전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.

토목공학과 교육과정 개발연구

成基泰,金知學,李興吉,辛逸善,金芳植,閔彰東 忠州大學校 1996 한국교통대학교 논문집 Vol.31 No.2

For resonable curriculum modification and development corresponding with training to competent high-level, engineering as educational object of industrial university this research was carried out as following process ; 1. Collection and analysis of present curriculum in civil engineering department of domestic industrial university including the curriculum of foreign industrial university. 2. Organization of advisory committee for insustry school cooperation and visiting insustry and interview. 3. Organization of all Korea Civil Engineering Department chief committe. 4. Result of research through the questionnaire for all Korea representative industry and academic could be summarized as follows : 1) Wide contact between college education and industry field should be strengthened, and field experiment education was strengthened to consider of ability, and construction management was edited compulsory major. 2) For the adapting trend of variety and subdivision of construction skill EDPS education was edited compulsory 3) The curriculum was endeavoured to fundamental science. 4) The curriculum enlarged the range of the optional subject which is able to manage the flexible curriculum for characterization of each local industrial university and endeavoured consideration of field adapting ability by classifing the civil design into Construction design and integration, Hydraulic design and integration, Earth design and integration. 5) The curriculum of academic theories and experiments were unificated into single subject for the purpose of flexible management 6) The curriculum was edited in the ration which is 20 to 80 between liberal and majoring arts in presentation on the basis of all accounts of opinion from the academic and field worker, and emphasized the importance of language education editing industrial English conversation because of demand of much ability along with foreign advance of construction technique. 7) The curriculum was emphasized in the necessity of the field experimental trained based on the information by all opinion. By operationg this curriculum, it is expected that the relationship between industry and academic will be efficiently considered.

부분 신절제 백서모델에서 Angiotensin Converting Enzyme Inhibitor 및 Angiotensin II ATI 수용체 길항제가 Plasma Renin Activity 및 Angiotensin II level에 미치는 영향

김종학,구영선,강민규,황평주,나기량,이강욱,서광선,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Renin-angiotensin-system(RAS) has been thought to have a pivotal role in renal injury mechanism. Many reports state that the inhibition of RAS prevents the progression of renal disease in 5/6 nephrectomized rats as a typical chronic renal failure model. Angiotensin converting enzyme inhibitor blocks the conversion from Angiotensin I to Angiotensin Ⅱ (A-Ⅱ ), and ATI RA inhibits the action of A-Ⅱ at the level of AT1 receptor. Therefore the PRA and A-Ⅱ level may be influenced independently by each treatment modality with these drugs. In this study, the influence of long term treatment with ACEI or AT1RA in these models on systolic blood pressure, PRA, and A-Ⅱ level was evaluated. Male Sprague-Dawley rats weighing 270-300 grams were anesthesized with thiopental sodium(50 mg/kg) and underwent right nephrectomy and partial(approximately two thirds) infarction of the left kidney by ligation of two-three segmental arterial branches. The rats were divided into four groups : sham group, control group, 5/6 subtotal nephrectomized and ACEI treated group (enalapril 100 mg/L in drinking water), 5/6 subtotal nephrectomized and ATIRA treated group (losartan, 200 mg/L in drinking water). They were treated for twelve weeks. In the twelve weeks, both groups treated with ACEI and AT1RA ingestion demonstrated a significant decrease in systolic blood pressure(165±23 vs. 132±9, mmHg, control vs. ACEI, M±SEM, p<0.05, 165±23 vs. 124±7 mmHg, control vs. ATIRA, M±SEM, p<0.01) compare to the control group. In both group treated with ACEI and AT1RA showed a significant increase in PRA(ACEI ; 7.2±2.9, AT1RA ; 4.7±0.4, control ; 2.7±1.1, sham ; 2.7±1.4, ng/ml/hr, ACEI vs. control and sham, M±SEM, p<0.05). However no significant differences were found in the sham vs. control(p>0.05), and in ACEI vs. control. The plasma A-II level was significantly increased in AT1RA treated group compared to sham and ACEI treated group(2,753±543 vs. 484±169.3, ng/ ml, AT1RA vs. Sham, p<0.01). In conclusion, treatment with ACEI and AT1RA for twelve weeks normalized systolic blood pressure, proteinuria and increased PRA compared to the control group; whereas plasma A-II level was increased only by AT1RA treatment.

