Effect of surface treatment of FRC-Post on bonding strength to resin cements / 대한치과보존학회지

OBJECTIVES: The purpose of this study was to evaluate the effect of surface treatment of FRC-Post on bonding strength to resin cements. MATERIALS AND METHODS: Pre-surface treated LuxaPost (DMG), Rely-X Fiber Post (3M ESPE) and self adhesive resin cement Rely-X Unicem (3M ESPE), conventional resin cement Rely-X ARC (3M ESPE), and Rely-X Ceramic Primer (3M ESPE) were used. After completing the surface treatments of the posts, posts and resin cement were placed in clear molds and photo-activation was performed. The specimens were sectioned perpendicular to the FRC-Post into 2 mm-thick segments, and push-out strength were measured. The results of bond strength value were statistically analyzed using independent samples t-test and one-way ANOVA with multiple comparisons using Scheffe's test. RESULTS: Silanization of posts affect to the bond strength in LuxaPost, and did not affect in Rely-X Fiber Post. Rely-X ARC showed higher value than Rely-X Unicem. CONCLUSIONS: Silanization is needed to enhance the bond strength between LuxaPost and resin cements.

A Case of Surgical Experience of Secondary Hyperparathyroidism / 대한내분비외과학회지

The enlarged parathyroid glands associated with chronic renal failure were recognized during the 1930's. The number of patients on long-term hemodialysis due to chronic renal failure is steadily increasing and the hyperparathyroid state certainly became a clinical problem in the dialysis population. The physiologic mechanisms leading to secondary hyperparathyroidism are multifactorial with renal phosphate retention, skeletal resistance to parathyroid hormone (PTH) action and impairment vitamin D metabolism being some of the known factors. Despite intensive medical management however inadequate control of parathyroid hyperplasia may necessitate surgical intervention. The goal of surgical therapy is to resect sufficient tissue to reverse the hyperparathyroidism without rendering the patient permanently hypoparathyroidism. We experienced a case of secondary hyperparathyroidism and reported its result of total parathyroidectomy, autogenous transplantation and cryopreservation of parathyroid gland.

Histopathologic Studies on Crescentic Glomerulonephritis / 대한신장학회잡지

BACKGROUND: Crescentic glomerulonephritis is expressed pathologically by crescent formation in Bowman's capsule and clinically by rapidly progressive loss of renal function. The pathologic experience of crescentic glomerulonephritis in one institution was analyzed here. METHODS: We classified 25 cases of crescentic glomerulonephritis patients into 4 categories and reviewed the cases pathologically and clinically. RESULTS: We found no case with group I (anti- GBM disease), 8 cases in group II (immune complex glomerulonephritis) including 3 patients with IgA nephropathy, 2 patients with Henoch-Sch nlein purpura and 3 patients with APSGN, 12 cases in group III (ANCA-associated glomerulonephritis) including 7 patients with microscopic polyangitis, 4 patients with Wegener's granulmatosis and 1 patient with ANCA GN, and 5 cases in group IV (idiopathic crescentic glomerulonephritis). The mean ages of patients with group II, III, and IV were 32.0, 59.3 and 39.0 years old, respectively, and mean serum creatinine levels at the time of biopsy were measured as 9.1, 5.2, 8.8 mg/dL in each group. On light microscopic findings, the frequency of crescents in glomeruli was 64.4% in group II, 43.7% in group III, and 51.2% in group IV. The score of infiltration into tubules of inflammatory cells was 0.8 in group II, 0.4 in group III, and 0.6 in group IV and the score of fibrosis in interstitium was 1.0 in group II, 0.8 in group III and 1.2 in group IV. The score of atherosclerosis in arteries was 1.4, 0.9 and 1.6 in each group. CONCLUSION: We conclude that the precise diagnosis and classification of crescentic glomerulonephritis by an early renal biopsy and clinical assessments are important in the management of rapidly progressive (crescentic) glomerulonephritis. Since the number of the cases was not so enough, we could not analyze the statistical significance between morphologic differences of each group of crescentic glomerulonephritis, but if more cases were collected, acknowledgements of differences and prognostic factors in pathologic findings could be possible.

Seasonal Variation of Interdialytic Weight Gain in Korean Hemodialysis Patients / 대한신장학회잡지

PURPOSE: Observational results on seasonal variation of interdialytic weight gain in patients with end-stage renal disease treated with hemodialysis are controversial till now. There has been no report about it for Korean patients. The relation of interdialytic weight gain and climatic factors was studied in one region of Korea. METHODS: From Jan. 2002 to Dec. 2002, fifty patients receiving conventional and regular hemodialysis three times a week in Hanyang University Hospital, Seoul, Korea, where there is distinct seasonal variation in monthly temperature, relatively humidity, and duration of sunshine, were analyzed. For each patient, body weight and blood pressure were measured before and after each dialysis treatment three times per week for one year. The monthly mean values for interdialytic weight gain and blood pressure in relation to the monthly values for climatic factors were then analyzed. RESULTS: The seasonal pattern of interdialytic weight gain was evident throughout the one-year period. The monthly mean temperature was highest in July and lowest in January and mean monthly interdialytic weight gain was lowest in July and highest in December. The difference of mean interdialytic weight gain between July and January was significant (p< 0.05). Interdialytic weight was inversely correlated with monthly mean temperature, mean maximal temperature, and mean minimal temperature(r= -0.721 with p=0.008, r=-0.714 with p=0.009, and r= -0.717 with p=0.009, respectively) but not with mean relatively humidity and duration of sunshine. Mean predialysis systolic and diastolic blood pressure were not related to changes in temperature, relative humidity, and duration of sunshine. CONCLUSION: Interdialytic weight gain in patients with end-stage renal disease treated on hemodialysis was correlated with seasonal variation in temperature, with higher values in the winter and lower values in the summer. It would be better to consider this finding to treat hemodialysis patients.

