복강내 동맥류 파열을 동반한 전신혈관염

김범 ( Beom Kim ),허우성 ( Woo Seong Huh ),백현정 ( Hyun Jeong Baek ),여호명 ( Ho Myoung Yeo ),김정아 ( Jung Ah Kim ),이방훈 ( Bang Hoon Lee ),김윤구 ( Yoon Goo Kim ),김대중 ( Dae Joong Kim ),오하영 ( Ha Young Oh ),권기영 ( Ghee 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.4

요추부 후방 골유합술시 제4요추 분절동맥의 손상에 의해 발생된 후복막하 혈종의 코일 색전술 치험 1례

이방훈,염진영,최승원,김선환,고현송 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

In spine sugery, iatrogenic vascular injury is unusual, and most common vascular injury is said to be a tear of the left common iliac artery. We report a case of retroperitoneal hematoma from lumbar segmental artery injury after posterior lumbar fusion and pedicle screw fixation. This 60-year-old woman presented with 6 months history of low back pain and radiating pain to the left lower leg. She complained of claudication after 10 meters walking due to spondylolisthesis and spinal stenosis at L2-L5 level. She underwent multiple total laminectomy, posterior lumbar inter-body fusion, and transpedicular screw at L2-L5. During operation there was not evidence of complications such as bleeding. She complained of abdominal pain on post-operation I day and showed tenderness on left upper quadrant. Hemoglobin was 8.4 g/dL on postoperative laboratory examination. Abdominal CT scan revealed retroperitoneal hematoma. We performed angiography for evaluation of hematoma and found extravasation of dye at segmental artery of L4 level. We embolized the bleeding artery with coil successfully. Her postoperative abdominal pain and tenderness were relieved after then and discharged without pain or neurological deficit.

급성 심근 허혈과 악성 심실빈맥으로 인한 심인성 쇽으로부터 응급수술에 의하여 회복된 급성 A 형 대동맥 박리증

이상훈,김덕경,강수정,조욱현,이원로,박표원,이방훈 대한내과학회 1998 대한내과학회지 Vol.55 No.3

Acute myocardial infarction is a common initial incorrect diagnosis in patients with acute aortic dissection. Distinction between these two conditions could be especially difficult in a patient who has severe chest pain and abnormal ECG findings. The consequence of such a misdiagnosis in the era of thrombolytic therapy could be catastrophic. We report a case of acute type A aortic dissection who was recovered from acute myocardial ischemia and malignant ventricular tachycardia by emergency surgical treatment. A 54-year-old male patient with no previous cardiac history visited ER because of syncope and severe chest pain of acute onset. Physical examination was normal except for a low blood pressure (90/40 mmHg) and heart rate of 55 beats/min. The ECG showed ST depression and negative T waves in leads II, III, aVF and V4 to 6. A chest X-ray was normal Acute myocardial infarction complicated by cardiogenic shock was diagnosed. Emergency cardiac catherization was performed. An aortogram demonstrate4 type A aortic dissection. The patient had a circulatory arrest with ventricular tachycardia and cardiogenic shack Cardiopulmonary resuscitation was performed for 50 minutes. He underwent emergency surgical correction. The ST segment returned to normal and there was no evidence of myocardial ischemia after these procedures. The postoperative course was unevenful.

Group G β-Hemolytic Streptococcus에 의한 간농양 2예

박상종,김현중,이방훈,이혁,백경란,김성민,송재훈,고광철,이남용 대한감염학회 1999 감염 Vol.31 No.2

비혈연간 동종골수이식에 의해 치료된 중증 재생불량성빈혈 1예

김현중,이홍기,이방훈,이창근,이종태,정현식,김원석,윤성수,강원기,박근칠,김대식,고영혜,박찬형 대한조혈모세포이식학회 1997 대한조혈모세포이식학회지 Vol.2 No.1

비혈연간 동종골수이식은 혈연간 동종골수이식이 불가능한 환자에서 기존의 면역역제요법으로 효과가 없었던 경우나 재발한 경우에 적응증이 될수 있다. 이식 거부와 이식편대숙주병의 발생이 골수 이식의 성공률을 감소시키므로, 보다 강력한 conditioning regimen의 사용과 T cell이 제거된 골수를 사용하는 것이 필요하다. 기존의 high dose corticosteroid나 cyclosporine에 대하여 불응성인 이식편대숙주병의 치료를 위해서 ATG와 Mycophenolate mofetil (Cellcept®) 의 사용이나 Tacrolimus, Methotrexate와 같은 다른 면역억제제치료를 고려해 볼 수 있다. It is known that allogenic bone marrow transplantation is the most effective treatment for aplastic anemia. However, this treatment is only applicable to a minority of patients because the proportion of patients who have HLA-matched siblings about 25% to 30% of all the aplastic anemia patients. In the case of the absence of HLA-matched donor, unrelated allogenic bone marrow transplantation is considered. However, (because of severe acute and chronic GVHD and graft failure) the success rate of this approach is only 20~30%. Recently, it was reported that increased immunosuppressive condition combined with T cell depletion of the marrow graft would result in greater success. There was no case of successfully treated aplastic anemia patient by unrelated allogenic bone marrow transplantation in Korea. Here, we report a case of severe aplastic anemia successfully treated with unrelated allogenic bone marrow transplantation.

