급성신우신염의 임상적 고찰

신영태,신승훈,이순구,이정호,이강욱 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

A clinical retrospective study was undertaken in 81 patients with acute pyelonephritis admitted to the Department of Internal Medicine, Chungnam National University Hospital from January 1983 to December 1989. The results were as follows : 1. Total number of patients studied was 81(M/F ratio, 1 : 4.4). The M/F ratio of 22 complicated patients (27.2%) was 1 : 2.7 2. The predisposing factors associated with complicated patients were as follows : 7 cases of urinary tract stone, 7 cases of pregnancy, 4 cases of neurogenic bladder and each one case of prostatic hypertrophy, ureter cancer, bladder diverticulum and polycystic kidney disease. 3. The common subjective symptoms on admission were fever and chills, frank pain, nausea and vomiting. High body temperature and CVA tenderness were noted in 61% and 95% of patients respectively. And 50.6% of patients revealed right CVA tenderness and 28.4% in left, 16% in both respectively. There was no difference in symptoms and signs between complicated and uncomplicated groups 4. In 50 patients(61.7%) microorganisms were isolated on the urine culture specimens. The most common organism was E. coli(80%), and followed by Staphylococcus aureus and Serratia odorifera. E coli was the most frequent pathogen in both female and male patients, and in complicated and uncomplicated groups. (In sensitivity test of complicated and uncomplicated groups). In sensitivity test of causative pathogens to antibiotics, E coli was sensitive to amikacin(93%), tobramycin(83.3%) and gentamycin(79.4%) and 88.9 percent of E coli were ressistant to ampicillin 5. In urinary examination on admission, pyuria was noted in 81% of patients, and proteinuria and microscopic hematuria were noted in 68% and 44% of patients respectively. 6. Within 3 days after antibiotics treatment deference was occured in 73.5% of total patients, and complicated patients revealed delayed defeverence compared to uncomplicated ones.

신증후군의 혈청 면역글로부린 농도에 관한 연구

辛榮泰 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

To evaluate the alterations of serum immunoglobulin concentrations in various pathologic types of idiopathic nephrotic sgndrome, serum concentrations of IgG, IgA, IgM and IgE were measured in 47 adult nephrotic syndrome who were admitted to Department of Internal Medicine, Chungnam National University Hospital from April 1982 to October 1987. The results were as follows 1. Serum IgG conceptions were depressed in most patients with nephrotic syndrome and correlated well with various parameters of nephrotic syndrome; with serum protein concentrations in MC(r=0.61, p<0.05); with serum cholesterol concentrations in MG(r=-0.54, p<0.05) ; with serum protein and cholesterol concentrations in MPGN(r=0.88, p<0.05 and r= -0. 89, p<0.05, respectively) 2. Serum IgA concentrations were within normal limit in most patients. 3. Serum IgM concentrations were elevated in 8 patients out of 20 patients with MC, 3 patient out of 15 patients with MG and 2 patients out of 4 patients with FGS. Those of the remaining patients revealed within normal limit or slightly decreased level. 4. Serum IgE concentrations were elevated in 6 patients out of 12 patients with MC and 3 patients out of 4 patients with MG.

