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Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients
오윤규,진호준,안신영,안정남,이정표,임춘수,오국환 대한의학회 2017 Journal of Korean medical science Vol.32 No.5
Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin.
골다공증성 척추 압박골절 환자의 경피적 척추성형술에서 Polymethylmethacrylate의 경막 외 유출
오윤규,류경식,박춘근,강준기,Oh, Yoon-Kyu,Ryu, Kyeong-Sik,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3
Objectives : The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. Methods : This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. Results : The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions : The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.
오윤규,나기영,김근호,김소영,한진석 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5
이뇨제는 신세관의 각 부위에서 소디움의 재흡수를 억제하여 소디움과 이에 상응하는 음이온의 배설을 증가시킴으로써 요량을 증가시키는 요소디움 배설 촉진제이다. 신증후군에서와 같이 부종이 있는 환자에서 이뇨제를 사용하면 역치 용량이 높아지는 이뇨제 저항성이 생기고, 이뇨제를 장기간 사용하게 되면 원위 네프론에서의 적응기전이 활성화되어 이뇨제의 효과가 떨어지게 되는 이뇨제 내성이 발생한다. 이뇨제 저항성의 기전을 밝히기 위해 신증후군 환자와 정상인에게 bumetanide 1 ㎎를 투여하였을 때, 최고 혈장 농도에 도달하는 시간이 신증후군 환자에서 길었으며 24시간 동안 배설된 비결합형 bumetanide 양도 정상인에 비해 신증후군 환자에서 감소해 있었다. 또한24 시간 동안 배출된 전체 및 비결합형 bumetanide 양에 대한 요량, 소디움 및 클로라이드의 배설량 비율도 신증후군 환자에서 정상인에 비해 낮아, 이뇨제의 약동학적 및 약력학적 변화가 이뇨제 저항성을 일으킬 수 있음을 추정할 수 있었다. Furosemide를 사용할 때 알부민을 투여하는 것이 이뇨작용에 상승효과가 있는지 알아보기 위해 신증후군 환자에게 furosemide 160 ㎎과 알부민을 병용 투여한 결과 알부민투여가 furosemide의 이뇨작용에 약동학적 및 약력학적으로 상승효과가 없었다. 또한 알부민을 furosemide 투여30분 전에 투여하였을 때 소변양은 증가하였지만 요 소디움 배설과 약동학적 지표들의 변화는 없었다. 장기간 이뇨제 투여가 원위 네프론의 소디움 운반체들의 발현에 미치는 영향을 알아보기 위하여 이뇨제를 투여한 쥐들의 콩팥을 이용해 반정량적 immunoblotting을 시행한 결과 furosemide를 투여한 군에서Na^+ -Cl^- cotransporter (TSC)단백 발현과 epithelial sodium channel(ENaC) 의α, β, γ subunit 단백 발현이 증가하였고, hydrochlorothiazide를 투여한 군에서도 ENaC의 일부subunit 단백 발현이 증가하였다. 이상의 결과에서 이뇨제 저항성과 내성을 극복하기 위해서 이뇨제를 역치 용량 이상으로 투여하거나 투여 횟수를 증가시켜야 하며 이뇨제 병합요법도 추천된다. 이뇨제와 더불어 알부민을 투여하는 것은 일부환자에서 제한적으로 사용되어야 할 것이다.
경막 성형술과 단락술로 치료한 외상성 척수 공동증 - 증례보고 -
오윤규,최영근,이강운,고원일,박익성,백민우,강준기,Oh, Yuun Kyu,Choi, Young Geun,Lee, Kang Woon,Ko, Won Il,Park, Ik Sung,Baik, Min Woo,Kang, Joon Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10
A case report of a post-traumatic syringomyelia in a 29-year old male, developed 15 years after an L1 burst fracture, is presented. On preoperative MRI, the syrinx extended cephalad above the fracture site through the whole thoracic and cervical cord. Serial myelo-CT was performed to evaluate the dynamics of CSF. It was managed by lysis of the arachnoid adhesions, syringosubarachnoid shunt, and expansile duraplasty. After surgery, the patient's symptoms improved, and marked decrease of the syrinx was seen on postoperative MRI. The pathophysiology, the role of preoperative diagnostic methods especially serial myelo-CT, and the contmporary management modalities for posttraumatic syringomyelia is reviewed along with the pertinent literature.