만성신부전증 환자에서 지속성 장투석의 효과

황일용(Il Yong Hwang),김건호(Gun Ho Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.6

N/A Objectives: This study deals with the therapeutic effects of continuous intestinal dialysis (CID) by oral non-absorbable mannitol solutions (NAMS) on chronic uremic patients. Methods: CID was carried out in 28 chronic uremic patients who had creatinine clearance of 7.6±4.3 ml/ min and drank 200~250 ml NAMS every sixth hour for 2 to 6 months. Results: Before CID, blood urea nitrogen (BUN), serum creatinine (SCr), serum phosphorus (SP), serum uric acid (SUa), and serum potassium (SK) were 90.1±32.2, 10.6±3.2, 6.3±1.6, 9.5±2.9mg/dl, and 4.8±0.3 mmol/1, respectively. During the 2 months of CID, BUN, SCr, SP, SUa, and SK were significantly lowered to 66.4±24.1, 9.0±3.1, 5.2±1.5, 8.3±2.4 mg/dl, and 4.5±0.8 mmol/dl from those before CID (p<0.05). In 9 chronic uremic patients who stopped the CID by themselves for 2 weeks after 2 months of CID, BUN, SCr, SP, and SUa increased to the levels of 104.2±32.8, 11.7±3.2, 7.6±2.2, and 10.9±3.2 mg/dl as compared to 63.6±25.7, 8.2±2.6, 4.9±1.5, and 7.7±2.4 mg/dl during CID of the same 9 patients (p<0.05). There were no significant changes in body weight, serum calcium, serum sodium, serum chloride, hemoglobin, hematocrit, and RBC counts (p>0.05). The high performance gel chromatography has been applied to sera from the chronic uremic patients before and during CID. Integrated absorbance of 3 peaks which corresponded low to middle molecule weight range (less than 1,500 daltons) significantly decreased during CID when compared with those before CID (p<0.05). Conclusion: From these clinical results, the CID by oral NAMS can be well tolerated, remove the uremic toxins, improve uremic symptoms and be a new approach to the replacement therapy of chronic uremic patients.

사람의 적혈구에서 용혈성을 이용하여 측정한 음이온 교환특성

우재석,김용근,황일용,Woo, Jae-Suk,Kim, Yong-Keun,Hwang, Il-Yong 대한생리학회 1986 대한생리학회지 Vol.20 No.2

