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복합교원성질환과 동반되어 나타난 MPO-ANCA 련 급속진행 사구체신염 1예
한상웅 ( Sang Woong Han ),홍현석 ( Hyun Seok Hong ),박지훈 ( Ji Hoon Park ),이주현 ( Ju Hyun Lee ),이주학 ( Joo Hark Yi ),박문향 ( Moon Hyang Park ),김호중 ( Ho Jung Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: Mixed connective tissue disease (MCTD) has the clinical feature of other collagen vascular diseases. According to several reports recently published, MCTD sometimes involved kidney as benign course. ANCA associated glomerulonephritis occurred in systemic autoimmune disease such as systemic sclerosis or rheumatoid arthritis, not in MCTD. In this case, as we experienced that MPO-ANCA associated glomerulonephritis arose and proceeded to rapid progressive glomerulonephritis (RPGN) in women with MCTD, we report it with review of reference. A 60-year-old woman was admitted with uremia and joint pain. In physical finding and serum test, she was diagnosed with MCTD according to Khan`s criteria. Also MPO antibody and ANCA were noted in specific immunological test and the histologic findings showed crescentic glomerulonephritis. So we diagnosed RPGN induced by MPO-ANCA associated glomerulonephritis. She was treated with immunosuppressive treatment and uremia was improved. RPGN induced by MPO-ANCA associated glomerulonephritis should be ruled out by prompt renal biopsy and require proper treatment.
한상웅(Sang-Woong Han),홍의경(Eui Kyeong Hong) 한국정보과학회 2000 한국정보과학회 학술발표논문집 Vol.27 No.2Ⅰ
XML은 최근 인터넷상에서 정보 교환의 표준으로 자리잡고 있다. 따라서, 그동안 semistructureddata와 XML데이터를 데이터베이스에 저장하고 검색하기 위한 많은 연구들이 진행되어 왔다. 본 논문에서는 기본에 개발된 RDBMS를 이용한 시스템과 OODBMS를 이용한 시스템의 장단점을 수용하여 ORDBMS 상에서 XML 문서를 저장하고 검색할 수 있는 시스템을 설계하였다. 이 시스템은 DTD 독립적인 XML 문서를 저장하기 위해 스키마와 분할저장 방법을 이용하여 임의의 XML 문서를 저장하고 저장된 문서의 갱신을 용이하게 처리할 수 있도록 하였다. 전체적인 시스템은 웹상에서 문서를 저장, 검색할 수 있는 웹 기반 시스템과 XML을 이용하는 응용프로그램의 데이터베이스 연동을 지원하는 응용기반 시스템으로 구분하였다.
저나트륨혈증 환자에서 저나트륨혈증의 치료에 영향을 미치는 요인에 대한 연구
민경환(Kyung Hwan Min),한상웅(Sang Woong Han),김호중(Ho Jung Kim),유준호(Jun Ho Ryu),강석우(Seok Woo Kang),양성규(Seong Kyu Yang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
N/A Hyponatremia, well known as a serious medical condition, is the most frequent electrolyte disorder in clinical medicine. The aim of this study is to bring to readers affecting factors in hyponatremia treatment and to suggest effective treatment guideline. We studied general characteristics, associated se-rum potassium change, relationship of sodium concentration in urine, and affecting factors on serum sodium correction in 76 hyponatremic patients who had admitted Hanyang University Kuri Hospital. These 73 hyponatremic patients were divided into 10 groups according to cause and treatment by retrospective analysis(1 group : G-I origin, 2 group : CRF, 3 group : CHF, 4 group: LC, 5 group : adrenal origin, 6 group : diuretics use, 7 group : CHF with di- uretics use, 8 group : LC with diuretics use, 9 group : polydypsia, 10 group : SIADH). Serum sodium were 124.2±6.9mEq/L in initial diagnosis, 125.6 ±7.7mEq/L after 48 hour, and 129.8±6.3mEq/L in final evaluation. Among these hyponatremic patients, thirty patients' (41.1%) sodium correction rate were below 0.5mEq/ L/hr during initial 48 hour and fifteen patients(20.5%) were corrected above 135mEq/l in serum sodium Initial serum potassium was average 4,07mEq/L, and 15 patients in 73 hyponatremic patients were hy- pokalemic feature. Eight patients of 15 hypokalemic patients were corrected to normal potassium level and in addition, four patients of 8 corrected patients were corrected to normal sodium level above 135mEq/L. The disease frequency were highest in GI origin (31.5%), followed by SIADH(20.5%) and LC(12.3%). In our study, hyponatremia correction was not related to patient sex, age, and initial serum sodium concentration. In conclusion, Hyponatremia prognosis was not related to initial serum sodium concentration and cor-ection rate, but related to treatment of underlying disease. And hypokalemia acompanied by hyponetre-mia was corrected after correction of hyponatremia.
