급성신부전으로 발현한 결절성 다발성 동맥염

박태운 ( Tae Woon Park ),우명렬 ( Myoung Lyeol Woo ),한서구 ( Seo Goo Han ),김정훈 ( Jeong Hun Kim ),전병수 ( Byung Soo Jeon ),이상철 ( Sang Cheol Lee ),송지선 ( Ji Sun Song ),윤수영 ( Soo Young Yoon ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.6

Classic polyarteritis nodosa (c-PAN), first described by Kussmaul and Maier in 1866, is a systemic illness characterized by necrotizing inflammation of mediumsized arteries. Rapid progressive renal failure is very rare in c-PAN in contrast to microscopic polyangiitis (MPA). We report a case of c-PAN presented with rapidly progressive renal failure. A 58 year-old male was referred to our hospital for evaluation of asthenia and right visual loss. An increase in serum creatinine level was developed in the 6th day of hospitalization and acute renal failure was aggravated rapidly. Renal biopsy showed the transmural fibrinoid necrosis of small and medium sized arteries with few glomerular crescents. P-ANCA was detected in serum, and all clinical and laboratory findings supported the diagnosis of c-PAN. He was treated with pulse methylprednisolone, followed by oral corticosteroid and cyclophosphamide, and received temporary hemodialysis. After the treatment, he recovered and was discharged but his visual defect was irreversible despite the treatment. (Korean J Nephrol 2006;25(6):1029-1034)

기계환기 중인 중환자에서 영양생화학적 지표 측정의 의의

한서구 ( Seo Goo Han ),박일운 ( Il Woon Park ),박태운 ( Tae Woon Park ),신보경 ( Bo Kyung Shin ),문동석 ( Dong Seok Moon ),김형진 ( Hyeong Jin Kim ),정재호 ( Jae Ho Chung ),최정은 ( Jung Eun Choi ),원영준 ( Young Jun Won ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2

목적: 중증의 환자에게 있어 생화학적 영양 상태는 질병에서 회복되는 데에 매우 중요하다. 따라서 본 연구에서는 기계 환기 중인 중환자에서의 영양생화학적 지표를 측정하고자 한다. 방법: 중환자실에 입원하여 기계 환기 중인 중환자 126명(남자 72명, 여자 54명)을 대상으로 하여 영양생화학적 지표로써 혈청 총단백, 알부민, 헤모글로빈, 헤마토크릿, 칼슘, 무기인, %임파구(%Lymphocyte), 혈액요소질소 및 크레아티닌을 조사하였다. 예후인자로 기계 환기 기간, 중환자실 입원기간 및 총 입원기간을 후향적으로 조사하여 예후인자와 영양생화학적 지표와의 상관관계를 분석하였다. 결과: 헤모글로빈은 예후인자인 중환자실 입원기간(p<0.05), 총 입원기간(p<0.01), 그리고 기계 환기 기간(p<0.01)과 음의 상관관계를 보였다. 크레아티닌은 중환자실 입원기간(p<0.01), 총 입원기간(p<0.01), 그리고 기계 환기 기간(p<0.05)과 양의 상관관계를 보였다. 예후인자에 따른 다중회귀분석에서 중환자실 입원기간에 영향을 미치는 독립된 인자는 혈액요소질소와 크레아티닌이었고, 총 입원기간에 영향을 미치는 독립된 인자는 혈액요소질소이었으며, 기계 환기 치료기간에 영향을 미치는 독립된 인자는 혈청 총단백, 알부민, 칼슘, 무기인, 혈액요소질소 및 크레아티닌이었다. 결론: 이러한 결과로 미루어 볼 때 기계 환기 중인 중환자에게는 영양 불량과 빈혈의 위험성이 있으며, 이에 영양 불량과 빈혈의 발생을 줄일 수 있는 적절한 영양 중재가 필요하다. Background: The nutritional status of critical-ill patients is important for recovering from the disease itself. Therefore, this present study was designed to assess the biochemical and nutritional parameters of Intensive-Care Unit (ICU) patients on mechanical ventilation. Methods: We retrospectively reviewed the medicial records of 126 patients (male/female=72/54) who were on mechanical ventilationin the ICU. The nutritional parameters such as serum total protein, albumin, hemoglobin, hematocrit, calcium, phosphorus, total cholesterol, % lymphocytes, blood urea nitrogen (BUN), and creatinine (Cr) were measured at the beginning of mechanical ventilation. We also measured the outcome variables such as the duration of mechanical ventilation, the ICU length of stay and the hospitalization period. We analyzed the relationship between the nutritional parameters and the outcome variables of ICU patients on mechanical ventilation. Results: The level of hemoglobin was negatively correlated with the outcome variables; the ICU length of stay (p<0.05), the hospitalized period (p<0.01), and the duration of mechanical ventilation (p<0.01). The creatinine level was positively correlated with the outcome variables; the ICU length of stay (p<0.01), the hospitalized period (p<0.01) and the duration of mechanical ventilation (p<0.05). On the multiple regression analysis, the serum total protein, albumin, calcium, inorganic phosphorus, BUN and creatinine were independent factors affecting the duration of mechanical ventilation. Conclusions: These findings indicate that ICU patients with mechanical ventilation have a risk for malnutrition and anemia. So, an adequate nutritional intervention is required for these patients in order to decrease the prevalence of malnutrition and anemia.(Korean J Med 73:151-158, 2007)

