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김진수(Jin Soo Kim),문경협(Kyoung Hyoub Moon),김민정(Min Jeong Kim),마상수(Sang Soo Ma),이후석(Hu Seok Lee),김미영(Mi Young Kim),노용호(Young Ho Rho) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
목적 : 척수 손상환자에서 신질환에 의한 유병율과 사망률은 매우 높다고 알려져 있으며 이들 환자에서 신 질환은 미세 단백뇨를 동반한 세뇨관성신실질 형태가 주된 질환인데 단백뇨를 가진 만성 척수 손상환자의 임상적 특징과 신부전에 이르기 전 단백뇨의 유발 위험요인에 대한 국내 조사가 없어 본 연구를 시작하였다. 방법: 1999년 12월부터 2000년 5월까지 6개월 동안 한국보훈병원에 입원 또는 외래진료 중인 척수 손상으로 인한 하반신 또는 전신마비 환자를 대상으로 하였으며, 환자는 연구기간 중 입원 중이거나 내과, 비뇨기과 외래진료 중인 환자를 대상으로 하였고, 24시간 채뇨와 일반적인 검사실 검사를 시행하였다. 신 초음과 검사는 24시간 체뇨 전후 6개월 이내에 시행하였다. 결과: 1g 이상의 병적인 단백뇨를 보였던 군에서 더 고령이었고, 더 오랜 척수 손상기간을 가졌으며 욕창에 대한 수술적 처치가 더 많았고, 흉수 이하 및 하반신마비 환자에서 더 많았으며, 수신증을 보이고 있었으나, 방광내 도관 삽입은 관계가 없었다. 당뇨환자는 통계적 차이는 보이지 않았으나 모두 병적인 단백뇨를 보이고 있었다. 결론: 척수 손상 환자에서 단백뇨는 욕창 치료 증가와 수신증 및 척수 손상 기간과 연관성을 보였으며, 사지마비보다 하지마비환자에서 더 유의하게 많았는데 이는 하지마비환자에서 척수 손상기간이 더 많았기 때문으로 생각된다. 만성 척수 손상환자의 신 기능을 보존하기 위하여는 정기적으로 수신증의 발생을 확인하여 대처하며, 무엇보다도 욕창의 발생을 피하고, 욕창에 대한 철저한 치료로 만성염증을 피하는 데에 더욱 노력하여야 한다. Background: Patients with spinal cord injury have a significant degree of morbidity and mortality caused by renal disease. Tubulointerstitial form of renal disease with minimal proteinuria predominate in this population. A retrospective study was performed to investigate the risk factors that may contribte to the development of proteinuria in patient with chronic spinal cord injury. Methods : Between December 1999 and May 2000, 40 spinal cord injury patient in Korean Veterans Hospital were recurited retrospectively into the study. The information was gathered included medical record, laboratory data, and radiological study. Results: Proteinuric subjects were older, had a longer duration of injury, had undergone a greater number of decubitus ulcer procedures and hydronephrosis. Conclusion : Proteinuria in the patients with spinal cord injury was related to the increase of the therapy for the decubitus ulceration, hydronephrosis, and the duration of the spinal cord injury, and it developed significantly more in paraplegia patients than in quadriplegia patients, which might be due to the more duration of the spinal cord injury in paraplegia patients. Therapeutic efforts directed toward preserving renal function should focus on avoidance of hydronephrosis, and decubitus ulceration.
혈액 투석중인 상염색체 우성 다낭성 신질환에서 발생된 요흉 1 예
소미진(Mi Jin So),나병주(Byoung Ju Na),김종률(Jong Lyul Kim),이진한(Jin Han Lee),김진수(Jin Su Kim),노용호(Young Ho Rho),김태효(Tae Hyo Kim),문경협(Kyoung Hyoub Moon) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
Urinothorax is rare cause of pleural effusion. Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. It has been reported in patients with trauma, malignancy, kidney biopsy and renal transplantation. Most cases are diagnosed retrospectively by promt resolution of symptoms after relief of urinary obstruction. But dia- gnosis can be made based on clinical suspicion, radiological findings and biochemical analysis of the effusion and most important finding is the pleural level of creatinine is higher than the serum level. We experienced right pleural effusion in autosomal dominant polycystic kidney disease hemodialyzed. The patient had right urinoma in the retroperitoneal space before pleural effusion developed. After 3month, he complained acute dyspnea. There was no effect in resolving effusion by lowering dry weight. We thou- ght alternative diagnostic possibility, urinothorax and checked the pleural fluid to serum creatinine ratio. Finally concluded that pleural effusion was urinothorax secondary to remnant left polycystic kidney rup- ture and tried left nephrectomy. The patient showed reduction of pleural effusion. It is important to alert physician to this condition and to avoid the other invasive diagnostic study.
유지혈액투석환자에서 우회술식으로 치료된 중심정맥폐쇄증 1예
이진한,김진수,노용호,김종률,정오영,소미진,나병주,문경협 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.4
Subclavian and internal jugular vein catheters are widely employed for temporary hemodialysis access. Placement of subclavian venous catheter has many complications such as pneumothorax and hemothorax, etc. Incidence of subclavian vein obstruction due to thrombosis is probably greater than is commonly appreciated. Subclavian vein obstruction may cause no specific complaints, but thrombosis in the presence of an arteriovenous fistula may produce severe symptoms such as massive edema and pain. This is report of one patient, who developed massive edema of upper extremity and in whom proximal subclavian vein occlusion developed after previous percutaneous dialysis catheter. Right internal jugular vein to axillary vein bypass with 8mm PTFE provided prompt and effective venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of the dialysis fistula.
Vancomycin 내성 enterococci 패혈증에서 성공적인 고용량 ampicillin, imipenem, teicoplanin 병합치료 1예
김민정,박환양,마상수,박영배,이명희,김춘관,김봉석,노용호 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.3
저자들은 면역부전 환자에서 발생한 VRE 패혈증을 고용량의 ampicillin(30g/일), imipenem(2.0g/일)과 teicoplanin(400㎎/일)의 병합치료로 성공적으로 치유하여 이에 대한 증례를 보고하는 바이다. Vancomycin-resistant enterococcus (VRE) infection have become a threatening problem. VRE bacteremia, especially in immunosuppressed host, is difficult to treat and has high mortality rate, because few antimicrobial agents are available. To date, a few studies were reported about combination therapy for VRE infection in animal model. We had experienced a case of successfully treated VRE septicemia by combination of high dose ampicillin (30g/day), imipenern (2.0g/day) and teicoplanin (400㎎/day) in a neutropenic patient. A patient with acute myelogenous leukemia had developed fever after high dose chemotherapy. Physical examination showed no definite focus of clinical infection. But, he had a Hickmann catheter and his peripheral blood examination revealed neutropenia. Initially, although ceftazidime was administered for 3 days, fever was persistent and septic shock developed. Microbiologic study showed that VRE grew in his blood culture. The VRE were determined to E. faecium of Van A type and MIC of ampicillin was more than 16㎍/mL. Hickmann catheter was removed and high dose ampicillin, imipenem and teicoplanin were administered. After that, VRE bacteremia was cleared and the patient successfully recovered from septic shock.