LC, Acute : O-061 ; Mode of cirrhosis related complication in Korean patients with liver cirrhosis -A prospective multicenter cohort study

( Hyun Young Woo ),( Jeong Won Jang ),( Sang Gyune Kim ),( Chang Hyeong Lee ),( Tae Yeob Kim ),( Won Young Tak ),( Sung Kyu Choi ),( Mong Cho1 ),( Jong Young Choi ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Cirrhosis-related complications are indications for transplantation. However, the mode of complication has not been evaluated so far. To better address this issue, we investigated the mode of cirrhosis related complication and impact of these complications on survival in prospective, multicenter, inception cohort study of subjects with liver cirrhosis presenting with the first onset of decompensated complication. Methods: In this observational study, 1515 patients with the confirmed onset time of the first decompensated complication were enrolled. The mortality risk of cirrhosis-related complications, including ascites, portal hypertensive gastrointestinal bleeding (PHGB), spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), hepatorenal syndrome (HRS), was analyzed in these cirrhotic patients. Result: As the first complication, ascites was the most frequent (53.8%), followed PHGB (36.2%), HE (7.6%), SBP (1.7%) and HRS (0.7%). During follow-up (mean 32±47 months), 484 (31.9%) experienced subsequent decompensations and the proportion of subsequent complication was consistently changed; the proportion of HE, SBP, HRS increased as time progressed. The interval between subsequent decompensative events was progressively shortened. The mortality rate according to the first complication was as follows; Ascites =PHGB> HE=SBP>HRS. The mortality rate of patients experienceing subsequent complication was significantly higher than those without subsequent complication. According to the kinds of subsequent complication, survival of HE was also higher than HRS but lower than ascites or PHGB and similar to that of SBP and this difference of survival disappeared after repeated complication. Conclusion: The mortality risk correlated with initial complication and the risk increases as the number of complication episodes is repeated. Patient`s mean age was 56±11.50 years and 72.1% was male. The cause of liver cirrhosis is hepatitis B virus (38.6%), alcohol (35.5%) and hepatitis C virus (8.9%).

LC, Acute : O-061 ; Mode of cirrhosis related complication in Korean patients with liver cirrhosis - A prospective multicenter cohort study

( Hyun Young Woo ),( Jeong Won Jang ),( Sang Gyune Kim ),( Chang Hyeong Lee ),( Tae Yeob Kim ),( Won Young Tak ),( Sung Kyu Choi ),( Mong Cho ),( Jong Young Choi ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Cirrhosis-related complications are indications for transplantation. However, the mode of complication has not been evaluated so far. To better address this issue, we investigated the mode of cirrhosis related complication and impact of these complications on survival in prospective, multicenter, inception cohort study of subjects with liver cirrhosis presenting with the first onset of decompensated complication. Methods: In this observational study, 1515 patients with the confirmed onset time of the first decompensated complication were enrolled. The mortality risk of cirrhosis-related complications, including ascites, portal hypertensive gastrointestinal bleeding (PHGB), spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), hepatorenal syndrome (HRS), was analyzed in these cirrhotic patients. Result: As the first complication, ascites was the most frequent (53.8%), followed PHGB (36.2%), HE (7.6%), SBP (1.7%) and HRS (0.7%). During follow-up (mean 32±47 months), 484 (31.9%) experienced subsequent decompensations and the proportion of subsequent complication was consistently changed; the proportion of HE, SBP, HRS increased as time progressed. The interval between subsequent decompensative events was progressively shortened. The mortality rate according to the first complication was as follows; Ascites =PHGB> HE=SBP>HRS. The mortality rate of patients experienceing subsequent complication was significantly higher than those without subsequent complication. According to the kinds of subsequent complication, survival of HE was also higher than HRS but lower than ascites or PHGB and similar to that of SBP and this difference of survival disappeared after repeated complication. Conclusion: The mortality risk correlated with initial complication and the risk increases as the number of complication episodes is repeated. Patient’s mean age was 56±11.50 years and 72.1% was male. The cause of liver cirrhosis is hepatitis B virus (38.6%), alcohol (35.5%) and hepatitis C virus (8.9%).

