• Proceedings of the KSCN Conference
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• 2004.05a
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• pp.417-417
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• 2004

지속성복막투석환자의 경우 투석에 의해 단백질 대사물질의 배설은 효과적으로 이루어지나 오랫동안의 만성신부전으로 인한 인의 배설 저하에 따라 골밀도가 대부분 저하되어 있으며 신성골이영양증을 수반하는 경우가 많다. 본 연구에서는 종합병원 신장내과 클리닉에 정기적 checkup을 받고 있는 지속성복막투석환자를 대상으로 골밀도를 측정하였으며 요추(L2-L4)와 대퇴부(femoral neck, trochanter)의 평균 골밀도의 T값이 모두 -1 미만인 군을 골감소증군으로 하였고(N=86) 1군데라도 T값이 -1 이상인 군은 정상군으로(N=32) 분류하여 영양소섭취량, 식행동, 우울정도에 따른 차이를 보고자 하였다.(중략)

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.252-259
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• 2005

To clarify the clinicopathologic features of small-cell carcinomas (SCC) of the stomach, we reviewed three cases of surgically treated SCC. The first case was a pure SCC, with severe pancreatic invasion and peritoneal seeding. A gastro-jejunostomy was performed. Postoperative chemotherapy was performed with CDDP and VP-16 (8 cycles) but showed disease progression (PD); a consecutive chemotherapy with CDDP and irinotencan (2 cycles) also showed PD. A third line with CDDP, VP16, ifosfamide, and mesna was followed by a 4th line (CDDP and Taxol). The male patient died with liver metastasis and peritoneal seeding 14 months after the operation. The second case was a SCC mixed with a poorly differentiated adenocarcinoma. Profound lymphadenopathy and liver metastasis were found. Two cycles of preoperative chemotherapy with TS-1 and CDDP were performed, which showed nearly complete remission for lymphadenopathy and partial response for the primary tumor site and liver metastatic lesion. A total gastrectomy and extended lymphadenectomy was performed. There were no viable cancer cells in 35 retrieved lymph nodes. Postoperative chemotherapy using the same regimen was performed for 4 cycles. Enlarged liver metastasis was found at the follow-up CT scan, so a posterior segmentectomy of liver was performed. After liver surgery, the chemotherapy regimen was changed to irinotecan and cisplatin. This male patient has been in good health for the f4 months since gastric surgery. The third case was a pure SCC, and a subtotal gastrectomy was performed curatively. That male patient received 5 cycles of TS-1 and is still in good health 14 months after operation.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.146-151
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• 2005

Background: Preoperative elevated serum creatinine values are associated with increased risk for both morbidity and mortality in patients undergoing on-pump coronary artery bypass surgery (CABG). We investigated the postoperative changes of renal function and proper management in the patients. Material and Method: Among 74 consecutive patients who underwent isolated on-pump CABG, 17 patients with increased serum creatinine level $(creatinine\;\geqq\;1.5\;mg/dL)$ within preoperative one week wereincluded in the study. Seven patients showed pre­operative serum creatinine level of 2.0 mg/dL or higher, and 3 of them had been undergoing hemodialysis. Preoperative hemodialysis was performed in the 3 patients due to end-stage renal failure (ESRD) the day before the operation. We started peritoneal dialysis immediately after the cardiopulmonary bypass in patients with ESRD or postoperative acute renal failure if it was necessary to remove intravascular volume and lower serum creatinine level. Result In most of the patients with CABG, postoperative serum creatinine level increased and recovered to the preoperative level at the discharge. In 2 of the 4 patients with serum creatinine level of 2.0 mg/dL or higher and 3 patients with ESRD, intravascular volume, serum creatinine level and serum electrolyte were controlled with peritoneal dialysis. Conclusion: Postoperative serum creatinine level increased transiently in most of CABG patients, and intravascular volume and serum creatinine level were controlled by peritoneal dialysis only in the patients with acute renal failure postoperatively and those depending on hemodialysis.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.34-40
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• 2009

Background: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. Material and Method: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. Result: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr ${\geq}$1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. Conclusion: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.

• Proceedings of the KSCN Conference
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• 2004.05a
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• pp.418.1-418
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• 2004

지속성 복막투석환자의 경우 오랫동안의 만성신부전으로 인해 영양소 섭취가 저하되어 근육의 손모, 체중감소 등으로 인해 골밀도에 부정적인 영향을 미치게 된다. 본 연구에서는 요추(L2-L4)와 대퇴부(femoral neck, trochanter)의 평균 골밀도의 T값이 모두 -1 미만인 군 86명과(골감소증군), 두 부위중 1군데 이상의 T값이 -1 이상인 군 32명 (정상군)을 대상으로 하여 신체계측치 및 생화학적 표지자, 생활습관의 차이를 조사하였다.(중략)

• The Monthly Diabetes
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• s.184
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• pp.24-27
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• 2005

일반적으로 만성신부전이라고 부르는 상태가 되면 치료의 목표는 신장기능의 악화를 막는 것에서 신장기능악화로 인하여 생기는 합병증을 예방하거나 치료하는 쪽으로 이동하게 된다.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.213-220
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• 2008

Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06$\pm$15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2%), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.247-255
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• 2007

