Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access

Kwon, T.H.,Kim, Y.L.,Cho, D.K. 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Background. Central venous access is a mandatory part of patient management in many clinical settings and is usually achieved with a blind, external landmark-guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. Methods. We prospectively evaluated an ultrasound-guided method in 28 patients undergoing femoral vein cannulation for acute haemodialysis access and compared the results with 38 patients in whom an external landmark-guided technique was used. External land-mark-guided technique was done by manual localization of the femoral artery in the femoral triangle inferior to the inguinal ligament with needle insertion medial to the artery. Ultrasound-guided cannulation was performed in the same location with the aid of an ultrasound device (Site-Rite, Dymax Corp., USA) with a 7.5 MHz transducer covered by a sterile sheath. Results. Cannulation of the femoral vein was achieved in all patients (100%) using ultrasound and in 34 patients (89.5%) using the landmark-guided technique. The vein was entered on the first attempt in 92.9% of patients using ultrasound and in 55.3% using the landmark technique (f<0.05). Average access time (skin to vein) was similar but total procedure time was 45.1±18.8s by the ultrasound approach and 79.4±61.7 s by the landmark approach (f<0.05). Using ultrasound, puncture of the femoral artery occurred in 7.1% of patients, and haematoma in 0%. Using external landmark technique, puncture of the femoral artery occurred in 15.8% of patients, and haematoma in 2.6%. Conclusions. Ultrasound-guided cannulation of the femoral vein reduces the time required for the procedure, reduces the number of passes needed to puncture the vein, and minimizes complications such as arterial puncture or haemaioma.

Cyclic AMP가 흰쥐 사구체 상피세포의 Heparan Sulfate Proteoglycan 유전자 조절에 미치는 영향

고철우,구자훈,박용훈 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Glomerualr membrane heparan sulfate proteoglycan(GBM HSPG)은 사구체 상피세포에서 생성되는 사구체 기저막 구성물질로서 사구체 기저막이 음전하를 띄게 함으로서 소위 전하장벽'을 이루어 사구체 기저막의 투과성을 안정되게 유지하는 역할을 하며, 사구체 기저막에서의 GBM HSPG의 소실은 단백뇨의 발생과 밀접한 관계가 있음은 이미 잘 알려져 있다. cAMP는 각종 유전자를 조절하는 중간 매개체로서 세포 특이적으로 작용하는 것으로 알려져 있으나, 아직까지 cAMP가 사구체 상피세포에서 GBM HSPG 유전자의 조절에 어떠한 영향을 미치는지 알려져 있지 않다. 이에 cAMP가 사구체 상피세포의 GBM HSPG 유전자 발현에 미치는 영향을 알아보아 사구채내에서 cAMP가 중가되어 있는 각종 신질환에서 단백뇨의 발생기전 규명에 도움을 주고자 본 연구를 시행하였다. 흰쥐의 사구채 상피세포를 배양하여 1mM 농도의 cAMP를 가한 후 1시간, 6시간, 24시간 및 48시간에 RNase protection assay법으로 GBM HSPG mRNA 발현의 변화를 살펴보고, 아울러 cAMP 첨가 후 12시간, 24시간 및 48시간에 면역침전법을 이용하여 GBM HSPG 생성을 정량적으로 측정하였다. 1mM cAMP 투여 후 GBM HSPG mRNA 발현의 변화를 살펴보면 투여 후 1시간, 6시간, 24시간 및 48시간에 각각 43%, 32%, 47% 및 47%의 감소가 관찰되었고, GBM HSPG의 생성은 12시간, 24시간 및 48시간 후에 각각 51%, 70% 및 68%의 감소가 있었다. 결론적으로 cAMP는 사구체 상피세포의 GBM HSPG myNA의 발현을 억제하였고, GBM HSPG의 생성을 감소시킴을 알 수 있었다. 따라서 사구체내에서 cAMP가 증가되어 있으면서 단백뇨를 동반하는 각종 신질환에서 단백뇨의 발생은 cAMP에 의한 사구체 상피세포의 GBM HSPG 유전자 억제와 밀접한 관계가 있을 것으로 생각된다. It is well known that the glomerular basement membrane heparan sulfate proteoglycan(GBM HSPG) synthesized by glomerular epithelial cell(GEC) has an important role in the permeability of glomerular basement membrane and cyclic AMP(CAMP) is involved in regulation of a wide variety of genes maybe including GBM HSPG gene. The direct effect of cAMP on GBM HSPG gene expression and metabolism was not evaluated as yet. Proteinuria represents an impairment of permselectivity function of glomerular basement membrane regulated by GBM HSPG and could be associated with increased glomerular level of CAMP in nephrotic syndrome of diverse causes. RPD-I(rat GBM HSPG core protein domain-I) detected a >9.5kb transcript of GBM HSPG in RNA of rat GEC. Employing a riboprobe synthesized from RPD-I in RNase protection assay, we examined whether cAMP regulated perlecan expression in the GEC. At 1, 6, 24 and 48 hrs of incubation, 1 mM cAMP caused 43%, 32%, 47% and 40% reduction in mRNA expression of perlecan, respectively. Immuno-precipitation showed a corresponding reduction of 51%, 70% and 68% in the synthesis of 35SO4 labeled GBM HSPG by the GEC following 12, 24 and 48 hrs of incubation with cAMP. Our results show that decrease in GBM HSPG gene expression and synthesis by cAMP may be of relevance to proteinuric states characterized by activation of these mediators.

