Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy / 대한신장학회지

PURPOSE: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. METHODS: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. RESULTS: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54+/-16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. CONCLUSION: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.

A Case of Ascending Aortic Aneurysm Associated with Congenital Bicuspid Aortic Valve

Bicuspid aortic valve is the most common form of congenital valvular disease, and its presence may predispose the patients to development of true aortic or dissecting aortic aneurysms. An intrinsic aortic weakness may underlie a bicuspid aortic valve, aortic aneurysm or aortic dissection. We experienced a case of an ascending aortic aneurysm associated with a functionally normal bicuspid aortic valve. A screening echocardiograph was performed due to atypical chest pain, which detected a large ascending aortic aneurysm and a bicuspid aortic valve. The patient underwent an operation for an ascending aortic aneurysm and, is living one year later, and is asymptomatic. To the best of our knowledge, this may be the first case of an ascending aortic aneurysm associated with a bicuspid aortic valve in Korea.

A Case of Gastric Injury by Acute Iron Intoxication / 대한소화기내시경학회지

Iron is a kind of corrosive agent. Iron overdose causes gastrointestinal complication such as mucosal ulceration, bleeding, intestinal perforation and may occur metabolic acidosis, hepatic dysfunction, hepatic failure, renal failure and cardiomyopathy. Delayed sequalae including gastric outlet obstruction develops 4 to 6 weeks after ingestion. The determination of serum iron and TIBC is an important factor in ascertaining the toxic potential in acute iron ingestion and more is the amount of ingested elemental iron, greater is a patient's toxicity. Supportive care is most important and patients who have severe symptom and abnormal vital sign should be treated with deferoxamine. We report the case that a 20-year-old pregnant female (33 weeks gestation) who had visited complaining of gastrointestinal symptom with iron overdose state was administrated with deferoxamine, therefore we removed iron loads within stomach with endoscopic suction and observed multiple gastric erosion with much old iron in endoscopic findings.

A Case of Large Bowel Herniation Through a Diaphragmatic Defect during Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a safe procedure and life-threatening complications occur rarely during diagnostic colonoscopy. There have been several reports of complications of colonoscopy, including bleeding, bowel perforation, bacteremia, vasovagal reactions and side effects of preparation and other more minor problems. The development of diaphragmatic hernia during diagnostic colonoscopy is extremely rare complication. We report a case of herniation and entrapment of the colon into the left thorax, via a small diaphragmatic defect caused by previous trauma, during diagnostic colonoscopy.

The Study of CDKN2/p16INK4A Mutation in Human Breast Cancer

The p16 is a cyclin-dependent kinase inhibitor(CDKI) that inhibits cell cycle progression. In recent studies, homozygous deletions of p16 gene have been noted in some cancer cell lines, which implies the deletion or mutation of p16 gene may contribute to the malignant progression of cells in some ways. This study was to investigate the frequency of p16 gene mutation in breast cancer patients by using polymerase chain reaction-single stranded confromational polymorphysm(PCR-SSCP) analysis. Examination of 24 blood samples and corresponding 16 tissue samples from 24 breast cancer patients were performed by PCR-SSCP method. Four from 24 blood samples(16.7%) disclosed 3 abnormal bands and one band shifting. Among 13 tissue samples revealed three conformational changes(23.1%). In two cases, there were abnormal bands in both blood samples and cancer tissues. One case with no products by PCR in the tissue sample showed a band shifting in the blood sample. Three cases with no PCR products in tissue samples may considered as total allelic deletion of the p16. The cases of abnormal PCR-SSCP results show some abnormalities on direct sequencing by Sanger method as T base insertion, C/T and A/G bases substitution. The results may suggest some of breast cancer patients have germline mutations of the p16 gene and some have somatic mutations. In the carcinogenesis of some breast cancers, p16 gene mutation may dysregulates the cell cycle, that may play an important role in the unlimited tumor cell proliferations.