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강건우 ( Gun Woo Kang ),박관규 ( Kwan Kyu Park ),이인희 ( In Hee Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
Renal cortical necrosis (RCN) is a rare cause of acute renal failure in which there is a complete or partial destruction of the renal cortex with sparing of the medulla. We report here a case of acute bilateral RCN associated with intra-abdominal operation. A 70-year-old female patient was admitted to our hospital because of abdominal pain secondary to perforated diverticulits in sigmoid colon. A segmental resection of the sigmoid colon and end-to-end anastomosis was performed on the third hospital day. Two days later, she suddenly developed oligo-anuria and she was treated with hemodialysis. A contrast-enhanced abdominal computed tomography scan showed lack of enhancement of the renal cortex with enhancement of the renal medulla. On the 21th hospital day, renal biopsy was done and microscopic examination of the specimen revealed RCN. Since then, she has been on regular hemodialysis for over six months with no signs of renal recovery. Occult sepsis associated with peritonitis and intra-abdominal operation seems to be the most possible etiologic factor of RCN in our patient.
당뇨병성 만성 신질환 환자에서 발생한 양측성 기종성 신우염 2예
강건우 ( Gun Woo Kang ),이인희 ( In Hee Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
Emphysematous pyelitis (EP) is an acute bacterial renal infection characterized by the presence of gas localized to the renal collecting system, sparing the renal parenchyma. It is seen more commonly in women, often associated with underlying diabetes mellitus or obstructing stone disease. To our knowledge, EP has not been frequently reported in the Korean literature. We report here two cases of bilateral EP due to Escherichia coli in 55-year-old female and 44-year-old female patients with diabetic chronic kidney disease, were successfully treated with medical management including intravenous administration of antibiotics. Early diagnosis by means of abdominal computed tomography along with prompt antibiotic therapy may be effective in patients with bilateral EP.
증례 : 신장 ; p-ANCA가 동시에 검출된 항사구체 기저막 항체 질환 2예
강건우 ( Gun Woo Kang ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ),최미선 ( Mi Sun Choe ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
Anti-glomerular basement membrane antibody (anti-GBM Ab) disease is characterized by circulating antibodies to the glomerular basement membrane and the deposition of IgG or, rarely, IgA along the glomerular basement membrane. This disease accounts for 10-20% of crescentic glomerulonephritis. We report two patients with anti-GBM Ab disease who were positive for perinuclear-anti-neutrophil cytoplasmic antibody (p-ANCA). Percutaneous renal biopsies showed many crescent formations and linear deposits of IgG along the glomerular basement membrane. Serologic tests for p-ANCA were positive. They were treated with steroid pulse and cyclophosphamide and one patient also underwent plasma exchange therapy. Despite immunosuppressive therapy, their renal functions did not improve and both required regular hemodialysis. (Korean J Med 2012;83:514-519)
증례 : 신장 ; 중증 저칼륨혈증에 의해 발생한 횡문근 융해증이 합병된 급성 대장 가성 폐쇄증 1예
이우현 ( Woo Hyun Lee ),이다영 ( Da Young Lee ),서지호 ( Ji Ho Seo ),강건우 ( Gun Woo Kang ),권중구 ( Joong Goo Kwon ),이인희 ( In Hee Lee ) 대한내과학회 2013 대한내과학회지 Vol.84 No.4
급성 대장 가성 폐쇄증은 자율 신경 이상과 관련된 다양한 원인에 의해 발생할 수 있으며, 드물게 저칼륨혈증에 의해서도 유발된다. 저자 등은 복부 팽만과 복통을 주소로 내원한 환자에서 혈청 검사, 심전도, 방사선 및 내시경 소견 등을 근거로 중증 저칼륨혈증에 의한 횡문근 융해증과 급성 대장 가성 폐쇄증을 진단하였으며, 이후 대증요법 시행과 네오스티그민 투여 후 임상 소견이 호전된 증례를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. Acute colonic pseudo-obstruction (ACPO) or Ogilvie`s syndrome is a rare disorder of intestinal motility characterized by massive colonic dilatation without mechanical obstruction. We report a case of ACPO combined with rhabdomyolysis induced by severe hypokalemia. A 78-year-old male with a 10-year history of hypertension presented with abdominal pain and distension for 2 days. The laboratory findings showed hypokalemia with markedly elevated serum creatine phosphokinase and myoglobin levels. A plain abdominal x-ray revealed a markedly distended ascending and transverse colon with a cut-off sign at the descending colon. Mechanical obstruction of the intestine was excluded by computed tomography and colonoscopy. He was initially treated with supportive therapy, including insertion of a rectal tube and intravenous fluids with potassium replacement. However, the ACPO persisted, and neostigmine was administered in two separate 2.0-mg intravenous injections, 24 hours apart. Subsequently, the abdominal pain and colonic distension were relieved. (Korean J Med 2013;84:591-596)
