이차성 부갑상선 기능 항진증이 있는 지속성 외래 복막투석(CAPD) 환자에서 칼시트리올(칼시오) 경구 충격요법과 저용량 매일요법의 비교 연구

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),황재하(Jae Ha Hwan 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A The most widely used method for treatment of secondary hyperparathyroidism(SH) in CAPD patients has been the administration of calcitriol by oral route. In this study, we compared the efficacy and safety of daily low dose calcitriol therapy with those of intermittent high dose pulse therapy. The study group consisted of 38 patients undergoing CAPD with serum intact PTH level of more than 200pg/ mL. Twenty patients were randomly administered daily low dose calcitriol(0.25μg/day for 1 month followed by 0.5μg daily dose for the next 3 mon-ths) while 18 patients were given intermittent pulse therapy(0.5μg-0.5μg-0.75μg 3 times a week for 1 month, increased to 1.0μg-1.25μg-1.25μg 3 times a week for the next 3 months). Thirty five patients completed the study : 17 on daily oral calcitriol (M: F=0.7:1, mean age=47.3±10.6 years, mean duration of CAPD=48.9±41.1 months), and 18 on oral pulse calcitriol(M: F=1.6: 1, mean age=41.5±12.7 years, mean duration of CAPD=49.2±41.6 months). The baseline serum levels of calcium, phosphorus, i-PTH, alkaline phosphatase, and total CO₂were not different be- tween daily and pulse group(9.5±0.8 vs 9.3±0.9mg/ dL, 5.8±1.3 vs 5.1±1.2mg/dL, 443.1±162.5 vs 546±385.9pg/mL, 91.8±47.7 vs 108.9±66.5IU/L, 23.7±1.9 vs 25.5±2.0mEq/L, p>0.05, respectively). The i-PTH level decreased significantly in daily calcitriol group after 1 month(332.8±214.8pg/mL, p<0.01), and at final evaluation(180.4±254.8pg/mL, p<0.01). In pulse calcitriol group, i-PTH level also decreased signi-ficantly to 400,4±225.8pg/mL(p<0.05), 89.4±122.6 pg/mL(p<0.01), respectively. The rate of decline in i-PTH level from baseline were similar(daily=25.4±22.7 vs pulse=19.5±12.6%decline/month, p>0.05). The serum calcium increased similarly in both groups after treatment(daily=10.6±0.8 vs pulse=l0.1±1.0mg/ dL, p>0.05). Hypercalcemia(>11.0mg/dL) was rarely observed in all patients(daily=5, pulse=8 episodes). In conclusion, both daily and pulse calcitriol therapy were similarly effective and safe in control of SH.

단회뇨의 protein/creatinine ratio를 이용한 일일 뇨단백량 예측에 영향을 미치는 인자

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),류동렬(Dong Yul Ryu),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A It's well known that protein/creatinine ratio(P/C ratio) in random urine samples reflects 24-hour urine protein. However, the factors affecting accurate quantitation of proteinuria using random urine P/C ratio are not fully evaluated. The aim of this study is to evaluate factors affecting accurate quantitaion of proteinuria using random urine P/C ratio. 118 patients admitted in Yonsei university medical center during June 1998 and Dec. 1998 were assessed for the measurement of random urine protein/creatinine ratio from second voided urine. 118 patients(mean age 41.5year, male: female 2.36: 1) had mean creati-nine level 1.83±1.78mg/dL, 24-hour pmteinuria 6.06±7.64g/day and P/C ratio 4.80±4.48, All the patiient.s were divided into A, B, C, I, II, K, IV according to serum creatinine level and 24-hour proteinurim amount. The correlation coefficient(R value) between proteinuria and P/C ratio are shown that in all pa- tients is 0.875, group A(Cr≤1.4) 0.884, group B(1A <Cr≤4.0) 0.819, group C(4,0<Cr) 0.844, gmup I (24-hr pro'≤0.3) 0.8%, group II(0.3<24-hr pro≤1.0) 0.813, group III(1.0<24-hr pro≤3.5) 0.716, group IV (3.5<24-hr pro) 0.637. These R value were statisti-cally significant(p value<0.05).(Cr serum creatinine, mg/dL, 24-hr pro ' 24-hour urine protein amount, g/day). Greater amount of proteinuria in 24-hour urine less correlated in sensitivity, specificity and positive predictive value with random urine P/C ratio. To evaluate factors affecting accurate quantitation of proteinuria by P/C ratio, multiple regression analysis was performed. The factors affecting accurate quantitation of proteinuria using random urine P/C ratio was 24-hour urine protein amount, not serum creatinine. Especially, in the patients with 24-hour pro-teinuria less than 4.0g/day, the random urine P/C ratio predicted 24-hour urine protein amount most accurately. In conclusion, random urine P/C ratio was well correlated with 24-hour proteinuria in the non-ne-phrotic range proteinuria especially, under 4.0g/day, irrespective of serum creatinine level.

간세포암의 십이지장침윤에 의한 상부위장관 출혈 1 예

유태현,한광협,박성하,김형길,문영명,한재호,조상호 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2

Recent advances in both the diagnosis and treatment of hepatocellular carcinoma have improved the prognosis and changed the clinical significance of the recently increasing distant metastases. Distant metastases found after successful treament of the primary lesions are of great clinical significance for the treatment of hepatocellular carcinoma. The duodenum is a rare site of hematogenous metastases or direct invasion from hepatocellular carcinoma. A 23 year old man was admitted with upper gastrointestinal bleeding. He had been diagnosed with hepatocellular carcinoma and treated by a left lobectomy and chemoembolization. The patient was admittted for 12 months after the treatment of the primary tumor. Endoscopic examination revealed a mass in the duodenal bulb that protruded into the lumen. He died due to massive hematemesis. We report on a rare case of hepatocellular carcinoma with duodenal invasion in a 23-year-old male patient.

