인공 간

최원충 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.4

제1회 연수강좌 : 간성뇌증 및 간부전

최원충 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.1(S)

(답변) 내시경적 담관 결석 제거술 후 담낭의 운명은?

최원충 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.3

실험적 허혈성 급성 신부전에서 칼슘 길항제의 투여가 신장과 혈장 Renin 활성도에 미치는 영향

최원충,김형규 인제대학교 1991 仁濟醫學 Vol.12 No.2

허혈성 급성신부전이 예상되는 경우, 칼슘대사 길항제인 Nifedipine을 전처치하여, 신기능 감소의 예방효과 및 혈장 Renin 활성도의 변화를 관찰하기 위하여, 고양이 10마리를 대조군, 실험군으로 나누어 실험 연구한 결과, 통계학적으로 유의하지는 않으나, 신기능 감소정도를 둔화시키며, 혈장 Renin 활성도의 변화율을 감소시키는 것으로 추정되었다. In the process of ischemic cell injury, alterations in one such variable, that of cellular calcium homeostasis, appear to be of major significance. Probably calcium entry blockers could protect against, attenuate the degree of, or enhance recovery from, renal ischemic injury by several mechanisms. And the retrain-angiotensin system may play a central role in the pathogeneisis of acute renal failure(ARF). The evidence that cytosolic Ca2+ is an inhibitory second messenger in renin secretion has been reviewed recently. Therefore the purpose of this study was to evaluate the effect of systemic calcium entry blockers pretreatment on renal function & plasma retrain activity (PRA) in the experimental ischemic ARF model. Ten cats were anesthesized with pentobarbital sodium (40mg/kg, I.M) and a tracheostomy, two IV line and a urinary catheter were placed In position. Temperature was maintained at 37.5 degrees C. By an abdominal approach, both renal arteries were isolated. Five cats were used as controls and received saline for 2 hours before bilateral renal artery clamp. Another five cats were treated with nifedipine (10mg/kg) subcutaneously 2 hours before bilateral renal artery clamp. All ten cats underwent 1 hour of renal artery clamp followed by 3 hours of reperfusion and hydration with saline. Before clamp and after reperfusion, blood and urine were sampled for creatinine, Na, β2-microglobulin, PRA and urine volume was measured. The resuls were as follows : In the control group, the Ccr value was 125.5±151.6ml/min/kg before clamp and decreased to 6.2±5.3ml/min/kg after reperfusion; in the experimental group, the Ccr value was 43.9±48.1ml/min/kg before clamp and decreased 5.6±5.9ml/min/kg after reperfusion(p<0.05). And creatinine clearance decreased experimental group(88.9±7.9%) compared with control group(98.7±11.1%), these results were not significant statistically(p>0.05). In the control group the PRA value was 14.9±9.2ng/ml/hr before clamp and decreased 14.0±10.1ng/ml/hr after reperfusion; in the experimental group the PRA value was 11.5±6.9ng/ml/hr before clamp and decreased 10.3±3.7ng/ml/hr after reperfusion(p>0.05). From these data, it was suggested that systemic nifedipine pretreatment exerts the insignificant protective effect on ARF and influence on the decrement value of PRA insignificantly.

비알코올성 지방간

최원충 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

알코올성 간질환 환자에서 알코올 금단증후 발생의 예측인자에 대한 연구

최원충,최대식 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.4

Background/Aims: Although alcohol withdrawal syndrome (AWS) is often developed in the patients with alcoholic liver disease, the studies about which clinical factors are associated with the development of AWS have been rarely studied. The aim of this study was to reveal clinical factors indicating a higher risk for the development of AWS at admission. Methods: The retrospective case-controlled study was conducted among patients with alcoholic liver disease. The cases were divided into two groups according to whether AWS was developed or not. We compared their past medical history, physical examination and laboratory data at admission. Results: AWS was significantly developed in patients who had experienced AWS in the past, increased serum chloride concentration at admission. Conclusions: It is possible to predict the patients who are more likely develop to AWS by means of past medical history and a serum biochemical test at admission. We suggest more intensive therapy will be required to prevent the development of AWS in these patients. These results are preliminary and need further prospective development and validation, particularly regarding the variety of variables.(Korean J hepatol 2000;6;441-447)

역수동혈구응집법을 이용한 결핵성 흉막염과 결핵성 수막염의 진단에 관한 연구

김대원,김민자,박승철,강경호,최원충 대한감염학회 1986 감염 Vol.18 No.2

Reverse passive hemagglutination test using tannic acid was performed to know the efficency as a immunodiagnostic tool in TB-pleurisy and TB-meningitis patients. The results of the study are summarized as follows: 1) There are mycobacterial antigenices in pleural effusion of TB-pleurisy patients and cerebrospinal fluid of TB-meningitis patients. 2) There was cross reaction between M. paratuberculosis and M. tuberculosis. 3) The cut off titer of TB-RPHA method in non-tuberculous pleural effusion and cerebrospinal fluid was 1 : 2. 4) In all the TB-pleurisy patients, TB-RPHA titers in pleural effusions were more than 1 : 4 ranging from 1 : 4 to 1 : 64. In two cases of TB-meningitis patients, TB-RPHA titers in cerebrospinal fluid was 1 : 16/1 : 32 and more than 1 : 64 respectively. 5) It was considered that TB-RPHA method is useful for the screening test of TB-pleurisy and TB-meningitis patients due to its high sensitivity, simple and relatively radid processes.

