• Journal of Chest Surgery
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• 제53권6호
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• pp.392-399
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• 2020

Background: Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. Methods: This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 ㎡ for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demographic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results: Patients' age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring maintenance hemodialysis. The mean operative time was 304 minutes and the mean intraoperative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (Eastern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion: ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.

• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.59-63
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• 2016

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.

• Journal of Genetic Medicine
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• 제11권2호
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• pp.74-78
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• 2014

Sotos syndrome (SS, OMIM 117550) is characterized by prenatal and postnatal overgrowth with multiple congenital anomalies. However, there have been few cases of growth retardation caused by renal failure from infancy. We report a case of dysplasia of the bilateral kidneys with renal failure and poor postnatal growth. A 2-month-old boy visited the emergency room owing to poor oral intake and abdominal distension. He was born at the gestational age of 38 weeks with a birth weight of 4,180 g. After birth, he had feeding difficulty and abdominal distension. Upon physical examination, his height and weight were in less than the 3rd percentile, while his head circumference was in the 50th percentile on the growth curve. He also showed a broad and protruding forehead and high hairline. Blood laboratory tests showed severe azotemia; emergent hemodialysis was needed. Abdominal ultrasonography revealed bilateral renal dysplasia with multiple cysts and diffuse bladder wall thickening. A posterior urethral valve was suggested based on vesicoureterography and abdominal magnetic resonance findings. Results of a colon study to rule out congenital megacolon did not reveal any specific findings. The conventional karyotype of the patient was 46, XY. Array comparative genomic hybridization study revealed a chromosome 5q35 microdeletion including the NSD1 gene, based on which SS was diagnosed. We describe a case of SS presenting with end stage renal disease due to posterior urethral valve. The typical somatic overgrowth of SS in the postnatal period was not observed due to chronic renal failure that started in the neonatal period.

• 대한임상독성학회지
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• 제12권2호
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• pp.39-45
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• 2014

Purpose: The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication Methods: PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Results: Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs 11 days) in case of delayed extracorporeal therapy. Conclusion: Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.

• Journal of Chest Surgery
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• 제55권3호
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• pp.197-205
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• 2022

Background: The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful impact on overall patient outcomes. Methods: A retrospective cohort study was conducted of all 165 patients who received a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our center. Based on operative reports and imaging, patients were divided into intrapleural (n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital mortality, while secondary outcomes included postoperative complications, cumulative readmission incidence, and 3-year survival. Results: There were no significant between-group differences in baseline demographics, risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%, with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no significant differences in the postoperative rates of right ventricular failure, kidney failure requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117, p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated to the device. Intrapleural patients had significantly more infection-related readmissions, predominantly driven by non-ventricular assist device-related infections (p=0.02), with 41% of these due to respiratory infections compared with 28% of intrapericardial patients. Conclusion: Compared with intrapericardial placement, insertion of an intrapleural HM3 may be associated with a higher incidence of readmission, especially due to respiratory infection.

• 한국식품영양과학회지
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• 제31권5호
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• pp.847-885
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• 2002

본 연구는 임상영양 분야의 전문 웹사이트로서 신장질환 환자를 위한 식사관리 및 영양평가프로그램을 개발하기 위하여 수행되었다 프로그램은 신장질환을 신증후군, 신부전증, 혈액투석 및 복막투석으로 분류하고 식단 및 영양관리 프로그램과 식사섭취의 진단 및 평가 프로그램으로 구성하였다. 프로그램은 신장질환별 영양권장량 및 표준체중 파일, 식사섭취자료, 식품 및 영양소 데이터베이스 파일, 음식영양소 함량 파일, 영양소별 20순위 식품 파일, 신장질환별 식단 및 일일 식단표 파일, 식사력 조사 및 평가 파일, 식사요법 및 영양관리 파일 등을 데이터 베이스로 하여 사용자가 편리하게 이용할 수 있도록 웹 페이지 형식으로 만들어졌다. 사용자는 인터넷 사이트로 들어가 자신의 신장질환 및 일반사항 등을 입력함으로서 표준체중, 체격지수, 열량 및 단백질, 나트륨 등의 영양소 필요량과 함께 사용자의 BUN, Cr, na, K, Ca, P Ccr, Alb이 표준수치와 비교 제시된다. 사용자의 열량 및 영양소 필요양에 대한 정보를 이용하여 그 환자에게 알맞은 10일간의 식단이 제공되며 그 중 원하는 식단의 선택에 따라 식품명, 섭취량, 목측량이 표시된 구체적인 일일 식단표도 제공받을 수 있다. 사용자가 자신이 섭취한 음식에 대하여 영양섭취상태를 평가받으려면 식사섭취 진단 항목을 클릭한 후 섭취 음식 입력 항목을 선택하여 날짜별, 식사별로 자신이 하루동안 섭취한 음식 및 섭취량 등을 입력하고 영양섭취상태를 클릭하면 식사별, 식품군별로 다양하게 식사섭취상태의 진단과 영양평가를 받을 수 있다. 또한 각 신장질환에 따른 식사력 조사 및 상담\ulcorner평가를 이용함으로서 자신의 식습관 및 식사요법 등에 있어서 문제점을 파악할 수 있도록 하였다. 이밖에 신장 질환별로 식품선택방법, 외식, 조리법, 식품교환표 등 환자들이 자신의 영양관리를 하는데 필요한 모든 정보를 제공받을 수 있도록 하였다.

