Efficacy and Safety of Biodegradable Microparticles in the Regeneration of Injured Rabbit Corpus Cavernosum: Primary Report / 대한남성과학회지

PURPOSE: This study analyzed the effectiveness of poly (lactic-co-glycolic acid) (PLGA) as a tissue recovery agent and determines the in vivo safety and efficacy of microparticle-based PLGA. MATERIALS AND METHODS: Fifteen 3-month-old male white rabbits were used. Allogenic adipose tissue derived stromal vascular fraction (SVF) was cultured and labeled with the fluorescent dye PKH26. The rabbits were divided into 4 groups: the SVF group, the PLGA group, the normal control group, and the disease control group. The right corpus cavernosal tissue of the rabbits was surgically removed in the selected portion, except in the normal control group. The defect space of each rabbit was replaced with 10(6) SVF cells in the SVF group and 0.1 g of biodegradable polymer solution in the PLGA group. Microscopic confirmation and analysis of tissue regeneration were performed after 8 weeks. Using confocal microscopy, the nuclei of the smooth muscle cells and SVF migration were examined. The composition of smooth muscle and fibrosis of the injured corpus cavernosum were compared and analyzed by Masson's trichrome stain. RESULTS: There were no signs of migration or rejection of the injected materials in any of the experimental groups. The mean amount of smooth muscle in the normal control group was 15.25+/-1.34 microm2 (right) and 13.90+/-0.703 microm2 (left); in the disease control group it was 11.10+/-0.87 microm2 (right) and 12.80+/-1.01 microm2 (left); in the SVF group it was 13.82+/-4.10 microm2 (right) and 13.96+/-3.94 microm2 (left); and in the PLGA group it was 12.89+/-1.39 microm2 (right) and 13.24+/-1.43 microm2 (left). Only the disease control group showed significant decreased smooth muscle in the left cavernosum (p0.05). Furthermore, no difference was found between any two groups (normal control versus SVF (p=0.705), normal control versus PLGA (p=0.88), SVF versus PLGA (p=0.23). CONCLUSIONS: PLGA microparticles had the same tissue restoring effect when compared with SVF and no adverse effect or migration of particles was found through the injection of PLGA or SVF. PLGA is safe and has the proper tissue recovery effect, saving additional tissue harvesting.

The Relation of Arterial Stiffness with Vascular Calcification and BMD in Chronic Kidney Disease / 대한신장학회지

PURPOSE:Vascular calcification with arterial stiffness as well as bone mineral density was compared in hemodialysis, peritoneal dialysis patients, and pre-dialysis patients. METHODS:The calcification level of the aorta was scored, the arterial stiffness level was examined by pulse wave velocity (PWV), and bone mineral density was measured by the use of DEXA, and analyzed. RESULTS:PWV was significantly higher in the calcification group. The systolic blood pressure and the PWV value of the HD group was r=0.566 (p<0.001), the PD group was r=0.711 (p<0.001), and the pre-dialysis patients group was r=0.461 (p=0.001), and in all groups, a high correlation was shown. In the association of the PWV value with BMD and T score, in the PD patient group, with spine BMD, it was r=-0.351 (p<0.05), femur BMD was r=-0.510 (p<0.01), and femur T score was r=-0.527 (p= 0.001). In the multivariate analysis of the PWV value, in the HD group, age and systolic blood pressure were significant and in the PD group, calcification score femur BMD, femur T score, and CRP were significant factors. In the pre-dialysis patients group, only femur T score was detected to be a significant factor for PWV. CONCLUSION:In hemodialysis patients, age and systolic blood pressure, and in peritoneal dialysis patients, vascular calcification and the BMD level were analyzed to be significant factors mediating effects on arterial stiffness.

Status of Initiating Pattern of Hemodialysis: A Multi-center Study

This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.

Successful Angioplasty of Arteriovenous Graft Obstruction Using Gadolinium chelate in a Patient with Iodine Hypersensitivity / 대한신장학회지

Percutaneous transluminal angioplasty (PTA) using iodine contrast dye has been used as the definitive method of choice for treating hemodialysis vascular access dysfunction. Occasionally, iodine material can not be used in the hemodialysis patients with a history of severe hypersensitivity reactions or the predialysis patients with premature access awaiting hemodialysis treatment. Gadolinium chelates have been reported as an alternative contrast agent for angiography or angioplasty in such patients. Here we report a case of successful angioplasty of arteriovenous graft obstruction using gadolinium chelate (gadopentetate dimeglumine) in a patient with repetitive iodine hypersensitivity reactions.

