Journal of Yeungnam Medical Science

Jong Won Park

9 Articles

Complete atrioventricular block during tunneled cuffed hemodialysis catheter insertion in a patient with pre-existing left bundle branch block.: Eun Woo Choi, Ji Yoon Jung, Jun Huck Su, Sae Huyn Park, Kyu Hyang Cho, Kyung Woo Yoon, Jong Won Park, Jun Young Do, Seok Hui Kang; Yeungnam Univ J Med. 2015;32(2):152-154. Published online December 31, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.2.152

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Abstract PDF: Arrhythmias are complications of tunneled cuffed hemodialysis catheter insertion. Most complications associated with arrhythmias occur during guide-wire access, where the guide wire can cause traumatic damage to the conduction system of the heart. Conducting system injury in tunneled cuffed hemodialysis catheter insertion often involves the right bundle, causing right bundle branch block (RBBB). Transient RBBB with sinus rhythm is not usually accompanied by abnormal vital signs. However if patients already have left bundle branch block (LBBB), new onset RBBB can cause complete atrioventricular block (AVB), which can lead to fatal complications requiring invasive treatment. We report on a patient with LBBB who developed complete AVB during hemodialysis catheter insertion.

A Case of Idiopathic Collapsing Glomerulopathy Showing Aggravation on a Chronic Progressive Course.: Jung Min Park, Mun Ju Hwang, Yo Han Jeong, Hansol Lee, Jong Won Park, Yong Jin Kim; Yeungnam Univ J Med. 2012;29(2):102-105. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.102

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Abstract PDF: Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.

Rhabdomyolysis Induced Acute Kidney Injury in a Patient with Leptospirosis.: Yoon Jung Choi, Jeung Min Park, Yo Han Jung, Jong Ho Nam, Hyun Hee Chung, Tae Woo Kim, Kyu Hyang Cho, Jun Young Do, Kyeung Woo Yun, Jong Won Park; Yeungnam Univ J Med. 2011;28(1):54-59. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.54

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Abstract PDF: Leptospirosis is a spirochetal infectious disease caused by Leptospira interrogans, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of Leptospira. Renal disorders caused by Leptospira infection vary from an abnormality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.

A Case of Acute Renal Failure Associated with Non-fulminant Acute Hepatitis A.: Ji Hoon Na, Jong Won Park, Kyu Hwan Park, Myong Jin Oh, Yun Jung Choi, Jung Min Park, Woo Jin Chang; Yeungnam Univ J Med. 2010;27(2):127-132. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.127

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Abstract PDF: Acute hepatitis A is a generally self-limiting disease of the liver. Acute renal failure is rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 36 years old male patient visited our hospital with complaint of general weakness, fatigue, nausea, vomiting and myalgia. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.

A Case of Exit-Site Infection and Abscess by Mycobacterium Abscessus in a CAPD Patient.: Sun Young Jung, Ji Hoon Na, Kyu Hyang Cho, Jong Won Park, Jun Young Do, Kyeung Woo Yun, In Wook Song, Jeong Hwan Cho, Chang Woo Son; Yeungnam Univ J Med. 2009;26(2):137-143. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.137

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Abstract PDF

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.

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A Case Report ofMycobacterium abscessusPeritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis
Seon Joo Kang, Heungsoo Kim, Kyoung Un Park, Young Ae Lim, Wee Gyo Lee
Annals of Clinical Microbiology.2013; 16(2): 101. CrossRef
A Case of Continuous Ambulatory Peritonitis Dialysis Peritonitis Due toStenotrophomonas maltophiliaUsing Antibiotic Combination
Hee Sung Ko, Ah Ran Choi, Tae Hoon Kim, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Jung Eun Lee
Yeungnam University Journal of Medicine.2013; 30(2): 109. CrossRef

A Case of Pneumatosis Intestinalis in Peritoneal Dialysis Peritonitis.: Sun Young Jung, Ji Hun Na, Yun Jung Choi, Sung Ae Koh, Ku Hyang Choi, Jong Won Park, Jun Young Do, Kyeng Woo Yun; Yeungnam Univ J Med. 2009;26(1):49-55. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.49

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Abstract PDF: Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

A Case of Adult onset Henoch-Sch?nlein Purpura with Acute Renal Failure.: Seok Min Kim, Kyung Ae Chang, Sun Young Jung, Chan Soh Park, Jong Won Park, Jun Young Do, Yong Jin Kim, Kyung Woo Yoon; Yeungnam Univ J Med. 2008;25(1):58-63. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.58

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Abstract PDF: Henoch-Schonlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and C3 deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.