일측 요관폐쇄에 의한 실험적 수신증에서 신조직내 MCP-1 및 TNF-α유전자 발현

나가량,황평주,김종학,구영선,강민규,서광선,이강욱,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

Early cellular and molecular derangements have been suggested as potential pivotal factors for the development of renal injury, such as interstitial fibrosis after the experimental hydronephrosis. Several recent studies have been demonstrating that one of the initial events taking place in the progressive renal injury process is the mononuclear cell infiltration in the glomeruli and tubulointerstitiuim. In order to evaluate the renal light microscopic findings as well as the renal cortical MCP-1 and TNF-α gene expressions which are modulating inflammatory process and the recruitment of mononuclear cells in many experimental models of renal injury, Sprague-Dawley rats underwent unilateral ureteral obstruction (UUO) and sham operation under the thiopental sodium anesthesia(50 mg/kg intraperitoneal injection). Three and 7 days after surgery, rats were sacrificed. By the competitive RT-PCR, the levels of TNF-α and MCP-1 mRNA in renal cortical tissues were measured. The magnitude of mononuclear cell infiltration and interstitial widening were evaluated by standard point counting method. The level of MCP-1 gene expression was significantly increased in UUO group compared to sham group at 3 and 7 days after surgery(UUO 3 days 8.99 ± 0.45, UUO 7 days 11.2 ± 0.26, sham 3 days 1.00 ± 0.08, sham 7 days 0.94 ± 0.05, p < 0.01, p < 0.01, mean ± SEM, respectively). The level of MCP-1 mRNA at 7 days after surgery was significantly higher than that at 3 days in UUO group. The TNF-α gene expression level of UUO group was also significantly higher than that of sham group at 3 and 7 days after surgery(UUO 3 days 1.73 ± 0.16, UUO 7 days 2.03 ± 0.21, sham 3 days : 1.00 ± 0.06, sham 7 days 1.09 ± 0.03, p < 0.01, p < 0.01, respectively). But there was no significant difference between the levels at 3 and 7 days after surgery in UUO group(p>0.05). On the light microscopic examination, the relative volume of interstitium (RVI) and the total count of infiltrated mononuclear cells(MCC) at 3 and 7 days after surgery in UUO group were also significantly higher than those of sham group(RVI ; UUO 7 days 14.9±1.0%,sham 6.0±0.7%, MCC; UUO 7days 34.0± 1.6, sham 3.7± 0.6, p < 0.01, p < 0.01, respectively). In conclusion, we speculated that the early up-regulation of MCP-1 and TNF-α genes of renal cortical tissue in this experimental hydronephrosis model is closely related to the mononuclear cell infiltration and tubulointerstitial fibrosis.

급성충소돌기염의 임상 : 병리학적 고찰

양기화,조준필,하영천,한진우,정학재,손수창,이성희,황재훈,신철호 최신의학사 1989 最新醫學 Vol.32 No.4

신이식에서 이식신의 생존분석

오선미,김종학,황평주,구영선,강민규,나기량,김종섭,김성숙,이강욱,신영태,설종구,배진선,손기섭 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To investigate the prognostic factors for the survival of transplanted kidney in patients with end-stage renal failure, 59 cases of renal transplantation from September 1986 to Feburary 1997 in Chungnam National University Hospital were analyzed retrospectively. The results were as follows: 1)The mean age of recipients was 33.8 years and that of doners was 38.9 years. The male to female ratio of recipients was 2.5:1, and that of donors was 1.03:1 2) Living related donore(LRD) were 79.6% and living non-related donors were 20.3%. The HLA-identical donors(ID) in LRD were 18.7% and HLA-haploidentical donors(HID) were 61.0%. In living non-related donors(LNRD), mean matched HLA-AB antigens were 1.56 and mean matched HLA-DR antigens were 0.56. 3) The average 5-year patient survival fate was 94%, and average 5-year graft survival rate was 70%. The 5-year graft survival fate of HLA-ID was 100%, and those HLA-HID and LNR were 70% and 36% respectively. 4) Total 33 episodes of acute rejection were found in 45.8% of transplanted patients. The number of acute rejection episode did not show significant difference between LRD and LNRD(P > 0.05). There was no significant difference in MLC between two groups(p > 0.05). 5) In comparison between the 18 patients who lost their graft function in 5 years and 17 patients who are maintaining graft function for more than 5 years, MLC was significantly lower in patients with functioning graft than of patients with non-functioning graft (p < 0.05). The number of rejection episode was also lower in patients with functioning graft than that of the patients with non-functioning graft(p < 0.05). However, there were no significant difference in recepient and donor age and history of pre-transplantation donor specific transfusion between two groups. With the results above, we can speculate that adequate donor selection according to good matched HLA typing and low MLC is very important for graft survival in renal transplantation. Prevention and treatment of acute rejection in renal transplantation is also na important factor for graft survival.

