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Endoscopic Treatment of Intussusception due to Intestinal Tuberculosis
김두엽,정현도,김민대,이재형,김석훈,강동구,김지하,이일선 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2
Traditionally, adult intussusception has required a bowel resection because of the malignancy risk. A patient with anorexia, weight loss, and abdominal pain visited our clinic. A physical exam and imaging study revealed no acute peritoneal signs. A colonoscopy for biopsy and bowel reduction was attempted. The tissue sample was consistent with intestinal tuberculosis. We report intestinal tuberculosis complicating intussusception which was treated without surgical intervention.
김두엽,최정현,홍그루,임세중,김장영,이상철,손일석,정욱진,서혜선,윤세정,조경임,최시완,이경진 한국심초음파학회 2017 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.25 No.1
Background: Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. Theaim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosisin routine clinical echocardiography. Methods: Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General imagequality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle(RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiographywith and without ultrasound contrast agent. Results: Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p < 0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p < 0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p < 0.001). The percentage ofpoor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p < 0.001), from 30.5% to 10.5% (p < 0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. Conclusion: Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision makingin Korean patients who undergo routine echocardiography.
신장이식 수술 후 7일 차에 발생한 이식신 동맥협착을 저압력 풍선 혈관성형술로 성공적으로 치료한 1예
김두엽,정현도,이진호,김한새,이동열,오준석,김성민,신용훈,김중경,허길,박종현,정규식 대한이식학회 2016 Korean Journal of Transplantation Vol.30 No.2
Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft’s renal artery and the patient’s common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90∼180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient’s common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient’s common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.
김동한,김희연,윤정희,김두엽,정현도,이진호,오준석,김성민,신용훈,김중경 대한이식학회 2015 Korean Journal of Transplantation Vol.29 No.4
Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.
Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults
오준혁,송승환,이하린,이선학,김두엽,최정천,안진희,박진섭,신명준,전윤경,이혜원,최정현,이한철,차광수 대한의학회 2019 Journal of Korean medical science Vol.34 No.30
Background: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non- invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. Methods: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. Results: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. Conclusion: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups