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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.
양종오,이상주,박기현,장윤경,이강욱,서광선,신영태 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2
Membranous nephropathy (MN) is a glomerular disease characterized by diffuse thickening of the glomerular basement membrane without significant mesangial proliferative change and is usually manifested by the nephrotic syndrome. To evaluate the clinical and pathologic characteristics of this disease in adults, we analyzed 65 patients with primary membranous nephropathy who were diagnosed at Department of Internal Medicine, Chungnam National University Hospital from February 1986 to February 2001. The results are as follows: 1) Of total 96 patients with membranous nephropathy, 67.7% was primary MN. Hepatitis B-associated MN and lupus MN were 22.9%, and 9.4%, respectively. Median duration of follow-up was 35.1 months(0.3∼177) in primary MN, 49.6 months(2.5∼103) in lupus MN, and 35.6 months(0.5∼108) in hepatitis B-associated MN. 2) Mean age of the patients with primary MN at the time of diagnosis(43.3 years) was significantly higher than that of lupus MN(30.4 years) and HBV-associated MN(36.2 years). Male to female ratio of primary MN was 1.03:l. 3) At the time of diagnosis, 89.2% of primary MN was presented with nephrotic syndrome. Twenty seven percent of patients showed hypertension. Hematuria was found in 58.5% of primary MN patients. Azotemia was noted in 3.1 %. 4) Global sclerosis, tubular atrophy and interstitial fibrosis were noted in 39.8, 16.1 and 11.3% of primaty MN, respectively. IgG and C3 were deposited on the glomerular capillary loop in 92.7% and 29% of primary MN patients. There was no significant correlation between the electron microscopic pathologic stage and clinical findings. 5) Of 56 patients with primary MN followed more than 6 months, 50(90.9%) patients were treated with prednisolone, cyclophosphamide or cyclosporin. Complete remission was obtained in 29 patients(51.8%), partial remission in 6 patients(10.7%), and no response in 18 patients(32.1%). Of 6 patients who were not treated with immunosuppressive drugs, 3 patients showed spontaneous complete or partial remission. Three patients who did not show clinical improvement progressed to end-stage renal failure. There were no significant clinical difference including renal pathology at the time of diagnosis between the patients who showed complete or partial remission and patients who did not. In conclusion, it was difficult to predict the long-term prognosis of primary MN at the time of diagnosis, clinically. The response to therapeutic modality would be the most important to predict long-term prognosis of primary MN.
만성 신질환에서 혈중납량 및 골중납량과 신기능 저하의 관련성
양종오 ( Jong Oh Yang ),김남수 ( Nam Soo Kim ),이은영 ( Eun Young Lee ),홍세용 ( Sae Yong Hong ),( Andrew C. Todd ),이병국 ( Byung Kook Lee ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.6
Purpose: This study assessed the environmental lead exposure in patients with chronic kidney disease (CKD) and the relationship between lead exposure and renal function indices. Methods: Seventy-one patients with CKD and 40 control subjects without known renal disease were included. Blood lead was measured by atomic absorption spectrophotometry and tibial lead was measured via 109Cd-based K-shell X-ray fluorescence. Blood urea nitrogen (BUN), serum creatinine, urine creatinine and urine N-acetyl-beta glucosaminidase (NAG) were also measured. Blood lead was corrected with hematocrit (female: 35%, male: 42%) to adjust for differences in anemic status of patients compared with control subjects. Results: The mean level of hematocrit-adjusted blood lead was significantly higher in patients with CKD (4.18±1.74 μg/dL) compared with that in control subjects (3.00±0.92 μg/dL); the mean tibial lead level tended to be higher in patients with CKD (3.38±9.93 μg/g) than that in control subjects (1.28±7.92 μg/ g), but no statistical significance was observed. In a multivariate regression analysis after adjusting for gender, age, and drinking and smoking status, adjusted blood lead was a significant predictor of increases in BUN and serum creatinine, but not of the level of urine NAG or creatinine. In contrast, no significant association between tibial lead and renal indices was observed in the multivariate regression analysis. Conclusion: These results suggest that environmental lead exposure may compromise renal function.
