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김성협,김지영,정승민,성태윤,임정애,우남식 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.2
Acute fatty liver of pregnancy is a rare but usually fatal complication of the third trimester.We report the case of a 28-year-old primigravida at 37 weeks of gestation with an acute fatty liver. Continuous fetal heart rate monitoring demonstrated frequent late fetal heart decelerations and the lack of beat-to-beat variability during the induction of vaginal delivery.We decided to perform an emergency cesarean section under a combined general-epidural anesthesia with bispectral index.No complications occurred during or after surgery except for a delayed recovery from the muscle relaxant.The patient made an uneventful recovery and discharged at eight days after cesarean section.
Asakage Ayu,Ishihara Shiro,Boutin Louis,Dépret François,Sugaya Takeshi,Sato Naoki,Gayat Etienne,Mebazaa Alexandre,Deniau Benjamin 대한진단검사의학회 2024 Annals of Laboratory Medicine Vol.44 No.2
Background: Acute kidney injury (AKI) is a common condition in severely ill patients asso- ciated with poor outcomes. We assessed the associations between urinary neutrophil ge- latinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods: We assessed the predictive performances of uNGAL, uLFABP, and uCysC mea- sured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr all- cause mortality. Results: In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on ad- mission were 147.6 (39.9–827.7) ng/mL, 32.4 (10.5–96.0) ng/mL, and 0.33 (0.12–2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentra- tions at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67–0.72], 0.63 [0.59–0.66], and 0.57 [0.51–0.63], respec- tively) were inferior to those of the other biomarkers. Conclusions: uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combina- tion, was limited. Further studies are required to confirm our results.
The Role of Urinary Liver-Type Fatty Acid-Binding Protein in Critically Ill Patients
조은정,양하나,조상경,조원용,김형규 대한의학회 2013 Journal of Korean medical science Vol.28 No.1
Although several urinary biomarkers have been validated as early diagnostic markers of acute kidney injury (AKI), their usefulness as outcome predictors is not well established. This study aimed to determine the diagnostic and prognostic abilities of urinary liver-type fatty acid-binding protein (L-FABP) in heterogeneous critically ill patients. We prospectively collected data on patients admitted to medical and surgical intensive care units (ICUs) from July 2010 to June 2011. Urine neutrophil gelatinase-associated lipocalin (NGAL) and L-FABP at the time of ICU admission were quantitated. Of the 145 patients, 54 (37.2%) had AKI defined by the Acute Kidney Injury Network (AKIN) criteria. AKI patients showed significantly higher level of urinary NGAL and L-FABP and also higher mortality than non-AKI patients. The diagnostic performances, assessed by the area under the ROC curve,were 0.773 for NGAL and 0.780 for L-FABP, demonstrating their usefulness in diagnosing AKI. In multivariate Cox analysis, urinary L-FABP was an independent predictor for 90-day mortality. Urinary L-FABP seems to be promising both for the diagnosis of AKI and for the prediction of prognosis in heterogeneous ICU patients. It needs to be further validated for clinical utility.
손인숙 ( In Sook Sohn ),김지연 ( Ji Yeon Kim ),권한성 ( Han Sung Kwon ),이선주 ( Sun Ju Lee ),이지영 ( Ji Young Lee ),김수녕 ( Soo Nyung Kim ),최원혁 ( Won Hyeok Choe ),우남식 ( Nam Sik Woo ),한혜승 ( Hye Seung Han ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.12
Acute fatty liver of pregnancy is a rare but usually fatal complication of the last trimester of pregnancy. The primary therapy is early delivery and supportive care. We report two cases of favorable outcomes in acute fatty liver of pregnancy. First case was a nulliparous twin pregnant woman at 33 weeks of gestation with jaundice, abdominal pain, and diarrhea. Because the acute fatty liver of pregnancy was diagnosed by typical laboratory findings, an emergency cesarean section was performed. Then, she showed the symptoms of acute renal failure, and the laboratory findings of disseminated intravascular coagulation. Second case was a nulliparous women at 37 weeks of gestation with malaise, upper abdominal pain, and elevated transaminase level. Under the impression of the acute fatty liver of pregnancy and fetal distress, an emergency cesarean section was performed under both epidural and general anesthesia. Liver biopsy was performed and showed microvesicular fatty infiltration of hepatocyte. In spite of the literature`s dismal prognosis, our cases seemed to be favorable maternal and perinatal outcomes because of early recognition and immediate termination of pregnancy with intensive and supportive care
서민아 ( Min A Seo ),김창운 ( Chang Woon Kim ),권민정 ( Min Jung Kwon ),지병주 ( Byung Ju Ji ),박경도 ( Kyung Do Park ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.5
Acute fatty liver of pregnancy are relatively rare but extremely dangerous, because they may quickly develop into a fulminant disease and become a serious life-threatening disorder for mother and fetus in the third trimester. Therefore, early diagnosis, prompt delivery and intensive supportive care the cornerstones in the management of acute fatty liver of pregnancy. Clinical findings in acute fatty liver of pregnancy vary because it may occur with varying degrees of clinical severity and in conjunction with other third trimester symptoms, making early diagnosis difficult. However, careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. We have experienced a case of acute fatty liver of pregnancy presenting as early hepatic encephalopathy, renal failure which developed during the third trimester. We diagnosed acute fatty liver of pregnancy based on clinical presentation and laboratory abnormalities. Despite of prompt delivery and adequate supportive care management, this severe complication of pregnancy has had an adverse outcome for mother.