정맥내 카테터 사용과 관련된 합병증 발생에 대한 전향적 조사연구

최선주,정희진,우흥정,김우주,박승철,박창현 대한병원감염관리학회 1998 의료관련감염관리 Vol.3 No.2

비부비동염에 의한 안와합병증의 임상적 분석

임근혜,김정수,김용대,예미경,신승헌 대한비과학회 2009 Journal of rhinology Vol.16 No.1

Background and Objectives:Sinusitis is frequently accompanied by severe orbital or intracranial complication which require a fast multidisciplinary therapy because a diagnostic delay may cause the patient’s sequeles. We aim to evaluate the clinical features, radiologic findings, disease courses and therapy of sinogenic orbital complication. Materials and Methods:We retrospectively reviewed the medical records of 34 patients with sinogenic orbital complications from January, 2002 to December, 2007. The clinical features of the complication, the radiologic findings, admission duration and treatment given to the patients were evaluated. The prognosis of each case was set according to the Chandler’s classification. Results:Periorbital cellulitis is the most common complication and it is found more frequently in children (54.5%) than in adult (21.7%). The most common symptom of sinogenic orbital complication is periorbital edema. In addition, facial and orbital pain is a common symptom. We identified the frequency of involved sinus in sinogenic orbital complications as follows;maxillary sinus (85.3%), anterior ethmoid sinus (82.4%), posterior ethmoid sinus (64.7%), frontal sinus (50.0%) and sphenoid sinus (35.3%). In terms of treatment, endoscopic surgery was needed in most cases except for periorbital cellulitis. Conclusion:Rhinosinusitis patients who have headache and ocular pain in spite of medical treatment need to consider the possibility of sinogenic complications. And early diagnosis and adequate treatment are important to prevent severe orbital complications. Background and Objectives:Sinusitis is frequently accompanied by severe orbital or intracranial complication which require a fast multidisciplinary therapy because a diagnostic delay may cause the patient’s sequeles. We aim to evaluate the clinical features, radiologic findings, disease courses and therapy of sinogenic orbital complication. Materials and Methods:We retrospectively reviewed the medical records of 34 patients with sinogenic orbital complications from January, 2002 to December, 2007. The clinical features of the complication, the radiologic findings, admission duration and treatment given to the patients were evaluated. The prognosis of each case was set according to the Chandler’s classification. Results:Periorbital cellulitis is the most common complication and it is found more frequently in children (54.5%) than in adult (21.7%). The most common symptom of sinogenic orbital complication is periorbital edema. In addition, facial and orbital pain is a common symptom. We identified the frequency of involved sinus in sinogenic orbital complications as follows;maxillary sinus (85.3%), anterior ethmoid sinus (82.4%), posterior ethmoid sinus (64.7%), frontal sinus (50.0%) and sphenoid sinus (35.3%). In terms of treatment, endoscopic surgery was needed in most cases except for periorbital cellulitis. Conclusion:Rhinosinusitis patients who have headache and ocular pain in spite of medical treatment need to consider the possibility of sinogenic complications. And early diagnosis and adequate treatment are important to prevent severe orbital complications.

Biliary Complication during ECMO Treatment

( Jin Ook Jang ),( Hye Ju Yeo ),( Woohyun Cho ),( Eunjeong Son ),( Jinho Jang ),( Tae Hwa Kim ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Background Extracorporeal membrane oxygenation (ECMO) has wide range of complications. Among GI tract complications, biliary problems such as bile stasis or acute acalculous cholecystitis are not fully assessed. Given cardiopulmonary instability, this serious subset of patients presents difficult challenges in adequate diagnosis and timely treatment of biliary complication. However, little is known about the incidence and clinical significance of biliary complications in patients on ECMO. We aimed to evaluate the incidence, associated factors and clinical outcomes of biliary complication during ECMO. Methods We retrospectively analyzed and reviewed ECMO cohort group (n=549) of our center from 2008.12 - 2019.10 and excluded 82 patients with less than 48hrs of ECMO application or having statistically missing data. ECMO cohort group (n=549) included entire ECMO cases of our center. We defined biliary complication as newly appeared radiologically diagnosed biliary related disease during ECMO, more specifically complicated biliary problems as biliary disease with inflammation such as cholecystitis, pancreatitis and uncomplicated biliary disease as rather incidental finding such as GB stones, GB sludge. Results 52 cases of total (n=467) had biliary complication. The incidence is 11.13% of total cases. Statistically (table 1), old age (P = 0.003), NPO days (P = 0.04), TPN days (P=0.003), and Presence of Hyperbilirubinemia (P = 0.026) have meaningful correlation with biliary complication during ECMO. Gender, BMI, SOFA, APACHE II, Renal replacement therapy, inotropic use, presence of liver cirrhosis, diuretic use and total bilirubin did not differ between two groups. Especially, plasma Hb, indicative mechanical hemolysis during ECMO, also did not differ between ECMO having biliary complication and without biliary complication. (P = 0.996) Conclusions Biliary complication was associated with old age, longer duration of fasting, days on total parenteral nutrition and the presence of hyperbilirubinemia. The predictors of biliary complications did not differ from those of the general ICU population.

