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Hemocatheter 삽입시술 후 발생한 쇄골하 가성동맥류에 의한 상완 신경총 손상 1예
김미혜,김진수,최승옥,갈응호,한병근 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5
As percutaneous catheterization of central vein has become common procedure, many different complications have been reported. The common complications are infection, hemorrhage, pneumothorax, embolism and vascular injury associated with aneurysm Aneurysm formation of the great vessel like subclavian artery is rare in patients undergoing central venipuncture. And brachial plexus injuries induced by iatrogenic pseudoaneurysm are quite rare. Despite low incidence, this complication account for a large portion of the serious disabilities and may result in debilitating or limb threatening condition if not diagnosed and treated promptly. We experienced the case of brachial plexus compression by subclavian pseudoaneurysm as a complication of subclavian vein catheterization for hemodialysis.
투석 중인 말기 신부전 환자에서 발생한 뇌졸중의 임상 양상
김미혜,김진수,윤현진,최승옥,갈응호,신표진,한병근,황금 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5
Cardiovascular and cerebrovascular diseases are important causes of death in patients receiving maintenance dialysis. Stroke occurred in high rate with the tendency to worsen prognosis. Also many patients with chronic renal failure(CRF) showed a high risk for stroke. From March 1985 to March 1999, at Wonju Christian Hospital, we investigated retrospectively risk factors, clinical appearance and prognosis for stroke in 20 patients with CRF who undergoing maintenance dialysis. The stroke occurred in nine male and eleven female with a mean age of 49.95±9.19 years. Seventeen patients underwent hemodialysis and three patients underwent peritoneal dialysis. Mean duratian of dialysis was 50.05±34.68 months. Causes of CRF were as follows: 55% glomerulonephritis, 20% diabetes mellitus, 5% polycystic kidney and 20% unknown origin. At the time of stroke, serum protein level was 6.68±0.86mg/dL, albumin 3.38±0.87g/dL, cholesterol 160.25±43.34mg/dL, HDL-cholesterol 41.41±11.86mg/dL. All patients were on antihypertensdication. Mean systolic blood pressure was 197±45mmHg, diastolic blood pressure 114±23mmHg. Systolic blood pressure of fourteen cases were more than 180mmHg. During hemodialysis, heparin dosage was an average 2425±371.48 IU. The types of stroke were intracerebral hemorrhage (ICH, 75%), subdural hematoma(10%), cerebral infarction(15%). One case developed both cerebral hemorrhage and subarachnoid hemorrhage. The sites of hematoma were basal ganglion-thalamus(60%), and subcortex(33.3%). Of these, nine cases had subsequent intraventricular hemorrhage(IVH). One case involved IVH only. The mean volume of hematoma was 66.42±29.92mL. Three cases of cerebral infarction developed in midcerebral arterial territory. Prognoses were as follows: Sixteen patients with cerebral hemorrhage died during hospitalization and one case has been monitored via outpatient department. One patient with cerebral infarction died during hospitalization and two have been discharged after symptom was improved. In conclusion, CRF patients rgoing maintenance dialysis showed higher incidence of ICH, unlike the recent studies which showed a higher rate of cerebral infarction to ICH in the general population. There was a higher incidence of stroke in patients whose blood pressure were poorly controlled. The most common site of ICH was basal ganglia and thalamus which was the same as in the general population. In many cases, it accompanied IVH and showed a higher mortality rate. Therefore, it is thought that aggressive blood pressure control is indicated to reduce mortality caused by stroke during maintenance dialysis.
