만성 신부전 환자에서 호모시스테인 대사와 고호모시스테인 혈증의 임상적 의의

윤견일(Kyun Il Yoon) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

N/A

혈액 투석 환자에서 Recombinant Human Erythropoietin ( rHuEpo ) 치료가 혈중 Lipoprotein ( a ) [ Lp ( a ) ] 를 포함한 지질 농도에 미치는 영향

강덕희(Duk Hee Kang),윤견일(Kyun Il Yoon) 대한내과학회 1996 대한내과학회지 Vol.51 No.5

N/A Objectives: The efficacy of rHuEpo in the correction of renal anemia has been well established resulting in theoretical benefits on cardiac function with the regression of left ventricular dilatation. However, hypertension and thrombogenic complications can be developed with rHuEpo therapy, which impose the deleterious effects on cardiovascular system. Moreover there has been no study into the effects of rHuEpo on uremic dyslipidemia which may also contribute to an increased cardiovascular mortality in dialysis patients. Methods: The present prospective study was undertaken to evaluate the effects of rHuEpo on lipid profiles including Lp (a) in 22 (M:F 12:10) maintenance HD patients. rHuEpo was started at a dose of 2000 unit, given subcutaneously two or three times a week, at the end of each dialysis session. Lp (a) and other lipid profiles including total cholesterol (TC), triglyceride (Tg), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C) were measured before treatment, and at two week intervals during the first eight weeks of rHuEpo. Results: Hct started to increase significantly 4 weeks after rHuEpo therapy. The concentrations of TC, Tg and LDL-cholesterol did not significantly change during rHuEpo. The median value of Lp (a) before rHuEpo therapy was 20.4㎎/dl with a distribution from 1.4 to 113.6㎎/dl. Five out of 22 patients (22.7%) had Lp (a) concentrations above 30㎎/dl, which value has been shown to be a high risk for atherosclerosis. The Lp (a) concentration also showed no statistically significant changes in spite of a tendency to decrease with rHuEpo. However, it was interesting that Lp (a) levels in all of the five patients whose Lp (a) was above 30㎎/dl decreased significantly 8 weeks after rHuEpo therapy (58.8±4.5 vs. 32.5±7.9㎎/dl, p<0.05). Conclusions: rHuEpo may decrease the serum Lp (a) level, especially in the high Lp (a) subjects. Although the exact mechanism of this favorable effect on Lp (a) during rHuEpo administration is uncertain, it may contribute to a decrease in cardiovascular morbidity, independent of the effects of anemia correction itself.

승모판막질환에서의 M - mode 심초음파검사소견에 관한 연구

이우형 ( Woo Hyung Lee ),윤견일 ( Kyun Il Yoon ),신길자 ( Gil Ja Shin ),이순남 ( Soon Nam Lee ),길선연 ( Sun Youn Kil ) 대한내과학회 1983 대한내과학회지 Vol.26 No.3

만성신부전증 환자의 혈중 세로토닌농도에 관한 연구

천은미(Eun Mee Cheon),윤견일(Kyun Il Yoon),강덕희(Duk Hee Kang) 대한내과학회 1995 대한내과학회지 Vol.49 No.3

N/A Objectives: Serotonin (5-hydroxytryptamine) is a vasoactive agent that influence coronary arterial tone during platelet aggregation and deposition, and high levels of serotonin contribute to hypertension in some patients. In addition, serotonin has recently been implicated in the pathogenesis of ischemic heart disease. The serotonin status of patients in chronic renal failure is not clear. Although there were several re- ports about the concentration and role of serotonin in chronic renal failure patients, no concordent data were available only with the results of possible relationship with hypertension and pruritus in these patients. Methods: We studied 55 patients with chronic renal failure (CRF with conservative treatment(n=10), hemodialysis (n=35), continous ambulatory peritoneal dialysis (n=10)), compared to normal healthy groups (n=20) in order to investigate the level of whole blood and serum serotonin according to the different modality of renal replacement therapy and also to know the possible association with the presence of ischemic heart disease and pruritus. Results: 1) The levels of serotonin decreased significantly in hemodialysis patients (serum ; 58±22 ng/ml, whole blood; 5.6±3.6 μg/dl) compared to normal control group (serum ; 151±45ng/ml, whole blood ; 6.8±2.9μpg/dl, p<0.01) and CAPD patients (serum ; 134±26ng/ml, p<0.01). 2) The whole blood serotonin levels in hemodialysis patients showed significant correlation with the peripheral blood platelets count (r=0.3295, p<0.05). 3) In hemodialysis patients, serum serotonin concentration increased significantly with the time of dialysis (p<0.01), although whole blood serotonin concentration showed constant level during dialysis. 4) Whole blood serotonin levels of hemodialysis patients with ischemic heart disease increased significantly compared to the patients without ischemic heart disease (7.1±3.4μg/dl vs. 4.9±2.3μg/dl, p<0.005). 5) There was no statistically significant difference in serotonin concentration in relation to the presence of pruritus. Conclusion. This study suggests that the level of serotonin decreased significantly in hemodialysis patients and serum serotonin concentration increased significantly with the time of hemodialysis.

