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박훈석,최범순,홍유아,정병하,김형욱,박철휘,양철우,진동찬,김용수 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.6
A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.
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Management of high-flow arteriovenous access
박훈석,신석준 대한신장학회 2025 Kidney Research and Clinical Practice Vol.44 No.1
An arteriovenous fistula or graft is essential for hemodialysis (HD). It involves connecting a high-resistance artery to a low-resistance vein, which increases cardiac output (CO). In the early days of HD, patients with end-stage kidney disease (ESKD) were typically younger, and their HD access was located in the distal forearm. However, in the modern era, ESKD patients are often the elderly, with many being the very elderly (over 80 years old). These elderly patients often have poor vessel quality, making distal forearm access unsuitable. As a result, upper arm access, which is more prone to high-flow access, is commonly used. The cardiac status of these modern elderly ESKD patients is vulnerable to high-flow access. High-flow HD access can lead to high-output cardiac failure in ESKD patients. Initial evaluation for high-flow access involves measuring the flow volume using Doppler ultrasound. If the HD access flow volume exceeds 2,000 mL/min, further assessments, including CO and cardiopulmonary recirculation ratio caused by the HD access, should be strongly considered. Treatment for high-flow access involves reducing the flow. There are several surgical and endovascular methods for flow reduction, such as aneurysmorrhaphy, short segment small-diameter graft interposition at the inflow area of the HD access, and banding. Patients with high-flow access are generally asymptomatic. Therefore, nephrologists as primary care physicians for HD patients should provide detailed explanations to patients with high-flow access and high-output cardiac failure and ensure that they understand the prognosis of these conditions. Nephrologists need increased attention to high-flow HD access.
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수술 받은 과거력이 없는 고령 환자에 발생한 횡행결장간막 탈장 1예
박훈석 ( Hoon Suk Park ),김진일 ( Jin Il Kim ),김명석 ( Myoung Seok Kim ),김순섭 ( Soon Sub Kim ),조세현 ( Se Hyun Cho ),박수헌 ( Soo Heon Park ),한준열 ( Joon Yeol Han ),김재광 ( Jae Kwang Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.4
Internal hernia is defined as the herniation of viscera through an anatomic or pathologic opening within the boundaries of peritoneal cavity. Transmesocolic hernia, a subtype of internal hernia, has a herniated sac through the transverse mesocolon. Transmesocolic hernia has been rarely described in the literature, and most of reported cases were associated with a history of operation or congenital anormaly. A 72-year-old female with chronic intermittent abdominal pain and bloating was admitted. Small bowel series showed multiple jejunal loops confined to the left upper quadrant of abdomen. Abdomen spiral computed tomography (CT) showed a cluster of mildly dilated small bowel loops with mesenteries on the same area. On the three-dimensional reconstruction CT scan, a herniated sac through the transverse mesocolon was identified. She was diagnosed as transmesocolic hernia by using the three-dimensional reconstruction CT and small bowel series, without surgical exploration. The symptoms were managed with conservative measures. (Korean J Gastroenterol 2006;48:286-289)
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