Acute Fatty Liver of Pregnancy 2 예
서동진(Dong Jin Suh),지종대(Jong Dae Ji),김연수(Yun Soo Kim),박진호(Jin Ho Park),이영호(Young Ho Lee),이신형(Sin Hyung Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.3
Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal complication of the third trimester of pregnancy. The exact cause of acute fatty liver of pregnancy is still debatable. If unrecognized or untreated, the disorder may progress to fulminant hepatic failure with jaundice, encephalopathy, disseminated intravascular coagulation, uncontrolled gastrointestinal and uterine bleeding. Early recognition of the disorder, rapid termination of pregnancy once the diagnosis has been made and intensive supportive care have improved the prognosis. We experienced two cases of acute fatty liver of pregnancy in a 27-year-old primigravida with female fetus at 36 weeks of gestation, and in a 28-year-old primigravida with male fetus at 34 weeks of gestation. They had severe hepatic dysfunction and typical histologic findings of AFLP such as microvesicular fat and cholestasis. Both patients recovered soon after delivery, although one had fetal death in uterus.
강미선;박상훈;박지영 서희영;허란;김상현 인제대학교 백병원 2011 仁濟醫學 Vol.32 No.-
Acute fatty liver of pregnancy (AFLP) was first described as a specific clinical entity in 1940 and thought to be universally fatal. Maternal mortality in the past approached 75 percent. However early diagnosis and prompt delivery have dramatically improved the prognosis, and maternal mortality rate is now less than 18 percent. A early diagnosis, a prompt delivery, and a intensive supportive care have improved maternal and perinatal outcome. We report a 30—year—old woman at 37 weeks gestation who have multiple complications including acute pancreatitis in AFLP. She was complicated with acute renal failure, disseminated intravascular coagulation, duodenal ulcer bleeding, spontaneous bacterial peritonitis, pulmonary edema and acute pancreatitis.
감영호(Young Ho Kam),곽태로(Tae Ro Kwak),곽정상(Jung Sang Kwak) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1
Acute fatty liver is rare but life threatening complication and usually manifests late in pregnancy. The mean gestational age onset of symptoms has been reported 35-37 weeks of gestation. Recently, several reports revealed acute fatty liver can develops in the second trimester of pregnancy. Recent reports suggest that early diagnosis and delivery decreased the mortality of fetus and mother. We have experienced a case of the second trimester onset acute fatty liver, in pregnancy so we report the case with brief review.
한우석 ( Woo Suk Han ),서용수 ( Yong Soo Seo ),임승연 ( Seung Yeon Im ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.9
Acute fatty liver of pregnancy (AFLP) is a serious maternal disease occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. Until recently the pathogenesis of AFLP was unknown and still has not been fully elucidated. However, recent molecular advances suggest that AFLP may result from mitochondrial dysfunction. Several reports have documented a strong association between AFLP and a deficiency of the enzyme long-chain 3-hydroxyacyl-CoA dehydrogenase in the fetus, a disorder of mitochondrial fatty acid beta-oxidation. Therefore in this case, through findings of liver biopsy from dead fetus, we report possible causal relationship between fetal liver disease and maternal AFLP with literature reviews.
최진백(JB Choi),박현(H Park),이동민(DM Lee),김성(S Kim),윤길중(GJ Yoon),황인수(IS Hwang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.7
Acute fatty liver of pregnancy is a rare, clinically distinct cause of jaundice occuring during the third trimester of pregnancy, with maternal death as the usual outcome and first described in 1,940 by Sheehan, which may be characterized by nausea, vomiting, epigastric pain, jaundice and confirmed by liver biopsy. We have experienced a case of acute fatty liver at 38 weeks of gestation in 30 year-old primigravida woman and reproted with a brief review of related literatures.