지속적 혈액투석환자에서 Desferrioxamine 투여 후의 혈장 Endothelin 농도 변화

최규복(Gyu Bog Choi),윤견일(Kyun Ill Yoon) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: It has been reported that the risk of oxygen radical injury is increased in chronic renal failure due to the decreased endogenous serum antioxidants. Especially, the C5a induced by membrane bioincompatibility can stimulates neutrophils to release of oxygen free radicals, resulting in endothelial cell injury. However, Desferrioxamine(DFO) act as an iron chelator, which blocks iron-catalyzed Haber-Weiss reaction and inhibits release of oxygen free radicals from activated neutrophils. It is also reported that endothelin(ET) can be released from endothelial cells in response to vascular damage such as atherosclerosis. Therefore, we administered DFO, into maintenance hemodialyein patients. Then we examined the possibility of oxygen radical injury during interdialytic period and its relation with the plasma ET concentration. Methods: During the last 1-2 hours of hemodialysis, DFO(40mg/kg in 5% D/W 200cc) was infused intravenously into 13 patients(DFO group), and placebo(5% D/W 200cc only) was infused with same manner into 9 patients(Placebo group). We sampled blood for measurement of plasma ET concentration just before the initiation of hemodialysis on the day of infusion, on the 2nd-3rd day and on the 7th day after infusion. Also, we examined 26 non-diabetic patients with normal renal function as a norma1 control. Results: The mean plasma ET concentration in total hemodialysis patients is higher (5.08±3.09pg/ ml) than in normal control (2.58±1.08pg/ml, p<0.01). There was no statistical difference between two hemodialysis groups in plasma ET concentration measured before infusion (5.56±3.50pg/ml in DFO group, 4.38±2.40 pg/ml in placeb group). In DFO group, plasma ET concentration decreased significantly on the 2nd-3rd day (3,49±2.08pg/ml, p<0.01), but increased significantly on the 7th day (5.62± 2.95pg/ml, p<0.05), In contrast, there were no significant changes in plasma ET concentration in placebo group. There was no significant difference in the decrement of plasma ET between the cases of transferrin saturation below and above 60% and there was no relation between the plasma ET decrement and transferrin saturation or serum ferritin in DFO group. Conclusion: The decrease of plasma ET concentration after DFO infusion might be the result of diminished endothelial cell injury from oxygen free radicals. Therefore, we believe that the oxygen radical injury can occur during not only the hemodialysis but also the interdialytic period. Also these results suggest that the oxidant damage of endothelial cell may be one of the causes of elevated ET concentration in chronic renal failure, However, we could not confirm in this study whether the obtained results were caused by the chronic effects of membrane bioincompatibility or by the decreased endogenous serum antioxidants.

고혈압 환자의 혈장 Endothelin 농도

최규복(Gyu Bog Choi),김성남(Seong Nam Kim),윤견일(Kyun Ill Yoon) 대한내과학회 1995 대한내과학회지 Vol.48 No.3

N/A Objectives: Following the discovery in 1988 of Endothelin by Yanagisawa, three types of Endothelin called Endothelin-l, Endothelin-2 and Endothelin-3 were identified. Among them, Endothelin-1 is secret- ed from vascular endothelial cells. Endothelin-1 has been shown to be a potent vasoconstrictor in isolated human vessels as well as having positive inotropic effects on human atria by a direct action on the heart muscle. Infusion of Endothelin-1 into human volunteers has also shown it to be a constrictor of resistance vessels in vivo. So it is possible that Endothelin-1 plays a role in maintenance of blood pressure, But there is debate on the plasma concentration of Endothelin-1 in hypertensive patients. Therefore, the present study was designed to deter- mine plama Endothelin concentration in hypertensive patients and control subjects. Methods: We measured and analyzed the endothelin concentration in plasma and 24- hours urine by radioimmunoassay in 15 patients with essential hypertension, 5 patients with secondary hypertension, 5 patients with chronic renal failure and 8 control groups. Results: 1) Comparison between Uncontrolled hypertensive patients and Control subjects: The mean level of plasma Endothelin in patients with essential hypertension(22.7±24.27pg/ml) was significantly higher than that in control subjects(4.0±2.9pg/ml; p<0.05). But there was no significant. difference in urine endothelin concentration and endothelin clearance among each groups. 2) Comparison between Controlled hypertensive patients and Control subjects: The mean level of plasma Endothelin in patients with essential hypertension(8.8±9.88pg/ml) seemed to be higher than that in control subjects(4.0±2.69pg/ml), but there was no statistical significance. The mean level of urine Endothelin in patients with secandary hypertension(57.1 + 13,17pg/ml) wns significantly higher than that in control subjects(16.1±9.64pg/ ml; p<0.05) and in patients with essential hypertension(14.2±3.46pg/ml; p<0.05). But there was no significant in endothelin clearance among each groups. Conclusion: In conclusion, it is hardly to say that endothelin has a primary pathophyaiological role in hypertension. Whereas plasma endothelin concen-tration might to be elevated secondarily as a result of endothelial damage from uncontrolled hypertension. But further study will be need about it.