흡연에 의한 급성 호산구성 폐렴 2예

박종빈,김학렬,주현준,유태양,신성남,신정현,송정섭,황기은,김소영,양세훈,정은택 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

최근 흡연을 시작한 젊은 성언에서 급성 호산구성 폐렴의 발생에 대한 증례가 보고되고 있다. 급성 호산구성 폐렴은 대개 발열을 동반하기 때문에 초기에는 감염성 폐렴으로 잘못 진단, 치료되는 경우가 많다. 아직 정확한 병태 생리 및 조직학적 소견은 밝혀져 있지 않지만 병력 청취 및 임상 양상, 방사선 소견의 관찰을 통해 급성 호산구성 폐렴을 의심하고, 진단을 위해 기관지 폐포 세척액 검사를 시행한다면 좀 더 쉽게 진단 내릴 수 있을 것이다. 본 저자들은 최근 처음 시작한 흡연에 의해 발생한 급성 호산구성 폐렴을 진단하고, 스테로이드를 투여하여 성공적으로 치료한 환자 2예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Acute eosinophilic pneumonia(AEP) is characterized by acute febrile respiratory illness associated with diffuse pulmonary infiltration and pulmonary eosinophilia. The specific etiology for acute eosinophilic pneumonia is elusive. By some investigators, cigarette smoking is suggested as a causative substance which can cause AEP. In recent, the authors experienced two cases of AEP following cigarette smoking. Both cases had characteristic features including age around 20 years, new onset smoking before occurance of AEP, diffuse infiltration on chest radiography, pulmonary eosinophilia based on bronchoalveolar lavage and acute improvement after steroid therapy. These clinical features are resemble with previous smoking induced AEP case reports. Base on these clinical features, cigarette smoking associated AEP could be diagnosed more easily.

유기산을 이용한 납 요염토양의 복원에 관한 연구

정의덕,강신원,박덕수,신학기,백우현 한국환경과학회 2000 한국환경과학회지 Vol.9 No.5

A study on the removal of Pb ion from Pb-contaminated soil was carried out, using ex-situ extraction process. Tartaric acid (TA) and iminodiacetic acid sodium salt (IDA) as a washing agent were evaluated as a function of concentration, reaction time, mixing ratio of washing agent and recycling of washing agent. TA showed a better extraction performance than IDA. The optimum washing condition of TA and IDA were in the ratio of 1 : 15 and 1 : 20 between soil and acid solution during 1 hr reaction. The total concentrations of Pb ion by TA and IDA at three repeated extraction, were 368.8 ppm and 267.5 ppm, respectively. The recovery of Pb ion from washing solution was achieved by adding calcium hydroxide and sodium sulfide, form the precipitation of lead hydroxide and lead sulfide, and optimum amounts of sodium sulfide and calcium hydroxide were 7 g/ℓ for the TA washing solution and 4 g/ℓ , 5 g/ℓ for the IDA washing solution, respectively. The efficiency of recycle for TA and IDA washing solution were 78.8%, 95.1% and 89.2%, 96.6%, at third extractions under Na_2S and Ca(OH)_2, respectively.

당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

당뇨병성 합병증을 가진 환자에서 혈중 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 朝鮮大學校 附設 醫學硏究所 1998 The Medical Journal of Chosun University Vol.23 No.1

