Percutaneous peritoneal dialysis catheter implantation with no break-in period: a viable option for patients requiring unplanned urgent-start peritoneal dialysis

Background@#Urgent-start peritoneal dialysis (PD) is applied to patients who need PD within two weeks but are able to wait for more than 48 hours before starting PD. To evaluate the usefulness of percutaneous PD catheter insertion in urgent-start PD, we reviewed the clinical outcomes of percutaneous catheter insertion with immediate start PD and surgical insertion with longer break-in time in Pusan National University Hospital. @*Methods@#This study included 177 patients who underwent urgent-start PD. Based on the PD catheter insertion techniques, the patients with urgent-start PD were divided into percutaneous (n = 103) and surgical (n = 74) groups. For the percutaneous group, a modified Seldinger percutaneous catheter insertion with immediate initiation of continuous ambulatory PD was performed by nephrologists. @*Results@#The percutaneous group showed higher serum urea nitrogen, creatinine, and lower serum albumin compared with the surgical group (P < 0.05). Ninety-day infectious and mechanical complications showed no significant differences between the two groups. Ninety-day peritonitis in the percutaneous group was 9.7% compared to 5.4% in the surgical group (P = not significant [NS]). Major leakage was 3.9% in the percutaneous group compared to 1.4% in the surgical group (P = NS). Overall infectious and mechanical complication-free survival was not significantly different between the two groups. The percutaneous group and surgical group showed no statistical difference with respect to catheter survival over the entire observation period (P = NS). @*Conclusion@#This study suggests that urgent-start PD can be applied safely with percutaneous catheter insertion by nephrologists with no break-in period.

Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis

BACKGROUND/AIMS@#The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP.@*METHODS@#In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching.@*RESULTS@#The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality.@*CONCLUSIONS@#Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Mallory-Weiss Tear After Cardiopulmonary Resuscitation in a Patient Suffering From Acute Myocardial Infarction / 고신대학교의과대학학술지

A report of a 79 year old male patient suffering from acute myocardial infarction with Mallory-Weiss tear after successful cardiopulmonary resuscitation(CPR) by emergency medical technician in the swimming pool is presented. Successful percutaneous coronary intervention(PCI) was done after appropriate transfusion. The patient survived and discharged without major complications after admitting 11days in the hospital. Importance of CPR in AMI patient is reiterated as complication such as Mallory-Weiss tear may arise.

Severe Fever with Thrombocytopenia Syndrome Accompanied by Hemophagocytic Lymphohistiocytosis / 대한내과학회지

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease caused by the SFTS virus (family Bunyaviridae, genus Phlebovirus). A 77-year-old female farmer was bitten by a tick and developed a fever 5 days later, resulting in admittance to the emergency room. The laboratory findings showed elevated liver enzyme levels, thrombocytopenia, and leukopenia. Lymphoma was suspected based on computed tomography results. After confirming SFTS virus infection via the polymerase chain reaction, a bone marrow biopsy revealed hemophagocytic lymphohistiocytosis (HLH). HLH is rarely observed in patients with SFTS and few studies have reported the presence of SFTS in bone marrow. Here, we report a case of SFTS that was initially mistaken for a lymphoma, and was accompanied by HLH.

Vitamin D Status and Its Association with the SCORAD Score and Serum LL-37 Level in Korean Adults and Children with Atopic Dermatitis

BACKGROUND: Vitamin D insufficiency could be associated with the prevalence of atopic dermatitis (AD). OBJECTIVE: To examine vitamin D status and the relations between serum 25-hydroxyvitamin D levels, SCORAD score, serum LL-37 level, and body mass index (BMI) in Korean AD patients, and to explore whether these associations differ between adults and children. METHODS: Serum 25-hydroxyvitamin D levels, serum LL-37, and clinical features were analyzed in a total of 72 Korean patients with AD (39 adults and 33 children) and 140 healthy control subjects (70 adults and 70 children). RESULTS: Serum 25-hydroxyvitamin D levels were significantly reduced in children with AD (15.06+/-4.64 ng/ml) compared with normal children in the control group (16.25+/-6.60 ng/ml) (p=0.036). Significant inverse correlations were found between BMI and 25-hydroxyvitamin D level (r=-0.315, p=0.007) and between the SCORAD score and serum LL-37 level (r=-0.3, p=0.011) in the total AD patients. CONCLUSION: The results showed that serum vitamin D levels were lower in children with AD than in healthy children; however, the same relation was not observed between adults with AD and healthy adults. Serum 25-hydroxyvitamin D concentration was not significantly correlated with AD severity or serum LL-37 levels in our study population.