삼첨판의 Ebstein 씨 기형에 대한 임상적 고찰

차홍도 ( Hong Do Cha ),노원식 ( Won Shick Loh ),심봉섭 ( Bong Sup Shim ),심원흠 ( Won Heum Shim ),윤견일 ( Kyun Ill Yoon ) 대한내과학회 1975 대한내과학회지 Vol.18 No.8

Urea Kinetic Modeling 을 이용한 지속적 혈액투석 환자의 영양 상태 평가

최규복(Gyu Bog Choi),변정란(Jung Lan Byun),박정은(Jeong Eun Park),이은영(Eun Young Lee),이지수(Ji Soo Lee),편욱범(Wook Bum Pyun),고영엽(Young Youp Koh),윤견일(Kyun Ill Yoon) 대한내과학회 1994 대한내과학회지 Vol.46 No.2

N/A Objectives: Nutritional factors play a role in the morbidity and mortality of patients in maintenance hemodialysis as well as in their quality of life and ultimate rehabilitative potential. It was reported that if the deviation of urea distribution volume calculated by Urea Kinetic Modeling(UKM) (Vol-Dev) from Anthropometric volume exceeded the acceptable range, clinical application of the NPCR (normalized protein catabolic rate) as nutritional index might be inappropriate. And it was also reported that if the KT/Vurea without consideration of residual renal function (D-KT/V) was above 1.5 or below 0.8, the NPCR might be inaccurate. So we selected patients whose Vol-Dev was within the acceptable range and grouped according to the D-KT/V. Then we analyzed the relationship between the NPCR and other nutritional parameters. Methods: We selected 17patients undergoing maintenance hemodialysis with adequate Vol-Dev level and grouped as group 1 if D-KT/V was between 0.8 and 1. 5, as group 2 if D-KT/V was below 0.8 or over l.5, We measured the mean level of albumin, calcium, phosphorus and hematocrit and calculated midarm muscle area (MAMA), midarm fat area (MAFA) as anthropometric measurements. Results: 1) Nutritional Index: There were no differences in serum albumin, calcium, phosphorus and hematocrit between two groups. The mean MAMA of group 1 (37.4cm2) was not different from that of group 2(27.9cm2), but mean MAFA of group 1(19.2cm2) was significantly higher than that of group 2(14.3cm2). The NPCR of group 1 (1.00) was not different from that of group 2(1.12). 2) UKM Parameter: The mean level of D-KT/V as single dialysis dose in group 1 (1.23) was significantly lower than that of group 2(1.69) and the mean level of TW-KT/V as weekly dialysis dose in Group 1 (3.17) was significantly lower than that of Group 2(4.05). The mean level of TWR-KT/V as weekly dialysis dose with consideration of residual renal function in Group 1(3.24) was significantly lower than that of Group 2(4.07) also. 3) Correlation between NFCR and dialysis dose: There was no correlation between D-KT/V and NPCR in both Group. In group 1, there was positive correlation between NPCR and TW-KT/V or TWR-KT/V. But in group 2, there was no correlation between NPCR and TW-KT/V or TWR-KT/U. 4) Correlation between NPCR and Nutritional Index: There was no correlation between NPCR and serum nutritional index (albumin, calcium, phosphorus, hematocrit). There was also no correlation between NPCR and anthropometric parameter (MAMA, MAFA). Conclusions: It is not likely that the NPCR reflects the protein catabolic rate accurately in case of D-KT/V exceeded adequate level (0.8≤, ≤1.5). Although the protein catabolic rate might be increased due to the effect of dialysis itself, there was no significant change in the nutritional status of patients. Even though the D-KT/V was within the adequate level, it is difficult to evaluate the patients nutritional status with NPCR only.

