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증례 : 신장 ; 혈액투석 환자에서 자연적으로 발생한 요관자연파열 1예
오병천 ( Pyung Chun Oh ),엄영실 ( Young Sil Eom ),박재찬 ( Jae Chan Park ),한우진 ( Woo Jin Han ),성주영 ( Ju Young Sung ),정우경 ( Woo Kyung Chung ),이현희 ( Hyun Hee Lee ) 대한내과학회 2009 대한내과학회지 Vol.76 No.2
요관자연파열은 요관의 기계적 조작, 외부 손상, 신수술의 과거력, 파괴성 신질환 없이 발생하는 경우를 말하며 매우 드물게 발생한다. 임상증상이 다양하고 급성복증(acute abdomen)과 감별하기 힘들기 때문에 진단이 어렵고 적절한 치료가 지연될 수 있다. 저자들은 진균성 농신장의 기왕력이 있는 혈액투석 환자에서 진균성 요로감염이 재발하고 요관자연파열이 발생하여 감염성 요종과 농양이 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Spontaneous ureteral rupture is rare, and refers to leakage in the absence of prior ureteral manipulation, external trauma, previous surgery, or any destructive kidney disease. It presents a major diagnostic challenge due to the diversity at presentation. Here, we present a rare case of spontaneous ureteral rupture in a 62-year-old man with a history of fungal pyonephrosis (Candida) on maintenance hemodialysis, causing a large infected urinoma and abscess and a review the literature. (Korean J Med 76:229-233, 2009)
관상동맥 중재술을 시행받은 급성심근경색증 환자에서 고중성지방혈증과 복부 비만이 예후에 미치는 영향
오병천 ( Pyung Chun Oh ),한승환 ( Seung Hwan Han ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2
Although there are still controversies about whether hypertriglyceridemia is an independent risk factor for coronary artery disease, recent analysis reported hypertriglyceridemia and central obesity are independent risk factors for coronary artery disease. However, the prognostic impact of hypertriglyceridemia and central obesity in acute myocardial infarction (AMI) patients underwent percutaneous coronary intervention (PCI) are still remained unclear. In this issue, Han et al. investigated the prognostic impact of hypertriglyceridemia and/or central obesity on baseline in AMI patients treated with PCI. In this editorial, we have reviewed the role of hypertriglyceridemia and central obesity on the prognosis after PCI in AMI patients. Although hypertriglyceridemia and central obesity on baseline in this study had no role on the prognosis following PCI in AMI patients, to confirm for these results, further studies on this topic will be warranted in the future. (Korean J Med 2014;86:165-168)
급성 관동맥증후군에서 예후평가를 위한 NT-proBNP, troponin 1, hs-CRP의 유용성
오병천 ( Pyung Chun Oh ),한승환 ( Seung Hwan Han ),정욱진 ( Wook Jin Chung ),강웅철 ( Woong Chol Kang ),서일혜 ( Yiel Hea Seo ),엄영실 ( Young Sil Eom ),문찬일 ( Chan Il Moon ),봉정민 ( Jeong Min Bong ),신미승 ( Mi Seung Shin ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2
Background/Aims: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. Methods: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a an of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. Results: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87; HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). Conclusions: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation. (Korean J 77:200-210, 2009)