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유지 혈액투석환자에서의 우울증 발생의 위험인자 및 우울증이 영양지표에 미치는 영향
김진철(Jin Cheol Kim),조성태(Sung Tae Jo),윤종우(Jong Yoo Yoon),김근호(Gheun Ho Kim),전노원(Rho Won Jeon),김형직(Hyung Jig Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),손봉기(Bong Ki Son),구자룡(Ja Roung Koo) 대한내과학회 2002 대한내과학회지 Vol.62 No.1
N/A Background: Depression is common in chronic renal failure patients and usually associated with poor appetite. Malnutrition with poor appetite is known to be associated with increased mortality in chronic hemodialysis (HD) patients. So we evaluated the prevalence, risk factors of depression and effects of depression to nutritional status in chronic HD patients. Methods: Sixty two HD patients (age 48.8±11.1 years, diabetes 29%) were investigated. Each patients were interviewed and completed the Beck depression inventory (BDI, 21 items, 0-3 point). To exclude the possible confounding effects of illness and treatment symptoms, cognitive depression index (CDI, a cognitive subset of 15 items selected from BDI) was used as a measure of depression. KT/V and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assesment (SGA), body mass index (BMI), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were also measured. Results: Corrected BDI score (CDI score multiplied by 21/15) was 24.9±12.7 and the prevalence of depression (corrected BDI score≥21) was 64.5%. DM patient s had higher CDI score than non DM patient (22.9±7.2 vs 15.6±9.0). In univariate analysis, CDI score was correlated with age (r =0.39, p <0.01), serum albumin (r =- 0.37, p <0.005), nPCR (r =- 0.30, p <0.05), SGA (r =- 0.42, p <0.05), BMI (r =- 0.28, p <0.05), TSF (r =- 0.41, p <0.05) and MAMC (r =- 0.50, p <0.01). In multivariate analysis, CDI score was the strongest correlate of nPCR, SGA, BMI, TSF and MAMC. But KT/V, hematocrit, erythropoietin usage, plasma bicarbonate, serum parathyroid hormone, c-reactive protein concentration and HD duration had no relationship with CDI score. Conclusion: The prevalence of depression in chronic HD patients was high. Diabetes and old age were import ant risk factors for depression. It was also concluded that severity of depression was correlated with markers of malnutrition and depression could be a independent risk factors of malnutrition in chronic HD patients.(Korean J Med 62:77-82, 2002)
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)
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.
특별강연 및 일반연제 발표 : IgA 신병증 환자의 신조직에서 여러 가지 cytokine 및 chemokine mRNA의 발현과 임상, 병리학적 소견의 상관 관계
임춘수 ( Im Chun Su ),정수환 ( Jeong Su Hwan ),이서진 ( Lee Seo Jin ),김연수 ( Kim Yeon Su ),안규리 ( An Gyu Li ),한진석 ( Han Jin Seog ),김성권 ( Kim Seong Gwon ),이정상 ( Lee Jeong Sang ),채동완 ( Chae Dong Wan ),전노원 ( Jeon N 대한신장학회 1999 춘계학술대회 초록집 Vol.18 No.2
김진철,이정열,구자룡,윤종우,채동완,김근호,전노원,노정우,김형직,노희종,주민하,전만조 대한내과학회 2001 대한내과학회지 Vol.60 No.5
Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning. (Korean J Med 60:490-495, 2001)