Urinary Tract Infection in Chronic Dialysis Patients : A Prospective Study

Yoon, Kyun Ill 梨花女子大學校 醫科大學 醫科學硏究所 1989 EMJ (Ewha medical journal) Vol.12 No.2

We studied prospectively 48 patients with end stage renal disease on chronic dialysis (hemodialysis or chronic ambulatory peritoneal dialysis). Of these 48 patients, 9(19%) had urinary tract infection (UTI), 4(8%) had symptomatic UTI, and 14(29%) had sterile pyuria. Among 16 patient who had documented previous UTI, 8(50%) had repeated UTI at presentation compared to 1 of 32 patients who had not documented previous UTI. Daily urine out put in all patients with sterile pyuria was lesser than 500ml. No significant correlation was seen between frequences of UTI and duration of dialysis therapy. Successful cure with oral antibiotic treatment for 1-2 weeks achieved in 6 of 9 patients with UTI. However, recurrence of infection occurred in 3, one patient was diabetic with neurogenic bladder, another was patient with chronic pyelonephritis who had experienced perinephric abscess. Third was patient with chronic pyelonephritis complicated with chronic UTI, paraplegia, and vesico-renal reflux. This patient was admitted to hospital for intravenous gentamycin therapy.

낭창성 신염 환자에서 혈중 및 요중 Endothelin-1의 의의

윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1993 EMJ (Ewha medical journal) Vol.16 No.3

Endothelin is a 21-residue peptide vasoconstrictor produced by endothelium. The exact roleof endothelin in the pathophysiology of renal disease has not yet been extensively demonstrated.Thus, to elucidate the pathophysiological significance of plasma and urinary endothelin-1 (ETI) in patients with lupus nephritis. we studied 7 patients diagnosed as lupus nephritis bykidney biopsy and 7 healthy volunteers. Serum and urinary biochemical studies includingcreatinine and ET-1 were done, and urinary excretion of N-acetyl-β-D-glucosaminidase(NAG)was also measured. The results were as follows ; 1) Patient poop and control group showed no significant differences in their clinical characteristics, basic biochemical studies, serum creatinine, plasma ET-1, urinary excretion of protein.NAG and creatinine and ET-1 clearance. Of 7 lupus nephritis patients, only 2 patients showedabnormal serum complement and anti-dsDNA. 2) In lupus nephritis patients, plasma ET-1 level showed no correlation with serum creatinine,complement and anti-dsDNA(p>0.05). 3) ET-1 clearance showed no significant correlaticn with creatinine clearance rate, complement anti-dsDNA ana urinlary NAG excretion. Plasma ET-1 level and its clearance rate could not reflect the lupus nephritis activity. Butour study included small number of patients and only 2 patients of pathologically provenlupus nephritis showed active disease, biochemically and clinically, ana the majority of patientshas alreday been in remission state after treatment Above factors probably acted as a biasagainst the results, leading to statistical limitations. In further studies, we should broaden oursubject group in number and to other renal diseases than limiting to lupus nephritis andprospective long term follow up study is indicated to further investigate the role of urinaryexcretion of ET-1 and their mechanism of action on renal disease.

