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살충제 중독환자에서 혈액관류가 혈중 살충제 농도에 미치는 영향
길효욱,양종오,이은영,홍세용,Gil Hyo-Wook,Yang Jong-Oh,Lee Eun-Yong,Hong Sae-Yong 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1
Purpose: Hemoperfusion is an effective modality of extracorporeal elimination of toxins in acutely poisoned patients. We evaluated the effect of hemoperfusion on plasma concentration of toxins in patients exposed to certain pesticides. Methods: Eleven patients who were acutely exposed to pesticides participated in our study. We measured plasma pesticide concentration from the whole blood obtained by arterial and venous sources by gas chromatography. Results: The plasma concentrations of only 3 patients was measured. Methidation clearance by hemoperfusion was 82.2%, fenitrothion was 23%, and endosulfan was 0% Conclusion: Measurement of plasma organophosphate concentration is not a practical application. Our results suggest that hemoperfusion is applicable in patients with pesticide intoxication according to clinical status.
원인 불명의 급성 신부전으로 발현된 급성 파라콰트중독 1례
길효욱,양종오,이은영,홍세용,Gil Hyo Wook,Yang Jong Oh,Lee Eun Young,Hong Sae Yong 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
Paraquat, a widely used herbicide, is extremely toxic, causing multiple organ failure in human. Many treatment modality has been used, but now paraquat is very fatal drug. Elimination rate of plasma paraquat seems to be a factor for the survival rate. So early diagnosis and early treatment are very important. Plasma paraquat concentration could be measured by radioimmunoassay. But it is impossible that the test was done at Emergency room and the result was checked immediately. There was relation between plasma paraquat concentrations and urine paraquat concentration. Because of its simplicity and low cost, urine paraquat concentration test is complementary to the plasma concentration measurement. If the patient has psychotic problem or unconscious mental state, and is observed unexplained dyspnea and oral ulcer, urine paraquat test is very important to rule out acute paraquat intoxication. We experienced a patient who was presented as unexplained acute renal failure initially and was diagnosed as paraquat intoxication later.
길효욱 ( Hyo-wook Gil ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5
Data reported recently suggest that acute kidney injury (AKI) is a systemic disease that adversely affects the function of other organs.including the heart, lung, liver, brain and immune system.which is related to the high mortality rate of affected patients. Kidney and lung function are closely related in both health and disease. Data support deleterious bidirectional crosstalk between the lung and kidney. AKI is a common complication in patients with acute respiratory distress syndrome, and has been reported to exert adverse effects on the lungs. Mortality rates for AKI combined with acute lung injury (ALI) can be up to 80% in critically ill patients. Although AKI-associated ALI presents clinically as increased pulmonary edema, the mechanism of AKI-associated ALI extends beyond simple volume overload. Data from animal studies suggest that AKI-induced pulmonary edema is related to both cardiogenic edema (due to elevated hydrostatic pressure) and non-cardiogenic edema (due to pulmonary endothelial and epithelial cell injury caused by inflammation, oxidative stress, and apoptosis). ALI with mechanical ventilation causes a decline in renal hemodynamic function and apoptosis. Elucidation of the mechanisms of kidney.lung crosstalk would facilitate development of effective therapies and reduce the mortality rate of AKI combined with respiratory failure. (Korean J Med 2016;90:389-393)
양종오,길효욱,이은영,홍세용,Yang Jong Oh,Gil Hyo Wook,Lee Eun Young,Hong Sae Yong 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.2
Purpose: Paraquat is the most commonly used herbicide in Korea. Exposure to paraquat through the skin has resulted in local irritation or inflammation of varying degree, sometimes severe. The purpose of this study was to review the patients with paraquat poisoning by skin absorption. Methods: We analysed retrospectively the clinical and laboratory findings of 45 patients with paraquat poisoning after dermal exposure, who were admitted to Soonchunhyang University Cheonan Hospital from January 1999 to December 2003. Results: Among 870 cases of paraquat poisoning, 45 cases were exposed to paraquat through the skin. The peak incidence was the fifth decade($40\%$). The clinical symptoms were pain, pruritus, nausea, and vomiting. The major skin lesions were generalized vesicobullae and necrotic erosion in face, scrotum, trunk, upper and lower extremities and etc. All patients were survived after skin contact or inhalation of paraquat. Conclusion: This study illustrates the extreme toxicity of paraquat and demonstrates that lethal quantities of paraquat may be absorbed if repeated exposure to it. Stricter precautions, including the mandatory use of protective clothing, should be recommended whenever this material is used.
홍세용,길효욱,양종오,이은영,Hong Sae Yong,Gil Hyo Wook,Yang Jong Oh,Lee Eun Young 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1
Purfose: This study was to observe the phosphamidon reduction rate after haemoperfusion (HP) and Hemodialysis (HD) in vitro. Methods: We started off by measuring the clearance of HD and HP for the phosphamidon in vitro. Phosphamidon was measured hourly by High-pressure liquid chromatography. Results: Phosphamidon clearance was effectiveness in HP and HD. Phosphamidon reduction rate was no difference between HD and HP; $64\%$ versus $91.\%1$ at starting, $82.2\%$ versus $80.2\%$ at 1 hours, $82.2\%$ versus $73.8\%$ at 2 hours, $34.4\%$ versus $14.0\%$ at 3 hours, $14.1\%$ versus $27.4\%$ at 4 hours, $0\%$ versus $3.3\%$ at 5 hours. Conculsion: Extracorporeal elimination of phosphamidon is effective by hemoperfusio and hemodialysis in vitro. We suggest hemoperfusion may be effective in organophsphate intoxication patients.