김미혜,이은영,김진수,최승옥,김명수,구철회,한병근,갈응호,신표진,윤현진 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6
The number of patients and long-term survival rates of chronic renal failure have been increasing since the development of renal replacement therapy. Therefore, continuous follow-up observation on an outpatient basis, vascular access for dialysis and the determination of when to start dialysis have clinical significance associated with the prognosis of these patients. Presently, there is little clinical data about chronic renal failure patients such as, clinical features at initial dialysis, the presence or absence of neph-rologist follow-up, and the types and timing of vas-cular access. The goal of this study therefore was to investigate the clinical features at initial dialysis, presence or absence of follow-up, types and timing of vascular access in 80 patients retrospectively. The results are as below ; 1) The mean age of the patients was 47.8±14.0 years, and there were 47 male and 33 female patients. 2) Seventeen patients(21.3%) had DM as an underlying disease and 63 patients(78.79%) were non-diabetic patients. 3) At the initial dialysis, the diabetic patients had an average BUN of 79.2±29.6mg/dl, average Cr of 7.82.0mg/dl and an average Ccr of 10.0±7.0ml/min. The non-diabetic patients had the following averages ' BUN 118.7±37.9mg/dl, Cr 15.3±6.3mg/dl and Ccr 5.5±4.3ml/min. 4) The initial meeting with a nephrologist prior to dialysis occured as follows : in the diabetic group, 13 patients(76.596) met their nephrologist 12 months before, 3 patients(17.6%) 1 month before, one patient(5.9N) met the specialist one to 3 months before and no one had meeting 4 to 12 month before their dialysis. In the non-diabetic group, 36 patients(63.2%) initially visited a nephrologist 12 months before, 16 patients (28.1%) one month before, 3 patients(5.3%) one to 3 months before and 2 patients(3.5%) had a meeting 4 to 12 months before the first dialysis. 5) The timing of native arteriovenous fistula formation was as follows; In the diabetic group, 10 patients(66.7%) had an A-V fistula constructed immediately upon admission, 2 patients(13.3%) had one constructed one to 3 months before, 2 patients(13.3%) had one made 4 to 12 months before, one patient (6.7%) had a fistula created one week to one month before, and no one had a fistula formed 12 months before their initial dialysis. In the non-diabetic group, 36 patients(69.2%) had an A-V fistula constructed on admission ll patients(21.2%), one week to one month before 2 patients(3.8%), one to 3 rnonths before 2 patients(3.8%), 4 to 12 months before: one patient(1.9%) had the fistula created 12 months before initial dialysis. From these results, we learned that the time interval between either the patient's first meeting with his/her nephrologist or initial referral for renal replacement and vascular access preparation for hemodialysis was much longer than what is currently known. In conclusion, prompt referral to a nephro-logist early in the course of the disease and proper education of the patient by the nephrologist can lead to timely initiation of dialysis at a lower serum creatinine and higher Ccr levels which will reduce mortality, morbidity, and hospital care cost.
선천성 고혈압 쥐에서 신성 고혈압 유발시 복부 대동맥의 수축 및 이완반응과 Angoitensin II 수용체 차단제(Losartan)의 역할에 대한 연구
김미혜,이은영,김진수,송기학,최승옥,이형준,김정민,한병근,갈응호 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6
This study was designed to evaluate the contractile and relaxing responses of abdominal aorta in renovascular hypertension accompanied with essential hyper- tension and to examine the effect of angiotensin II receptor blocker(losartan). An experimental renovascular hypertension accompanied with essential hypertension model was established by clipping the left renal artery of spontaneously hypertensive rats(SHR). These rats were then divided into two groups of which one was given losartan during the one week postopertion before being terminated. Ring preparations of the abdominal aorta were obtained one week after the operation. The contraction of abdominal aorta strips were induced by high potassium or norepinephrine, and relaxation produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with data obtained from the control group. In the second experiment, the rats received angiotensin Il blocker(LRAO group), losartan in the drinking water for 7 days after the induction of the renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method. The following results were obtained; 1) The contractile responses to the high level potassium solution and norepinephrine in renal artery occlusion(RAO) group were significantly increased compared with SHR group(p$lt;0.05). 2) The contractile reponses to the high level norepinephrine in LRAO group were similar to that of SHR control group. However, there was no remarkable differences for high potassium. 3) The relaxing responses to the acetylcholine were significantly reduced in the RAO group compared with the SHR group. However, there was no remarkable differences for sodium nitroprusside. 4) There were no significant differences in the acetylcholine or sodium nitroprusside induced vasodilation response between the LRAO group and SHR group. From the above result, it is suggested that renovascular hypertension in spontaneously hypertensive rats might induce changes of vascular responses and this effects may be concerned with endothelium-dependant mechanism. And angiotensin II receptor blocker rnay prevent the development of abnormal endothelium-dependent relaxation in renovascular hypertension accompanied with essential hypertension by maintaining endothelial function.