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혈액투석을 위한 내경정맥 도관 삽입 중 진단한 무형성 우상대정맥 및 지속성 좌상대정맥 1 예
이태유(Tae Yu Lee),김근숙(Keun Sook Kim),정연손(Youn Son Chung),진희종(Hee Jong Jin),민영훈(Young Hoon Min),조구영(Goo Yeong Cho),박홍석(Hong Suk Park),김근호(Gheun Ho Kim),김성욱(Sung Wook Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4
Persistent left superior vena cava(PLSVC) derives from abnormally persistent patency of an embryological vessel normally present during the early developmental period. The incidence of PLSVC is 0.3% in healty persons, 4.8% in patients with congenital heart anomaly. Most of the patients with PLSVC have normal right superior vena cava (RSVC), but PLSVC plus absent RSVC is very rare, especially in those without congenital heart anomalies. We experienced a case of PLSVC and absent RSVC during an insertion of internal jugular venous catheter for acute hemodialysis. A 53-year-old female was admitted due to uremia for initiation of dialytic therapy. She had long history of diabetic nephropathy but without congenital heart anomalies. We inserted a dual lumen catheter for acute hemodialysis via right internal jugular vein. On the chest x-ray film taken after the insertion of the catheter, we detected unusual course of the catheter curved to the left. PLSVC and absent RSVC was confirmed by normal saline contrast echocardiography and CT angiograpy.
초기 동맥혈 Carboxyhemoglobin 농도가 높았던 화상 환자들의 예후지표에 관한 연구
최창순 ( Choe Chang Sun ),김철홍 ( Kim Cheol Hong ),김근숙 ( Kim Geun Sug ),이태유 ( Lee Tae Yu ),정연손 ( Jeong Yeon Son ),엄광석 ( Eom Gwang Seog ),박용범 ( Park Yong Beom ),장승훈 ( Jang Seung Hun ),김동규 ( Kim Dong Gyu ),박 대한결핵 및 호흡기학회 2003 Tuberculosis and Respiratory Diseases Vol.55 No.2
김성욱 ( Sung Wook Kim ),민영훈 ( Young Hoon Min ),진희종 ( Hui Jong Chin ),이태유 ( Tae Yu Lee ),최창순 ( Chang Soon Choi ),정연손 ( Youn Son Chung ),김근숙 ( Gun Sook Kim ),김근호 ( Gheun Ho Kim ),김종현 ( Jong Hyun Kim ),박윤규 대한내과학회 2002 대한내과학회지 Vol.63 No.5
N/A Background : Acute renal failure (ARF) is not a rare occurrence in severe burns and is an important complication leading to an increase in mortality. This study was undertaken to characterize the ARF occurring in major burn patients and to investigate the impact of burn size and initial serum albumin concentration on the occurrence of ARF and patient survival in major burns. Methods : The clinical characteristics of 147 adult patients with second- and third-degree burns covering 30% or more of their body surface area were analyzed retrospectively. All patients were admitted over a 1-year period to a single burn intensive care unit in Seoul, Korea. Logistic regression was used to estimate of the relative risks of ARF and mortality associated with the larger burn size and the lower serum albumin level at admission. Results : Mean burned body surface was 60.0±21.8% (range, 30 to 100%). Twenty-eight (19.0%) out of 147 patients experienced ARF, defined as a serum creatinine > 2 mg/dL, during the admission. The ARF was preceded by significant hypotension (burn shock), rhabdomyolysis, sepsis or use of aminoglycosides. The occurrence of ARF was not associated with age, sex or burn type. The patients with ARF had larger burn size (79.5±15.4% vs. 55.3±20.5%, p<0.0001) and lower serum albumin concentration at admission (1.92±0.66 g/dL vs. 2.48±0.82 g/dL, p<0.0005) compared with those without ARF. All patients with ARF expired, whereas 29.4% (35/119) of the patients without ARF died. The burn size > 65% was associated with a risk of ARF that was 9.9 times and with a risk of death that was 14.2 times as high as that for the burn size < 65%. The initial serum albumin level < 2.5 g/dL was associated with a risk of death that was 2.7 times as high as that for the initial serum albumin level > 2.5 g/dL. Conclusion : When major burns are complicated by ARF, the mortality increases very high. Burn size is an independent predictor of ARF occurring in major burns. Initially depressed serum albumin level is associated with an increase in mortality in the major burn patients. (Korean J Med 63:539-545, 2002) Key Words : Acute renal failure, Burn, Albumin, Burn size, Mortality
화상 환자에서 발생한 외과적 중재술을 요하는 감염성 심내막염 2예
김근숙,이태유,정연손,최창순,최민호,류제헌,김철홍,조구영,우흥정 대한감염학회 2003 감염과 화학요법 Vol.35 No.3
감염성 심내막염은 화상 후에 발생할 수 있는 치명적인 합병증이다. 임상 증상은 일반적으로 없는 경우가 대부분이고 지속되는 발열과 양성 혈액 배양 검사가 유일하다. 감염의 다른 확실한 원인 없이 발열과 양성 혈액 배양 검사가 있을 때는 감염성 심내막염을 강력하게 의심해야 하며 심장 초음파로 진단 가능하다. 감염성 심내막염은 사망률은 높지만 초기에 진단하면 항생제 정주를 지속하는 것으로 치료할 수 있다. 저자들은 화상환자에서 발생한 수술적 처치를 필요로 하는 감염성 심내막염 2예를 경험하였기에 보고하는 바이다. Infective endocarditis is a rare but fatal complication following burn injury. The clinical presentation is silent, but with persistent fever and positive blood culture. The manipulation of clinical care as well as the burn wound itself and immunosuppression caused by extensive bums puts the burn patients at risk of bacteremia. Staphylococcus aureus and Gram-negative bacilli are most common pathogens of infective endocarditis following burns. We report herein two cases of infective endocarditis in the burn patients who requires surgical intervention. The first case was caused by Pseudomonas aeruginosa with complication of multifocal pneumonia, and the second case by coagulase-negative stapylococcus with cerebral hemorrhage.