One-Year Mortality of Acute Kidney Injury in Patients with Acute Myocardial Infarction / 대한신장학회지

PURPOSE: Acute kidney injury (AKI) is a common complication during hospitalization and is an accepted risk factor for in-hospital mortality. However, the association of severity of AKI with the long-term risk of death is not well known. This study aimed to investigate the incidence and clinical significance of AKI in patients with acute myocardial infarction (AMI). METHODS: To examine the effect of the severity of AKI on 1-year risk of death following AMI, we performed an observational study of 1,224 patients admitted for AMI. We evaluated the association between AKI and all-cause mortality. Patients with maintaining hemodialysis treatment (n=7), and who died during hospitalization (n=71) were excluded. Remaining 1146 patients were divided into three groups according to the Acute Kidney Injury Network (AKIN) criteria (Stage-1, -2, and-3). The primary end point of the study was 1-year all-cause mortality after hospital discharge. The relation between the severity of AKI and 1-year mortality after AMI was analyzed. RESULTS: AKI was developed in 222/1,146 (19.3%) patients during the hospital stay. Adjusted hazard ratio for 1-year mortality was 3.064 (95% CI 1.618 to 5.803, p=0.001), 6.112 (95% CI 2.344 to 15.935, p<0.001) and 20.030 (95% CI 5.428 to 73.912, p<0.001) in stage-1, -2, and stage-3 AKI groups compared with that of no AKI group. CONCLUSION: The severity of AKI is strongly related to 1-year all cause mortality in patients with AMI.

Hypercalcemia Associated with Acute Kidney Injury and Metabolic Alkalosis

Most cases of hypercalcaemia are secondary to malignancy or primary hyperparathyroidism. We report a patient presenting with a triad of hypercalcemia, metabolic alkalosis, and renal failure secondary to treatment of iatrogenic hypoparathyroidism and osteoporosis. Persistent ingestion of calcium carbonate and vitamin D caused milk-alkali syndrome. The patient was managed with intravenous fluids and withdrawal of calcium carbonate and vitamin D. She responded well to the treatment and the calcium concentration, renal function and metabolic alkalosis were normalized. Milk-alkali syndrome may be important as a reemerging cause of hypercalcemia.

A Case of Macroscopically Unvisualized Mucin-hypersecreting Biliary Papillomatosis Diagnosed by Microscopy / 대한소화기학회지

The mucin-hypersecreting biliary papillomatosis is a premalignant neoplasm characterized by intraductal papillary proliferation involving extensive areas of the intrahepatic and/or extrahepatic bile duct. We report a case of mucin-hypersecreting biliary papillomatosis manifested as obstructive jaundice and diagnosed only by microscopy, with a review of literatures. A 74-year-old female, who had a past history of cholecystectomy about 13 years ago, was admitted to our hospital with jaundice. A CT scan showed marked dilatation of intrahepatic and extrahepatic bile duct without intraductal filling defect or extrabiliary mass. During endoscopic retrograde cholangiopancreatography, mucin extrusion from the duodenal major papilla and dilated common bile duct with amorphous filling defects was noted. Percutaneous transhepatic biliary drainage for cholangioscopy was failed. In the operation field, there was a lot of mucin but was no visible mass at the common bile duct with bare eyes and cholangioscopy. However, papilloma was detected at the random biopsy specimen by microscopy. The patient underwent partial resection of common bile duct and choledocho-jejunal anastomosis.

Immunohistochemical comparison of the telomerase expression between low-grade and high-grade gastric dysplasia / 대한내과학회지

BACKGROUND: Telomeres are simple repeats elements located at each end of the chromosomes of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer, but also in precancerous lesion. In this study, we compared the telomerase expression between low-grade and high-grade gastric dysplasia. METHODS: The telomerase expression of 43 patients with gastric dysplasia (22 low-grade and 21 high-grade) was evaluated by immunohistochemical staining in tissues. RESULTS: The telomerase expression was much higher in the tissues from the patients with high-grade gastric dysplasia than in those tissues of the patients with low-grade gastric dysplasia. CONCLUSIONS: Activation of telomerase may be related with the malignant potentiality in gastric cells. Further studies are needed to define the role of telomerase in gastric tumorigenesis.