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      • 경피적 신생검 94례에 대한 분석

        윤경우,임상우,강호정,도준영 영남대학교 의과대학 1995 Yeungnam University Journal of Medicine Vol.12 No.1

        저자들은 영남대학교 의과대학 부속병원 내과에서 1985년 1월부터 1994년 5월까지 시행한 경피적 신생검 110례 중, 추적관찰이 가능한 94례(원발성 91례, 속발성 3례)를 대상으로 조직형별에 따른 임상상과 치료반응을 관찰하여 다음과 같은 결과를 얻었다. 1) 신생검 전 임상진단은 신증후군이 69례, 무증상성 요이상 20례 등이었고, 연령분포는 15세에서 30세사이가 총 52명으로 전체의 55.3%를 차지하였으며 남녀비는 1.76 : 1로 남자가 많았다. 2) 병리 조직학적소견상 원발성 신증후군은 미세변화 신증후군 41례(43.6%), 메산지움증식성사구체신염 28례(29.8%), 막성 사구체신염 12례(12.8%), Type 1 메산지움모세관성 사구체신염 4례(4.3%), 소상성분절상 경화중 3례(3.2%), 반월상 사구체신염 3례(3.2%)였으며, 속발성은 루푸스 신염 2례(2.1%), B형 간염 연관 막증식성 신염 1례(1.1%)로 전체적으로 미세변화 신증후군이 가장 많았고, 젊은 연령층에서는 미세변화 신증후군과 메산지움증식성 사구체신염이 많았으며 50세 이상의 노인층에서는 막성 사구체신염과 소상성분절상 사구체경화증이 많았다. 3) 스테로이드 치료에 대한 효과는 치료를 시행한 86례 중 41례(47.7%)가 완전관해를, 18례(20.9%)가 부분관해를, 5례(5.8%)가 스테로이드 의존성을 보였으며, 스테로이드 의존성 5례중 4례에서 cyclosporin A를 사용하여 4례 모두에서 단백뇨의 관해를 보였고, 스테로이드에 반응이 없었던 경우는 22례(25.6)였으며, 이외에 ACE inhibitor와 항혈소판제제를 사용하였으나 현재까지 단백뇨의 관해는 볼수 없었고, 이중 메산지움증식성 사구체신염 1례와 막성 사구체신염 1례, 반월상 사구체신염 1례, 루푸스 신염 1례등 모두 4례에서 만성 신부전으로 진행하였다. 4) 조직형별로 치료에 대한 효과는 미세변화 신증후군이 가장 좋았으며 스테로이드 의존성을 보인 5례중 4례에서 cyclosporin A를 사용하여 4례 모두에서 단백뇨의 관해를 보였으며, 메산지움모세관성 사구체신염 4례는 스테로이드 사용없이 항혈소판제제와 ACE inhibitor 등을 사용중이며 단백뇨의 개선은 보이지 않고 있으나 현재까지 전 예에서 정상 신기능을 유지하고 있다. A clinical and histopathological study was performed on ninety-four patients with nephrotic syndrome (91 idiopathic and 3 secondary) who were admitted to Department of Internal Medicine, Yeungnam University Hospital during the period of nine years, from January 1985 to May 1994. The results were as following. 1. the ratio of male to female was 1.76:1. In young age group, minimal change was the most predominant type. In old age group, membranous glomerulonephritis and focal glomerulosclerosis were predominant types. 2. The primary nephrotic syndromes were 96.8% and secondary nephrotic syndromes were 3.2. Histopathologic findings of 94 renal biopsy tissue were classified into minimal change (43.6%), mesangial proliferative glomerulonephritis (29.8%), membranous glomerulonephritis (12.8%), Typel membranous proliferative glomerulonephritis (4.3%), focal glomerulosclerosis (3.2%) and others (6.4%). 3. The response of eighty-six patients treated with steroid showed complete remission in 51.2%, partial remission in 20.9%, steroid dependent in 2.3%, and no effect in 25.6% of cases respectively. The response to steroid therapy was most effective in the patients with minimal change lesion. 4. In the patient with membranous proliferative glomerulonephlitis, Iong-term angiotensin converting enzyme inhibitor treatment showed less deterioration of renal function.