간경변증이 동반된 말기신부전환자에서의 지속성 외래복막투석

김용림,권태한,조동규 경북대학교 의학연구소 1999 경북대학교병원의학연구소논문집 Vol.3 No.1

Obijectives : The spontaneous tendency to arterial hypotension in cirrhotic patients makes adequate hemodialysis therapy extremely difficult. Hemedialysis in these patients may produce intradialytic hypotension, limiting the amount of ultrafiltration. These patients are also at high risk for gastrointestinal bleeding, which can be exacerbated by anticoagu-lation. Recently peritoneal dialysis has been sug-gested for the management of this population. Methods : Seven patients with chronic renal failure and liver cirrhosis treated by CAPD are described. Six of the seven patients were complicated by ascites on starting CAPD. Hepatocellular carcinoma was identified in one patient. Three had been transferred from hemodialysis for henmodynamic intolerance, one far vascular access problem. All PD catheters were surgically placed. Results : The hemodynamic tolerance was excellent in all patients. Four patients developed bleeding immediately after catheter insertion. Two patients developed early leaks and one patient late leak. Four patients had a decline in serum albumin level of 0.5 gm/dL or more during the course of chronic PD. Peritonitis occurred on average at 8.7 month interval. Three episodes of catheter removal occurred in 148 patient-months of PD(0.24 per patient-year). Four patients died while maintained on PD; three deaths were due to hepatic encephalopathy on PD far dura-tion of 4 to 60 months and the fourth was due to Perironitis after 24 months of PD. One patient died due to malnutrition after 2 months on switching to hemodialysis because of peritonitis after 32 months of PD. Conclusion : Early mechanical complications after catheter insertion(bleeding, leak) were more common than usual. But CAPD was better tolerab1e than hemodialysis and may be a reasonable choice with an acceptable survival rate in end-stage renal disease patients with preexisting liver cirrhosis.

전립선암과 전립선비대증 환자에서 혈청 유리 및 총전립선특이항원 측정의 의의

서혁준,박형민,권태균,정성광,김법완,이재태 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Purpose: This study was peformed to investigate whether the free to total PSA ratio(F/T PSA ratio) offers a better discriminant for the detection of patient with prostatic cancer(CaP) and those with benign prostatic hyperplasia(BPH) than serum total PSA alone. Materials and Methods: From September 1996 to February 1999, free and total PSA levels were measured on frozen sera samples of 154 men with BPH and 46 with CaP using immunoradiometric assay. Results: In all subjects, the mean total PSA was significantly higher in CaP group(72.57±66.58ng/ml) than BPH group(3.12±4.10ng/ml). The mean PSAD was significantly higher in CaP group(1.64± 1.86) than BPH group(0.08±0.01). The mean F/T PSA ratio was significantly lower in CaP group(0.19± 0.07) than BPH group(0.30±0.13). Among 41 subjects whose total PSA were between 4-20ng/ml, the mean PSAD was significantly higher in CaP group(0.37±7.16) than BPH group(0.17± 0.07), but the mean F/T PSA ratio was not significantly different between CaP(0.19± 0.10) and BPH group(0.25±7.13). By comparing the sensitivity and specificity of total PSA alone, PSAD and F/T PSA ratio on receiver operating characterislic (ROC) Cutie in all subiects and subiects with total PSA between 4-20ng/ml, F/T PSA ratio had no superiority than total PSA alone and PSAD for discrimination between CaP and BPH. Conclusions: We suggest that the F/T PSA ratio is not superior to total PSA alone and FSAD in the detection of prostatic cancer, and further evaluation of the usefulness of F/T PSA ratio should be required.