Association of Arterial Stiffness with the Decrease of Post-Dialysis Blood Pressure in Maintained Hemodialysis Patients / 대한신장학회지

PURPOSE: Cardiovascular disease is one of the leading causes of mortality and morbidity in hemodialysis patients. Arterial stiffness is known to be associated with vascular calcification in HD patients. Post-dialysis hypotension is a risk factor for cardiovascular mortality. We evaluated the relation between arterial stiffness and post-dialysis blood pressure in maintained HD patients. METHODS: 72 HD patients were enrolled in this study. They had been under maintenance HD for more than 3 months. We checked the biochemical data, including the troponin T, CRP and OPG (osteoprotegerin) levels before their dialysis session and the baPWV (brachio-ankle pulse wave velocity) after the session. We defined post-dialysis BP decrease as a drop of BP of more than 5% of the average MAP for 2 weeks (6 sessions). RESULTS: There were 34 and 38 patients with and without post-dialysis BP decrease, respectively. The BP decrease group had higher CRP, troponin T and OPG levels (p<0.05, 0.01 and 0.01, respectively). The PWV was higher in the BP decrease group (p<0.001). The CRP and troponin T levels were positively correlated with the PWV (r=0.26, p<0.05; r=0.31, p<0.01, respectively). The OPG level was positively correlated with the PWV (r=0.44, p<0.001). Age, pre-dialysis pulse pressure and drops in the patients MAP were correlated with the PWV (r=0.33, p<0.05; r=0.31, p<0.05; r=0.30, p<0.05, respectively). On multivariate analysis, PWV was the independent factor related to the drops in the MAP of the patients (beta=0.311, p=0.021). CONCLUSION: Arterial stiffness is associated with post-dialysis blood pressure decrease.

A Case of Post-Streptococcal Glomerulonephritis with Diffuse Alveolar Hemorrhage

Acute post-streptococcal glomerulonephritis (PSGN) is characterized by an abrupt onset of edema, hypertension, and hematuria. Life-threatening diffuse alveolar hemorrhage (DAH) is rarely associated with acute PSGN. There have been only two reported cases worldwide, and no case has been reported previously in Korea. Here, we present a patient who clinically presented with pulmonary-renal syndrome; the renal histology revealed post-infectious glomerulonephritis of immune complex origin. A 59-yr-old woman was admitted with oliguria and hemoptysis two weeks after pharyngitis. Renal insufficiency rapidly progressed, and respiratory distress developed. Chest radiography showed acute progressive bilateral pulmonary infiltrates. The clinical presentation suggested DAH with PSGN. Three days after treatment with high-dose steroids, the respiratory distress and pulmonary infiltrates resolved. Electron microscopy of a renal biopsy specimen sample revealed diffuse proliferative glomerulonephritis with characteristic subendothelial deposits of immune complex ("hump''). The renal function of the patient was restored, and the serum creatinine level was normalized after treatment.

The Effect of Cutting Balloon Angioplasty on Vascular Access Dysfunction in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND:When angioplasty is performed using conventional balloon to treat arteriovenous fistula stenosis, treatment failure frequently occurs in case stenosis is very seve or tight. Cutting balloons were made to overcome these disadvantages. The purpose of this study is to evaluate the clinical effectiveness of cutting balloon angioplasty (CBA). METHODS:Twenty-four patients treated with CBA were included in this study. We evaluated clinical signs of venous stenosis, fistulographic findings, indications of CBA, procedure outcomes, and its complications. RESULTS:Out of the total 24 patients, the most common indication for fistulogram was increased negative arterial pressure (n=8). The stenotic lesions were juxta-anastomotic vein (n=19), graft-venous anastomosis (n=3), artery-venous anastomosis (n=1), and axillary vein (n=1), retrospectively. Conventional angioplasty had been attempted but failed in all 24 patients who were treated with CBA. The initial success rate of CBA was 100%, and the follow-up patency rate at 6, 12, 24 month after the procedure were 73.1%, 65.8%, and 49.3%, respectively. Procedure- related complications were minimal leakage of contrast media (n=3), partial rupture of vessel wall (n= 3), and vessel dissection (n=2). Three partial ruptures and one severe dissection were successfully treated only with balloon inflation without surgical operation. And leakages and one mild dissection spontaneously improved without specific treatment. CONCLUSION:This study suggests that cutting balloon angioplasty is relatively safe and effective in treating failed stenotic lesions when compared with conventional angioplasty in hemodialysis patients.

