남북 정부간 불신의 원인과 해소방안

최성철 ( Choe Seong Cheol ) 한림과학원 2002 신뢰연구 Vol.12 No.2

성인에서 장기간 Furosemide 오용과 연관된 신수질 석회화

최성철 ( Choe Seong Cheol ),김윤구 ( Kim Yun Gu ),김정아 ( Kim Jeong A ),도정호 ( Do Jeong Ho ),한혁준 ( Han Hyeog Jun ),이현희 ( Lee Hyeon Hui ),윤수진 ( Yun Su Jin ),이영기 ( Lee Yeong Gi ),허우성 ( Heo U Seong ),김대중 ( Kim Da 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6

목 적: Furosemide 장기간 사용은 신생아에서 신수질 석회화(medullary nephrocalcinosis)발생의 주 위험 인자로 알려져 있다. 비록 furosemide가 성인에서도 여러 임상적 상황들에서 사용되지만 성인에서 신수질 석회화와 연관성은 확실하지 않다. 저자들은 성인에서 furosemide 장기간 사용과 신수질 석회화 사이에 연관성이 있는지를 알아보기 위하여 본 연구를 시행하였다. 방 법 : 오랜 기간(복용기간 범위 3-25년) 부종이나 체중 조절을 목적으로 습관적으로 furosemide를 복용한 18명(남 : 녀=1 : 17, 연령범위 21-59세)을 대상으로 하였다. 신수질 석회화는신초음파나 컴퓨터 단층 촬영, 또는 신생검을 통해 확인하였고 대상환자들을 신수질 석회화(+)군과 신수질 석회하(-)군으로 분류하여 임상적 특성들을 비교하였다. 결 과 : 신장 초음파와 컴퓨터 단층 촬영상 신수질 석회화는 양측 신장 수질부 추체(pyramid)들에서 18명 중 15명(83.3%)에서 관찰되었다. Furosemide 오용기간은 신수질 석회화(+)군과 신수질 석회화(-)군에서 차이가 없었지만(10.1±1.7년 대 15.3±0.9, p>0.05), furosemide 하루복용 용량은 신수질 석회화(+)군이 신수질 석회화(-)보다 더 많았다(538±174 대 67±13 mg/일, p<0.01). 두 군간 하루 요 칼슘배설양과 혈청 칼슘, 크레아티닌 청소율치의 차이는 없었다.대상 환자 중 3명에서 시행한 신생검 병리소견에서 국소적인 세뇨관 간질 위축과 섬유화가 관찰되었고 석회화는 외부 수질 세뇨관 간질에서 관찰되었다.결 론: 저자들은 성인에서 furosemide 장기 복용이 신수질 석회화를 유발할 수 있으며 신수질 석회화 발생의 위험성은 furosemide 복용 용량과 관련이 있다는 것을 알 수 있었다. 저자들은 성인에서 우연히 신장 초음파나 컴퓨터 단층 촬영상 신수질 석회화 소견이 관찰되면 furosemide 장기 오용 여부를 반드시 감별진단 해야 한다고 제안한다. Background : The use of furosemide is well recognized as a predisposing factor to nephrocalcinosis (NC) in infants. Although furosemide is widely used for various clinical settings in adults, the association of furosemide use and nephrocalcinosis in adults is not well established. Methods : We studied 18 consecutive adult patients( male : female=1 : 17, age range 21-59 years) who took furosemide habitually to control their weights or edema for a long-term period(range 3-25 years). NC was evaluated using renal ultrasonography(US), computed tomography(CT) and/or kidney biopsies. Patients were categorized into NC(+) and NC(-) groups while the difference in clinical features were investigated. Results : Renal US and CT revealed nephrocalcinosis in the bilateral medullary pyramids in 15(83.3 %) out of 18 patients. The duration of furosemide abuse was not different between NC(+) and NC(-) groups(10.1±1.7 years vs. 15.3±0.9, p>0.05). The daily dose of furosemide was higher in NC(+) group than the NC(-) group(538±174 vs. 67±13 mg/day, p<0.01), however. All patients showed a variable degree of renal insufficiency and there was no difference in creatinine clearance between two groups(p>0.05). The kidney biopsies performed in three patients showed focal tubulointerstitial fibrosis and atrophy and calcifications were observed at outer medullary tubulointerstitium. Conclusion : Long-term furosemide abuse could cause medullary nephrocalcinosis in adults and the risk of developing of nephrocalcinosis is correlated with the daily dose of furosemide. We suggest that long-term furosemide abuse should be suspected in adult patients when medullary nephrocalcinosis is incidentally detected by US and/or CT.