혈액투석 환자에서 발생한 중심정맥 협착의 경피적 혈관성형술 및 스텐트 삽입술
양종오 ( Yang Jong O ),이상주 ( Lee Sang Ju ),박기현 ( Park Gi Hyeon ),장윤경 ( Jang Yun Gyeong ),강민규 ( Kang Min Gyu ),성인환 ( Seong In Hwan ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6
중심정맥 삽관의 부작용 중 중심정맥의 협착은 비교적 흔하여 쇄골하정맥 삽관을 시술 받은만성 신부전증 환자의 15-50%에서 발생한다. 중심정맥 협착 발생시 정맥압의 증가로 부종 등의 증상으로 같은 쪽 팔의 동정맥루를 사용할 수 없게 된다. 중심정맥 협착의 치료방법으로 경피적혈관성형술 및 스텐트 삽입의 임상적 의의를 알아보고자 저자들은 충남대학교병원에서 1999년 3월부터 2001년 2월까지 혈관조영술상 중심정맥 협착으로 진단 받고 경피적 혈관성형술 및 스텐트 삽입술을 시행 받은 10명을 대상으로 분석하였다. 대상환자 중 남자가 3명, 여자가 7명이었고, 평균 나이는 55(39-74)세이었다. 스텐트 삽입 후 추적기간은 중앙값 15.8(9.3-23.7)개월이었다. 만성 신부전증의 원인은 고혈압 4명, 당뇨병 4명, 원인 불명 2명이었다. 대상자 중 8명은 동정맥루이고 2명은 인조혈관을 이용한 동정맥 이식편으로 혈액투석 치료를 받고 있던 환자였다. 부종이 발생한 상완은 좌측이 9명, 우측이 1명이었고 모두 환자의 동정맥루가 있는 쪽 팔에 발생했다. 혈액투석 시작 후 시술까지의 기간은 중앙값 28(0.5-180)개월이었다. 중심정맥 삽관의 평균 사용기간은 중앙값 35일이었고, 병변이 있는 쪽 팔의 동정맥루의 평균 사용기간은 중앙값 15.1개월이었다. 모든 환자에서 스텐트를 성공적으로 시술하였고 시술 직후부터 상완의 부종이 감소하였다. 병변 부위는 좌측 쇄골하정맥 2명, 좌측 상완두정맥 7명, 우측 상완두정맥 1명이었다. 3명의 환자에서 시술 후 재협착이 발생하여 풍선 성형술을 다시 시행하여 모두 성공적으로 치료하였다. Stenosis of the subclavian vein after cannulation occurs in 15-50% of chronic hemodialysis patients, and impedes the placement of an arteriovenous fistula in the ipsilateral arm. Its natural history and pathogenic mechanism are not well established yet. To investigate the clinical characteristics of the patients and therapeutic effect of percutaneous angioplasty and stenting, 10 consecutive chronic hemodialysis patients(3 men and 7 women; mean 55 year old) from March 1999 to February 2001 who showed subclavian vein stenosis and were treated with above percutaneous procedure were included in this study. The patients were followed for median 15.8(9.3-23.7) months after stenting. The causes of chronic renal failure were hypertension in four, diabetes mellitus in four, and unknown in two patients. Edema was noted on left upper extremity in nine and right in one patient. All cases of stenosis of central vein were found in ipsilateral side. Duration from beginning of hemodialysis to angioplasty and stenting was median 28(0.5-180) months. Duration for keeping subclavian vein catheter was median 35(13-65) days and duration for arteriovenous fistula in ipsilateral arm was median 15.1(1.1-120) months before stenting. All patients were performed stenting successfully and edema of upper extremities began to decreased immediately after the procedure. Involved stenosis lesions were noted on left bracheocephalic vein in seven, left subclavian vein in two, and right bracheocephalic vein in one patient. Restenosis after the procedure occurred in three patients in 1 year after stenting, and percutaneous balloon angioplasty(198, 256, 276 days after initial stenting) was performed again successfully. There was no severe complication during the procedure in all patients. In conclusion, we speculate that percutaneous angioplasty and stenting is a safe and effective therapeutic modality in chronic hemodialysis patients with central vein stenosis.