• Journal of Chest Surgery
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• 제40권4호
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• pp.247-255
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• 2007

배경: 일반적으로 선천성 심장질환의 수술교정에는 체외 심폐 순환(체외순환)이 이용된다. 체외순환과 관련된 폐손상이 잘 알려져 있는데, 임상적으로 산소화의 저하, 폐유순도의 감소, 폐혈관의 저항과 반응성의 증가의 소견을 보이며 수술 후 합병증 및 사망의 중요한 원인이 된다. 이러한 폐손상의 원인은 보체의 할성화, 호중구의 축적, 산소라디칼손상을 포함하여 아주 다양하지만, 폐혈관 내피의 손상과 그에 의한 endothelin-1 발현의 변화가 주된 원인이라고 보고되고 있다. 저자들은 복막 투석이 혈장 endothelin-1의 제거에 기여할 수 있는지 여부에 대한 연구를 하였다. 대상 및 방법: 2005년 3월 부터 2006년 3월 사이에 18명의 환자를 대상으로 하였다. 혈장 검체는 수술 전후로 채취하였고, 수술 후 복막 투석 카테터를 삽입하여 체외순환 이탈 후의 복막 유출액 검체를 채취하였다. Endothelin-1의 농도측정은 ELISA (enzyme Linked Immunosorbent assay)로 시행하였다. 결과: 술 전에 측정된 endothelin-1 값이 술 전 폐혈류 혹은 폐동맥압의 증가의 진단을 가진 환아에서 유의하게 높았다 (4.2 vs 1.8 pg/mL, p<0.001). 수술 전 혈장 endothelin-1의 평균 농도는 $3.61{\pm}2.17pg/mL$이었고, 체외순환 이탈 직후는 $5.33{\pm}3.72 pg/mL$로 가장 높게 측정되었다. 복막 투석 시작 후, 농도는 감소하기 시작하여 체외순환 이탈 직후에 비해 18시간째에는 유의하게 낮은 농도를 나타내었다(p=0.036). 결론: 혈장 endothelin-1 농도가 체외순환 이탈 직후에 가장 높게 측정되었고, 복막 투석 후 감소하기 시작하는 소견은 복막 투석으로 혈장 endothelin-1이 제거될 수 있는 가능성을 강하게 시사한다.

• Journal of the Optical Society of Korea
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• 제19권3호
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• pp.228-236
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• 2015

Fluorescence recovery after photobleaching (FRAP) is a well-established method commonly used to measure the diffusion of fluorescent solutes and biomolecules in living cells or tissues. Here a fiber-optic-based FRAP (f-FRAP) system was developed, and validated using macromolecules in water and agarose gels of different concentrations. We applied f-FRAP to measure the site-specific diffusion of fluorescein (NaFluo) in peritoneal membranes (PMs) on the liver, cecum, and kidney of a living rat during peritoneal dialysis. Diffusion of fluorescein in PM varied in a time-dependent manner according to the type of organ ($D_{PM\;on\;Liver}/D_{NaFluo}=0.199{\pm}0.085$, $D_{PM\;on\;Cecum}/D_{NaFluo}=0.292{\pm}0.151$, $D_{PM\;on\;Kidney}/D_{NaFluo}=0.218{\pm}0.110$). The proposed method allows direct quantitative measurement of the three-dimensional diffusion in local PM in vivo, which was previously inaccessible by peritoneal function test methods such as peritoneal equilibration test (PET) and standardized PM assessment (SPA). f-FRAP is promising for local and dynamic assessments of peritoneal pathophysiology and the mass transport properties of PMs, presumed to be affected by variation of tissue structures over different organs and functional changes of the PM with years of peritoneal dialysis.

• 대한핵의학회지
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• 제23권2호
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• pp.231-236
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• 1989

Continuous ambulatory peritoneal dialysis (CAPD) is a well established method of treating end stage renal failure, and is commonly used as an alternative to hemodialysis. Several complications have been observed. These include catheter malfunction, abdominal and inguinal hernia, and peritonitis. A relatively frequent complication is swelling of external genitalia, due to bowel fluid passing through a patent processus vaginalis. Special diagnostic procedures are necessary to determine the nature of the abnormality and to guide the surgical correction. We reported two cases of patent processus vaginalis in patient on CAPD proved by radionuclide peritoneal scintiscan using Tc-99 m-tin colloid.

• Journal of Chest Surgery
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• 제32권6호
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• pp.588-590
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• 1999

오늘날 말기 신부전 환자에서의 심장수술은 보편화 되는 추세이며, 만성 신부전 환자들의 수가 늘어남에 따라 이들 환자에 대한 적절한 치료법 개발이 필요하게 되었다. 이 환자들에게는 관상동맥질환 뿐만 아니라 판막질환도 드물지 않다. 이들에게 시행되는 복막투석은 체외순환에 다소의 지장은 있을수 있지만 수술 전후에 적절한 대책을 준비한다면 더 이상 심장수술의 걸림돌이 되지 않는다. 저자는 심한 승모판막 폐쇄부전과 만성신부전을 동반한 33세의 무뇨증 여자환자에서 기계판막치환술을 시행하였다. 환자는 수술전에 복막투석을 주기적으로 함으로써 수분 및 전해질 균형을 적절히 유지시켰고, 수술후에도 혈액 생화학적 검사결과를 수시로 예의검토하면서 복막투석을 계속시행함으로써 무사히 회복될 수 있었다.