갑상선 질환의 외과적 절제술에 대한 국소적 합병증

조현진(Hyun Jin Cho),조태형(Hyung Tae Cho) 대한두경부종양학회 1995 대한두경부 종양학회지 Vol.11 No.1

This study was retrospectively reviewed and analysis of postoperative local complication on all patient undergoing thyroid operation of 242 cases of thyroid disease, at Department of General Surgery, Chosun University Hospital from January 1988 to December 1992. The result were follow: Postoperative local complication are as follow; 52 cases of transient hypocalcemia, 7 cases of thansient hoarseness, 3 cases of permanent hypocalcemia, 2 cases of permanent hoarseness, and other local complication were postoperative bleeding with airway obstraction, hematoma, infection. In pathologic classification according to complicative patients; The most common frequency of complication in benign disease was Graves' disease with 13 cases(54.2%), and the most frequency of complication in malignance disease was follicalar adenocarcinoma with 7 cases(53.9%). The frequency of complication according to operation procedure were unilateral lobectomy in 31 cases(19.9%), subtotal thyroidectomy in 15 cases(39.5%), near total thyroidectomy in 12 cases (44.4%), and total thyroidectomy in 10 cases(55.6%). There was a significant relationship between extent of operative procedure and frequency of complication. The incidence of local complication after thyroid resection was 57 of 196(29.1%) in the benign disease that was 15 of 26(57.7 %) in the intrathyroidal carcinoma and 13 of 20(65.0%) in the extrathyroidal carcinoma. There was significant different in frequency of local complication according to invasion and malignance of pathologic lesion. The most frequent complication after thyroid resection is transient hypocalcemia ; 39 of 196(19.9%) in the benign disease, 7 of 26(26.9%) in the intrathyroida1 carcinoma, and 6 of 10(30.0%) in the extrathyroidal carcinoma. Their complication rate increased in direct relationship to the invasion and malignance of pathologic lesion, but there was no statistically significant. Transient hypocalcemia was encountered in 52 cases of the total 242 patient(21.9%) ; 29 of 156(18.6%) after unilateral lobectomy, 9 of 38(23.7%) after subtotal thyroidectomy, and 5 of 18(27.8 %) after total thyroidectomy. The relation ship between temporal hypocalcemia and the extent of surgery was not statistically significant.

중심정맥 도관 삽입술의 성공률과 합병증 발생 빈도에 대한 전향적 연구

배창황(Chang Hwang Bae),김우건(Woo Kun Kim),박완(Wan Park),박진희(Jin Hee Park),김정균(Jeong Kyun Kim),최성준(Sung Jun Choi),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objectives: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. Methods: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hemato1ogy/ oncology department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, lD numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others, Results: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. Conclusion: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4times at initial trial.

경요도 전립선절재술 후 시기별 및 수술 적응도에 따른 합병증 발생율에 따른 임상적 고찰 : A Clinical Experience

김홍섭,이종찬,노용수 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-

We evaluate morbidity of transurethral resection of prostate(TURP) for benign prostatic hyperplasia, especially late complication beyond 6 months of period after discharge. We experienced 164 TURPs performed by one urologist for 5 years and evaluated factors affecting complications, complication rates at each postoperative period(immediate, predischarge, postdischarge: early and late) and parameters according to operator's adaptation to TURP. The late complication were evaluated by mailed quetionnaires or telephone. The complication rates were 12.2%(20 of 164: prostatic bleeding 14, clot retention 5, etc.) at immediate, 25.0%(41 of 164: urge incontinence 19, urinary retention 7, retrograde ejaculation 6, symptoms) at early and 31.0%(18 of 58: urethral stricture 4, etc.) at late followup period. There were more complications(p<0.05) in following groups: resection time above 60 mins, resected spectimen weight above 40 g. amount of irrigation fluid beyond 20,000 ml. presence of acute urinary retention at admission. No differences(p<0.05) were found in complication rate and TURP parameters according to operator's adaptation except resection time(before 1994 vs. after 1994→43.3mins vs. 34.2mins). Our data shows that there were no significant differences in complication rate and TURP parameters according to operator's adaptation, but relatively high rates of late complications compared with other reports. We suggest that risk factors such as prolonged resection, excessive resection and overusage of irrigation fluid should be avoided during TURP to minimize intraoperative and postoperative complication.