• 대한정형외과스포츠의학회지
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• 제6권2호
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• pp.110-114
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• 2007

목적: 전투 경찰에게서 과도한 신체 활동 후 발생한 횡문근 융해증의 임상 양상 및 치료에 대해 알아 보고자 하였다. 대상 및 방법: 2004년 6월 1 일부터 2005년 5월 23일까지 운동이나 훈련 후 발생한 근육통 및 근육종창을 주소로 본원을 방문한 전투 경찰 중에서 횡문근 융해증이 의심되어 입원한 13명의 환자를 대상으로 혈액검사(CPK, CK-MB, AST BUN/Cr, Electrolyte) 및 임상 경과를 관찰하였다. 이 들은 모두 남자였고, 평균 연령은 20세 ($19\sim21$세) 였다. 발병 원인으로는 팔굽혀펴기 후 발생한 것이 7례, 축구 경기 후 발생한 것이 5례, 시위 진압 후 발생한 것이 1례였다. 이 학적 소견상 다양한 신체 부위에 종창 및 압통을 호소하였는데 전완부에 발생한 경우가 4례, 상완부가 3례, 견갑부가 1례, 하지가 5례였다. 횡문근 융해증의 진단기준은 내원 당시 임상증상과 함께 혈중 CPK가 1,000 IU/L이상인 경우로 하였고 약물 복용력이나 내과적 질환이 있는 경우는 대상에서 제외하였다. 모든 환자에서 99mTc-MDP 20mCi를 정맥주사 후 4시간에 bone scan을 시행하였다. 치료는 침상 안정가료 및 수액요법을 시행하였고 동통을 심하게 호소하는 환자에게는 부목고정을 실시 하였다. 결과: 전체 입원환자 13명의 평균 재원 기간은 20일 (14일$\sim$42일)이었고 내원 당시 급성신부전을 보인 1례를 제외하고는 수액 요법 및 휴식을 시행한지 평균 8일 (2일$\sim$11일) 후 혈액학적으로 CPK가 1000이 하로 감소되었으며 임상적으로도 뚜렷한 회복을 보였다. 급성신부전을 보인 1례에서는 혈액투석 및 수액요법을 시행 한 후 회복되었다. 결론: 심한 운동이나 훈련 후 부종 및 근육통을 호소하는 환자에서 운동 유발 횡문근 융해증을 의심하여 조기에 혈액검사 및 수액 치료를 시행하는 것이 중요하다.

• 대한유전성대사질환학회지
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• 제14권2호
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• pp.142-149
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• 2014

목적: 당원병은 장기 내에 글리코겐이 축적되는 선천적 대사이상 질환으로 그 중 제 Ia형이 가장 많다. 당원병 제 Ia형으로 진단받은 환아들의 검사소견 및 임상양상에 대해 알아보았다. 방법: 2002년 7월부터 2014년 7월까지 서울 순천향대학병원 소아청소년과에서 당원병 제 Ia형으로 진단된 환아 5명을 대상으로 임상적 특성과 유전자 변이에 대해 분석하였다. 결과: 본원에서 당원병 제 Ia형을 진단받은 환아들의 진단 당시 나이는 생후 6개월에서 16세까지 분포하였다. 환아들은 내원 당시 모두 간 비대가 있었으며 초음파 검사상 지방간이 확인되었고, 신체발달은 모두 정상이었다. 검사실 소견상 5명 모두에게 고지혈증, 고요산혈증, 젖산혈증이 확인되었으며 빈혈이 있는 환아는 3명, 저혈당증을 보인 환아는 한 명이었다. 5명의 환아는 유전자분석을 통해 확진 하였으며 발견된 유전자형은 c.648G>T의 동형접합, c.122G>A/c.648G>T, c.248G>A/c.648G>T였다. 환아 중 1명에서 신장 결석이 관찰되어 구연산칼륨을 복용 중이며, 1명의 환아가 갑상선기능저하증을 진단받아 씬지로이드 복용 중이고 2명의 환아는 항고지혈증 약을 복용하며 조절 중으로 그 중 1명은 12세에 모야모야병을 진단받고 수술 받은 과거력 있으며 현재 만성 신부전으로 투석치료 중이다. 5명 모두 하루 3회 식사와 3회의 간식, 4번의 옥수수전분 투여를 시행하고 있다. 결론: 본원에서 진단된 당원병 제 Ia형 환아들은 모두 신체진찰상 간 비대 소견을 보였으며 검사실 소견상 고지혈증, 고요산혈증, 젖산혈증이 관찰되었다. 따라서 이러한 증상을 가진 환아들에게 유전자검사를 시행하여 당원병의 조기 진단율을 높일 수 있을 것이라 생각된다. 또한 16세에 진단받은 환아의 경우 치료에도 불구하고 간경화가 진행되고 만성 신부전으로 투석치료를 하고 있어 조기 진단 및 치료가 후기 합병증 예방에 중요하며 당원병과 함께 동반될 수 있는 모야모야병이나 당원병의 합병증으로 잘 알려져 있는 신장결석 등의 다른 질환으로 먼저 진단된 환아들도 위와 같은 임상증상이 나타난다면 반드시 당원병 제 Ia형을 의심해보아야 하겠다.

