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RISS 인기검색어
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- 저자 : Ch`ang Bum Rim (검색결과 4 건)
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S-476 A rare case of malignant hypertension with pulmonary alveolar hemorrhage needing dialysis
( Ch`ang Bum Rim ),( Jin Uk Jeong ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Introduction: Although blood pressure increases with age, it has been recognized that target organ injury is associated with rapid progressive blood pressure elevation in some individuals. If these blood pressure elevations are not treated, the mortality rate in patients with target organ injury, including papilledema and declining kidney function, can exceed 50% over 6-12 months; this hypertension is considered “malignant." Malignant hypertension is histologically characterized by fibrinoid necrosis of arterioles and rapid progression. It is observed in a variety of organs, including the kidneys, pancreas, gastrointestinal tract, liver, retina, brain, myocardium, prostate, and skeletal muscles. However, pulmonary hemorrhage is rare. Here, we report a rare case of malignant hypertension associated with pulmonary alveolar hemorrhage. Case: A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. The patient’s renal function was low, and he needed emergency renal replacement therapy. There was no evidence of Goodpasture syndrome; therefore, systemic lupus erythematosus or other forms of systemic vasculitis, malignant hypertension, and acute kidney injury were suspected. Antihypertensive therapy and hemodialysis were immediately started. A renal biopsy examination was performed to examine the underlying disease. Typical pathological changes associated with malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endarteritis at the interlobular arteries were observed. The patient’s renal function improved gradually and the pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Discussions: We reported a rare case of malignant hypertension with pulmonary alveolar hemorrhage and acute kidney injury that needed dialysis. It was difficult to determine whether the malignant hypertension was primary or secondary. Renal biopsy was used to exclude the possibility of underlying systemic diseases, such as systemic angiitis syndrome and Goodpasture’s disease.
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( Kyoung Min Moon ),( Min Soo Han ),( Ch`ang Bum Rim ),( Jun Ho Lee ),( Min Seok Kang ),( Ji Hye Kim ),( Sang Il Kim ),( Sun Young Jung ),( Yongseon Cho ) 대한결핵 및 호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.1
Background: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. Methods: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean±standard deviation age of 71.2±11.1 years and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were 71.2±8.3 years and 71.2±11.1 years, respectively. Results: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). Conclusion: Thus, five factors-acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH-can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.
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Transfusion Related Acute Lung Injury after Cesarean Section in a Patient with HELLP Syndrome
Kyoung Min Moon,Min Soo Han,Ch`ang Bum Rim,So Ri Kim,Sang Ho Shin,Min Seok Kang,Jun Ho Lee,Jihye Kim,Sang Il Kim 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.1
Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient’s condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions.
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Moon, Kyoung Min,Han, Min Soo,Rim, Ch'ang Bum,Lee, Jun Ho,Kang, Min Seok,Kim, Ji Hye,Kim, Sang Il,Jung, Sun Young,Cho, Yongseon The Korean Academy of Tuberculosis and Respiratory 2016 Tuberculosis and Respiratory Diseases Vol.79 No.1
Background: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. Methods: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean${\pm}$standard deviation age of $71.2{\pm}11.1years$ and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were $71.2{\pm}8.3years$ and $71.2{\pm}11.1years$, respectively. Results: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). Conclusion: Thus, five factors-acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH-can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.
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