β2-microglobulin의 복막이동 특성 및 복막 청소율에 관한연구

문지현,김대중,오하영,이숭구,이방훈,채영숙,김범,오동진,허우성,김윤구,강우헌 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4

In addition to CAPD, various modalities of peritoneal dialysis such as CCPD and NIPD have been introduced recently. The adequacy in these peritoneal dialysis has been evaluated by clearance of small molecular weight solutes such as creatinine(molecular weight 113 Dalton) and urea(molecular weight 60 Dalton). The middle molecular weight solutes(molecular weight 3,000 to 12,000 Dalton) have been regarded as one of the uremic toxins. Relatively larger clearance of middle molecular weight solutes is one of the advantages of CAPD compared with HD. Although peritoneal transport of middle molecular solutes can be different from that of small molecular weight solutes because of its size, there are a few reports about peritoneal transport characteristics and clearance of middle molecular weight solutes in various modalities of PD. We wanted to analyze peritoneal transport characteristics and clearances of middle molecular weight solute in various modalities of peritoneal dialysis in comparison with small molecular weight solutes. To evaluate the potential differences in peritoneal transport characteristics and clearances of middle and small molecules in CAPD, CCPD and NIPD, we compared transport characteristics and clearance of β2-MG and creatinine. 35 CAPD patients, 9 CCPD patients, 7 NIPD patients were included in the study, who were clinically stable for at least one month without peritonitis. he β2-MG concentrations in serum and dialysate as measured by radioimmunoassay. Standard peritoneal equilibration test and a weekly peritoneal clearance for creatinine and β2-microglobulin were used. The results were as follows: 1)Dialysate to plasma ratio of β2-MG were 0.11±0.03, 0.13±0.05, 0.10±0.02, 0.08±0.03, respectively in high(N=6), high average(N=13), low average(N= 14), low(N=7) group according to PET. There were significant differences between high average and low average, high average and low group(p$lt;0.05). Correlation between D/Pβ2-MG ratio and D/Pcr ratio was significant(spearman's p=0.453, p$lt;0.05). 2)Ipatients, peritoneal creatinine and β2-MG clearance were 48.9, 8.2L/wk, respectively and there was a weak correlation between them (Spearman's p=0.294, p$lt;0.05). 3)The peritoneal creatinine clearance were 48.9, 41.0, 35.9L/wk and ?2-MG clearance were 8.2, 5.5, 4.1L/wk, respectively in CAPD, CCPD and NIPD. The ratio of peritoneal β2-MG clearance to creatinine clearance were 0.16, 0.14, 0.11, respectively in CAPD, CCPD and NIPD. Peritoneal β2-MG clearance in APD such as CCPD and NIPD is lesser than that in CAPD. In conclusion, peritoneal transport characteristics for β2-MG differ from that for creatinine, although peritoneal clearnce for β2-MG corrleated with that for creatinine. Perioneal clearance for β2-MG was better in CAPD than in APD.

한국인에서 혈청 크레아티닌을 이용한 크레아티닌 청소율의 계측

김대중,오하영,오동진,김범,이숭구,서기현,강우헌,이방훈,김혜영,이윤하,허우성,김윤구 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6

Cockcroft and Gault's formula is frequently used to estimate creatinine(Ccr) in clinical practice. To determine the accuracy of such estimation in Korean patients, we measured simultaneously, serum creatinine and 24-hour urinary creatinine excretion in 696 Korean patients(male:350, female:346). Measured Ccr was significantly different from estimated Ccr in several age groups and the decrease of creatinine excretion with age is less than Cockcroft and Gault's estimation. We assumed that this difference can be due to difference of the body habitus and difference of urinary creatinine excretion per body weight between different races. So we divided the sample population into two groups and derived the new formula in one group with regression analysis between age and 24 hour urinary creatinine excretion per body weight for estimation of Ccr as Cockcroft and Gault derived their formula and applied it to another group to compare the new formula with Cockcroft and Gault's formula in Korean patients. The new formula was Ccr(mL/min)=[(260-age)?weight(kg)]/[160?serumCr(mg/dL)] for male and Ccr (mL/min)?[(236-age)?weight(kg)]/[180?serum Cr(mg/dL)] for female. Predictive accuracy of the new formula was significantly better than the Cockcroft and Gault's formula in the other sample population and also in subgroup of the patients with azotemia.

