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백선하,신호준,Ki Young Na,Dong-Wan Chae,김세중 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.3
Background: Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI. Methods: We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results: The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120-129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100-109 mmHg: HR 1.56, P = 0.038; 110-119 mmHg: HR 1.15, P = 0.483; 130-139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005). Conclusion: Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.
백선하,김은상,김동규,김현집,한대희 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.12
Far lateral disc herniation(FLDH) with compression of the nerve root as it exits through the foramen has been a recognized entity for a number of years. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the innocent interspace. If these herniation are diagnosed, they often cannot be adequately exposed by the classic minline hemilaminectomy approach. A partial or complete unilateral facetectomy to expose these herniations can lead to vertebral instability or contribute to continued postoperative back pain. The authors present 5 patients who were diagnosed as having far lateral lumbar disc herniations from 1988 to 1990. Two of these were at L_(4-5) level, two at L_(5)-S₁level and one at L_(3-4) level and all were over 60 years old. High resolution CT scan appeared to be the best study and the paramedian muscle splitting microsurgical approach, done in 3 cases, was found to be the most direct and favorable anatomical route to FLDH for vertebral stability and minimal postoperative back pain.
전신성 모세혈관 누출 증후군으로 인한 만성 신질환 1예
백선하,신나라,김효진,한미연,최동주,방수미,김세중,백진호 영남대학교 의과대학 2012 Yeungnam University Journal of Medicine Vol.29 No.2
Systemic capillary leak syndrome (SCLS) is an unusual entity characterized by hypovolemic shock, hemoconcentration, and hypo-albuminemia associated with paraproteinemia as a result of marked capillary hyperpermeability. Complications of this syndrome can include compartment syndromes, pulmonary edema, thrombosis, and acute kidney injury. This paper reports a case of severe SCLS accompanied by acute tubular necrosis caused by hypoperfusion and myoglobinuria secondary to rhabdomyolysis, which resulted in chronic kidney disease that necessitated hemodialysis. However, there have been rare data of residual end-organ damage after acute attacks in Korea. Therefore, this paper reports a case of complicated SCLS enough to hemodialysis and that developed into chronic kidney disease.
뇌종양에서 17번 염색체 단완부 소실에 관한 분자유전학적 연구
백선하,김은상,김동규,정희원,김현집,조병규,한대희,이승훈,김종현 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1
With the methods of restriction fragment length polymorphisms(RFLPs) and southern blot analysis, gene deletion of chromosome 17p in 16 cases of brain tumors, was investigated. There were 4 cases of glioblastoma multiforme, 1 case of anaplastic astrocytoma, 4 cases of low grade astrocytoma, 3 cases of oligodendroglioma, and 4 cases of meningioma. Among restriction fragment length polymorphism(RFLP) DNA located in chromosome 17p, p144D 6 and p SNZ 22 were imployed as the probes. In eight of 16 cases(50%) constitutional heterozygosity was observed for p144 D6 probe on the short arm of chromosome 17, and in nine of 16 cases(56%) for PYNZ 22.1 probe. With both probes constitutional heterozygosity was observed in thirteen of 16 cases(81%). And the loss of constitutional heterozygosity was detected in two of 14 informative cases. Although, with the malignant gliomas, including 4 cases of glioblastoma multiforme and 1 case of anaplastic astrocytoma, two of 4 informative cases showed loss of constitutional heterozygosity. None of 9 informative cases showed loss of heterozygosity with the other brain tumors(low grade astrocytoma, oligodendroglioma, and meningioma).