      • 만성 신부전환자의 빈혈에 있어서 Erythropoietin 치료에 따른 혈청지표의 양상

        윤경우,박종원,강호정,도준영,임종식 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.1

        1992년 12월부터 1993년 7월까지 8개월동안 영남대학교 의과대학 부속병원 내과에서 치료중인 혈액투석환자 64명을 대상으로 erythropoietin 치료 유무와 간기능 검사 이상 유무에 따라 군을 나누어 각 군간의 혈색소, 적혈구 용적, 적혈구 지수, 망상 적혈구수, 혈청철, TIBC, ferritin, transferrin saturation을 비교하여, 이들 값과 수혈양의 관계를 조사한 성적은 다음과 같다. 대상환자의 MCH는 28.8 ±2.0 pg, MCV 92.4 ±4.7 fl로 정색소성 정구성 빈혈의 소견을 나타냈다. Ferritin치는 남자 657.4 ±292.0 ng/ml, 여자 511.5 ±370.7 ng/ml, serum iron치는 남자 145.5 ±63.7 ㎍/dl, 여자 125.6 ±57.1 ㎍/dl, transferin saturation은 61.6 ±28.4%로 ferritin, serum iron, transferrin saturation 모두 정상인보다 높았으며 EPO 치료 유무에 따른 환자비교에서, EPO치료를 받는 환자(20례)의 혈색소, 적혈구 용적은 비 EPO치료군 보다 유의하게 높았고, 1달간 평균 수혈량은 비 EPO치료군에서 유의하게 높았다(p<0.05). 간기능 이상이 있는 군(10례)과 간기능이 정상인 군(54례)간의 비교에서, 혈청 철 및 transferin saturation은 간기능 이상이 있는 군에서 유의하게 높았다(p<0.05). 수혈횟수는 ferritin(r=0.4675), transferrin saturation(r=0.3823), iron(r=3386)과 유의한 상관관계를 보였다. 결론적으로 빈혈의 교정을 수혈에 의존하는 환자는 철분 과부하, 즉 hemosiderosis, hemochromatosis 등의 위험이 있으며, erythropoietin치료는 철분 과부하를 포함한 수혈과 관련된 여러 가지 위험성을 감소시킬 것으로 생각된다. Clinical study was carried out on the 64 hemodialysis patients(HD) with chronic renal failure who had been treated from December 1992 to July 1993 in Yeungnam University Hospital. The following results were obtained. In hematologic parameters, MCH was 28.8 ±2.0pg, and MCV was 92.4 ±4.7fl. Result revealed normochromic and normocytic anemia. Mean values of serum ferritin were 657.4 ±292.0ng/ml in men and 511.5 ±370g in women. Mean valuses of serum iron were 145.5 ±63.7㎍/dl. Mean values of transferrin saturation was 61.6 ±28.4%. Serum frerritin, serum iron and transferrin saturation were higher in HD group than normal reference. In erythropoeitin treatment group, Hb and Hct were significantly higher than non-erythropoietin treatment group. Amount of transfusion was significantly higher in non-erythropoietin treatment group than erythropoeitin treatment group(p<0.05). Values of iron, transferrin saturation were significantly higher in abnormal liver function test(LFT) hemodialysis group than normal LFT group(p<0.05). Transfusion amounts revealed positive correlation with ferritin(r=0.4675), transferrin satruation(r=0.3823) and iron(r=0.3386)(p<0.05). In conclusion, erythropoietin treatment cna reduce requirement of blood transfusion and transfusion related side effects such as iron overload, hemosiderosis and hemochromatosis.