• 대한간호학회지
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• 제26권2호
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• pp.304-319
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• 1996

It is important to evaluate nutritional status of elderly patients receiving dialysis, since wasting and malnutrition are their common problems. This study aims at assessing their nutritional status by the type and duration of dialysis. The nutritional status such as somatic fat and protein storage was evaluated with anthropometric measure including weight/height ratio, triceps skinfold thickness and midarm muscle circumference. It was also measured with albumin, transferrin, C3 and IGF-1 and calorie and protein intakes. The general clinical condition of patients was evaluated with the severity of uremia and metabolic acidosis. which were measured through the levels of serum urea, creatinine and bicarbonateion. The data were analyzed by using t-test, ANOVA, Wilcoxon-rank sums test, Scheffe test, Kruskal-Wallis test and Pearson correlation coefficients. The results are following : 1. There was no significant difference in the calorie and protein intakes by the type and duration of dialysis received. 2. As for the anthropometric measures, no significant difference was found by the type of dialysis in body mass index triceps skinfold thickness and midarm muscle circumference. Yet these anthropometric measures differed significantly by the duration of dialysis in those elderly patients receiving hemodialysis(HD group), but this finding was not found in those receiving continuous ambulatory peritoneal dialysis(CAPD). 3. Regarding the indicators of uremia and metabolic acidosis, blood urea nitrogen(BUN) and creatinine were lower in the CAPD group than in the HD group, whereas bicarbonate ion was higher in the CAPD group than in the HD group, with no statistical significance. In the HD group, creatinine increased significantly with the increase of the duration of dialysis. 4. Serum trasferrin and C3 were significantly higher in the CAPD group than in the HD group. However. each of biochemical indices did not show statistical significance by the duration of dialysis in both HD and CAPD groups. 5. Anthropometric measures were significantly associated with dietary intake. Significant correlations were observed between biocarbonate ion, BUN and creatinine. In addition, the correlations between serum protein and albumin and between transferrin and C3 were statistically significant. Yet, IGF-1 revealed no significant correlation with other nutritional indices. The above findings indicate that there were no difference in nutritional status measured with protein and calorie intakes between the type and duration of dialysis, but CAPD seems to benefit correcting uremia and metabolic acidosis than HD. Studies of dietary management for dialysis patients need to be pursued in order to improved the quality of aged patients receiving dialysis.

• 대한핵의학회지
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• 제15권1호
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• pp.27-32
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• 1981

HBsAg. was identified in the urine of the patients positive for serum HBsAg. by Tripatzis in 1970. In 1977, Hourani et al reported the incidence of HBsAg. in urine was about 52% in the patients positive for serum HBsAg. with hemodialysis treatment due to chronic renal failure. A series of studies on the HBsAg. in urine has revealed the urine of the patients positive for serum HBsAg. to be important source of infection. But there's much room to debate on the relationship of HBsAg. in urine with infectivity and the exact mechanism of urinary emergence of HBsAg. The authors detected HBsAg. in serum and urine by employing sandwitch solid-phase rad ioimmunoassay, and performed urinalysis, liver function test and renal function evaluation. Percutanous liver and/or kidney biopsis were done. Among 38 renal disease patients, 9 cases (23.4%) were shown to be positive for serum HBsAg. and 5 cases (55.5%) among above 9 patients positive for urine HBsAg.. 56 cases (67.4%) of 83 liver disease patients revealed positive for serum HBsAg. but only 11 cases (13.2%) among the 56 cases positive fo urine HBsAg. All 10 renal and liver disease patients revealed positive serum HBsAg., and among the 9 cases (90%) positive for urine HBsAg.. In the 25 patients positive for urine HBsAg. all of 5 renal patients and 9 renal and liver patients had hematuria or/and proteinuria above 2 positive for albumin. But in the 11 liver patients 6 cases (55.1%) were normal findings. And there's no significant difference in cpm of urine HBsAg. between the patient positive for serum HBsAg. and negative, and in cpm of serum HBsAg. between liver and renal disease patients. But there's statistical significance in cm of urine HBsAg. between renal and liver diseases.