전신성 홍반성 낭창의 임상적 고찰

신영태,이정호,신승훈,이강욱 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.2

To elucidate the clinical feature and clinicopathologic correlation of systemic lupus erythematosus(SLE), the authors analized symptoms and signs, laboratory findings and kidney pathology in 25 patients with SLE who were admitted to the Department of Internal Medicine, Chungnam National University Hospital from My 1985 to October 1989. Kidny biopsy was performed in 15 patients out of 19 patients who showed lupus nephritis. The results were as follows: 1. The ratio of male of females was 1:11.5. They were 14 to 53 years old and mean age was 30.2 years old. The peak age incidence was 3rd and 4th decades. 2. The most frequent chief complaint on admission was fever and chills. Most patients had two or more symptoms such as arthralgia, malar rash, generalized edema or weakness. 3. In 84% of the patients, duration from onset of the disease to diagnosis of SLE was longer than 1 month, which suggested that diagnosis of SLE is not easy in early stage of SLE. 4. The positive anti -DNA was the most frequently observed ARA criteria of SLE. And positive ANA, malar rash, persistent proteinuria, leukopenia, positive LE cell preparation, arthritis and oral ulcer were observed in order of frequency. 5. The frequent and pertinent general symptoms, not included in ARA criteria were fever and chills, arthralgia and abdominal pain which were observed in more than half of the patients. 6. On immunologic test, serum concentrations of C3 and C4 were decreased in 96% of the patients, serum concentration of Ig G, Ig A were increased in 65%, 36.8% and 26.3% of the patients respectively. The RA test was positive in 25% of the patients. 7. Lupus nephritis represented 76% of all SLE patients and pathological classification on 15 patients with lupus nephritis revealed class IV lupus nephritis in 9 patients(60%), class II n 3 patients (21%), class V in 2 patients(13.3%) and class III in 1 patient. 8. 7 out of 9 patients with class IV lupus nephritis and 1 out of 2 patients with class V lupus nephritis showed nephrotic syndrome. Progressive azotemia were observed in 3 out of 9 patient with class IV lupus nephritis and in 1 out of 2 patients with class V lupus nephritis. There were no nephrotic syndroms or azotemia in class II and class III lupus nephritis. 9. Of 17 patients who can be followed up, 9 patients were improved, 5 patients became progressive azotemia and 3 patients resulted in death. The causes of death were myocarditis with pericarditis in 1 patients, pneumonia with acute respiratory failure in 1 patient and CNS involvement of SLE in 1 patient.

혈청 HBsAg 양성인 사구체신염의 임상상 및 신조직 소견

신영태,구영선,강민규,황평주,김종학,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Hepatitis-B-associated glomerulonephritis is one of the immunologically mediated disorders associated with chronic Hepatitis B virus(HBV) infection. The frequency of HBsAg infection has been high in East Asia and it is one of the most important etiologic factors of the secondary glomerulonephritis. We reviewed the clinical and pathologic features of 29 patients with glomerulonephritis and HBs antigenemia, who were admitted to Chungnam National University Hospital from January 1988 to Febuary 1999. The results were as follows : 1) The average age of the patients was 33.8±10.4(mean±SD) and male to female ratio was 3.8. Proteinuria was present in 27 patients(93%), hematuria in 20 patients(69%) and hypertension in 17 patients(59%). Two patients(7%) manifested with renal insufficiency and 8 patients(28%) with nephrotic syndrome. 2) Renal pathology revealed membranous nephropathy(41%), membranoproliferative glomerulonephritis(21%), mesangial proliferative glomeulonephritis(21%), minimal change nephritis (14%) and focal segmental glomerulonephritis(3%). 3) The pathologic findings of liver were chronic active hepatitis(68%), chronic persistent hepatitis(38%) and liver cirrhosis(8%). 4) During the follow-up period(average:49.4 months), 7 patients(68%) presented persistent proteinuria, 5 patients(21%) progressed to renal failure and 2 patients(8%) resolved clinically. 5) The treatment was done with prednisolone to 3 patients, and with alpha-interferon to 3 patients. One patient treated with prednisolone resolved clinically, but this resolution did not coincide with disappearance of the hepatitis B antigens.

전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.