      • 혈액 투석 환자에서 조혈 호르몬 치료 효과 향상에 대한 연구

        박종원,도준영,윤경우 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2

        Anemia in chronic renal failure plays an important role in increasing morbidity of dialysis patients. The causes of the anemia are multifactorial. With using of erythropoietin(EPO) , most of uremia-induced anemia can be overcome. However, about 10% of renal failure patients shows EPO-resistant anemia. Hyporesponsiveness to EPO has been related to many factors: iron deficiency, aluminum intoxication, inflammations, malignancies and secondary hyperparathyroidism. So I evaluated the improvement of EPO responsiveness after correction of above several factors. Materials and Methods: Seventy-two patients on hemodialysis over 6 months were treated with intravenous ascorbic acid(IVAA, 300 mg t.i.w. for 12 weeks). After administration of IVAA for 12 weeks, patients were classified into several groups according to iron status, serum aluminum levels and i-PTH levels. Indivisualized treatments were performed; increased iron supplement for absolute iron deficiency, active vitamin D3 for secondary hyperparathyroidism and desferrioxamine(DFO, 5 mg/kg t.i.w. ) for aluminum intoxication or hyperferritinemia. Results: 1) Result of IVAA therapy for 12 weeks on all patients(n=72) Hemoglobin levels at 2, 4, 6 week were significantly elevated compared to baseline but those of hemoglobin at 8, 10, 12 week were not significantly different. 2) Result of IVAA therapy for 20 weeks on patients with 100 ㎍/1≤ferritin<500㎍/1 and transferrin saturation(Tsat) below 30%(n=30) After treatment of IVAA for 12 weeks, patients were evaluated the response of therapy according to iron status. Patients with 100 ㎍/1 ≤ ferritin<500㎍/1 and Tsat below 30% showed the most effective response. These patients were treated further for 8 weeks. Hemoglobin levels at 2, 4 week were significantly increased compared to baseline with significantly reduced doses of EPO at 2, 4, 6, 10, 12, 16, 20 week. Concomitantly significantly improvement of Tsat at 2, 6, 16, 20 week compared to baseline were identified. 3) Result of IVAA therapy for 12 weeks followed by DFO therapy for 8 weeks on patients with serum aluminum above 4㎍/1(n=12) Hemoglobin levels were not significantly increased during IVAA therapy for 12 weeks but dosages of EPO were significantly decreased at 2, 4, 6, 8 week during DFO therapy compared to pre-treatment status. Conclusion: IVAA can be helpful for the treatment of the anemia caused by functional iron deficiency and can reduce the dosage of EPO for anemia correction. And administration of low dose DFO, in cases of increased serum aluminum level, can reduce the requirment of EPO.

      • Pd (II)-catalyzed vinyl addition polymerization of novel functionalized norbornene bearing dimethyl carboxylate groups

        Liu, Binyuan,Li, Yang,Shin, Boo-Gyo,Yoon, Do Yeung,Kim, IL,Zhang, Li,Yan, Weidong Wiley Subscription Services, Inc., A Wiley Company 2007 Journal of polymer science Part A, Polymer chemist Vol.45 No.15

        <P>Three novel functionalized polynorbornenes (PNB) with pendant dimethyl carboxylate group (carboxylates—acetate, propionate, and butyrate) are synthesized as a vinyl-type with a palladium (II) catalyst in high yield. The effects of size of substitutents, molar ratio of monomer to catalyst, solvent polarity, reaction time, and temperature on the polymerization of exo-norbornene dimethyl propionate were systematically investigated. The low molar ratio and temperature, as well as high polarity of solvent, and long reaction time, are favorable for the enhancement of the monomer conversion, especially, the solvent have an obvious effect on the catalyst activity. The resulting poly(cis-norbornene-exo-2,3-dimethyl carboxylates) (PNB-dimethyl carboxylates) show good solubility in common organic solvent and high thermal stability up to 360 °C. The glass transition temperature was detected by DMA at 331, 324, and 318 °C for acetate, propionate, and butyrate, respectively. © 2007 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 45: 3391–3399, 2007</P> <B>Graphic Abstract</B> <P>Three novel functionalized PNB-2,3-dimethyl carboxylates (carboxylates—acetate, propionate, butyrate) are synthesized as a vinyl-type with a palladium (II) catalyst in high yield. The resulting PNB-dimethyl carboxylates show good solubility in common organic and high thermal stability up to 360 °C. The glass translation temperature was determined by DMA at 331, 324, and 318 °C for PNB-dimethyl acetate, PNB-dimethyl propionate, and PNB-dimethyl, respectively.</P><P> <img src='wiley_img/0887624X-2007-45-15-POLA22091-gra001.gif' alt='wiley_img/0887624X-2007-45-15-POLA22091-gra001'> </P>

      • SCOPUSKCI등재

        복막 투석 환자에서 도관 관련 감염 및 복막염에 대한 Mupirocin 과 Catheter Revision 의 효과

        정항재(Hang Jae Jung),도준영(Jun Young Do),윤경우(Kyung Woo Yoon),박준범(Jun Bum Park),조규향(Kyu Hyang Jo),김정미(Jung Mi Kim),최준혁(Jun Heuk Choe),김영진(Yeung Jin Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

        N/A Background: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Methods : We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started me-dications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results : The total follow-up was 2401 patient months(pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus(MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them im-proved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse(The mean duration : 14.0 months) The rates of ESI were more reduced after using mupi-rocin than before(l per 12.7 vs 34.0 pt.mon, p<0.01). Conclusion: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

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      • SCISCIESCOPUS

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