혈액 투석환자에서 혈중 알루미늄 농도에 관한 임상적 고찰
서연석 ( Yun Seok Seo ),길효욱 ( Hyo Wook Gil ),양종오 ( Jong Oh Yang ),이은영 ( Eun Young Lee ),홍세용 ( Sae Yong Hong ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.4
Purpose : This study was performed to evaluate the aluminum level in hemodialysis patients and to find a correlation between aluminum level and bone specific alkaline phosphatase level. Methods : Eighty five randomly selected patients with end-stage renal disease, undergoing maintenance hemodialysis treatment over 1 year were studied. Serum aluminum and bone specific alkaline phosphatase concentration were measured. Low dose desferrioxamine test (5 mg/kg) was done. Results : The serum aluminum concentration before and after low dose desferrioxamine test were 4.21±2.13 μg/L and 8.89±4.48 μg/L (p<0.01) respectively. Bone-specific alkaline phosphates and parathyroid hormone concentration were 39.08±39.90 mg/dL and 98.27±112.92 pg/mL. The aluminum level after desferrioxamine test was correlated with duration of hemodialysis (r=0.238, p=0.03). Aluminum level was not correlated with bone specific alkaline phosphatase level. Conclusion : Aluminum level was lower than that of previous studies. Aluminum level was not increased in patients with low bone specific alkaline phosphatase. Thus, it seems that serum aluminum level is not a major problem in hemodialysis patients with lower turnover bone disease. However, confirm diagnosis of aluminum related bone disease in hemodialysis patients needs combined study of bone histology with a large number of cases.
증례 : 신장 ; 아세트아미노펜 중독에 의한 급성 신부전 1예
이지연 ( Ji Yeon Lee ),길효욱 ( Hyo Wook Gil ),양종오 ( Jong Oh Yang ),이은영 ( Eun Young Lee ),홍세용 ( Sae Yong Hong ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3
아세트아미노펜에 의한 급성 신부전은 잘 알려져 있지 않으며 그 치료에 대해서도 확립되어 있지 않다. 저자들은 58세 여자 환자가 과량의 아세트아미노펜 중독으로 인해 급성 신부전이 발생하였으나 N-acetylcystein 투여와 적절한 혈액 관류 및 혈액 투석으로 성공적으로 치료하였기에 보고하는 바이다. Acetaminophen is a widely used analgesic and antipyretic. Acetaminophen-induced kidney injury is poorly described. Hepatorenal syndrome, prerenal failure, and direct toxicity of acetaminophen metabolites could be involved in the development of acute renal failure with acetaminophen intoxication. We treated a 58-year-old female who was found stuporous and brought to the emergency room by ambulance. She had ingested acetaminophen 4~5 g per day for a chronic headache for over 10 years. At presentation, she had ingested about 8 g of acetaminophen. She presented in non-oliguric acute renal failure with hepatic injury. Hemoperfusion, hemodialysis, and N-acetylcysteine infusion were applied. The creatinine peaked on the sixth day. Subsequently, her renal function recovered. After 34 days, she was discharged in relatively good condition. In conclusion, supportive care and proper extracorporeal therapy can improve the survival in acute renal failure after acetaminophen intoxication. (Korean J Med 2011;80:348-351)
당뇨병성 신증에서 angiopoietins 유전자의 변화
이은영 ( Eun Young Lee ),길효욱 ( Hyo Wook Gil ),양종오 ( Jong Oh Yang ),고장현 ( Jang Hyun Koh ),정춘희 ( Choon Hee Chung ),홍세용 ( Sae Yong Hong ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.3
Purpose : It has been reported that angiopoietins and Tie-2 receptor play an important role in the maintenance of glomerular filtration barrier in various glomerulonephritis models. We studied the role of angiopoietins on renal injury in diabetes. Methods : In this study, we examined the changes of angiopoietin-1, angiopoietin-2, Tie-2 receptor, and nephrin expression in the experimental diabetic nephropathy and also determined whether these changes were modified by renoprotective intervention by angiotensin II receptor blocker, α-lipoic acid, and peroxisome proliferator activated receptor (PPAR)-agonist. Results : A marked increase in urinary albumin excretion and glomerular volume was observed in diabetic rats. Renal angiopoietin-2 and Tie-2 receptor expression were significantly higher in diabetic rats than in the control groups, with a significant reduction in renal angiopoietin-2 expression, albuminuria, and renal hypertrophy in angiotensin II receptor blocker-treated diabetic rats. And there was significant reduction in renal Tie-2 expression and renal hypertrophy in α-lipoic acid-treated and PPAR-γ agonist-treated diabetic rats. Conclusion : These results demonstrate that the dysregulation of angiopoietins and Tie-2 receptor can lead to renal hypertrophy and albuminuria. Angiotensin II receptor blocker, α-lipoic acid, and PPAR-γ agonist attenuated these changes in angiopoietins and/or Tie-2 expression and prevented the development of albuminuria and renal hypertrophy in vivo.