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강우헌,안병훈,정만표,김호중,권오정,이종헌,김진국,한정호,이경수,Kang, Woo-Heon,Ahn, Byung-Hoon,Chung, Man-Pyo,Kim, Ho-Joong,Kwon, O-Jung,Rhee, Chong-H.,Kim, Jhin-Gook,Han, Jung-Ho,Lee, Kyung-Soo 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1
We report a rare case of primary tracheal malignent melanoma documented by careful clinical examination. Differentiation between primary and metastatic malignant melanoma is very difficult We conclude that this tracheal tumor is a primary malignant melanoma based on characteristic pathologic features and the exclusion of the possibility of spontaneous regression of the primary site by patient's history and physical examination.
신장내과 조기의뢰가 혈액투석 예후에 미치는 영향 : 단일 임상 기관 연구
강우헌 ( Woo Heon Kang ),오하영 ( Ha Young Oh ),신유정 ( You Jung Shin ),설정숙 ( Jeong Sook Seol ),강문자 ( Moon Ja Kang ),탁은영 ( Eun Young Tak ),이남선 ( Nam Sun Lee ),이미경 ( Mi Kyoung Lee ),류로사 ( Ro Sa Ryu ),송영혜 ( You 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.2
CAPD 환자에서 발생한 투석액의 흉강 누출에 의한 흉수 - 비디오 흉강경 ( VATS ) 과 Talc 를 이용한 흉막 유착술 1 예
강우헌(Woo Heon Kang),김정아(Jung Ah Kim),김대중(Dae Joong Kim),여호명(Ho Myoung Yeo),임영환(Young Hwan Lim),김범(Beom Kim),윤수진(Su Jin Yoon),이현희(Hyun Hee Lee),이영기(Young Ki Lee),오하영(Ha Young Oh) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5
Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end-stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.
한국인에서 Iohexol의 혈장 청소율을 이용한 사구체 여과율의 측정
강우헌 ( Kang U Heon ),권태근 ( Kwon Tae Geun ),김대중 ( Kim Dae Jung ),강명재 ( Kang Myeong Jae ),백현정 ( Baeg Hyeon Jeong ),여호명 ( Yeo Ho Myeong ),임영환 ( Im Yeong Hwan ),김정아 ( Kim Jeong A ),이방훈 ( Lee Bang Hun ),김범 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2
배 경 : Iohexol (Omnipaque^(?))은 혈장 청소율이 GFR과 일치하는 물질로, 서구에서는 iohexol의 배설단계의 혈장 농도와 그 반감기를 이용하여 혈장 청소율을 계산하고 이를 보정하여 GFR을 추정하고 있다 [Bro¨chner-Mortensen (B-M)법]. 그러나 아직 한국인을 대상으로 그 방법이 정립된 바 없으며 또 가장 적절하고도 편리한 혈장 농도 측정 시간 및 횟수에 대해서는 논란이 있는 실정이다. 이에 저자들은 iohexol외 혈장반감기를 이용한 위와 같은 측정법을 검체 횟수 및 시간 간격을 달리하여 한국인에 적용하였을 때 GFR 측정의 정확도 및 크레아티닌 청소율을 비롯한 여러 GFR 계측 공적들의 정확도를 다음과 같이 검증하였다. 방 법 : 신장질병이 없는 한국인을 대상으로 (n=19) iohexol 정주 후 HPLC로 측정한 14시점의 혈장 농도들을 이용하여 2구획 모델에 의한 iohexol의 혈장 청소율 (CL-T)을 구하였다. 이를 기준으로 첫째 배설단계의 8시점의 농도를 이용하여 B-M법으로 계산된 청소율 (CL-M8), 둘째 그 중 각각 3, 2시점의 농도를 가지고 같은 방법으로 계산된 청소율 (CL-M3, CL-M2), 셋째 CCr를 비롯한 여러 계측 공식들을 이용한 GFR 예측치를 비교하였다. 각 측정치의 정확도는 CL-T를 기준으로 하여 -0.1≤(측정값-CL-T)/CL-T≤0.1를 만족하는 정도 (%)로 평가하였다 (DOQI guideline). 결 과 : CL-T, CL-M8, CL-M3와 CL-M2는 각각 101.9±24.0, 101±18.7, 101.7±18.6,101.9±곤19.5 mL/min/1.73 ㎡로서 서로 차이가 없었으며 CL-M8의 정확도는 74%이었고, CL-M3, CL-M2의 정확도는 각각 84%, 79%로 상호간에 차이가 없었다. GFR 계측 공식 중에서는 MDRD 공식이 비교적 정확하였다 (47%). 결 론 : 이상에서 저자들은 신장질환이 없는 우리나라 사람을 대상으로 iohexol을 이용하여 B-M 보정법으로 사구체 여과율 측정하였을 때 2회의 검체 채취로도 정확하게 사구체 여과율을 측정할 수 있음을 확인하였으나 향후 GFR 값이 다양한 보다 많은 환자를 대상으로 추가 연구가 필요할 것으로 생각한다. Background : Plasma clearance of iohexol (Omnipaque^(?)) which used widely in radiologic procedure is considered as useful method for estimation of GFR because iohexol is neither reabsorbed nor secreted from tubule after filtered as inulin and its extrarenal clearance is negligible. Plasma clearance of iohexol can be calculated from two compartment