동위원소 ( 99mTc - DTPA ) 를 이용한 신사구체 여과율 측정의 유용성

추원오(Won Oh Choo),우제영(Je Young Woo),김용수(Yong Soo Kim),구완서(Wan Suh Koo),장윤식(Yoon Sik Chang),윤영석(Young Suk Yoon),방병기(Byung Kee Bang),정수교(Soo Kyo Chung) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

Background: Although creatinine clearance is most commonly used to evaluate renal function, it overestimates glomerular filtration rate and needs 24 hour urine collection. In the last several years, it was reported that glomerular filtration rate using radioisotope has advantages of creatinine clearance. Methods: Glomerular filtration rate estimated by fractional accumulation of 99mTc-DTPA (CDTPA), creatinine clearance (Ccr), predicted creatinine clearance estimated by the formula devised by Cockcroft and Gault (PCcr) and 100/serum creatinine (100/Scr) were measured simultaneously in 89 medical outpatients whose serum creatinines ranged from 0. 6 mg/dl to 11, 2 ma/dl. Results: 1) CDTPA were closly correlated to Ccr (r=0.84), PCcr (r=0.88) and 100/Scr (r=0.86). 2)CDTPA were inversely correlated to Scr. 3) In patients with normal renal function (Scr<1.2 mg/dl) or mild to moderate renal insufficiency (1,2< Scr < 4. 0 mg/dl), CDTPA A were significantly lower than Ccr and 100/Scr, and simmilar to PCcr. 4) In patients with severe renal insufficiency (Scr>4. 0 mg/dl), CDTPA were significantly higher than Ccr, PCcr and 100/Scr. 5) Cm of left kidney were closely correlated to those of right kidney (r=0.91). The absolute differences of CDTPA between right and left kidneys were 5,1±4.9ml/ min/l. 73 M2, which were not significant statistically. 6) In 4 patients who had a past history of unilateral nephrectomy, DDTPA were measured falsely by 7.4±4.9 ml/min/1,73 M2 in nephrectomized side. 7) This procedure needs only 6 minutes of patient time. Conclusion: These observations suggest that determining glomerular filtration rate using 99mTc-DTPA is a rapid, accurate method in patients with normal or mild to moderate renal insufficiency, both as a total value and individually for each kidney. But it overestimates glomerular filtration rate in patients with severe renal insufficiency.

수은 증기 흡입에 의한 급성 호흡부전증 및 급성 신부전증 1 예

이상헌(Sang Heon Lee),김석헌(Seok Heon Kim),김영균(Young Kyoon Kim),우제영(Je Young Woo),한석원(Sok Won Han),박인수(In Soo Park),박성학(Sung Hak Park),강성구(Sung Koo Kang) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Mercury is a commonly found substance in the environment. Nowadays the incidence of mercurey poisining is increasing, especially in developed cauntries. In contrast to extensive literature addressing long- term exposure, to our knowledge there are relatively few reports regarding acute toxicity with mercury. Rare cases have been reported of very high exposure to metallic mercury vapor. We report a case of acute mercury poisoning after exposure to metallic mercury vapor, which occured in a home by spontaneous inhalation of mercury vapor. Severe life-threatening respiratory symptoms developed due to acute chemical pneumonitis, Therefore, prompt treatment with oxygen, penicillamine, corticosteroid and antibiotics was instituted, but the patient died of acute respiratory failure and acute renal failure.

연하곤란을 동반한 상부식도 Web 1 예

김재광,우제영,김부성,정인식,선희식,송기호,홍현상,서정화 대한내과학회 1988 대한내과학회지 Vol.35 No.6

Upper esophageal webs occur when the mucosal membranes project into the esophageal lumen. It can be associated with a number of condition, including iron deficiency anemia, dysphagia, carcinoma, glossitis, thyroid disease, ulcerative colitis, rheumatoid arthritis, pernicious anemia, epidermolysis bullosa, and pemphigoid. Recently we experienced a case of upper esophageal web with rheumatoid arthritis. A 53-year-old woman had complained of dysphagia for 15 years. Esophagogram showed a symmetrical annular web projecting into the esaphagus at the level of the 6th cervical vertebra. Electric cutting of the web and bougienage during endoscopy were performed successfully and she became well after these procedures. Hence, we present a case of upper esophageal web and a review of literature.

내시경검사상 조기위암에서 진해위암으로 이행된 1예 보고

정인식,우제영,김부성,선희식,송기호 대한소화기내시경학회 1988 Clinical Endoscopy Vol.8 No.1

Early gastric cancer is defined carcinoma that is limited to the gastric mucosa and submucosa and that does not extend into the muscularis propria. The development and widespread use of upper gnstrointestinal endoscopy with biopsy and cytology have enhanced our ability to make early diagnosis of gastrie carcinoma. Gastric cancinoma is being diagnosed at an ealry stage aad the survival rates for these patients are significantly greater than those with advanced gastric carcinoma. These ealry lesion can be cured in over 90% of the cases. In fact, it is almost impossible to follow up cases of early gastric cancer without surgical treatment. We report a case developed advanced gastric carcinoma 34 months after initial endoseopic diagnosis of early gastric cancer. A, 48-year-old woman was diagnosed early gaatrie cancer on June 21, 1985 by endoscopy. Proper surgical intetvention was not carried out due to her liver cirrhosis. The follow-up endoscopic examination was done on March 16, 1988. The gastric cancer looked like an advanced stomach and extended to other site.

