Polymorphism in the promoter region of the klotho gene (G-395A) is associated with early dysfunction in vascular access in hemodialysis patients

BACKGROUND/AIMS: Vascular access dysfunction is an important cause of morbidity and mortality in hemodialysis (HD) patients. Recent studies have shown that a klotho gene mutation is related to endothelial dysfunction, thrombosis, and arteriosclerosis, which are regarded as causes of vascular access dysfunction. We investigated the relationship between the klotho G-395A polymorphism and early dysfunction in vascular access in HD patients. METHODS: Patients who underwent vascular access operations between 1999 and 2002 were enrolled (n=126). Genotyping was performed by allelic discrimination using a 5'-nuclease polymerase chain reaction assay. Clinical data that could be relevant to access dysfunction were obtained from medical records. Early dysfunction of vascular access was defined as the need for any angioplastic or surgical intervention to correct or replace a poorly or nonfunctioning vascular access within 1 year and at least 8 weeks after initial access placement. RESULTS: Of the 126 patients, the genotype frequency of G-395A was 72.2% for GG (n=91), 24.6% for GA (n=31), and 3.2% for AA (n=4), and the frequency of minor allele was 0.155. Clinical data were similar between the two groups, divided according to the status of the A allele. Early dysfunction occurred in 34 (27.0%) of patients, but it occurred at a significantly higher rate in A allele carriers (45.7%, 16/35) than in noncarriers (19.8%, 18/91; p=0.003). CONCLUSIONS: Our results suggest that the klotho G-395A polymorphism could be a risk factor for early dysfunction of vascular access in HD patients.

Effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth / 대한치과보존학회지

The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats under general anesthesia before and after injection of local anesthetics and after cavity preparation. 2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into the dentin on both teeth. The obtained data was analyzed with paired t-test. Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05), whereas there was no significant change of PBF with the physiologic saline as a control. Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less increase of PBF than in control tooth (p < 0.05). Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with 1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.

Ultrasound Assessment of Invasive Breast Cancer: Correlation with Histologic Grade

PURPOSE: To correlate the final assessment of ultrasound and histologic grade in patients with invasive breast cancer. MATERIALS AND METHODS: The study consisted of one hundred eighty-six women with breast masses that were evaluated by ultrasound and subsequently found to have invasive ductal carcinoma not previously diagnosed. Two radiologists prospectively analyzed the results of the ultrasounds and issued an American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) assessment category which indicates the probability of malignancy. The histologic grade of the 186 invasive ductal carcinomas were separated as follows, low grade in 22 lesions (9%), intermediate grade in 91 lesions (50%), and high grade in 73 lesions (41%). RESULTS: In the 186 invasive ductal carcinomas not previously diagnosed, a circumscribed margin was seen in 4% (three of 73) of high-grade tumors compared to none in intermediate-grade and low-grade tumors. A spiculated margin was seen in 59% (13 of 22) of low-grade tumors compared, to 20% (18 of 91) in intermediate-grade and 7% (five of 73) in high-grade tumors. Posterior acoustic enhancement was seen in 33% (24 of 73) of high-grade tumors compared, to 20% (18 of 91) in intermediate-grade and none in low-grade tumors. Posterior acoustic shadowing was seen in 59% (13 of 22) of low-grade tumors compared, to 34% (31 of 91) in intermediate-grade and 15% (11 of 73) in high-grade tumors. The final BI-RADS assessment of the 186 cases separated as follows, three lesions (2%) were category 3 probably benign, 115 lesions (62%) were category 4 suspicious, and 68 lesions (37%) were category 5 highly suggestive of malignancy. The three cases misclassified as probably benign were high-grade tumors. CONCLUSION: Breast cancer showing a spiculated margin and posterior acoustic shadowing on ultrasound were mainly low-grade tumors whereas breast cancer showing benign features were high-grade tumors.

