경피적 관상동맥 확장술 전후의 QT 간격분산 ( QT dispersion ) 비교

한혁준(Hyeok Jun Han),노태호(Tai Ho Rho),이만영(Man Young Lee),김희열(Hee Yeol Kim),윤호중(Ho Joong Youn),김종진(Jong Jin Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: QT dispersion(QTd) is defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. It was reported previously that QTd was dependent on the degree of reperfusion in myocardial infarction. The purpose of this study is to investigate the effects of percutaneous transluminal coronary angioplasty(PTCA) on QTd. Methods: We studied in 21 patients(15 men and 6 women: mean age, 53±7.5 years: 14 acute myocardial infaction, 4 angina pectoris and 3 unstable angina). All standard 12-lead ECGs were recorded at a paper speed of 25mm/sec and examined retrospectively by single observer. QT interval was measured from 11.3±1.1 leads using a computerized program interfaced with digitizer. QTd corrected for heart rate(QTcd) was calculated by Bazett`s formula. Each cases were divided to 2 stages, before and after PTCA(mean obsevation duration, 16.8±9.7 days vs. 22.5±21.9 hours). The difference of QT dispersions was assessed by comparing by paired t-test. Results: There were significant difference in QTd (mean 110.2±37.4 vs. 90.4±37.6 msec, p<0.05). Results did not change when Bazett`s QTc was substituted for QT(QTcd: mean 125.5±38.3 vs. 97.9±29.8 msec, p<0.05). Conclusion: Successful PTCA is associated with less QTd after PTGA. The results are equally significant when either QT or QTc is used for analysis. In our limited study, measurement of QT dispersion, an easily accessible, resonably accurate, noninvasive method, may be a valuable tool in assessment of patients before and after PTCA. However, this study must be confirmed in prospective trial.

점증적 복막투석에서 저분자량 용질과 중분자량 용질의 복막 청소율의 비교

도정호(Jung Ho Do),김대중(Dae Joong Kim),최성철(Sung Chul Choi),한혁준(Hyeok Jun Han),정시정(Shi Jung Chung),박진아(Jin Ah Park),오동진(Dong Jin Oh),허우성(Woo Seong Huh),김윤구(Yoon Goo Kim),오하영(Ha Young Oh) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Objective To evaluate the peritoneal clearance of the middle molecule compared with that of the small molecule in incremental peritoneal dialysis(PD). Methods: Peritoneal clearances of the creatinine and β2-microgloblulin were compared in 57 continuous ambulatory PD patients with full dose 4 times exchange and in 54 incremental PD patients with 2 or 3 times exchange over 24 hours. The clearances were also compared when there were changes in the peritoneal dialysis regimen such as in the number of exchanges and dwelling time. Results : Peritoneal creatinine clearance increased almost linearly along with the increase in the number of exchanges. In contrast, peritoneal clearance of β2-microglobulin was 9.1±3.6 L/week, 8.8±4.4 U week, and 7.9±2.5 L/week respectively with 2, 3 and 4 exchanges per day, not different from each other. Peritoneal clearance of 0z-microglobulin did not change when there was an increase in the number of exchange from 2 to 3 times and 3 to 4 times over a period of 24 hours, whereas the peritoneal clearance of creatinine increased. Peritoneal clearance of β2-microglobulin almost doubled from 5.4±2.7 L/ week with 2 times exchange over 12 hours per day, to 9.5±4.4 L/week with 2 times exchange over 24 hours, whereas the creatinine clearance did not change. Conclusion: In contrast to peritoneal clearance of small molecule which depends on the number of dialysate exchange, peritoneal clearance of middle molecule depends mainly on the total dwelling hours rather than the number of exchange per day in incremental PD. This can be another advantage of incremental PD since peritoneal clearance of middle molecules in incremental PD over 24 hours is com- parable to that in full dose PD.