복막투석 환자에서 혈청 Leptin과 Leptin의 발현에 관한 전향적 연구

강순아,허우성,박진아,오동진,김대중,오하영,김윤구,이방훈,강우현 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.4

The ob gene product leptin is thought to be an adipostatic hormone through the regulation of food intake and energy expenditure. There are many reports that serum leptin concentration was increased in CRF patients, especially CAPD patients. The causes of elevated serum leptin concentration in CRF are believed to be multifactorial. Increased body fat mass, decreased residual renal function, active inflammation and hyperinsulinemia all are suggested to influence serum leptin concentration in CAPD patients. In this study, in order to investigate the pathogenic mechanism of increased serum leptin level in CAPD patients, we observed the changes of serum leptin concentration, leptin expression in the abdominal subcutaneous fat tissue, body fat composition, residual renal function, serum insulin concentration and CRP. Thirteen patients(7 men and 6 women, mean age 53±14 years) were enrolled in this study. Serum leptin concentration was measured by RIA before start of CAPD(baseline data), 5 days and 1, 3 months afterstart of CAPD. Simultaneously, fat tissues were aspirated from the abdominal subcutaneous fat tissues for analysis of ob gene expression. Ob mRNA expression was measured by semiquantitative RT-PCR method. The changes of serum insulin concentration, C-reactive protein, residual renal function were measured. All studies were done immediately before starting CAPD, 5 days, 1 month and 3 months after starting CAPD. Total body fat was estimated by dual energy X-ray absorptiometry and abdominal visceral and parietal fat area measured by computed tomography were done at 1-3 days(baseline data), 1 month, 3 months after start of CAPD. Serum leptin concentration increased significantly as early as 5 days after start of CAPD and maintained high up to 3 months(4.3±2.6→8.2±7.6→7.4±6.5→10.8±13.8ng/mL), while leptin expression in the abdominal subcutaneous fat tissue did not change during the study period(0.24±0.06→0.25±0.08→0.20±0.07→0.34±0.21ng/mL). No significant changes of body fat composition, residual rend serum insulin concentration were observed during the study period. These results suggest that increase of serum leptin concentration after CAPD may be due to increase of local leptin production, especially from the peritoneum, as has also been suggested by several reports of relatively higher dialysate leptin.

복막투석액의 저류가 위배출시간에 미치는 영향

오하영,오동진,김범,이숭구,김윤구,강우헌,이방훈,김혜영,허우성,김대중 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6

We evaluated gastric emptying time(GET) by using Tc99m-sulfur colloid gastric emptying scintigraphy in 11 patients with CAPD(6 male, 5 female) and 14 healthy volunteers. We investigated the effect of dialysate dwelling on GET by studying twice, once without dialysate in the abdomen(drained) and once with 2 L of dialysate in the abdomen(full), and the relationship between body surface area(BSA) and delayed gastric emptying. 1) The mean of gastric emptying rate in 120 minute in patients with CAPD when drained(67.8±13.4%) was not different from that in healthy volunteers(65.4±8.6%) 2) The mean of gastric emptying rate in 120 minute when full(55.6±14.6%) was significantly lower than that when drained(67.8±13.4%)(P$lt;0.05). In four of the 11 patients(36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. 3) The BSA(1.5±0.11m2)of patients who had extremely delayed GET from normal to abnormal range was smaller than that(1.74±0.22m2) of patients who had minimal delayed or unchaET when full. This study showed the patient with CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwelling, especially in the patients who has less than 1.5m2 of body surface area. Therefore, we suggest that intermittent nocturnal peritoneal dialysis or a small volume of dialysate may be considered for the patient with small body surface area based on the adequacy.

한국 정상 성인에서 초음파로 측정한 신장의 크기

황선희,오동진,김범,김대중,오하영,최상희,안홍준,김윤구,허우성,강우헌,이방훈,서기현,이숭구,김보현 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1

Background:The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. Methods:One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. Results:Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8?10.3 in male, 48.1?9.5 in female. 1) The average value of left and right kidney was 10.65±0.80cm, 10.50?0.78cm respectively, and the left kidney was greater than right one(P$lt;0.01). 2) The difference between male and female was 10.77cm, 10.49±0.78cm respectively in the left kidney and 10.66±0.76cm, 10.27±0.75cm in the right kidney(P$lt;0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P$lt;0.01) respectively. Conclusion:The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(±2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P$lt;0.01).