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투석식 초여과를 이용한 간경변 환자에서의 저항성 복수의 조절
한상진(Sang Jin Han),정의훈(Eui Hun Jeong),백광호(Gwang Ho Baik),윤동석(Dong Seok Yoon),김명빈(Myung Bin Kim),고문수(Moon Soo Koh),구자룡(Ja Ryong Koo),장웅기(Ung Ki Jang),김동준(Dong Jun Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.5
N/A Background: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. Methods: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. Results: The mean ultrafiltration time was 231±28min, ultrafiltrated volume was 5.15±1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5±23.7㎎/dL to 25.7±20.2㎎/dL; serum aldosterone level decreased from 807.3±301.1pg/ml to 431.1±187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67±0.28g/dL to 1.90±1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. Conclusion: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
이영진(Lee Young Jin),정의훈(Jeong Eui Hun),이준혁(Lee Jun Hyuk) 한국지적학회 2005 한국지적학회지 Vol.21 No.2
본 연구에서는 공간정보의 위치정확도와 메타데이터에 대한 기준과 작업규정을 분석하고, 테스트지역에 대한 실측 및 분석결과를 토대로 평가절차를 제시하고자 하였다. 선정된 다수의 테스트 지역에서는 토탈스테이션(TS)과 위성측위시스템(GPS)에 의한 지상실측을 통해 수치지형도와 수치시설물도에 대한 정확도 등을 분석, 평가하였으며, 미국 NSSDA(National Standard for Spatial Data Accuracy) 기준과의 분석을 통해 국내에서 적용할 수 있는 위치정확도에 대한 검정, 평가 절차를 체계화하여 제안하였다. The purpose of this study is to analyze the spatial data standards and specifications on positional accuracy and metadata, and to propose the evaluation procedures of field tests. Some of selected test areas of digital topographic maps and facility management maps, are evaluated by field measurement, such as total station(TS) or global positioning system(GPS). An evaluation procedures of positional accuracies on digital maps and/or control points, that is suitable in Korea, are proposed on the basis of USA National Standard for Spatial Data Accuracy(NSSDA)
심한 황달을 동반하며 악화되는 만성 B 형 간염환자에 대한 임상적 고찰
추원석(Won Suk Choo),이재명(Jae Myung Lee),조병동(Byung Dong Cho),이록윤(Rok Yun Lee),오흥국(Heung Kook Oh),정의훈(Eui Hun Jeong),김용범(Yong Bum Kim),김학양(Hak Yang Kim),박충기(Choong Kee Park),유재영(Jae Young Yoo) 대한내과학회 1996 대한내과학회지 Vol.51 No.1
N/A Objectives: Recurrent exacerbation of hepatitis activity is regarded as one of the most important etiological factor in the natural history of chronic hepatitis B in Korea. Among them the development of progressive jaundice seems to be the worst prognostic marker for the progression. This study is conducted to investigate the significance of progressive jaundice in patients with exacerbation of hepatitis H. Methods: We evaluated 30 patients with exacerbation of chronic hepatitis H. The patients were divided into two groups according to the development of jaundice. 15 patients with progressive jaundice were included in Group A, and the other 15 without jaundice were in Group B. Liver function test, serum HBV markers, HBV-DNA and immunoperoxidase staining for HBsAg and HBcAg were performed and followed-up up to one and half years. Results: 1) Among 30 patients, 27 were male and 3 were female and ages from 16 to 57(Mean in Group A;A3 8r Group B; 37) year.;. 2) Serum bilirubin was markedly elevated in Group A, 17.5-36.4(mean 28.0)mg/dL and serum pro- tein, albumin and cholesterol were also markedly decreased compare with those of Group B. 3) Serum HBV-DNA was detectable in all 26 HBeAg positive patients, but was undetectable in 4 HBeAg negative patients in Group A. 4) There was no difference of distribution of HBsAg and HBcAg in the liver tissures by immunoperoxidase staining. The staining pattern was also similar in 2 Groups, mostly cytoplasmic HBcAg. 5) In Group A, spontaneous bacterial peritonitis was complicated in all patients who developed ascites. Hut no ascites or bacterial peritonitis was found in Group B. 6) In Group A, 2 patients died during the hospitalization (within 4 weeks after developing jaundice), and one died during follow-up(15 month after initial exacerbation) 6 progressed to decompensated cirrhosis and the rest 6 were in stable state during follow up. In contrast, there was no death in group H and only 2 were progressed to decompensated cirrhosis. Conclusion: Patients with acute exacerbation of hepatitis developing jaundice showed more severe disease activity regardless of the etiological factor(s). It may be related to the immune status of the patients and/or some kinds of environmental factors which are not yet identified. It would also be necessary to identify the precore mutant infection to these type of patients and extensive treatment modalities should be investigated.
공간 점유 병소로서 간경변과 동반하여 발생한 무산소성 가성분엽성 간괴사 1예
한상진,고문수,김동준,백광호,정의훈,장웅기,김명빈,윤동식 대한소화기학회 1998 대한소화기학회지 Vol.31 No.3
The common space-occupying lesions of the liver associated witb cirrhosis are hepatocellular carcinoma, regenerating nodule, simple liver cyst, hepatic necrosis, and abscess. The differential diagnosis of hepatocellular carcinoma from other lesions is important for its treatment and prognosis. Anoxic pseudolobular necrosis of the liver associated with cirrhosis resembles hepatocellular carcinoma in view of clinical and radiological findings. Clinical diagnosis may depend on biopsy, although differentiation between this lesion and necrotic hepatocellular carcinoma may be difficult. A 55-year-old man was admitted with bematemsis and melena. Radiologic examination showed small, round space occupying lesions of the liver. These lesions resembled necrotic hepatocellular carcinoma. We diagnosed this lesions as anoxic pseudolobular necrosis of liver by repeated biopsies. We report this case because of its similarity with necrotic hepatocellular carcinoma in view of radiologic findings and its rarity.
한상진,최영희,박영의,이진,고문수,김동준,주상언,백광호,정의훈,김명빈,장웅기 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.2
More than 17 different terms, including carcinosatcoma and pseudosarcoma, have been applied to the rare polypoid tumors of the esophagus that demonstrate both carcinomatous and sarcomatous components. The multiplicity in terminology seems related to the uncertain histogenesis of these tumors. A demonstration of the ultrastructure of the spindle cells (containing desmosomes and tonofilaments) is consistent with an epithelial origin. The patient was a 53 year-old man who had suffered from dysphagia and foreign body sensation in larynx. Endoscopic finding was a large polypiod mass with ulceroinfiltrative lesion at the level of 27cm from the incisor. Pathologic findings were that the covering epithelium showed well differentiated squamous carcinoma with invasive pattern and the stroma contained islands of sarcoma and squamousl cell carcinoma. Immunoreactivity to cytokeratin was not observed. Partial esophagectomy and esophagogastrostomy was done. We report a case of rare malignant esophageal carcinosarcoma.