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수술 받은 과거력이 없는 고령 환자에 발생한 횡행결장간막 탈장 1예
박훈석 ( Hoon Suk Park ),김진일 ( Jin Il Kim ),김명석 ( Myoung Seok Kim ),김순섭 ( Soon Sub Kim ),조세현 ( Se Hyun Cho ),박수헌 ( Soo Heon Park ),한준열 ( Joon Yeol Han ),김재광 ( Jae Kwang Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.4
Internal hernia is defined as the herniation of viscera through an anatomic or pathologic opening within the boundaries of peritoneal cavity. Transmesocolic hernia, a subtype of internal hernia, has a herniated sac through the transverse mesocolon. Transmesocolic hernia has been rarely described in the literature, and most of reported cases were associated with a history of operation or congenital anormaly. A 72-year-old female with chronic intermittent abdominal pain and bloating was admitted. Small bowel series showed multiple jejunal loops confined to the left upper quadrant of abdomen. Abdomen spiral computed tomography (CT) showed a cluster of mildly dilated small bowel loops with mesenteries on the same area. On the three-dimensional reconstruction CT scan, a herniated sac through the transverse mesocolon was identified. She was diagnosed as transmesocolic hernia by using the three-dimensional reconstruction CT and small bowel series, without surgical exploration. The symptoms were managed with conservative measures. (Korean J Gastroenterol 2006;48:286-289)
혈액투석 환자에서 혈관접근로의 동맥 미세석회화가 관상동맥 석회화와 심혈관 사망률에 끼치는 영향
이영복 ( Yeong Bok Lee ),최보미 ( Bo Mi Choi ),황현석 ( Hyeon Seok Hwang ),박훈석 ( Hoon Suk Park ),박순철 ( Sun Chul Park ),김영옥 ( Young Ok Kim ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3
목적: 혈액투석 환자에서 혈관접근로의 AMiC와 관상동맥 석회화 간의 상관관계 및 AMiC 유무가 심혈관 사망률에 미치는 영향을 조사하였다. 방법: 2011년 4월부터 2015년 5월까지 혈관접근로 수술과 CACS 검사를 시행한 119명의 환자를 대상으로 하였다. 혈관접근로의 AMiC는 수술 중 획득한 동맥 표본의 von Kossa 염색으로 진단하였다. 모든 환자는 비조영 증강 다중 검출 컴퓨터단층촬영을 시행하여 CACS를 계산하였다. 대상 환자에서 AMiC와 CACS의 상관관계를 조사하였다. 또한 2017년 2월까지 추적 조사하였고 환자를 AMiC 유무에 따라 두 군으로 나누어 심혈관 사망률을 비교하였다. 결과: 남녀 대상자 수는 각각 76명(64%)과 43명(36%)이었고 평균 나이는 64.3 ± 13.0세였다. 67명(56%)의 환자에서 von Kossa 염색에서 혈관접근로의 AMiC가 관찰되었고 평균 CACS는 430.4 ± 720.2였으며 99명(83%)의 환자에서 관상동맥 석회화가 관찰되었다. 다중 로지스틱회귀분석 결과 CACS(OR: 1.002, 95% CI: 1.001-1.004, p < 0.05)는 AMiC와 유의한 상관관계를 보였다. 추적 관찰 기간 동안 전체 사망은 26명이었고 그중 17명이 심혈관 사망이었다. Kaplan-Meier 생존분석에서 AMiC 양성인 군에서 음성인 군에 비해 심혈관 사망률(log rank = 9.0, p < 0.05)이 유의하게 높았다. 결론: 본 연구는 혈액투석 환자에서 AMiC와 CACS와 밀접하게 연관되어 있으며 AMiC와 CACS는 심혈관 질환 사망의 위험 인자임을 시사한다. Background/Aims: The aim of this study was to explore the relationship between arterial micro-calcification (AMiC) and coronary artery calcification, and to determine the impact of AMiC on cardiovascular mortality in incident hemodialysis patients. Methods: One hundred and nineteen hemodialysis patients who received vascular access surgeries between April 2011 and May 2015 were included in this study. AMiC was diagnosed by pathologic examination of arterial specimens acquired during surgery, using von Kossa stain. All patients underwent multi-detector computed tomography imaging, and coronary artery calcium scores (CACS) were calculated. We evaluated the association between AMiC and CACS in these patients, and examined the incidence of cardiovascular death (through Febraury 2017) in patients with and without AMiC. Results: The mean age of the patient group was 64.3 ± 13.0 years, and 64% were male (n = 76). Of 119 patients, 67 (56.3%) were positive for AMiC of the vascular access. The mean CACS was 430.4 ± 720.2 (0-3,954), and 99 patients were considered positive for CAC (83.1%). By multivariate logistic regression analysis, CACS was independently associated with AMiC. The mean follow- up period was 35.5 ± 17.8 months. During this time there were 26 all-cause deaths, of which 17 were cardiovascular. Kaplan-Meier survival analysis revealed that AMiC was associated with cardiovascular mortality (log rank = 9.0, p < 0.05). Conclusions: AMiC may be associated with coronary artery calcification in incident hemodialysis patients, and may also be a risk factor for cardiovascular mortality. (Korean J Med 2017;92:269-276)