말기 신부전 환자에서 발생한 기종성 위염

고근준 ( Geun Jun Ko ),박경석 ( Koung Suk Park ),박태운 ( Tae Woon Park ),우명렬 ( Meung Yeul Woo ),한기준 ( Ki Jun Han ),이상철 ( Sang Cheul Lee ),조재희 ( Jae Hee Cho ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1

Emphysematous gastritis is a rare infection of the stomach wall with high mortality rate. It is caused by gas forming organisms and may arise by local spread through the mucosa or hematogenous dissemination from distant focus. Clinical manifestation includes acute abdomen with systemic toxicity, and diagnosis is based on radiologic demonstration of gas within the gastric wall. Treatment should be aimed to cover gram-negative organisms and anaerobes using wide-spectrum intravenous antibiotics, and sometimes surgical management may be needed in order to enhance survival. Herein, we report a case of emphysematous gastritis in a patient with end stage renal disease on hemodialysis. (Korean J Gastroenterol 2011;58:38-41)

혈액투석, 복막투석 : 온라인 혈액투석여과법이 심박수 변이성에 미치는 영향 -2년 추적 연구 결과-

윤수영 ( Soo Young Yoon ),이상철 ( Sang Cheol Lee ),박태운 ( Tae Woon Park ),우명렬 ( Myoung Lyeol Woo ),양성자 ( Sung Ja Yang ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

헬리코박터 제균 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과

이은재 ( Eun Jae Lee ),감창우 ( Chang Woo Gham ),박태운 ( Tae Woon Park ),홍성일 ( Sung Il Hong ),고근준 ( Geun Jun Ko ),최창환 ( Chang Hwan Choi ),한기준 ( Ki Joon Han ),조현근 ( Hyeon Geun Cho ),이재은 ( Jae Eun Lee ),김재영 ( J 대한내과학회 2006 대한내과학회지 Vol.71 No.2

목적: 헬리코박터 제균 요법은 소화성 궤양 환자의 치료에서 필수적인 부분이나, 기능성 소화불량증 환자의 치료에 있어서는 아직 그 유용성에 대하여 논란이 많은 상태이다. 본 연구에서는 기능성 소화불량증 환자와 소화성 궤양 환자에 있어서 제균 요법 이후의 증상 호전상태를 추적, 비교함으로써 기능성 소화불량증 환자에서의 제균 요법의 유용성을 평가하고자 하였다. 방법: 2003년 3월부터 2004년 2월에 걸쳐 헬리코박터 감염이 증명된 기능성 소화불량증 환자 123명과 소화성 궤양 환자 80명을 대상으로 하여 1주 또는 2주 간의 rabeprazole을 포함한 3제 제균 요법을 시행하였으며, 치료종결로부터 최소 4주가 경과한 후 제균 상태를 확인하였다. 증상척도 변화에 대한 추적 조사는 치료 전 및 치료 후 최장 18개월까지 3개월 간격으로 시행하였으며, 평균 추적기간은 12개월이었다. 결과: 평균 제균율은 82.8%로 소화성 궤양군과 기능성 소화불량증군 간에 의미 있는 차이는 없었으며, 1주 또는 2주의 제균 기간에 따른 유의한 차이도 없었다. 치료 후 3개월째 양 군 모두에서 치료 전(소화성 궤양군; 3.5±1.1 vs. 기능성 소화불량증군; 3.4±0.1)에 비하여 유의한 증상의 호전을 보였으며(1.4±0.4 vs. 1.6±0.5), 이러한 증상의 호전은 상당수의 환자에서(72.5% vs. 67.4%) 12개월 이상의 추적기간동안 유지되었다. 양 군에서 모두 제균에 실패한 경우 유의한 증상의 악화를 보였으며, 제균에 성공한 경우에 비해 유의하게 높은 누적 재발률(66.7% vs. 25.5%; 57.1% vs. 21.2%)을 보였다. 결론: 헬리코박터 감염이 있는 기능성 소화불량증 환자의 치료에 있어서 헬리코박터 제균 요법은 유용한 선택이 될 수 있으며, 제균의 실패는 증상 재발의 한 요인일 수 있다. 그러나 기능성 소화불량증 환자의 치료에 있어서 제균 요법의 역할을 정확히 규명하기 위해서는 보다 큰 규모의 무작위 연구 및 비용-효과 분석이 필요하다고 판단된다. Background: In the functional dyspepsia, Helicobacter pylori has been suggested as a causative agent. But, the effect of H. pylori eradication is still debated on functional dyspesia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in the improvement of the symptoms in patients with functional dyspepsia. Methods: The convenience sample consisted of 123 patients with functional dyspepsia and 80 patients with peptic ulcer diseases who were infected with H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked about their symptomatic improvement every three months. The degree of symptom was rated on a five-point Likert scale. Results: Overall eradication rate of H. pylori was 82.8% (168/203), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up period was 12 months. The symptomatic improvement in both group was maintained over 12 months in most patients (PUD 72.5% vs. FD 67.4%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure in both group (FD p=0.007 vs. PUD p=0.014). Conclusions: The eradication therapy of H. pylori can be one of the therapeutic options for patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom. (Korean J Med 71:141-148, 2006)

