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백선하,김은상,김동규,김현집,한대희 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.12
Far lateral disc herniation(FLDH) with compression of the nerve root as it exits through the foramen has been a recognized entity for a number of years. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the innocent interspace. If these herniation are diagnosed, they often cannot be adequately exposed by the classic minline hemilaminectomy approach. A partial or complete unilateral facetectomy to expose these herniations can lead to vertebral instability or contribute to continued postoperative back pain. The authors present 5 patients who were diagnosed as having far lateral lumbar disc herniations from 1988 to 1990. Two of these were at L_(4-5) level, two at L_(5)-S₁level and one at L_(3-4) level and all were over 60 years old. High resolution CT scan appeared to be the best study and the paramedian muscle splitting microsurgical approach, done in 3 cases, was found to be the most direct and favorable anatomical route to FLDH for vertebral stability and minimal postoperative back pain.
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백선하,왕규창,오창완,정천기,김동규,정희원,김현집,조병규,최길수,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7
Diphenylhydantoin(DPH) has been used intravenously as a drug of choice in conditions which seizure patients are incapable of oral Teeding or in a state of status epilepticus However, its clinical use has limitations because of its serious side effects o# cardiac depression or systemic hypotension In Western countries. the recently do- veloped intravenous sodium valproate has been reported as safe and e#Tective for seizure control in such patients To assess the safety and effectiveness in seizure control we investigated the serum levels of the drug at f4 hours 48 hours and 7 days after intravenous administration of sodium valproate(Depakine른. occurrence of seizures in the perioperative period and the side eT#ects of the drugs in 30 neurosurgical patients older than 3 years of age The mean serum concentrations of valproic acid after bolus injection To IS mg/kg followed by continuous infusion with the rate To OSmg/kg/hour, were over 450 rg/ml . 좌S 0± IS 3 ff/ml at 운4 hours, 504±fl 0 f(g/ml at 좌』 hours and 58 9±tO 7 賠,/1 at 7 days aTter the sta「t of the adinistration All the Patients whose se「u vaIProic acid levelwas witHin the therapeutic range(40-100 rr/ml). had never experienced an episode of seizure attack during the perioperative days There was no evidence of elevated liver enzyme activity, but there were evidence of some tendencyof decreased platelet count in the peripheral blood at f days a#ter the administration of intravenous Yalproic acid Four patients experienced episodes of mild nausea and/or vomiting in conclusion per'ioperat'ive intravenous administration of valproic acids in neurosurgical patients was safe and effective in seizure control However it must be used precauciously in the patients with compromized coagulation system
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뇌종양에서 17번 염색체 단완부 소실에 관한 분자유전학적 연구
백선하,김은상,김동규,정희원,김현집,조병규,한대희,이승훈,김종현 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1
With the methods of restriction fragment length polymorphisms(RFLPs) and southern blot analysis, gene deletion of chromosome 17p in 16 cases of brain tumors, was investigated. There were 4 cases of glioblastoma multiforme, 1 case of anaplastic astrocytoma, 4 cases of low grade astrocytoma, 3 cases of oligodendroglioma, and 4 cases of meningioma. Among restriction fragment length polymorphism(RFLP) DNA located in chromosome 17p, p144D 6 and p SNZ 22 were imployed as the probes. In eight of 16 cases(50%) constitutional heterozygosity was observed for p144 D6 probe on the short arm of chromosome 17, and in nine of 16 cases(56%) for PYNZ 22.1 probe. With both probes constitutional heterozygosity was observed in thirteen of 16 cases(81%). And the loss of constitutional heterozygosity was detected in two of 14 informative cases. Although, with the malignant gliomas, including 4 cases of glioblastoma multiforme and 1 case of anaplastic astrocytoma, two of 4 informative cases showed loss of constitutional heterozygosity. None of 9 informative cases showed loss of heterozygosity with the other brain tumors(low grade astrocytoma, oligodendroglioma, and meningioma).
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전신성 모세혈관 누출 증후군으로 인한 만성 신질환 1예
백선하,신나라,김효진,한미연,최동주,방수미,김세중,백진호 영남대학교 의과대학 2012 Yeungnam University Journal of Medicine Vol.29 No.2
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 hyperpermeability. 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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백선하,신호준,Ki Young Na,Dong-Wan Chae,김세중 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.3
Background: Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI. Methods: We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results: The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120-129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100-109 mmHg: HR 1.56, P = 0.038; 110-119 mmHg: HR 1.15, P = 0.483; 130-139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005). Conclusion: Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.
