우리나라 무증상 성인에서의 신장기능 및 성인병의 발현빈도

진동찬(Dong Chan Jin),윤영석(Young Suk Yoon),신영신(Young Shin Shin),송호철(Ho Cheol Song),박철휘(Cheol Whee Park),안석주(Seog Ju Ahn),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang) 대한내과학회 1996 대한내과학회지 Vol.51 No.5

Objectives: This report is the results of mass study on renal functions and prevalence of adult diseases in asympotmatic Korean. Methods: The subjects were 50,000 persons (male 31,633, female 18,367) who were enrolled a regular health check up program, June 1990 to Dec 1994, at Catholic Medical Center, Korea. Results: The mean serum creatinine were 1.073±0.19㎎/dl in male and 0.824±0.13㎎/dl in female. Abnormal creatinine (over mean plus 2 standard deviation) prevalence rate were 0.37% in male (1.6㎎/dl and aver) and 0.65% in female (1.2㎎/dl and over). The prevalence of urine occult blood (one positive) were 3.6% in male, 13.4% in female. The proteinuria were 3.3%, 2.1%, respectively. The differences between age group of serum creatinine were little, but that of blood pressure, cholesterol, body mass index were significant, especially before and after menopause in woman. The prevalence of hypertension were 27.1% in male and 24.2% in female. Hyperlipidemia and obesity (BMI over 25㎏/㎡) were 9.5, 9.3% in male and 28.9, 25.0% in female, respectively. Conclusion: These data were may represent overall Korean normal value and could be useful as reference value in Korea.

증례 / 갈색종양 ( brown tumor ) 골절로 우연히 진단된 상종격동 부갑상선 선종 1예

손호영(Ho Young Son),강성구(Sung Ku Kang),이승규(Seung Kyu Lee),문성대(Sung Dae Moon),김현수(Hyun Su Kim),박은정(Eun Jung Park),안석주(Suk Ju Ahn),한제호(Je Ho Han),강무일(Moo Il Kang),차봉연(Bong Youn Cha),이광우(Kwang Woo Lee) 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Primary hyperparathyroidism is characterized by hypercalcemia and increased intact parathyroid hormone, and associated with reduced bone density and bony change. We experienced the case of a 18-year-old man presenting as fracture of brown tumor. And then ectopic superior mediastinal parathyroid adenoma was detected by preoperative localization studies (Tc-99m sestamibi scan, neck CT). The patient presented with fracture of the right 5th proximal phalanx which was brown tumor, and was diagnosed as having primary hyperparathyroidism due to elevated serum calcium level (12.1 mg/dl) and intact parathyroid hormone levels (1631.8 pg/ml). Ultrasonography, Tl-201/Tc-99m subtraction scan, Tc-99m sestamibi scan, computed tomography was performed, and then revealed an enlarged parathyroid gland in the superior mediastinum. Tumor was removed via a transcervical approach. Pathologically, the tumor was confirmed to be a parathyroid adenoma. After his operation, his calcium level rapidly returned to within normal ranges, and increased bone density and some remineralization of brown tumor has occurred after eight months.

혈액 투석시 발생하는 저혈압에 대한 Amezinium Methylsulfate(Risumic)의 예방 효과에 대한 다기관 공동연구

김용수(Yong Soo Kim),방병기(Byung Kee Bang),김영옥(Young Ok Kim),송호철(Ho Chul Song),양철우(Chul Woo Yang),박정희(Jung Hee Park),박주현(Joo Hyun Park),김병수(Byung Soo Kim),박철휘(Cheol Whee Park),안석주(Suk Ju Ahn),최의진(Eui Jin C 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Background : Dialysis-induced hypotension is a very common but difficult complication to manage. Amezi-nium methylsulfate is a newly developed sympatho-mimetic agent which has been reported as effective in postural hypotension. We studied the preventive effect of amezinium methylsulfate on dialysis-induced hypo- tension in chronic hemodialysis patients. Methods: Twenty-five hemodialysis(HD) patients who were maintaining on hemodialysis longer than 3 months and had frequent episodes of dialysis hypoten-sion were enrolled in this study. After 4 weeks of observation period, patients received one tablet of ameziniurn 30 minutes prior to every hemodialysis session for 4 weeks. We com mean arterial pressure(MAP), number of hypotensive episodes and number of nursing interventions(defined as position change, bolus injection of saline or 50% dextrose in water, need to decrease transmembrane pressure or discon- tinuation of dialysis) between observation and medi-cation period in each patient. Results: The number of nursing interventions (mean, 2.5±0.9 interventions vs. 1.4±0.9 interventions, p<0.05) and hypotensive episodes(mean, 1.7±0.7 episodes per session vs. 0.9±0.7 episodes per session; p<0.05) decreased significantly in the medication period and the nadir MAP(57±13mmHg vs 70±15mmHg; p<0.05), mid-HD MAP(65±15mmHg vs. 79±15mmHg; p<0.05) and post-HD MAP(66±14mmHg vs 78±16 mmHg ; p<0.05) are higher in the medication period compared with observation period. Conclusion : These results show that amezinium methylsulfate is useful to prevent dialysis-induced hypotension in chronic hemodialysis patients.