A Case of Idiopathic Nodular Glomerulosclerosis Presenting Rapid Progressive Renal Failure / 대한신장학회잡지

Idiopathic nodular glomerulosclerosis is an unusual entity with histopathologic features resembling nodular diabetic glomerulosclerosis but occurs in non diabetic patients and predominantly in older males with smoking and long standing hypertension. It is characterized histologically by nodular mesangial sclerosis, glomerular basement membrane thickening, and arteriolosclerosis in the absence of immune-type deposit, and clinical presentations typically include renal insufficiency and severe proteinuria with relatively poor prognosis. We experienced a rare case of idiopathic nodular glomerulosclerosis presenting rapid progressive renal failure in a 42-year-old man without clinical evidence of diabetes. He was admitted with peripheral edema and renal insufficiency. He had a history of hypertension for 2 years and chronic hepatitis B for 5 years. Funduscopy and renal ultrasound were normal. HbA1c and oral glucose tolerance test were normal and on serum and urine electrophoresis, M-spike was not found. Light microscopic examination demonstrated the characteristic features of lobular glomerulonephritis showing glomerular hypertrophy and nodular mesangial sclerosis. Immunofluorescence was negative for immune-type deposits. Electron microscopy showed marked increase of mesangial matrix, mesangial cell proliferation, moderate effacement of foot processes, and glomerular basement thickening without electron-dense deposits or other specific fibrils. Idiopathic nodular glomerulosclerosis was diagnosed. After discharge, he continued smoking and his blood pressure was not controlled. Three months after first biopsy, second biopsy was performed because of increasement of serum creatinine and specimens showed progression of tubulointerstitial change and nodular mesangial sclerosis. Subsequent serum creatinine was progressively increased and hemodialysis was started 13 months after diagnosis.

The Clinical Significance of Nutrition Assessed by DEXA in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Malnutrition is one of the important predictors for mortality in maintained hemodialysis patients. DEXA is known to be a useful method to assess the nutritional status of hemodialysis patients (Though the methods to detect malnutrition in HD paitents are SGA, anthropometric methods, and serological study, which one is the best thing is still controversial). METHODS: Ninety seven hemodialysis patients without acute infection, inflammation, and acute coronary syndrome were included. SGA, anthopometric examination, serologic studies, and DEXA were performed. RESULTS: Mean age was 54.6+/-13.1 years and hemodialysis duration was 57.7+/-47.0 (range: 3-180) months. There were significant differences in creatinine, protein, triglyceride, and prealbumin between well nourished and malnutrition group by SGA, but not in albumin, CRP, troponin T, and DEXA parameters. Between normal and high CRP group, creatinine, albumin, prealbumin, troponin T, TNFRII, CRP were different, but not in DEXA parameters. There were significant difference in creatinine, albumin, prealbumin, troponin T, TNFRII, CRP, MAMC between low and high LTLM groups. LTLM ratio was negatively correlated with age, CRP, and TNFRII, positively correlated with albumin, prealbumin, creatinine, and MAMC. Creatinine and TNFRII were independent parameters for LTLM by multivariate analysis. CONCLUSION: (DEXA was the useful tool for malnutrition in HD paients. Malnutrition may be assicaiated with inflammation and apotosis.) These findings suggest that malnutrition may be associated with inflammation and apoptosis in maintained hemodialysis patients.