성장호르몬 결핍 성인에서 성장호르몬 투여가 심혈관 질환의 표지자에 미치는 영향

최형섭 ( Hyung Seob Choi ),김상수 ( Sang Soo Kim ),고근준 ( Kun Joon Ko ),이은재 ( Eun Jae Lee ),박일운 ( Il Woon Park ),박태운 ( Tae Woon Park ),한서구 ( Seo Goo Han ),우명렬 ( Myoung Lyeol Woo ),조지훈 ( Ji Hoon Cho ),홍성일 ( S 대한내과학회 2005 대한내과학회지 Vol.68 No.5

목적 : 성인 성장호르몬 결핍증 환자에서 3개월간의 성장호르몬 투여가 체중, 체질량지수, 허리둘레와 같은 신체검사결과, 혈당, 지질수치, 혈압 등의 잘 알려진 심혈관 질환의 위험인자들과 C-반응단백 및 PAI-1과 같은 염증반응인자들에 미치는 영향을 위약-대조군 연구를 통해 조사하였다. 방법 : 총 37명의 성인형 성장호르몬 결핍증 환자들과 65명의 정상인이 임상시험에 참여하였다. 시험시작 전과 3개월 후에 키, 몸무게, 허리둘레, 엉덩이둘레를 측정하였 Background : Subjects with growth hormone-deficiency (GHD) have increased cardiovascular mortality, and growth hormone (GH) replacement may modulate cardiovascular disease risk. Therefore, we evaluated the effects of GH administration on the markers of ca

후천성 면역 결핍증 환자에서 발현된 Rhizobium radiobacter에 의한 원발성 균혈증 1예

박일운,박태운,한서구,조지훈,우명렬,이혁민,이꽃실 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Rhizobium radiobacter는 면역능력이 떨어져 있는 환자에서 유치도관과 관련하여 기회감염을 일으키지만 지역획득 감염을 일으킬 수도 있다. 저자들은 AIDS 환자에서 발생한 Rhizbium radiobacter에 의한 원발성 균혈증을 경험하였으며, 항균요법으로써 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다. Rhizobium radiobacter, which has been previously discribed as Agrobacterium radiobacter, is a group of phytopathogenic organisms widely distributed in soil. Over the past decade, increasing number of infections due to Rhizobium radiobacter has been reported. Rhizobium radiobacter is now recognized as rare human pathogens affecting mostly immunocompromised hosts and is an opportunistic pathogen often associated with indwelling catheters. We report a case of bacteremia due to Rhizobium radiobacter in an acquired immunodeficiency syndrome (AIDS) patient. The patient was admitted for fever. In the blood culture, Rhizobium radiobacter was isolated. These symptoms and signs were successfully resolved with antibiotics.

헬리코박터 제균 3제 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과 : 평균 9개월 추적 결과

이은재,감창우,김상수,박태운,홍성일,최창환,한기준,조현근,이재은,김재영 關東大學校 醫科大學 醫科學硏究所 2004 關東醫大學術誌 Vol.8 No.1

Background: The eradication of Helicobacter pylori is approved as an essential therapy in the treatment of the peptic ulcer patients. In the functional dyspepsia patients, H.pylori has been suggested as a causative agent. However, the effectiveness of the eradication therapy is still debated in the treatment of the patients with functional dyspepsia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in patients with functional dyspepsia. In this study, we surveyed and compared the degree of symptom between the groups of patients with peptic ulcer disease and functional dyspepsia for nine months on the average after eradication of H. pylori. Methods: The convenience sample consisted of 119 patients with functional dyspepsia and 73 patients with peptic ulcer diseases who had infected by H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked every three months about the symptomatic improvements. The degree of symptom was rated on an 1(asymptomatic) to 5(symptomatic, unable to perform ADL) scale. Results : Overall eradication rate of H. pylor was 84.9%(163/192), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up periods were nine months. The mean score of the degree of symptom in pre-treatment state was 2.7±0.8 in peptic ulcer disease group and 2.6±0.7 in functional dyspepsia group. The degree of symptom was significantly lowered to 1.3±0.5 in peptic ulcer group (p<0.001) and 1.3±0.4 in functional dyspepsia group(p<0.001) three months after the treatment. The symptomatic improvement in both group was maintained over nine months in most patients(73.9%:76.7%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure (p=0.01). Conclusion : In the patients with functional dyspepsia, the symptoms were significantly improved after several weeks of treatment including eradication therpay of H. pylori. In 76.7% of patients with functional dyspepsia, the symptomatic improvement was maintained over nine months. Therefore, the study suggests that the eradication therapy of H.pylori can be one of the therapeutic options in the treatment of patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom.