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최한림,권순길,Han Joung-Ho,Lee Junsung,강길원,Kang Minseok 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.2
Background: Patients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea. Methods: The Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.Results: A total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis. Conclusions: Patients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.
병원 환자군에서의 복부대동맥 장골동맥류의유병률 및 치료실태
최한림,이충헌,장이찬 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.4
Purpose: Abdominal aortoiliac artery aneurysm (AIAA) is a common disease in the elderly. The prevalence of AIAA was well known in western countries. However, in Korea, there are a few studies regarding the prevalence. This study was carried out to determine the prevalence of AIAA by reviewing the radiological reports of abdominal computed tomography (CT). Methods: We searched the words like “aneu” or “rysm” in radiological reports of 22,520 abdominal CT (11,974 patients) between January 1, 2005 and March 31, 2010 in patients over 50 years old. We found 121patients who had AIAA of more than 3 cm or more than 1.8 cm isolated iliac artery aneurysm. We analyzed the characteristics of these patients with aneurysm. Results: The prevalence of aneurysms was 1.01% (121 patients). The aneurysms in men were more prevalent than women (1.39% vs. 0.51%). In the octogenarian, the aneurysms were found to be most frequent (2.75%). Among the 121 aneurysms, aortic, aortoiliac, and isolated iliac artery aneurysms were 66 (54.6%), 28 (23.1%),and 27 (22.3%). In terms of aneurysmal size, greater than 6 cm, 5 to 6 cm, and less than 5 cm were 19(20%), 13 (14%), and 62 (66%), respectively. The rupture rate was 18% (6 patients) in more than 5 cm abdominal aortic aneurysm. Conclusion: The prevalence of AIAA is lower than Western countries. This is not a national-wide survey,but results are similar to the other Korean reports. Reviewing radiologic reports of abdominal CT is another way to study the prevalence of aneurysms.
최한림(Han-Lim Choi),양화연(Hwa-Yeun Yang),류동희(Dong-Hee Ryu),장이찬(Lee-Chan Jang),이상전(Sang-Jeon Lee),송영진(Young-Jin Song),선우영(Woo-Young Sun) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
The use of totally implantable central venous access devices (chemoport) has increased with the development of chemotherapeutic agents in oncologic patients, especially with no venous access site. However, there can be various complications such as port site infection, thromboembolism, injury of central vein, fracture of catheter, and migration of catheter. We report a rare case of migration of catheter to right atrium due to the separation of the catheter from the chemoport.
소포종양이 의심되는 갑상선 결절에서 초음파 검사 소견의 재검토가 진단적 갑상선 절제를 줄일 수 있는가?
최한림(Han-Lim Choi),김동주(Dong-Ju Kim),선우영(Woo-Young Sun),윤효영(Hyo-Young Yun),장이찬(Lee-Chan Jang),최재운(Jae-Woon Choi),이승영(Sung-Young Lee),이옥준(Ok-Jun Lee),박진우(Jin-Woo Park) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.2
Purpose: Follicular neoplasms (FNs) such as follicular adenoma and carcinoma (FTC), nodular hyperplasia (NH) and follicular variant of papillary carcinoma (FVPC) share cytological features. In the present study, we investigate whether review of sonographic findings in patients with thyroid nodules suspicious of FN spares diagnostic thyroidectomies (DTs) by excluding benign diseases such as NH or not. Methods: From June 1999 to May 2007, DTs were performed on 98 patients who had nodules suspicious of FN. High resolution sonographic findings are available for 53 patients. According to the final histologic diagnosis: Group Ⅰ (23 patients) consisted of 20 FNs (11 FTCs), 1 Hurthle cell adenoma, 2 FVPC; Group Ⅱ (30 patients) consisted of all others (23 NHs, 4 Hashimoto’s thyroiditis, 3 papillary carcinomas (PTCs). Sonographic features were compared between the two groups. Results: Three differential sonographic findings (DSF) i.e. irregular margin, absence of peripheral halo or marked inhomogeniety were identified more often in Group Ⅱ than Group Ⅰ (P<0.05). If we spared DTs for patients who have at least one DSF, 18 patients (34.0%) would have been selected for clinical follow-up whose final diagnoses were 14 NHs and 4 PTCs (including 1 FVPC). Sparing DTs by DSFs shows sensitivity, 56.7%; specificity, 95.7%; positive predictive value, 94.4%; negative predictive value, 62.9%; and accuracy, 73.6%, respectively. Conclusion: In patients with thyroid nodules suspicious of FN, sonographic findings such as irregular margin, absence of peripheral halo or marked inhomogeneity might spare DTs with the help of other diagnostic modalities such as cytogenetic or immunohistochemical studies.