발작성 야간혈색소뇨증 : 1예의 MR, CT 소견

양익,정수영,박해정,이열,전노원,노정우,Yang, Ik,Chung, Soo-Young,Park, Hai-Jung,Lee, Yul,Chun, Rho-Won,Noh, Jung-Woo 대한영상의학회 1995 대한영상의학회지 Vol.33 No.5

발작성 야간혈색소뇨증은 매우 드문 용혈성 빈혈로 MR 소견이 보고되기전까지는 특징적인 방사선학적 소견에 대하여 별로 알려져 있지 않았다. 그러나 최근 MR과 CT의 특 징적 소견이 외국 문헌에는 보고된 바 있으나 국내 보고는 없어 MR 및 CT 소견을 보고한 다. 암적색 혈뇨와 만성 빈혈증상으로 반복 수혈후 발작성 야간혈색소뇨증으로 진단된 61세 여자 환자로 복부 MR의 T1, T2 강조영상에서 신피질은 신수질과 비교해 특징적인 저신호 강도를 보였으며 이러한 저신호강도 부위는 조영제를 사용치 않은 CT에서 신피질의 증가된 음영과 일치하였다. 다량 수혈에 의한 혈철증으로 간은 MR에서 저신호강도를 보였고 비장 은 정상이었으며 또한 조영전 CT 상 비장과 비교해 증가된 간 음영을 볼 수 있었다. Paroxysmal nocturnal hemoglobinuria(PNH) is a rare, acquired disease involving multiple hematopoietic celllines. Characteristics of PNH are intrinsic hemolytic anemia, iron deficiency anemia and venous thrombosis. Wereport a case of PNH with characterostoc MR and CT findings. The signal intensity of renal cortex was lower thanthat of medulla on both T1- and T2- weighted MR imaging. On T2 weighted MR images, the liver showed very lowsignal intensity but the signal intensity of the spleen was normal. On precontrast CT the attenuation of renalcortex was higher than that of renal medulla and the attenuation of liver was higher than that of the spleen.These findings of MR imaging and CT were the result from the deposition of hemosiderin in the cells of proximalconvoluted tubules and transfusional hemosiderosis of liver.

Phalloidin 에 의해 유발된 간미세구조의 변화

김우중(Woo Joong Kim),천진옥(Jin Ok Chun),홍은경(Eun Gyoung Hong),성현주(Hyun Joo Sung),임인기(In Kee Rim),전용철(Yong Cheol Jeon),전노원(Rho Won Chun),이명석(Myung Seok Lee),정규원(Kyu Won Chung) 대한내과학회 1995 대한내과학회지 Vol.48 No.1

N/A Objectives: It is well known that adult experimental rats parenterally poisoned with a lethal dose of phalloidin die of hemorrhagic necrosis of liver. Although the precise mechanism is unknown so far, it is believed that interaction of microfilamentous structures with phalloidin is the primary toxic event of phalloidin poisonings. The purpose of these experiments was to examine the influence of phalloidin on hepatocyte ultrastructure, and to determine the possible mechanism by which this agents interferes with normal microfilament function. Methods: Rats were divided into 3 groups: normal control, intravenously phalloidin injected group (10 min, 30 min and 60 min group respectively), intraperitoneally phalloidin administered group (1st day, 7th day and 14th day group respectively). At the time of sacrifice, blood was withdrawn for liver function tests and the liver tissues were observed under the light microscope and transmission electron microscope. Results: 1) Compared with control, the ratio of liver/body weight increased from 30 minutes and sustained in elevated level unti114 days after phalloidin administration. 2) Liver function test showed no significant change in serum bilirubin levels, but serum glucose levels decreased significantly in intravenously injectioned group than that of control. SGOT levels were elevated through experimental period and SGPT levels were higher in 60 minute and 14th day groups than that of control. 3) Light microscopic examination in the intravenously injected group showed highly vacuolized cytoplasm with erythrocytes-containing vacuoli in the hepatocytes and the foci of hemorrhagic necrosis scattered throughout the hepatic lobules. No significant changes in liver tissue were noted light microscopically in intraperitoneally administered group. 4) Transmission electron microscopic examination in the intravenously injected group revealed numerous variously sized vacuoles filled with erythrocytes and fibrins in the cytoplasm of hepatocyte. In intraperitoneally administered group, proliferation of microfilaments beneath the plasma membrane of hepatocytes, canalicular luminal dilation and loss of canalicular microvilli were most prominent findings. Conclusion: Hepatic injury induced by intravenous and intraperitoneal administration of phalloidin mainly involves cytoplasmic vacuole formation in the hepatocytes and proliferation of microfilaments especially around bile canaliculus, respectively. This effect of phalloidin may prove a useful tool for the study of drug-induced liver injury and of the role of microfilament in the process of bile secretion.