• Journal of Yeungnam Medical Science
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• 제16권2호
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• pp.333-341
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• 1999

충분히 복막투석을 시행 중인 환자에서 혈압 조절은 혈액투석에 비해 비교적 용이한 것으로 알려져 있다. 저자들은 복막투석 환자의 혈압 조절 특성 및 이에 미치는 여러 인자들을 분석하여 다음과 같은 결과를 얻었다. 1) 복막투석 시작 시 69명 모두에서 고혈압으로 항고혈압제를 사용하였으나 마지막 추적 관찰 시 항고혈압제가 전혀 필요 없었던 경우가 15명이었고 평균동맥압(mmHg)은 복막투석 시작 시 105.1에서 마지막 추적 관찰 시 97.6로 유의한(p<0.05) 감소가 있었다. 2) 6개월간 추적 관찰한 43명에서의 평균동맥압(mmHg)은 복막투석전 107, 복막 투석 후 1개월째 101.5, 2개월째 99, 3개월째 98, 4개월째 98.1, 6개월째 99.5이었고 항고혈압제 사용량(%)은 복막 투석 전 항고혈압 약제 사용량을 100%로 할 때 복막 투석 후 1개월에 75.9, 2개월에 70.4, 3개월에 64.4, 4개월에 56, 6개월에 52.1이었다. 12개월간 추적 관찰한 32명에서의 평균동맥압(mmHg)은 복막투석전 108.1, 복막투석 후 1개월에 99.1, 2개월에 98.4, 3개월에 96.9, 4개월에 97.5, 6개월에 99.2, 9개월에 98.9, 12개월에 96.1이었고 항고혈압제 사용량(%)은 복막투적 전 100, 복막투석 후 1개월에 81.9, 2개월에 73.4, 3개월에 65.7, 4개월에 55.2, 6개월에 58.1, 9개월에 45.8, 12개월에 46.7이었다. 3) 혈액투석에서 복막투석으로 전환한 환자 10명에서 혈액투석 시와 복막투석 시 평균동맥압(mmHg)이 각각 $107{\pm}4.56$, $98.6{\pm}8.77$로 복막투석 시 유의하게(p<0.05) 낮았고, 항고혈압제 사용량(%)은 각각 $5.6{\pm}2.6$, $2.0{\pm}2.5$로 복막투석 시 항고혈압 약제의 사용이 유의하게(p<0.01) 적었다. EPO 용량(U/week)은 각각 $4600{\pm}2660$, $2000{\pm}1630$로 복막투석 시 유의하게(p<0.05) 낮았다. 4) 복막투석군 중에서 항고혈압제 사용량 결정에 유의한 영향을 미치는 인자는 평균동맥압과 하루 동안의 초여과 양이었고 그 밖의 PET의 지표나 투석 적절도는 항고혈압제 사용량과 관계가 없었다. 이상의 결과로 보아 복막 투석 환자의 고혈압 치료 시에는 초여과 양을 충분히 고려한 항고혈압제의 사용이 필요할 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제34권1호
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• pp.119-122
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• 2017

Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.

• Childhood Kidney Diseases
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• 제22권2호
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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.

• Clinical and Experimental Pediatrics
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• 제56권7호
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• pp.304-307
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• 2013

Polyclonal gammopathy represents the diffuse activation of B cells and is usually related to inflammation or immune-related diseases. However, the mechanisms leading to polyclonal gammopathy are essentially speculative. Generally, infectious, inflammatory, or various other reactive processes may be indicated by the presence of a broad-based peak or band in the gamma region on serum protein electrophoresis results. A 15-year-old girl, who had been receiving peritoneal dialysis, presented with polyclonal gammopathy and massive gross hematuria. Renal artery embolization was performed, after which the continuous bleeding subsided and albumin-globulin dissociation resolved. This is a rare case of polyclonal gammopathy related to renal bleeding.

• 대한의생명과학회지
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• 제23권3호
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• pp.185-193
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• 2017

Malnutrition is common and the major risk factor of mortality of end stage renal disease (ESRD) patients. The aim of this study is to assess nutritional status of malnutrition patients on dialysis by various methods and compare nutritional parameters of continuous ambulatory peritoneal dialysis (CAPD) patients with hemodialysis patients. 137 patients on dialysis from April 2009 to July 2013 were enrolled. Nutritional parameters of 66 CAPD and 71 hemodialysis patients were investigated by anthropometry, biochemical study, diet analysis and questionnaires. Malnutrition patients were selected by body mass index (BMI), serum albumin and pre-albumin based on International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria for protein-energy wasting and compared with non-malnutrition patients. In comparison of CAPD and hemodialysis patients, most anthropometric values showed no significant difference except total body water (TBW). TBW was lower in CAPD patients (P=0.024). Although serum albumin was slightly higher in hemodialysis patients (P=0.047), pre-albumin were significantly higher in CAPD patients (P=0.000). Serum blood urea nitrogen (BUN) was higher in hemodialysis patients (P=0.000). In diet analysis, Total calorie (P=0.000) and total cholesterol (P=0.012) intakes were higher in CAPD patients. Mean subjective global assessment (SGA) grade was higher in CAPD patients (P=0.003). Several nutritional parameters of CAPD patients were better than hemodialysis patients implying more intensive therapeutic approach may be needed for hemodialysis patients. We have to understand multiple factors contributing malnutrition of ESRD patients and individualized therapeutic approach is needed.

• Journal of Yeungnam Medical Science
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• 제26권2호
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• pp.137-142
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• 2009

Nontuberculous mycobacterial infections are a rare, but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. This is typically suspected when a patient does not respond to treatment with the usual antibiotics. We describe here a case of $Mycobacterium$ $abscessus$ exit site infection with abdominal wall abscess formation that was associated with CAPD, which required peritoneal catheter removal, surgical debridement of the abscess and long term antibiotic therapy.