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혈액투석중인 만성신부전 환자에서 혈압조절의 양상과 투석적절도가 혈압에 미치는 영향
김명빈(Myung Bin Kim),박규용(Ky Yong Park),김근호(Guen Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo) 대한내과학회 1999 대한내과학회지 Vol.56 No.5
N/A Objective : Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. Methods : The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. Results : The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP <114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. Conclusion : Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.
Trypsin과 chymotrypsin이 호산구 화학주성 및 활성화에 미치는 효과
이명구 ( Myung Goo Lee ),김명빈 ( Myung Bin Kim ),김진환 ( Jin Hwan Kim ),윤택중 ( Taek Joong Yun ),최정은 ( Jeong Eun Choi ),김동환 ( Dong Hwan Kim ),모은경 ( Eun Kyung Mo ),박명재 ( Myung Jae Park ),현인규 ( In Gyu Hyun ),정기석 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.3
투석식 초여과를 이용한 간경변 환자에서의 저항성 복수의 조절
한상진(Sang Jin Han),정의훈(Eui Hun Jeong),백광호(Gwang Ho Baik),윤동석(Dong Seok Yoon),김명빈(Myung Bin Kim),고문수(Moon Soo Koh),구자룡(Ja Ryong Koo),장웅기(Ung Ki Jang),김동준(Dong Jun Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.5
N/A Background: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. Methods: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. Results: The mean ultrafiltration time was 231±28min, ultrafiltrated volume was 5.15±1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5±23.7㎎/dL to 25.7±20.2㎎/dL; serum aldosterone level decreased from 807.3±301.1pg/ml to 431.1±187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67±0.28g/dL to 1.90±1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. Conclusion: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
이원영(Weon Young Lee),기모란(Moran Ki),오진경(Jin Kyoung Oh),이종구(Jong Koo Lee),김명빈(Myung Bin Kim),최보율(Bo Youl Choi) 한국역학회 2004 Epidemiology and Health Vol.26 No.2
Objectives: To estimate the complication rate and the societal cost of measles, a survey was conducted in Seoul, Jeonju city, and Kyonggi province in 2001. Methods: A telephone survey was conducted in Jeonju city (175/307) and four local areas of Kyonggi province (793/1,238) to gather information on the complications of measles. To estimate societal cost, the telephone survey was conducted for the sampled subject by complication type and the age group. The response rate was 78% (180/230). Paid bills were examined for direct cost estimation, and the time cost and the transportation expense were analyzed for indirect cost estimation. Results: The incidence of a complication of measles was 3.1% which found to be higher in younger age group. The incidence of pneumonia, otitis media, and encephalitis were 2.1%, 0.8%, and 0.2% respectively. Direct and indirect costs of in-patients without a complication were $417.00 (US $1.00 = 1,000 won) and $256.00 per case, respectively, and the out-patients who have no complication were $54.00 and $65.00, respectively. The average cost for a patient with measles without complication was $119.00 as the result. The societal cost of encephalitis was high as $6,660. Estimated total societal cost of measles ranges from $14 million to $69 million in the year 2000. Conclusion: Complication rate of measles was fairly low compared to foreign countries. The lower rate could result from the difference in vaccination rate and the age distribution of the measles patients. The cost of measles without complication was not high. However, the cost for the complication and the total disease burden caused by measles shown to be high in the year 2000.
공간 점유 병소로서 간경변과 동반하여 발생한 무산소성 가성분엽성 간괴사 1예
한상진,고문수,김동준,백광호,정의훈,장웅기,김명빈,윤동식 대한소화기학회 1998 대한소화기학회지 Vol.31 No.3
The common space-occupying lesions of the liver associated witb cirrhosis are hepatocellular carcinoma, regenerating nodule, simple liver cyst, hepatic necrosis, and abscess. The differential diagnosis of hepatocellular carcinoma from other lesions is important for its treatment and prognosis. Anoxic pseudolobular necrosis of the liver associated with cirrhosis resembles hepatocellular carcinoma in view of clinical and radiological findings. Clinical diagnosis may depend on biopsy, although differentiation between this lesion and necrotic hepatocellular carcinoma may be difficult. A 55-year-old man was admitted with bematemsis and melena. Radiologic examination showed small, round space occupying lesions of the liver. These lesions resembled necrotic hepatocellular carcinoma. We diagnosed this lesions as anoxic pseudolobular necrosis of liver by repeated biopsies. We report this case because of its similarity with necrotic hepatocellular carcinoma in view of radiologic findings and its rarity.