쇄석위에서 시행된 부인과 수술에서의 신경학적 합병증

박은경 ( Eun Kyung Park ),신우미 ( Woo Mi Sin ),천근영 ( Keun Young Cheon ),이해남 ( Hae Nam Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.4

목적: 사지의 신경학적 합병증은 쇄석위에서 시행된 수술의 가능한 합병증으로 잘 인식되어져 왔다. 본 연구의 목적은 이러한 합병증의 빈도와 위험인자를 평가하는 것이다. 연구방법: 2003년에서 2005년까지 A대학 병원에서 쇄석위로 부인과 수술을 시행 받은 322명 환자의 수술 전후 기록을 후향적으로 평가하였다. 신경학적 합병증은 수술 후 시기동안 어떤 사지 육의 무력증이 있거나 사지 신경의 분포영역에 극심한 통증이 있거나 또는 없으면서 이상감 또는 감각장애의 증상으로 정의하였다. 결과: 사지의 신경학적 합병증은 5명의 환자(1.6%)에서 발생했다. 다음과 같은 신경이 환자의 한쪽에만 영향을 주었다; 좌골신경 (4명의 환자), 요골신경 (1명의 환자). 모든 환자들은 운동성의 무력감과 이상감을 불평하였다. 구획증후군에 의해 근육 손상이 의심되었던 2명의 환자는 통증성 부종을 보였다. 증상은 수술 당일과 수술 1병일이나 2병일에 나타났다. 이런 증상은 5명의 환자 중 4명에서 5개월 안에 회복되었다. 신경학적 합병증의 발생에 대한 위험성은 수술 전후의 수혈 (r=0.128, P<0.05)과 쇄석위에서의 수술시간을 포함했다. 결론: 본 연구에서 사지의 신경학적 합병증은 수술과 마취 후 매우 곧장 나타나는 흔하지 않은 합병증이었다. 예후는 대부분 경미하고 자발적으로 회복이 되나 심각할 수 있고 지속적이고 영구적인 후유증과 관련이 될 수 있다. 환자가 쇄석위에서 오랫동안 자세를 취할수록 신경학적 합병증이 발생할 가능성은 더 커진다. 쇄석위에서 수술 시간의 감소와 적당한 자세가 신경학적 합병증 발생의 위험성을 줄일 수 있다. Objective: Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication. Materials and Methods: We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period. Results: Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (fourpatients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01) Conclusions: In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.

단일 기관에서 경험한 Glufosinate 급성 중독 후 발생한 의학적 합병증의 발병 예측인자에 관한 비교 분석

김영기,김기환,문형준,정동길,이동욱,박세훈,이정원 대한응급의학회 2016 대한응급의학회지 Vol.27 No.1

Purpose: Glufosinate-containing herbicides intoxication causes mild to severe complication, depending on patients’ factors. However, it is not clearly known whether there are factors affecting glufosinate-containing herbicides intoxicated patients who develop complications. Thus, we sought to identify independent factors comparing the complicated group with the non-complicated group and to predict which patients will develop subsequent medical complication. Methods: The medical records of patients with exposure to Glufosinate-containing herbicides at a tertiary academic university hospital in Korea from January 2012 to April 2015 were reviewed retrospectively. Demographic and clinical data of 75 patients were then analyzed by univariate and multivariate stepwise logistic regression analyses to identify potential predictors of significant complications following acute Glufosinate-containing herbicides poisoning for comparison of complicated patients with non-complicated patients. Results: Of 75 patients, 44 (58.6%) had medical complications and 6 (8%) were dead. Neurologic complications (n=26, 35%) were the most common including seizure (n=18), delirium tremens (n=5), and amnesia (n=4). The results of univariate analysis showed that an advanced age (>60 years old), higher ingested amount of the herbicide (>100 mL), vomiting at arrival, medical history of hypertension, metabolic acidosis, and systemic inflammatory response score (SIRS)≥2 were significant factors. However, the results of multivariate analysis showed that an advanced age (p<0.001) and higher ingested amount of herbicide (p<0.001) were independent factors associated with serious complications and require aggressive medical treatment. Conclusion: The results of this study showed that age>60 years, and amount ingested>100 mL were significant predictive factors for significant medical complications in patients with Glufosinate-containing herbicides poisoning.