사람의 적혈구에서 여러 가지 음이온들의 등삼투성 암모늄 염으로 된 용액속에서의 용혈성을 이용하여 이들 음이온들이 $HCO_3\;^-$ 혹은 $OH^-$와 교환되어 이동되는 정도와 몇 가지 억제 물질의 영향, pH 및 온도 변화의 효과를 관찰하여 그 결과를 지금까지 방사성동위원소를 이용한 실험에서 보고된 성적들과 비교하였다. $SITS.\;H_2DIDS$, furosemide등은 농도에 비례하여 등삼투성 $NH_4Cl$ 용액에서의 용혈 시간을 연장시켰으며 $t_{1/2}$를 두배로 연장시킨 농도는 각각 $ 2.3{\times}10^{-7}M,\;3{\times}10^{-7}M,\;2.5{\times}10^{-5}M$이었다. Acetazolamide도 농도에 비례하여 적혈구 용혈 시간을 연장시켰으며 $t_{1/2}$을 2배로 연장시킨 농도는 $2.4{\times}10^{-5}M$이었다. 온도를 $2^{\circ}C$에서 $37^{\circ}C$까지 변화시키며 적혈구 용혈시간을 관찰했을 때 높은 온도 의존성을 보였으며 $1/t_{1/2}$을 Arrhenius plot하였을 때 $20^{\circ}C$에서 회절점을 보였고 activation energy는 $20^{\circ}C{\sim}37^{\circ}C$범위에서 11.2kcal/mol이었다. 여러 가지 무기 음이온의 투과도를 $t_{1/2}$을 기준으로 비교했을 때 $Cl^->NO_3\;^->SCN^->SO_4\;^{2-}>SSO_3\;^{2-}>HPO_4\;^{2-}$의 순이었으며 유기 음이온 중 oxalate는 $Cl^-$보다 높은 투과도를 succinate는 낮은 투과도를 보였다. 이상의 결과를 종합하면 등삼투성 암모늄염 용액에서의 적혈구 용혈성을 이용하여 음이온 이동에 대하여 관찰한 결과들이 지금까지의 동위원소를 이용한 실험 성적들과 유사한 결과를 보여주고 있으며 특히 이동률이 빠르거나, 높은 온도범위에서의 음이온의 이동을 관찰하는데는 동위원소를 이용한 실험의 단점을 보완할 수 있는 장점도 있어 이 방법의 적혈구 막을 통한 음이온의 이동 기전과 이에 영향을 미치는 인자들을 연구하는데 간편하고 유용하게 이용될 수 있을 것으로 사료된다. The characteristics of anion exchange with internal $HCO_3\;^{-}\;(or\;OH^-)$ was studied by determining the time course of hemolysis in isoosmotic ammonium salt solution in human erythrocytes. The effects of inhibitors, pH and temperature on the exchange between internal $HCO_3\;^-\;(or\;OH^-)$ and external $Cl^-$ were observed and the permeabilities of various organic and inorganic anions were also measured. The results were compared with data previously reported from the experiments using radioisotopes. The results are as follows; 1) SITS $H_2DIDS$ and furosemide inhibited the hemolysis of erythrocytes in isoosmotic $NH_4Cl$ solution in a dose·dependent manner, and the concentrations for lengthening twice the time for $half-hemloysis(t_{1/2})\;were\;2.3{\times}10^{-7},\;1.3{\times}10^{-7}\;and\;2.5{\times}10^{-5}M$, respectively. 2) Acetazolamide also shifted the time-dependent hemolytic curve to the right in a dose-dependent manner, and the concentrations for lengthening twice $t_{1/2}\;was\;2.4{\times}10^{-5}M$. 3) The time-dependent hemolysis was delayed by decreasing pH from 7.0 to 6.2, but w·as not affected by the change of pH in the range of 7.0 to 8.2. 4) The time for $half-hemloysis(t_{1/2})$ showed a temperature-dependency and Arrhenius plot exhibited a break point at $20^{\circ}C$. The apparent activation energy calculated from this plot was 18.1 kcal/mol between $2^{\circ}C-20^{\circ}C$ and 11.2 kcal/mol between $20^{\circ}C-37^{\circ}C$, respectively. 5) The apparent permeabilities of various inorganic anions based on $t_{1/2}$ were in the order of $Cl^->NO_{3}\;^->SCN^->SO_4\;^{2-}>SSO_3\;^{2-}>HPO_4\;^{2-}$. which was similar with the previous reports based on the experiment using radioisotopes. The results Obtained from this study are comparable with the previous data reported from the experiments using radioisotopes. This indicates that the hemolysis of erythrocytes in isoosmotic ammonium salt solution can be used as a simple and good method for the study of anion exchange in erythrocyte membrane.

선천성 고관절 탈구에 대한 Colonna 관절낭 관절성형술

김광회(Kwang Hoe Kim),최일용(Il Yong Choi),황건성(Kuhn Sung Hwang),서경환(Kyung Hwan Seo) 대한정형외과학회 1983 대한정형외과학회지 Vol.18 No.2

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.

Purification and Biochemical Characterization of the Amiloride-Sensitive Sodium Channels

Hwang, Il Yong 대한신장학회 1992 대한신장학회잡지 Vol.11 No.부록6

신 유두괴사 1 예

김건호,김명희,이옥재,황일용,안인옥,심대석,원용환,류경렬,지혜기 대한내과학회 1994 대한내과학회지 Vol.47 No.1

We report a case of renal papillary necrosis which has recurrent urinary tract infections, partial unilateral ureteral obstruction, and the classic cavity pattern by I.V.P.. Renal papillary necrosis is defined as an ischemic necrosis involving the renal medulla which, in the absence of localizing obstructive or vascular factors, is generally bilateral and most often is associated with infections of the urinary tract. The clinical course is characterized by lumbar pain, hematuria, pyuria, bacteriuria, and sepsis; occasionally also by the passage of whole renal papillae or sections there of in the urine. The diagnosis can sometimes be made by finding pieces of renal medullary tissue in the urinary sediment. Pyelography may demonstrate cavities and sinuses in the region of the papillae. The classic ring-shadow pattern results from detachment of a papilla and its outline within the contraet-filled cavity.

