Meckel 게실의 합병증으로 수술 받은 환아의 임상양상

김현아,최금자,한후재 이화여자대학교 2003 EMJ (Ewha medical journal) Vol.26 No.2

Objectives : The purpose of study is to assess the clinical characteristics of complicated Meckel's diverticulum in children. Methods : A retrospective review of pediatric cases of complicated Meckel's diverticulae that were surgically treated at Ewha Womans University Hospital from 1985 was performed. The charts were reviewed for the age and sex of the patients, operation finding, treatment, and outcome. Results : A total 13 patients with a complicated Meckel's diverticulum were identified. There were 8 boys(61.5%) and 5 girls (38.5%) with a mean age of 5.3 years (range, 1month to 14years). Presenting signs and symptoms included digestive hemorrhage (6), intestinal obstruction(4), perfora-tion (1), intussusception due to inverted Meckel's diverticulum (1) and diverticulitis (1). A ^(99m) technetium pertechnetate scintiscan was positive in 3 of 4 patients. Barium contrast studies and colonoscopys were not diagnostic. The mean distance from the ileocecal valve to the diverticulum was 47.0±15.7cm. Average length of the diverticulum was approximately 4.7±3.0cm. Segmen-tal small bowel resection including Meckel's diverticulum (84.6%) or wedge excision(15.4%) was done for treatment. In the bleeding group, ectopic gastric mucosa was present in 5 of 6 patients. Postoperative morbidity and mortality was each 0%. Conclusion : The results of this study draw attention to the fact that the complicated Meckel's diverticulum must be suspected in children with acute abdomen or gastrointestinal bleeding. 목적: Meckel 게실의 합병증의 원인이 되어 수술적 치료를 받은 소아 환자들의 임상적 증상과 수술소견, 병리학적 소견을 분석하여 이들의 특징을 알아보고자 하였다. 방법 : 1985년 이후 이화대학교의료원에서 Meckel 게실의 합병증으로 수술을 받은 15세 이하의 소아들 대상으로 하여 의무기록과 조직병리 검사 결과를 조사하였다. 결과: 총 13명의 환아가 Meckel 게실의 합병증으로 수술을 받았으며 남녀의 비는 1.6:1로 남아에서 호발하는 경향을 보였으며, 수술 시 평균 연령은 5.3세였다. 수술의 원인이 된 Meckel 게실의 진단은 장출혈 6예, 장폐색 4예,Meckel 게실의 천공 1예, 장중첩 1예, 게실염 1예였다. 회맹판에서 게실까지의 평균길이는 47.0±15.7cm이었으며, 소장부분절제술과 쐐기절제술이 각각 84.6%와 15.4%에서 시행되었다. 장출혈을 나타내었던 환아 6명 중 5예에서 병리조직에서 이소성 위 점막이 관찰되었다. 술 후 합병증과 사망예는 없었다. 결론 : 소아에서 외과적 급성 복증이나 장출혈의 증상이 나타날 경우, Meckel 게실의 합병증의 가능성에 대한 외과의의 인식이 필요하다.

CAPD 환자에서 복막 투석 도관을 제거하지 않고도 치료된 Rhizobium radiobacter 복막염 1예

한금현 ( Kum Hyun Han ),한상엽 ( Sang Youb Han ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

