http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
변승운 ( Seung Woon Byun ),이지영 ( Ji Young Lee ),박정식 ( Jung Sik Park ),박수길 ( Su Kil Park ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
A 41-year-old female was admitted for a subcapsular hematoma of her graft kidney six weeks after she underwent a kidney transplant. No report on subcapsular hematomas of graft kidneys has been published in Korea. Subcapsular hematoma of graft kidneys is one of a few very rare causes of bleeding. The clinical manifestations of subcapsular hematoma are the abrupt onset of flank pain or upper abdominal pain, nausea, anorexia, dizziness, and decrease in hemoglobin. If it is diagnosed late, it can result in renal insufficiency, hypovolemic shock, and even death. During the authors` management of a subcapsular hematoma of a renal graft, pure red cell aplasia induced by the parvovirus B19 was found to coexist. Bone marrow suppression, immunosuppressants and other drugs, bleeding, iron deficiency, and renal graft function insufficiency can result in anemia after a kidney transplant. Even though pure red cell aplasia is a rare cause of anemia, it should not be forgotten that pure red cell aplasia induced by parvovirus B19 infection can cause anemia after a kidney transplant.
변승운 ( Seung Woon Byun ),최성호 ( Seong Ho Choi ),박현구 ( Hyun Gu Park ),김범준 ( Beom Jun Kim ),김의영 ( Eui Young Kim ),이규형 ( Kyoo Hyung Lee ),양원석 ( Won Seok Yang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4
저자들은 비타민의 공급 없이 총정맥영양법을 시행 중에 발생한 젖산산증에서 티아민 공급 후 수시간 이내로 산증이 교정된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이며, 티아민을 공급하지 않는 총정맥영양법을 장기적으로 시행 중 발생한 젖산산증에는 티아민 결핍에 의한 젖산산증의 가능성을 반드시 염두에 두어야 할 것으로 사료된다. Lactic acidosis commonly occurs in association with shock. We encountered lactic acidosis in a patient with normal blood pressure. The patient was a 17 year-old man with acute lymphocytic leukemia. He was admitted for bone marrow transplantation. During hospitalization, he relied on total parenteral nutrition due to his poor oral intake. On the 37th day after admission, he developed lactic acidosis without an episode of hypotension or any causative medication. Because vitamins were not included in the parenteral nutrition, we prescribed thiamine replacement, and this corrected the acidosis within a few hours. Thiamine (in its active derivative) is a coenzyme for pyruvate dehydrogenase; thus, its deficiency causes accumulation of pyruvate and lactate. This case suggests that thiamine deficiency should be included in a differential diagnosis of lactic acidosis in patients who are on total parenteral nutrition without vitamin supplementation.(Korean J Med 73:443-447, 2007)
신이식 후 발생한 Posttransplant Lymphoproliferative Disease
변승운 ( Seung Woon Byun ),박혜원 ( Hye Won Park ),송주형 ( Ju Hyung Song ),오지선 ( Ji Seon Oh ),김은희 ( Eun Hee Kim ),허주령 ( Joo Ryung Huh ),서철원 ( Cheol Won Suh ),박수길 ( Su Kil Park ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.5
Posttransplant lymphoproliferative disorders (PTLD) is an infrequent but serious complication of transplantation. Previous studies have suggested the terms of reference, early PTLD (referring to PTLD that occurs within 1 year of transplantation) and late PTLD (PTLD that occurs after 1 year). Early PTLD generally involves a single organ or nodal region and often responds favorably to a decrease in immunosuppression. Late PTLD tends to be disseminated, responds less frequently to a decrease in immunosuppression, and has a dismal prognosis. We encountered a diffuse large B-cell lymphoma in a 44-year-old man who underwent kidney transplantation over 10 years ago, in 1995. In situ hybridization for Epstein-Barr virus showed positive results in tumor cell. With decreased immunosuppressants and chemotheraphy, he is currently in complete remission. Korean J Nephrol 2006;25(5): 871-876)
만성 항체 매개성 거부 반응에서 경정맥 면역 글로불린으로 치료한 1예
변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),박정식 ( Jung Sik Park ),조영미 ( Yong Mee Cho ),박수길 ( Su Kil Park ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
A 66-year-old male was admitted for increasing azotemia. He was diagnosed with chronic antibody-mediated rejection and had received a livingdonor renal transplant from his 32-year-old son prior to his admission. The peritubular capillaries of his kidney were diffusely positive on C4d immunostaining. It is known that there is an agreement between C4d staining and serological and histopathological data during rejection that is thought to have a humoral component. The role of alloantibodies in chronic renal allograft deterioration and the corresponding morphologic changes have been increasingly recognized during the recent years. However the treatment guidelines for chronic antibody-mediated rejection have not yet been established. Intravenous immunoglobulin (IVIG) has been shown to decrease the titers of anti-HLA antibodies in highly sensitized patients awaiting transplant. There are also numerous proposed mechanisms regarding how IVIG exerts its immunomodulatory action. As we have experienced chronic antibody-mediated rejection and how IVIG treatment improves renal function, we recognize that IVIG has the potential to be used for treating certain subgroups of chronic allograft nephropathy patients with positive C4d staining and anti-HLA antibodies.
