• Journal of Chest Surgery
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• 제40권1호
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• pp.32-36
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• 2007

배경: 관상동맥우회술 후 발생하는 급성신부전은 비교적 드물게 발생하지만, 일단 발생하면 높은 사망률을 가지는 심각한 합병증이다. 본 연구의 목적은 심폐기를 사용한 관상동맥우회술 후 발생한 급성신부전 환자에서 지속적 신대체요법의 조기 적용의 이점 및 효과를 알아보고자 함이다. 대상 및 방법: 2002년 5월부터 2006년 2월까지 본 병원에서 심폐기 가동하에 관상동맥우회술만을 단독으로 시행 받았던 287명의 환자 중 수술 후 급성신부전이 발생하여 지속적 신대체요법을 적용한 11명과, 수술 전에 투석의존성 만성신부전이 있어 수술 후 혈역동학적 안정을 위해 지속적 신대체요법을 적용한 4명을 포함, 총 15명(15/287, 5.2%)을 대상으로 하였다. 신대체요법이 필요한 급성신부전의 진단은 심폐기 가동을 종료한 후, 이뇨를 촉진하기 위한 모든 약제의 사용 및 혈역동학적 동태의 조절에도 불구하고, 소변량의 감소(체중 및 시간당 0.5cc 미만)가 2시간 이상 지속되거나, 심장중환자실로 이송된 후에 측정한 혈중 크레아티닌(creatinine) 수치가 2.0 mg/dL 이상인 경우로 정하였다. 결과: 수술전 투석의존성 만성신부전이 있었던 4명을 제외한 283명 중 수술 후 발생한 급성신부전으로 지속적 신대체요법을 적용하였던 경우는 11명으로, 관상동맥우회술 후 급성신부전의 발생률은 3.9% (11/283)였고, 이중 4명이 병원 내에서 사망하여 원내 사망률은 36.4%였다. 수술 전 투석의존성 만성신부전이 있었던 4명은 수술 후 모두 지속적 신대체요법을 적용하였고, 이중에서는 1명이 사망하여, 지속적 신대체요법을 적용한 15명의 원내 사망률은 33.3% (5/15)였다. 수술 후 지속적 신대체요법의 적용까지 소요된 시간은 평균 $25.8{\pm}5.8$시간이었고, 평균 적용기간은 $62.1{\pm}41.2$시간이었다. 수술 후 발생한 급성신부전으로 지속적 신대체요법 적용 후 생존한 7명 중 6명은 병원에서 신기능을 회복하였고, 1명은 퇴원 후에도 영구적인 투석치료가 필요하였다. 결론: 심폐기 가동하 관상동맥우회술 후 발생한 급성신부전 환자에서 지속적 신대체요법의 조기적용으로 혈역동학적 동태의 안정적 유지와 함께 기존의 보고들에 비해 향상된 생존율을 기대할 수 있었다.

• Archives of Pharmacal Research
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• 제17권4호
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• pp.263-268
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• 1994

This study was conducted to characterize the in vivo pharmacology of KR-30988, KR-30992 and losartan, new AT antagonists, given as i.v. cumulative doses, in two antimal models of high renin, conscious renal artery-ligated hypertensinve rats (RHRs) and nomotensive rats anesthetized with urethane (90 mg/kg, i.p.) and .alpha.-chloralose (90 mg/kg, i.p.), with a special emphasis on the phamacological characterization of the latter model. In conscious RHRs, KR-30988, KR-30992, losartan and captopril caused a dose-dependent decrease in blood pressure, their relative potencise ($ED_{20}$) being 0.057, 0.028, 0164 and 0.018 mg/kg, i.v., repectively. In anesthetized rats, 2 hours after anesthesia, plasma renin activity was increased from 7.31 tp 34.07 ng/ml/h, the level approximately 1.5 times greater than the highest level in RHRs. In anesthtized rats, the $ED_{20}$s for all four compounds were 0.004 mg/kg i.v., respectively. By comparison, $ED_{20}$sfrom anesthetized rats were 4 to 5 times smaller than those from conscious RHRs, with a good correlation (.gamma. = 0.999) noted between thetized rats to the hypotensive activity of the compounds and the same order of potencies intwo models. These results suggest that, in addition to PHRs, the normotensive rats anesthetized as above can serve as a suitable model for the rapid phamacological evaluation of $AT_1$ receptor antagonists.