기능부전 혈액투석동정맥루 치료법으로서 경피경관혈관성형술의 임상적 의의 및 효과

정연순,김민대,신호식,정규식,유창현,김홍기,황일용,임학 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 기능부전 혈액투석동정맥루의 치료로서의 경피경관혈관성형술의 임상적 의의와 장기개통률에 영향을 미치는 요소에 대하여 알아보고자 본 연구를 시행하였다. 방 법 : 기능부전 혈액투석동정맥루로 정맥조영술을 시행한 53명의 환자(총 61예) 중 동정맥루의 협착 및 폐쇄로 경피경관혈관성형술이 시도된 환자는 49명(총 57예)이었으며 이들의 정맥조영술 적응증을 알아보았다. 이 중 경피경관혈관성형술을 성공적으로 시행받은 38명의 환자(총 46예)를 대상으로 하여 임상적 특성과 6, 12, 24개월의 개통률을 분석하였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기개통률에 미치는 영향을 Kaplan-Meier method에 의한 log-rank test를 이용하여 평가하였고, multivariate analysis로 Cox Regression Model을 사용하여 평가하였다. 통계적 유의성 검정은 p값이 0.05 미만인 경우로 하였다. 경피경관혈관성형술을 실패한 경우의 정맥조영술 소견과 시술 전후의 합병증을 조사하였다. 결 과 : 시술의 성공률은 80.7%(46/57)였으며 성공한 예의 추적 검사에서 개통률(postintervention primary patency)은 6, 12, 24개월 각각 68, 38, 5%였다. 재협착으로 인해 2번의PTA를 시행받은 환자가 8명 있었으며, 이들 경우를 포함했을 때의 개통률(postintervention assisted primary patency)은 6, 12, 24개월 각각 69, 40, 10%였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기 개통률에 미치는 영향은 통계학적으로 유의한 경우는 없었다(p>0.05). 혈관성형술을 실패한 경우는 총 11예로 대량혈전으로 인한 완전폐쇄가 6예, 광범위한 과도한 혈관협착이 5예였다. 시술과 연관된 합병증은 없었다. 결 론 : 이상의 결과로 동정맥루 협착이 동반된 혈액투석 환자에서 경피적경관혈관성형술은 안전하고 비교적 효과적인 치료법으로 사료되며, 장기 개통률에 영향을 미치는 요소는 없었다. Purpose : The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty( PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. Methods : Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier logrank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated. Results : The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p>0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. Conclusion : PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study. (Korean J Nephrol 2002;21(2):276-284)

장기 혈액투석 환자에서 합병된 혈색소증 1 예

김건호,이옥재,신원호,심대석,류경렬,김건용,황일용 대한내과학회 1993 대한내과학회지 Vol.45 No.5

Secondary hemochromatosis is primarily a consequence of the treatment of the anemia of long term hemodialysis patients with frequent blood transfusions, seldom a result of oral or parentral iron therapy. Clinically, iron overload may be a serious problem for some maintenance hemadialysis patients and may be manifested by organ dysfunctions. Diagnosis of iron overload can be established by serum ferritin determination, liver biopsy or bone marrow examination, which correlates closely with total body iron stores. It is important to early detect the iron overload and to ristrict blood transfusions or iron therapy in these patients. We present secondary hemochromatosis in a long term hemodialysis patients with 140 pints blood transfusions for 5 years, confirmed by serum ferritin level, HLA (human leukocyte antigen) test and liver biopsy. We are treating this patient with recombinant human erythropoietin (EPO) in order to reduce the frequency of blood transfusions.

지속성 외래 복막투석 환자에 동반된 음낭 수종 및 간접 서혜부 탈장 1 예

김건호,하우송,이옥재,김성욱,김한모,심대석,황일용,함종렬,안인옥 대한내과학회 1994 대한내과학회지 Vol.46 No.5

Abdominal wall hernia is one of complications on CAPD patients. The incidence of this complication varies from 9.9 to 24% among CAPD patients, with a greater incidence among women and old men. The majority of the reported herniae can be differentiated to be incisional (i.e., in the incision of the implanted catheter), umbilical and inguinal according to their locations. It is necessary that patients on CAPD be examined regularly for symptoms and signs of abdominal hernias. Recently, we experienced a 61-year-old man on continuous ambulatory peritoneal dialysis complained of left scrotal and inguinal swelling and tenderness, which was diganosed as indirect inguinal hernia, left, associated with a hydrocele by transillumination and ultrasonography. A herniorraphy was performed, and his symptoms were subsided.