유지 혈액투석치료를 받는 만성신부전에 수반된 우울증에서 항우울제 치료에 따른 우울증상 및 영양지표의 변화

정연순 ( Yeon Soon Jung ),박시성 ( Si Sung Park ),민은정 ( Eun Jeong Min ),한병호 ( Byung Ho Han ),엄은아 ( Eun A Eum ),임학 ( Hark Rim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

목적: 유지 혈액투석치료를 받고 있는 만성신부전 환자에서 수반되는 우울증과 우울증상의 특성 및 정도를 조사하고, 항우울제 치료 전후의 우울증상 및 영양지표의 변화를 측정하여, 우울증과 우울증상의 치료가 유지 혈액투석치료를 받고 있는 만성신부전 환자에게 미치는 임상적 영향을 살펴보고자 하였다. 방법: 고신대학교 복음병원 인공신장실에서 6개월 이상 동안 유지 혈액투석치료를 받고 있는 만성신부전 환자 64명을 대상으로 우울증 및 우울정도와 영양상태 지표들을 조사하였다. 주요우울증의 진단은 반구조화된 면담을 통하여 DSM-IV TR 기준을 사용하였다. 우울증상의 정도는 17문항의 Hamilton Rating Scale for Depression (HRSD)을 사용하여 측정하였다. Subjective global assessment (SGA), body mass index (BMI), triceps skin fold thickness (TSF), mid-arm muscle circimference (MAMC)와 handgrip strength를 측정하였으며 KT/V, normalized protein catabolic rate (nPCR), 혈청 알부민 농도 등과 같은 영양지표도 측정하였다. 우울증이 있는 경우 8주간의 항우울제 약물치료를 시행하였고, 치료 이후 우울증상과 영양상태의 항목들을 재평가하였다. 결과: 만성신부전으로 유지 혈액투석치료를 받고 있는 환자들 중 우울증으로 진단된 환자는 19명으로 42.2% (주요 우울장애 11명 24.4%, 기분부전장애 8명 17.8%)였다. 우울증이 있는 경우 우울한 기분, 죄책감, 자살사고, 수면장애, 일과 활동의 저하, 정신운동의 지연, 정신적 불안 및 신체 불안, 전반적인 신체증상 및 건강염려 등이 유의하게 높았다. 항우울제 약물치료 후 우울한 기분과 정신적 불안, 죄책감, 자살사고, 일과 활동, 수면장애 및 전반적인 신체증상 등이 유의하게 호전되었다. 치료 후 TSF (p<0.05), handgrip strength (p<0.01)와 hematocrit (p<0.05)이 개선되었다. 결론: 유지 혈액투석 중인 만성신부전 환자에서 우울증이 수반될 경우 우울증상에 대한 항우울제 치료는 수면과 신체증상 등을 포함하여 우울증상을 호전시킬 뿐만 아니라 삶의 질을 향상시킬 것으로 기대되므로 적극적인 항우울제 치료가 필요하다고 하겠다. Purpose: Depression is common in patients with chronic renal failure on maintenance hemodialysis, though success rate of treatment is low. This study aimed to investigate the features and severity of the depressive symptoms and nutritional indices, and significant changes after antidepressant treatment. Methods: The authors assessed 45 patients. Diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using Hamilton Rating Scale for Depression via semistructured interview. Subjective global assessment, anthropometric measurements and nutritional indices such as Kt/V, nPCR were examined. Depressive patients were treated for 8 weeks with SSRI (citalopram), and all the variables were examined again after the treatment. Results: 19 (42.2%) patients were diagnosed as depression. Nutritional status was not different between patients with depression and those without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, guilty feeling, suicide idea, psychic and somatic anxiety, lower work and activities, psychomotor retardation, sleep disturbances, general somatic symptoms and hypochondriasis. After antidepressant treatment, depressed mood, guilty feeling, suicide idea, psychic anxiety, initial insomnia, middle insomnia, early awakening, work and activities and general somatic symptoms were improved significantly. TSF (p<0.05), handgrip strength (p<0.01) and hematocrit (p<0.05) were significantly increased. Conclusion: Antidepressant treatment is helpful not only for the improvement of depressive symptoms such as sleep and somatic symptoms but for the improvement of quality of life. Proper treatment should be more actively attempted for the hemodialytic patients with depression.