The Protection of the Retina from Ischemic Injury by the Free Radical Scavenger EGb 761 and Zinc in the Cat Retina

Shin, Jae-Pil,Kim, Si-Yeol,Kwak, Sung-Sik,Lee, Sang-Hee 경북대학교 의학연구소 1999 경북대학교병원의학연구소논문집 Vol.3 No.1

We investigated the effects of a free radical scavenger (EGb 761) and zinc in experimentally induced ischemic injury in the cat retina. Total retinal ischemia for 90 min was produced in the left eyes of 40 cats by raising intraocular pressure. In group 1, 10 cats were used as control. The free radical scavenger (EGb 761, 100 mg/kg) in group 2 (10 cats)and zinc chloride (250㎍/kg) in group 3 (10 cats) were administered intravenously at the end of ischemia. In group 4, both EGb 761 (100 mg/kg) and zinc chloride (250㎍/kg) were infected into 10 cats. ERG and a histologic study were performed 1 h, 1 day, 3 days, 1 week and 2 weeks after ischemia. The amplitude of the ERG b-wave was 62.73±0.32, 84.31±6.10, 83.65 ±12.23 and 102.4±14.27%, and the summed amplitude of oscillatory potentials was 66.16±16.42, 99.44±14.92, 95.45±6.42 and 99.62±12.32% in each group 2 weeks after ischemia. There was no significant effect in animals that received zinc alone (group 3) by the end of 1 week but some additive effect in combining EGb 761 and zinc chloride (group4) 1 h after ischemia. These findings suggest that the free radical scavenger EGb 761 may efficiently protect the retina from ischemic injury and zinc may have an additive effect when combined with a radical scavenger.

망막전위도의 전력 산출

원철호,조진호,김상하,임정훈 경북대학교 의학연구소 1999 경북대학교병원의학연구소논문집 Vol.3 No.1

주파수영역에서 망막전위도의 총전력을 계산하고, 시간영역에서 망막전위도의 면적을계산할수 있는 프로그램을 개발함으로써 전기생리학적 진단의 효능을 향상시키는데 목적을 두었다. 총전력은 망막전위도 신호를 Fourier 변환을 이용하여 주파수 영역의 신호로 바꾼 다음 스펙트럼의 제곱을 적분함으로써 구하였다. 우세전력은 우세주파수의 전력으로 이부분의 전압을 제곱후 적분하여 얻은 값이다. 원하는 부분은 수동입력하여 구간주파수의 제곱적분을 할 수 있게 하였다. 이 소프트웨어는 시간 영역에서 진동양소파의 진폭의 합 및 면적도 구할 수 있는 기능을 가졌으며, 사용자에게 편리하도록 그래픽 환경 하에서 마우스와 팝업 메뉴에 의하여 각 기능들이 작동되며, UTAS-E2000 시스템과도 상호 호환성을 갖고 있다(한안지 38:817∼823, 1997). The Calculation of the Electroretinographic Power Chul Ho Won*, Jin Ho Cho, Ph.D.**, Sang Ha Kim, M. D., Jung Hoon Lim, M. D. To promote the electrophysiologic diagnostic efficiency, the program for calculation of the total power in the frequency domain and of the area in the time domain of the electroretinogram was designed. The total power is calculated by integration of the squared power spectrum obtained by Fourier transform (Parseval theorem) in the time domain. The dominant power is the power of the dominant frequency in power spectrum and is calculated by integration of the squared peak area spectrum. The sectional integration of the square power spectrum can be established by manual input. The implemented software also has the functions that calculate the summed amplitude and area of the oscillatory potentials in the time domain. And it performs each functions by selection of pop-up menu with mouse to use conveniently under graphic interface, compatible with UTAS-E2000 system (J Korean Ophthalmol Soc 38:817∼823, 1997).