혈액투석중인 만성신부전 환자에서 혈압조절의 양상과 투석적절도가 혈압에 미치는 영향

김명빈(Myung Bin Kim),박규용(Ky Yong Park),김근호(Guen Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objective : Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. Methods : The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. Results : The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP <114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. Conclusion : Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.

만성 혈액투석환자에서 유병과 사망에 기여하는 인자

임인서(In Seo Lim),이건웅(Gun Young Lee),전상현(Sang Hyun Chun),김근호(Gheun Ho Kim),구자룡(Ja Ryong Goo),전노원(Rho Won Chun),채동완(Dong Wan Chae),김형직(Hyung Jik Kim),노정우(Jung Woo Noe) 대한내과학회 1995 대한내과학회지 Vol.49 No.5

N/A Objectives: Several factors have been raised as contributing to morbidity and mortality among patients with end-stage renal disease treated with hemodialysis. We performed this study to evaluate morbidity and the factors contributing to them in chronic hemodialysis patients. Methods. We analyzed retrospectively the demo- graphic chracteristics, regularly tested laboratory findings (CBC, blood chemistry, chest X-ray, ECG), hospitalization rate, and gross mortality among 84patients in the Hallym University Medical Center from February I, 1992 to January 31, 1994. Results: 1) Age distribution of the patients was 54±13(mean±SD) years (range, 23-79 years); 41 patients were men, 43patients were women: 30patients(35.7%) had diabetes. The duration of hemodialysis was 33±30 months (range, 3-125 months). 2) Forty four patieints(52.4%) required hospitalization during the 2-year follow-up period, and the most common causes of hospitalization were infection and cardiovascular disease. 3) A total of 1H(21.4%) of the patients died the 2-year follow-up period, and cardiovascular disease was commonest cause of death. 4) The factors such as advancing age, the duration of hemodialysis, and diabetes were neither associated with the risk hospitalization nor with that of death. The serum albumin concentration in dead patients(3.4±0.4g/d1) was lower(p<0.001) than that in survived patients(3.8±0.4g/dL). As compared with patients who had serum albumin concentration ≥3.5g/dL, patients with serum albumin concentration <3.5g/dL had increased odds ratio(8.14) for death. The serum creatinine concentration in dead patients (9.5+3.0g/dL) was lower(p<0.%! than that in survived patients(11.8±3.1g/dL). Conclusion: We concluded that regularly tested serum albumin concentration was the most important predictive factor for death in chronic hemodialysis patients.

Paraquat 중독 환자에 대한 hemoperfusion 과 continuous veno-venous hemofiltration 의 치료 효과

노희종(Hee Jong Noh),구자룡(Ja Ryong Koo),이정열(Jeong Yeol Lee),주민하(Min Ha Joo),전만조(Man Jo Jeon),김진철(Jin Cheol Kim),김근호(Gheun Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. Methods : There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4±3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1±1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4±20.9 hours; ultrafiltration volume, 33.8±3.9 L/day) after hemoperfusion. Results : There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: 〈 1 mouthful, 0% (0/5); 1 mouthful, 53% (8/15); 2 mouthful, 65% (11/17); ≥ 3 mouthful, 82% (27/33); unknown, 60% (6/10). Conclusion : Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.(Korean J Med 59:651-656, 2000)

만성신부전 환자에서 심근 troponin I와 T 및 CK-MB의 진단적 의의

윤정이(Jung E Yun),이형철(Hyung Cheol Lee),이준상(June Sang Lee),박규용(Kyu Yong Park),박대균(Dae Kyun Park),구자룡(Ja Ryong Goo),김형직(Hyung Jik Kim),김근호(Gheun Ho Kim),전노원(Rho Won Chun),채동완(Dong Wan Chae),노정우(Jung Woo N 대한내과학회 2000 대한내과학회지 Vol.58 No.2