Heparin 백서 사구체 메산지움 배양세포의 중식에 미치는 영향

강덕희(Duk Hee Kang),윤견일(Kyun Il yoon),강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: Glomerular mesangial cells are the main component of human glomerulus, and exist as a quiescent state in normal healthy kidney. It is now apparent that mesangial cells do not act as a mere framework within the glomerular tuft, but that these cells can undergo striking phenotypic transformation after an exposure to a variety of such as platelet derived growth factor(PDGF) and epidermal growth factor(EGF). Proliferation of mesangial cells is a prominant histologic feature of various glomerular diseases in human as well as in experimental animal. Because glomerular mesangial cells have direct relation with glomerular function through their contractility and proliferation, the inhibitory effects on cell proliferation can result in preventing or delaying the progression of renal disease into end stage renal failure. Heparin is a highly sulfated glycosaminoglycan with anticoagulant activity. It has also been shown that heparin exhibits antiproliferative effects in cultured vascular smooth muscle cells and can ameliorate glomerular injury in some animal model. Methods: The present study was undertaken to characterize the inhibitory effects of heparin on PDGF- and EGF-induced proliferation of mesangial cells isolated from male Sprague-Dawley rat in vitro. Also to examine whether this antiproliferative effects of heparin is related with anticoagulant activity, the effect on the PDGF-induced mesangial cell proliferation was assessed using N-desulfated and N-desulfated N-acetylated heparin which showes no anticoagulant effects. Results: 1) PDGF stimulated the DNA synthesis of glomerular mesangial cell assessed by 3H-thymidine uptake in a dose-dependent manner. At a concentration of 10ng/ml, 3H-thymidine uptake was significantly increased compared to the control value (512,0±38.6 vs. 3300.0±432,5cpm, p<0.05) 2) EGF also induced a significant increase of DNA synthesis of cultured mesangial cell, and at the concentrations of 5ng,ml or higher, the increases in DNA synthesis assessed by 3H-thymidine uptake were statistically significant compared to the control value(428.0±50.4 vs. 1618.0±219.7cpm, p<0.05). 3) Intact heparin caused a dose-dependent inhibition of PDGF-induced DNA synthesis of mesangial cells. At a concentration of 1 ㎍/ml of heparin, 36.7% of inhibition in DNA synthesis of mesangial cell was found. At a concentration of 25, 100 and 500㎍ /ml of heparin, PDGF-induced 3H-thymidine uptake of mesangial cell was reduced by 44.4%, 56.2% and 69.8%, respectively. Chondroitin sulfate and N-desulfated N-acetylated heparin also caused a significant inhibition of PDGF-induced DNA synthesis at the concentraion of 25㎍/ml or higher. However, N-desulfated heparin showed no significant inhibitory effects on PDGF-induced proliferation of mesangial cell at all concentrations. 4) Intact heparin, N-desulfated N-acetylated he- parin and chondroitin sulfate caused a significant inhibition of EGF-induced DNA synthesis only at the highest concentration of 500o㎍/ml. 5) Cell count assessment by hemocytometer revealed the similar results with 3H-thymidine uptake. Conclusion : Heparin had an inhibitory effect on the PDGF-induced DNA synthesis and proliferation of mesangial cell. These antiproliferative effects appear to be unrelated to the anticoagulant effects of heparin, and mediated by selective inhibition of protein kinase C-dependent pathway of mesangial cell proliferation. Further studies utilizing in-vivo glomerulonephritis model are warranted to clarify the potential benefit of heparin in the treatment of glomerulonephritis and to document expected effects of heparin in delaying the progression of glomerulonephritis into end stage renal failure.

