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      • KCI등재후보

        말기신부전 환자의 혈액투석에 있어서 혈관 성숙기간이 동정맥루 생존율에 미치는 영향

        박규용(Ky Yong Park),김근호(Guen Ho Kim),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo),조진원(Jin Won Cho),여미애(Mi Ae Yeo),양형원(Hyung Won Yang),김경희(Kyung Hee Kim),이기성(Ki Sung Lee),전로원 대한내과학회 1999 대한내과학회지 Vol.57 No.1

        N/A Arteriovenous fistula(AVF) has been the most important, primary mode of achieving vascular access for chronic hemodialysis by this time. In general, maturation period over 4 to 8 weeks after operation for the formation of AVF has been recommended for the long-term survival of AVF, and so insertion of central venous catheter without using AVF being matured has been primarily recommended whenever hemodialysis is needed. But not infrequently, serious complications have been reported in association with the insertion and the use of central venous catheter. So earlier use of AVF is regarded as a good method of avoiding serious complications with regard to the insertion and the use of central venous catheter. But early use of AVF has not been generally recommended, for early use of AVF has been regarded to be associated with early failure of AVF. But few studies have reported the correlation between maturation period and AVF survival. And in practice, early use of AVF has already been performed frequently by not a few nephrologists or nurses of dialysis units. So authors tried to examine the correlation between maturation period and AVF survival rate, and to find the validity of early use of AVF if it is regarded usable for the hemodialysis by experienced hemodialysis nurses and nephrologists. Methods : A retrospective analysis using 88 AVF cases which had been created in 85 patients from Oct. 1986 through June 1996, and from which authors could get enough information for this study was done. Authors compared one year survival rates of AVF according to the maturation period, the presence of DM, and condition of AVF assessed clinically by doctors and experienced nurses in hemodialysis units. Also from the cases with AVF obstruction, authors examined the 1st, 2nd, and 3rd year survival rate of AVF according to the maturation period. Results : One year survival rate of AVF with maturation period less than 4 weeks was higher than that with maturation period more than 4 weeks, but there was no statistical significance. One year survival rate, irrespective of the length of maturation period for AVFs, of AVF regarded to be usable and good for hemodialysis was higher than that of AVF regarded to be usable but not good for hemodialysis. In the study with the AVF obstruction group only, one year survival rate of AVF with maturation period less than 4 weeks was higher than that of AVF with maturation period more than 4 weeks but there was no statistical significance. And one year AVF survival rate was higher in non DM group(94.1%) than DM group(60%) regardless of maturation period of AVF(P<0.05). Conclusion : On the contrary to the views that longer maturation period of more than 4 weeks will be necessary for the long-term survival of AVF, our results suggest that shorter maturation period for AVF less than 4 weeks does not necessarily mean early failure of AVF once AVF is regarded to be usable for hemodialysis. So it is suggested that early use of AVF instead of inserting central venous catheter is a reasonable approach for getting an adequate vascular access for hemodialysis in chronic renal failure patients who were subjected to receive hemodialysis on waiting peroid of AVF maturation.

      • SCOPUSKCI등재

        흡인성 폐렴으로 발현안 식도게실에 동반된 기관식도루

        김우중(Woo Joong Kim),이명석(Myung Seok Lee),이준상(Jun Sang Lee),김지현(Ji Hyun Kim),양형원(Hyung Won Yang),김경환(Gyoung Hwan Kim),김경희(Gyoung Hee Kim) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.5

        Acquired tracheoesophageal fistula through esophageal diverticulum is infrequent, and they are caused by carcinoma, trauma, infection, and traction. The most common clinical findings are cough associated with eating, production of sputum mixed with food, and weight loss with profound weakness. In the vast majority of patients, diagnosis was made using esophagography, fiberoptic esophagoscopy and bronchoscopy. We reported a case of non-malignant tracheoesophageal fistula through esophageal diverticulum combined with aspiration pneumonia found in a 34 year old woman who complained of chronic coughing, fever, and frequent episodes of paroxysmal coughing. Patients symptom and condition improved after surgical repair including fistulectomy with esophageal repair, and segmental lobectorny. (Korean J Gastroenterol 1997; 30:677-683)

      • 경피 폐생검으로 확진된 폐 Cryptococcosis 1예

        양형원,김경환,최정은,모은경,우인숙,이명구,박명재,정기석,박해정,안혜경 대한감염학회 1997 감염 Vol.29 No.2

        Cryptococcosis is a systemic infection caused by the yeastlike fungus Cryptococcus neoformans, involving central nervous system, lung, skin, prostate and bone. We have experienced a case of pulmonary cryptococcosis without involving other organ in healthy person. A previously healthy 74-year old female patient was admitted due to cough, sputum, general weakness and perioral numbness. As compared with chest PA which was taken 1 year before admission, single nodule of left upper lobe was enlarged slightly. CT-guided needle aspiration and biopsy wee done and cryptococcsis was diagnosed by pathology. After central nervous system infection was excluded, oral fluconazole was given for 12 weeks. The cryptococcoma was nearly disappeared with 12-weeks' treatment and did not relapse until 6 month later.

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