Ring Neutrophils and Hyposegmented Cells in Hematologic Diseases / 대한혈액학회지

BACKGROUND: Neutrophil nuclei in rodents may mature by ring formation. These cells are called ring neutrophils or doughnut cells. In man, small numbers of these mysterious cells may occur in myeloproliferative disease or in myelodysplastic syndrome (MDS). However, the incidence of ring neutrophils in the general population is unknown and their significance in disease states therefore remains obscure. METHODS: We have evaluated peripheral blood and bone marrow smears of patients with chronic myelogenous leukemia (CML), MDS, megaloblastic anemia, and these findings were compared with those of healthy controls. Only granulocytes with an unequivocal nuclear hole, not caused by superposition of nuclear lobes, were counted. To be counted, the hole should contain material with the same texture as the cytoplasm. Cells with hyposegmented nuclei were counted as well. Only distinct spectacle-like or peanut-shaped nuclei as well as the occasional single rounded nuclei were taken into account. RESULTS: 1) The number of patients enrolled was 58 (32 males and 26 females). The age ranged from 16 to 77 (mean 46) years. Twenty-eight cases of CML, 23 of MDS, 7 of megaloblastic anemia and 20 of healthy controls were included in this study. 2) In peripheral blood smears, the occurrence and numbers of ring neutrophils and hyposegmented cells were not significantly different between underlying diseases (P>0.05). In CML, as opposed to the control group, significantly more patients showed hyposegmented cells (P0.05). As compared with control group, there were no differences in the occurrence and numbers of ring neutrophils and hyposegmented cells (P>0.05). 4) Nuclear ring formation appeared to be significantly related to granulocytic hyposegmentation. CONCLUSION: These results suggest that ring neutrophils and hyposegmented cells can be nonspecifically found in patients with various hematologic diseases and healthy controls. To optimize the definite clinical significance of these cells, further studies will be needed.

Association between ACE Gene Polymorphism and Nephropathy in NIDDM Patients / 대한신장학회잡지

It has been reported that the genetic susceptibility may be an important factor in the development of nephropathy in diabetic patients, and the genetic polymorphism of angiotensin-converting enzyme (ACE) has been extensively studied for its possible role. The ACE affects the cardiovascular system through angiotensin II formation and inactivation of bradykinin. The 21 kilobases-long ACE gene located on the long arm of chromosome 17 is composed of 26 exons and 25 introns. The presence/absence of a 287 base pairs fragment in the 16th intron of the ACE gene determines its genotype either as insertion(I) or deletion(D). These genotypes in turn are used to characterize the polymorphism as II, ID or DD type. Each of these genotypes has been reported to show different activity of serum ACE. Recent reports have suggested that genotype DD or D allele may be involved in the nephropathy in diabetics while genotype II may lower the chance for diabetic nephropathy. The present study investigates the effects of genetic polymorphism of ACE on the nephropathy in NIDDM by assessing ACE genotypes and activities on 148 NIDDM patients who have been diagnosed at least 10 years prior to the study, as well as 146 normal controls. The NIDDM group is composed of 70 patients with nephropathy and 78 without nephropathy. The results were as follows. 1) In the diabetic group, the absence/presence of nephropathy showed no significant difference in terms of age, gender, body mass index, HbA1C, cholesterol, triglyceride and HDL cholesterol(p>0.05). No significant differences on the clinical parameters were noted according to the ACE genotypes either(p>0.05). 2) The ratio of ACE genotypes(II:ID:DD) was 0.36:0.48:0.16 for the normal control group, 0.28:0.56: 0.16 for the NIDDM without nephropathy group, and 0.26:0.51:0.23 for the NIDDM with nephropathy group. The ratios of I and D allele were 0.60:0.40, 0.56:0.44 and 0.51:0.49, respectively. In all three groups, higher ratio I allele over D allele was noted and the ID genotype was most frequent followed by II and DD types, although the differences between the groups were not statistically significant(p>0.05). 3) In the normal controls group, ACE activities for DD, ID and II genotypes were 54.0 15.0, 40.4 12.4 and 30.1 11.8U/L, respectively, with significant difference among the genotypes. In the NIDDM without nephropathy group, there was no difference among the three genotypes(DD, ID, II; 47.2 15.1 vs. 36.6 18.7 vs. 32.0 13.4). In the NIDDM with nephropathy group, the activity for DD and ID genotypes were significantly higher than II genotype(47.7 31.0, 47.4 30.7 vs. 17.8 17.9U/L, p0.05). The results of the present study show that in the normal group genotype ID is most frequent followed by II and DD, and the I allele is more frequent than D allele. These results are similar to the reports from China and Japan, unlike the results from Europe or USA where genotype DD and D allele are more frequent than II genotype and I allele, suggesting an ethnic difference. Furthermore, the NIDDM patients group, regardless of the presence of nephropathy, showed no significant difference from the normal group in terms of ACE genotypes or allele types, suggesting lack of association between the nephropathy and the ACE gene polymorphism. The ACE activity also showed no significant relationship with various clinical parameters or complications. Further studies on the effects of ACE polymorphism and ACE activity on the progression of nephropathy may be needed.