기관지 폐포 세척술로 확인된 백혈병 세포의 폐침윤

박종원,박성학,우제영,송정섭,김춘추,한치화,김동집,양철우 대한내과학회 1988 대한내과학회지 Vol.35 No.3

In the vast majority of acute or chronic leukemia cases, pulmonary lesions have proven to be manifestations of infection, pulmonary hemorrhage, or hemorrhagic infarction. Leukemic infiltrates may be found in the lungs at autopsy in a high proportion of patients who die with either acute or chronic leukemia. In the vast majority of these case, there are no roentgenographic manifestations of these infiltrates. Pulmonary infilfration by leukemic cells resulting in respiratory symptoms is a rare complication of acute leukemia. We report a case of a patient with acute lymphocytic leukemia during the partial remission state, who presented with acute onset of fever with chill, in whom the diagnosis of pulmonary invasion of leukemic cells was made by bronchoalveolar lavage.

장기 혈액 투석 환자에서 발생한 수근관 증후군 1 예

김용수,박인석,김석영,우제영,윤영석,방병기,구완서,장윤식 대한신장학회 1990 Kidney Research and Clinical Practice Vol.9 No.4

Carpal tunnel syndrome (CTS) is a late complication of chronic hemodialysis. This complication results from the deposition of ?2-microglobulin as an amyloid-like substance. CTS results from entrapment of the medial nerve at the wrist. ?2-microglobulin deposits have been reported in bones, kidney, liver, bowels, and vasculature. We report here our experience with carpal tunnel syndrome in 47-year-old women treated exclusively with hemodialysis over a period of 14 years. She showed pain/paresthesia at night, weakness, burning pain in palm of right hand and right shoulder pain. Also, she showed decreased sensation to light touch and pin prick, positive Tinnels sign of the right hand. Nerve condnction studies showed an increased terminal latency of the right median nerve. Management of the carpal tunnel syndrome have not been altogether satistactory. Surgical decompression of the median nerve has been of the greatest benefit to patients with marked disability and pain from the carpal tunnel syndrome. A brief review of the literature was made.

자기공명촬영으로 진단된 결핵성척추 지주막염 2예

유순집,김석헌,김용주,방병기,강문원,최의진,김석영,우제영,양철우 대한감염학회 1993 감염 Vol.25 No.3

Tuberculous arachnoiditis of the spine is a serious illness with no known definite pathogenesis and therapeutic modalities. It usually has been diagnosed by invasive procedures such as conventional myelography and CT myelography. We recently experienced two patients with arachnoiditis whose conditions were too poor to perform these invasive studies. One was CRF patient in the course of tuberculous meningitis and the other was the patient with comatous mentality and paraplegia which developed during the acute stage of tuberculous menigitis. These patients were diagnosed tuberculous arachnoiditis by spine MRI and medicated antituberculous drug and steroid combination or steroid therapy alone with successful clinical improvement. We reviewed the MRI as a diagnostic tool and steroid as a therapeutic regimen.

당뇨병성 신증 및 신증후군 환자의 혈중 Lp ( a )

유순집,윤건호,이광우,손호영,권혁호,우제영,차봉연,강성구 한국지질학회 1993 韓國脂質學會誌 Vol.3 No.1

There are intimate relationship between dyslipidemia and atherosclerosis. The incidence and the mortality of cardiovascular disease increased in proteinuric disorder such as diabetic nephropathy and nephrotic syndrome. Recently there were evidence that increased concentrations of serum Lp(a), which is independent risk factor to atherosclerotic cardiovascular and cerebrovascular disease, in proteinuric disorder. We intended to search and identify the mechanism of altered concentrastions of Lp(a) in proteinuric disorder via measuring serum Lp(a) concentrations with ELIZA in 26 patients with diabetic nephropathy, 20 patients with nephrotic syndrome and 59 control. The results were as follows 1) There were significantly increased amounts of 24 hour urine protein in diabetic nephropathy group[DN](6.0±4.5 g/㎗) and nonremission group [R-](4.8±1.8 g/㎗) of nephrotic syndrome compared to remission group[R+](0.7±0.4 g/㎗) (p$lt;0.05) and significantly decreased serum albumin level in [R-](2.2±1.3g/㎗) compared to [DN](3.1±0.6g/㎗) and [R+](3.4±0.8g/㎗) (p$lt;0.05) and significantly decreased serum protein level in [R-](6.6±0.7g/㎗) compared to [R+](5.1±1.2g/㎗) (p$lt;0.05). 2) There were significantly increased level of total cholesterol and LDL-cholesterol in [R-](327.8±141.3 g/㎗ & 234.1±129.7㎎/㎗) compared to [DN](246.6±66.4 ㎎/㎗) (p$lt;0.05), but no significant difference in triglyceride and HDL-cholesterol among [R-]. [R+] and [DN](p$gt;0.05). 3) There were significantly increased concentration of serum Lp(a) in [DN] [median 36.3 (range 4.0-164.0 ㎎/㎗)], [R+] [28.3 (15.0-145.0 ㎎/㎗)]. [R-] [130.5 (10.1-177.0 ㎎/㎗)] compared to control [median 13.0 (range 1.0-70.0㎎/㎗)](p$lt;0.05). And there were significant difference in serum Lp (a) concentration of [R-] compared to [DN] and [R+](p$lt;0.05). 4) There were significant correlations in serum Lp(a) concentrations with serum albumin, total cholesterol and LDL-cholesterol, but no significant correlations in age, sex, fasting blood sugar, serum creatinine, triglyceride, HDL-cholesterol and 24hr urine protein in proteinuric disorder. There were statistically significant increased concentrations of serum Lp(a) in proteinuric disorder compared to control group and the concentrations were variable according to kind and state of disease. The results suggested that increased hepatic synthesis of Lp(a) would be one of the mechanism of increased concentrations of serum Lp(a) in these proteinuric disorder and it would be relate to decreased level of serum albumin.