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말기 신부전 환자에서 시행한 관상동맥 조영술 소견과 치료에 대한 고찰
김재헌(Jae Heon Kim),윤수영(Soo Young Yoon),노현정(Hyun Jeong Roh),박형천(Hyung Cheon Park),강남규(Nam Gyu Kang),최동훈(Dong Hoon Choi),강신욱(Shin Wook Kang),장양수(Yang Soo Jang),신원흠(Won Heum Shim),조승연(Seung Yun Cho),이호영(H 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Background - Disease of the heart remains the leading cause of death in patients treated for endstage renal disease(ESRD). In contrast to person with normal renal function, coronary risk factors or indicators could not yet clearly be defined in renal insufficiency. The aim of this study is to elucidate whether conventional risk factors are valid predictors of coronary artery disease(CAD) in ESRD patients and to examine the therapeutic outcome of percutaneous transluminal coronary angioplasty(PTCA) and coronary artery bypass graft(CABG) in chronic dialysis patients. Methods: Between 1997 and 1999, 44 ESRD patients were perfomed by echocardiography and coronary angiography. Results: 31 patients showed positive results in coronary angiography. In patients with CAD, there were statistically significantly older(45.4 vs 60.6 yrs), had higher LP(a> level(18.0 vs 37.5 mg/dL), lower HDL cholesterol level(42.5 vs 33.6 mg/dL), higher BMI (20.7 vs 22.6), and lesser degree of ejection fraction on echocardiography(58.6Yo vs 42.8Yo). And there were more patients who had DM(30.8 vs 64.5Fo) and previous myocardial infarction(MI) histories(7.796 vs 38.7 96) in CAD group. Logistic regression analysis suggested that old age, high Lp(a), and previous MI history could be risk factors for coronary artery disease in ESRD patients. Among the 31 patients had CAD, 10 in HD and 3 in CAPD group experienced PTCA, and another 2 in HD and 4 in CAPD group experienced CABG. Treatment modality and mortality were not different between the two groups. Follow up angiography were performed in 4 HD patients, and 2 of them had restenosis of previously involved vessels. Conclusion: Old age, previous MI history and high Lp(a) are independent risk factors for the presence of CAD in ESRD patients.
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Human immunodeficiency virus(HIV) 감염자에 있어서 3제 병용요법의 치료효과 및 안전성
홍성관(Sung Kwan Hong),박윤수(Yoon Soo Park),조정호(Jeong Ho Cho),노현정(Hyun Jung Roh),김효열(Hyo Yeol Kim),장경희(Kyung Hee Chang),송영구(Young Goo Song),김준명(June Myung Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.5
N/A Background : Antiretroviral combination therapy with one protease inhibitor and two reverse transcriptase inhibitors is profoundly suppressive of HIV replication. To determine the efficacy and safety of the triple combination therapy in persons with HIV infection in Korea, we analyzed the response of therapy in terms of immunity and viral load. Methods : Ten persons with HIV infection, who were treated with triple combination therapy at least 12 months at Yonsei University College of Medicine from 1997 to 1999 were studied. The triple combination therapy regimen consisted of two reverse transcriptase inhibitors (zidovudine or didanosine, lamivudine) and one protease inhibitor (indinavir). We analyzed the levels of HIV RNA, CD4+ cell counts, β2MG, and p24Ag before and after treatment. Adverse drug reactions during therapy were described. Results : The mean age of patients at treatment was 38.7 years. Nine patients were male, and 1 patient was female. Six patients received triple combination therapy as initial treatment, while 4 patients received it as re-treatment. The mean level of HIV RNA was 129,222 copies/mm3 before treatment. RNA level decreased to less than 500 copies/mm3 (non-detectable range) at 1 month in 7 of 10 patients, at 12 months in 9 