급성 간부전의 뇌압상승에 대한 최신지견

유정암 ( Jeong Am Ryu ) 대한간학회 2020 간학회 싱글토픽 심포지움 Vol.2020 No.1

Endoscopic removal of gastric ectopic pancreas: an initial experience with endoscopic submucosal dissection.

Ryu, Dong Yup,Kim, Gwang Ha,Park, Do Youn,Lee, Bong Eun,Cheong, Jae Hoon,Kim, Dong Uk,Woo, Hyun Young,Heo, Jeong,Song, Geun Am WJG Press 2010 World journal of gastroenterology Vol.16 No.36

<P>To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.</P>

LC,Acute : PO-29 ; Effect of balloon-occluded retrograde transvenous obliteration on liver function

( Kwang Duck Ryu ),( Jeong Heo ),( Hyun Young Woo ),( Dong Uk Kim ),( Gwang Ha Kim ),( Geun Am Song ),( Mong Cho ),( Ki Tae Yoon ),( Chang Won Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Balloon-occluded retrograde transvenous obliteration (BRTO) is one of the therapeutic methods for the treatments of gastric varices with splenorenal shunt. BRTO is a very useful treatment in terms of bleeding control. However there are few reports that evaluated about influence of liver function after BRTO procedures. Methods: From August 2004 to September 2011 at Pusan National University Hospital, we retrospectively reviewed the medical records of patients with liver cirrhosis, who were performed the BRTO procedures to treat their gastric varices or gastric variceal bleeding. The improvement of liver function was defined reduction of Child-Pugh (CP) score. CP class checked at before BRTO, 3month and 6month after. Results: Total 81 patients were analyzed. At baseline, 40.7% was CP class A, 53.1% CP class B, 4.9% CP class C. CP class data at 3 months was available in 57 patients and at 6 months in 42 patients. At 3 month, CP class was improved in 17.3% (14/81), not changed in 49.4% (40/81) and worsened in 3.7% (3/81). At 6 month, CP class was improved in 16.0% (13/81), not changed in 27.2% (22/81) and worsened in 6.2% (5/81). In multivate analysis, independent predictor associated with improvement of liver dysfunction was only CP class at baseline (p=0.005). Patient with improvement at 3 months was CP class A in 0, CP class B in 13 and CP class C in 1. Patient with improvement at 6 months was CP class A in 1, CP class in 11 and CP class C in 1. Rebleeding after BRTO occurred in 6 patients and all of them had baseline CP class B (p=0.044) Conclusion: Liver dysfunction was not significantly worsened in cases of liver cirrhosis after BRTO procedures. Liver function might be improved in some patients after BRTO.

LC, Acute : PO-29 ; Effect of balloon-occluded retrograde transvenous obliteration on liver function

( Kwang Duck Ryu ),( Jeong Heo ),( Hyun Young Woo ),( Dong Uk Kim ),( Gwang Ha Kim ),( Geun Am Song ),( Mong Cho ),( Ki Tae Yoon ),( Chang Won Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Balloon-occluded retrograde transvenous obliteration (BRTO) is one of the therapeutic methods for the treatments of gastric varices with splenorenal shunt. BRTO is a very useful treatment in terms of bleeding control. However there are few reports that evaluated about influence of liver function after BRTO procedures. Methods: From August 2004 to September 2011 at Pusan National University Hospital, we retrospectively reviewed the medical records of patients with liver cirrhosis, who were performed the BRTO procedures to treat their gastric varices or gastric variceal bleeding. The improvement of liver function was defined reduction of Child-Pugh (CP) score. CP class checked at before BRTO, 3month and 6month after. Results: Total 81 patients were analyzed. At baseline, 40.7% was CP class A, 53.1% CP class B, 4.9% CP class C. CP class data at 3 months was available in 57 patients and at 6 months in 42 patients. At 3 month, CP class was improved in 17.3% (14/81), not changed in 49.4% (40/81) and worsened in 3.7% (3/81). At 6 month, CP class was improved in 16.0% (13/81), not changed in 27.2% (22/81) and worsened in 6.2% (5/81). In multivate analysis, independent predictor associated with improvement of liver dysfunction was only CP class at baseline (p=0.005). Patient with improvement at 3 months was CP class A in 0, CP class B in 13 and CP class C in 1. Patient with improvement at 6 months was CP class A in 1, CP class in 11 and CP class C in 1. Rebleeding after BRTO occurred in 6 patients and all of them had baseline CP class B (p=0.044) Conclusion: Liver dysfunction was not significantly worsened in cases of liver cirrhosis after BRTO procedures. Liver function might be improved in some patients after BRTO.

반복적인 위장관 출혈로 발현한 소장의 원발 혈관육종

류동엽 ( Dong Yup Ryu ),황상연 ( Sang Youn Hwang ),이동원 ( Dong Won Lee ),김태오 ( Tae Oh Kim ),박도윤 ( Do Youn Park ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),조몽 ( Mong Cho 대한소화기학회 2005 대한소화기학회지 Vol.46 No.5

Resuscitation Fluid Use in a Single Surgical Intensive Care Unit

Yong Dae Lee,Jeong-Am Ryu,Dae-Sang Lee,Jinkyeong Park,Joongbum Cho,Chi Ryang Chung,Yang Hyun Cho,Jeong Hoon Yang,Gee Young Suh,Chi-Min Park 대한외상중환자외과학회 2020 Journal of Acute Care Surgery Vol.10 No.1

Purpose: The aim of this study was to analyze the temporal change of resuscitation fluid use based on all fluids administered in a surgical intensive care unit (ICU). Methods: The administration of resuscitation fluid to all patients admitted to a surgical ICU of a tertiary referral hospital was investigated from 2008 to 2015. The types and volumes of fluid, and laboratory data taken within 7 days after ICU admission were evaluated. Resuscitation fluids were defined as fluids infused according to stat orders, rather than routine orders. Results: There were a total of 8,885 admissions to the ICU for 7,886 patients. The volumetric proportion of crystalloid to total resuscitation fluids increased significantly over the study period (p < 0.001; 79.6% in 2008; 93.7% in 2015). Although the proportion of 0.9% saline to crystalloids decreased, that of balanced solutions increased (p < 0.001; 29.5% in 2008; 55.6% in 2015). The use of colloids decreased from 20.4% in 2008, to 6.3% in 2015 (p < 0.001). Proportions calculated using the number of individual fluids administered revealed trends similar to those calculated using volumetric data. The amount of infused 0.9% saline was weakly correlated with the lowest blood pH and the highest serum chloride levels (ρ = -0.26 and 0.19, respectively). Conclusion: Changes in the trends of fluid resuscitation practice were noted in a single surgical ICU over the 8-year study period. Crystalloid use increased owing to a rise in the utilization of balanced solutions with a downward trend in colloid use.

장결핵과 크론병의 감별 진단에 있어서 체외 Interferon-γ 검사의 유용성

이정남 ( Jung Nam Lee ),류동엽 ( Dong Yup Ryu ),박성한 ( Sung Han Park ),유현석 ( Hyun Seok You ),이봉은 ( Bong Eun Lee ),김동욱 ( Dong Uk Kim ),김태오 ( Tae Oh Kim ),허정 ( Jeong Heo ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am So 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6