Four Cases of Verapamil Deleterious Effects in Chronic Renal Failure / 대한신장학회잡지

Four hypertensive patients with chronic renal insufficiency who were treated with sustained release verapamil hydrochloride subsequently developed acute toxic effects. All four patients developed marked bradycardia, hypotension, hyperkalemia and metabolic aciodosis and were treated with atropine, fluid therapy, potasium lowing measure, dialysis, and temporary pacemaker, and were restored to the renal function and sinus rhythm after 12-24 hr. Patients with renal impairement who are treated with sustained release verapamil may accumulate verapamil or its metabolites and develop toxic side effects. We conclude that sustained release verapamil should be used with caution in chronic renal failure and that patients should be closely monitored for adverse cardiovascular, metaboic, and hepatic side effects.

The anti-inflammatory effects of angiotensin II blockade in animal model of cyclosporine-induced nephropathy / 대한내과학회지

BACKGROUND: Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the anti-inflammatory effect of angiotensin II blockades using losartan (LSRT) in a rat model of chronic CsA nephropathy. METHODS: Male Sprague-Dawley rats, initially weighing 225 to 250 g, were used. After 1 week of a low-salt diet (0.05% sodium), the rats were randomized into four groups and treated for 4 weeks. The Vehicle (VH) group was treated with olive oil. The VH+LSRT group was treated with olive oil and LSRT. The CsA group received CsA. The CsA+LSRT group was simultaneously treated with CsA and LSRT. The anti-inflammatory effect of LSRT was evaluated with C-reactive protein (CRP) expression, osteopontin (OPN) mRNA and protein expression, and ED-1 infiltration RESULTS: The CsA treatment caused an increase in serum creatinine and a decrease in creatinine clearance compared with that of the VH group. Intrarenal CRP positive cells were significantly decreased in the CsA+LSRT group compared with the CsA group (38.0 +/- 2.1 vs. 65.0 +/- 5.1, p<0.01). In the CsA group, the degree of OPN mRNA expression was increased compared with that of the VH group. But, OPN mRNA expression was decreased in the CsA+LSRT group (387.5 +/- 56.6% vs. 719.8 +/- 58.5%, p<0.05). In the degree of ED-1 infiltration, we had a similar results such as CRP and OPN mRNA expression (CsA group 30.5 +/- 8.0 vs. CsA+LSRT 86.0 +/- 11.0, p<0.01). CONCLUSION: We concluded that the anti-inflammatory effects of angiotensin II blockade has a potential protective effect against CsA-induced renal injury.

Adequacy of Dialysis in Anuric CAPD Patiens / 대한신장학회잡지

BACKGROUND: Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/ 1.73 m2 or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. METHODS: The 27 anuric CAPD patients (patients on 4x2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4x2 L daily exchanges for 7 days) followed by high dose dialysis (5x2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m2 according to DOQI guideline. RESULTS: Selected patients were 12 men and 15 women, mean age was 49+/-2 years, mean weight was 59.2+/-0.1 kg , mean peritoneal dialysis duration was 51+/-5 months. Weekly Kt/V was 1.7+/-.3 in standard dose dialysis patients and 2.1+/-.4 in high dose dialysis patients, mean Ccr was 48.8+/-.2 L/ week/1.73 m2 in standard dose dialysis patients and 63.1+/-2.1 L/week/1.73 m2 in high dose dialysis patients. This difference is statistically significant (p< 0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis, 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9+/-.9 L vs 37.7+/-.6 L) was significantly different (p<0.05). CONCIUSION: This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients.

Adequacy of Dialysis in Anuric CAPD Patiens / 대한신장학회잡지

BACKGROUND: Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/ 1.73 m2 or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. METHODS: The 27 anuric CAPD patients (patients on 4x2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4x2 L daily exchanges for 7 days) followed by high dose dialysis (5x2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m2 according to DOQI guideline. RESULTS: Selected patients were 12 men and 15 women, mean age was 49+/-2 years, mean weight was 59.2+/-0.1 kg , mean peritoneal dialysis duration was 51+/-5 months. Weekly Kt/V was 1.7+/-.3 in standard dose dialysis patients and 2.1+/-.4 in high dose dialysis patients, mean Ccr was 48.8+/-.2 L/ week/1.73 m2 in standard dose dialysis patients and 63.1+/-2.1 L/week/1.73 m2 in high dose dialysis patients. This difference is statistically significant (p< 0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis, 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9+/-.9 L vs 37.7+/-.6 L) was significantly different (p<0.05). CONCIUSION: This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients.