N/A Background : Nonspecific elevations of CK-MB, cTnT have been well known in patients with chronic renal failure(CRF) on maintenance hemodialysis. It has been suggested that recently developed cTnI seldom shows nonspecific elevations in these patients. Status of CRF patients can be divided into three groups: predialysis group, hemodialysis group and peritoneal dialysis group. Until now, most researchers have studied CK-MB, cTnT and cTnI only in CRF patients receiving maintenance hemodialysis. No previous studies have ever compared the differences of the nonspecific positivity of CK-MB, cTnT and cTnI according to the different status of CRF patients. Methods : Nonspecific positive ratios of cTnI, cTnT, & CK-MB in were evaluated 20 predialysis patients, 13 CAPD patients and 20 hemodialysis patients. No one had had any evidence of myocardial ischemia during the previous 3 months before the study entry. The predialysis group was again divided into two groups according to the cut off level of serum creatinine of 3.0 mg/dl. Authors also compared the nonspecific positive ratios of cTnI, cTnT, CK-MB between diabetic CRF group and non diabetic CRF group. The sensitivity, specificity and false positive ratios of each enzymes were examined on and 6 hours after arrival in 21 CRF patients who visited the emergency room with the complaint of chest pain. Results : 1) There were no nonspecific significant elevations of cTnI in CRF patients regardless of the status of CRF. But there were significant nonspecific elevations of CK-MB, cTnT in them. It was more marked in cTnT especially with the cut-off value of 0.1 ng/ml. 2) Nonspecific positive ratios of cTnT was significantly increased in diabetic CRF patients. 3) The sensitivity and specificity of cTnI were 100% and 93.3% each, which were significantly higher than those of CK-MB(83.3%, 66.7%) & cTnT(66.7%, 53.3%). Conclusion : In CRF patients, the nonspecific positive ratios of CK-MB, cTnT were higher than that of cTnI, and only cTnI did show significant specific elevations in all the CRF patients with acute myocardial infarction. It is likely that the status of CRF patients, dialysis mode, the sampling time point would not give significant changes in the nonspecific positive ratios of CK-MB, cTnT and cTnI.(Korean J Med 58:204-212, 2000)

CaNa₂-EDTA 연(鉛) 동원 검사에 의해 확진된 연중독 1 예

이정상,채동완,이건용,전노원,노정우,안규리,김근호 대한내과학회 1996 대한내과학회지 Vol.51 No.6

Recently, cases with lead poisoning due to herb medication with unknown ingredient have been reported increasingly, In general, lead poisoning has been confirmed through estimation of the concentration of lead in serum, of amount of lead excreted in 24 hour urine and so on. But in cases when lead poisoning is suspisious but routine laboratory findings are not compatible with lead poisining, CaNa₂ EDTA mobilization test with determination of excreted amount of lead in 24 hour urine has been known to be an effective method of confirming lead poisoning through determination of chelatable lead stores in the body. Authors experienced one case of suspicious lead poisoning with normal serum leaed concentration, with equivocal results in lead excretion in 24 hour urine collections. Authors confirmed lead poisoning by applying CaNa₂ EDTA mobilization test, for the first time in Korea, to the patient with equivocal laboratory and clinical findings. Here, a case of lead poisoning confirmed by CaNa₂ EDTA mobilization test is presented and recent literatures are reviewed.

섬유근이형성의 혈관조영술소견 : 경피적혈관성형술례를 중심으로 Percutaneous Transluminal Angioplasty Cases

김숙현,정수영,박기순,이열,전노원 한림대학교의료원 1992 人間科學 Vol.16 No.9

가토의 항-사구체기저막 항체에 의한 사구체신염에서 기질단백 mRNA의 연속적 변화에 관한 연구

박문향,이언화,한인섭,전노원,노정우 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.9

유지 혈액투석 환자에서 수면장애 양상

김진철,구자룡,채동완,전노원,송관욱,노정우,김형직,김근호,박규용 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6

Sleep disturbance and restless legs syndrome (RLS) among uremic patients is known to be high, but data on the prevalence, clinical significance, and causative factors are limited. A semiquantitative sleep and RLS questionnaire was distributed to 62 chronic hemodialysis(HD) patients. 74.5N had sleep complaints and frequent awakening was the most frequent specific sleep complaints followed by daytime sleepiness. Presence of diabetes mellitus(DM), RLS, depression, high CRP level, low intact parathyroid hormone level, low subjective global assessment score, and short HD duration were associated with more sleep complaints. 58.3N had RLS and presence of DM, low serum albumin level were also associated with more severe RLS. But Kt/V, protein catabolic rate, hematocrit, plasma bicarbonate level, use of erythropoietin and sleep medication were not associated with sleep complaints and RLS. Sleep problems and RLS are comrnon in HD patients and seem to be associated with malnutrition. Presence of DM, depression, and RLS are likely to contribute the high prevalence of sleep disturbance.