Paraquat 중독 환자에 대한 hemoperfusion 과 continuous veno-venous hemofiltration 의 치료 효과

노희종(Hee Jong Noh),구자룡(Ja Ryong Koo),이정열(Jeong Yeol Lee),주민하(Min Ha Joo),전만조(Man Jo Jeon),김진철(Jin Cheol Kim),김근호(Gheun Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. Methods : There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4±3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1±1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4±20.9 hours; ultrafiltration volume, 33.8±3.9 L/day) after hemoperfusion. Results : There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: 〈 1 mouthful, 0% (0/5); 1 mouthful, 53% (8/15); 2 mouthful, 65% (11/17); ≥ 3 mouthful, 82% (27/33); unknown, 60% (6/10). Conclusion : Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.(Korean J Med 59:651-656, 2000)

복부 대동맥류에서 발치 후 발생한 범발성 혈관내 응고증 1 예

안종호 ( Jong Ho Ahn ),이정열 ( Jeong Yeol Lee ),노희종 ( Hee Jong Noh ),주민하 ( Min Ha Joo ),전만조 ( Man Jo Jeon ),윤병인 ( Byung In Yun ),장흥문 ( Heung Moon Chang ) 대한내과학회 2001 대한내과학회지 Vol.61 No.5

N/A Disseminated intravascular coagulation (DIC) is the result of a severe underlying disorder thatinitiates massive activation of the coagulation system. We report an unusual case of 79- year - old man who developed DIC after tooth extraction in abdominal aortic aneurysm. He was referred to our hospital because of persistent bleeding after tooth extraction. Physical examination indicated a pulsating mass in abdomen. Abdominal computerized tomography (CT) scan revealed 70 mm diameter aneurysm of the abdominal aorta, extending from the renal infrahilar level to the common iliac artery, and his coagulation profile showed the features of DIC by revealing thrombocytopenia, hypofibrinogenemia, and increased level of fibrinogen degradation product (FDP). After he had received blood component therapy including fresh frozen plasma and continuous intravenous heparin infusion (4,800 U/day), the bleeding diathesis and coagulopathy improved. He refused to have definitive surgery for the aneurysm. (Korean J Med 61:572- 576, 2001)

다양한 종에서 하우스키핑 유전자 선택의 중요성

채한화(Han-Ha Chai),노윤정(Yun Jeong Noh),노희종(Hee-Jong Roh),임다정(Dajeong Lim) 한국산학기술학회 2020 한국산학기술학회논문지 Vol.21 No.8

하우스키핑 유전자는 에너지생성, 물질합성, 세포사멸 및 세포방어 등과 같은 세포의 기본적인 기능을 수행하기 때문에 모든 유기체의 세포에서 발현된다. 세포의 기본적인 기능을 유지하기 때문에 발현 수준이 상대적으로 일정하여 단백질 발현 및 목적 유전자의 mRNA 발현 분석 등과 같은 유전자 발현 연구에서 기준 유전자로 사용되고 있다. 그러나 이들 유전자의 발현 수준은 조직과 세포마다 다를 수 있으며, 특정 환경 하에서 변할 수 있다. 그러므로 하우스키핑 유전자의 발현 안정성을 탐색하여 유전자 발현 연구에서 최적의 기준 유전자를 선택하는 것이 중요하다. 이 리뷰는 문헌을 통해 인간, 닭, 돼지 그리고 쥐에서 발견된 하우스키핑 유전자를 요약하고, geNorm, NormFinder 그리고 BestKeeper 소프트웨어를 통해 발현 안정성을 추정하였다. 하우스키핑 유전자의 발현 안정성에 대한 탐색은 유전자 발현 연구에서 실험 조건에 따라 가장 적합한 기준 유전자를 선별할 수 있고, 데이터의 정규화를 위해 적용될 수 있다. Housekeeping genes are expressed in cells of all organisms and perform basic cellular functions such as energy generation, substance synthesis, cell death, and cell defense. Accordingly, the expression levels of housekeeping genes are relatively constant, and thus they are used as reference genes in gene expression studies, such as protein expression and mRNA expression analysis of target genes. However, the levels of expression of these genes may be different among various tissues or cells and may change under certain circumstances. Therefore, it is important to select the best reference gene for specific gene expression research by exploring the stability of housekeeping gene expression. This review summarizes housekeeping genes found in humans, chickens, pigs, and rats in the literature and estimates expression stability using geNorm, NormFinder, and BestKeeper software. The most suitable reference housekeeping gene can selected based on expression stability according to the experimental conditions of the gene expression study and can thus be applied to data normalization.