투석막에 따른 염증성 싸이토카인의 생성 및 응고기전 활성화에 관한 연구

한금현(Kum Hyun Han),이지은(Ji Eun Lee),서지아(Ji A Seo),성수아(Su Ah Sung),이소영(So Young Lee),조상경(Sang Kyung Jo),조원용(Won Yong Cho),김형규(Hyung Kyu Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 혈액투석 중 혈액-투석막간의 상호작용에 의해 혈액 옹고계, 섬유소성 용해계 및 혈구성분의 활성화가 일어나는지 알아보고, 생체적합도가 다르다고 알려진 hemophan 투석막과 polysulfone 투석막에서의 차이가 있는지 알아보았다. 방 법 : 유지혈액투석을 받는 25명의 말기 신부전 환자를 hemophan 투석막 (n=13), polysulfone 투석막 (n=12)의 두 군으로 나누어 2주간 혈액투석을 시행한 뒤, 투석 전후의 혈액을 채취하여 혈청 Thrombin-antithrombin complex (TAT), D-dimer, tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), fibrinogen, aPTT를 측정하고, 이들의 혈액투석 전후의 변화와 투석막에 따른 변화율의 차이를 비교하였다. 단핵구 활성시 생성되는 염증성 싸이토카인인 TNF-α 단백의 혈청 농도로 단핵구의 활성을 평가하였다. 결 과 : 혈액투석 후 혈청 TNF-α 단백 농도의 변화가 없었으며, Hemophan군과 polysulfone군 사이에도 차이가 없었다. 혈액투석 후 PAI-1를 제외한 aPTT, fibrinogen, TAT, D-dimer, tPA의 농도는 모두 의미있게 증가되었다. Hemophan굴과 polysulfone군 사이의 aPTT, fibrinogen, D-dimer, PAI-1, tPA의 투석 친후 변화량 (Δ)은 차이가 없었으나, TAT의 변화량 (Δ)은 polysulfone군에서 의미있게 적었다. 결 론 : 혈액-투석막간의 상호작용은 혈액 응고계 뿐 아니라 섬유소성 용해계도 활성화시키며, 혈액 응고계의 활성을 적게 일으킨다는 점에서 polysulfone의 생체적합도가 hemophan에 비해 우수하다. 혈액-투석막간의 상호작용이 혈청 TNF-α 단백 농도에 변화를 주지 못했는데, 향후 연구가 필요하리라 생각된다. Background : Blood-dialyzer membrane interaction in hemodialysis has the potential to activate blood coagulation and fibrinolysis, and it might elicit production of inflammatory cytokine such as TNF-α by monocytes activation. The aim of the present study was to; ⅰ) assess changes in coagulation status, fibrinolytic activity and plasma level of TNF-α during hemodialysis; ⅱ) determine whether the extent of activation is dependent on the dialyzer material used. Methods : Twenty-five end-stage renal failure patients who had undergone maintenance hemodialysis were included in the study. Patients were randomly divided into two groups; one using hemophan dialyzer membrane (n=13) and the other using polysulfone dialyzer membrane (n=12). On sixth dialysis session, blood samples were obtained before and at the end of hemodialysis. Thrombin-antithrombin complex (TAT) and D-dimer, each reflecting in vivo thrombin generation and fibrin degradation product respectively, were measured for coagulatory and fibrinolytic activity. Tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen were measured. Activated partial thromboplastin time (aPTT) was measured for efficancy of anticoagulant. Plasma level of TNF- a was also measured. Results : During hemodialysis, plasma level of TNF-α did not change. Between hemophan dialysis and polysulfone dialysis group, the change in plasma level of TNF-α (Δ TNF-α) was not different. Significant changes were observed in aPTT, fibrinogen, TAT, D-dimer, tPA during hemodialysis (p<0.05) except in PAI-1 (p=0.71). Between two groups, changes in aPTT, fibrinogen, D-dimer, PAI-1 and tPA (ΔaPTT, Δfibrinogen, ΔD-dimer, ΔPAI-1, ΔtPA) were not different (p>0.05). However, the change in TAT (ΔTAT) was significantly lower in polysulfone dialysis group (p=0.049). Conclusion : Hemodialysis enhances coagulatory activity despite the use of anticoagulant and also enhances fibrinolytic activity, which is likely the result of tPA release. In activation of coagulatory system, biocompatibility of polysulfone membrane is superior to that of hemophan membrane. Plasma level of TNF-α did not change during hemodialysis, further study should be considered.

사구체 여과율의 지표로서 혈청 크레아티닌과 비교한 혈청 Cystatin C 농도

한금현 ( Kum Hyun Han ),한상엽 ( Sang Youb Han ),강영선 ( Young Sun Kang ),차대룡 ( Dae Ryong Cha ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.5

당뇨병 신증 : 스트렙토조토신 유발 당뇨병 쥐에서 펜톡시필린 투여가 MCP-1 발현과 콩팥병증에 미치는 효과

한금현 ( Kum Hyun Han ),한상엽 ( Sang Youb Han ),이윤미 ( Yun Mi Lee ),김한성 ( Han Seong Kim ),고강지 ( Gang Jee Ko ),강영선 ( Young Sun Kang ),차대룡 ( Dae Ryong Cha ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

Feasibility and Efficacy of Stereotactic Ablative Radiotherapy for Barcelona Clinic Liver Cancer-C Stage Hepatocellular Carcinoma

Bae, Sun Hyun,Kim, Mi-Sook,Cho, Chul Koo,Kim, Kum Bae,Lee, Dong Han,Han, Chul Ju,Park, Su Cheol,Kim, Young Han The Korean Academy of Medical Sciences 2013 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.28 No.2

<P>The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose ≥ 80 Gy<SUB>10</SUB> were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy<SUB>10</SUB> is required for BCLC-C stage.</P>