Ten-Year Study of Bacteremia in Hemodialysis Patients in a Single Center / 대한신장학회잡지

BACKGROUND: The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. METHODS: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication and mortality of bacteremia. We compared clinical factors, morbidity and mortality between arteriovenous fistula and central venous catheter groups. RESULTS: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%) and staphylococcus aureus was most common. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n=4), aspiration pneumonia (n=2), hypoxic brain injury (n=1), gastrointestinal bleeding (n=1), and rupture of aortic pseudoaneurysm. Central venous catheter group (n= 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p<0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p=0.042) than arteriovenous group. CONCLUSION: This data showed that bacteremia caused high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.

Endothelin-1, Endothelin-2 and Endothelin-3 Induced Expression of Monocyte Chemoattractant Protein-1 in Rat Mesangial Cells / 대한신장학회잡지

BACKGROUND: Monocyte chemoattractant protein- 1 (MCP-1) is an important mediator for monocyte/ macrophage infiltration in various inflammatory renal diseases and is produced by renal cells. In the process of renal diseases, endothelin-1 (ET-1) is known to play an active role in cell growth, inflammation and fibrosis. The aim of this study was to investigate whether three isoforms of endothelin regulate MCP-1 expression in cultured mesangial cells. METHODS: Mesangial cells were incubated with or without various doses of ET-1, ET-2 or ET-3. To determine the monocyte chemotactic activity, chemotaxis assay was performed in modified Boyden chambers using freshly isolated human monocytes. MCP-1 mRNA expression in mesangial cells was measured by Northern blot analysis. RESULTS: ET-1, ET-2 and ET-3 stimulated monocyte chemotactic activity released from mesangial cells in a dose-dependent manner. ET-1, ET-2 and ET-3 also stimulated MCP-1 mRNA expression in a time-dependent manner, which was seen as early as 4 hours and was maintained up to 24 hours. CONCLUSION: These data suggest that ET-1, ET- 2 and ET-3 stimulate MCP-1 expression in mesangial cells and may contribute to the monocyte/ macrophage infiltration in inflammatory renal diseases.

Clinical Characteristics of Severe Hypertensive Patients with Improved Renal Dysfunction after Blood Pressure Control / 대한신장학회잡지

BACKGROUND: Mild renal dysfunction is relatively common in patients with long standing primary hypertension, ranging from 10% to 40% in various studies. The presence of renal dysfunction is associated with high cardiovascular mortality and morbidity rates of patients with primary hypertension. The purpose of this study is to analyze the clinical characteristics of patients with severe hypertension and reVersible renal dysfunction after blood pressure control. METHODS: This retrospective study enrolled 14 patients with severe hypertension and reVersible renal dysfunction after blood pressure control, between January 1993 and December 2002 at Kangnam St. Mary's Hospital and St. Paul's Hospital. We investigated the laboratory data using Wilcoxon signed rank test, and analysed renal biopsy findings and antihypertensive drugs. RESULTS: The mean age of the patients was 38+/-9 years and the number of male patients was 8. During 33.5+/-28.8 months of mean follow-up period, there was a significant decrease in mean arterial pressure and serum creatinine level, and significant increase in hematocrit level. But there was no significant changes in the level of uric acid, total cholesterol, and triglyceride. Each patient took more than 3 antihypertensive drugs consisting angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (22%), calcium channel blocker (21%), and beta blocker (21%). Renal biopsy was done in 6 cases, and histologic diagnosis resulted in 4 cases of benign hypertensive nephrosclerosis and 2 cases of IgA nephropathy. The typical morphological features of hypertensive nephrosclerosis were seen in all cases, and there were varying degrees of glomerular sclerosis from 0% to 92%. But the percent of glomerular sclerosis was not related to the level of initial serum creatinine, mean arterial pressure, and amount of proteinuria per day. CONCLUSION: Careful monitoring of renal function and effective treatment of blood pressure are therefore mandatory in treating young patient with severe hypertension with renal dysfunction.

