Kyung Nam Lee

Decreased Renal Function Is an Independent Predictor of Severity of Coronary Artery Disease: An Application of Gensini Score

Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD).Although many studies have shown a higher prevalence of CAD among these patients, the association between the spectrum of renal dysfunction and severity of CAD remains unclear. In this study, we investigate the association between renal function and the severity of CAD. We retrospectively reviewed the medical records of 1,192 patients who underwent elective coronary angiography (CAG). The severity of CAD was evaluated by Gensini score according to the degree of luminal narrowing and location(s) of obstruction in the involved main coronary artery. In all patients, the estimated glomerular filtration rate (eGFR) was independently associated with Gensini score (β=-0.27, P < 0.001) in addition to diabetes mellitus (β=0.07, P = 0.02), hypertension (β=0.12, P < 0.001), low density lipoprotein (LDL)-cholesterol (β=0.08, P = 0.003), and hemoglobin (β=-0.07, P = 0.03) after controlling for other confounding factors. The result of this study demonstrates that decreased renal function is associated not only with the prevalence, but also the severity, of CAD.

The Modified Chimney Technique With a Thoracic Aortic Stent Graft to Preserve the Blood Flow of the Left Common Carotid Artery for Treating Descending Thoracic Aortic Aneurysm and Dissection

While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.

Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

APOLIPOPROTEIN B/A1 IS INDEPENDENTLY ASSOCIATED WITH CAROTID INTIMAL-MEDIAL THICKNESS IN CHRONIC KIDNEY DISEASE PATIENTS.

Serum apolipoprotein B/A1 (apo B/A1) ratio has been known for strong predictor of cardiovascular disease (CVD). Measuring carotid artery intimal-medial thickness (CIMT) is non-invasive modality used to evaluate subclinical atherosclerosis and to predict future cardiovascular disease. The objective of this study is to evaluate the association between apo B/A1 and CIMT in chronic kidney disease (CKD).We retrospectively reviewed the 293 patients who had visited health promotion center in a single community. The patients were divided into 2 group which are CKD group (n=99, estimated glomerular filtration rate (eGFR): 15-59 mL/min) and non-CKD group (n=194, eGFR ≥ 60 mL/min). Age, sex, presence of diabetes mellitus (DM)/hypertension, smoking status, eGFR, body mass index, and various biochemical blood examinations (serum LDL/HDL cholesterol, serum homocystein, and serum apo B/A1 ratio) were evaluated in each patient. CIMT was measured by high-resolution B-mode ultrasonography. Multivariate linear regression analysis was performed to investigate which factors are associated with CIMT in each of 2 groups. In CKD group, age (β=0.163, p=0.024), presence of hypertension (β=0.208, p=0.006), and presence of DM (β=0.236, p=0.002) were independently associated with CIMT adjustment for other confounding factors. However, in CKD group, serum apo B/A1 (β=0.572, p In conclusion, this study showed serum apo B/A1 ratio was independently associated with CIMT only in CKD group, not in non-CKD group. Because CIMT is a strong predictor of CVD, the result of this study demonstrates serum apo B/A1 ratio could be included in cardiovascular risk stratification in CKD patients