지속적 혈액투석환자에서 Desferrioxamine 투여 후의 혈장 Endothelin 농도 변화

최규복(Gyu Bog Choi),윤견일(Kyun Ill Yoon) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: It has been reported that the risk of oxygen radical injury is increased in chronic renal failure due to the decreased endogenous serum antioxidants. Especially, the C5a induced by membrane bioincompatibility can stimulates neutrophils to release of oxygen free radicals, resulting in endothelial cell injury. However, Desferrioxamine(DFO) act as an iron chelator, which blocks iron-catalyzed Haber-Weiss reaction and inhibits release of oxygen free radicals from activated neutrophils. It is also reported that endothelin(ET) can be released from endothelial cells in response to vascular damage such as atherosclerosis. Therefore, we administered DFO, into maintenance hemodialyein patients. Then we examined the possibility of oxygen radical injury during interdialytic period and its relation with the plasma ET concentration. Methods: During the last 1-2 hours of hemodialysis, DFO(40mg/kg in 5% D/W 200cc) was infused intravenously into 13 patients(DFO group), and placebo(5% D/W 200cc only) was infused with same manner into 9 patients(Placebo group). We sampled blood for measurement of plasma ET concentration just before the initiation of hemodialysis on the day of infusion, on the 2nd-3rd day and on the 7th day after infusion. Also, we examined 26 non-diabetic patients with normal renal function as a norma1 control. Results: The mean plasma ET concentration in total hemodialysis patients is higher (5.08±3.09pg/ ml) than in normal control (2.58±1.08pg/ml, p<0.01). There was no statistical difference between two hemodialysis groups in plasma ET concentration measured before infusion (5.56±3.50pg/ml in DFO group, 4.38±2.40 pg/ml in placeb group). In DFO group, plasma ET concentration decreased significantly on the 2nd-3rd day (3,49±2.08pg/ml, p<0.01), but increased significantly on the 7th day (5.62± 2.95pg/ml, p<0.05), In contrast, there were no significant changes in plasma ET concentration in placebo group. There was no significant difference in the decrement of plasma ET between the cases of transferrin saturation below and above 60% and there was no relation between the plasma ET decrement and transferrin saturation or serum ferritin in DFO group. Conclusion: The decrease of plasma ET concentration after DFO infusion might be the result of diminished endothelial cell injury from oxygen free radicals. Therefore, we believe that the oxygen radical injury can occur during not only the hemodialysis but also the interdialytic period. Also these results suggest that the oxidant damage of endothelial cell may be one of the causes of elevated ET concentration in chronic renal failure, However, we could not confirm in this study whether the obtained results were caused by the chronic effects of membrane bioincompatibility or by the decreased endogenous serum antioxidants.

증례 : 위기저부 중복환자에서 빈혈 및 장이상회전증을 동반한 1 예

이우형 ( Woo Hyung Lee ),윤견일 ( Kyun Il Yoon ),신길자 ( Gil Ja Shin ),이순남 ( Soon Nam Lee ),이영규 ( Young Kyu Lee ) 대한내과학회 1983 대한내과학회지 Vol.26 No.3

고혈압 환자의 혈장 Endothelin 농도

최규복(Gyu Bog Choi),김성남(Seong Nam Kim),윤견일(Kyun Ill Yoon) 대한내과학회 1995 대한내과학회지 Vol.48 No.3

N/A Objectives: Following the discovery in 1988 of Endothelin by Yanagisawa, three types of Endothelin called Endothelin-l, Endothelin-2 and Endothelin-3 were identified. Among them, Endothelin-1 is secret- ed from vascular endothelial cells. Endothelin-1 has been shown to be a potent vasoconstrictor in isolated human vessels as well as having positive inotropic effects on human atria by a direct action on the heart muscle. Infusion of Endothelin-1 into human volunteers has also shown it to be a constrictor of resistance vessels in vivo. So it is possible that Endothelin-1 plays a role in maintenance of blood pressure, But there is debate on the plasma concentration of Endothelin-1 in hypertensive patients. Therefore, the present study was designed to deter- mine plama Endothelin concentration in hypertensive patients and control subjects. Methods: We measured and analyzed the endothelin concentration in plasma and 24- hours urine by radioimmunoassay in 15 patients with essential hypertension, 5 patients with secondary hypertension, 5 patients with chronic renal failure and 8 control groups. Results: 1) Comparison between Uncontrolled hypertensive patients and Control subjects: The mean level of plasma Endothelin in patients with essential hypertension(22.7±24.27pg/ml) was significantly higher than that in control subjects(4.0±2.9pg/ml; p<0.05). But there was no significant. difference in urine endothelin concentration and endothelin clearance among each groups. 2) Comparison between Controlled hypertensive patients and Control subjects: The mean level of plasma Endothelin in patients with essential hypertension(8.8±9.88pg/ml) seemed to be higher than that in control subjects(4.0±2.69pg/ml), but there was no statistical significance. The mean level of urine Endothelin in patients with secandary hypertension(57.1 + 13,17pg/ml) wns significantly higher than that in control subjects(16.1±9.64pg/ ml; p<0.05) and in patients with essential hypertension(14.2±3.46pg/ml; p<0.05). But there was no significant in endothelin clearance among each groups. Conclusion: In conclusion, it is hardly to say that endothelin has a primary pathophyaiological role in hypertension. Whereas plasma endothelin concen-tration might to be elevated secondarily as a result of endothelial damage from uncontrolled hypertension. But further study will be need about it.

