• Childhood Kidney Diseases
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• 제7권2호
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• pp.133-141
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• 2003

목적 : 막성 신병증은 소아에서 드문 신질환이다. 저자들은 일차성 막성 신병증의 임상 경과의 이해와 치료 방침의 결정에 도움을 주고자 일차성 환자들을 후향적으로 고찰하였다. 방법 : 1977년부터 2003년에 소아 막성 신병증 환자 58명 중 42명(72.4%)이 B형 간염 연관성이었고, 16명(27.6%)이 일차성이었다. 2000년 이후 진단된 환자는 모두 일차성이었다. 임상-병리학적 소견(성별, 연령, 단백뇨, 혈청 알부민, 콜레스테롤, 크레아티닌 청소율, 신세뇨관-간질 변화, 신사구체 경화증, 고혈압, 신정맥혈전증, ACE inhibitor 및 면역억제제 사용력)을 조사하였고, 관해군과 비관해군 간 비교를 하였다. 결과 : 남자 6명, 여자가 10명이었고, 진단 시 중앙 연령은 13세 5개월이었다. 발현 증상은 신증후군(7명, 43.8%), 육안적 혈뇨(5명, 31.3%)와 현미경적 혈뇨 및 단백뇨(3명, 18.8%)였다. 고혈압(2명, 12.5%), 신정맥 혈전증(2명, 12.5%)과 저칼슘성 테타니(1명)가 동반되었다. 조직소견 상범사구체성(6명, 37.5%) 또는 분절성 경화증(5명, 31.3%), 반월체(1명)와 경도(11명, 68.7%) 또는 중등도의 신세뇨관-간질 변화(3명, 18.8%)가 보였다. 13명(86.7%)이 스테로이드를 투여 받았고, 이 중 2명은 cyclophosphamide, 1명은 cyclosporin을 투여 받았다 10명(52.5%)은 ACE inhibitor를 투여받았다. 진단 1개월 후 누락된 1명을 제외하고, 7명(46.7%)에서 단백뇨가 소실되었고, 8명(53.3%)은 단백뇨가 지속되었으며, 그 중 2명(13.3%)은 만성신부전으로 진행하였다. 관해군과 비관해군간에 임상-조직 병리학적 소견은 유의한 차이가 없었다. 결론 : 우리나라 소아에서 막성 신병증은 일차성이 막성 신병증의 대부분을 차지하게 되었는데, 그 이유는 B형 간염 예방 접종 도입 이후 B형 간염 연관성 막성 신병증이 현저하게 감소하였기 때문이다. 이 질환의 임상 경과의 이해와 치료 방침의 확립을 위해서 다기관의 전향적 연구가 필요하다.

• 대한정형외과학회지
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• 제56권6호
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• pp.504-511
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• 2021

목적: 양측 슬관절 퇴행성 관절염으로 동시에 시행하는 양측 인공 슬관절 전치환술(simultaneous bilateral total knee arthroplasty, SBTKA)의 정맥 투여 금기에 해당하는 환자를 포함하여 관절강 내 트라넥삼산(tranexamic acid, TXA) 투여 후 배액량, 실혈량, 수혈률, 수혈량 및 합병증 발생의 차이를 비교해 보고자 하였다. 대상 및 방법: 2016년 4월부터 2018년 12월까지 퇴행성 관절염으로 SBTKA를 시행하였던 환자 중 관절낭 봉합 후 배액관을 통해 관절강 내로 한쪽당 3 g의 TXA를 주입한 139명을 실험군(group T), 2007년 10월부터 2010년 8월까지 TXA를 주입하지 않고 수술하였던 SBTKA 환자 57명(group A)을 대조군으로 설정했다. 양 군은 나이, 성별에 따른 유의한 차이는 없었다(p=0.572, 0.474). TXA는 정맥 내 투여의 금기에 해당하는 환자들에게도 관계 없이 주입하였고 염증성 관절염으로 수술을 시행한 환자는 본 연구에서 제외시켰다. 각각 평균 배액량, 실혈량, 수혈률, 수혈량과 일 평균 혈색소의 변화 추이, 일 평균 수혈량을 비교하였다. 합병증으로 심부 정맥 혈전증, 폐색전증, 감염, 뇌경색, 심근경색 발생 여부를 조사하였다. 결과: 평균 실혈량은 group A와 group T에서 각각 2195.32±1175.63 ml, 1145.09±382.95 ml, 평균 배액량은 1178.30±484.59 ml, 774.19±310.06 ml로 group T에서 각각 유의하게 적었다(p=0.002, <0.001). 수혈률은 각각 77.2% (44/57), 0.7% (1/139), 전체 평균 수혈량은 각각 735.44±550.83 ml, 4.60±54.28 ml로 group T에서 각각 유의하게 적었다(p<0.001, <0.001). 혈색소는 group A, group T에서 각각 술 후 3, 4일째 증가하였다(p<0.001, 0.001). 합병증으로 심부 정맥 혈전증이 group T에서 2예(1.4%), 폐색전증이 3예(2.2%) 발생하였으나 group A에서는 발생하지 않았다. 감염, 뇌경색, 심근경색은 모두에서 발생하지 않았다. 결론: 동시에 시행하는 SBTKA에서 TXA의 관절강 내 주입은 TXA의 평균 배액량, 실혈량, 수혈률, 수혈량을 유의하게 감소시키며 정맥 내 투여 금기에 해당하는 환자들을 포함하여도 합병증 발생률이 높아지지 않는다.