Proximal Vein Obstruction or Stenosis Failed to Angioplasty in Hemodialysis Patients: Treatment with Endovascular Stent / 대한신장학회잡지

Although percutaneous angioplasty is effectively used in the treatment of vascular access stenosis in hemodialysis patients, it has low initial success rate and high recurrence rate for proximal vein obstruction or stenosis. We evaluated the effect of endovascular stent placement on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients. Wallstent was placed in 8 hemodialysis patients with vascular access obstruction or stenosis. All lesions were proximal to a functioning access which had been created one month to 4 years prior to onset of symptoms. Of the total patients, 4 patients had central vein stenosis(2 subclavian, 2 innominate vein stenosis) and they all had a history of subclavian vein catheterization for hemodialysis. Seven patients presented with arm edema, one suffered from needling difficulty. Venography showed complete obstruction in 4 patients and severe stenosis in 4 patients. Angioplasty was attempted before stent placement but failed in all patients. The stent placement initially succeeded in all patients. There were no acute complications such as stent displacement, sepsis, and bleeding. After this intervention, clinical symptoms disappeared and all patients could be immediately treated with hemodialysis via corrected access. The patients were followed for 8.0+/-4.6 months (3-16 months). During this period, restenosis occurred in 2 patients. Of the 2 patients, one patient was successfully treated with angioplasty. In conclusion, endovascular stent placement seems to be effective on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients.

Successful Management with Glue Injection of Arterial Rupture Seen during Embolization of an Arteriovenous Malformation Using a Flow-Directed Catheter: A Case Report

We present a case in which an arterial rupture occurring during embolization of an arteriovenous malformation of the left occipital lobe with a flow-directed micro-catheter,was successfully sealed with a small amount of glue. We navigated a 1.8-Fr Magic catheter through the posterior cerebral artery, and during superse-lective test injection, extravasation was observed at the parieto-occipital branch. The catheter was not removed and the perforation site was successfully sealed with a small amount of glue injected through the same catheter. Prompt recogni-tion and closure of the perforation site is essential for good prognosis.

Diabetic Ketoacidosis after Steroid Administration for Minimal Change Disease / 대한신장학회잡지

Although diabetic ketoacidosis is relatively common in primary diabetes mellitus, it is very rare in diabetes mellitus secondary to steroid therapy. We here present a case of diabetic ketoacidosis after steroid administration for minimal change nephrotic syndrome. A 29-year-old man was first admitted with generalized edema and massive proteinuria. He had no past history of diabetes mellitus. Kidney biopsy revealed minimal change disease and he was treated with prednisolone(1mg/kg). Eight weeks after steroid treatment, proteinuria disappeared completely and steroid dose was decreased by 10mg in a week. Nine weeks after steroid treatment, diabetes mellitus newly develped and it was well controlled with insulin therapy. As prednisolone dose was decreased, insulin requirement also diminished. When he was taking 30mg of prednisolone, insulin therapy was stopped because of good glycemic control. He complained of vomitting and abdominal pain, and tachypnea a week after withdrawl of insulin. Laboratory findings revealed severe diabetic ketoacidosis. Steroid was stopped and he was treated with fluid, insulin and potassium. Now he is beibg successfully treated with 20 unit of NPH insulin without relapse of nephrotic syndrome.

A Case of Ventricular Tachycardia Induced by Amitriptyline in a Patient with Painful Diabetic Neuropathy / 대한내분비학회지

Diabetic neuropathy is one of the most common complications of diabetic mellitus and has myriad clinical presentations. Amitriptyline is an effective drug for painful diabetic neuropathy, but has a wide variety of cardiovascular effects. We report a case of amitriptyline-induced ventricular tachycardia in a patient with painful diabetic neuropathy. A 48-year-old man with no history of heart disease was treated with amitriptyline for the past 2 months. The dosage of this drug was gradually increased and the maximal dose was 170 mg per day. Prior to administration of this drug, his chest X-ray and electrocardiogram were normal. On admission he complained of chest discomfort and palpitation for 3 days, but his vital sign was stable. The electrocardiogram showed a wide QRS complex with a rate of 170 beats per minute. The ventricular tachycardia was successfully treated with electrical cardioversion.