Effects of online hemodiafiltration on anemia and nutritional status in chronic hemodialysis patients

Background@#Online hemodiafiltration (OL-HDF) offers considerable advantages in clearance of molecules of various sizes. However, evidence of clinical effects of OL-HDF is scarce in Korea. In this study, we investigated changes in laboratory values over more than 12 months after switching to OL-HDF. @*Methods@#Adult patients with end-stage renal disease undergoing hemodialysis (HD) were prospectively enrolled in a K-cohort (CRIS no. KCT0003281) from 6 tertiary hospitals in South Korea. We recruited 435 patients, 339 of whom were on HD at enrollment. One hundred eighty-two patients were followed for more than 24 months. Among them, 44 were switched to OL-HDF for more than 12 months without conversion to HD. We used a paired t test to compare baseline and 24-month follow-up results. @*Results@#The mean age of the subjects was 61.2 ± 12.2 years, and 62.6% were male. The baseline hemoglobin level was not significantly different between HD and OL-HDF group (10.61 ± 1.15 vs. 10.46 ± 1.03 g/dL, P = 0.437). However, the baseline serum protein and albumin levels were significantly lower in the OL-HDF group (6.82 ± 0.49 vs. 6.59 ± 0.48 g/dL, P = 0.006; 3.93 ± 0.28 vs. 3.73 ± 0.29 g/dL, P < 0.001). In patients switched to OL-HDF, levels of hemoglobin and serum albumin significantly increased (10.46 ± 1.03 vs. 11.08 ± 0.82 g/dL, P = 0.001; 3.73 ± 0.29 vs.

Efficacy of a Hair Tonic Containing Human Umbilical Cord Blood Mesenchymal Stem Cell-derived Conditioned Media in Patients with Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: The development of a safe and convenient agent that can promote hair growth in patients with androgenetic alopecia remains challenging. OBJECTIVE: This study was designed to investigate the efficacy of a newly developed hair tonic containing a human umbilical cord blood mesenchymal stem cell (hUCB-MSC)-derived conditioned medium in promoting hair growth. METHODS: This double-blind, placebo-controlled clinical study investigated the efficacy of a hair tonic containing an hUCB-MSC-derived conditioned medium in 30 patients with patterned hair loss. Treatment efficacy was determined using phototrichograms to evaluate the density, diameter, and hair growth rate at baseline levels and after 4, 8, and 16 weeks of treatment. RESULTS: The hair density in the group treated with the hair tonic significantly increased from 125.2 to 134.6 hairs/cm2 (p<0.05). In this same group, the thickness of hair also increased from 0.083 to 0.110 mm (p<0.05). Additionally, the hair growth rate increased from 0.285 to 0.338 mm/day (p<0.05). No severe adverse reactions were reported. CONCLUSION: A hair tonic containing an hUCB-MSC-derived conditioned medium could be a new effective alternative to treat patients with androgenetic alopecia.

Verruca Plana Developed after Tattooing / 대한피부과학회지

No abstract available.

A Case of Palmoplantar Keratoderma Presenting as Multiple Cutaneous Horns / 대한피부과학회지

No abstract available.

A Case of Superficial Spreading Capillary Hemangioma / 대한피부과학회지

No abstract available.

A Case of Disseminated Infection with Skin Manifestation due to Non-neoformans and Non-gattii Cryptococcus in a Patient with Refractory Acute Myeloid Leukemia

Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.

Administration of a High-Dose Erythropoietin-Stimulating Agent in Hemodialysis Patients is Associated with Late Arteriovenous Fistula Failure

PURPOSE: Investigating the risk of vascular access failure is critical for maintenance hemodialysis (MHD) patients. Erythropoietin stimulating agents (ESA) typically used for anemia of chronic kidney disease (CKD) may also stimulate neointimal hyperplasia, which is the most important factor in late arteriovenous fistula (AVF) failure. The aim of this study was to investigate whether ESA treatment is associated with late AVF failure. MATERIALS AND METHODS: The late AVF failure group comprised 51 patients who underwent percutaneous intervention or surgery for fistula revision after successful use for at least three months. There were 51 controls whose AVF had been patent for at least 24 months. RESULTS: The mean time from the first cannulation to late loss of AVF patency was 8.4±4.2 months. The average weekly dose of ESA was significantly higher in patients with AVF failure (4782.2±2360.5 IU/mL/wk vs. 7161.8±2775.2 IU/mL/wk, p<0.001). The only independent predictor of late AVF failure in multivariate analysis was high average ESA dose (odds ratio=1.015, 95% confidence interval=1.002–1.028, p=0.022). CONCLUSION: Patients with late AVF patency loss exhibit an association with a higher dose of ESA, although causality is unproven. Further study to elucidate potential mechanisms is warranted.