Adriamycin 투여가 흰쥐 신사구체 기저막의 형태적 변화가 Laminin 분포에 미치는 영향
정호삼(Ho Sam Chung),한상웅(Sang Woong Han),김호증(Ho Jung Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
세포 및 조직의 접합물질인 laminin은 신장의 신사구체 기저막을 구성하는 당단백 물질로 알려져 있으며, 상피조직, 신경조직 및 근육조직의 기저막에 분포되어 있어 조직내 세포의 재생, 극성 및 물질수용 동 필수적이고 미세한 역할을 한다고 보고되어 있다. 정상 신장에서는 제 4형 아교질, heparan sulfate proteoglycan 및 fibronectin 등과 함께 가시구조를 이루고 있다. 최근 많은 학자들은 여러 종류의 사구체질환에서 특히, membranous lupus nephriis, 막성증식성신사구체염, 사구체경화증 등에서 기저막내 laminin 의 분포가 변동된다고 주장한 바 있다. 이에 저자들은 신장에 독성이 큰 것으로 알려진 adriamycin을 실험동물에 투여하였을 때 신사구체기저막동에서 laminin의 분포 변동과 신사구체의 형태적 변화와의 관계 여부를 규명하고자 하였다. 본 실험에 사용한 실험동물은 SD계 체중 150g내외의 흰쥐로 대조군과 실험군으로 나뉘었다. 실험군의 흰쥐에는 체중 kg당 25mg되게 adriamycin을 증류수에 희석하여 0.2ml를 복강내로 투여하였고, 대조군에는 주사용 증류수만 투여하였다. Adriamycin 투여후 24시간, 48시간, 72시간, 1주일 및 2주일 경과 후 신장을 절제하여 면역조직화학염색과 전자현미경을 이용한 면역도금법을 위해 조직절편을 제작하여 1차 및 2차 항체에 반응시켜 광학현미경과 전자현미경을 이용하여 관찰하여 다음과 같은 결과를 얻었다. 1) Adriamycin 투여후 24시간 48시간 경과군에서 신사구체내 laminin 면역반응이 강하게 나타났고, 특히 기저막내 금과립이 증가되었고 혈관사이세포의 세포질에서 금과립이 약간 증가되었다. 그러나 adriamycin 투여 1주일 및 2주일 군에서는 laminin반응이 대조군의 것과 같이 laminin 반응이 약화되었고, 기저막내 금과립도 감소되어 대조군의 것과 비슷하였다. 2) Adriamycin 투여 24시간군에서는 신사구체기저막은 두터워졌고 기저막내 lamina densa층이 관찰되지 않았으며, 기저막의 투명성이 상실되었다. 이상과 같은 결과는 adriamycin이 신독성에 의한 기저막의 손상 등의 형태적 변화와 함께 laminin의 기저막내 증가는 laminin에 의한 신사구체기저막의 재생능에 따른 것으로 생각되었다. 이상과 같은 결과는 adriamycin에 의한 혈관내피세포 및 혈관사이세포등에서 laminin생성의 조절기능 상실에 의한 기저막내 비정상적인 laminin 발현을 나타내는 것으로 생각되고 따라서 기저막의 재생에 laminin의 미세한 역할이 있다고 생각된다. Laminin is a glycoprotein that is composed of the basement membrane of renal glomerulus and various tissues, such as epithelium, nervous tissue, and muscle tissues. Functions of laminin have been dem- onstrated to play an essential role in the regeneration and polarity of cells as well as the reservation of materials inside of the tissues. In collaboration with type IV collagen, heparan sulfate proteoglycan, and fibronectin, laminin forms a spike-like structure in the renal glomerular basement membrane of normal kidney. Recently, many investigators have suggested that the distribution of laminin in the basement membrane was altered in a variety of renal diseases, expecially in membranous lupus nephritis, membra- nous proliferative gromerular nephritis, and glomerulosclerosis. To investigate whether the morphologic changes in the glomerulus are associated with the profile of laminin distribution in the renal glomerular basement membrane, the gromerulus was examined after exposure to adriamycin, a potent inducer of nephritis. Male rats(Sprague Dawley strain) were intraperitoneally injected with 0.2ml adriamycin at 25mg/kg body weight. At 24 hour, 48 hour, 72 hour, one week, and 2 week after adriamycin administration, kidney isolated from sacrificed rats was sectioned and observed by immunohistochemical staining and electron microscopy using the immunogold method. The results we obtained were as follows: 1) Renal