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만성신부전 환자에서 Carbamylated Hemoglobin의 임상적 의의
김명재,정인경,이태원,고관표,홍성표,임천규 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.6
Carbamylated hemoglobin(CarHb) is formed by the reaction of hemoglobin with cyanate derived from the spontaneous dissociation of in vivo urea. Previous studies have shown that formation of CarHb depends upon both the severity and the duration of renal failure. To study the clinical significances of CarHb in Korean patients with chronic renal failure, we measured CarHb levels by high-performance liquid chromatography in 159 CRF patients and 46 normal controls. Patients with CRF had a higher CarHb concentration than normal controls(107.9±58.8 vs 35.1±14.2μgVH/gHb; P$lt;0.001). In patients with CRF, nondialysis group had a higher value than dialysis group (129.8±77.9 vs 98.7±46.1μgVH/gHb; P$lt;0.05). There were no siginificant difference in CarHb levels between hemodialysis(92.0±35.8μgVH/gHb) and peritoneal dialysis(106.7±55.3μgVH/gHb) groups. CarHb levels were not different between diabetic and nondiabetic patients in predialysis and hemodialysis groups. Although there was a significant difference in perilysis group, the BUN levels were also lower in diabetic patients than nondiabetic patients. There were no correlation between CarHb and HbA1c percentage in patients with diabetes. CarHb levels were positively correlated with BUN (r=0.489; P$lt;0.001) and creatinine(r=0.458; P$lt;0.01) concentrations. There were negative correlations between CarHb and both Kt/V(r=-0.358; P$lt;0.05) and URR(r=-0.415; P$lt;0.05) in hemodialysis patients. In conclusion, CarHb may be a useful index of uremic control in patients with chronic renal failure, and are independent of the mode of dialysis and the presence of diabetes.
경비위관이 파열부를 관통한 Boerhaave 증후군 1 예 : 응급수술 없이 생존한 증례
김병호,김효종,김경진,장린,동석호,장영운,황일섭,송민수,고관표,이정일 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3
Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.