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김재필(Jae Phil Kim),조대옥(Dae Ok Cho),고경식(Kyung Sik Ko),안재형(Jai Hyung Ahn),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.1
N/A Objectives: Renal transplantation is a major therapeutic advance for patients with chronic renal failure. But recipients of renal transplantation are prone to infection with both common and unusual organisms. And infectious diseases remain a major cause of morbidity and mortality in renal transplant recipients. This study was to analyze the infections in renal transplant recipients; its occurrence according to sites and organisms; comparison among immunosuppressive agents; prognostic differences of urinary tract infections(UTI) between those developed during 1 month after transplantation and those not developed; graft outcome; and patients mortality. Mothods: 181 renal transplant recipients were examined. They received renal transplantion between january 1979 and December 1992 at the Kyung-Hee University Hospital. 158 of them received transplantation from living-related donors, 22 from living-unrelated donors, and 1 from cadaver donor. Their age at the time of transplantation ranged from 14 to 66 years(mean 35.6 years), and the male to female ratio was 2.3: 1. The observation period ranged from 1 to 144 months(41.26±31.71, mean±S. D.). Results: 1) 110 recipients(60.7% of total) had 232 episodes of infectious complications whereas 71(39.3% of total) had no infectious episodes. About half of infectious episodes(128 episodes, 55.2% ) occurred during 1 month after transplantation. 2) The most common site of infection was urinary tract(138 episodes, 59.2%) whth the next sites coming in this order, bacteremia(32 episodes, 13.8%), pulmonary(21 episodes, 9.1%), and skin(21 episodes, 9.1%). 3) The causative organisms of UTI ranked in this order E. coli 21.7%, staphylococcus spp 14.5%, and pseudomonas spp 13.0%. 4) The causative organisms of bacteremia ranked in this order E. coli 34.4% salmonella spp 18.8%, pseudomonas spp 12.5 %, and staphylococcus spp 12.5%. 5) There was no significant differences of infectious episodes among immunosuppressive regimens. 6) Early UTI group(UTI occurred during 1 month after transplantation) recorded significantly higher incidence of urinary tract infections after 1 month that followed than non-UTI group. But there was no differences between two groups on graft and patients outcome. 7) The major cause of death was life-threatening infections(63.2 %). Conclusion: Most infections due to various organisms may occur during 1 month after transplantation. And still they constitute a major cause of death in renal transplant recipients.
하부식도 괄약근 이완에 대한 Somatostain Analogue(Octreotide)의 효과에 관한 연구
김만호,김병호,김효종,김영관,장린,이정일,장영운,조대옥 대한소화기학회 1992 대한소화기학회지 Vol.24 No.3
Lower esophageal sphincter relaxation (LESR) during swallowing may be induced by the cessation of tonic neural excitation and activation of nonadrenergic, noncholinergic (NANC) inhibitory neurons to the sphincter. Vasoactive intestinal polypeptide (VIP) is now well known to be an inhibitory peurotransmitter, releases from NANC neurons, reponsible for LESR. Somatostatin has been shown to have multiple inhibitory effects on the release of hormones of peripheral as well as pituitary origin. Because somatostatin analogue (octreotide) is capable of blocking the release of VIP which been sbown to decrease LES pressure (LESP), we performed this study in 24 healthy volunteers to test the hypothesis that somatostatin may inhibit LESR. Basal LES pressure and wet swallow-induced LESR were recorded using a Dent sleeve catheter before and after either IV saline or 50 mcg octreotide. LESR was expressed as a percentage of basal LESP. Resting, basal LESP averaged 19.3±4.8 mmHg. LESP decreased to 21.2% (4.1±3.2 mmHg) of resting tone with wet swallows. Basal LESP after IV saline was 21.2±3.6 mmHg. LESP decreased to 17.4% (3.7±3.3 mmHg) of resting tone with wet swallows after IV saline. Basal LESP was 19.5±5.1 mmHg after administration of 50 mcg octreotide. However, octreotide inhibited LESR which reached only 47.1% (9.2±4.5 mmHg) of baseline. Therefore, although octreotide did not affect the basal LESP (p$gt;0.1), octreotide significantly inhibited LES relaxation with wet swallows (p$lt;0.001). In conclusion, it is auggested that somatostatin may play a role in the control of LES relaxation with swallowing. And, octreotide may be used in the treatment of patients with gastroesophageal reflux diseases.
Anti-Neutrophilic Cytoplasmic Autoantibody(ANCA) 연관성 급속 진행성 사구체 신염에 관한 임상경험 2 예
김명재,양문호,박원도,이태원,임천규,조대옥,안재형,김신규 대한내과학회 1992 대한내과학회지 Vol.43 No.4
Antineutrophilic cytoplasmic autoantibodies (ANCA) are specific for constituents of neutrophilic granules and monocyte lysosomes, and two types, C-ANCA and P-ANCA was recognized by indirect immunofluorescence microscopy. ANCA are found in patients with necrotizing systemic vasculitis, such as Wegener`s granulomatosis and polyarteritis nodosa and patients with idiopathic crescentic glomerulonephritis. ANCA-associated glomerulonephritis are characterized by necrosis, crescent formation and a paucity of demonstrable immune deposits in renal biopsy. We report two cases of rapidly progressive glomerulonephritis, who had pauci or no immune deposits in renal biopsy and positive C-ANCA in indirect immunofluorescence microscopy.