Break - in Period 동안 시행한 혈액 투석이 지속성 외래 복막 투석 환자의 잔여 신기능에 미치는 영향

박진아(Ji Nah Park),김대중(Dae Joong Kim),정시정(Shi Jung Chung),한혁준(Hyeok Jun Han),허우성(Woo Seong Huh),김윤구(Yoon Goo Kim),오하영(Ha Young Oh) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

복막 투석 도관 삽입 후, 도관 및 수술 부위에 관련된 합병증을 줄이기 위하여 도관 삽입 2주내지 4주 후 복막 투석을 시작하도록 권유하고 있고, 이 기간을 break -in period라고 한다. 일부 환자에서 이 기간 동안 유지 혈액 투석을 하게 되는 경우가 있다. 잔여 신기능이 혈액 투석을 하는 환자보다 복막 투석 환자에서 잘 보존되는 것으로 알려져 있으므로, 혈액 투석을 거치지 않고 복막 투석을 직접 시작한 환자에 비해 break-in period동안 혈액 투석을 한 환자에서 잔여 신기능이 더 감소할 것으로 예상된다. 이에 저자들은 지속성 외래 복막 투석 환자에서 break-in period동안에 시행한 혈액 투석이 잔여 신기능에 미치는 영향을 알아보기 위하여 이 연구를 시작하였다. 1999년 3월 이후 지속석 외래 복막 투석을 시작하고 임상적으로 안정적인 20명의 환자를 대상으로 하였다. 6명의 환자에서 1개월의 break-in period동안 혈액 투석을 시행하였고, 그 후 지속성 외래 복막 투석을 시작하였다(A군). 14명의 환자에서는 1개월, 3개월, 6개월 후에 사구체 여과율(소변에서 측정한 요소 청소율과 크레아티닌 청소율의 평균)과 소변에서의 요소 제거율(urine Kt/V)을 측정하였다. 잔여 신기능과의 상관관계를 보기 위한 변수로 평균 동맥혈압, 혈청 알부민, 혈색소, 적혈구 용적율, 연령, 성별, 당뇨병의 유무, 복막염의 발생을 관찰하였다. 신대체 요법 시작 시점에서 두 군의 평균 동맥혈압, 혈청 알부민, 혈색소, 적혈구 용적율, 연령, 성별 당뇨병의 유무는 통계학적인 차이는 없었다. 신대체 요법 시작 시점의 사구체 여과율은 A군이 B군보다 낮았으나(A군: 45.0±10.1L/week, B군: 54.6±5.7L/week), 통계학적인 차이는 없었다. 신대체 요법을 시작한 뒤 1개월 후 측정한 사구체 여과율은 B군에서는 변화가 별로 없었으나 A군에서는 현저히 감소하여 두 군 사이에 유의한 차이를 보였고(A군: 28.6±5.3L/week, B군: 54.4±5.7L/week), 이 차이는 6개월 시점까지 지속되었다. 사구체 여과율과 소변에서의 요소 제거율의 변화는 평균 동맥혈압, 혈청 알부민, 혈색소, 적혈구 용적율과 상관관계가 없었으며, 성별이나 당뇨병의 유무, 복막염의 빈도등에 의해 영향을 받지 않았다. Break-in periond의 혈액 투석은 잔여 신기능의 감소를 가져왔고 이는 신대체 요법후 6개월까지도 회복되지 않았다. 이에 저자들은 지속성 외래 복막 투석을 시행할 환자의 경우 적절한 시기에 도관을 삽입하여 혈액 투석에 의한 잔여 신기능의 감소를 피하는 것이 바람직할 것으로 생각하였다. To avoid later complication of peritoneal dialysis catheter, it is recommended to delay regular exchange of peritoneal dialysis for about 2-4weeks after insertion of catheter(break-in period). During break-in period some patients need hemodialysis(HD) or other intermittent dialysis. In such cases residual renal function(RRF) can decrease substantially compared with patients who do not need HD during break-in period since RRF is preserved better in CAPD patients than HD patients. This is prospective observational study to examine such an effect of HD during break-in period on residual renal function in CAPD patients. 20 patients who were clinically stable and had been on CAPD since March, 1999 were observed. 6 patients were treated with HD for 1month during break-in period and CAPD thereafter(group A). 14 patients were treated with CAPD without HD(group B). GFR(mean of creatinine and urea clearance of urine) and urine Kt/V urea were measured at start, and 1, 3, 6 months of renal replacement therapy. Covariables analyzed in this study were mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, the presence of diabetes mellitus, and peritonitis episode. There was no significant difference in initial RRF, mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, and the presence of diabetes mellitus between 2 groups. Initial GFR was a little smaller in group A than group B(45.0±10.1 L/week vs. 54.6±5.7L/week) which was not statistically significant. GFR after 1, 3 and 6months of dialysis(including 1month of HD in group A) were smaller in group A than B(28.6±5.3L/week vs. 54.4±5.7L/week, 32.7±5.2L/week vs 56.9±6.1Lweek, 21.0±4.1L/week vs 53.6±5.4L/week at 1,3,6 months after dialysis in group A and B), which were significant. Urine Kt/V showed same pattern. The change of GFR and urine Kt/V have no correlation with serum albumin, hemoglobin, hematocrit, and change of mean arterial blood pressure and is not affected by sex, and presence of DM or peritonitis. We concluded that HD during break-in period can decrease RRF in CAPD patients, which may not recover after 6months of dialysis. Avoiding HD during break-in period with appropriate preparation can preserve RRF in CAPD patients.