A Predictive Factor in Overactive Bladder Symptoms Improvement after Combined Anterior Vaginal Wall Prolapse Repair: A Pilot Study

PURPOSE: We aimed to determine whether a preoperative urodynamic parameter is a valuable predictor for the persistence of OAB symptoms after the AVP repair. MATERIALS AND METHODS: 65 OAB patients with concomitant POP-Q stage III, IV anterior vaginal wall prolapse underwent a surgical repair were involved. All the patients were subjected to a preoperative urodynamic study, for whom the OABSS on questionnaire were preoperatively recorded. We firstly analyzed the correlation between the BOOI and the OABSS, then randomly divided patients into two groups: the group A (high PdetQmax, BOOI> or =20) and the group B (low PdetQmax, BOOI<20). In each group, the OABSS was repeatedly measured post-operatively and the change were analyzed. RESULTS: 31 patients were classified as the group A and 34 patients were classified as the group B. The group B showed significant decrease of symptom score in daytime frequency (p<0.01), urgency (p=0.04), urge incontinence (p=0.03), nocturnal frequency (p=0.01) and total score (p=0.01). The group A showed no significant decrease of symptom score in daytime frequency (p=0.42), urgency (p=0.61), urge incontinence (p=0.3), total score (p=0.15) except nocturnal frequency (p=0.01). CONCLUSIONS: A preoperative pressure-flow study can be a valuable tool in predicting the OAB symptoms change after the combined AVP repair. While the AVP repair leads to the improvement of OAB symptoms generally, some patients with a higher preoperative PdetQmax are still in need of the additional medical treatment.

A Novel Pathway Underlying the Inhibitory Effects of Melatonin on Isolated Rat Urinary Bladder Contraction

The aim of the present study was to elucidate the direct effects of melatonin on bladder activity and to determine the mechanisms responsible for the detrusor activity of melatonin in the isolated rat bladder. We evaluated the effects of melatonin on the contractions induced by phenylephrine (PE), acetylcholine (ACh), bethanechol (BCh), KCl, and electrical field stimulation (EFS) in 20 detrusor smooth muscle samples from Sprague-Dawley rats. To determine the mechanisms underlying the inhibitory responses to melatonin, melatonin-pretreated muscle strips were exposed to a calcium channel antagonist (verapamil), three potassium channel blockers [tetraethyl ammonium (TEA), 4-aminopyridine (4-AP), and glibenclamide], a direct voltage-dependent calcium channel opener (Bay K 8644), and a specific calcium/calmodulin-dependent kinase II (CaMKII) inhibitor (KN-93). Melatonin pretreatment (10(-8)~10(-6) M) decreased the contractile responses induced by PE (10(-9)~10(-4) M) and Ach (10(-9)~10(-4) M) in a dose-dependent manner. Melatonin (10(-7) M) also blocked contraction induced by high KCl ([KCl]ECF; 35 mM, 70 mM, 105 mM, and 140 mM) and EFS. Melatonin (10(-7) M) potentiated the relaxation response of the strips by verapamil, but other potassium channel blockers did not change melatonin activity. Melatonin pretreatment significantly decreased contractile responses induced by Bay K 8644 (10(-11)~10(-7) M). KN-93 enhanced melatonin-induced relaxation. The present results suggest that melatonin can inhibit bladder smooth muscle contraction through a voltage-dependent, calcium-antagonistic mechanism and through the inhibition of the calmodulin/CaMKII system.