연구 배경 : 고혈당성에 의한 산화환원반응 이상(가저산소증)이 조절 되지않는 당뇨병의 특징으로 혈관과 신경 기능에 대한 진성 저산소증의 효과와 유사하며, 당뇨 합병증의 병태생리에 중요한 역할을 한다. 고혈당이 있는 인슐린 비의존형 당뇨병 환자에서 인슐린 수준이 정상이듯이, 빈혈이 있는 당뇨병 환자에서 EPO의 농도는 실제 혈색소 농도의 감소비율과 차이가 있을 것이라 추측된다. Friedman 등은 당뇨병성 합병증 원인 인자로 가저산소증(pseudohypoxia) 또는 저산소증(hypoxia)을 제기하였고 이런 인자들이 EPO의 상대적 또는 절대적 결핍에 의한 것임을 보고하였다. 방법 : EPO-Trac^(TM 125)I RIA kit을 이용하여 방사면역측정법으로 EPO 수준을 검사하였다. 전혈 3㎖을 5-10㎖ 시험관에 정맥 채혈하였으며, 용혈과 장기간의 보존을 위하여 원심분리를 즉시 시행하여 혈청을 영하 200C에서 냉동 보관 후 일괄적으로 검사 결과를 얻었다. 결과 : 1996년 9월부터 1997년 2월까지 조선대학교 부속병원 내과에 입원한 2형 당뇨병 환자 63례를 대상으로 하여 다음과 같은 결과를 얻었다. 1) 당뇨병성 합병증이 없는 군과 있는 군간의 혈색소, 혈중 EPO농도의 차이는 유의한 차이가 있었으며 혈색소의 감소율보다 혈중 EPO의 감소율이 더 높았다. 2) 당뇨병성 망막증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으나 혈중 EPO농도는 유의한 차이가 있었다. 증식성군에서만 혈중 EPO의 감소비율이 혈색소에 비해 높았다. 3) 당뇨병성 신증의 유무에 따른 혈색소, 혈중 EPO농도는 유의한 차이가 있었고 혈색소 감소율에 비해 EPO농도의 감소율이 높았다. 신증의 중증도에 따른 혈색소, EPO의 차이는 미세알부민뇨군을 제외하고는 유의한 차이를 보였고 혈색소 감소율에 비해 EPO의 감소율이 더높았다. 4) 당뇨병성 신경병증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으며 EPO농도는 유의한 차이를 보였다. 혈색소와 EPO의 감소비율은 비슷하였다. 신경병증의 중등도에 따른 혈색소와 EPO농도의 변화는 유의한 차이가 없었으나 stage 3에서는 혈색소감소율보다 EPO감소율이 더높았다. 결론 : 당뇨병성 합병증을 가진 환자에서 빈혈의 정도는 대부분 혈청 EPO치의 절대적 감소에 의함을 간접적으로 밝혀낼 수 있었으며 차후 더 많은 대상으로 비교 분석이 필요하리라 사료된다. Background: Hyperglycemic-induced redox(pseudohypoxia) imbalance is a characteristic feature of poorly controlled diabetes that mimics the effects of true hypoxia on vascular and neural functions and plays an important role on the pathogenesis of diabetic complications. As is true for apparently "normal" insulin levels typically found in NIDDM even in the presence of hyperglycemia, a "normal" erythropoietin level in an anemic diabetic subject may be disproportionally low for the actual red cell mass. Therefore, Friedman et al suggested that pseudohypoxia or hypoxia as an etiological factor of diabetic complications are due to absolute or relative erythropoietin deficiency Method: EPO-TracTM 125I RIA kit was used for the quantitative determination of erythropoietin(EPO) in serum by radioimmunoassay. An adequate sample of blood (3ml whole blood) was collected aseptically by venipuncture in a 5~10ml glass tube to yield a minimum of 400 L of serum per assay. The serum was promptly removed from the clot by centrifugation in order to avoid hemolysis. Then to increase its storage time it was frozen at -200C in a nonself defrosting freezer. Finally, tests were undertaken simultaneously Results We studied 63 cases with diabetes mellitus, who were admitted to Chosun University Hospital from September, 1996 to February, 1997 at the Department of Internal Medicine. We defined the control group, as diabetic patients who did not have anemia(<13mg/dl), diabetic complications(retinopathy, nephropathy, neuropathy) and the remainders were defined as the experimental group(we excluded anemic patients, who had secondary causes of anemia and diabetic patients with end stage renal disease)Data were as follow 1) The relationship of Hb and the 24hr urine protein between diabetic patients with and without complications significantly differed(p=0.02, < 0.001 respectively), but the Hb level was poorly related between diabetic patients with and without retinopathy(except in preproliferative, proliferative subgroups) and neuropathy. 2) Subgroups of patients with diabetic complications had higher 24hr urine protein than patients without diabetic complications, except stage I diabetic neuropathy 3) The EPO level was significantly different between diabetic patients with and without complications. 4) The correlation between EPO and Hb was significantly different, especially in diabetic patients with retinopathy and nephropathy according to severity of diabetic complications, compared with patients who did not have diabetic complications such as retinopathy and nephropathy. Conclusion: We know that anemia induced by diabetic complications is due to relative EPO deficiency than absolute EPO deficiency, and further evaluation and studies are needed on many cases in the future