• Clinical and Experimental Pediatrics
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• 제51권7호
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• pp.736-741
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• 2008

목 적 : 소아 신증후군에서 혈전-색전증은 낮은 빈도이지만 심각한 임상 경과를 취하는 합병증이다. 그러나 폐 혈전-색전증의 경우 실제 임상에서 호흡 곤란, 빈호흡, 흉막 동통, 각혈 및 청진상 수포음 또는 호흡음 감소 등의 뚜렷한 임상 증세를 보이는 경우는 드물고, 신정맥 혈전증의 경우도 요통, 육안적 혈뇨 및 신비대 등의 전형적인 소견을 보이는 경우는 드물다. 이에 저자들은 처음 신증후군으로 진단된 환아에서 혈전-색전증 확인을 위한 screening 검사가 필요한지 알기 위해 본 연구를 시행하였다. 방 법 : 신증후군을 진단 받은 62명의 환아 중 폐 관류 검사와 신장 도플러 초음파 검사를 실시한 54명을 연구에 포함하였다. 신장 초음파 검사와 폐 관류 검사는 처음 신증후군 진단 후 2주 이내에 실시하였고, 폐 관류 검사가 양성일 경우 컴퓨터 단층 폐 혈관 조영 검사를 실시하여 이상이 있을 경우에만 폐 혈전-색전증으로 진단하였다. 또한 모든 환아들은 혈전-색전증의 임상적 징후와 신장 질환의 생화학적 지표, 혈액 응고 지표를 측정하였다. 결 과 : 검사 기간 동안 임상 증세 및 신장 초음파 검사상 신정맥 혈전증을 보인 환아는 없었다. 폐 관류 스캔상 이상 소견을 보여 폐 혈전색전증이 의심된 경우는 15례(27.8%)였으나, 이 중 12명만 컴퓨터 단층 폐 혈관 조영 검사가 가능하여 폐 혈전-색전증으로 확진된 경우는 모두 5례로, 폐 혈전-색전증의 발생 빈도는 8.1%였다. 폐 혈전-색전증 5례 중 3례에서만 기침, 가래, 빈호흡, 청진상 수포음, 호흡음 감소 등의 비특이적인 호흡기 증세를 나타내었으며, 2례는 청진 소견상 정상이었다. 또한 폐 혈전-색전증이 없었던 49명의 환아 중 21명이 비특이적 호흡기 증상을 나타내어 두 그룹 간에 호흡기 증상의 발생률의 차이는 없었다. 신장 질환의 생화학적 지표와 혈액 응고 지표 중 폐 혈전-색전증 그룹의 평균 섬유소원 농도만 $776.7{\pm}382.4mg/dL$로 유의하게 높았다(P<0.05). 결 론 : 신증후군 환아에서 신정맥 혈전증 진단을 위한 신장 도플러 초음파 검사의 역할은 분명치 않아 향후 더 많은 연구가 필요할 것으로 생각된다. 신증후군 환아에서 비특이적인 흉부 증상, 청진상 호흡음의 감소가 있을 경우 반드시 폐 혈전-색전증의 유무를 확인하여야 한다. 그러나 폐 혈전-색전증으로 확진된 경우에도 호흡기 증상 및 징후가 없는 경우가 있어서 폐 혈전-색전증을 임상적으로 진단하기가 쉽지 않다. 따라서, 초기 발병 후 완해가 오기 전 신증후군 재발을 많이 하는 시기에는 무증상의 신증후군 환아도 폐 혈전-색전증의 가능성을 염두에 두고 폐 관류 스캔을 screening 검사로 시행하여야 할 것으로 사료된다.

