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급성심근경색증 환자에서 응급으로 시행한 Tc - 99m Sestamibi 심근관류 SPECT와 심전도의 비교
원규장(Kyu Chang Won),이형우(Hyoung Woo Lee),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee),조인호(Ihn Ho Cho),박종선(Jong Sun Park),도준영(Jun Young Do),신동구(Dong Gu Sin),윤경우(Kyung Woo Yoon),김영조(Young Jo Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1
N/A We did Tc-99m sestamibi myocardial perfusion SPECT in 36 patients with acute myocardial infarction when they arrived at the emergency room. And we compared myocardial perfusion images with ECG findings. Then we obtained the follows. The myocardial infarction by the obstruction of left coronary descending artery and right coronary artery showed a good concordance in the diagnosis and infarction site between myocardial perfusion images and ECG findings. The 7 patients with myocardial infarction by a left circumflex coronary artery showed a perfusion defect in the lateral wall in myocardial perfusion SPECT images. But 4 patients of them showed ST segment elevation, 2 patients showed ST depression and 1 patient showed normal ECG findings. The diagnostic sensitivity of Tc-99m sestamibi myocardial perfusion SPECT was 100% by a qualified analysis. The perfusion defect site in the myocardial perfusion SPECT were con-responded with the infarct related coronary artery in 31 patients which was diagnosed by coronary angiograpy. The size of perfusion defect in the polar map was 31±18%(M±SD), in the myocardial infarction with left anterior descending coronary arery obstruction, 31±13% (M±SD) in the myocardial infarction with right coronary artery obstruction and 25±5.9%(M±SD) in the myocardial infarction on with left circumflex coronary artery obstruction. We concluded that emergency myocardial perfusion SPECT images are useful in the diagnose of myocardial infarction and it's very useful when we are difficult to diagnose with ECG like as lateral wall infarction or left bundle branch block.
증례 : 지속성 외래 복막투석 환자에서 발생한 비브리오 불니피쿠스(Vibrio vulnificus) 복막염 2예
배동운 ( Dong Woon Bae ),장경애 ( Kyung Ae Chang ),이승현 ( Seung Hyun Lee ),김민선 ( Min Seon Kim ),박종원 ( Jong Won Park ),도준영 ( Jun Young Do ),윤경우 ( Kyung Woo Yoon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6
복막염은 CAPD 환자에서 가장 흔한 감염성 합병증이다. 하지만 V. vulnificus에 의한 복막염은 외국의 1예를 제외하고, 국내에서는 아직 보고된 적이 없기에 문헌고찰과 함께 저자들이 경험한 2예를 보고한다. 치명적인 패혈증을 유발하는 V. vulnificus 감염에 의한 복막염을 예방하기 위해서는 말기 신질환자들이 해산물을 날 것으로 섭취하지 말고, 상처가 해수에 노출되지 않도록 주의하여야겠다. Peritonitis is the most common infectious complication of continuous ambulatory peritoneal dialysis (CAPD). However, CAPD-related peritonitis caused by Vibrio vulnificus is rarely reported. V. vulnificus is marine bacterium and opportunistic human pathogen. In an immunocompromised host, e.g. with chronic liver disease, end-stage renal disease, hemochromatosis, and other iron-overload disorders, this organism has been associated with the development of life-threatening primary septicemia and severe wound infection. However, CAPD-related peritonitis caused by V. vulnificus has not been reported, except for one case in Hong Kong, China. We report on two patients receiving CAPD who developed peritonitis caused by V. vulnificus after ingestion of seafood, for the first time in Korea. (Korean J Med 72:684-688, 2007)
급성 신부전을 동반한 성인 Henoch-Schonlein 자반증 1예
김석민 ( Seok Min Kim ),장경애 ( Kyung Ae Chang ),정선영 ( Sun Young Jung ),박찬서 ( Chan Soh Park ),박종원 ( Jong Won Park ),도준영 ( Jun Young Do ),김용진 ( Yong Jin Kim ),윤경우 ( Kyung Woo Yoon ) 영남대학교 기초/임상의학연구소 2008 Yeungnam University Journal of Medicine Vol.25 No.1
Henoch-Schonlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and C3 deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.