파국과 구원의 변증법 -발터 벤야민의 탈역사주의적 역사철학-

최성철 ( Choe Seong Cheol ) 한국서양사학회 2003 西洋史論 Vol.0 No.79

The following paper aims to critically evaluate Walter Benjamin`s philosophy of History from today s point of view. His philosophy of History was completed during the period when the Fascism was at its peak. And it fundamentally rejected the two traditional ways of understanding about History dominant in Europe by that time. They are 1) classical philosophy of History, which had seen the process of History as progressive and 2) traditional Historicism, which had always advocated the ideas of the History for Winners. In order to form his new- concept of history, first Benjamin established his own unique concept of time. While declining the traditional concept of chronological time continuity, he introduced a time concept called Jetztieit(now-time). time as a dialectic synthesis of revolution and standstill. Also for Benjamin who perceived history as having an indivisible relationship with ideology, genuine historical experience and vision are supposed to be political ones. In addition he claimed that in order to discover the history of the oppressed and the past that had been denied for the access of recording, one should re-evaluate the moral of the History for Winners. In order to form this kind of concept for history, Benjamin suggested a unique historical methodology. While negating the classical Historicist`s method of `reconstruction`. The proposed the method of `construction` in which an historian actualizes an experienced event in the past here and now through the helps of his or her `memory(Erinnerung)` and `remini scencet(Eingedenken)`. Through these new historical concepts and methods, Benjamin`s unique philosophy of History comes into being in a nimble combination between Historical Materialism and Judaic Messianism. Ultimately Benjamin s philosophy of History aims the rehabilitation of the people who had passed away as expendable or unknown in history. In other words, it stands for the salvation of forgotten past. This task can be accomplished only through one s gaining of a genuine historical consciousness over the moment of catastrophe. For Benjamin history is not terminated but remained as opened. Catastrophe eventually heads toward salvation. As the real meaning of salvation shows, Benjamin s philosophy of History would be eventually led toward the historical theology.

A Study on the Effect of Residual Stress between Body and Glaze of Pottery on the Mechanical Strength

이진하,나은상,최성철,Lee, Jin-Ha,Na, Eun-Sang,Choe, Seong-Cheol Materials Research Society of Korea 1999 한국재료학회지 Vol.9 No.2

In this study, the effect of residual stress on mechanical strength was investigated with 1 kind of whiteware body and 4 kinds of glazes which are produced in succeeding ceramic art place. Using dipping method, the body was coated for different times in order to manipulate the coating thickness and sintered in the different temperatures ($1200^{\circ}C$, $1250^{\circ}C$, $1300^{\circ}C$, $1350^{\circ}C$) for two thus hours. The sintered bodies were characterized by XRD, EPMA, FEM and UTM in order to study the forming of reaction layer between body and glazes, residual stresses and the effects of residual stresses on mechanical strength of pottery. At $1300{\circ}C$, we obtained maximum density and mechanical strength. By the finite element method, the residual stresses in surface of body were minimum in specific thickness of glazes and the mechanical strength of body in that thickness of glazes showed maximum when the firing temperature was settled.