위암에 속발한 발작성야간혈색소뇨증 : 양의 골수섬유증 1예 Like Secondary Myelofibrosis with Gastric Cancer

윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1982 EMJ (Ewha medical journal) Vol.5 No.4

A case of PNH-like secondary myelofibrosis associated gastric cancer is presen-ted with brief literal view. This 45 years old Korean male who had gastric cancer, was admitted to Ewha University hospital with marked pallor and bone pain. On hematologic examination, hemoglobin 4.0 gm/dl, hematocrit 8%, and RBC count was 92×10^4/㎣. WBC count was 16,200/㎣, with normal differentiation and platelet count was 18,000/㎣. Reticulocyte count was 5%. Peripheral blood smear showed anisocytosis, poikilocytosis and schistocytes including tear-drop cell. Two attempts of bone marrow biopsy disclosed island-shape of gastric cancer call infiltration and reticulin strands. After transfusion with 4 units of whole blood over the night, his early morning urine color was dark reddish-brown. The HAM test was positive and the value of the leukocyte alkaline phosphatase was very high. But there was no specific change of urine after administration of Iron-dextran. The author assure that this case was accompanied by Paroxysmal Nocturnal Hemoglobinuria-like red cell defect rather than microangiopathic hemolytic anemia.

혈액투석 환자에서의 생존율 및 사망에 관한 연구

윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1991 EMJ (Ewha medical journal) Vol.14 No.3

We reached the following conclusions from analyzing survival rates and causes of death of 71 patients who received hemodialysis at our hemodialysis center from January 1983 to December of 1990 using life-table method. 1) The 5-year survival rate of the whole patients was 52%. 2) The survival rate decreased significantly with increasing age after 3 years from commencement of dialysis. The 5-year survival rate of patients under the age of 30 was 89%, the rate of patients between the age of 31 and 50 was 70% . and the rate of patients above the age of 51 years was 30%. 3) Diabetes Mellitus had no slgnificant influence on survival rate in patients over the age 51. 4) The survival rates according to sex revealed no significant difference. 5) The leading cause of death was cardiovascular disease including cerebrovascular accident amounting 47.6% and next was infectious disease 23.8%. Additional study on survival rate in age group over 51 with or without Diabetes Mellitus is required in the future.

말기신부전증 환자에서 혈청 알루미늄 농도에 관한 연구

윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1990 EMJ (Ewha medical journal) Vol.13 No.4

Oral aluminum salt intake has been implicated in aluminum intoxication in patients suffering from chronic renal failure. We studied to observ a level of serum aluminum in patients with maintenace dialysis and their relationship with oral aluminum salt intake. The results are as follows ; 1) Serum aluminum concetration was 40± 12.0ug/1. 2) Average daily dose of aluminum salt was 34± a2/12.2mg/kg. 3) Recent daily dose of aluminum salt was 32a8± 18.9mg/kg. 4) Total does of aluminum salt was 22± 23.2g/kg. 5) Correlation coefficient between serum aluminum concentration and total dose was 0.32. 6) Correlation coefficient between serum aluminum concentration and mean corpuscular volume of erythrocyte was -0.27. 7) Correlation coefficient between serum ferritin and mean corpuscular volume of erythrocyte was 0.3. 8) There was no correlation between serum aluminum concentration and several other variables including serum ferritin, daily dose of aluminum salt and serum creatinine. 9) There was no correlation between mean corpuscular volume of erythrocyte and dose of aluminum salt.

僧帽瓣狹窄症을 同伴한 Marfan症候群 1例

尹堅一,全利理,李圭玉,朴利甲 최신의학사 1977 最新醫學 Vol.20 No.11

The Marfan syndrome is a heritable, generalized disorder of connective tissue, clinically manifested by abnormalities of the eye (especially ectopia lentis), of the skeletal system (especially excessive length of the long bones), and of the cardiovascular system (especially diffuse and/or dissecting aneurysm of the ascending aorta). This report describes a 27 year old Korean man who had Marfan syndrome associated with pure mitral stenosis, severe aortic regurgitation, aneurysm of the ascending and the abdominal aorta. Family pedigree of this case demonstrated heritable nature and it's transmission as a abdominal trait. He showed typical arachnodactyly with abnormal skeletal ratio and dolichocephaly, high. arched palate, also. There was no optical involvement. The mitral stenosis was diagnosed successfully with cardiac catheterization. The aortic regurgitation and aneurysm of the ascending aorta and the abdominal aorta were discovered by cineangiography.