Static Venous Pressure Measurement by Access Alert in Detecting Vascular Access Stenosis / 대한신장학회잡지

BACKGOUND: K/DOQI guideline recommends measurement of vascular access blood flow and static intra-access pressure (SIAP) as important vascular access monitoring methods. Vascular access blood flow is measured by ultrasongraphic dilution method or Doppler sonographic examination. But these two examinations are expensive and the former needs special apparatus and the latter has the limitation of inter- and intra-observer variability. This study was performed to evaluate the utility of SIAP measured by Access Alert in detecting vascular access monitoring in hemodialysis (HD) patients. METHODS: Ninety-two patients on chronic HD via arteriovenous fistulas (AVF) and grafts (AVG) were included in this study. Mean age was 5513 and the number of man was 34. Sixteen patients had AVG. We measured both dialysis venous pressure (DVP) and SIAP. SIAP was measured by Access Alert (Medisystems, Seattle, WA) via arterial and venous canulation into vascular access and then static intra-access pressure ratio (SIAPR) was calculated by SIAP/MAP (mean arterial pressure. Venography was performed to find venous stenosis in patients who had abnormal levels of SIAPR. RESULTS: Arterial and venous SIAPRs in patients with AVG were higher than those in patients with AVF, respectively (arterial line:0.69+/-0.24 vs. 0.29+/-0.18, pp<0.001, venous line:0.60+/-0.23 vs. 0.23+/-0.16, p<;0.001). Of the total 92 patients, 30 patients had abnormal SIAPR. We performed venography in 19 out of these 30 patients. Of the 19 patients, 17 patients had stenotic venous lesions in which 14 patients had severe stenotic lesions and required radiologic intervention. In 14 patients with severe stenotic lesions, only 2 patients showed abnormal DVP and other patients showed normal DVP. CONCLUSION: The measurement of static intra-access pressure by Access Alert is simple and effective in detecting vascular access stenosis.

Lethal Measles Pneumonia after Allogenic Hematopoietic Stem Cell Transplantation / 감염

As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in measles in our countries. In these situation, it has been reported that measles associated pneumoinia is easily complicated with fatal respiratory failure, especially in immunocompromised patients. Herein we report the case of lethal measles pneumonia after allogenic hematopoietic stem cell transplantation in adults proven by autopsy. Recently, one case of measles was encountered in a 39-year-old female patients after allogenic bone marrow transplanted case (chronic myelogenous leukemia), who progressed into interstitial pneumonia pattern, despite treatment including antibiotics, immunoglobulin. The patient died of giant cell pneumonia compatible with that of measles which was comfirmed in the section of necropsy lung specimen.