成人 Henoch-Schoenlein 자반증의 임상적 고찰

신영태,이강욱 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

Twenty cases of Henoch-Schoenlein purpura were studied in the Department of Internal Medicine, Chungnam National University Hospital from November 1986 to September 1992. The results were summerized as follows 1. There were 11 males and 9 females. They were 14 to 59 years old and the median value of the age was 19 years old. 2. The chief complaints on admission were purpura in 12 cases, hematuria in 4 cases and abdominal pain in 4 cases. Seven out of 20 cases had antecedent infection history; 5 cases with URI, 1 case with pneumonia and 1 case with meningitis. 3. The organ involvement were skin in all cases, kidney in 80%. gastrointestinal tract in 65% and joint in 45% of the patients. 4. Other main symptoms or signs were fever of chills, gross hematuria, melena, flank pain and nausea and vomiting in 9, 7, 6, 6 and 5 cases, respectively. 5. Abnormal hematologic or coagulation findings were leukocytosis in 45%, thrombocytosis in 15% and prolonged aPTT in 16.7% of the patients. 6. Serum C_3 were decreased in 2 out of 18 cases and C_4 were normal in all cases. Serum IgG and IgA were elevated in 27.8% and 61.6% of the cases, respectively. 7. The ASO titers were increased in 2 out of 18 casese and CRP were positive in 40% of the patients. 8. The histopathologic finding of the skin biopsies were leukocytoclastic vasculitis in all cases. 9. Nephritis were observed in 16 cases(80%). Seven out of 16 cases had history of gross hematuria. Severe proteinuria over 3.5gm/day were observed in 3 out of 16 cases. Among them, only one case showed decreased renal function. 10. Light microscopic finding of the 13 kidney biopsies showed grade Ⅰ in 1 case, grade Ⅱ in 4 cases, grade Ⅲa in 4 cases, grade Ⅲb in 3 cases and grade Ⅳ in 1 case. Immunofluorescent microscopic findings of the 12 kidney biopsies showe IgA, fibrinogen, C_3 , IgM and IgG deposits in 83.3%, 75%, 41.7%, 8.3% and 0%, respectively. 11. The outcome of the 4 cases without nephritis was symptom free status after short-term corticosteroid therapy. The outcome of he 15 cases with nephritis were disease free in 4 cases, improved in 3 cases, no changes in 6 cases and aggravated in 2 cases(13.3%) during the follow up period. The renal pathology of the two aggravated cases were grade Ⅲb. One case of them had severe proteinuria and gross hematuria and another case was older age(48 years old) compared with other patients.

지속성 외래 복막투석 환자의 복막염

신영태,황평주,김종학,강민규,구영선,양종오,장윤경,이강욱 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

CAPD has established itself as an effective method maintaining the patients with end stage renal disease. CAPD peritonitis is one of the most important complication of peritoneal dialysis. We analyzed the incidence, pathogens, and outcome of the peritonitis, of the 95 patients who underwent CAPD at CNUH from January 1993 to July 1998. The result were as follows : 1) A total of 72 episodes of peritonitis occurred during this periods. The incidence of peritonitis were 0.64/patient/year. 2) The first episode of peritonitis was occurred within a year in 75%, within two year in 95.8%. 3) The rate of positive and negative culture were 27.8% and 72.2% respectively. Gram positive organisms were cultured in 60%, Gram negative organisms in 40%. S. aureus were most prevalent organisms(30%). 4) The cure rate were 83.3% in Gram positive organisms and 62.5% in negative organisms. 5) Peritoneal catheter were removed in 18 cases. Among them, 7 cases are due to peritonitis. In conclusion, improved technology and increasing patients' effort to careful management of catheter will reduce the incidence of peritonitis.

자발적 초점성분절성사구체경화증 Mouse 모델에서 TGF-β및 MCP-1 유전자발현에 미치는 Renin Angiotensin System 의 영향에 관한 연구