• 한국임상약학회지
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• 제23권2호
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• pp.151-157
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• 2013

Purpose: Warfarin is the most widely used anticoagulant drug for preventing cardiovascular diseases after ischemic stroke and thromboembolism related to atrial fibrillation, artificial heart valves, deep vein thrombosis, and pulmonary embolism. Warfarin is commonly used in combination with other drugs such as diuretics in order to treat the comorbidity. Although several warfarin-diuretics interactions have been reported, the results are conflicting. Therefore, the initial aim of this study was to identify the effects of diuretics on the warfarin response in patients with atrial fibrillation. Methods: One hundred forty six patients with atrial fibrillation who were on anticoagulation therapy with warfarin and maintained INR levels of 2-3 for three consecutive times were followed up, retrospectively. Stable warfarin doses and INR per stable warfarin dose were compared according to age, gender, comorbidity, and concurrent medication. The stable warfarin dose was defined as the maintenance dose of warfarin of the measured patient whose INR was within the target INR range more than 3 times consecutively. Results: The differences of stable warfarin doses in patients with ($3.22{\pm}1.21$ mg/day) and without ($3.58{\pm}1.14$ mg/day) diuretics were marginally significant (P=0.069). On the other hand, stable warfarin doses were $2.97{\pm}1.10$ mg/day in patients with thiazide (n=36) and $3.58{\pm}1.14$ mg/day in patients without diuretics (n=82), which was statistically significant (p=0.009). INR values per stable warfarin dose in patients with diuretics and thiazide were $0.84{\pm}0.31$ and $0.90{\pm}0.34$, respectively, which were statistically different from those without diuretics ($0.72{\pm}0.21$, P=0.010 and P=0.006, respectively). Age, gender, and concurrent use of thiazide diuretics were found to have significant influence on the warfarin response from multivariate analysis. Conclusion: Our study showed that the concurrent use of thiazide diuretics could increase the response of warfarin in patient with atrial fibrillation. Therefore, clinicians should be aware that warfarin dose needs to be adjusted when it is used with thiazide diuretics concomitantly.

• Radiation Oncology Journal
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• 제33권3호
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• pp.179-187
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• 2015

Purpose: The purpose of this study was to investigate the predictable value of pretreatment $^{18}F$-fluorodeoxyglucose positron emission tomography-computed tomography ($^{18}F$-FDG PET-CT) in radiotherapy (RT) for patients with hepatocellular carcinoma (HCC) or portal vein tumor thrombosis (PVTT). Materials and Methods: We conducted a retrospective analysis of 36 stage I-IV HCC patients treated with RT. $^{18}F$-FDG PET-CT was performed before RT. Treatment target was determined HCC or PVTT lesions by treatment aim. They were irradiated at a median prescription dose of 50 Gy. The response was evaluated within 3 months after completion of RT using the Response Evaluation Criteria in Solid Tumors (RECIST). Response rate, overall survival (OS), and the pattern of failure (POF) were analyzed. Results: The response rate was 61.1%. The statistically significant prognostic factor affecting response in RT field was maximal standardized uptake value (maxSUV) only. The high SUV group (maxSUV ${\geq}5.1$) showed the better radiologic response than the low SUV group (maxSUV < 5.1). The median OS were 996.0 days in definitive group and 144.0 days in palliative group. Factors affecting OS were the %reduction of alpha-fetoprotein (AFP) level in the definitive group and Child-Pugh class in the palliative group. To predict the POF, maxSUV based on the cutoff value of 5.1 was the only significant factor in distant metastasis group. Conclusion: The results of this study suggest that the maxSUV of $^{18}F$-FDG PET-CT may be a prognostic factor for treatment outcome and the POF after RT. A %reduction of AFP level and Child-Pugh class could be used to predict OS in HCC.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.4077-4082
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• 2016