Pure Red Cell Aplasia Due to Parvovirus B19 in Renal Transplants / 대한신장학회잡지

Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts, including organ transplant recipients. We report a case of pure red cell aplasia caused by parvovirus B19 in renal transplants. The patient was 16-year-old male who was diagnosed as chronic renal failure 7 years ago and had been on hemodialysis twice a week. He got renal transplantation in June 1999. But anemia was not improved in first postoperative period. On admission hemoglobin was 43.0 g/L, hematocrit was 12.7%. The bone marrow biopsy revealed severe erythroid hypoplasia with giant pronormoblasts. The pronormoblasia with giant prominent intranuclear inclusions, characteristic of parvovirus B19 infection. The parvovirus B19 PCR and anti-parvovirus B19 IgM were positive. The patient was treated with intravenous immunoglobulin and then reticulocyte count was increased 5 days later. Hemoglobin level restored to 104 g/L teo months later.

Lower Extremities Edema and Hemoptysis

No abstract available.

Predictive Value of an Immunohistochemical Staining for HLA-DR, ICAM-1 and VCAM-1 in Acute Renal Allograft Rejection / 대한이식학회지

PURPOSE: We have evaluated the diagnostic and predictive value of HLA-DR, ICAM-1 and VCAM-1 expression in patients clinically suspected with acute rejection. METHODS: Immunohistochemical staining for HLA-DR, ICAM-1 and VCAM-1 was performed in 21 patients who had graft dysfunction. According to the Banff 97 working classification of renal allograft pathology, eight cases were classified as acute rejection (one borderline changes, two Type IA, two Type IB, one Type IIA, two Type IIB). The other cause of renal dysfunction included mild acute tubular necrosis (n=4), recurrent focal segmental glomerulosclerosis (n=3), recurrent IgA nephropathy with or without chronic transplant nephropathy (n=3), chronic allograft nephropathy (n=2), allograft glomerulopathy (n=1). Among these, three patients showed mild acute cyclosporin toxicity. RESULTS: Expression of HLA-DR more than 25% of tubular cells was noted in 8 cases out of 12 patients with clinically improved serum creatinine levels. These 8 cases were pathologically diagnosed as borderline in 1 case, acute rejection Type IA in 2, Type IB in 2, Type IIA in 1 case and Type IIB in 2 cases. In one patient showing pathologically 'borderline changes' and high HLA-DR expression (90% of tubular cells), serum creatinine level was remarkably improved from 5.5 mg/dl to 1.5 mg/dl after treating for acute rejection. Nine cases with no or low expression of HLA-DR (weak staining in less than 10% of tubular cells) include 3 biopsies of recurrent FSGS, 3 recurrent IgA nephropathy, 1 allograft glomerulopathy, 3 acute cyclosporin toxicity, and 3 acute tubular necrosis. CONCLUSION: Our data show that increased tubular expression of HLA-DR, ICAM-1 and VCAM-1 is significantly related to acute graft rejection. Immunohistochemical staining for HLA- DR is more useful than ICAM-1 and VCAM-1 in the diagnosis of renal allograft rejection.

Extra-gastric MALT lymphoma: Analysis of 50 cases / 대한내과학회지

BACKGROUND: Mucosa-associated lymphoid tissue(MALT) lymphoma has an indolent natural course. However, extra-gastric MALT lymphoma has been reported to have more frequent relapses and shorter time to progress than gastric MALT lymphoma. We performed this study to analyze clinical features of extra-gastric MALT lymphoma. METHODS: We retrospectively reviewed the medical records of the patients who were diagnosed as extra-gastric MALT lymphoma at the Samsung Medical Center from March 1995 to January 1999. The survival was analyzed by Kaplan-Meier method. RESULTS: During the study period, extra-gastric MALT lymphoma was diagnosed in 50 patients. The median age was 51(28-87)yaers. The male to female ratio was 22:28. Commonly involved sites were conjunctiva (25/50, 50%), lung (6/50, 12%) and intestine(6/50, 12%). Histopathologically, low to high grade ratio of extra-gastric MALT lymphoma was 47:3. Among 41 patients who were staged, 32 patients(78%) had stage I or II and 9 patients(22%)had stage IV. B symptoms were seen in only 3 patients. Bone marrow involvement was observed in 4 patients. The duration of median follow up was 22 months. The 1-year and 2-year survival rates were 95.1% and 91.4% retrospectively. CONCLUSION: Majoity of our cases with extra-gastric MALT lymphoma had low grade, early stage, good treatement reponse and good prognosis.