Electrode Position and the Clinical Outcome after Bilateral Subthalamic Nucleus Stimulation
백선하,이지영,김한준,강대희,임용훈,김미령,김철영,전범석,김동규 대한의학회 2011 Journal of Korean medical science Vol.26 No.10
We compared the surgical outcome with electrode positions after bilateral subthalamic nucleus (STN) stimulation surgery for Parkinson’s disease. Fifty-seven patients treated with bilateral STN stimulations were included in this study. Electrode positions were determined in the fused images of preoperative MRI and postoperative CT taken at six months after surgery. The patients were divided into three groups: group I, both electrodes in the STN;group II, only one electrode in the STN; group III, neither electrode in the STN. Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr stage, and activities of daily living scores significantly improved at 6 and 12 months after STN stimulation in both group I and II. The off-time UPDRS III speech subscore significantly improved (1.6 ± 0.7 at baseline vs 1.3 ± 0.8 at 6 and 12 months, P < 0.01) with least L-dopa equivalent daily dose (LEDD) (844.6 ± 364.1 mg/day at baseline; 279.4 ± 274.6 mg/day at 6 months; and 276.0 ± 301.6 mg/day at 12 months, P < 0.001) at 6 and 12 months after STN deep brain stimulation (DBS) in the group I. Our findings suggest that the better symptom relief including speech with a reduced LEDD is expected in the patients whose electrodes are accurately positioned in both STN.
백선하,오창완,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12
From January 1995 to September 1995, we enrolled 30 patients with a clinical status over Hunt and Hess grade Ⅳ, presenting within 5 days after spontaneous subarachnoid hemorrhage to determine the effectiveness in early intervention of nimodipine on short-term outcome and its safety. The blood cell count and chemistry were performed before and 7 days after nimodipine treatment, and at discharge. The clinical outcome of the patients was assessed at discharge according to the Glasgow outcome scale. There was no evidence of abnormal change in blood chemistry including liver enzyme activity during the study. Four patients experienced episodes of decreased blood pressure : in one of them, drug administration was discontinued transiently. There was no significant difference in the short-term outcome between the nimodipine treated patients in this study and aneurysmal patients treated without nimodipine in our previous study. However, four of five patients experiencing symptomatic vasospasm in this study showed good outcome at discharge. In conclusion. administration of nimodipine in the patients with spontaneous subarachnoid hemorrhage was safe and nimodipine seeemed to have beneficial effect in protecting the patients with symptomatic vasospasm from severe ischemic damages.
백선하,손영돈,정현태,김동규,조장희 대한의학회 2011 Journal of Korean medical science Vol.26 No.6
In the study we assessed the distortion of 7.0 T magnetic resonance (MR) images in reference to 1.5 T MR images in the radiosurgery of metastatic brain tumors. Radiosurgery with Gamma Knife Perfexion^® was performed for the treatment of a 54-yr-old female patient with multiple brain metastases by the co-registered images of the 7.0 T and 1.5 T magnetic resonance images (MRI). There was no significant discrepancy in the positions of anterior and posterior commissures as well as the locations of four metastatic brain tumors in the co-registered images between 7.0 T and 1.5 T MRI with better visualization of the anatomical details in 7.0 T MR images. This study demonstrates for the first time that 7.0 T MR images can be safely utilized in Perfexion^® Gamma Knife radiosurgery for the treatment of metastatic brain tumors. Furthermore 7.0 T MR images provide better visualization of brain tumors without image distortion in comparison to 1.5 T MR images.
백선하,황재하,김동규,최승홍,손철호,박성혜,손영돈,김영보,조장희 대한의학회 2014 Journal of Korean medical science Vol.29 No.7
A 45-yr-old female patient was admitted with one-month history of headache andprogressive left hemiparesis. Brain magnetic resonance imaging (MRI) demonstrated a masslesion in her right frontal lobe. Her brain tumor was confirmed as a small cell glioblastoma. Her follow-up brain MRI, taken at 8 months after her initial surgery demonstrated tumorrecurrence in the right frontal lobe. Contrast-enhanced 7.0T brain magnetic resonanceimaging (MRI) was safely performed before surgery and at the time of recurrence. Compared with 1.5T and 3.0T brain MRI, 7.0T MRI showed sharpened images of the braintumor contexture with detailed anatomical information. The fused images of 7.0T and 1.5Tbrain MRI taken at the time of recurrence demonstrated no significant discrepancy in thepositions of the anterior and the posterior commissures. It is suggested that 7.0T MRI canbe safely utilized for better images of the maligant gliomas before and after surgery.