Studies on bone markers and bone mineral density in patients with chronicrenal failure

Renal osteodystrophy has become a frequent complication in patients with chronic renal failure (CRF), and various histologic forms such as high turnover, low turnover and mixed bone disease have been demonstrated. The only reliable method for distinguishing patients with high turnover from those with low turnover bone disease is bone histomorphometric study, but its clinical utility is restricted. Because of its invasive nature, efforts have been made to predict indirectly the type and severity of thi metabolic bone disease by serum assays. In this cross-sectional study, we measured total and regional (head, arms, trunk, ribs, legs, spine and pelvis) bone mineral densities (BMD) by dual X-ray absorptiometry (DXA) in patients with variable degrees of CRF and correlated them with various bone markers. Decreased BMDs were detected in various skeletal sites (trunk and pelvis) in the patients' group. Total BMD Z score was lower in predialysis CRF patients than in the control subjects. Decreased BMD Z scores on weight-bearing bone were pronounced at L1 lumbar vertebra, femur trochanter, femur neck and Ward's triangle. Positive linear correlations were found between creatinine clearance and trunk, ribs, pelvis, and spine BMDs. There were inverse linear correlations between total BMD and total BMD Z score and alkaline phosphatase (AP), urine deoxypyridinoline (U-DPD) in the patients' group. There were no correlations between regional and total BMD, total BMD Z score and serum calcium, ionized calcium, and serum phosphate. There were inverse linear correlations between BUN, creatinine and bone-specific alkaline phosphatase in the predialysis CRF group. We evaluated the correlations between intact parathyroid hormone (i-PTH) and biochemical and other bone markers. There was statistically significant linear correlation between i-PTH and AP. Other bone markers have no significant correlations with i-PTH. Our results demonstrated that there is significant bone loss in patients with CRF before the start of dialysis and also regional variations of BMDs in predialysis CRF patients. DXA is a useful method for evaluating regional and total BMDs and provides information about diverse regional skeletal changes. AP, i-PTH and U-DPD can predict BMD of predialysis CRF patients.

Studies on bone markers and bone mineral density in patients with chronicrenal failure

Renal osteodystrophy has become a frequent complication in patients with chronic renal failure (CRF), and various histologic forms such as high turnover, low turnover and mixed bone disease have been demonstrated. The only reliable method for distinguishing patients with high turnover from those with low turnover bone disease is bone histomorphometric study, but its clinical utility is restricted. Because of its invasive nature, efforts have been made to predict indirectly the type and severity of thi metabolic bone disease by serum assays. In this cross-sectional study, we measured total and regional (head, arms, trunk, ribs, legs, spine and pelvis) bone mineral densities (BMD) by dual X-ray absorptiometry (DXA) in patients with variable degrees of CRF and correlated them with various bone markers. Decreased BMDs were detected in various skeletal sites (trunk and pelvis) in the patients' group. Total BMD Z score was lower in predialysis CRF patients than in the control subjects. Decreased BMD Z scores on weight-bearing bone were pronounced at L1 lumbar vertebra, femur trochanter, femur neck and Ward's triangle. Positive linear correlations were found between creatinine clearance and trunk, ribs, pelvis, and spine BMDs. There were inverse linear correlations between total BMD and total BMD Z score and alkaline phosphatase (AP), urine deoxypyridinoline (U-DPD) in the patients' group. There were no correlations between regional and total BMD, total BMD Z score and serum calcium, ionized calcium, and serum phosphate. There were inverse linear correlations between BUN, creatinine and bone-specific alkaline phosphatase in the predialysis CRF group. We evaluated the correlations between intact parathyroid hormone (i-PTH) and biochemical and other bone markers. There was statistically significant linear correlation between i-PTH and AP. Other bone markers have no significant correlations with i-PTH. Our results demonstrated that there is significant bone loss in patients with CRF before the start of dialysis and also regional variations of BMDs in predialysis CRF patients. DXA is a useful method for evaluating regional and total BMDs and provides information about diverse regional skeletal changes. AP, i-PTH and U-DPD can predict BMD of predialysis CRF patients.