Effect of oral guava leaf extract administration on antioxidant and vasculoprotective activity in ovariectomized rats / 한국영양학회지

PURPOSE: The aim of this study was to assess the effects of guava leaf extract (GLE) supplementation on antioxidant enzyme activity and expression of endothelial nitric oxide synthase (eNOS) mRNA in ovariectomized rats. METHODS: All animals were randomly assigned to four groups (n = 7 for each group): non-ovariectomized control (Sham), the ovariectomized control (OVX), ovariectomy + 150 mg/kg b.w. of GLE (OVX·GL), and ovariectomy + 300 mg/kg b.w. of GLE (OVX·GH). Treatment groups were administered GLE for 8 weeks every day. RESULTS: Body weight gain was significantly reduced in the OVX·GL group compared with the OVX group (p < 0.05). The level of serum 17β-estradiol (E2) was significantly lower in the OVX groups than the Sham group (p < 0.05). Serum triglyceride (TG) and HDL-cholesterol levels were not significantly different between all groups. However, serum total cholesterol (TC) level was significantly reduced in the OVX·GH group compared with the OVX group (p < 0.05). Serum free fatty acid (FFA) level and liver TG level were significantly reduced in both OVX·GL and OVX·GH groups compared with the OVX group (p < 0.05). Furthermore, serum glutathione peroxidase (GPx) activity was significantly elevated in the GLE groups (p < 0.05). The mRNA expression level of GPx was not affected by ovariectomy. However, administration of GLE resulted in significantly increased nuclear factor erythroid 2-related factor (Nrf2) and catalase (CAT) mRNA expression levels in the liver (p < 0.05). In addition, liver nitric oxide (NO) level was significantly reduced in the OVX·GH group compared with the OVX group (p < 0.05). Expression level of endothelial nitric oxide synthase (eNOS) was significantly elevated in the OVX·GH group compared with the OVX group (p < 0.05). CONCLUSION: These results suggest that GLE could have protective effects in OVX rats by stimulating eNOS expression and improving the antioxidant defense system.

A Local Clinic Experience of Facial Redness in Koreans / 대한피부과학회지

No abstract available.

Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.

Eccrine Syringofibroadenoma in a Patient with Long-Standing Exfoliative Dermatitis

Eccrine syringofibroadenoma (ESFA) is a rare benign cutaneous adnexal lesion characterized by a hyperplastic epithelium and eccrine ductal differentiation. In the present case, a 73-year-old Korean male presented with symmetrical numerous widespread, pinkish nodules with a cobblestone appearance over both legs for 2 years. He had a history of generalized erythematous scaly patches over his entire body for 20 years. On histopathologic findings, diagnosis of ESFA was confirmed. Our unusual and interesting case emphasizes the first report described one case in which multiple cobblestone like ESFAs arising from long-standing exfoliative dermatitis.

Serum 25-hydroxyvitamin D as a predictor of hospitalization-free survival in predialysis and dialysis patients with chronic kidney disease: a single-center prospective observational analysis

BACKGROUND: Vitamin D has pleiotropic effects important for the proper functioning of multiple organ systems. We investigated whether serum 25-hydroxyvitamin D [25(OH)D] levels influenced hospitalization-free survival in patients with chronic kidney disease (CKD). METHODS: In this prospective study, serum levels of 25(OH)D were measured in 210 patients with CKD in the winter of 2009. Data regarding hospitalizations were collected over the subsequent 3 years. RESULTS: Vitamin D deficiency, as defined by a serum 25(OH)D level below 15 ng/mL, was observed in 76.7% of the patients. The mean 25(OH)D serum level was 13.6 ± 7.8 ng/mL in predialysis patients (n = 62) and 11.3 ± 6.7 ng/mL in dialysis patients (n = 148). During the follow-up, 107 patients (28 predialysis and 79 dialysis) were hospitalized because of infectious (33.6%) or cardiovascular diseases (23.4%). Predialysis and dialysis groups were divided into 2 subgroups based on the median 25(OH)D serum level. Kaplan-Meier analysis revealed that the risk of hospitalization was significantly lower in both predialysis and dialysis patients with above-median serum 25(OH)D levels (log-rank test; P = 0.043 and 0.002, respectively). Multivariate Cox proportional hazards models also demonstrated that the risk of hospitalization was significantly lower for patients with higher serum 25(OH)D levels in both the predialysis (hazard ratio, 0.963; 95% confidence interval, 0.93-0.99) and dialysis groups (hazard ratio, 0.955; 95% confidence interval, 0.91-0.99). CONCLUSION: A lower serum 25(OH)D level predicted poorer hospitalization-free survival in both predialysis and dialysis CKD patients.

A Case of Cytomegalovirus-associated Giant Gastric Ulcer in a Patient Who Healed by Discontinuing Immunosuppressive Therapy

Cytomegalovirus (CMV) is not a rare infection and is frequently observed in immuoncompromised patients. CMV infection is usually asymptomatic in immunocompetent patients however it can be a major cause of morbidity and mortality in immunocompromised patients. The diagnosis of CMV gastric ulcer is not easy because of the absence of characteristic endoscopic features and the difficulty in the identification of infection by routine histologic examinations. We experienced a case of CMV-associated giant gastric ulcer in a patient receiving immunosuppressive therapy. She was a 45-year-old woman with dermatomyositis and had received steroid therapy to control her disease. Epigastric pain developed during therapy and upper endoscopy revealed a gastric ulcer. Despite proton pump inhibitor therapy, her epigastric pain aggravated and follow-up endoscopy revealed a huge gastric ulcer approximately 10 cm in diameter. Histologic findings showed intracellular inclusion bodies after immunostaining which confirmed CMV-associated gastric ulcer. Steroid therapy was discontinued and she received proton pump inhibitors without antiviral agents. Her symptoms improved and follow-up endoscopy revealed successful healing of the CMV-associated gastric ulcer. If an unusual gastric ulcer develops in the immunocompromised patients, CMV gastric ulcer should be suspected and examination for inclusion bodies using CMV immunostaining should be considered.

