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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.
Mesalazine 치료 중인 궤양성 대장염 환자에서 동반된 미세변화 신증후군
양종오 ( Yang Jong O ),김성은 ( Kim Seong Eun ),이상주 ( Lee Sang Ju ),박기현 ( Park Gi Hyeon ),장윤경 ( Jang Yun Gyeong ),서광선 ( Seo Gwang Seon ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6
Mesalazine has been widely prescribed for the treatment of inflammatory bowel disease. In renal disease associated with inflammatory bowel disease, nephrolithiasis and amyloidosis are most common, and obstructive uropathy, acute renal failure, glomerular abnormalities and interstitial nephritis due to drug may be occur. However, glomerulonephritis presenting as nephrotic syndrome in patients with ulcerative colitis is very rare. We present a case of minimal change nephrotic syndrome probably associated with mesalazine treatment in patient with ulcerative colitis. A 31-year-old man was admitted with generalized edema and proteinuria. He had been initially treated by sulphasalazine and then received mesalazine for 6 months, recently. Kidney biopsy revealed minimal change disease. Mesalazine was discontinued immediately and prednisolone(1 mg/kg, P.O.) was prescribed. Eight weeks after prednisolone treatment, proteinuria disappeared and patient recovered completely.
Erythropoietin 항체에 의해 유발된 진성 적혈구 무형성증 (Pure Red-cell Aplasia)
양종오 ( Yang Jong O ),길효욱 ( Gil Hyo Ug ),권순효 ( Kwon Sun Hyo ),최영진 ( Choe Yeong Jin ),이은영 ( Lee Eun Yeong ),홍세용 ( Hong Se Yong ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.3
Recombinant human erythropoietin (rHuEPO) is extensively used in anemic patients on dialysis. We experienced a case of pure red-cell aplasia (PRCA) caused by anti-rHuEPO Antibody. A 48-year-old male with CRF was placed on chronic hemodialysis. He developed severe anemia (Hb 6.6 g/dL) without any apparent blood loss. A transfusion was given and the rHuEPO dose was increased to 12,000 U/week SC. A bone marrow study was carried out. Anti-rHuEPO antibodies were positive. rHuEPO therapy was stopped. No improvement in the anemia was apparent. Although very rare, anti-rHuEPO an tibodies should be evaluated in patients with severe anemia without obvious etiology. (Korean J Nephrol 2004;23(3):528-531)
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.
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,양종오,이은영,홍세용,GiI Hyo Wook,Yang Jong Oh,Lee Eun Young,Hong Sae Yong 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2
Paraqaut, a widely used herbicide, is extremely toxic, causing multiple organ failure in human. Most of paraquat intoxications happen through oral administration. But there is no clinical data for parenteral paraquat intoxication. A 35-year-old male injected paraquat solution on his forearm. He visited emergency room within 10 minutes and was treated with tourniquet, incision, washing and suction. After eight days, the patient was discharged without respiratory symptoms and complications. In treatment of parenteral paraquat intoxication, first aid was very important and the treatment should include tourniquet, incision, washing and suction in order to delay absorptions.
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.