glomerulus was strongly stained with anti-laminin antibody when 24 or 48 hours passed after adriamycin administration. However, after 1 or 2 weeks later, the antibody response became weak at the level comparable with the vehicle controls. The renal glomerular basement membrane exhibited an increase of gold particles in subjects passed both 24 and 48 hours after adriamycin administration. This increase was observed in mesangial cells in the same subjects. In contrast, both 1 and 2 week- passed subjects displayed a reduction in the binding of gold particles at the level comparable with the vehicle controls. 2) 24 hour-passed rats upon treatment with adriamycin showed various morphologic changes in the renal glomerulus, including thicker and less transparent basement membrane and undetectable lamina densa layer. In conclusion, these results suggest that adriamycininduced renal toxicity leads to the morphologic alteration along with an increase in laminin expression and that these aspects may be attri- butable to the regenerative potential of laminin.
김종순(Jong Soon Kim),한승수(Seung Soo Han),소용선(Yong Seon So),김태형(Tae Hyung Kim),한상웅(Sang Woong Han),권기현(Ki Hyeon Kweon),김석환(Seok Hwan Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1
N/A Bone scan is known to be an effective tool for observing the state of soft tissues and bones of electric bum patients. It is also used for observing the progress of patients after debridement or skin graft as well as determing to amputate specific body parts. To evaluate bone scan's role in electric bum, we analyzed bone scan 37 patients with electric burn. Among the 37 patients, 8 of 37 were injured in low voltage and 29 of them in high voltage. 27 patients received the electrical input through the hand, 6 through the scalp, 2 through the shoulder, 1 through the left chest wall and 1 through the left inguinal area. Among 29 patients received high voltage, 22 patients had the electrical output through the foot, 3 through the hand, 2 through the shoulder, 1 through the buttock and 1 through the left chest wall. Bone scans revealed cellulitis in 37 patients with 47 sites, osteomyelitis in 15 patients with 15 sites & bone defects in 4 patients with 4 sites. In 4 patients with skin graft or skin flap, follow up bone scan showed improvements of bony uptake in preoperatively bony defect area and all of them were healed without complication There were 2 cases in which uptake increased in the myocardium, 1 in the liver and 6 in the kidney, however, ssrum calcium level, EKG, cardiac enzyme, liver and renal function tests were normal. In conclusion, bone scans are helpful in the assessment of injury sites after electrical insult and in differential diagnosis of cellulitis and osteomyelitis. It is also useful tool of assessment after skin graft or skin flap, however, it should be further evaluated about internal organ damage.