김정미(Jung Mi Kim),김동한(Dong Han Kim),김태우(Tae Woo Kim),조규향(Kyu Hyang Cho),박종원(Jong Won Park),도준영(Jun Young Do),윤경우(Kyung Woo Yoon),최준혁(Jun Hyuk Choi) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.3
배 경: Cyclosporine은 탁월한 면역 억제 작용으로 인해 이식 환자에게 널리 사용되는 약제이나 약물 농도의 치료 범위(therapeutic window)가 좁다. 따라서 체내 cyclosporine의 약물농도가 낮은 경우에는 급성 거부반응과 이식 장기의 소실 빈도를 증가시키고 cyclosporine의 약물 농도가 높은 경우에는 각종 부작용을 야기한다. 또한 cyclosporine은 약물 흡수의 변동이 심하여 만성 거부반응을 일으키는 요인이 되기도 한다. 그래서 각종 부작용은 피하면서 면역 억제 작용은 극대화하고자 cyclosporine의 체내 적정 약물 농도를 측정하기 위한 여러 가지 방법들이 제시되었다. C0 농도(cyclosporine trough level)가 임상에서 비교적 간편하게 cyclosporine의 체내 적정 약물 농도를 평가하는 방법으로 사용되고 있으나 C2 농도(2-hour postdose blood level)를 통한 cyclosporine의 혈중 농도 감시가 AUC0-4h(area under the concentrationtime curve 0-4 hr)와 연관성이 높고 한번의 채혈 결과만으로도 체내 약물 농도를 비교적 정확하게 반영할 수 있다는 점에서 신 이식 환자를 비롯한 각종 장기 이식 환자에서 점차 C2 농도가 C0 농도를 대신하게 되었다. 그러나 이식 후 12개월이 지난 안정된 신 이식 환자에서 체내 cyclosporine의 적정 C2 농도 기준은 아직 마련되어 있지 않은 실정이다. 따라서 본 연구에서는 이식 후 12개월이 지난 안정된 신 이식 환자에서의 cyclosporine의 체내 적정 약물 농도 기준 으로서 C2 농도의 유용성을 알아보기 위해 C0 농도와 C2 농도간의 상관 관계 유무 및 적정 C2 농도를 알아보았다. 방 법 : 2001년 5월 현재 영남대학교병원 신장내과에서 추적 관찰 중인 신 이식 환자 중 이식 후 12개월이 지난 안정된 신 이식 환자 73명을 대상으로 하였다. 환자들에게서 cyclosporine을 투약하기 전 혈중 C0 농도와 투약 후 2시간째 혈중 C2 농도 및 혈청 크레아티닌을 측정하였고 투약 받은 cyclosporine의 용량을 기록하였다. 결 과: 전체 C0 농도와 C2 농도간에 통계적으로 유의한 상관 관계가 있었으나(r=0.313, p=0.004), C0 농도의 평균값(mean±SD)을 기준으로 하여 세 군으로 나누었을 때 각 군에서 C0 농도와 C2 농도간에 통계적으로 유의한 상관 관계는 없었다. 그러나 정상 C0 군에서 환자 체중에 따른 cyclosporine의 용량과 C2 농도 사이에는 통계적으로 유의한 상관 관계가 있었다(r=0.269, p=0.039). 결 론: 따라서 저자들은 이식 후 12개월이 지난 안정된 신 이식 환자에서 C0 농도가 정상 범위인 경우 적정 C2 농도는 724.7±210.1 ng/mL로 제시하였다. Background : Cyclosporine dosing is traditionally based on trough levels(C0 level) rather than area under the concentration-time curve(AUC), although AUC correlates better with post transplantation acute rejection and acute toxicity. It is reported that C2 levels(2-hour postdose blood levels) are single sampling point that best reflects AUC0-4. But there has been no recommended C2 levels for patients after 12 months post kidney transplantation. The purpose of this study was to evaluate the correlation between C0 levels and C2 levels and define recommended target C2 levels in patients after 12 months post kidney transplantation. Methods : Seventy three patients after 12 months post transplantation were studied. 83 data were obtained from 73 renal transplant patients. Blood C0 levels, blood C2 levels, body weight and serum creatinine level were measured. Blood cyclsporine levels were measured by monoclonal fluorescence polarization immunoassay(mFPIA)(TDX, Abbot). The data of C0 levels were divided into three groups : low group (<mean-SD, 119.3 ng/mL), normal group(mean±SD, 158.2±38.9 ng/mL), high group(>mean+SD, 197.1 ng/mL). Results : There was a positive correlation between C0 levels and C2 levels, but no correlation between C0 levels and C2 levels when C0 levels were divided into three groups. There was a positive correlation between cyclosporine/body weight and C2 levels in normal C0 group. Recommended C2 levels in normal C0 group is 724.7±210.1 ng/mL. Conclusion : It is assumed that cyclosporine doses can be individualized by using C2 levels rather than C0 levels in renal transplant patients. However, prospective study may be needed to confirm the improvement of longterm renal allograft survival by individualizing cyclosporine doses based on C2 levels.