• The Korean Journal of Physiology and Pharmacology
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• 제4권2호
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• pp.143-147
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• 2000

The present study was aimed at investigating whether there are changes in the expression of nitric oxide synthase (NOS) in relation with the unclipping-induced fall of blood pressure in two-kidney, one clip (2K1C) hypertension. Male Sprague-Dawley rats were made 2K1C hypertensive by clipping the left renal artery for four weeks. Sham-clipped rats served as control. The expression of endothelial constitutive (ec) NOS proteins and tissue levels of NO metabolites were determined in the kidney. Systolic blood pressure was significantly increased in clipped rats compared with that in the control. The development of hypertension was associated with decreases in the expression of ecNOS proteins and tissue levels of NO metabolites in the clipped kidney. The blood pressure at twenty-four hours after removal of the renal arterial clip fell to the control level. Accordingly, in the unclipped kidney, the expression of ecNOS proteins and tissue contents of NO metabolites were increased to the control level. The contralateral kidney was not affected by the development or reversal of hypertension. It is suggested that an enhanced expression of ecNOS in the unclipped kidney is an important component in the reversal of renovascular hypertension.

• Clinical and Experimental Pediatrics
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• 제62권4호
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• pp.144-147
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• 2019

The most common type of refractory hypertension found in children is secondary hypertension, which is a potentially curable disease. Reninoma, a renin-secreting juxtaglomerular cell tumor, is a rare cause of severe hypertension that is usually diagnosed in adolescents and young adults. Surgical resection of the tumor completely cures the hypertension of patients with reninoma. The typical clinical presentation of reninoma includes hypokalemia, metabolic alkalosis, and features secondary to the increased activation of the renin-angiotensin system without renal artery stenosis. We report a case of reninoma in a female adolescent with a typical clinical presentation, in which surgical removal of the tumor completely cured hypertension. We discuss here the clinical features, imaging studies, and immunohistochemical examination of the tumor used to establish the diagnosis of reninoma and for the management of the condition.

• 대한한의학방제학회지
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• 제31권3호
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• pp.157-169
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• 2023

Gracilaria Verrucosa (GV), a seaweed used in traditional Korean medicine, was studied for its effects on MI-induced heart failure in rats. MI is caused by a blocked coronary artery, leading to severe cardiac dysfunction. The study used a rat model to assess cardiac changes over time and evaluate the impact of GV on heart failure. Ischemia was induced through LAD ligation surgery, and the extent of ischemic area was measured as a prognostic factor. GV extract administration significantly improved cardiac morphology and reduced cardiac weight compared to the MI group. GV treatment also improved cardiac function, as evidenced by positive effects on chamber dilation during MI-induced heart failure. Parameters such as ejection fraction (EF) and fractional shortening (FS) were measured. The MI group showed decreased EF and FS compared to the sham group, while these parameters improved in the GV group. GV treatment also reduced levels of LDH, CPK, and CK-MB in the serum, indicating reduced myocardial damage. Histological analysis revealed that GV treatment attenuated cardiac hypertrophy and fibrosis, with reduced collagen deposition in the myocardium. Immunohistochemistry analysis showed suppressed expression of TGF-β1 and collagen 1, involved in fibrosis. In conclusion, GV showed potential in improving cardiac function in a rat model of MI-induced heart failure. It alleviated myocardial damage, attenuated cardiac hypertrophy and fibrosis, and suppressed fibrotic markers. Further studies are needed to explore its clinical efficacy and underlying mechanisms in cardiac diseases beyond animal models.