공여자가 동일한 사체신이식에서 Mycophenolate Mofetil(MMF)과 Azathioprine(AZA)의 비교 연구

도정호 ( Do Jeong Ho ),허우성 ( Heo U Seong ),김정아 ( Kim Jeong A ),이효락 ( Lee Hyo Lag ),최성철 ( Choe Seong Cheol ),한혁준 ( Han Hyeog Jun ),김대중 ( Kim Dae Jung ),김윤구 ( Kim Yun Gu ),오하영 ( O Ha Yeong ),이광웅 ( Lee Gwan 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6

목 적: 뇌사 공여자로부터 적출된 두개의 신장을 하나는 MMF(연구군)에 다른 하나는 AZA(대조군)에게 이식하여 공여자 차이로 인한 영향을 최소화 하여 두 약제가 신이식 후 초기 급성거부반응과 이식신 생존율에 미치는 영향을 비교 분석하고자 하였다. 방 법 : 1998년 4월부터 2000년 1월까지 성균관의대 삼성서울병원에서 시행된 신장이식 중 공여자의 양측 신장(34쌍)이 제공된 68예의 사체 신이식을 대상으로 각 쌍을 MMF군(34예)과AZA군(34예)으로 무작위 배정을 하였고 면역억제제는 3제요법을 시행하여, MMF군은 Cyclosporine,MMF, Prednisolone을 AZA군은 Cyclosporine, AZA, Prednisolone을 투여 하였다. 두 군간의 6개월 이내의 급성 거부반응의 발생률과 CMV 감염 발생률 그리고 1년 이식신의 생존율 등을 전향적인 방법에 의해 비교하였다. 결 과: MMF군과 AZA군 간에 성별, HLA 부적합, 냉무혈시간, 몸무게 등의 유의한 차이는 없었다. 급성 거부반응 발생 또는 치료실패는 각각 12예(35.3%)와 11예(32.4%)로 두 군간에 유의한 차이가 없었고(p>0.05), 1년 이식신의 생존율은 각각 91.2%, 97.1%였고 CMV 감염은 각각 1예와 3예로 차이를 보였으나 통계적 의미는 없었다. 결 론: MMF와 AZA, 두 신이식 군에서 약제로 인한 급성 거부반응 발생률의 차이와 이식신 생존율의 차이는 없었다. 이는 기존의 보고들과는 다른 결과로 사체신이식일 경우 공여자의요인이 신장이식의 결과에 많은 영향을 미친다는 것을 의미한다. 그러므로 사체신이식을 통한 비교 임상 시험을 시행할 때는 기존의 연구들에서 제시한 공여자 인자 외 다른 공여자 인자들에 대한 충분한 고려가 있어야 하겠다. Objective : In order to evaluate how immunosuppressive agents such as MMF and AZA would influence on the outcome of the graft kidney, we analyzed the incidence of acute rejection episodes and one year graft survival rate after minimizing influences of donor factors by grafting the same cadaveric donor kidney. Methods : From April, 1998 to January, 2000, sixty eight patients grafted by 34 cadaver donors were enrolled in our study. From the same donor, one was randomly assigned to the MMF group(n=34) who were treated with cyclosporine, MMF, prednisolone while the other kidney was assigned to the AZA group(n=34) with cyclosporine, AZA, prednisolone. We analyzed the incidence of acute rejection episodes and CMV infection within the first 6 months of renal transplantation and one year graft survival rate was studied prospectively. Results : There were no significant differences in sex, HLA mismatch, cold ischemic time, and patients` weight between two group. Acute rejection or treatment failure occurred in 35.3% in the MMF group by 6 months after transplant, compared with 32.4% in the AZA group without statistic significance(12/34 vs. 11/34, p>0.05). One year graft survival rate was 91.2% and 97.1%, respectively, and CMV infection was documented in 4 patients(1/34 vs. 3/34, p>0.05). Conclusion : There were no significant differences in the incidence of acute rejection episodes and one year graft survival rate between two groups. In contrast, previous studies showed that MMF could have lowered the incidence of acute rejection episodes and improved graft survival rate. This discrepancy in results might be explained that donor factors were important to cadaveric renal transplantation. Thus, we suggest that the influences of donor factors should be considered in further clinical study of cadaveric renal trans-plantation.