Cytochrome P450 2E1 유전자의 다형성이 알코올성 간경변증 환자의 간손상에 미치는 영향

고문수(Moon Soo Koh),이정열(Jeong Yeol Lee),주민하(Min Ha Joo),전만조(Man Jo Jeon),노희종(Hee Jong Noh),김진봉(Jin Bong Kim),김동준(Dong Jun Kim),김정아(Jung A Kim),정영화(Young Hwa Chung) 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Background : There is an individual variation in the hepatic injuries following alcohol abuse, which may be partly caused by the diverse activities of enzymes participating in the degradation of alcohol. Polymorphism of cytochrome P450 2E1 (CYP2E1) gene has been reported to affect the degradating activity of the enzyme, which may be eventually associated with the severity of alcoholic liver disease. In this study we were to evaluate the effects of genetic polymorphism of CYP2E1 on hepatocellular injury or fibrosis. Methods : We analyzed the relationship of CYP2E1 genotypes to the biochemical and clinical characteristics as well as TGFβ1 expressions in a total of 33 patients (M:F=32:1) with advanced alcoholic liver cirrhosis. CYP2E1 genotypes were determined by RFLP using RsaI and PstI. The amounts of serum TGFβ1 were measured by ELISA (TGFβ1 ELISA system, Promega, USA). Results : Out of 33, 23 (70%) had the CYP2E1 of genotype A and all of the remaining 10 (30%) were type B; there was no one who had type C. The serum albumin levels of patients with type A of CYP2E1 gene were lower than those with type B (p=0.01); the Child-Pugh scores were also higher in patients with type A than B (p=0.03). However, there was no difference between the two groups in the serum AST, ALT, γ-GTP and bilirubin levels. The patients expressed similar amount of serum TGFβ1 regardless of their CYP2E1 genotypes. Conclusion : Our data indicates that the most common genotype of CYP2E1 is type A (70%) in patients with advanced alcoholic liver cirrhosis in Korea. It is also suggested that patients with genotype A of CYP2E1 may be associated with more advanced alcoholic liver cirrhosis compared to those with type B.(Korean J Med 60:222-227, 2001)

폐섬유화를 보인 paraquat 중독의 치료 2 예

김진철,이정열,구자룡,윤종우,채동완,김근호,전노원,노정우,김형직,노희종,주민하,전만조 대한내과학회 2001 대한내과학회지 Vol.60 No.5

Paraquat, a very potent herbicide, has produced many fatalities through indiscriminate usage and suicides. It is known that with ingestion of more than one mouthful of 20% paraquat, death usually occurs by pulmonary fibrosis. We experienced two cases of successful outcome in patients with paraquat poisoning complicated with pulmonary fibrosis through active, intensive treatment from the early phase after ingestion. They swallowed one to two mouthfuls of the 20% commercial paraquat, and received hemoperfusion within 2-3 hours after ingestion. Then, combination therapy with steroid, vitamin C, D-penicillamine, allopurinol, colchicine was administered from the early phase. They showed moderate to severe hypoxemia and pulmonary fibrosis on chest HRCT during hospital course, but recovered from hypoxemia and remained very well on follow up over 3 months and 12 months after ingestion, respectively. We report these cases with literature review on treatment and prognosis of paraquat poisoning. (Korean J Med 60:490-495, 2001)