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신장이식 57 예에서의 공여자특이수혈 및 거부억제제 치료법에 따른 이식신의 예후
황영표(Young Pyo Hwang),유홍(Hong Yoo),김영호(Young Ho Kim),표광민(Kwang Min Pyo),이상욱(Sang Uk Lee),주운수(Woon Soo Joo),최창필(Chang Pil Choi),박진석(Jin Seok Park),김홍기(Hong Khee Kim),이시래(Si Rhae Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.3
N/A 57 cases of renal transplantation from December 1984 to August 1987, of which 10 cases were HLA-identical (HLA-ID), 39 cases were HLA-haploidentical (HLA-HID) and 8 cases were living-unrelated (LUR). The mean age of recipients and donors was 35.3 years and 40.3 years, respectively, Underlying renal diseases of the recipients were mostly chronic glomerulonephritis (52 cases), and the remaining 5 cases were chronic pyelone-phritis, reflux nephropathy, hypertentsive nephrosclerosis, polycystic renal disease and diabetic nephropathy. The post donor specific transfusion (DST) sensitization rate was compared between a group treated by DST alone and a group treated by DST with Azathioprine The effect of Cyclosporine A plus prednisolone (Cs-A+P group) and Azathioprine plus prednisolone (Aza+P group) as immunosuppressive agents on renal allograft function was compared in the HLA-ID, HLA-HID and LUR group. The post-DST sensitization rate was 20.0% in the DST alone group and 4.9% in the DST with Azathio-prine group, however the difference was not statistically significant. Acute rejection after renal transplantation developed in 4 of 19 cases (21.1%) in the Cs-A+P treated HLA-HID group, in 2 of 10 cases (20.0%) in the HLA-ID group and in 7 of 17 cases (41.2%) in the Aza+P treated HLA-HID group. Again, the difference among these groups was not significant. Excluding 4 cases of graft failure due to nonimmunolgical causes, the acturial graft survival for 2 years was 10096 in the HLA-ID group, 88% in the HLA-H1D group and 71.4% in the LUR group. The number of patients with serum creatinine below 2 mg/dl was 19 of 19 cases (100%) in the Cs-A+P treated HLA-HID group during 7.68±5.18 months, and 14 of 17 cases (82.4% ) in the Aza+P treated HLA-HID group during 12.5±7.5 months, and the difference was not statistically significant. The above results suggest that the pretransplant allosensitization by DST was lower in the DST+Aza group than in the DST alone group, and the effect of Cs -A+P on renal allogrsft seemed to be better than that of Aza+P. However, further studies including more cases and longer observation periods are necessary to conclude which posttransplantation regimen is better between Aza+P and Cs-A+P, even after DST.
편도철(Do Chul Pyun),김중경(Jung Kyoung Kim),공덕경(Deog Gyeong Gong),김태용(Tae Yong Kim),주운수(Woon Soo Joo),김홍기(Hong Khee Kim),이시래(Si Rhae Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.4
N/A Antibody formation against the A or B antigen in renal transp1antation resulting in autoimmune hemolytic anemia has been reported on rare occasions. We recently experienced a case of autoimmune hemolytic anemia in a blood group Rh+A male patient, who had received a kidney from his blood group Rh0 mother. He was maintained under immunosuppression with Cyclosporin-A and prednisolone. On days 12 to 13 posttransplantation, hemolysis developed. The Hb dropped from 9.6%/dl to 6.4%/dl, reticulocyte count was 3,0%, and peripheral blood smear showed spherocytosis. LDH was 580units and haptoglobin was 27 mg/dl. His direct Coomb`s test was positive with both anti-IgG and anti-complement. Anti-A was eluted from his serum. He was transfused with 2 units of compatible blood group Rh'0 washed RBCs without any incident. There was improvement of anemia after reducing Cs-A and adding azathioprine.
장태원(Tae Won Jang),서보원(Bo Won Seo),김중경(Jung Kyung Kim),정만홍(Man Hong Jung),주운수(Woon Soo Joo),한동선(Dong Sun Han),이재우(Jae Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.5
N/A To evaluate the effect of chronic alcohol ingestion on heart function, we performed a controlled study with 40 alcoholics and 34 non-alcoholics. The alcoholics ingested more than 90 grams of ethanol per day over 10 years, without any symptoms related to heart failure. Left ventricular size, ejection fraction, fractional shortening, LV mass, systolic time intervals, and transmitral flow velocities were measured by non-invasive methods using EKG, phonocardiogram, carotid pulse tracing, M mode and Doppler echocardiography. The results were as follows 1) Average daily alcohol consumption was 144±80.2 g/day of ethanol in alcoholics and 2.7±5.1 g in non- alcoholics. 2) There were no statistically significant differences in the left ventricular dimensions, ejection fraction, fractional shortening, left ventricular mass and systolic time intervals between the 2 groups. 3) Transmitral flow velocity in alcoholics showed an early peak flow velocity (EPFV) and atrial peak flow velocity (APFV) of 45±9cm/sec and 51.7±9cm/sec, and in non-alcoholics, 51.2±11.4 cm/sec and 46.9±9.3 cm/sec, respectively. Early to atrial peak flow velocity ratio (EPFV/APFV) was 0.895±0.245 in alcoholics and 1.135±0.333 in non-alcoholics, which was statistically significant (p<0.005). The results suggest that left ventricular dysfunciton may present in alcoholics before the development of alcoholic cardiomyopathy and that diastolic dysfunction precedes systolic dysfunction.