Clinical Manifestations of the Lung Involvement in Behet's Syndrome / 결핵

Background: Behet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behet's syndrome is a unique clinical feature, differing from other vascuitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behet's syndrome was 2%(10/487). The male to female ratio was 8: 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary arteries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion: Pulmonary vasculitis is a main feature of the lung involvement of Behet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

Clinical Manifestations of the Lung Involvement in Behet's Syndrome / 결핵

Background: Behet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behet's syndrome is a unique clinical feature, differing from other vascuitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behet's syndrome was 2%(10/487). The male to female ratio was 8: 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary arteries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion: Pulmonary vasculitis is a main feature of the lung involvement of Behet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

Dysphagia due to mediastinal tuberculous lymphadenitis presenting as an esophageal submucosal tumor: a case report

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.

A Case of Interrupted Aortic Arch(Type B)

Interrupted aortic arch may be defined as a discontinuity of the aortic arch. This uncommon anomaly was first described by Steidele in 1778 and was later classified into 3 types by Celoria and Patton. We experienced the case of a 25-year-old male with an interrupted aortic arch(Type B) which was well supplied by collateral circulations. Ligation of collateral supplies and a Y-graft replacement from ascending aorta to descending thoracic aorta and left subclavian artery was done. Postoperative aortogram revealed no collateral circulations and good continuity of the aorta without narrowing of the anatomic site. During the period of 2-month follow up, the patient was able to lead a relatively active life.

The correlation between 24-hour ambulatory blood pressure and echocardiographic LVH in hypertension / 대한내과학회지

No abstract available.

Coverage of the soft tissue defect of the calcaneal area, exposed achilles tendon

No abstract available.

Coverage of the soft tissue defect of the calcaneal area, exposed achilles tendon

No abstract available.

The usefulness of V-Y myocutaneous flaps for pressure sore in throchanteric and ischial area

No abstract available.

Computed tomography of pancreatic carcinoma

CT has proven useful in diagnosing pancreatic disease. It is well known that CT is a reliable, simple,noninvasive method for detecting pancreatic carcinoma and extension of the pathology. Of 1150 cases studied forabdominal pathology with Varian-360-3 whole body scanner from June 1980 to June 1982, 38 cases were confirmed tobe pancreatic carcinoma clinically or operatively. We reviewed the CT findings of above cases and the results wereas follows; 1. The sex ration was 31 males to 7 females and the greatest number of cases (31.6%) were seen infourth decade. 2. There were enlargement of pancreas in 37 cases (97.4%), peripancreatic fat obliteration in 28cases (73.7%), dilatation of bile duct in 27 cases (71.1%), enlargement of retroperitoneal lymph nodes in 32 cases(84.2%), dilatation of pancreatic duct in 12 cases (31.6%), Thick vessel sign in 10 cases (26.3%), atrophy ofpancreas body and tail in 3 cases (7.9%), and metastasis in 17 cases (44.7%). 3. In 37 cases of enlargement ofpancreas, enlargement of head in 24 cases, enlargement of head and body in 7 cases, enlargement of body in 2cases, enlargement of body and tail in 2 cases, enlargement of tail in 1 case, and diffuse enlargement of pancreasin 1 case, were observed. 4. Associated findings on CT were pleural effusion (5 cases), ascites (4 cases), livercirrhosis(3 cases), splenomegaly (2 cases), gall stones (3 cases), cholecystitis(2 cases), CBD stone (1 case), IHDstone (1 case), Hydronephrosis (2 cases), renal cyst (2 cases), intraabdominal abscess(1 case), and spinetuberculosis(1 case). 5. There were difficulties in diagnosing one case of diffuse enlargement of opancreas withhead cancer, one case of necrotic head cancer similar to pseudocyst, one case of tail cancer associated withabscess and one case of head cancer associated with pseudocyst in lesser sac.