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백선하,오창완,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12
From January 1995 to September 1995, we enrolled 30 patients with a clinical status over Hunt and Hess grade Ⅳ, presenting within 5 days after spontaneous subarachnoid hemorrhage to determine the effectiveness in early intervention of nimodipine on short-term outcome and its safety. The blood cell count and chemistry were performed before and 7 days after nimodipine treatment, and at discharge. The clinical outcome of the patients was assessed at discharge according to the Glasgow outcome scale. There was no evidence of abnormal change in blood chemistry including liver enzyme activity during the study. Four patients experienced episodes of decreased blood pressure : in one of them, drug administration was discontinued transiently. There was no significant difference in the short-term outcome between the nimodipine treated patients in this study and aneurysmal patients treated without nimodipine in our previous study. However, four of five patients experiencing symptomatic vasospasm in this study showed good outcome at discharge. In conclusion. administration of nimodipine in the patients with spontaneous subarachnoid hemorrhage was safe and nimodipine seeemed to have beneficial effect in protecting the patients with symptomatic vasospasm from severe ischemic damages.
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Predialysis hyponatremia and mortality in elderly patients beginning to undergo hemodialysis
백선하,Sejoong Kim,Ki Young Na,Suhnggwon Kim,Ho Jun Chin 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.5
Background/Aims: Predialysis hyponatremia has been recently reported to be associated with mortality in incident hemodialysis patients. However, whether hyponatremia is associated with unfavorable outcomes in elderly patients remains unknown. We hypothesized that nephrology referral inf luences hyponatremia, and aimed to define how nephrology referral affects the association between hyponatremia and mortality in the elderly. Methods: We retrospectively assessed mortality in 599 incident hemodialysis patients aged ≥ 70 at a tertiary university hospital, between 2000 and 2010. We analyzed 90-day and 1-year all-cause mortality (ACM) in relation to predialysis serum sodium (sNa). We divided the patients into two groups according to predialysis glucose-corrected sNa: hyponatremia (< 135 mmol/L) and normonatremia (135 to 145 mmol/L). Results: Low estimated glomerular filtration rate, high phosphorus, low albumin, nonpreparation of arteriovenous fistula or graft, and late referral were associated with a low sNa in the elderly. Among 599 patients, 106 and 174 patients died at the 90-day and 1-year follow-ups, respectively. Each 10-mmol/L increase in predialysis sNa tended to be associated with lower 90-day and 1-year ACM. When patients were stratified by nephrology referral, hyponatremia was associated with increased mortality in early referral group (90-day ACM: hazard ratio [HR] = 2.335, p = 0.041; 1-year ACM: HR = 1.790, p = 0.024). However, hyponatremia was not associated with mortality in late referral group. Conclusions: Predialysis hyponatremia at hemodialysis initiation is associated with late referra.
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백선하,차란희,강신욱,박철희,차대룡,김성균,윤선애,김세중,한상엽,박정환,장재현,임춘수,김연수,나기영 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4
Background/Aims: Patients with chronic kidney disease (CKD) have been found to show markedly increased rates of end-stage renal disease, major adverse cardiovascular and cerebrovascular events (MACCEs), and mortality. Therefore, new biomarkers are required for the early detection of such clinical outcomes in patients with CKD. We aimed to determine whether the level of circulating renalase was associated with CKD progression, MACCEs, and all-cause mortality, using data from a prospective randomized controlled study, Kremezin STudy Against Renal disease progression in Korea (K-STAR; NCT 00860431). Methods: A retrospective analysis of the K-STAR data was performed including 383 patients with CKD (mean age, 56.4 years; male/female, 252/131). We measured circulating renalase levels and examined the effects of these levels on clinical outcomes. Results: The mean level of serum renalase was 75.8 ± 34.8 μg/mL. In the multivariable analysis, lower hemoglobin levels, higher serum creatinine levels, and diabetes mellitus were significantly associated with a higher renalase levels. Over the course of a mean follow-up period of 56 months, 25 deaths and 61 MACCEs occurred. Among 322 patients in whom these outcomes were assessed, 137 adverse renal outcomes occurred after a mean follow-up period of 27.8 months. Each 10- μg/mL increase in serum renalase was associated with significantly greater hazards of all-cause mortality and adverse renal outcomes (hazard ratio [HR] = 1.112, p = 0.049; HR = 1.052, p = 0.045). However, serum renalase level was not associated with the rate of MACCEs in patients with CKD. Conclusions: Our results indicated that circulating renalase might be a predictor of mortality and adverse renal outcomes in patients with CKD.
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