저용량 Mitomycin-C에 의한 혈전성 미소혈관중 3예

정연순 ( Yeon Soon Jung ),김현영 ( Hyun Young Kim ),육동승 ( Dong Seung Yook ),천봉권 ( Bong Kwon Chun ),황일용 ( Il Yong Hwang ),임학 ( Hark Rim ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Mitomycin (MMC) is a naturally ocurring alkylating agent, introduced for clinical use as early as 1958. This drug is useful in the therapy of gastrointestinal carcinoms when used in combination with 5-fluorouracil. Nephrotoxicity among toxicities from MMC is unusual with cumulative doses less than 30 mg/m^2. In large studies in which the incidence of MMC nephrotoxicity were assessed, 3-15% of patients developed total dose related renal dysfunction. Three patients in our clinical practice have developed thrombotic microangiopathy clearly related to MMC. We report the clinical and pathologic features of ourcases. In view of the probable dose-related and delayed toxicity of MMC, it seems necessary to monitor regularly after initiation of chemotherapy. Early detection of the renal impairment and withdrawal of MMC might halt further progression of renal failure.

계열별 고등학교 진로교육 실태 분석을 통한 농업계 고등학교 진로교육 개선방안

정연순 ( Yeon Soon Jung ),유병민 ( Byeong Min Yu ),진성미 ( Sung Mi Jin ),남영옥 ( Yeong Ok Nam ) 한국농촌지도학회 2010 농촌지도와 개발 Vol.17 No.2

Agricultural high schools has been changing themselves toward more effective education system to survive in rapidly changing society. Changes occur in new students, in objects of school, and in curriculum. The purpose of this study was to analyze the condition of career education in agriculture high school. Questionnaires were use to collect data from 894 agricultural high schools. Results of this study show that the career education in agriculture high school has many problems in its curriculum, its contents, and the public relation of educational materials. It is recommended that various materials and manuals for career education should be developed and implemented for effective career education in agricultural high school.

이식신에서 발생한 허탈성사구체병증 (Collapsing Glomerulopathy)

김지환 ( Ji Hwan Kim ),정정임 ( Jung Im Jung ),남주연 ( Ju Yeon Nam ),김종인 ( Jong In Kim ),김중경 ( Joong Kyung Kim ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ),정민정 ( Min Jung Jung ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

Collapsing glomeruopathy (CG) is a clinicopathologic variant of focal segmental glomerulosclerosis (FSGS) and is characterized by severe nephrotic syndrome, rapid progression to end stage renal disease, and features of visceral epithelial cell injury and glomerular capillary collapse. Such characteristics closely resemble those of HIV associated nephropathy. The frequency of CG has increased over the last decade. The cause of CG is unknown. The lesion has rarely been described in renal allografts with features similar to CG in native kidney. We recently identified allograft CG in a 44 year-old male patient who underwent biopsy for graft dysfunction after autodermic graft. The biopsy showed typical characteristics of CG. Serologically, the patient had no evidence of HIV infection. The renal function was not restored to normal in spite of methylprednisolone pulsing therapy. Now he is on conservative treatment with a functioning graft.

신이식 후기에 발생한 이식신의 분절성 경색

신호식 ( Ho Sik Shin ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.1

말기신부전 환자에서 척골동맥-척축피정맥 동정맥루의 임상적 의의

김지혜 ( Ji Hye Kim ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ),유창현 ( Chang Hyun Yoo ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

배 경 : 말기신부전 환자에서 요골동맥-요측부정맥 동정맥루는 가장 좋은 동정맥루 수술법이나 이용 가능한 정맥이 제한되어 있어 이식편의 사용과 상완의 동정맥루 수술이 증가하고 있다. 이에 저파들은 요골동맥-요측부정맥 동정맥루 수술이 불가능한 환자에서 상완정맥을 보존하기 위한 정완의 동정맥루 수술 방법으로 임상적으로 흔히 사용되지 않는 부위인 척골동맥-척측피정맥 동정맥루 (ulnobasilic arteriovenous fistula, UBF) 수술의 임상적 의의를 알아보고자 한다. 방 법 : 1999년 6월부터 2000년 4월, 2001년 10월부터 2002년 2월의 기간동안 시행된 동정맥루 형성술 256예 중, UBP 26예를 대상으로 2002년 4월까지 동정맥루의 생존율과 합병증을 후향적으로 조사하였다. 결 과 : 수술 후 동점맥루의 평균 추적 조사 기관은 추적조사 당시까지 8 (1-19)개월이었으며, 동정맥루 개존율은 수술 직후, 6개월, 12개월에 각각 80%, 56%, 45%였다. 동정맥루를 1회 이상 사용하였던 21명 중에서 18명은 혈액투석 동안 불편감이 없었으며 나머지 3명에서만 경미한 불편감을 호소하였다. 결 론 : UBF는 상완 정맥을 보존할 수 있는 동정맥루 수술방법이 될 수 있을 것으로 사료된다. Background :Although native radiocephalic arteriovenous fistula provides the best possible vascular access for hemodialysis, available veins for this fistula are limited, Ulnobasilic arteriovenous fistula (UBF) is alternative method for native fistula of forearm. But this method is not commonly used because detection of the vein is difficult and cannulation for hemodialysis id uncomfortable. This study was performed to evaluate clinical usefulemess of UBF. Methods : From June 1999 to April 2000 and from September 2001 to February 2002, 256 arteriovenous fistulae were made in 239 patients with chronic renal failure and among them, 26 UBF were made by one surgeon. At April 2002, a total of 26 UHF were reviewed. Results : The results were as follows : There were 17 men and 9 women, aged 31 to 72 years. There were 7 diabetic patients. 22 patients of them had previous history of arteriovenous fistula operation. There were six failures : one delayed occlusion; one venous hypertension due to proximal stenosis during hemodialysis; four inadequate maturation. The 20 patients showed good patency. Conclusion; : This study shows that UBF can be useful method in patients with failed radiocephalic arteriovenous fistula or poor cephalic vein and preserve upper arm vein for future operation.