홍창우 ( Chang Woo Hong ),노신영 ( Sin Young Nho ),이인희 ( In Hee Lee ),안기성 ( Ki Sung Ahn ),박관규 ( Kwan Kyu Park ),강건우 ( Gun Woo Kang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Ethambutol is commonly used as a first-line drug for the treatment of tuberculosis. The most serious adverse effect of ethambutol therapy is optic neuropathy. However, ethambutol-induced acute kidney injury is extremely rare. We report herein a case of acute kidney injury secondary to ethambutol-associated acute interstitial nephritis. A 65-year-old man with pulmonary tuberculosis presented with a > 7-day history of nausea and vomiting. He had begun antituberculosis medications including ethambutol 3 weeks previously. His laboratory findings showed elevated blood urea nitrogen and serum creatinine levels (32.6 and 3.6 mg/dL, respectively). Examination of percutaneous renal biopsy specimens showed diffuse interstitial mononuclear cell infiltration with mild interstitial edema. The patient was treated by cessation of ethambutol and supportive care. His renal function completely recovered (creatinine, 1.1 mg/dL) and his clinical symptoms improved. (Korean J Med 2014;87:352-356)
투석환자에서 수면장애에 영향을 주는 심리학적 요인과 의학적 요인
지윤미(Yoonmi Ji),강건우(Gun Woo Kang),서민재(Min Jae Seo),김홍익(Hong Ik Kim),우정민(Jungmin Woo) 대한생물치료정신의학회 2016 생물치료정신의학 Vol.22 No.3
Objectives:The purpose of this study is to determine the factors affecting sleep problems and assess the relationship between sleep quality and quality of life in hemodialysis patients. Methods:One hundred forty three patients participated in this study. The Pittsburgh Sleep Quality Index(PSQI) and World Health Organization Quality of Life Scale Abbreviated Version(WHOQOL-BREF) were used to assess sleep quality and quality of life respectively. The psychological status was measured using Hospital Anxiety and Depression scale(HADS). Results:The percentage of poor sleepers was 74.8%. The mean of all WHOQOL-BREF domains in the poor sleeper were significantly lower than in the good sleepers. The factors showing statistical difference between good and poor sleepers were Body Mass Index(p=0.035), Calcium(p=0.049), Kt/V(p=0.001), HADS-Depression(p=0.045), HADS-Anxiety(p<0.001) and HADS-Total(p<0.001). The PSQI score correlated positively with phosphorus, kt/V, Urea reduction ratio(URR), HADS-Anxiety(HADS-A), HADS-Depression(HADS-D) and HADS-Total(HADS-T) and correlated inversely with all domain except social relationships and overall QOL. Multiple linear regression analysis revealed that phosphorus and HADS-Total were independent variables associated with PSQI score. Conclusion:Our results demonstrated that sleep problems are common and associated with decreased quality of life in hemodialysis patients. We propose the management of psychological factors as well as medical factors affecting sleep problems to improve the quality of life of hemodialysis patients.
급성신손상과 횡문근융해증이 합병된 amlodipine 중독
이인희 ( In Hee Lee ),강건우 ( Gun Woo Kang ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1
Amlodipine, a calcium channel blocker of the dihydropyridine group, is commonly used in management of hypertension, angina, and myocardial infarction. Amlodipine overdose, characterized by severe hypotension, arrythmias, and pulmonary edema, has seldom been reported in Korean literature. We report on a fatal case of amlodipine intoxication with complications including rhabdomyolysis and oliguric acute kidney injury. A 70-year-old woman with a medical history of hypertension was presented at the author``s hospital 6 hours after ingestion of 50 amlodipine (norvasc) tablets (total dosage 250 mg) in an attempted suicide. Her laboratory tests showed a serum creatinine level of 2.5 mg/dL, with elevated serum creatine phosphokinase and myoglobin. The patient was initially treated with fluids, alkali, calcium gluconate, glucagon, and vasopressors without a hemodynamic effect. High-dose insulin therapy was also started with a bolus injection of regular insulin (RI), followed by continuous infusion of RI and 50% dextrose with water. Despite intensive treatment including insulin therapy, inotropics, mechanical ventilation, and continuous venovenous hemodiafiltration, the patient died of refractory shock and cardiac arrest with no signs of renal recovery 116 hours after her hospital admission.