Effects of Psychotropic Drugs on Quantitative EEG among Patients with Schizophrenia-spectrum Disorders

OBJECTIVE: We examined how psychotropic medications affected quantitative EEG (qEEG) results among patients with a schizophrenia-spectrum disorder. METHODS: The drugs were clustered into nine groups depending on their mechanism. We hypothesized that drugs would affect the relative power shown in qEEG results independently and investigated the effect of each drug group on relative power using multiple linear regression analysis and independent samples t-tests. RESULTS: We found that antipsychotics other than clozapine induced an increase in the relative power of alpha activity. Clozapine markedly increased slow waves and decreased alpha activity in the occipital area. The main findings for antidepressants and antiepileptic drugs were the beta increment and lithium increased the power of delta and theta activity. However, we found no evident changes in power due to benzodiazepine. CONCLUSION: Our results are generally consistent with previous pharmaco-EEG studies, despite some differences. Therefore, the EEG effect in each drug group could be singled out even under the polypharmacy condition, with the possible exception of benzodiazepines. Our results support using a new methodological approach to identify the qEEG effects of various psychotropic drugs in clinical settings.

A Clinical and Histopathological Study of 122 Cases of Dermatofibroma (Benign Fibrous Histiocytoma)

BACKGROUND: Many variants of dermatofibromas have been described, and being aware of the variants of dermatofibromas is important to avoid misdiagnosis. OBJECTIVE: We wanted to evaluate the clinical and pathologic characteristics of 122 cases of dermatofibromas. METHODS: We retrospectively reviewed the medical records and 122 biopsy specimens of 92 patients who were diagnosed with dermatofibroma in the Department of Dermatology at Eulji Hospital of Eulji University between January 2000 and March 2010. RESULTS: Nearly 80% of the cases occurred between the ages of 20 and 49 years, with an overall predominance of females. Over 70% of the lesions were found on the extremities. The most common histologic variant was a fibrocollagenous dermatofibroma (40.1%). Other variants included histiocytic (13.1%), cellular (11.5%), aneurysmal (7.4%), angiomatous (6.5%), sclerotic (6.5%), monster (4.9%), palisading (1.6%) and keloidal dermatofibromas (0.8%). There were 9 dermatofibromas (7.3%) that were the mixed type with two co-dominant histologic features. CONCLUSION: The results of this study are consistent with previous reports on the clinical features of dermatofibromas. However, we observed several characteristic subtypes of dermatofibroma and we compared the frequency of the histologic subtypes.

Comparative Analysis of the Efficacy and Safety of Conventional Transurethral Resection of the Prostate, Transurethral Resection of the Prostate in Saline (TURIS), and TURIS-Plasma Vaporization for the Treatment of Benign Prostatic Hyperplasia: A Pilot St

PURPOSE: This study was conducted to perform a comparative analysis of the efficacy and safety of conventional transurethral resection of the prostate (TUR-P), transurethral resection in saline (TURIS), and TURIS-plasma vaporization (TURIS-V) when performed by a single surgeon for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The clinical data of 73 consecutive men who underwent conventional TUR-P (39), TURIS (19), or TURIS-V (15) for BPH were retrospectively analyzed. All procedures were carried out by a single surgeon between October 2007 and April 2010. The patients were assessed preoperatively and perioperatively and were followed at 1, 3, and 6 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcomes were compared, and major complications were recorded. RESULTS: In all groups, significant improvements in subjective and objective voiding parameters were achieved and were sustained throughout follow-up. TURIS-V had the shortest operation time compared with conventional TUR-P and TURIS (p=0.211). TURIS-V significantly decreased procedural irrigation fluid volume, postoperative irrigation duration, catheter duration, and hospital stay compared with conventional TUR-P and TURIS. There were no significant differences between the groups in hemoglobin levels or serum sodium levels before and after the operations. There were three transfusions and four clot retentions in the TUR-P group, and one transfusion and one clot retention in the TURIS group. The TURIS-V group had no complications. CONCLUSIONS: TURIS and TURIS-V were effective for the surgical treatment of BPH in addition to conventional TUR-P. TURIS-V was not inferior to conventional TUR-P or TURIS in terms of safety.