류마티스 관절염환자에 동반된 불현성 말초신경병증

김진구 ( Jin Gu Kim ),정연순 ( Yeon Soon Jung ),유경무 ( Kyung Moo Yoo ),홍관표 ( Kwan Pyo Hong ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.2

Objective: Symptomatic neuropathy is uncommon in rheumatoid arthritis (RA) but, compression neuropathy and vascular neuropathy were reported in longstanding RA. To investigate the occurrence of electrophysiologically evident peripheral nerve involvement in RA patients without a clinical manifestation of peripheral nerve involvement, we studied nerve conduction velocity study (NCV) in RA patients without symptomatic neuropathy. Methods: Twenty-five RA patients were evaluated neurological examination and by NCV. We compared clinical parameters between electrophysiologic positive group and negative group. Results: There was no patient who had neurologic symptoms or signs of peripheral involvement. Eleven patients (44%) of all exhibited NCV findings consistent with distal symmetrical sensorimotor polyneuropathy, 5 patients (20%) had entrapment neuropathy, 2 patients (8%) showed distal symmetrical sensory polyneuropathy, 1 patient (4%) had digital neuropathy, and 6 patients (24%) had normal NCV. Conclusion: Patients with RA may have electrophysiologic peripheral nerve damage, even in the absence of clinical evidence of peripheral nerve involvement. There was no correlation with any clinical parameters. The inclusion of electrophysiologic examination of the RA patients is recommended in routine diagnostic procedures.

폐색전증을 동반한 Endosulfan 중독 1예

박기룡 ( Ki Ryong Park ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S

진성다혈구증이 병발된 IgA 신증

김지혜 ( Ji Hye Kim ),최바울 ( Paul Choi ),정연순 ( Yeon Soon Jung ),장성훈 ( Seong Hoon Chang ),어완규 ( Wan Kyu Eo ),천봉권 ( Bong Kwon Chun ),임학 ( Hark Rim ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

Secondary polycythemia occasionally associated with renal diseases such as renal tumors, cysts, hydronephrosis, renal transplantation, renal artery stenosis and Banter`s syndrome and is rarely associated wish nephrotic syndrome, nephrosclerosis, pyelonephritis, chronic gromerulonephritis and membranous nephropathy. The association of polycythemia vera and immunoglobulin A nephropathy (IgAN) is well not known, and there are only a few isolated reports presnting the concomitance of polycythemia vera and IgAN. We report one patient with concomitant polycythemia vera and Ig A nephropathy. A 53 year-old male visited our hospital because of elevated hemoglobin level. Blood value of hemoglobin was 22.1 g/dL. Isotopic blood studies with radioactive chromium (^51CO-labelled red blood cells revealed a total blood volume of 90 mL/㎏ and total red cell volume of 61.8 mL/㎏. The concentration of serum erythropoietin measured by radioimmunoassay was 14.29 mIU/mL (normal 10.2-25.2 mIU/mL). Bone marrow aspirate revealed hypercellularity and panmyelosis, characteristically, Renal biopsy specimens showed moderate mesangioproliferative lesions with mesangial IgA and C_3 deposition. Treatment with phlebotomy, hydroxyurea and oral prednisolone (1 ㎎/㎏/day) was done. There was no decrease of urinary protein following treatment of phlebotomy and hydroxyurea. But urinary protein decreased and hemoglobin level normalized following combination treatment of phlebotomy, hydroxyurea and oral prednisolone.

성인에서 발견된 신석회증을 동반한 Bartter씨 증후군 1예

오혜주 ( Hyae Ju Oh ),임학 ( Hark Rim ),정연순 ( Yeon Soon Jung ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.3