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지속성 외래 복막투석 환자에서 복막염의 발병 양상 단일 임상 기관 연구
안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),오윤규(Yoon Kyu Oh),김현리(Hyun Lee Kim),정우경(Woo Kyung Chung),오국환(Kwook Whan Oh),양재석(Jae Suk Yang),김세중(Se Jung Kim),이경이(Kyung Ey Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Peritonitis remains the leading cause of the patient dropout in CAPD in many developing countries. In Korea, 71% of CAPD patients dropout is caused by peritonitis. To elucidate an adequate guideline for treating peritonitis in our country, we analyzed clinical and bacteriologic profiles of peritonitis(1995. l. 1- 1999. 12 31). Two hundred and twenty eight episodes of peritonitis were developed in 127/247 patients. The incidence of peritonitis was 0.41/patient-year in general, which was decreased to 0.24/patient-year in 1999. The incidence of causative organisms were as follows: 82(36.0%) by Gram positive organisms, 38 (16.2%) by gram negative organisms, 16 cases(7.0%) by mixed organsisms, and 5 cases(2.2%) by fungus. During study period, the incidence of peritonitis by gram positive organsism was decreased while the incidence of peritonitis by gram negative organism was not changed. Recurrent infection/relapse was noted in 58 patients(45%). Peritonitis were eradicated only in 66% of the cases by initial antibiotics(cefazolin+aminoglycoside); and another 17% responded by second line antibiotics. Peritoneal catheters were removed in 38 episodes(16.7%). Patients with exit infection were more frequent in removal of catheter. Risk factor analysis was performed in 146 patients, who were newly started CAPD. There were 60 initial episodes of peritonitis(mean duration of follow up was 16.7 patient months). Sixty-five percent were free of peritonitis at the end of first year, 54% at the end of second year and 45% at the end of third year (Kaplan-Meier). Factors such as age, sex, underlying DM, were not risk factor for CAPD peritonitis. In conclusion, we observed that the incidence of peritonitis decreased every year. It was revealed however that only 66% of peritonitis can be successfully treated by first line antibiotics. Second line antibiotics such as ceftazidime may need to be introduced in early phase of CAPD peritonitis. Up to one third of patients had recurrent infection/relapse, which raised the incidence of peritonitis. Continuing education as well as better exit care is needed to improve technical survival of CAPD patients in Korea.
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성인 지속성 외래 복막투석 환자의 생존에 영향을 미치는 인자
김기원,이정상,정우경,양재석,한진석,김성권,김강석,황영환,안규리,오윤규,김연수,이상구,이중건,이경이 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.5
As a single CAPD center in Korea, we, at the department of internal medicine, Seoul National University Hospital, conducted a retrospective study in CAPD patients for the causes of death, patient survival rate, technique success rate, and risk factors. We enrolled in our study 167 patients who had began CAPD as an initial replacement therapy for end stage renal disease from March 1992 to July 1997 and survived for more than 2 months. As the prognostic factors of patient survival and technique success, we analyzed demographic features, clinical features including comorbid conditions at the beginning of CAPD, and laboratory findings at the beginning and 6 months after the start of CAPD. The mean age of patients was 49.8 12.5, and sex ratio was 1.4: 1(M: F). The mean follow-up period was 24.0±14.4 months. Cerebrovasular accident(CVA), the patient giving up on the treatment, cardiac diseases and peritonitis were the main causes of death in CAPD patients. Among the causes of death, although CVA and the patient giving up on the treatment were relatively important, the most important causes of death were cardiovascular diseases. The 2 year survival rate and 4 year survival rate of CAPD patients were 89.4% and 55.57% respectively ; the 2 year technique success rate and 4 year technique success rate of CAPD were 87.37% and 63.18% respectively ; and the mean survival period and technique success period were 50.57±2.42 and 49.37±2.85 rnonths, respectively. We determined the independent prognostic factors for patient survival to be diabetes mellitus$lt;DM$gt;(p=0.0004, relative risk$lt;RR$gt;=5.9263) and liver cirrhosis(p=0.0032, RR=5.3211) using multivariate analysis with Cox proportional hazard model. Although the results were statistically insignificant, the patients with cardiac diseases(p=0.0961, RR= 2.0116) and older patients who were over 60 years old(p=0.1312, RR=1.8431) had a poor prognosis. The probable prognostic factors for 2 year survival of patients, considered marker of risk factors for early death, were DM, liver cirrhosis, and cardiac diseases, though statistically insignificant, and they were similar to prognostic factors for the patient survival during the entire period. The independent prognostic factor of technique failure of CAPD was DM(p= 0.0150, RR=2.6762). The patient survival rate and technique success rate of CAPD patients were similar to the outcomes reported in other countries. However, the fact that liver cirrhosis was included as one of the independent prognostic factors seems to reflect a disease characteristic of Korean population in whom chronic liver diseases are prevalent. Due to ever increasing proportions of DM, cardiac diseases, and older patients in CAPD patients and the prevalence of liver cirrhosis in Korea, more intensive management is necessary for CAPD patients with these disorders/ conditions.
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무증상의 거대 석회화된 만성뇌경막하혈종 1례 : 증례보고 Case Report
김진호,배학근,이경석,도재원,윤일규,배원경,김의한,변박장 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.8
Althouth the connective-tissue membrane surrounding a subdural hematoma has been described as hyalinized. calcified partially or in patches, a totally organized, calcified or ossified chronic subdural hematoma in the elderly patient is extremely rare We report an asymptomatic case of a huge calcified chronic subdural hematoma in a 67-year-old male patient who had no previous trauma history Computerized tomographic(CT) scan showed an oval-shaped mass with totally calcified rim at the left frontotemporoparietal region After en-block removal of the calcified mass postoperative CT scan showed intracerebral hematoma at the deepest portion of the calcified mass that was partially adhesive to the pia mater The patient suffered from a transient motor aphasia after the operation Relevant literatures are briefly reviewed.
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