The Significance of Persistent Abnormal Urine Cytology

PURPOSE: We investigated the factors that predicted later transitional cell carcinoma (TCC) in a subgroup of patients with abnormal cytology and negative initial evaluations. MATERIALS AND METHODS: From January 2002 to June 2007, we retrospectively identified 58 patients. Cases were considered discordant if a work-up of urine cytology was abnormal although initial cystoscopy, upper tract evaluation, and biopsies resulted in a negative or benign diagnosis. Patients who could complete a urine cytology test after 6 to 8 weeks and who were followed up for at least 1 year were included in this study. According to later TCC demonstration, we compared risk factors for TCC between the later TCC group and the benign group and evaluated the independent factors that predicted later TCC by use of a Cox proportional hazards regression model. RESULTS: Of the 58 patients, the mean follow-up was 12.7+/-17.3 months (range: 2-83 months), and 14 patients (23.7%) had a prior history of TCC. During follow-up, 9 patients (15.3%) had TCC and 1 patient had prostate cancer. In the later TCC group, the incidence of a prior history of TCC (p=0.03) and persistent abnormal cytology (p<0.001) were higher than in the benign group in univariate analysis. In the Cox proportional hazards regression model, persistent abnormal cytology (p=0.033, relative risk (RR): 17.380 [95% CI: 1.265-238.783]) was the only independent factor to predict later TCC. The mean follow-up duration of later TCC demonstration was 8.55 months (range: 2-32 months). CONCLUSIONS: Our results suggest that in the setting of persistent abnormal urine cytology with a negative initial evaluation, 53.3% of patients will later develop TCC. Patients with persistent abnormal cytology need intensive follow-up within 1 year.

A Case of Cutaneous Protothecosis / 대한의진균학회지

Cutaneous protothecosis is a rare skin infection, caused by the genus prototheca, especially Prototheca wickerhamii. A 73-year-old woman had a painful, ulcerative patch and oozing plaque on left wrist and dorsum of hand for 2 months. Biopsy specimen revealed thick walled morula-like sporangia in the dermis. P. wickerhamii was isolated in the culture. Oral itraconazole therapy for 8 weeks is not satisfactory. New skin lesion is formed. After oral fluconazole therapy, patient's skin lesion is improved.

Development of Nomogram for Predicting Pathologic Outcome using Prostate-specific Antigen, Gleason Score, and the Percentage of Positive Core in the Clinically Confined Prostate Cancers, and Comparison with Nomogram using Existing Factors / 대한비뇨기과학회지

PURPOSE: There have been reports that clinical stages do not reflect patients' postoperative prognosis well. On the contrary, the clinical application of the percentage of positive core(%(+) core), which predicts tumor volume has been increasing. We developed nomogram for predicting pathologic outcome using prostate-specific antigen(PSA), Gleason score and %(+) core based on data of radical prostatectomy and compared it with nomogram using clinical stage instead of %(+) core. MATERIALS AND METHODS: Two hundred and fifty nine patients with clinically confined prostate cancers were included in the study. Nomogram for predicting pathologic outcome was developed through multinominal logistic regression analysis, and pathologic outcomes were extracapsular invasion(ECE), seminal vesicle invasion(SVI) and bladder neck invasion(BNI). The accuracy of each nomogram for predicting each pathologic outcome was compared on the basis of receiver operating characteristic(ROC) curve analysis. RESULTS: The mean %(+) core was 24.6% and clinical stages T1c, T2a,b and T2c were 58.7%, 32.0% and 9.3%, respectively. ECE was observed in 45(17.4%), SVI in 9(3.5%), and BNI in 12(4.6%). With an increase in PSA, Gleason score, clinical stage, or %(+) core, the incidence of extraprostatic involvement increased gradually. Two nomograms for predicting pathologic outcome were developed. In quantifying expected predictive improvement, area under ROC curve for predicting ECE was greater in the nomogram using %(+) core than clinical stage(0.815 vs. 0.778). These values for predicting SVI were 0.886 and 0.760, respectively, and for predicting BNI, 0.743 and 0.764, respectively. CONCLUSIONS: We developed nomogram for predicting pathologic outcomes using %(+) core instead of clinical stage. Nomogram using %(+) core predicted ECE and SVI with greater accuracy than nomogram using clinical stage.