혈액 투석 환자에서 epoetin alfa와 darbepoetin alfa의 조혈 효과 비교: 무작위 교차 연구
이지영 ( Ji Young Lee ),변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),양원석 ( Won Seok Yang ),박수길 ( Su Kil Park ),박정식 ( Jung Sik Park ),장재원 ( Jai Won Chang ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Purpose: We aim to compare the erythropoietic effects of epoetin-α (EA, 4000 IU SC thrice a week) with those of darbepoetin-α (DA, 60ug IV weekly, conversion rate to EA=200:1). Methods: Forty one stable hemodialysis patients were enrolled in this randomized crossover study. After a washout period of erythropoietin stimulating agents (ESA), the patients with hemoglobin (Hb) level of ≤11.0 g/dL were randomly assigned to DA or EA and we measured Hb and reticulocyte levels. When Hb reached >11.0 g/dL, we stopped ESA. When Hb level decreased to ≤11.0 g/dL again, we switched to alternative ESA and repeated the rest of the steps. Results: Thirty six patients (M:F=20:16, age 62±11 years, Kt/V 1.65, nPCR 1.13 g/kg/day) completed the study. No significant differences were observed in baseline parameters between DA and EA during the period of the clinical trial. The rate of Hb level increase (EA 0.29 g/dL/week, DA 0.30 g/dL/week, p=0.76) and decrease (EA 0.45 g/dL/week, DA 0.38 g/dL/week, p=0.14) were not different between two periods. After ESA stopped, the duration of decreased Hb level of ≤11.0 g/dL was not significantly different (4 weeks in EA vs. 3.9 weeks in DA, p=0.86). Erythropoietin resistance index was 10.59 in the EA period. It was not significantly different from 10.97 in DA period (p=0.49). Nine patients (25%) showed a >30% change in EA efficiency relative to DA efficiency. Conclusion: There was no significant difference in erythropoietic parameters for both EA and DA.
투석 : 혈액 투석환자에서 Darbepetin-α와 Epoetin-α의 Erythropoiesis 효과의 비교: 무작위 교차 연구
이지영 ( Ji Young Lee ),변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),장재원 ( Jai Won Chang ),양원석 ( Won Seok Yang ),김순배 ( Soon Bae Kim ),박수길 ( Su Kil Park ),이상구 ( Sang Koo Lee ),박정식 ( Jung Sik Park ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1
송주형 ( Ju Hyung Song ),서동완 ( Dong Wan Seo ),변승운 ( Seung Woon Byun ),구동회 ( Dong Hoe Koo ),배정호 ( Jung Ho Bae ),이상수 ( Sang Su Lee ),이성구 ( Sung Koo Lee ),김명환 ( Myung Hwan Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.5
목적: 중증 괴사췌장염 환자에서 괴사 조직의 감염은 50% 이상의 높은 사망률의 주요 원인이며, 이 경우 즉각적인 수술 치료를 추천하고 있다. 그러나 감염의 초기에 수술치료를 하는 것은 높은 사망률을 보이기 때문에 보다 안전한 치료 방법을 모색하는 것이 필요하다. 대상 및 방법: 이번 연구에서는 지난 16년간 입원했던 중증 괴사췌장염 환자를 대상으로 후향 연구를 시행하였고, 감염이 의심된 경우 세침흡입 검사를 통해 균 동정을 시도하였고 경피배액술을 포함한 적극적인 내과 치료를 시행하였다. 결과: 총 71예의 중증 괴사췌장염 환자 중 46예에서 감염이 의심되었고 21예에서 세침흡입 검사로 균이 동정되었다. 이 중 19예에서 초기 적극적인 내과 치료를 시행하였으나, 4예에서 치료 도중 감염이 조절되지 않아 수술 치료로 전환하였다. 내과 치료의 성공률은 79% (15/19)였고, 사망률은 5% (1/19)였다. 결론: 이번 연구에서는 감염 초기에 적극적인 내과 치료를 하는 것이 수술 치료와 비슷하거나 우수한 결과를 보여주었다. 이는 감염이 동반된 괴사췌장염의 치료로 조기 수술이 아닌 내과 치료가 바람직한 방법으로 이용될 수 있음을 시사한다. Background/Aims: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. Methods: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score≥8, or Ranson`s score≥3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. Results: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). Conclusions: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding. (Korean J Gastroenterol 2006;48:337-343)
신 이식 환자에서 Sirolimus 투여 후 발생한 간질성 폐렴 1예
이지영 ( Ji Young Lee ),김선영 ( Sun Young Kim ),변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),장재원 ( Jai Won Chang ),양원석 ( Won Seok Yang ),김순배 ( Soon Bae Kim ),박정식 ( Jung Sik Park ),박수길 ( Su Kil Park ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5
Sirolimus is a promising immunosuppressive drug for renal transplantation to avoid nephrotoxicity of calcineurin inhibitor. However, it has been associated with uncommon but, important pulmonary toxicity. We present a case of sirolimus related dyspnea with abnormal chest radiographic finding in a 63 year old male renal transplantation recipient. There was no evidence of bacterial, fungal, or viral infection. Dose reduction of sirolimus resulted in a significant improvement of the symptoms and chest radiographic finding.