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투석 중인 말기신부전 환자에서 관동맥 우회로술과 관동맥 중재술의 장기 성적 비교
선휘경 ( Hui Kyoung Sun ),김나경 ( Na Kyoung Kim ),조유정 ( Yu Jung Cho ),강승대 ( Seung Dae Kang ),김태완 ( Tae Wan Kim ),한금현 ( Kum Hyun Han ),도준형 ( Joon Hyung Doh ),이성윤 ( Sung Yun Lee ),김창영 ( Chang Young Kim ),장우익 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
Purpose: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. Methods: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. Results: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. Conclusion: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.
박재윤 ( Jae Yoon Park ),이성우 ( Sung Woo Lee ),이하정 ( Ha Jeong Lee ),박혜인 ( Ha Yne Park ),구호석 ( Ho Seok Koo ),이향림 ( Hyang Lim Lee ),선휘경 ( Hui Kyoung Sun ),김동기 ( Dong Ki Kim ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5
Purpose: Percutaneous renal biopsy (PRB) may become complicated by serious bleeding. Overnight observation after renal biopsy is a standard safety strategy. Although it was recently reported that outpatient observation is safe, appropriate observation time after the renal biopsy is still in debate. We evaluated prospectively the incidence, onset time and risk factors of hemorrhagic complications to determine the optimal duration of observation after PRB. Methods: We enrolled 100 patients who underwent renal biopsy from October 2009 to April 2010 using the standard strategy. The biopsy was performed by two experienced nephrologists using 16-gauge spring-loaded biopsy gun under real-time ultrasound guidance. Serial color Doppler ultrasound was done immediately, 8 hours, 24 hours and 1 week after the PRB. Results: The 32 patients experienced hemorrhagic complications (32.0%, 10 with gross hematuria, 26 with hematoma, and 4 with both), and 1 major complication occurred 3 days after PRB. Baseline serum creatinine of the patient with the major complication was 6.0 mg/dL. Serum creatinine and BMI were higher in complication group (p<0.05). Number of needle passes, blood pressure, and degree of edema and proteinuria were not related to the complication. In multivariate analysis, serum creatinine was the only significant risk factor of complication (p=0.007). Hemorrhagic complications developed in 9 patients (28.1%) between 8 and 24 hours after PRB, all of which were minor. Conclusion: The 8 hours` observation time after renal biopsy may be deemed appropriate for stable patients with normal creatinine.
유지 혈액 투석환자의 혈중 포도당 농도 변화에 관한 연구
박재선,선휘경,박봉건,이상준,김은순,김희숙,정우경,권인순,고행일,정귀원 인제대학교 2000 仁濟醫學 Vol.21 No.2
Objectives: The study was done to investigate the changes of serum glucose concentrantion and glucose loss during hemodialysis with and without glucose in the dialysate. Method and Materials: Authors studied 23 patients(11 non-diabetes and 12 diabetes) with end-stage renal disease undergoing long-term maintainence hemodialysis. Hemodialysis was performed with glucose free and glucose containing dialysate. Each blood and dialysate outlet fluid sample was drawn for glucose concentration every hour. Results: 1) In non-diabetes and diabetes, serum glucose concentration was decreased during hemodialysis with glucose free dialysate. 2) Net glucose loss during the four hours of hemodialysis was 50-7lg. 3) There was no change in serum glucose concentration during hemodialysis with glucose containing dialysate in non-diabetic endstage renal disease. But, in diabetes, the serum glucose concentration was decreased during hemodialysis with glucose containing hemodialysate. Conclusion: This study suggested that blood glucose concentration was decreased during hemodialysis because of glucose loss in dialysate outlet fluid. Therefore, the addition of glucose to dialysis fluid may help the prevention of hypoglycemia and energy balance. But, in diabetes, further study is needed.
비정맥류, 비궤양성 장관 내 출혈 및 용종 제거술 후 내시경적 밴드 결찰술
이정환,김유선,김은순,배원기,우광훈,문정섭,유권,전영빈,류정임,선휘경,하근우 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2
Background/Aims: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gastrointestinal hemorrhage and post-polypectomy hemorrhage. Methods: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were; Dieulafoy’s lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post- endoscopic biopsy bleeding in I. Results: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy’s lesion. The remaining case was early band detachment. Conclusions: Endoscopic band ligation is effective for non-riceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.