of 10 patients. The mean CD4+ cell counts was 206/mm3 before treatment, and 376/mm3 after 12 months treatment. The β2MG decreased to 2.7 mg/L from 2.8 mg/L after 12 months of treatment. The p24Ag was positive in 3 of 10 patients and negative in all of the patients at 3 months treatment. Mild hyperbilirubinemia (5 cases) was the most frequent adverse reaction followed by flank pain (3 cases), skin rash (2 cases), abdominal discomfort (2 cases), and mild elevation of AST/ALT (1 case). Conclusion : The triple combination therapy in HIV infection appeared to be generally well tolerated, and was able to profoundly sustain suppression of HIV replication.(Korean J Med 58:582-589, 2000)
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말기 신부전 환자에서 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 환자의 임상적 경과
한승혁(Seung Hyeok Han),이상철(Sang Cheol Lee),강이화(E . Hwa Kang),구영석(Young Suk Goo),박형천(Hyung Chun Park),노현정(Hyun Jeong Roh),노현진(Hyun Jin Noh),윤수영(Soo Young Yoon),윤도식(Do Sik Yun),최소래(So Rye Choi),강신욱(Shin W 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1
배 경 : 말기 신부전 환자의 내과적 치료에 교정되지 않는 중증 이차성 부갑상선 기능항진증시 외과적 부갑상선 절제술이 시행되어져 왔다. 부갑상선 절제술 시행 후 추적결과에 대한 보고가 드물어 본 연구를 시행하였다. 방 법 : 1990년부터 1999년까지 신촌세브란스병원에서 중증 이차성 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 24 명을 대상으로 후향적으로 분석하였다. 결 과 : 술후 병리소견으로 미만성 17예, 결절성 6예, 선종이 1예였다. 임상증상으로 골통 또는 관절통은 19명(79.2%), 근육통은 17명(70.8%), 신체 불쾌감은 10명(41.7%), 소양증은 13명 (54.2%)였고, 술후 임상증상의 호전을 보였다. 술후 혈청 칼슘, 혈청 인, intact PTH는 각각 7.3±1.4 ㎎/dL, 4.0±1.3 ㎎/dL, 89.3±146.1 pg/mL로 술전과 비교하여 감소하였고(p<0.01), 혈청 alkaline phosphatase는 술후 738.8±935.1 IU/L로 술전 보다 증가하였다(p<0.01). 재발 5예 중 결절성 과증식형이 4예로 미만성 과증식형에 비해 높은 빈도를 보였고(p=0.006), 비재발군에 비해 수술 전후의 intact PT H의 감소차가 적었다(945.3±374.6 v s 1,385.8±481.8, p=0.036). 결 론 : 중증 이차성 부갑상선 기능항진증에서 외과적 부갑상선 절제술은 증상완화나 술후 intact PTH의 감소 등 좋은 결과를 기대할 수 있다. 병리학적 유형과 술후 intact PTH 감소 정도가 재발을 예측할 수 있는 인자로 생각된다. Backg round : Medical treatments such as restriction of phosphate, phosphate binder use, and active vitamine D therapy have been widely used for hyperparathyroidism in ESRD patients, and surgical parathyroidectomy should be considered in patients with uncontrolled hyperparathyroidism. Methods : A retrospective study w as performed in 24 ESRD patients with severe and uncontrolled hyperparathyroidism despite of medical treatment who undertook surgical parathyroidectomy in Severance hospital from 1990 to 1999. Results : Sixteen patients had total parathyroidectomy with immediate autotransplant, 7 patients had subtotal parathyroidectomy and only 1 patient had minimally invasive parathyroidectomy. An excellent short-term control of hyperparathyroidism was achieved in all patients after parathyroidectomy. Preoperative bone and joint pain improved in 16 of 19 patients. Muscle weakness and pain improved in 11 of 17 patiens, malaise improved in 8 of 10 patients and pruritus improved in 10 of 13 patients. In addition, clinical laboratory finding improved after parathyroidectomy. No clinical differences were seen between 16 patients who undertook total parathyroidectomy with immediate autotransplant and 7 patients who undertook subtotal parathyroidectomy. Recurrence of hyperparathyroidism ocurred in 5 of 24 patients with 4 nodular hyperplasia and 1 diffuse hyperplasia in pathologic finding . T he less degree of attenuated response of intact PTH levels immediately after operation w as observed in 5 recurrent cases. Conclusion : Good results were obtained after parathyroidectomy. We believe that histologic subtype and the attenuated response of intact PTH after surgical parathyroidectomy could be possible predictors of the recurrent hyperparathyroidism.
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