신영태,서광선,이강욱 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

The role of angiotensin Ⅱ in the pathogenesis of the progressive renal injury process has been studied in many human renal diseases and animal renal injury models. The inhibition of angiotensin Ⅱ also has been reported to be effective to attenuate renal injury process in many human renal diseases and animal models. The activation of TGF-β and MCP-1 gene is thought to be related with renal injury process. A mutant strain FGS/Nga/Kist mouse is reported to develop focal and segmental glomerulosis, spontaneously. In order to evaluate renal pathology, MCP-1 and TGF-β gene expressions and the effect of renin-angiotensin system inhibition, 8 FGS/Nga/Kist mice were treated by angiotensin converting enzyme inhibitor, enalapril (150 mg/L in drinking water) for 12 weeks. Another non-treated, agematched 8 FGS/Nga/Kist mice and 6 nomal CBA/Nga mice were also included in this study. The urinary protein excrtion, magnitude of glomerular sclerosis, and renal express of MCP-1 and TGF-β were evaluated by uristick, light microscopic examination and competitive RT-PCR, respectively. CBA/Nga mice did not show significant proteinuria. However, urinary protein scores of enalapril-treated FgS/Nga/Kist mice was significantly lower than that of non-treated FGS/Nga/Kist mice (2.0±0.3, 4.1±0.5, respectively, p <0.05). Focal and segmental glomerular scierosis index of enalapril treated FGS/Nga/Kist mice was significantly lower than that of non-treated FGS/Nga/Kist mice (120±13, 189±15, respectively, p < 0.05). The level of renal TGF-β gene expression of enalapril treated FGS/Nga/Kist was significantly higher than that of CBA/Nga mice (4.7±1.3, 1.0±0.3, respentively, p< 0.05). But, enalapril treated FGs/Nga/Kist mice showed significantly lower level of TGF-β expression than that of non-treated FGS/Nga/Kist mice(p<0.05). MCP-1 gene expression of untreated FGS/Nga/Kist mice was significantly lower than that of CBA/Nga mice. However, enalapril treated FGS/Nga/Kist mice showed markedly increased level of MCP-1 gene expression compared to the untreated FGS/Nga/Kist mice(9.8±1.8, 3.6±1.2, respectively, p<0.05). With the above result, we speculate that angiotensin converting enzyme ingibition attenuates the renal injury process in this model and the regulation pathway of MCP-1 by renin-angiotensin system may be different from other animal renal injury models.

한국형출혈열의 血液像에 관한 연구

신영태,김민범,이정호,김상용 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

To elucidate the hematologic alterations in Korean hemorrhagic fever(KHF), hemoglobin concentration, reticulocyte percent, platetet count, fibrinogen concentration, fibrin degradation product(FDP), prothrombin time(PT) and partial thromboplastin time(PTT) were measured in 27 patients with KHF who were admitted to Chungnam National University Hospital from Oct. 1986 to Sept. 1988. The results were as follows 1. 19 patients(70.4%) out of 27 patients with KHF revealed petechial hemorrhage on axilla and soft palate. UGI bleeding, epistaxis and gross hematuria were also observed in 2, 2 and 2 patients, respectively. 2. In early phase of KHF, hemoglobin concentration showed normal in 21 patients (77.8%), reduced in 5 patients (18.5%)'and elevated in 1 patient. In late phase of KHF, it showed normal in 16 patients(59.3%) and reduced in 11 patients (40.7%). 3. Reticulocyte percent was significantly lower in early phase than late phase of KHF. 4, In early phase of KHF, peripheral blood leukocyte count was elevated in 23 patients(81.2%). In late phase, it became to normal in most patients. 5. In early phase of KHF, peripheral blood platelet counts was decreased in 24 patients (88.9%). In late phase, it became to normal in most patients. 6. In early phase of KHF, fibrinogen concentration was decreased in 3 (13.6%) out of 22 patients. In late phase it became to normal in all patients. FDP showed increased in 9 (40.9%) out of 23 patients in early phase of KHF and 2 (18.2%) out of 11 patients in late phase of KHF 7. PT showed normal range in all patients of early and late chase of KHF. In early phase, PTT was prolonged in 7 (29.2%) out of 24 patients and it became to normal in late phase of KHF.