The Effects of Hantaan Virus on the Expression of Platelet Activating Factor Receptor and on the Activity of Platelet Activating Factor Acetylhydrolase.: Ji Young Hwang, Jong Won Park, Sae Yong Hong, Ho Sun Park; Yeungnam Univ J Med. 2008;25(1):41-49. Published online June 30, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.1.41

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Abstract PDF: BACKGROUND
The central physiological derangement of hemorrhagic fever with renal syndrome (HFRS) caused by hantaan virus (HTNV) is a vascular dysfunction, manifested by hemorrhage, impaired vascular tone and increased vascular permeability. Platelet activating factor (PAF), whose actions are mediated through a specific receptor, is a potent bioactive lipid. PAF has diverse biological functions in the vascular system, such as increasing vascular permeability, adhesion of leukocytes to the endothelium and reduction of cardiac output, which result in hypotension and shock. The goal of the present study was to investigate whether PAF is involved in the pathogenesis of HFRS. For this purpose, we evaluated the effect of HTNV on the expression of PAF receptor (PAF-R) and on the activity of PAF-acetylhydrolase (PAF-AH) instead of PAF because PAF is rapidly degraded by PAF-AH in vivo. MATERIALS AND METHODS: To evaluate the expression of PAF-R, we performed reverse-transcription PCR, western blot and FACS analyses using HTNV-infected human umbilical vein endothelial cells (HUVECs) and non-infected (control) HUVECs. In addition, we measured the activity of plasma PAF-AH in HFRS patients and normal healthy persons. RESULTS: The mRNA and protein expression of PAF-R was increased in HTNV-infected HUVECs compared with control HUVECs at 2 and 3 days post-infection (d.p.i.). FACS analysis showed that HTNV induced the surface expression of PAF-R in HUVECs from 2 d.p.i. The activity of plasma PAF-AH was 2.5-fold lower in HFRS patients than in normal healthy persons. CONCLUSION: Increased PAF-R expression by HTNV might increase the responsiveness to PAF in endothelial cells. Reduced PAF-AH activity in the blood of HFRS patients might delay PAF degradation. These results suggest that changes in PAF-R and PAF-AH by HTNV might influence to PAF activity and might be involved in the vascular dysfunction of HFRS.

A Study for Improvement of Erythropoietin Responsiveness in Hemodialysis Patients.: Jong Won Park, Jun Yeung Do, Kyung Woo Yoon; Yeungnam Univ J Med. 2001;18(2):226-238. Published online December 31, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.2.226

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Abstract PDF: BACKGROUND
Anemia in chronic renal failure plays an important rolr in increasing morbidity of dialysis patients. The causes of the anemia are multifactorial. With using of erythropoietin(EPO), most of uremia-induced anemia can be overcome. However, about 10% of renal failure patients shows EPO-resistant anemia. Hyporesponsiveness to EPO has been realted to many factors: iron deficiency, aluminum intoxication, inflammations, malignancies and secondary hyperparathyroidism. So I evailuated the improvement of EPO responsiveness after correction of above several factors. MATERIALS AND METHODS: Seventy-two patients on hemodialysis over 6 months were treated with intravenous ascorbic acid(IVAA, 300 mg t.i.w. for 12 weeks). After administration of IVAA for 12 weeks,patients were classified into several groups according to iron status, serum aluminum levels and i-PTH levels. Indivisualized treatments were performed; increased iron supplement for absolute iron deficiency, active vitamin D3 for secondary hyperparathyroidism and desferrioxamine(DFO, 5 mg/kg t.i.w.) for aluminum intoxication or hyperferritinemia. RESULTS: 1) Results of IVAA therapy for 12 weeks on all patients(n=72) Hemoglobin levels at 2,4,6 week were significantly elevated compared to baseline. but those of hemoglobin at 8, 10, 12 week were not significantly different. 2) Result of IVAA therapy for 20 weeks on patients with 100 microgram/1< or =ferritin<500 microgram/1 and transferrin saturation(Tsat) below 30%(n=30) After treatment of IVAA for 12 weeks, patients were evaluated the response of therapy according to iron status. Patient with 100 microgram/1< or =ferritin?500 microgram/1 and Tsat below 30% showed the most effective response. These patients were treated further for 8 weeks. Hemoglobin levels at 2, 4 week were significantly increased compared to baseline with significantly reduced doses of EPO at 2, 4, 10, 12, 16, 20 week. Concomitantly significantly improvement of Tsat at 2, 6, 16, 20 week compared to baseline were identified. 3) Result of IVAA therapy for 12 weeks followed by DFO therapy for 8 weeks on patients with serume aluminum above 4 microgram/1(n=12) Hemoglobin levels were not significantly increased during IVAA therapy for 12 weeks but dosages of EPO were significantly decreased at 2, 4, 6, 8 week during DFO therapy compared to pre-treatment status. CONCLUSION: IVAA can be helpful for the treatment of the anemia caused by functional iron deficiency and can reduce the dosage of EPO for anemia correction. And administration of low dose DFO, in cases of increased serum aluminum level, can reduce the requirment of EPO.

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