Novel Treatment Using Intradermal Radiofrequency and Hyaluronic Acid Filler to Correct Marionette Lines

No abstract available.

Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature

Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis.

Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata

BACKGROUND: Severe alopecia areata (AA) is resistant to conventional treatment. Although systemic oral corticosteroids are an effective treatment for patients with severe AA, those drugs have many adverse effects. Corticosteroid pulse therapy has been introduced to increase therapeutic effects and reduce adverse effects. However, the treatment modality in severe AA is still controversial. OBJECTIVE: To evaluate the effectiveness of corticosteroid pulse therapy in patients with severe AA compared with treatment with oral cyclosporine with corticosteroid. METHODS: A total of 82 patients with severe AA were treated with corticosteroid pulse therapy, and 60 patients were treated with oral cyclosporine with corticosteroid. Both groups were retrospectively evaluated for therapeutic efficacy according to AA type and disease duration. RESULTS: In 82 patients treated with corticosteroid pulse therapy, 53 (64.6%) were good responders (>50% hair regrowth). Patients with the plurifocal (PF) type of AA and those with a short disease duration (< or =3 months) showed better responses. In 60 patients treated with oral cyclosporine with corticosteroid, 30 (50.0%) patients showed a good response. The AA type or disease duration, however, did not significantly affect the response to treatment. CONCLUSION: Corticosteroid pulse therapy may be a better treatment option than combination therapy in severe AA patients with the PF type.

A Case of Drug Eruption Similar to Erythema Multiforme Induced by Sorafenib / 대한피부과학회지

Sorafenib is an oral multi-kinase inhibitor with effects on tumor cell proliferation and tumor angiogenesis. The drug is associated with a relatively high incidence of dermatologic adverse events. Frequently observed clinical presentations include skin rash, a hand-foot skin reaction, alopecia, splinter subungual hemorrhages, and xerosis. There have been few reports of erythema multiforme or leukocytoclastic vasculitis related to sorafenib use. We report a case of a 72 year-old male diagnosed with renal cell carcinoma with distant metastasis, who developed an erythema multiforme-like drug eruption on his trunk and extremities after use of sorafenib.

Mass-forming Eosinophilic Infiltration Involving the Central Airway: A Case Report of Endobronchial Involvement of Eosinophilic Inflammation Mimicking Bronchogenic Malignancy / 대한내과학회지

We report a very unusual case of endobronchial involvement of eosinophilic inflammation. A 58-year-old woman visited our clinic complaining of cough. A chest computed tomography scan showed a poorly enhancing mass compressing both main bronchi in the subcarinal area. Bronchoscopy also showed stenosis of the two main bronchi with irregular mucosal thickening. A bronchoscopic endobronchial mucosal biopsy revealed eosinophilic inflammation without evidence of malignancy. The subcarinal mass disappeared after systemic steroid treatment. This is the first report of mass-forming eosinophilic infiltration involving the central airway mimicking primary lung cancer.

The Effect of Evening Primrose Oil for the Prevention of Xerotic Cheilitis in Acne Patients Being Treated with Isotretinoin: A Pilot Study

BACKGROUND: The most common adverse effects of oral isotretinoin are cheilitis, skin dryness, dry eyes, and conjunctivitis, whereas evening primrose oil (EPO) is known to improve skin moisture and transepidermal water loss (TEWL) in healthy adults and atopic patients. OBJECTIVE: To evaluate the clinical efficacy and safety of EPO in preventing xerotic cheilitis in acne patients being treated with oral isotretinoin. METHODS: Forty Korean volunteers of Fitzpatrick skin types III and IV, having moderate acne, were enrolled and randomized to receive either isotretinoin with or without EPO for 8 weeks. The efficacy of treatment was evaluated on the basis of global acne grading system scores, number of inflammatory and noninflammatory lesions, TEWL, corneometry, physician's global assessment, and patient satisfaction. RESULTS: The results after 8 weeks of treatment showed that the TEWL of the lip increased significantly during isotretinoin treatment, whereas the TEWL of the hand dorsum showed no significant change. The increase of the TEWL of the lip was more definite in the control group than in the experimental group. The number of acne lesions decreased significantly in both groups, and there were no differences between them. CONCLUSION: Our study suggests that the addition of EPO improved xerotic cheilitis in acne patients being treated with oral isotretinoin. However, besides TEWL and corneometry assessments, additional studies are required for a complete understanding of the role of EPO in xerotic cheilitis in acne patients being treated with oral isotretinoin.

Multiple Epidermal Cysts as a Complication of Gold Acupuncture

No abstract available.