조현홍(Hyun Hong Cho),김종명,이재익(Jae Yik Lee),윤경우(Kyung Woo Yoon),이현우(Hyun Woo Lee),김경동(Kyung Dong Kim),김정숙(Chung Sook Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.5
N/A The purpose of the present study was to evaluate the nutritional status of 46 chronic renal failure (CRF) patients. Forty-one chronic renal failure patients and 61 normal control persons were included in the study. There were no differences in mean age and sex distribution between the two groups. We measured serum transferrin with a radioimmunodiffusion method, serum albumin with a bromo cresol Green method and plasma zine with atomic absorption spectrometry. The anthropometric measurements were triceps skinfold thickness (TSF) and midarm circumference (MAC), and from these, midarm muscle circumfrence (MAMC), midarm muscle area (MAMA), and midarm fat area (MAFA) were calculated. The results were as follows: 1) The mean height of the CRF group (164.11±6.50 cm: N=46) was not different from that of the control group (164.01±8.17cm: N=40), but the mean weight of the CRF group (55.27±8.33kg: N = 4ti) was significantly (p=0.33) lower than that of the control group (59.41±9.26kg: N=39). 2) The mean MAMA of the CRF group (40.81±10.11㎠. N =46) was significantly (p=0.005) lower than that of the control group (46.35±9.73㎠. N=61), and the mean MAFA of the CRF group (13.34±7.56㎠: N=46) was significantly (p=0.005) lower than that of the control group (18.03+ 8.97㎠: N =61). 3) The mean serum transferrin of the CRF group (172.23±26.70mg/dl: N=46) was significantly (p=0) lower than that of the control group (307.14±67.23mg/ddl: N =41), the mean plasma zinc of the CRF group (69.56±42.93㎍/dl: N =46) was significantly (p=1.90E-6) lower than that of the control group (123.38±55.49㎍/dl: N = 42), and the mean seurm albumin of the CRF group (3.81±0.52g/dl: N=16) was significantly (p=4.00E-15) lower than that of the control group (4.7±0.52 g/dl: N=41). 4) There was a positive correlation (r=0.78, p=0.00) between MAMA and body weight, a positive correlation (r=0.368, p=0.044) between MAMA and MAFA in CRF patients. 5) There was a positive correlation (r=0.416, p=0.0039) between plasma zinc and serum transferrin, but a negative correlation (r=0.31, p=0.034) between plasma zinc and body weight in CRF patients. 6) There was no correlation between the duration of hemodialysis and body weight, MAMA, serum transferrin, and plasma zinc. We concluded that 1) there were impairments of protein, fat and trace metal metabolism in CRF patients, 2) hemodialysis duration was not a factor influencing the nutritional status of CRF patients, and 3) MAMA, MAFA, serum transferrin and plasma zinc would be good indices to reflect the nutritional status of CRF patients.
복막 투석 환자에서 도관 관련 감염 및 복막염에 대한 Mupirocin 과 Catheter Revision 의 효과
정항재(Hang Jae Jung),도준영(Jun Young Do),윤경우(Kyung Woo Yoon),박준범(Jun Bum Park),조규향(Kyu Hyang Jo),김정미(Jung Mi Kim),최준혁(Jun Heuk Choe),김영진(Yeung Jin Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
N/A Background: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Methods : We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started me-dications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results : The total follow-up was 2401 patient months(pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus(MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them im-proved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse(The mean duration : 14.0 months) The rates of ESI were more reduced after using mupi-rocin than before(l per 12.7 vs 34.0 pt.mon, p<0.01). Conclusion: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.