Background: Hepatocellular carcinoma (HCC) is a dreadful complication of end stage liver disease with high morbidity and mortality. Aim: The aim was to assess the role of serum talin-1 and non-invasive fibrosis in patients with HCC. Materials and Methods: A total of eighty seven subjects were enrolled, with 22 two healthy individuals as a control group (n=22), 22 patients in the cirrhosis group and finally 43 in the group with HCC diagnosed with positive triphasic CT abdomen criteria. Serum talin-1 and noninvasive fibrosis parameters were assessed in all subjects. Results: Compared to the cirrhosis group, patients with HCC had higher serum talin-1 ($32.9{\pm}12.6$ vs. $11.1{\pm}2.79ng/ml$), FIB4 ($9.96{\pm}15.3$ vs. $2.90{\pm}1.87$) and $fibro-{\alpha}$ ($10.9{\pm}18.1$ vs. $1.55{\pm}0.28$) but not fibrosis index scores ($4.47{\pm}0.95$ vs. $4.98{\pm}0.96$; p=0.046). Patients with large focal lesions (${\geq}5cm$) had different ALBI scores ($-1.02{\pm}0.63$ vs. $-1.72{\pm}0.59$; p=0.001) serum talin-1 ($9.72{\pm}13.81$ vs. $28.6{\pm}38.89ng/ml$; p=0.007) and fibrosis index scores ($0.85{\pm}0.99$ vs. $4.20{\pm}4.85$; p=0.026). No statistical differences were noted between patients with and without portal vein thrombosis. For detection of HCC, serum talin-1 had 97.7% sensitivity and 100% specificity with a 17.2 ng/ml cutoff. AFP at a 13.7 ng/ml cutoff had 72.1% sensitivity and 6.3.6% specificity. The cutoff for the $fibro-{\alpha}$ score was 1.61 with 81.4% sensitivity and 77.3% specificity. Serum talin-1 (odds=1.08; C.I=1.016-1.150; p=0.014), fibrosis index score (odds=2.35; C.I=1.055-5.217; p=0.037) and the ALBI score (odds=6.9; C.I=1.924-24.708; p=0.003) were predictors of large focal lesions. Conclusions: Serum talin-1, AST/ALT ratio, $fibro-{\alpha}$ score are useful for the assessment of HCC patients.

• Tuberculosis and Respiratory Diseases
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• 제51권2호
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• pp.178-183
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• 2001

악성종양에 동반되는 신증후군은 비교적 드문 부신생물증후군이며 가장 흔한 종양은 폐암, 특히 소세포 폐암이다. 그러나 비세포성 폐암과 동반된 경우는 매우 드물고 국내에서는 보고된 바가 없다. 저자들은 막성사구체신염으로 치료 중 편평상피세포 폐암이 발현된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6705-6709
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• 2015

Background: Venous thromboembolisms (VTEs) constitute a group of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). They regarded as the second leading cause of death in cancer patients and several studies have confirmed that VTEs have a negative impact on survival and recurrent rate in both ovarian and endometrial cancer cases. The incidence of VTEs differs worldwide and depends on several risk factors including race, underlying disease, lifestyle, body weight, BMI and genetic risk factors. There is heterogeneity of DVT rates between Asian and Western countries. This study was conducted in order to evaluate the character and incidence of VTEs in gynecologic oncology patients in King Chulalongkorn Memorial Hospital over a 10 year period. Materials and Methods: A retrospective chart review was performed with VTEs defined as objective diagnosis of acute DVT or PE with typical symptoms and signs. Diagnoses were approved byan internist and/or confirmed with imaging studies. Data from both outpatient and inpatient sessions of the affected cases from January 2004 to December 2013 were extracted. General characteristics of the patients were collected with details of the diseases, types of cancer, stage, date of diagnosis of cancer, operative data, treatment outcome, progression free survival and overall survival. Results: Thirty cases of VTEs were identified in a total 2,316 gynecologic oncology cases. The incidence of symptomatic VTEs in total gynecologic oncology patients in our institution is 1.295%. The incidence of VTEs in ovarian cancer patients in our institution was 5.9%. Duration for VTE detection ranged from 13 months before diagnosis of cancer to 33 months after diagnosis of cancer. Most of the VTE cases were detected in ovarian cancer patients (60%). The most common cell type was adenocarcinoma (moderately to poorly differentiated) which accounted for 26.7% of the cases. The second most common cell type was clear cell carcinoma with 23.3% of the cases. Thirty percent of VTE cases developed before cancer was diagnosed, 20% were diagnosed at the same time as cancer detection and fifty percent developed after cancer was diagnosed. Median disease free survival of the gynecologic oncology patients with VTE was 7.5 months. Median overall survival (OS) was 12 months. Median progession free survivals of DVT and PE groups were 11.5 and 5.5 months, respectively. OS of DVT and PE was 12.0 and 11.5 months respectively. Conclusions: The incidence of VTE in Asian countries is believed to be lower than in European or Western countries. From our retrospective review, the incidence of VTEs in all types of gynecologic oncology was 1.295%, much lower than reported in the West. The reason for the lower incidence may genetic differences. Another factor is that VTE in this review was symptomatic, which is less than asymptomatic VTE. More than half of VTEs in this study developed in ovarian cancer patients. The results are compatible with earlier reports that among gynecologic malignancies, the incidence of VTE is highest in ovarian cancer.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.289-293
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• 2006

By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer

• Archives of Plastic Surgery
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• 제39권5호
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• pp.540-545
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• 2012

Background Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. Methods This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 ${\mu}g/mL$ remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 ${\mu}g/mL$ and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. Results Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. Conclusions Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.