Periodontitis and Periodontal treatment of Hansen's Patients in National Sorokdo Hospital (Case Report) / 나학회지

The purposes of this case report(8 case) were to investigate the oral health periodontal conditions (CPITN 1 : 3, CPITN 2 : 182, CPITN 3 : 528) and prevent natural teeth through periodontal treatment(non-surgical periodontal treatment and surgical periodontal treatment) of patients who have Hansen's disease, which is an infectious periodontitis. Operative method of periodontal treatment are scaling, root planning, gingivectomy, partial flap, full flap.

An analytical on the periodontal conditions and treatment in leprous patients / 나학회지

The purpose of this study was to investigate the oral health periodontal conditions (CPITN(0), CPITN(1) CPITN(2) CPITN(3)) and periodontal treatment (non-surgical periodontal treatment and surgical periodontal treatment) of patients who have leprous disease. The objects for this study were 754patients (male: 453, female: 301, 60-69ages: 340, 70-79ages: 414) treated in the oral health center among Leprous disease patients with gingivitis and periodontal disease, residents in the Sirocco from 2003, May 1st to 2005, April 30th. The subdivided result carrying out periodontal conditions and treatment were as follows: 1. The results of periodontal conditions investigated that the number of 60-69year-old patients group were Community Periodontal treatment need index (CPITN)0: 15, CPITN1: 2, CPITN2: 66, CPITN3: 257, and 70-79year-old patients group were CPITN0: 27, CPITN1: 1, CPITN2: 116, CPITN3: 271 (Community Periodontal treatment need index(CPITN)0 of patients who have Leprous disease means exodontias states) 2. The results of periodontal treatment investigated that Non surgical periodontal treatment 25%, Surgical periodontal treatment 70%

A Clinical Analysis of Primary Focal and Segmental Glomerulosclerosis in Adults / 대한신장학회잡지

PURPOSE: Primary focal and segmental glomerulosclerosis(FSGS) is a clinicopathological entity defined by the segmental sclerosis involving glomeruli in a focal distribution with poor prognosis. Approximately 50% to 70% of adults with FSGS manifests nephrotic syndrome, and the others show mild to moderate proteinuria. In this study, we intended to figure out the clinical course, treatments and possible prognostic factors of FSGS in adults. METHODS: We retrospectively reviewed the clinical characteristics of 54 adult patients diagnosed as primary focal segmental glomerulo-sclerosis(FSGS) by renal biopsy in Chungnam National University Hospital. from Dec. 1989 to Jan. 2000. RESULTS: Mean age of 54 patients was 36.8+/-24.6 (15-75) years. Male to female ratio of them was 1.08 : 1. Thirty one patients(57%) of them were manifested as nephrotic syndrome and their male to female ratio was 1.4 : 1. In all of 54 primary FSGS patients, generalized edema(59%), microscopic hematuria (44%), hypertension(39%) and azotemia(15%) were noted as clinical manifestations at the time of diagnosis. Median duration of follow-up was 48.7(6-123) months. Except generalized edema, serum cholesterol and albumin level, and 24 hour urine protein excretion, there was no significant difference in hypertension, hematuria, serum creatinine, duration of follow- up and progression to chronic renal failure between 31 nephrotic and 23 non-nephrotic patients. Sixteen (52%) of 31 nephrotic patients with primary FSGS showed complete remission. Seven(22%) of them showed partial remission and eight(26%) of them showed no response after 8 weeks of first steroid treatment. No response group of primary FSGS nephrotic patients progressed significantly more to chronic renal failure than remission group including complete or partial remission patients. No response groups showed significantly higher serum creatinine, lower creatinine clearance, higher degree of glomerular global sclerosis and interstitial fibrosis than remission group at the time of diagnosis. Eleven patients(8 nephrotic and 3 non-nephrotic patients) of 54 primary FSGS patients progressed to CRF during follow-up period, and they showed significantly lower creatinine clearance and higher degree of global glomerular sclerosis at the time of diagnosis than normal renal function maintaining group. CONCLUSION: It is speculated that initial renal function and degree of global glomerular sclerosis at the time of diagnosis in primary FSGS patients, and additively response to initial steroid therapy and the degree of interstitial fibrosis at the time of diagnosis in nephrotic primary FSGS patients are thought to be significant long-term prognostic factors.

A Clinical Study on Adult Thrombotic Thrombocytopenic Purpura / 대한신장학회잡지

OBJECTIVE: Thrombotic thrombocytopenic purpura (TTP) is a disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, fluctuating neurological symptoms and a variable degree of impairment of renal function, which are thought to be due to endothelial cell injury, platelet activation and subsequent formation of thrombi in the microcirculaion. It usually occurs in adults but few reports are available on etiology, clinical manifestation, progression and the outcome of disease in Korea. METHODS: We investigated 10 adult patients who had admitted and were diagnosed as TTP in Department of Internal Medicine, Chungnam National University Hospital from Dec. 1994 to Jul. 2001. RESULTS: The male to female ratio was 1 : 4. The etiologic antecedants were infectious diarrhea in 3 patients, upper respiratory infection in 3 patients and pregnancy was related with TTP in 2 patents. The clinical manifestations were variable neurologic symptoms(100%), renal involvement(90%), hemorrhagic manifestations(80%), fever(60%), and diarrhea(40%). Acute renal failure was noted in 6 patients and hemodialysis was required in 5 patients. Plasma exchange was performed in 9 patients and corticosteroid was prescribed in 8 patients, simultaneously. Vincristine, azatioprine and cyclophosphamide were added in 2 patients. One patient died of hepatic failure. Seven patients showed complete recovery. One patient progressed to end-stage renal failure. The other patient showed multiple recurrences. CONCLUSION: It is thought that a considerable number of TTP patients show very serious acute renal failure and plasma exchange should be included in therapeutic modalities of TTP.

Causes of Failed Internal Arteriovenous Fistula and Their Salvage Procedures

Adequate vascular access is essential for hemodialysis and Cimino type arteriovenous fistula is the solution for this purpose. But even after we made that fistula, we faced with early fistula failure in about 5~15% of these internal fistula and about 10% drop of fistula patency during the follow up each year. In order to select adequate salvage procedures after fistula failure, we analyzed the causes of failure and compared the result of salvage procedures performed in 423 re-arteriovenous fistula cases which were done between March 1983 through February 1996 in the Department of Surgery Dongsan Hospital, Keimyung University. In early failure cases, poor arterial flow(51.4%) and missed proximal obstruction of fistulated vein before fistula creation(20.9%) were two most common causes of failure but in late failure, stricture and thrombosis were leading causes(81.4%). In the case of repeated arteriovenous fistula, usage of proximal artery showed less early failure rate(5.6%) than opposite radial or ulnar artery(14.8%). This is especially true in patient with diabetes, collagen disease or obesity. Both repeat arteriovenous fistula and salvage procedure showed more early fistula rate and less mean patency compare with primary fistula. Among the salvage procedures of late onset fistula failure, patch graft and bridge graft showed less failure rate(7.1% and 8.3% each) compared with balloon angioplasty(60.0%) or thrombectomy(25.0%). Thrombosis or occlusion at around the fistula site can be managed by performing new fistula using the arterized vein and artery 1~2 cm proximal to the previous fistula. In summary, salvage procedure in the failed arteriovenous fiatula should be chosen according to their failure causes and onset time.