갑상선암의 임상적 관찰

신영태,조보연,이문호,고창순,박선양,김병국 대한핵의학회 1978 핵의학 분자영상 Vol.12 No.2

저자들은 1972년 1월부터 1978년 4월까지 서울대학교병원에서 병리조직검사로 갑상선암으로 확인된 147명을 대상으로 임상 및 병리조직학적 소견을 조사하여 다음과 같은 성적을 얻었다. 1) 병리조직학적 연령에 따른 갑상선암의 발생빈도는 유두상암이 76.2%, 여포상암이 19.0%였으며 occult sclerozing carcinoma 3례, 거대세포암과 전이성흑색종이 각각 1례 있었다. 2) 남녀비는 1:8.3으로 여성에서 많았으며, 유두상암과 여포상암에서의 차이는 없었다. 3) 연령분포는 30대에 29.3%로 가장 많았고, 유두상암은 30대와 40대에 각각 31.3% 및 20.5%로 많았고, 여포상암은 30대, 40대, 50대에 각각 25.0% 21.4%와 17.9%가 속해 있었다. 4) 갑상선암의 진단시까지 존재기간은 평균 5.0년이었으며, 유두상암이 평균 4.4년, 그리고 여포상암이 평균 7.6년이었다. 5) 갑상선암의 크기는 직경 5cm 미만이 53.6%로 가장 많았고, 5cm 이상 10cm 미만이 6.4%였다. 6) 갑상선암이 주변조직에 고정되어 있는 경우는 36.4%였다. 7) 주변 임파선으로의 전이는 40.0%에서 관찰할 수 있었고, 유두상암에서 45.2%로 여포상암의 17.6%보다 많았으며, 폐 및 골에의 전이는 각각 10.0%와 4.4%였다. 8) 방사성동위원소를 이용한 갑상선주사에서는 88.9%에서 기능저하의 냉소를 관찰할 수 있었고 기능이 증가된 결절은 발견되지 않았다. 9) 병리조직소견에서 이형적인 사종체(psammoma body)가 발견된 것은 21.3%였으며, 그 외의 14.6%에서도 석회화된 부위를 발견할 수 있었다. 10) 병리조직학적 진단을 얻기 전까지 임상적으로 갑상선암으로 진단이 가능하였던 경우는 64.5%였다. 11) 임상적으로 갑상선암을 staging한 결과, stage Ⅰ이 436.%, stage Ⅱ가 26.4%, stage Ⅲ가 20.9%, 그리고 stage Ⅳ가 9.1%였다. 12) 다른 갑상선질환과 동반된 경우는 Hashimato씨 갑상선염이 4례, 결절성갑상선종이 3례, 그리고 여포성갑상선종이 1례 있었다. Clinical features of 147 patients with biopsy-proven thyroid carcinomas were investigated from January, 1972 to April, 1978 at the Seoul National University Hospital with the following results. 1) The incidence of thyroid carcinomas according to their histopathological classification revealed 76.2% of papillary carcinoma, 19.0% of follicular carcinoma, and 3 cases of occult sclerozing carcinoma, 1 case of giant cell carcinoma and 1 case of metastatic melanoma. 2) The ratio of male to femle patients was 1:8.3 and showed no difference between papillary and follicular carcinomas. 3) The age distribution showed the peak incidence in the fourth decade (29.3%) followed by the fifth and sixth decades. 4) The average duration of illness from the onset of symptoms was about 5 years while it was 4.4 years and 7.6 years in the papillary and follicular carcinomas respectively. 5) The diameter of the thyroid masses was smaller than 5cm in 53.6% of the patients, from 5cm to 10cm in 40.0% and larger than 10cm in 6.4%. 6) In 36.4% of the patients with thyroid carcinomas the thyroid masses were fixed to adjacent tissues. 7) Metastasis to the regional lymph nodes was noted in 40.0% of the total cases, and in 45.2% and 17.6% of the papillary and follicular carcinomas respectively, while the lung and bone metastases were found in 10.0% and 4.4% in each type respectively. 8) 88.9% of the patients showed cold areas in the thyroid scans using( 131)^I. 9) Typical psammoma bodies were observed in 21.3% of the cases in the microscopic examination of the pathological specimens. 10) The initial diagnosis of thyroid malignancy could be made before histological confirmation in 64.5% of the patients. 11) The clinical staging slightly modified from Schulz method revealed 43.6% of the patients in stage I, 26.4% in stage Ⅱ, 20.9% in stage Ⅲ and 9.1% in stage Ⅳ. 12) The association with Hashimoto's thyroiditis was noted in 4 cases, with nodular goiter in 3 cases, and with follicular adenoma in 1 case.