Background: Lung injury that follows bypass has been well described. It is manifested as reduced oxygenation and lung compliance and, most importantly, increased pulmonary vascular resistance reactivity; this is a known cause of morbidity and mortality after repair of congenital heart disease. Injury to the pulmonary vascular endothelium, and its associated alterations of endothelin-1, is considered to be a major factor of bypass-induced lung injury. Removing endothelin-1 after bypass may attenuate this response. This study measured the concentration of serum and peritoneal effluent endothelin-1 after performing bypass to determine if endothelin-1 can be removed via peritoneal dialysis. Material and Method: From March 2005 to March 2006, 18 patients were enrolled in this study Peritoneal catheters were placed at the end of surgery. Serum samples were obtained before and after bypass, and peritoneal effluents were obtained after bypass. Endothelin-1 was measured by enzyme linked immunosorbent assay (ELISA). Result: In the patients with a severe increase of the pulmonary artery pressure or flow, the mean preoperative plasma endothelin-1 concentration was significantly higher than that in the patients who were without an increase of their pulmonary artery pressure or flow (4.2 vs 1.8 pg/mL, respectively, p<0.001). The mean concentration of plasma endothelin-1 increased from a preoperative value of $3.61{\pm}2.17\;to\;5.33{\pm}3.72 pg/ml$ immediately after bypass. After peritoneal dialysis, the mean plasma endothelin-1 concentration started to decrease. Its concentration at 18 hours after bypass was significantly lower than the value obtained immediately after bypass (p=0.036). Conclusion: Our data showed that the plasma endothelin-1 concentration became persistently decreased after starting peritoneal dialysis, and this suggests that peritoneal dialysis can remove the circulating plasma endothelin-1.

• Childhood Kidney Diseases
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• v.2 no.2
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• pp.95-103
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• 1998

Purpose : To find and solve the common problems of peritoneal dialysis(PD) by analysing the clinical data of pediatric PD performed in Korea. Methods : 264 cases of CAPD and acute PD had been performed from Nov.1987 to Oct. 1997 in 17 institutions of pediatric nephrology in Korea. Results : CAPD was performed in 114 cases. The mean age of the patients was $10.5{\pm}6.6$ years and male to female ratio was 1.4:1. The original renal diseases of ESRD were proven in 92 cases($80\%$). The common renal disease of ESRD were FSGS($17\%$), reflux nephropathy ($11\%$), chronic glomerulonephritis($9.6\%$). Mean duration of CAPD was $20{\pm}16.9$ months. Peritonitis was the most common complication and incidence was one episode/18.2 patient-months. Other complications were exit site infection in 10 cases, obstruction in 7 cases, leakage of dialysate in 6 cases. The most common etiologic organism of peritonitis was staphylococcus aureus and the next was staphylococcus coagulase(-). Acute PD was performed in 150 cases. Most common underlying causes were congenital heart disease, hemolytic uremic syndrome, sepsis and dehydration. The mean duration was $10.3{\pm}11.3$ days. The most common complication was peritonitis($20.6\%$). The most common etiologic organism was staphylococcus aureus and coagulase(-), acinetobactor and pseudomonas. Conclusion : Reflux nephropathy should be emphasized in early diagnosis and treatment to prevent ESRD. Incidence of congenital anomaly($7\%$) as a original disease of ESRD was relatively low in Korea. Growth status was not significantly improved after CAPD. In acute PD, the incidence of peritonitis was rapidly increased at 2weeks after beginning of dialysis.

• Journal of Gastric Cancer
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• v.1 no.3
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• pp.136-143
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• 2001

Purpose: The prognosis for gastric cancer with peritoneal seeding is very poor, and the role of surgical intervention is limited. We evaluated the effect of radical removal of primary and metastatic lesions on survival in gastric cancer with peritoneal seeding. Materials and Methods: From May 1989 to March 1999 at Kosin University Gospel Hospital, 115 patients revealed gastric cancer with peritoneal seeding but without liver or lung metastasis and without follow-up loss. The study group included 86 patients who underwent surgery for radical removal of primary gastric and metastatic peritoneal lesions. The control group included 29 patients who experienced incomplete removal of primary or metastatic lesions. Both groups received intraoperative intraperitoneal chemotherapy using mytomycin or cisplatin, and 25 patients underwent postoperative intravenous chemotherapy. Results: The median survival times in the study and the control groups were 13 months and 4 months, respectively (p<0.0001). The 1-year, 2-year, and 5-year survival rates were, respectively, $50.6\%,\;18.1\%$, and $11.3\%$ in the study group and $14.8\%,\;3.7\%$ and $0\%$ in the control group (p<0.0001). In the study group, neither postoperative intravenous chemotherapy nor microscopic invasion of the resection margin had any effect on survival, but intraoperative intraperitoneal chemotherapy and degree of peri-toneal seeding, especially the amount of peritoneal seeding, had an effect on survival. In the control group, neither intraperitoneal nor intravenous chemotherapy had any effect on survival, but resection of the primary gastric lesion improved survival. Conclusion: Radical removal of primary gastric and metastatic peritoneal lesions improved the survival rate for gastric cancer with peritoneal seeding. However, a randomized prospective study is needed to correctly evaluate the effect of intraperitoneal or intravenous chemotherapy.