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신이식환자에서 B 형 및 C 형 간염의 유병율과 임상경과
양철우(Chul Woo Yang),신영신(Young Shin Sin),윤선애(Sun Ae Yoon),진동찬(Dong Chang Jin),안석주(Suk Joo Ahn),김용수(Yong Soo Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),윤영석(Young Suk Yoon),방병기(Byung Kee Bang) 대한내과학회 1994 대한내과학회지 Vol.47 No.5
N/A Objectives: To evaluate the prevalence and clinical course of HBsAg positive and anti-HCV positive renal transplant recipients. Methods: According to serologic result, we divided the patients into HBsAg positive (HBV) and anti-HCV positive (HCV) group, and evaluated the clinical course based on duration and severity of hepatic dysfunction. Mean duration of observation was 3.8 years. Results: 1) HBsAg positivity was 11.3% and anti-HCV positivity was 13.3%, respectively. Before transplantation, in HBV group, HBsAg positivity was observed in 83.5% before renal transplantation, and 16.5% patients acquired HBsAg after renal transplantation, In HCV group, anti-HCV positivity was observed 54% before transplantation and 19.6% acquired anti-HCV after renal ransplantation. 2) The prevalence of chronic hpatitis in HBV and HCV grup was not different (25.7% vs. 25.5%). Among those with chronic hepatitis in HBV group, four cases progressed to fulminant hepatic failure, one case progressed end-stage of liver cirrhosis and one case progressed to hepatocelluar carcinoma. However, in HCV group, no case showed progression of chronic hepatitis. 3) Overall mortality of HBV and HCV group 25.3% and 7.8%, respectively (p=0.001): Among twenty fatal cases in HBV group 9 cases were liver disease-related but no liver disease-related death was observed in HCV group. Conclusion: HCV as well as HBV infection is quite prevalent and implortant cause of posttransplant chronic hepatitis, and clinical course of anti-HCV-posi- tive recipients are less aggressive than HBsAg positive recipients.
양철우(Chul Woo Yang),장윤식(Yoon Sik Chang),한치화(Chi Hwa Han),윤영석(Young Suk Yoon),박종원(Chong Won Park),김춘추(Choon Choo Kim),방병기(Byung Kee Bang),김동집(Dong Jip Kim),김학기(Hark Ki Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.1
N/A We reviewed 38 cases of patients with bone marrow transplantation (BMT) and the results are as follows: 1) Thirty of thirty eight patients (82%) showed nephrotoxicity: 12 cases of electrolyte imbalance (31%), 2 cases (8%) of acute renal failure (ARF), and both, 16 cases (43%). 2) Incidence of ARF in Cyclosporin A (CsA) plus antimicrobial agents (AM) group, AM group and CsA group was 60%, 33% and 16% respectively. 3) The most common incidence of electrolyte imbalance was hypokalemia (26 cases, 70%), followed by hypocalcemia (14 cases, 38%), hypophosphatemia (10 cases, 27%), hyponatremia (5 cases, 13%), and hypomagnesemia (3 cases, 8%) 4) Clinical characteristics of patients with ARF were non-oliguric (2,867±481ml/24hrs), mildly azotemic (serum Cr: 2.2±0.6mg/dl), and reversible except one expired case. 5) The increase in serum creatinine was correlated with the duration of the administration of the nephrotoxic drugs (r=0.60, p<0.05). Though the impact of the nephrotoxic drugs could not be evaluated individually, it seems that, combined use of antimicrobial agents and CsA after BMT be the major factor of ARF.
위선암에 병발된 미세맥관 용혈성 빈혈의 2 가지 유형 - 임상특징 , 치료 및 예후 -
양철우(Chul Woo Yang),강혜정(Hae Chung Kang),문한림(Han Lim Moon),박종원(Chong Won Park),김훈교(Hoon Kyo Kim),김호연(Ho Youn Kim),김춘추(Choon Choo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.6
N/A Microangiopathic hemolytic anemia (MAHA) is char-acterized by schizocytes, intravascular hemolysis and in some instances, thrombocytopenia and coagulation factor deficiencies. Of many cases of cancer related MAHA reported, gastric adenocarcinoma is most frequently related. We found 10 cases of MAHA in gastric adenocarcinoma and analysed their clinical features, therapy and response, and prognosis, and then classified them into two groups. The results are as follows: 1) Cancer related A1AHA could be classified into two groups according to their clinical manifestations: pure MAHA (Group 1:7 cases), and a syndrome of MAHA, renal insufficiency and pulmonary edema (Croup II: 3 cases). 2) Croup I patients showed bane marrow metastasis (Stage IV), no previous chemotherapy (except 2 cases) and consumption coagulopathy in 2 cases. In contrast. Group II patients showed no bone marrow metastasis, but all had previous chemotherapy, especially mitomycin-C, and no evidence of disseminated intravascular coagulation. 3) Therapeutic approaches were directed to reduce tumor burden and immune complexes. In Group I, single or combination chemotherapy reduced the hemolytic event in peripheral blood, but most patients expired due to progression of cancer. In Group II, treatments with plasmapheresis and high dose steroid were tried, but the response was poor and all patients expired due to complications (bleeding, ARDS and uremia) within I month after detection of MAHA.
한상우 ( Sang Woo Han ),김진영 ( Jin Young Kim ),김수현 ( Su Hyun Kim ),최범순 ( Bum Soon Choi ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),문인성 ( In Sung Moon ),김동구 ( Dong Goo Kim ),고용복 ( Yong Bok Koh ),방병기 ( Byu 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.1
Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.