Effect of IgA Aggregates on Transforming Growth Factor-β1 Production in Human Mesangial Cells and the Intraglomerular Expression of Transforming Growth Factor-β1 in Patients with IgA Nephropathy

( Sang Youb Han ),( Chun Gyoo Ihm ),( Dae Ryong Cha ),( Young Sun Kang ),( Kum Hyun Han ),( Hyoung Kyu Kim ),( Jee Young Han ) 대한내과학회 2005 The Korean Journal of Internal Medicine Vol.20 No.1

Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

( Sollip Kim ),( Hyun-jung Kim ),( Hyeong-sik Ahn ),( Se Won Oh ),( Kum Hyun Han ),( Tae-hyun Um ),( Chong-rae Cho ),( Sang Youb Han ) 대한신장학회 2017 Kidney Research and Clinical Practice Vol.36 No.3

Background: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. Methods: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. Results: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/ min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference -80.47 mg/gCr, 95% CI -149.29, -11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference -0.92 mg/dL, 95% CI -1.29, -0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001). Conclusion: Febuxostat might be more renoprotective than allopurinol.

당뇨병성 신증쥐에서 retinoid와 PPAR-γ 촉진제 병합투여에 관한 연구

한상엽 ( Sang Youb Han ),김시현 ( Cy Hyun Kim ),한금현 ( Kum Hyun Han ),차대룡 ( Dae Ryong Cha ),김한성 ( Han Seong Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

Purpose : An inflammatory mechanism has been suggested to contribute to the progression of diabetic nophropathy. Both retinoid and PPAR-7 agonist, known anti-inflammatory agents, have been reported to be beneficial in diabetic nephropathy. Because they form heterodimer for transcription within the nucleus, we investigated the effect of a combination treatment with them in streptozotocin (STZ)-induced diabetic rats. Methods: STZ-induced diabetic rats were treated with retinoid and PPAR- r agonist. The effects were determined by measuring urinary monocyte chemoattractant peptide (MCP)-i, proteinuria, and intrarenal ED-1 expression. Results Blood glucose concentration was higher in diabetic rats than in control rats. Retinoid and PPAR- r agonist did not affect blood glucose concentration. Urinary protein excretion (8.6 I 0.69 vs. 22.1 mg/mgCr, p<0.0l) and urinary MCP-1 (19.8z3.4 vs. 61.5±6.1 pg/mgCr, p`cO.Ol) were significantly higher in diabetic rats at four weeks after the induction of diabetes compared with controls. Proteinuria in the group with retinoic acid (16.9 1.4, mg/mgCr, pcz0.05) and PPAR-7 agonist (14.6 `1.5 mg/mgCr, pc0.05) were decreased. Retinoic acid (42.2±2.7 pglmgCr, p<O.05) and PPAR- agonist (40.5 `4.2pg/mgCr, pc0.05) significantly suppressed MCP-1 level in diabetic rats. However, combination treatment ment was not effective to proteinuria and urinary MCP-1 concentration. Urinary protein excretion was significantly correlated with MCP-1 (r0.9, p`c0.0i). Immunohistochemistry revealed a significant increase in staining for ED-i protein in the diabetic kidneys. Both retinoid and PPAR-γagonist significantly suppressed intrarenal ED-i synthesis. However combination treatment didnt show any additional beneficial effects. Conclusion: Both retinoic acid and PPAR-γagonist suppressed preteinuria and inflammatory changes in diabetic rats. However, there were no additional effects of the combination treatment present. Further ressrch is needed to determine the effect of the combination treatment on diabetic nephropathy.

A Perirenal Abscess Recurring with Methicillin-Resistant Staphylococcus Aureus and Mycobacterium Tuberculosis Co-Infection after Treatment of Escherichia Coli Infection: A Case Report

( Tae Wan Kim ),( Seung Dae Kang ),( Han Sang Lee ),( Sang Youb Han ),( Yee Gyung Kwak ),( Keon Cheol Lee ),( Han Seong Kim ),( Kum Hyun Han ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6

Renal and perirenal abscesses are disease entities caused by infections in or around the kidneys. As imaging modalities have improved in quality and convenience, diagnosing these diseases has become easier. Some cases are refractory to conventional treatment and require surgical correction, although most patients can be cured by antibiotic treatment and percutaneous drainage. We here report the case of a patient with a perirenal abscess that recurred twice after appropriate antibiotic treatment and percutaneous drainage. Although Gram-negative bacilli are the most common pathogenic cause of these diseases, we isolated methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis in our patient. Thus, poor responses to appropriate treatment in patients with a perirenal abscess can result not only from antimicrobial resistance or a co-infection but also from the 2 conditions existing concomitantly.