목적: 소화기 증상과 대장 또는 회맹부 궤양을 보이는 환자에서 장결핵과 크론병을 임상 소견 및 내시경 소견만으로 구분하는 것은 어렵다. 이번 연구에서는 장결핵과 크론병의 감별을 위한 체외 interferon-γ (INF-γ) 검사의 유용성을 알아보고자 하였다. 대상 및 방법: 이번 연구는 2007년 1월부터 2009년 1월까지 장결핵과 크론병의 감별 진단이 어려웠던 60명을 대상으로 하였다. ESAT-6과 CFP-10에 반응하여 INF-γ을 생산하는 T 림프구를 측정하는 T-SPOT.TB 검사를 시행하였으며 최종 진단과 비교하여 T-SPOT.TB 검사의 유용성을 평가하였다. 결과: T-SPOT.TB 검사 결과 양성이20명, 음성이 40명이었다. 장결핵으로 확진된 12명의 환자는 T-SPOT.TB 검사가 모두 양성이었고, 기타 6명의 크론병환자와 2명의 베체트장염 환자에서 T-SPOT.TB 검사가 양성이었다. T-SPOT.TB 검사가 음성인 40명 중 크론병 38명, 베체트장염과 비특이 장염이 각각 1명이었고 장결핵은 없었다. T-SPOT.TB 검사의 장결핵 진단에 대한 민감도는 100%, 특이도는 83.3%, 양성 예측도는 60.0%, 음성 예측도는 100%였다. 결론: 장결핵과 크론병의 감별 진단이 어려운 경우에 T-SPOT.TB 검사는 음성일 경우 장결핵을 배제할 수 있는 신속한 검사로 생각한다. 향후 T-SPOT.TB 검사의 장결핵과 크론병 감별 진단에의 유용성을 확인하기 위해 대규모 전향 연구가 필요하다. Background/Aims: It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohn`s disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-γ) assay for differential diagnosis between ITB and CD. Methods: Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-γ-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis. Results: Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcet`s enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcet`s enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively. Conclusions: When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD. (Korean J Gastroenterol 2010;55:376- 383)

Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea

이윤임,Ko Ryoung-Eun,나수진,Ryu Jeong-Am,Cho Yang Hyun,양정훈,정치량,서지영 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.2

Background Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia. Results During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ. Conclusions In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

Clinical Outcomes Associated with Degree of Hypernatremia in Neurocritically Ill Patients

Yun Im Lee,Joonghyun Ahn,Jeong-Am Ryu 대한신경외과학회 2023 Journal of Korean neurosurgical society Vol.66 No.1

Objective : Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia. Methods : Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis. Results : Among 1146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p<0.001 and p=0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR], 4.58; 95% confidence interval [CI], 2.15–9.75 and adjusted OR, 6.93; 95% CI, 3.46–13.90, respectively) and 28-day mortality (adjusted OR, 3.51; 95% CI, 1.54–7.98 and adjusted OR, 10.60; 95% CI, 5.10–21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p=0.720 and p=0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate. Conclusion : Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

Effect of Early Intervention on Long-Term Outcomes of Critically Ill Cancer Patients Admitted to ICUs*

Lee, Dae-Sang,Suh, Gee Young,Ryu, Jeong-Am,Chung, Chi Ryang,Yang, Jeong Hoon,Park, Chi-Min,Jeon, Kyeongman by 2015 by the Society of Critical Care Medicine a 2015 Critical care medicine Vol.43 No.7

OBJECTIVES:: The objective of this observational study was to evaluate whether early intervention was associated with improved long-term outcomes in critically ill patients with cancer. DESIGN:: Retrospective analysis with prospectively collected data. SETTING:: A university-affiliated, tertiary referral hospital. PATIENTS:: Consecutive critically ill cancer patients who were managed by a medical emergency team before ICU admission between January 2010 and December 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: During the study period, 525 critically ill cancer patients were admitted to the ICU with respiratory failure (41.7%) and severe sepsis or septic shock (40.6%) following medical intervention by a medical emergency team. Of 356 ICU survivors, 161 (45.2%) received additional treatment for cancer after ICU discharge. Mortality was 66.1% at 6 months and 72.8% at 1 year. Median time from physiological derangement to intervention before ICU admission was significantly shorter in 1-year survivors (1.3 hr; interquartile range, 0.5–4.8 hr) than it was in nonsurvivors (2.9 hr; interquartile range, 0.8–9.6 hr) (p< 0.001). Additionally, the early intervention (≤ 1.5 hr) group had a lower 30-day mortality rate than the late intervention (> 1.5 hr) group (29.0% vs 55.3%; p < 0.001) and a similar difference in mortality rate was observed up to 1 year. Other factors associated with 1-year mortality were illness severity, performance status, malignancy status, presence of more than three abnormal physiological variables, time from derangement to ICU admission, and the need for mechanical ventilation. Even after adjusting for potential confounding factors, early intervention was significantly associated with 1-year mortality (adjusted hazard ratio, 0.456; 95% CI, 0.348–0.597; p < 0.001). CONCLUSION:: Early intervention for clinical derangement on general wards was significantly associated with long-term outcomes in critically ill cancer patients.