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( Han Jak Ryu ),( Yung Ly Kim ),( Kyoung Sook Park ),( Young Eun Kwon ),( Mi Jung Lee ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Tae Hyun Yoo ),( Shin Wook Kang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Diastolic heart failure (HF) is associated with cardiovascular (CV) morbidity and mortality in the general population as well as patients with end-stage renal disease (ESRD). However, it is not clear whether diastolic HF per se is associated with poor CV outcome in this population. This study was aimed to elucidate the impact of isolated diastolic dysfunction with preserved systolic function on CV outcomes in incident dialysis patients. Methods: A total of 194 incident ESRD patients, who started dialysis between July 2008 and August 2012 and had normal left ventricular (LV) systolic function, were included. The independent prognostic values of echocardiographic parameters for CV events were ascertained by multivariate Cox proportional hazard regression analysis. Kaplan-Meier curves were also constructed, and between-group survival was compared. Results: During a mean follow-up duration of 27.2 months, CV events occurred in 57 patients (29.4%). Compared to the CV event-free group, LV mass index, the ratio of early mitral fi ow velocity (E) to early mitral annulus velocity (E`) (E/E`), left atrial volume index (LAVI), and right ventricular systolic pressure were signifi cantly higher in patients with CV events. In multivariate Cox proportional hazard analysis, severe diastolic dysfunction (E/E`>15) and severely enlarged LA volume (LAVI>32 mL/m2) were independent risk factors for CV events [E/E`>15: hazard ratio (HR)=5.40, 95% confi dence interval (CI)=2.73-10.70, P<0.001; LAVI>32 mL/m2: HR=5.56, 95% CI=2.28-13.59, P<0.001]. When patients were divided into four groups according to E/E` and LAVI, Kaplan-Meier analysis revealed that patients with both E/E`>15 and LAVI>32 mL/m2 had the worst CV outcomes (P<0.001). Conclusions: Diastolic dysfunction even with preserved LV systolic function was associated with poor CV outcomes in incident dialysis patients.
구연 : 그랜드볼룸 ; 라미부딘과 아데포비어에 순차 내성을 보이는 만성 B형간염 환자에서 라미부딘, 아데포비어 병합 요법과 엔테카비어 단독 요법의 치료 효과 (초)
( Chang Young Son ),( Han Jak Ryu ),( Sang Hoon Ahn ),( Do Young Kim ),( Myoung Ha Lee ),( Kwang Hyub Han ),( Chae Yoon Chon ),( Jun Yong Park ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3(S)
( Mi Jung Lee ),( Young Eun Kwon ),( Yung Ly Kim ),( Kyoung Sook Park ),( Han Jak Ryu ),( Youn Kyung Kee ),( Chang Yun Yoon ),( Eunyoung Lee ),( Young Su Joo ),( In Mee Han ),( Sung Gyu Han ),( Hyung 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Sarcopenia is an important cardiovascular risk factor in patients with end-stage renal disease. Recent studies have indicated that skeletal muscles mediate their protective effect by secreting myokines. However, to date, the pathophysiologic role of irisin, a novel myokine, has not been evaluated in peritoneal dialysis (PD) patients. In this study, therefore, we investigated the association of irisin with sarcopenia and carotid atherosclerosis in these patients. Methods: Serum irisin levels were assessed by enzyme-linked immunosorbent assay in 102 prevalent PD patients. To determine sarcopenia and carotid atherosclerosis, anthropometric indices including mid-arm muscle circumference (MAMC) and carotid intima-media thickness (cIMT) were measured. Linear and logistic regression analyses were performed to ascertain the independent association of irisin with sarcopenia and carotid atherosclerosis. Results: The mean serum irisin levels were 184.2 ± 88.0 ng/mL. Thirty-seven patients (36.3%) had carotid atherosclerosis. In univariate linear regression analysis, serum irisin concentrations were positively correlated with MAMC, thigh circumference, and serum creatinine levels, whereas negatively correlated with residual renal function and cIMT. Multivariate analysis revealed that MAMC [ß = 0.31, 95% confi dence interval (CI) = 1.89 to 17.85, P = 0.02] and cIMT (ß = -0.29, 95% CI = -92.53 to -17.11, P = 0.005) had independent association with serum irisin levels. In addition, serum irisin concentration was a signifi cant independent risk factor for carotid atherosclerosis after adjustment for confouding variables (per 1 ng/mL increase, odds ratio = 0.987, 95% CI = 0.979 to 0.996, P = 0.004). Conclusions: This study demonstrated for the fi rst time that circulating irisin levels were signifi cantly associated with sarcopenia and carotid atherosclerosis in PD patients, suggesting that irisin could mediate the detrimental effect of sarcopenia on cardiovascular disease.