박기저막 질환에 동반된 원발성 막성신병증

최성진 ( Sung Jin Choi ),조현오 ( Hyeon Oh Jo ),최혁환 ( Hyeok Whan Choi ),정용덕 ( Yong Duk Jung ),유재연 ( Jae Yeon Yoo ),한혁준 ( Hyeok Jun Han ),김용진 ( Yong Jin Kim ) 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.1

신증후군에 합병된 다발성 혈전증에 대한 MRA 진단 및 성공적인 혈전 용해술 1 예

최성철(Sung Chul Choi),허우성(Woo Seong Huh),도정호(Jung Ho Do),김정아(Jung Ah Kim),한혁준(Hyeok Jun Han),정시정(Shi Jung Chung),박진아(Jin Ah Park),김윤구(Yoon Goo Kim),김대중(Dae Joong Kim),오하영(Ha Young Oh),김보현(Bo Hyun Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5

The nephrotic syndrome has been considered a hypercoagulable state since it may be complicated by thromboembolic events of the venous or the arterial circulations. Diverse pathogenetic factors leading to the hypercoagulable state in nephrotic syndrome have been recognized. Renal vein thrombosis is a serious complication, which might lead to either renal failure or to secondary thromboembolic processes like pulmonary thromboembolism. Although it may present acutely with flank pain and macroscopic hematuria, the majority of cases run an indolent course. Until relatively recently, the diagnosis could only be confidently confirmed or excluded with selective renal venography but, more recently, computerized tomography and magnetic resonance imaging have been used. Anticoagulant therapy with heparin and warfarin apparently halts the natural progression of the disease and allowing for slow recovery. The possibility of more rapid and complete resolution with thrombolytic agents warranted their application. We described a case of bilateral renal vein thrombosis diagnosed by the new technique of magnetic resonance angiography and successful treatment by thrombolytic agent.

경막외로 전이된 원발성 간암

정규원(Kyu Won Chung),선희식(Hee Sik Sun),심상인(Sang In Shim),강창석(Chang Suck Kang),박수헌(Soo Heon Park),한혁준(Hyeok Jun Han),노대근(Dae Keun Lo),박진노(Jin No Park),방춘상(Chun Sang Bang),최명규(Myong Gyu Choi) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

Hepatocellular carcinoma is one of the most common malignancies reported in ost of the Africa and South-east Asia. As hepatocellular carcinoma metastases well to distant site, half of the cases metastases to distant site at diagnosis. Hepatocellular carcinoma usually spread to regional lymph nodes around porta hepatis via lyphatics and venous metastasis can occur via intrahepatic vein. The usual sites of extrahepatic metastasis are lung, local lymph nodes, adrenal glands and bones, but epidural metastasis is very rare. Although the prognosis of the hepatocellular carcinoma was very poor in the past, the survival time seemed to be prolonged by early diagnosis and improvement of medical therapy. Therefore the importance of metastatic lesion of the hepatocellular carcinoma might be reemphasized. Recently we experienced a case of the hepatocellular carcinoma who developed paraplegia suddenly. MRI revealed ovoid epidural rnass at 6th and 7th dorsal vertebra level posteriorly. After emergency operation, the resected mass was confirmed metaststic hepatocellular carcinoma. (Korean J Gastroenterol 1997;30:119-125)