B형 간염바이러스의 태아와 성인간세포에 대한 감염성 해명 연구

정태호,김성국,서화정,윤영국,임종완,차상호 경북대학교 의학연구소 1999 경북대학교병원의학연구소논문집 Vol.3 No.1

사람의 태아와 성인의 간세포에 대한 B형 간염바이러스의 감염도를 비교 분석함으로써 HBV 와 간세포간의 친화도내지는 HBV 수용체에 관한 정보를 얻고자 함 대상 및 방법 : 성인이 외상을 입어 부득이 손상된 간조직을 절제하였을 경우와 모자보건법상 임신지속이 어려운 상태에서 부인과적 수술시 21주 전후의 태아 간조직을 얻어 DMEM 을 배지로 50% 용량으로 HBsAg 양성인 사람 혈청을 가하여 5일간 체외 배양하고 병리조직학적 처리후 효소 면역학적 방법으로 HBsAg 를 염색하여 바이러스의 존재 여부를 검색하였다. 결과 : 태아와 성인 간조직을 5일간 체외 배양하였을 때 그 조직상은 간조직임을 인지할 수 있었다. HBV 의 감염여부는 DAKO 사의 효소면역 법으로 조사한 결과 태아의 간조직에서는 HBsAg 양성부위를 발견하지 못하였으나, 성인 간조직에서는 HBsAg 양성부위가 발견되었다. 결론 : 태생 21주 전후의 태아의 간세포는 HBV 와 친화도는 아주 미약하거나 없고, 성인 간세포는 HBV에 대한 친화도가 높다. 따라서 태생 21주의 간세포에는 HBV 의 감염이 어렵다는 것을 인지하게 되었다. Considerable progress has been made in the immune prophylaxis of hepatitis B virus(HBV) infection and in the understanding of its replication and pathogenecity at the molecular level. However, a convenient in vitro assay for HBV infectivity has been lacking and the early steps of viral life cycle are now yet well understood. Primary cultured human hepatocytes are reported to be susceptible to HBV 10-12, but these systems are not practical because they are short-lived and require primary explanted human liver. However, it is uncertain yet whether primary hepatocytes of human fetal liver are susceptible to HBV for infection or not. We have expanded the infectivity of HBV into a primary cultures of human fetal hepatocytes together with controversy of adult primary hepatocytes. To investigate the infectivity of HBV for, adult and fetal hepatocytes After 5 day culturing fetal(1) and adult(2) liver tissues, which obtained from a surgical operation on DMEM culture media with half HBV positive serum, separating liver cells and fixing them, the existence of HBsAg antigen was investigated through the immuno-enzymatic staining. HBsAg stained area was not found in the 21 weeks gestation liver cells until 5 days of invitro-culture, while it was found in the adult liver cells. This test result showed that the HBV infection is very hard to happen in the liver cells 21 weeks gestation or prior one.

Sandblast 처리한 상아질면의 접착에 관한 연구

김교한,나환옥,황성욱 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Dentin adhesion was studied on sandblasted dentin with 4-MET/MMA-TBB resin. The effect of change of air pressure, with or without pretreatment and primer on tensile bond strength, was mainly investigated. In the effect of air pressure at sandblast treatment, the higher pressure showed the increase of tensile bond strength. The pretreatment with 10-3 solution after sandblast treatment increased tensile bond strength in the almost conditions. Application of primer also increased the tensile bond strength, confirmed the effect of primer application after sandblast treatment. Alumina particle was not found on the dentin surface in the SEM and EDAX examination.

Microchanges of Rat Joint Cartilage after Administration of Fluoride

Song, Keun Bae,Bae, Yong Chul 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

The objective of this study was to investigate some changes of rat joint cartilage layers after administration of various concentrations of sodium fluoride in the drinking water. Four weeks old, fouty-eight female Sprague-Dawley rats were divided into four groups. The control group was given tap water and other three experimental groups were supplied with 1, 10 and 100 ppm fluoridated water ad libitum. The rats were sacrificed at three and six weeks experimental day. Thickness of resting, proliferation and maturation layers were measured with light micoscope using eyepiece reticule and stage micrometer. Increases in thickness of the maturation layers of joint cartilage were noted in rats given 10 and 100 ppm sodium fluoride in drinking water. The observed thickening was attributable to increase in number and size of cells of the maturation layer. A relationship between fluoride dose and the degree of thickening of maturation layer was proposed. It is possible to suggest that the fluoride may be related to stimulation of chondrocyte growth or inhibition of calcification of the cartilage matrix.

Induction of fibronectin gene expression by inhibitors of protein phosphatase yype 2B in normal and transformed fibroblasts

Rhew, Jung-Hwa,Shin, Young-Ah,Lee, Byung-Heon,Park, Rang-Woon,Kim, In-San 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Two intracellular signal pathways mediated by CAMP and protein kinase C (PKC) were involved in the regulation of FN gene expression (Lee et al., Exp. Mol. Med. 30: 240, 1998). In this study, a possible involvement of protein phosphatase-dependent pathways in the regulation of FN gene expression was investigated by using protein phosphatase type 2B (PP2B) inhibitors, cyclosporin A and ascomycin. Both cyclosporin A and ascomycin increased the levels of FH mRNA in Wl-38 human lung fibroblasts and the SV40-trans formed Wl-38 cells but not in MC3T3-E1 osteoblasts. The expression of FN appears to increase from six hours up to 48 hours after treatment suggesting that it is not an immediate effect. In addition, this effect required a new protein synthesis. Neither cyclosporin A nor ascomycin affects the phorbol myristate acetate (PMA)-induced stimulation of FN gene expression and the same result occurred in vice versa suggesting the mechanism of PMA and cyclosporin A/ascomycin in the regulation of FN gene expression may share a common downstream pathway. Taken together, thins study suggests that PP2B is involved in the regulation of FN gene expression in normal and transformed fibroblasts but not in osteoblasts.