( Young Eun Kwon ),( Hyun Wook Kim ),( Yung Ly Kim ),( Kyoung Sook Park ),( Han Jak Ryu ),( Mi Jung Lee ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Tae Hyun Yoo ),( Shin Wook Kang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Vitamin D plays indispensable roles in the immune system, and there may be an association between vitamin D defi ciency and infection in patients with kidney transplantation (KT). Therefore, this study was aimed to investigate the impact of pre-KT vitamin D defi ciency on the development of urinary tract infection (UTI) after KT. Methods: 25-hydroxyvitamin D [25(OH)D] levels were measured in 410 patients within two weeks before KT. Vitamin D defi ciency was defi ned as 25(OH)D < 10 ng/mL. The primary outcome was the occurrence of UTI after KT. Cox proportional hazard analysis was performed to determine the independent association of vitamin D defi ciency with UTI. Results: The mean 25(OH)D levels were 12.8±6.9 ng/mL, and 171 patients (34.4%) were defi cient in vitamin D. Vitamin D defi ciency was signifi cantly associated with female gender [ß=2.30, 95% confi dence interval (CI) = 1.41 to 3.77, P=0.001], hemoglobin (ß=0.83, 95% CI = 0.72 to 0.95, P=0.006) and serum albumin concentrations (ß=0.17, 95% CI = 0.10 to 0.30, P <0.001), and the season of KT operation (summer, ß=0.22, 95% CI = 0.11 to 0.42, P <0.001; autumn, ß=0.32, 95% CI = 0.17 to 0.63, P=0.001, spring as a reference). During a median follow-up duration of 7.1 years, the incidence rates of UTI were signifi cantly higher in patients with vitamin D defi ciency compared to those without defi ciency [52 (30.4%) vs. 40 patients (16.7%), P=0.001). Moreover, multivariate Cox analysis showed that vitamin D defi ciency was a signifi cant independent predictor of UTI after KT (hazard ratio=1.81, 95% CI = 1.11 to 2.97, P=0.018). Conclusions: Vitamin D defi ciency was an independent risk factor for UTI after KT, suggesting that determining 25(OH)D levels might be helpful to predict infectious complications after KT.
증례 : 선천적 배측 췌장 부분 발육 부전증과 동반된 Castleman 병 1예
박수영 ( Soo Young Park ),방승민 ( Seung Min Bang ),김명환 ( Myoung Hwan Kim ),류한작 ( Han Jak Ryu ),정재복 ( Jae Bock Chung ),이우정 ( Woo Jung Lee ),송시영 ( Si Young Song ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1
배측 췌장의 발육 부전증은 배측 원기로부터 유래하는 췌장의 체부와 미부가 형성되지 않는 매우 드문 췌장의 선천적 기형이다. Castleman 병 역시 매우 드문 림프절 종양으로 일반적으로 종격동에서 호발하나 후복막강의 췌장 미부 위치에서 발견된 예는 흔하지 않다. 배측췌장 발육 부전증과 췌장 미부에 위치하는 Castleman병이 한 환자에서 동시에 발견된 예는 아직 보고된 바 없다. 저자들은 췌장의 부분 발육 부전증이 있는 환자에서 마치 췌장 미부의 종양처럼 보이는 Castleman 병을 영상학적 검사와 수술 및 조직 검사를 통해 확진하였기에 이를 보고하는 바이다. Agenesis of dorsal pancreas is a very rare congenital anomaly which comes from the failure of development of the body and tail of pancreas in embryogenesis. Castleman`s disease is a rare lymphoid tumor which usually occurred in the mediastinum, but it is very uncommon in the retroperitoneal pancreatic tail area. We report a case of partial agenesis of dorsal pancreas with Castleman`s disease in pancreatic tail area, mimicking a pancreatic tumor. A 46-year-old woman was admitted to our hospital with intermittent abdominal discomfort for 2 months. Computed tomography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor at distal pancreatic tail area, short pancreatic duct, and absence of pancreatic body and tail. The surgical excision of the tumor revealed hyaline-vascular type Castleman`s disease.(Korean J Med 71:80-85, 2006)
급성 A형 전격성 간염 (Fulminant Hepatitis)과 동반된 급성 신부전증
이동형 ( Dong Hyung Lee ),김자경 ( Ja Kyung Kim ),정현수 ( Hyun Soo Chung ),류한작 ( Han Jak Ryu ),문성진 ( Sung Jin Moon ),안상훈 ( Sang Hoon Ahn ),전재윤 ( Chae Yoon Chon ),한대석 ( Dae Suk Han ),강신욱 ( Shin Wook Kang ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.1