고뇨산성 신병증 발병 기전에서 대식세포 유주 억제 인자의 역할

정시정(Shi Jung Chung),최성철(Sung Chul Choi),도정호(Jung Ho Do),김정아(Jung Ah Kim),윤수진(Soo Jin Yoon),이현희(Hyun Hee Lee),박진아(Jin Ah Park),한혁준(Hyeok Jun Han),이영기(Young Kee Lee),허우성(Woo Seong Huh),김대중(Dae Joong Kim 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5

배 경 : 고뇨산혈증 환자에서 신장에 요산 결정 침착이 지속되면 만성 신세뇨관 간질성 손상과 거대 세포를 포함하는 육아종 발생이 특징적인 병리 소견이다. 이러한 육아종 형성은 요산 결정이 지연성 과민 유사 반응을 유발할 수 있음을 시사하는 소견이며, 대식세포 유주억제인자(macrophage migration inhibitory factor, MIF )는 최근 지연성 과민 반응에 가장 중요한 매개 물질로 밝혀진 바 있다. 따라서 저자들은 요산 결정 침착이 MIF를 국소적으로 발현시켜 육아종을 형성하고 신장 조직 손상을 유발한다는 가설을 세우고 이를 증명하고자 고뇨산성 신병증 동물 모델에서 이 연구를 시행하였다. 방 법 : 고뇨산성 신병증은 Sprague- Dawley 쥐에서 uricase 억제제인 oxonic acid(OA, 2%)와 요산(1.5%)을 식이에 보충하여 35일 동안 투여하여 유발하였고(UA군) 정상 식이를 투여한 군(대조군)과 비교하였다(각 군 n=6). 35일째에 신장을 절제하여 병리 소견을 관찰하였고 면역 조직화학 염색법과 in situ hybridization으로 MIF의 발현과 침착된 세포들을 관찰하였다. 결 과 : UA군에서는 신세뇨관내 요산 결정과 육아종을 동반한 광범위한 세뇨관 간질성 손상이 관찰되었다. UA군에서 신세뇨관 MIF mRNA 발현은 정상 대조군 보다 6배 이상 증가하였으며(p<0.001) MIF mRNA는 신세뇨관 손상 부위와 육아종내에서 주로 발현되었다. 또한 UA군에서는 대식세포(p< 0.001)와 T 세포(p<0.001) 밀집이 대조군에 비하여 심하였고 육아종 부위에서 주로 관찰되었다. 대조군에서는 모두 광학 현미경 소견상 정상 신장 조직 소견을 보였고MIF mRNA와 단백 발현은 미세하였다. 결 론 : 고뇨산성 신병증에서 발생하는 육아종 형성과 신손상은 MIF에 의해서 매개되는 지연성 과민 유사 반응과 관련이 있을 것으로 생각한다. N/A

스테로이드 복용력이 없는 성인 여자에서 발생한 거대 간세포선종 1 예

김인철,한상원,김명훈,김병기,김동구,김부성,박두호,이창돈,김성수,윤승규,김선무,한혁준 대한내과학회 1996 대한내과학회지 Vol.51 No.5

Hepatocellular adenoma is a benign epithelial tumor of liver, occurring in non-cirrhotic liver, especially in women. And the most of them are associated with oral contraceptives. We experienced a case of hepatocellular adenoma in a 38 years old woman without a history of taking contraceptive steroid, and the mass was about 15㎝ in diameter. Hepatocellular adenoma containing suspicious cancerous lesion was confirmed by operation and histologic examination.

신증후군에 합병된 다발성 혈전증에 대한 MRA 진단 및 성공적인 혈전 용해술 1예

최성철,허우성,도정호,김정아,한혁준,정시정,박진아,김윤구,김대중,오하영,김보현 대한신장학회 2001 대한신장학회잡지 Vol.20 No.5