 127bp and 129bp) were found with the frequencies of 0.5, 0.0347, 0.0382, 0.0451, 0.1944, 0.1736, 0.0035, 0.0069 and 0.0035 rewpectively. And CW2 marker system showed 15 alleles, 109 bp with the frewuencies of 0.0035, 0.0035, 0.0104, 0.0417, 0.1076, 0.1354, 0.3333, 0.1319, 0.0938, 0.0660, 0.0486, 0.0139, 0.0035, 0.0035 and 0.0035 respectively. Heterozygosity and PIC (polymorphic information content) was 0.3516 and 0.2990 in KG8 system, 0.6773 and 0.6380 in 16AC2.5 system and 0.8240 and 0.8204 in CW2 system. The overall heterozygosity ofthe three microsatellite marker systems were 0.9632. With the three flanking markers ADPKD might be diagnosed prenatally or presymptomatically with the probability of 96.32%
이상인,문성수,허갑도,나산균,조성락,김순관,최태룡,변상준,최세식 대한내과학회 1992 대한내과학회지 Vol.43 No.1
Choledochal cyst is a rare congenital malformation of the pancreaticobiliary system. Cystic dilatation of the biliary tree has been reported in many forms. The etiology is multifaceted and evidence of the existence of both acquired and congenital cyst is presented. The anomalous pancreaticobiliary ductal union (APBD) has received attention because of its importance in pathogenesis of the pancreaticobiliary disease. APBD is associated with congenital cystic dilatation of common bile duct and carcinoma of gall bladder. We report two cases of choledochal cyst combined with anomalous pancreaticobiliary ductal union.
급성 신부전이 병발된 Acute Multifocal Bacterial Nephritis 2 예
김인수,김지윤,박현진,문성수,유병희,윤종현,이태광 대한내과학회 1994 대한내과학회지 Vol.46 No.1
Renal bacterial infection spans a continuum of severity from uncomplicated acute pyelonephritis (APN) through progressively worsening stages of interstitial inflammation to frank abscess formation. Acute multifocal bacterial nephritis (AMBN) is a severe form of acute renal infection in which a heavy leukocytic infiltrate occurs throughout the kidney. Clinically, the patients have evidence of a severe urinary tract infection secondary to a gram-negative organism, usually E. coli or Klebsiella. About half of the reported patients have been diabetic, and there are frequently signs of sepsis. AMBN could be diagnosed by clinical manifestations and radiologic grounds including abdominal computed tomography which shows multiple wedge shaped, poorly defined areas of decreased contrast enhancement in multiple renal lobes. In contrast to uncomplicated APN, the presence of AMBN seemed to correlate well with protracted clinical course and the need for prolonged antibiotic treatment. We report two cases of acute bacterial nephritis with the reviews of literatures which showed multifocal involvement of both kidneys and complicated with acute renal insufficiency.