ABSTRACT
BACKGROUND: Neointimal hyperplasia and thrombosis are the major factors responsible for vascular access occlusion. Previous studies suggested that the renin-angiotensin system has been implicated in the pathogenesis of neointimal hyperplasia and thrombosis. Recent studies have shown that angiotensin-converting enzyme (ACE) gene polymorphism may have a association with venous thrombosis. We conducted a retrospective case control study to determine the influence of ACE gene polymorphism on the progression of radiocephalic wrist arteriovenous fistulae (RCAVF). Also, we investigated the association between ACE polymorphism and various thrombotic factors in thrombosed and nonthrombosed subjects. METHODS: 56 patients (24 males and 32 females, mean age 49.8, age range 12-81) whose RCAVF had been maintained in good condition after 2 months of vascular access operation were included in this study. Lipoprotein (a), total cholesterol, C-reactive protein (CRP) and homocystein were measured before hemodialysis session in fasting state. Clinical data such as body mass index (BMI), cigarette smoking, hypertension, and diabetes were retrieved from patient's records. The ACE genotype was analyzed by the polymerase chain reaction (PCR). RESULTS: The incidence of diabetes and cigarette smoking were similar in the three genotypes. There were no significant differences in BMI, total cholesterol, lipoprotein (a), CRP and homocystein (p=0.551, 0.429, 0.279, 0.392, 0.124, respectively) among DD, ID and II genotypes. The percentage of the DD, ID and II genotypes were 16%, 43%, 41%, respectively. Compared with the ID and II genotypes, the proportion of the thrombosed AV shunts was larger in DD genotypes. But there was no statistically significant difference between ACE polymorphism and RCAVF thrombosis (x2=1.027, df=2, p=0.598). ACE polymorphism is shown to have no association with body mass index, blood level of total cholesterol, lipoprotein (a), CRP and homocystein. CONCLUSION: These results suggest that ACE polymorphism may have some influences on the vascular access occlusion in maintenance hemodialysis patients and have no relationship with body mass index, total cholesterol, lipoprotein (a), CRP and homocystein.
Subject(s)
Female , Humans , Male , Arteriovenous Fistula , Body Mass Index , C-Reactive Protein , Case-Control Studies , Cholesterol , Fasting , Genotype , Hyperplasia , Hypertension , Incidence , Lipoprotein(a) , Polymerase Chain Reaction , Renal Dialysis , Renin-Angiotensin System , Retrospective Studies , Smoking , Thrombosis , Venous Thrombosis , WristABSTRACT
Fenoverine is a non-atropine like spasmolytic drug that inhibits calcium channel currents in the smooth muscle. It has been occassionally reported that fenoverine can cause rhabdomyolysis under the certain conditions such as hepatic dysfunction, concomitant use of HMG-CoA reductase, mitochondrial myopathy, lipid storage myopathy or malignant hyperthermia. However, there is no report of fenoverine-induced rhabdomyolysis in type 2 diabetic nephropathy patient. So we describe here a case of fenoverine-induced rhabdomyolysis in type 2 diabetic patient. A 70-year-old man had both lower legs and shoulder pain for 5 days prior to hospital admission. He was a type 2 diabetic patient and had been managed for diabetic nephropathy. He had been consumed common doses of fenoverine for 20 days due to abdominal pain and diarrhea. Results of investigations showed evidence of rhabdomyolysis. Fenoverine therapy was stopped after admission and he was treated supportive care, his condition was recovered. In this case, renal function impairment may have been a predisposing factor for fenoverine-induced rhabdomyolysis. The incidence of muscular complications of fenoverine therapy could be reduced by avoidance of prescription of the drug in patients with diabetic nephropathy.
Subject(s)
Aged , Humans , Abdominal Pain , Calcium Channels , Causality , Diabetic Nephropathies , Diarrhea , Incidence , Leg , Malignant Hyperthermia , Mitochondrial Myopathies , Muscle, Smooth , Muscular Diseases , Oxidoreductases , Prescriptions , Rhabdomyolysis , Shoulder PainABSTRACT
Korean hemorrhage fever(KHF) is an acute febrile disease with high fever, hypotension, gastrointestinal symptom, hemorrhagic symptom and renal failure. An adult patient with KHF presented with normal EKG on admission and no hypotensive period, subsequently developed dypnea on 10 th hospital days. Pulmonary edema pattern of the chest x-ray, T inversion of EKG and diffuse ventricular dyskinesia of echocardiography apperaed on 10th hospital days, and then disappered on 2 month. We experienced a rare case of KHF associtaed with myocarditis. This case suggests that the Myocarditis can be associated with KHF.
Subject(s)
Adult , Humans , Dyskinesias , Echocardiography , Electrocardiography , Fever , Hemorrhage , Hemorrhagic Fever with Renal Syndrome , Hypotension , Myocarditis , Pulmonary Edema , Renal Insufficiency , ThoraxABSTRACT
Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.
Subject(s)
Aged , Humans , Male , Amphotericin B , Chronic Disease , Eating , Gastrointestinal Tract , Hematemesis , Hyphae , Kidney Failure, Chronic , Malnutrition , Mucormycosis , Organ Transplantation , Renal Dialysis , Spores, Fungal , Stomach , Transplants , UlcerABSTRACT
Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection which usually develops in immunosuppressant patients, especially in patients with AIDS, organ transplantation, diabetic mellitus, administration of steroid, chronic illness, severe malnutrition. It is classified into four groups as clinical forms and one of its, gastrointestinal type is an unusual form, believed that infection of the gastrointestinal tract is acquired through ingestion of the ubiquitous fungal spores, the stomach being the most frequently involved site. Especially, gastric mucormycosis, vascular invasive type is frequently fatal. Recently we experienced a case of gastric mucormycosis, vascular invasive type found in a 74-year old male undergoing hemodialysis for chronic renal failure and he was in severe malnutrition. In the course of the admission, unexpectedly, hematemesis was developed. Upper gastrointestinal fiberoscopy was done and we found a ulcerative lesion, geographic in body of stomach and on histologic examination, characteristic findings of nonseptate hyphae with right angle branchings was observed in the ulcer debris with vessel invasion. The patient was treated with systemic antifungal agent, amphotericin B but expired due to massive hematemesis.