• The Korean Journal of Physiology
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• 제23권1호
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• pp.43-49
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• 1989

Atrial natriuretic peptide (ANP)의 혈압조절에 대한 효과를 구명하기 위하여 2-kidney, 1-clip 흰쥐의 고혈압 발생에 미치는 ANP의 영향을 조사하였다. 실험군은 왼쪽 신동맥에 clip을 끼우고 경정맥내에 지속적으로 ANP를 주입한(atriopeptin III, 500 ng/h) 군으로 하였으며, 대조군은 clip을 끼웠으나 ANP를 주입하지 않은 군으로 하였다. Clip을 끼우기 전과 clip을 끼운 제 4,7,10일에 꼬리동맥으로부터 혈압을 측정한 후 단두하여 혈액을 채취하고 양측 신장을 떼어내어 renin 치를 구하였다. ANP 주입군은 대조군에 비하여 고혈압의 발생이 약화되었고 혈장 renin활성도가 유의하게 낮았으나 신피질 renin함량은 양군간에 유의한 차이가 없었다. 한편 clip을 끼우지 않은 흰쥐에서는 ANP 주입군과 비주입군간에 혈압, 혈장 renin 활성도와 신피질 renin 함량 등이 모두 서로 유의한 차이를 보이지 않았다. 이상의 실험결과는 지속적 ANP 주입이 2-K, 1-C 흰쥐의 고혈압 발생을 방지하지는 못하였으나 약화시켰음을 보여주었으며, ANP는 적어도 부분적으로는 renin-angiotensin계를 길항하므로써 장기적 혈압 조절에 관여하는 것이 시사되었다.

• 한국임상수의학회지
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• 제25권4호
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• pp.257-262
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• 2008

신장의 허혈-재관류 손상은 수술하는 동안 부득이하게 발생하는 허혈-재관류 손상에 대한 이식조직의 내성에 따라 이식된 장기의 생존력이 달려있기 때문에 임상적으로 아주 중요하다. 본 연구의 목적은 신장 혈관을 차단하여 유발한 허혈-재관류 모델에서 관류-흡인의 효과를 알아보고자 실시하였다. 신기능과 항산화 효소를 검사하기 위해 혈액 샘플을 채취하였고 신장내 동맥의 혈류저항을 측정하였다. 14일째 신장을 절제하여 조직검사를 실시하였다. 신기능(Cr, BUN)은 처치군에 비해 비처치군에서 유의성 있는 상승을 보였다. 신장내 혈류 저항은 두 그룹 사이에 유의성이 없었다. 항산화 효소 활성은 대조군에 비해 비처치군에서 유의성 있는 감소를 보였으나, 처치군에서는 대조군과 유의성이 없었다. 조직검사 결과에서도 처치군이 비처치군에 비해 적은 조직손상을 보였다. 이러한 결과는 관류-흡인 과정이 신장의 허혈-재관류 손상을 감소시키는데 유용한 단계임을 시사한다.

• Journal of Chest Surgery
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• 제28권3호
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• pp.332-334
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• 1995

Two hypertensive men with DeBakey type III dissection were admitted due to acute onset of leg ischemia.One patient had ischemia of both legs,The other patient had ischemia of the right leg.Angiograms showed occlusion of aortic bifurcation in one patient and occlusion of right common iliac artery and right renal artery in the other patient.The first patient who had ischemia of both legs was relieved by axillo-bifemoral bypass operation and the second patient with right leg ischemia by femoro-femoral bypass.The dissection of the aorta was successfully managed by conservative measures including hypotensive medication.The bypass grafts was functioning well one year later.The aortic dissection should not be overlooked as an etiology of acute onset of ischemia of the lower extremities.

• Journal of Chest Surgery
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• 제11권1호
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• pp.81-84
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• 1978

A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.106-113
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• 2019

Objective : The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods : A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results : The average age of 50 males and 29 females was $57.6{\pm}13.5$ years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion : Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature.