• 대한영상의학회지
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• 제83권5호
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• pp.1116-1120
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• 2022

신장은 이소성 부신 선종의 드문 부위이다. 우리가 아는 한, 신장에서 발생한 이소성 부신 선종의 일부 증례가 보고되었지만, 이러한 증례들 중 병변의 컴퓨터단층촬영 및 자기공명영상소견을 설명하는 경우는 거의 없다. 47세 남자 환자가 정기 건강검진을 위해 복부 컴퓨터단층촬영을 시행한 결과 왼쪽 신장동에 1.2 cm 크기의 조영 증강이 되는 종괴가 발견되었다. 추가적으로 시행한 자기공명영상에서 지방 성분을 의미하는 신호 강하 소견을 보였다. 종괴는 수술 후 이소성 부신 선종으로 확인되었다.

• The Korean Journal of Physiology and Pharmacology
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• 제28권1호
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• pp.11-19
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• 2024

Acute kidney injury (AKI) is one of the major complications of sepsis. Aurantio-obtusin (AO) is an anthraquinone compound with antioxidant and anti-inflammatory activities. This study was developed to concentrate on the role and mechanism of AO in sepsis-induced AKI. Lipopolysaccharide (LPS)-stimulated human renal proximal tubular epithelial cells (HK-2) and BALB/c mice receiving cecal ligation and puncture (CLP) surgery were used to establish in vitro cell model and in vivo mouse model. HK-2 cell viability was measured using MTT assays. Histological alterations of mouse renal tissues were analyzed via hematoxylin and eosin staining. Renal function of mice was assessed by measuring the levels of serum creatinine (SCr) and blood urea nitrogen (BUN). The concentrations of pro-inflammatory cytokines in HK-2 cells and serum samples of mice were detected using corresponding ELISA kits. Protein levels of factors associated with nuclear factor kappa-B (NF-κB) pathway were measured in HK-2 cells and renal tissues by Western blotting. AO exerted no cytotoxic effect on HK-2 cells and AO dose-dependently rescued LPS-induced decrease in HK-2 cell viability. The concentrations of pro-inflammatory cytokines were increased in response to LPS or CLP treatment, and the alterations were reversed by AO treatment. For in vivo experiments, AO markedly ameliorated renal injury and reduced high levels of SCr and BUN in mice underwent CLP operation. In addition, AO administration inhibited the activation of NF-κB signaling pathway in vitro and in vivo. In conclusion, AO alleviates septic AKI by suppressing inflammatory responses through inhibiting the NF-κB pathway.

• Journal of Gastric Cancer
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• 제18권3호
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• pp.287-295
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• 2018

Purpose: The surgical outcomes of end-stage renal disease (ESRD) patients undergoing radical gastrectomy for gastric cancer were inferior compared with those of non-ESRD patients. This study aimed to evaluate the short- and long-term surgical outcomes of ESRD patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer. Materials and Methods: Between 2004 and 2014, 38 patients (OG: 21 patients, LG: 17 patients) with ESRD underwent gastrectomy for gastric cancer. Comparisons were made based on the clinicopathological characteristics, surgical outcomes, and long-term survival rates. Results: No significant differences were noted in the clinicopathological characteristics of either group. LG patients had lower estimated blood loss volumes than OG patients (LG vs. OG: 94 vs. 275 mL, P=0.005). The operation time and postoperative hospital stay were similar in both the groups. The postoperative morbidity for LG and OG patients was 41.1% and 33.3%, respectively (P=0.873). No significant difference was observed in the long-term overall survival rates between the 2 groups (5-year overall survival, LG vs. OG: 82.4% vs. 64.7%, P=0.947). Conclusions: In ESRD patients, LG yielded non-inferior short- and long-term surgical outcomes compared to OG. Laparoscopic procedures might be safely adopted for ESRD patients who can benefit from the advantages of minimally invasive surgery.

• 대한골관절종양학회지
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• 제6권4호
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• pp.173-177
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• 2000

횡문근양 종양은 주로 소아기의 신장에서 발생하는 신생물로, 침습적인 양상을 보이는 비교적 드문 종양이다. 최근에 신장 외의 다양한 부위에서 발생한 예들이 보고되고 있으며, 연부 조직에 발생한 경우에는 미분화된 횡문근 육종으로 오진되기 쉽다. 횡문근양 종양은 횡문근 육종보다 침습적이고 나쁜 예후를 보이는 종양으로, 횡문근 육종과의 조직학적인 정확한 감별이 필요하며, 면역조직화학 검사가 그 감별에 도움을 줄 수 있다. 저자들은 치골 부위와 하복벽 부위에서 발생한 횡문근양 종양을 경험하여 문헌의 고찰과 함께 보고하고자 한다.

• Childhood Kidney Diseases
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• 제24권1호
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• pp.42-46
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• 2020

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.

• 한국임상수의학회지
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• 제22권3호
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• pp.271-274
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• 2005

Three dogs that had a history of abdominal distension were referred to the hospital. All were female with unilateral involvement. History and clinical signs were nonspecific. Abdominal radiographs demonstrated that the abdomen of all cases was filled with large masses. At laparotomy, all masses were kidney tumors with invasion around tissue. The tumors were soft, irregular, creamish and confined within the capsule. One case had liver metastasis. Another case was found to have adrenal gland metastasis. One case had caudal vena cava invasion. A ureteronephrectomy was performed unilaterally in all cases. In the microscopic appearances, all the tumors had malignant features with nuclear pleomorphism and amount of necrosis. Three cases were diagnosed as renal carcinomas.

• Journal of Chest Surgery
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• 제35권6호
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• pp.471-474
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• 2002

수혈관련 이식편대숙주병은 동양인에서 개심술후에 주로 보고되는 드물지만 치명적인 병이다. 이는 신선 전혈의 수혈 전 감마선 조사로 예방할 수 있다. 61세 남자환자가 관상동맥수술을 시행받은 후 수혈 관련 이식편대숙주병이 발생하였다. 술후 환자는 두 아들에게서 2단위의 전혈을 수혈받았다. 술후 10일째 퇴원 당시 경미한 설사만 있었다. 퇴원 이틀째 지속적인 설사와 전신적 홍반 및 고열을 주소로 재입원하였다. 임상검사상 간, 신장, 소화기 및 골수의 기능 부전을 보였고, 혈역학적으로 급격히 악화되어 술후 17일에 다발성 장기 기능부전으로 사망하였다. 저자들은 본원에서 심장수술을 시행한 이래 이식편대숙주병을 처음으로 경험하였고, 이 후 전혈수혈에 대한 방침을 수정하였다.

• Journal of Chest Surgery
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• 제46권6호
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• pp.426-432
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• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

• Journal of Chest Surgery
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• 제35권10호
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• pp.755-759
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• 2002

64세 남자가 혈뇨를 주소로 입원하여 하대정맥으로 종양 혈전이 파급된 우측 신세포암으로 진단받았다. 우신 적출술 시행 후 역행성 뇌관류하면서 심도 저체온 순환정지 하에 하대정맥 혈전 제거술을 시행하였다. 종양 혈전은 우 신에서 기원하여 하대정맥으로 자라면서 좌 신정맥의 생식선정맥 유입구까지, 위로는 간정맥 유입부까지, 아래로는 신정맥 하방 3cm까지 파급되어 있었다. 심도 저체온 순환 정지 하에서 하대정맥 손상 없이 혈전을 완전히 제거하였고 술 후 경과는 순조로웠다. 술 후 인터페론 면역 치료를 받았고 특별한 문제없이 추적관찰 중이다.

• Journal of Chest Surgery
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• 제53권1호
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• pp.8-15
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• 2020

Background: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.