model or one compartment model with Bro¨chner Mortensen (B-M) modification which convenient and reliable. But there were controversies about sufficient sampling numbers and times for B-M modification of iohexol clearance. Methods : Nineteen healthy Korean without renal disease underwent measurement of iohexol clearance. Iohexol was given as a single iv dose, and 14 blood sample were drawn up to 300 min. A reference GFR was iohexol clearance calculated from two-compartment model using 14 samples (CL-T). From 8, 3 and 2 samples clearances were calculated by B-M modification (CL-M8, 3 and 2 respectively). The accuracy of estimates was evaluated as percent of estimates falling within 10% above or below the reference GFR. Accuracy of CCr and equations for GFR estimation were also compared. Results : CL-T, CL-M8, CL-M3 and CL-M2 were not different (101.9±24.0, 101.9±18.7, 101.7±18.6, 101.9±19.5 mL/min/1.73 m² respectively). Accuracy of CL-M8, 3 and 2 were not different (74%, 84% and 79% respectively, p>0.05). MDRD equation had higher accuracy (47%) compared with other equations. Conclusion : These results indicate that sampling simplified method might be reduced to only two without accuracy loss in Korean without renal disease.
금식유발 다뇨 및 요농축력 감소 병인으로 신장 수분통로 및 나트륨 운반체 조절 변화
박병석 ( Byoung Seok Park ),배은희 ( Eun Hui Bae ),강우헌 ( Woo Heon Kang ),박정우 ( Jeong Woo Park ),마성권 ( Seong Kwon Ma ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ),이종은 ( Jong Un Lee ),김수완 ( Soo Wan Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.1
Purpose: Starvation causes impairment in the urinary concentration ability. However, the molecular basis for the impaired urinary concentration and polyuria remains undefined. We examined the effects of food deprivation on the water handling by the kidney and it`s regulatory mechanism. Methods: Sprague-Dawley rats were used. They were placed in metabolic cages and deprived of food but had free access to water for 24 hours. Control rats had free access to both water and food. Protein expression of aquaporin-2 (AQP2) and Na(+)-K(+)-2Cl(-) cotransporter (NKCC2) was determined in the kidney by Western blot analysis. Protein expression of type VI adenylyl cyclase and prostaglandin E2 synthase (PGES) was determined. Urinary PGE2 excretion was also determined by radioimmunoassay. Results: Food deprivation (FD) resulted in impaired urinary concentration associated with decreased tubular water reabsorption and increased urine output. The expression of AQP2 proteins was significantly decreased in the inner stripe of the outer medulla (ISOM). The expression of NKCC2 was not affected in ISOM. The adenylyl cyclase VI expression was increased in ISOM in FD rats. The protein expression of PGES was decreased in the cortex/OSOM and ISOM. The 24 hr urinary excretion of PGE2 was significantly decreased in FD rats compared with controls. Conclusion: These findings indicate that FD-induced urinary concentration defect may related to a reduced abundance of AQP2 in the kidney. It is also suggested that the primary impairment in the pathway to the activation of AQP2 in food deprivation is independent of vasopressin/cAMP or prostaglandin activity.