• 제목/요약/키워드: chronic complications

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A Rare Case of Unilateral Pleural Effusion in a Pediatric Patient on Chronic Peritoneal Dialysis: Is it a Pleuroperitoneal Leakage?

  • Yoo, Sukdong;Hwang, Jae-Yeon;Song, Ji Yeon;Lim, Taek Jin;Lee, Narae;Kim, Su Young;Kim, Seong Heon
    • Childhood Kidney Diseases
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    • v.22 no.2
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    • pp.86-90
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    • 2018
  • Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year- old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula.

Middle meningeal artery embolization for chronic subdural hematoma in elderly patients at high risk of surgical treatment

  • Jin Hoo Seok;Jong Hyun Kim;Taek Hyun Kwon;Joonho Byun;Won Ki Yoon
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.25 no.1
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    • pp.28-35
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    • 2023
  • Objective: The purpose of this study was to evaluate the effectiveness of middle meningeal artery embolization (MMAE) in elderly high-risk patients with symptomatic chronic subdural hematoma (CSDH) in terms of reduction in hematoma volume and recurrence rate. Methods: We retrospectively reviewed data prospectively collected from nine patients who underwent 13 MMAE for CSDH between June 2017 and May 2022. The volume of the subdural hematoma was measured using a computer-aided volumetric analysis program. Hematoma volume changes during the follow-up period were analyzed and clinical outcomes were evaluated. Results: The mean follow-up period was 160 days (range, 46-311 days). All procedures were technically successful and there were no procedure-related complications. Of the 13 MMAE, 84% (11 out of 13 hemispheres) showed mean 88% of reduction on follow-up volumetric study with eight cases of complete resolution. There was one refractory case with MMAE which had been performed multiple burr-hole trephinations, for which treatment was completed by craniotomy and meticulous resection of multiple pseudomembranes. There was no recurrent case during the follow-up period, except for refractory case. Conclusions: MMAE for CSDH in selected high-risk elderly patients and relapsed patients might be effective. Despite the small cohort, our findings showed a high rate of complete resolution with no complications. Further prospective randomized trials are warranted to evaluate its usefulness as a primary treatment option for CSDH.

Impact of Various Types of Comorbidities on the Outcomes of Laparoscopic Total Gastrectomy in Patients with Gastric Carcinoma

  • Jeong, Oh;Jung, Mi Ran;Ryu, Seong Yeob
    • Journal of Gastric Cancer
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    • v.18 no.3
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    • pp.253-263
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    • 2018
  • Purpose: With increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma. Materials and Methods: We retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses. Results: A total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03-4.64), along with old age and intraoperative bleeding. Conclusions: Among the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.

An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems (추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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Pharmacokinetic Changes of Gentamycin After Intravenous Administration to Rabbits with Alloxan-Induced Diabetes Mellitus (알록산으로 유도된 당뇨병 토끼에서 겐타마이신의 약물동태 변화)

  • Kang, T.S.;Choi, J.S.;Lee, J.H.
    • YAKHAK HOEJI
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    • v.44 no.6
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    • pp.539-544
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    • 2000
  • Many diabetic patients develop serious complications during the course of the disease, including cardiovascalar disorders, nepropathy, neuropathy and retinopathy. Because some physiological changes occurring in diabetes mellitus patients could alter the pharmacokinetics of drugs used to treat the disease, the pharmacokinetics of gentamycin was investigated after intravenous administration (2 mg/kg) to control rabbits and acute or chronic alloxan-induced diabetes mellitus rabbits (AIDRs). After intravenous administration, the serum concentrations of gentamycin were significantly higher between 6 and 12 hr in chronic AIDRs compared with those in control rabbits. The AUC was significant greater in chronic ($31.91\;{\pm}\;3.76\;{\mu}g/ml{\cdot}hr$) AIDRs than that in control ($21.60\;{\pm}\;2.45\;{\mu}g/ml{\cdot}hr$) rabbits. Total body clearance (CLt) in AIDRs were significantly decreased compared with that in control rabbits. Cumulative urinary excretion of gentamycin was decreased, although not significantly, in AIDRs compared with that in control rabbits.

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Chest Wall Reconstruction for Chronic Intrathoracic Wounds Using Various Flaps

  • Hong, Joon Pio;Cho, Pil-Dong;Kim, Sug Won;Chung, Yoon-Kyu;Kim, Eun-Gi
    • Archives of Reconstructive Microsurgery
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    • v.9 no.1
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    • pp.68-74
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    • 2000
  • The treatment of chronic chest wounds should be focused on eradicating the infection and obliterating the dead space thus providing improved pulmonary function. Chronic chest wounds, although the incidence has decreased over the years, is still associated with high morbidity and prolong hospitalization. In cases where the disease is advanced and conventional measures fail, aggressive approaches achieve adequate resolution or significant improvement. This paper reports four cases of chronic chest wound including bronchopleural fistula and osteomyelitis managed by debridement followed by muscle coverage using latissimus dorsi, rectus abdominis, and omental flap. The intrathoracic reconstruction entails thorough debridement of empyema cavities, bronchpleural fistulas and infection focus. The infection must be completely eradicated prior to or at the time of flap transposition. The flaps used for obliteration of dead spaces provided adequate bulk, abundant blood supply, and minimal donor morbidity. The results were satisfactory with improved respiratory function without complications.

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A Case of Chronic Renal Failure Associated with Systemic Capillary Leak Syndrome (전신성 모세혈관 누출 증후군으로 인한 만성 신질환 1예)

  • Baek, Seon Ha;Shin, Nara;Kim, Hyo Jin;Han, Mi Yeun;Choi, Dong-Ju;Bang, Soo-Mee;Kim, Sejoong;Paik, Jin Ho
    • Journal of Yeungnam Medical Science
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    • v.29 no.2
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    • pp.145-149
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    • 2012
  • 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 hyper-permeability. 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.

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Surgical Treatment of Chronic Constrictive Pericarditis (만성 교약성 심낭염의 외과적 치료)

  • 강면식
    • Journal of Chest Surgery
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    • v.22 no.1
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    • pp.67-73
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    • 1989
  • Forty two patients with chronic constrictive pericarditis, who were admitted to the Yonsei University College of medicine over a period of 18 years from January, 1970 to August, 1988, were analyzed retrospectively. Mean age of the patient was 33.5 year ranging from 6.8 to 60 years old. Male to female ratio was 1.3 to 1. Twenty-one cases [50%] were tuberculous origin [based on either associated pulmonary tuberculosis and/or caseous necrosis in thickened pericardial specimen] and 17 cases [40.5%] were idiopathic [non specific chronic inflammatory change was considered to be idiopathic]. Dyspnea on exertion was evident in 30 cases [71.4%] and abdominal distention in 21 cases [50%]. On physical examination, hepatomegaly [83.3%], neck vein distention [54.8%], distant heart sound [47.6%] and ascites were found. Thirty-nine patients showed low voltage of QRS and/or T wave flattening or inversion on EKG. Thirty-one cases had undergone cardiac catheterization which showed data compatible with chronic constrictive pericarditis. Midsternostomy group [n=15] had shown the most remarkable CVP decline [12.20 mmHg] as compared with bilateral submammary incision group [n=25, 8.96 mmHg] and left thoracotomy group [n=2, 7.75 mmHg] but difference was not significant statistically There was four early death among 42 patients [9.5%] including 3 cases of left ventricular failure and one cardiac tamponade. Main postoperative complications were wound infection [6 cases] and arrhythmia [3 cases]. Follow-up of 24 patients [mean; 55.3 months, ranging from 2 months to 155 months] revealed good functional status.

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Clinical study on one case of a patient with chronic PID (만성골반염(慢性骨盤炎) 환자에 대한 치험일례(治驗一例))

  • Seo, Ji-Young;Kim, Yoon-Sang;Lim, Eun-Mee
    • The Journal of Korean Obstetrics and Gynecology
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    • v.15 no.4
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    • pp.218-227
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    • 2002
  • Pelvic Inflammatory Disease(PID) is a spectrum of inflammatory disorders of the female genital tract involving at least the endrometrium and may include the fallopian tubes, ovaries, and pelvic cavity. Women with PID acutely experience pain and are at risk for sepsis; however, the long-term complications such as chronic pelvic pain, organic changes like chronic salpingitis, adhesions, etc., and the significant increases in ectopic pregnancy and infertility are more important and hard to control. This study is about one patient who has chronic PID with inflammatory pelvic mass. The patient was treated with retention enema therapy which use herbs effective for reducing inflammation, resolution abdominal mass, promoting blood circulation. Also, treated with herbal medication of Danchisoyosan(丹梔逍遙散) and Moxibution at Zhongwan(中脘), Guanyuan(關元). After total treatment for three months, the patient's symptoms are improved and the size of inflammatory pelvic mass is reduced. This results indicates that the combination treatment, especially the retention enema therapy is effective on reducing symptoms of PID and the size of secondary inflammatory organic changes.

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One Case Report of Chronic Renal Failure Patient Prescribed Gyulpyjeonwon (귤피전원(橘皮煎元)을 처방한 만성신부전 환자 1례에 대한 보고)

  • Jung, Gi-Hun;Chang, Sun-Kyu;Cho, Chung-Sik;Kim, Chul-Jung
    • Journal of Haehwa Medicine
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    • v.16 no.2
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    • pp.229-234
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    • 2007
  • Objectives : Chronic renal failure(CRF) is a pathophysiologic process with multiple etiologies, resulting in the inexorable attrition of nephron number and function and frequently leading to end-stage renal disease. It causes various symptoms(edema, general body weakness, nausea, anorexia, uremia, osteodystrophy and so on) which impair quality of life and long term complications. The purpose of this case is to report the improvement of a patient with chronic renal failure. Methods : We treated the patient with herbal medication(Gyulpyjeonwon) and measured the creatinine, BUN, albumin, hemoglobin in the serum. Results : Gyulpyjeonwon decreased serum creatinine and BUN level and increased serum albumin and hemoglobin level. And the symptoms of CRF(edema, general body weakness, anorexia) was improved significantly. Conclusions : This case suggests the efficacy of herbal medication(Gyulpyjeonwon) to patient who was involved CRF.

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