한국의 신대체요법 현황

최의진,안석주 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1

The status of renal replacement therapy in Korea as follows; 1) The response rate to questionaire was 57.9% of the 226 hemodialysis centers in Korea and data file was sent in the 62.4% of responder. 2) The number of dialysis center was 226 and the number of hemodialysis machine was 3,507 and annual increasing rate were 8,7%, 14.0%, respectively. 3) The total number of ESRD patients was 20,244 and prevalance and incidence of ESRD were 431.9 and 101.1 patients per million population(ppm). 4) The proportion of renal replacement therapy was hemodialysis(HD) 53.3%, peritoneal dialysis(PD) 17.196, renal transplants(KT) 29.5%. 5) The proportion of long-term and elderly patients was markedly increased comparing 1985 (long term dialysis 20% vs. 2%, over 60 year old patients 26.2% vs. 13.8%. 6) The primary cause of renal disease was diabetic nephropathy 34.09o, chronic glomerulone-phritis 20.8%, hypertensive nephropathy 15.7%. 7) The mean BMI(body mass index; kg/M²)in over 18 year old patients was 20.7±2.7 kg/M² in the HD and 22.2±3.0 kg/M² in the PD. 71.9M of HD patients and 73.2% of PD were in the normal range (18.5-24.9). 8) The fistula survival rate was 6 month 93.4%, 1 yr 91.7%, 3 yr 87.6%, 5 yr 84.7%. 9) The cause of death were cardiac disease 31.8%, miscellaneous 23.5%, vascular disease 17.2%, infection 14.2%, liver disease 1.2%, social cause 5.9%.

민물에서의 가익사후 발생한 급성 신부전 1예

김성래,김석영,이영재,김태연,문건웅,윤성노,이종민,안석주,방병기,서광선 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

저자들은 민물에 빠진후 4일간의 오심, 구토를 동반한 복통을 주소로 내원한 22세 남자 환자에서 조직 검사상 허혈성 급성 신부전으로 증명된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A number of complications may arise in patients who survive episodes of near-drowing. After aspiration of fresh water, extensive hemolysis, anoxia and hypotension occur, and may predispose a patient to the development of acute tubular necrosis, which is a recognized complication of near drowning in fresh water. A 22-year-old man was admitted to hospital with abdominal pain for 4 days following an episode in which near drowning while swiming in the river. We determined that he was in acute renal failure. The renal biopsy revealed acute tubular necrosis (ATN) and we suspected that the cause of ATN was hypoxemia. To our knowledge, this is first report of ATN by near drowning in Korea. We report the case and the review of the literature.

신증후군과 내분비 기능저하증으로 발현된 임파종과 동반된 AA 유전분증

김희정,김기원,박석영,김석영,한충민,박관규,서광선,박용현,방병기,안석주,윤성로,박철휘 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.5

Amyloidosis is a rare complication of nonhodgikin's lymphoma. In review of the literature, almost all amyloidosis in lymphoma are the AL type and they are resulted frorn monoclonal light chains synthesized by the lymphoma cells. But we want to describe the AA type in patient with small lymphocytic lymphoma. A 60-year-old male patient admitted due to generalized edema and asthenia. He complained anorexia and dizziness at standing. Initial laboratory test revealed nephrotic range proteinuria and hypoalbuminemia. Combined pituitary stimulation test confirmed a decreased pituitary function and the adrenal function was also regarded hypofunctioning status in view of decreased cortisol response. Serum protein electrophoresis revealed monoclonal peak in gamma globulin area. This protein was composed by IgG and Lambda. We found the monotonous cellular infiltration in bone marrow specimen. These cells were lambda positive in immunohistochemical staining and only CD 20 positive in immunophenotype study. We made a diagnosis of small lymphocytic lymphoma with bone marrow involvement. Kidney biopsy revealed amyloidosis and the electrornicroscopy showed definite randomly arranged amyloid fibril, but immunohistochemical staining was positive with AA amyloid, unexpectedly. We suggest that all amyloidosis in lymphoma patient should be explored the origin of the amyloid fibrile, that is AA type or AL type.