Applicability of Bioartificial Liver and Liver Transplantation for Fulminant Hepatic Failure

최원충 ( Choe Won Chung ) 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.3(S)

백서에서 간외폐쇄성 황달의 간손상 및 Ursodeoxycholic Acid의 예방 효과

최원충(Won Choong Choi),류호상(Ho Sang Ryu),현진해(Jin Hai Hyun) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.2

N/A Background/Aims: Generally many reports were known that the liver function was decreased with different forms of extrahepatic obstructive jaundice. To clarify the mechanism of these hepatic dysfunction in extrahepatic obstructive jaundice, we studied histologica] and biochemical alterations of experimental rats with obstructive jaundice induced by common bile duct(CBD) ligation at two time periocL(group I) and the limiting effects of administration of ursodeoxycholic acid(UDCA) or NSAID(lndomethacin) on the histological and biochernical alterations(group II). Methods: In control, lO rats underwent laparotomy without CBD-ligation(sham-operation). In group I, the CBD of 20 rats was ligated by laparotomy. Three(group Ia) and Four(group Ib) weeks aft=r ligation and 4 weeks after in case of control rats, the liver was isolated and microscopic examination was done. In group II, 40 rats with ligation of CBD were ramdomly assigned to receive UDCA(25 mg/kg/day) for 15 rats and NSAID(indomethacin, 4 mg/kg/day) for 15 rats and placebo for 10 rats. Results: In the study of group I, bi]e ducts proliferation was observed from portal tracts to porta] tracts and to hepatic lobules in group la, and hepatic ]obules were destroyed by severe prc>]iferation and fibrosis, and the area ratio of hepatocytes and sinusoid was decreased relatively in thie microscopic field in group lb. In the study of group II, the decreased area ratio of hepatocytes and sinusoid was limited in UDCA treoted group, but not in indomethacin group. Biochemical abnormalities(s-GPT, alkaline phosphatase, tota] bilirubin) were not limited significantly in both drug treated groups. Conclusions: Impairment of liver function of the rats with extrahepatic obstrutive jaundice may be due to relatively decreased hepatocytes and sinusoid ratio by bile duct proliferation and interstitial fibrosis and this alteration may be prevented by administration of UDCA. (Korean J Gastroenterol 1996; 28:232 240)

대량 복수가 동반된 만성 간질환 환자에서 치료 목적의 복수 천자에 대한 전향적 연구

김성준,최원충 인제대학교 1997 仁濟醫學 Vol.18 No.4

간경변증이나 간암 등의 만성 간질환 환자에서는 합병증 치료를 포함한 보존적 치료만이 가능한 경우가 많고 그 중 복수에 대한 치료가 가장 중요하다. 대부분 저염식과 이뇨제로 나트륨 균형을 조절하여 치료하지만 5-10%의 환자에서는 이뇨제에 반응이 없고, 대량의 복수일 때 입원 기간을 줄이기 위해 치료 목적으로 복수 천자가 필요하다. 이와같은 치료적 복수 천자시 알부민이나 다른 혈장 대용물을 정맥주사하면서 흡입 펌프로 복수를 거의 전부 천자하는 이전 방법의 효용성, 부작용 및 비용에 대하여 논란이 많다. 저자 등은 임상에서 쉽게 할 수 있는 중력에 의한 체위 배액으로 복수 천자를 시도하였다. 그 결과 1∼5시간 동안에 3∼6L의 복수가 부작용이 없이 효과적으로 천자되었고, 천자하는 동안 생리 식염수, 알부민 및 텍스트란-40 중 한가지를 선택하여 정맥주사하였는데, 혈장 대용물의 종류에 따른 유의한 차이는 없었다. Objectives : It has been shown that total paracentesis wish albumin infusion is rapid, effective and safe therapy of tense ascites in cirrhosis and recently, total paracentesis with infusion of the other plasma expanders such as dextran-40 or dextran-70 were studied. In this controlled and randomized study, we compared the effectiveness and the safety of postural drainage of tense ascites with intravenous infusion of albumin, dextran-40 or small amount of saline. Methods : 30 liver cirrhosis or hepatoma patients with tense ascites were randomized to 3 groups : 10 patients were treated with paracentesis plus saline infusion (25ml/h) (group 1), 10 patients were treated with paracentesis plus albumin infusion (6g of albumin per liter of ascites removed) (group 2), 10 patients were treaded with paracentesis plus dextran-40 infusion (10g of dextran-40 per liter of ascites removed) (group 3). We compared changes in mean arterial pressure, sodium level (serum and urine), BUN, creatinine, renin, and aldosterone before paracentesis, at 1hour and 48hours after paracentesis in three group. Results : Paracentesis was effective in relief of tense ascites in all patients and the amount of drained ascites was 3-6L for 1-5h duration. Any significant changes was not observed in mean blood pressure, blood test (sodium, BUN, creatinine, renin, aldosterone) or urine sodium excretion before paracentesis, at 1hour and 48hours after paracentesis in three groups. Conclusion : Partial paracentesis by postural drainage was effective and safe in the treatment of the chronic liver disease with tense ascites, regardless of sort of infusional fluid, saline, albumin or dextran-40.