직시하위생검 (直視下胃生檢)

조상호(Sang Ho Cho),최흥재(Heung Jai Choi),문영명(Young Myoung Moon),윤견일(Kyun Il Yoon),윤영남(Young Nam Yoon),박인서(In Suh Park),이유복(Yoo Bock Lee) 대한소화기학회 1972 대한소화기학회지 Vol.4 No.2

N/A The introdaction of fibergastroscope in recent years has f:acilitated the observation on conditions inside the stomach, and diagnostic value of this device in early detection of stomach cancer has advanced markedly. In some cases, however,it is often difficult to give judgement of benignancy or malignancy observed by a fibergastroscope. The most effective diagnostic methcd is to earry out biopsy of the stomach in conjunction vrith fibergastroscope by which the tissue can be sampled directly from the lesion under fiberscopic observation. We performed direct vision biopsy during the period fro'm June, 1970 to September 1971 in 203 cases, who had been suspected to have stomach cancer, benign gastric ulcer or gastritis in X-ray study, with fibergastroscope (Machida FGS-B and Olympus GFB). The results are as following: 1. The X-ray diagnoses before endoscopic examination of 203 cases were gastric cancer in 96 cases, benign gastric ulcer in 42 cases, chronic gastritis in 49 cases, normal in 15 cases, and other in 1 case. 2. The diagnoses by endoscopic examination with direct vision biopsy were gastric cancer in 45 cases, benign gastric ulcer in 28 cases, atypical hyperplasia in 2 cases, pofyp in 2 cases, bezoar in 2 cases, gastritis in 151 cases and normal in 11 cases. 3. Only 43 cases (44. 7%) among 96 of the suspected gastric cancer on X-ray examination were confirmed by the endoscopy and the direct vision biopsy, most of the rest seemed to be pseudo- positive on X-ray examination. The rate of pseudo-negative result for the gastric cancer of X-ray examination vras 1.9%. The compatability of benign ulcer between X-ray and endoscopic diagnosis were only 30.9% and pseudo-negative result of X-ray examination for benign ulcer was 9.3%. Although tne compatability (86. 9%) between X-ray and endoscopic diagnosis in gastritis was high, pseudo-negative result was also high (69%), suggesting unreliability of X-ray diagnosis of gastritis. It was thought to be impossible to diagnose the gastritis in X-ray study.

유지 혈액투석 환자에서 투석중 베타 엔도르핀 ( β - endorphin ) 농도의 변화

이은영(Eun Young Lee),최규복(Kyu Bok Choi),윤견일(Kyun Il Yoon) 대한내과학회 1998 대한내과학회지 Vol.55 No.1

N/A Objective : β -endorphin, most potent endogenous opioid peptide, is known to play an important role in many homeostatic systems such as the maintenance of blood pressure, regulation of body temperature and the control of pituitary hormone secretion. Previous reports of plasma levels of β -endorphin in patients with chronic renal failure have mostly shown elevated levels. Rut the effect of hemodialysis on the plasma levels of β -endorphin in patients with maintenance hemodialysis is controversial. The aim of this study was to evaluate the effect of a hemodialysis session on the plasma concentrations of β -endorphin in patients with end-stage renal disease and also to investigate changes of hemodynamic response according to the changes of plasma levels of β -endarphin. Methods: We study group comprised 36 patients who had received regular hemodialysis. Blood for analysis of β -endorphin was sampled before and immediately after hemodialysis and measured by immunoradiometric assay. Extracellular fluid / total body water (ECF/TBW) was measured before and after the hemodialysis session by multifrequency bioimpedance analyzer (InBody 2.0®, Biospace Co., Ltd., Seoul, Korea). Systolic and diastolic blood pressure were measured by Centrysystem 3 BP monitor every 30 minutes. Results: 1) As a whole, the predialysis β -endorphin did not differ significantly from postdialysis levels. Blood pressure increased significantly during dialysis. The postdialysis value of ECF/TBW was significantly decreased(0.37±0.02 vs. 0.34±0.02, p<0.01). 2) The patients were divided into 2 groups according to the pre-, and post-dialysis β -endorphin levels(Group 1, predialysis β -endorphin > postdialysis β -endor- phin(n=23); group 2, predialysis β -endorphin ≤ postdialysis β -endorphin(n=13)). 3) During dialysis, the systolic and diastolic blood pressure increased significantly in group 1(p<0.05), but not in group 2. 4) The postdialysis value of ECF/TBW was significantly decreased from baseline value to reference range (0.34±0.01) in group 1, but to above the reference range in group 2. 5) The plasma concentrations of β -endorphin did not change by administration of recombinant human erythropoietin. Conclusion : In conclusion, the elevation in plasma β -endorphin concentrations probably occur to balance the changes in vasocnnstrictive substances. An increase in vasoconstrictive substances is mainly secondary to the decrease in plasma volume during hemodialysis. The data also suggest that certain vasoactive substances might participate in the hemodynamic response to hemodialysis although their exact roles remain to be further elucidated.