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Analysis of the risk factors of acute kidney injury after total hip or knee replacement surgery
( Yoo Jin Lee ),( Bong Soo Park ),( Sihyung Park ),( Jin Han Park ),( Il Hwan Kim ),( Junghae Ko ),( Yang Wook Kim ) 영남대학교 의과대학 2021 Yeungnam University Journal of Medicine Vol.38 No.2
Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients’ preoperative estimated glomerular filtration rate (eGFR) was 66.66±34.02 mL/min/1.73 ㎡ in the AKI group and 78.07±21.23 mL/min/1.73 ㎡ in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.
김태홍 ( Taehong Kim ),김태형 ( Tae Hyung Kim ),이원혁 ( Won Hyuk Lee ),이유진 ( Yoo Jin Lee ),박시형 ( Sihyung Park ),박봉수 ( Bong Soo Park ),김양욱 ( Yang Wook Kim ) 대한내과학회 2016 대한내과학회지 Vol.91 No.3
대장 내시경 검사에서 장 정결은 필수적인 조건이며, 이를 위해선 장 정결제가 반드시 필요하고 정결제는 각기 다른 특성을 지니고 있다. 따라서 정상 신기능을 가진 환자라도 대장 내시경의 목적 및 환자의 증상에 따라 장 정결제 선택에 주의를 해야 할 것으로 생각된다. Most reported cases of hypermagnesemia are related to laxative abuse and impaired renal function, while hypermagnesemia is uncommon without iatrogenic magnesium administration and decreased renal function. Magnesium-containing bowel-cleansing agents are widely used before colonoscopy, usually without complications. However, we experienced a case of symptomatic hypermagnesemia with normal renal function after using a bowel-cleansing agent. A 74-year-old man with normal renal function complained of lethargy and motor weakness after taking a bowel-cleansing agent containing 14 grams of magnesium before a colonoscopy for hematochezia. His magnesium level was 12 mg/dL. Fluid stasis in the gut due to colonic obstruction might have caused the hypermagnesemia. He was treated successfully with a bowel enema and intravenous calcium. We should be cautious when prescribing drugs for colonoscopy if colonic obstruction is suspected. (Korean J Med 2016;91:306-310)
Aerococcus urinae에 의한 합병된 요로감염 패혈증
허창민 ( Chang Min Heo ),조경민 ( Kyeong Min Jo ),장지훈 ( Ji Hoon Jang ),이유진 ( Yoo Jin Lee ),박봉수 ( Bong Soo Park ),김양욱 ( Yang Wook Kim ),박시형 ( Sihyung Park ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2
요양 시설에서 지내던 83세 여성이 요로감염으로 입원하였으며 혈액 배양의 염기서열 분석에서 Aerococcus urinae가 동정되었다. 항생제 감수성 결과에 따라 ceftriaxone을 총 3주간 투여하였고 요로결석은 자연적으로 배출되어 환자는 합병증 없이 완치되었다. 오염균으로 오인될 수 있는 A. urinae는 요로감염, 심내막염을 비롯한 심각한 감염 등을 일으킬수 있는 원인 균임을 인지해야 한다. Aerococcus urinae is a gram-positive coccus that produces alpha-hemolysis on blood agar and is negative for catalase. A. urinae can often be misidentified as a streptococcus, staphylococcus, or enterococcus by most commercial identification systems. Although A. urinae is a rarely reported human pathogen, it can be fatal in some cases. Here we report on a case of urosepsis caused by A. urinae, identified by 16S rRNA gene sequencing in a patient with ureter stones and hydronephrosis, for the first time in Korea. It is important for physicians to consider A. urinae as a potential pathogen and to prescribe the most suitable antibiotics to ensure the best outcome. (Korean J Med 2016;91:229-232)