A Study on the Incidence and Preoperative Predicting Factors of Extraprostatic Extension in T1c Prostate Cancers / 대한비뇨기과학회지

PURPOSE: To evaluate the incidence and identify the predicting factors of extraprostatic extension(EPE) in T1c prostate cancers. MATERIALS AND METHODS: Of 267 consecutive men who underwent radical retropubic prostatectomy(RRP) as initial treatment for prostate cancers, 131(49.1%) presented with a clinical stage T1c disease. Clinicopathological data were collected, and factors related to biopsy collected; i.e. the number of positive cores(No.(+) core); the percentage of positive cores(%(+) core); the maximal tumor length(Max. mm cancer); the sum of tumor length (Total mm cancer); the maximal ratio of tumor/core length(Max. % mm cancer) and the mean ratio of tumor/core length(Mean % mm cancer). A logistical regression analysis was performed after dividing the cases into organ-confined(OC) and EPE. RESULTS: Of the T1c tumors, 107(81.7%) and 24(18.3%) were found to be OC and to have EPE after RRP, respectively. The preoperative factors that showed a significant difference between the two groups(OC vs. EPE) were %free prostate-specific antigen(17.7 vs. 11.1%), prostate volume(43.5 vs. 34.6ml), Gleason score(6.4 vs. 6.8), %(+) core(17.9 vs. 27%), Max. mm cancer(3.5 vs. 6.7mm) and Max. % mm cancer(24.0 vs. 41.6%). Of these factors, those significantly predicting EPE in the receiver operator characteristics curve were: the Gleason score, %(+) core, Max. mm cancer and Max. % mm cancer. Of these, only the %(+) core and Max. mm cancer were significant in predicting EPE in the multivariate logistical regression. When the cutoff of %(+) core was 19%, the risk of EPE increased 2.3 times, and when the cutoff of Max. mm cancer was 5mm the risk increased 3.6 times. CONCLUSIONS: Max. mm cancer and %(+) core during a biopsy are preoperative factors that predict the EPE of a clinical stage T1c disease, and should be considered for modifying the surgical technique and in establishing treatment plans.

Pathologic Characteristics of Prostate Cancers Missed by Application of the Age-specific Prostate-specific Antigen Reference in Men over Sixties / 대한비뇨기과학회지

PURPOSE: To examine the pathologic characteristics of prostate cancers missed by application of the age-specific prostate-specific antigen(PSA) reference in Korean men over sixties in clinical practice based on PSA cutoff 3.0ng/ml. MATERIALS AND METHODS: We made retrospective analysis of 1,063 patients aged between 60-79 who had had transrectal ultrasonography(TRUS)- guided biopsy due to the rise of PSA over 3.0ng/ml or abnormal findings in digital rectal examination(DRE) or TRUS. Age-specific PSA reference was set at 3.9ng/ml for 60s and 5.4ng/ml for 70s. RESULTS: Prostate cancer was detected in 34.3%(365/1,063) as a whole, and 31.5% in 60s, and 39.5% in 70s according to the age. When age-specific reference 3.9ng/ml was applied to 60s, 20(9.6%) cancers were missed compared with clinical cutoff value(3.0ng/ml). When age-specific reference 5.4ng/ml was applied to 70s, 23(16.0%) cancers were missed. On the average, 43(12.2%) of cancers were missed in 60s and 70s. Of 43 missed cancers, 39(90.7%) were with normal DRE and TRUS. Of these cancers, 16(41.0%) were clinically insignificant on biopsy, but only 7(22.6%) were insignificant in the pathologic examination of 31 radical prostatectomy specimens. CONCLUSIONS: In our clinical practice based on PSA cutoff 3.0ng/ml, most cancers missed by application of age-specific reference are clinically significant. But, considering the positive effect of age-specific reference on avoidance of unnecessary biopsies, large prospective study is needed to evaluate the efficacy of age-specific reference in Korean men over sixties.

A Case of Leukocytoclastic Vasculitis after Influenza Vaccination / 대한피부과학회지

Influenza vaccination is recommended for all people over 65 years, for those with chronic respiratory disease and chronic renal failure. Severe side effects of influenza vaccination are rare. We report a case of leukocytoclastic vasculitis in a 68-year-old woman which developed 2 days after influenza vaccination. Disseminated palpable purpura were located on both her lower extremities. A skin biopsy showed characteristic features of leukocytoclastic vasculitis. Purpura were reduced after prednisolone and dapsone medication.

A Case of Barrett's Esophageal Ulcer following Esophagomyotomy for Achalasia / 대한소화기내시경학회지

We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.