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중증 전자간증 환자에서 동반되는 급성 신부전증의 임상적 특성에 관한 연구
방병기(Byung Kee Bang),김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),양철우(Chul Woo Yang),조재형(Jae Hyung Cho),권용일(Yong Il Kwon),권동진(Dong Jin Kwon),박태철(Tae Chul Park) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
N/A To evaluate the risk factors and clinical characteristics of acute renal failure(ARF) in patients with severe preeclampsia, we retrospectively investigated medical and obstetric histories, clinical and laboratory findings, maternal morbidity, and perinatal outcome between renal insufficiency and normal groups in patients with severe preeclampsia. Of the total 307 patients with severe preeclampsia, ARF occurred in 36 patients and its incidence was 11.7%. ARF developed before labor in 17 patients and postpartum in 19 patients. Oliguria occurred in 13 patients(36.1%) and 3 out of these patients required hemodialysis. Of the 31 patients who was observed for 3 months, renal function did not recover in 3 patients(9.7%). The systolic and diastolic blood pressures in renal insufficiency group(n=36) were higher than those in normal group(systolic:173±22 vs 164±19mmHg, p<0.02, diastolic:119±17 vs 108±14mmHg, p<0.01). In addition to degree of blood pressure, this study demonstrated that the risk factors of acute renal failure at admission were history of chronic hypertension, twin pregnancy, hypoalbuminemia, and thrombocytopenia. The incidences of maternal compli-cations such as syndrome of hemolysis, elevated liver enzymes, and low platelets(HELLP syndrome), abrup-tio placenta, pulmonary edema and perinatal morbidity in renal insufficiency group were higher than those in normal group, respectively. In conclusion, acute renal failure in severe pre-eclampsia occur frequently in patients with history of chronic hypertension, twin pregnancy, severe hypertension, severe hypoalbuminemia, and thrombocytopenia.
혈액투석 환자에서 동정맥루의 과도한 혈류에 의한 고박출성 심부전
방병기(Byung Kee Bang),김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),천경아(Kyung Ah Chun),김남일(Nam Il Kim),김현재(Hyeon Jae Kim),전희경(Hui Kyung Jeon) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
Although excessive arteriovenous fistula blood flow may be a factor in the development of high-output cardiac failure, this diagnosis is easily over-looked. Surgical reduction of fistula blood flow can improve the condition. We here report a case of high-output cardiac failure due to excessive arterio-venous fistula blood flow in a hemodialysis patient. A 51-year-old man who had been treated with hemodialysis since 5 years ago was admitted for increasing cardiac failure. Echocardiographic evaluation of cardiac output and duplex measurement of the fistula confirmed the diagnosis of high-output cardiac failure due to excessive arteriovenous fistula blood flow. After surgical closure of the fistula, the signs and symptoms of cardiac failure subsequently subsided and both systolic and diastolic dimension of left ventricle much decreased.
방병기(Byung Kee Bang),양철우(Chul Woo Yang),박정희(Jung Hee Park),고경근(Kyung Keun Ko),한혜원(Heo Won Han),임현선(Hyun Sun Leem),김용수(Young Soo Kim) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
Subclavian catheters were used in the treatment of chronic renal failure patients waiting for the maturation of AV fistula. But, it sometimes causes fatal complications. Of these, massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but causes very serious complication. Most of patients with hemothorax are successfully treated with conservative treatment(i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy) but it sometimes needs surgery. We recently experienced a case of ARDS complicated by hemothorax which was successfully treated with thracooscopic drainage. We reviewed the pathogenesis of ARDS by hemothorax and suggested the guidlines for the treatment of massive hemothorax using video-assisted thoracoscopic surgery.
생체 신장이식에서 이식신 생존율에 미치는 HLA 적합성의 영향
윤영석(Young Suk Yoon),방병기(Byung Kee Bang),김원일(Won Il Kim),고용복(Yong Bock Koh) 대한내과학회 1992 대한내과학회지 Vol.43 No.4
N/A Background & Methods: HLA matching continues to stand out as an important factor in renal transplantation despite improvement in immunosuppression. Therefore, we have analyzed 478 first living renal transplants who had been treated with Aza (n=68) or CsA (n=410) between April 1979 and March 1991 to determine the beneficial effect on graft survival of HLA antigens matching. Results: CsA signiftcantly improved kidney graft survival by 17% at 5years as compared with Aza group (77% vs. 65%; p=0.0252), Matching for the HLA-A+B significantly improved kidney graft survival, which the difference between 1 mismatched group and 2mismatehed group was 27% at 5years (67% vs. 40% p=0.0436) in the Aza group, but not in the CsA group, An impressive 34% difference in kidney graft survival was observed at 5years between the CsA-treated patients who received 0 and 2HLA-DR mismatches (83% vs. 49%; p=0,00001), but not between Aza-treated patients. The 5-year kidney graft survival in the 1 B+ DR mismatched CsA group was 86d, which was significantly different from 64Fp survival in the 4 B+DR mismatched group (p=0.0105), but not in the Aza group. The effect of HLA -A+DR and HLA-A+B+DR matching showed a little difference between the groups with different mismatches number in the Aza and CsA groups. Conclusion: Matching for the HLA-A+B significantly improved kidney graft survival in the Aza group. Matching for the HLA-DR and B+DR significantly improved kidney graft survival in the CsA group. The best kidney graft survival was observed in the HLA -A+B+DR identical combination group treated with Aza (80Fp at 5years); while in 0 HLA-A+B mismatched recipients treated with CsA (95% at 5years).