1979∼1984년 및 1991∼1996년에 있어서 자연판막 심내막염의 역학 및 임상양상 비교

박성하,유태현,염준섭,최영화,이충렬,장경희,송영구,조승연,김준명 대한감염학회 1998 감염 Vol.30 No.4

목 적 : 최근 선진국에서는 류마티스성 심장질환의 감소, 감염성 심내막염의 소인이 되는 심장질환을 앓는 인구들의 평균 생존기간의 증가, 그리고 전 인구의 평균 연령의 증가에 따른 퇴행성 심장 질환의 발생증가 등으로 인해 자연판막 심내막염의 역학 및 임상 양상에 변화가 오고 있다. 이에 저자들은 우리나라에서의 자연판막 심내막염의 역할 및 임상양상의 시기적 변화를 규명하고 하였다. 방 법 : 1980년대 (1979∼1984) 및 1990년대 (1991∼1996)에 연세대학교 의과대학 세브란스병원에서 자연판막 심내막염으로 진단된 환자들을 대상으로 1979∼1984년에 진단된 46명을 Ⅰ군, 1991∼1996년에 진단된 40명을 Ⅱ군으로 하였으며, 의무기록을 중심으로 후향적 연구를 시행하였다. 결 과 : 1) 남녀비는 Ⅰ군과 Ⅱ군이 각각 28.18 (1.56:1), 25:15 (1.67:1)로 남자가 여자보다 많았고 평균 연령은 Ⅱ군이 Ⅰ군보다 많았으며, 특히 50세 이상의 고연령층에서 Ⅱ군이 Ⅰ군에 비해 높았고 50대 연령층에서 Ⅱ군이 Ⅰ군에 비해 많았다. 2) 선행되는 심장질환은 Ⅰ군에서는 대동맥 판막 역류층이 가장 많았고 Ⅱ군은 승모판막 역류증이 가장 많았으며 각 질환별로 빈도수는 의의있는 차이가 없었다. 3) 혈액배양 검사 결과 Ⅰ군은 69.6%, Ⅱ군은 62.5%에서 세균이 동정되었고 두 군에서 모두 α-용혈성 연쇄상 구균이 가장 많이 동정되었다. 4) 각 판막별로 우종 (vegetation)의 발생에 있어서 두군을 비교해 본 결과 Ⅱ군이 Ⅰ군에 비해 2개 이상의 판막을 침범한 경우가 의의있게 많았다. (P=0.022). 5) 합병증은 두 군에서 모두 울혈성 심부전증이 가장 많았으며 Ⅱ군이 Ⅰ군에 비해 판륜농양의 발생이 의의있게 많았다(P=0.03). 6) 수술적 치료는 Ⅱ군에서 Ⅰ군에 비해 의의있게 더 많이 시행하였고 (P=0.003) 두군간에 의의 있는 사망률의 차이는 없었다. 결 론 : 본 연구에서 볼 수 있듯이 최근 들어서 자연판막 심내막염에 이환된 환자들의 평균연령이 증가되고 있는 추세이고 수술적 치료 기술의 발달 및 합병증 빈도의 감소로 인해수술적 치료가 많이 시행되고 있으며 50세 이상의 고연령층에서는 자연판막 심내막염의 기저질환이 류마티스성 심장질환에서 퇴행성 심장질환으로 변호고 있음을 추정할 수 있었다. 따라서 우리나라에서도 자연판막 심내막염의 역학 및 임상양상이 최근 미국이나 유럽에서 보고되는 것과 유사한 양상으로 점차 변화될 것으로 추정되며 이에 대한 지속적인 연구와 조사가 필요하리라 생각된다. Background : The changes in the epidemiology of native valve endocarditis have been known in western countries recent years due to the decrease in the incidence of rheumatic heart disease, increased longevity of patients with valvular or congenital heart diseases, and the increase in degenerative heart disease due to the increase in the average life span of the general population. In this study, we analyzed and compared the epidemiological and clinical characteristics of patients with native valvular endocarditis fro two different time periods. Methods : We compared native valve endocarditis patients diagnosed from 1979∼1984 (group Ⅰ) with those diagnosed from 1991∼1996 (group Ⅱ). We used modified Duke's criteria for the diagnosis and statistical analysis was done using SPSS window program. Results : In our study, mean age of the population was higher in group Ⅱ and significantly larger number of patients were over the age of 50 in group Ⅱ. Involvement of multiple valves with vegetations and perivalvular abscess were found more frequently in group Ⅱ. Also, significantly higher percentage of patients from group Ⅱ underwent surgical treatment. Conclusion : The results of this study suggest that the epidemiolocaland clinical characteristics of infective endocarditis in Korea may change to resemble those in western countries. Further studies regarding this subject are needed.

성인 원발성 초점성 사구체 경화증의 예후인자

송영수,최훈영,유태현,강신욱,이중민,정현주,이호영,한대석,최규헌 대한신장학회 2004 대한신장학회잡지 Vol.23 No.1