Two cases of small cell lung cancer with bony metastases diagnosed with FDG - PET despite a normal planar bone scan / 대한내과학회지

Bone scintigraphy is a very sensitive and cost-effective diagnostic method for detecting bony metastases of malignant neoplasm. However it has been reported that bone scan is less sensitive for early bony metastases, especially vertebral metastases. PET is a non-invasive clinical imaging methodology that can be used to assess such biochemical disturbance in tissue in vivo quantitatively with high resolution.We experienced two cases of small cell lung cancer with multiple bony metastases which were detected on PET imaging but not on planar bone scan. This case report suggests that FDG-PET will be a very effective diagnostic tool for bony metastases especially in clinically suspected case despite a normal planar bone scan.

A Case of Acute Cortical Necrosis Associated with Uterine Leiomyoma / 대한신장학회잡지

Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.

A case of pancytopenia secondary to low-dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiency

Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm3 and platelet count of 64000/mm3. The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor (G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particularly impaired renal function, should be mandatory for all patients who are receiving MTX therapy.

Left Ventricular Geometry in Essential Hypertensive Patients Versus Hemodialysis Patients

BACKGROUND: In end stage renal disease, left ventricular hypertrophy developed frequently due to volume and pressure overload and other unclarified precipitating factors which could not be seen in essential hypertension. It is now well established that left ventricular hypertrophy and patterns of left ventricular geometry can influence the prognosis in essential hypertension. The aim of present study was to investigate the characteristics and prognostic significance of left ventricular hypertrophy and geornetrir patterns in hemodialysis patients and to compare them with essential hypertension group. METHOD: One hundred and forty essential hyertensive patients and forty eight hemodialysis patients were enrolled and their left ventricular geometric patterns(normal, roncentric remodeling, concentric hypertrophy, eccentric hypertrophy) were compared. RESULTS: 1) Mean age was higher in essential hypertension group(57.3+/-13.5 years versus 48.8+/-11,2 years) but the left ventricular mass index was higher in hemodialysis group(126.0+/-35.3g/m versus 142.6+/-44.4g/m, p=0.01). 2) Among left ventricular geometric patterns in hemodiaysis patients, only the prevalence of concentric hypertrophy was higher statistically compared with essential hypertensive patients(p= 0.014). 3) In essential hypertension group, age(B=0.18, p=0.016), systolic blood pressure(B=0.40, p<0.01) and total peripheral resistance(B=- 0.45, p<0.01) were correlated with left ventricular mass index. On the other hand, mean blood pressure(B=0.38, p<0.01), heart rate(B=- 0.39, p=0.012) and total peripheral resistance(B= - 0.70, p<0.01) were correlated with left ventricular mass index in hemodialysis group. 4) The hemodynamic characteristics of left ventricular hypertrophy were similar in both groups. Cardiac index was lowest and total peripheral resistance was highest in concentric remodeling. Left ventricular mass index, left ventricular septal and posterior wall thickness were highest in concentric hypertrophy and left ventricular internal dimension was highest in eccentric hypertrophy. 5) Comparing the difference between pre- and post-dialysis, only norrnal pattern slightly showed decreased left ventricular internal dimension in diastole, increased relative wall thickness and increased fractional shortening. CONCLUSION: It is considered that the characterization of geometric patterns of left ventricular hypertrophy and investigation of its precipitating factors in essential hypertensive patients and hemodialysis patients mll be helpful to improve their mortality and morbidity.

Effect of Changes of Inferior Vena Cava Diameter on Left Ventricular Hypertrophy in Hemodialysis Patients / 대한내과학회지

BACKGROUND: Volume overload is one of the most important, correctable factor for blood pressure control in hemodialysis patient. But objective parameter for the ideal body weight is not available in clinical field yet. Recently inferior vena caval examination became a possible candidate for an objective parameter for intravascular volume status. Therefore we investigated how inferior vena cava changes during hemodialysis compared with total amount of ultrafiltration and ANP, and also the effect of changes of IVC diameter on LVH. METHODS: 43 patients on stable maintainance hemodialysis were enrolled. Among them, 21 patients were on antihypertensive medication. Just before and after the hemodialysis, inferior vena cava diameter, plasma atrial natriuretic peptide and left ventricular mass index were measured for each patient. Inferior vena cava was examined at the level just below the hepatic vein during quiet respiration and left ventricular mass index was calculated. RESULTS: Inferior vena cava at expiration (IVCe) was significantly decreased during hemodialysis (before hemodialysis 21.9 4.9 mm, after hemodialysis 18.3 4.4 mm, p = 0.02). Collasibility index was significantly increased during hemodialysis (before hemodialysis 0.24 0.15, after hemodialysis 0.41 0.19, p < 0.001). Atrial natriuretic peptide (ANP) was significantly decreased during hemodialysis (before hemodialysis 252.3+/-119.0 pg/ml, after hemodialysis 185.6+/-93.2 pg/ml, p<0.001). Total ultrafiltration amount was significantly correlated with collapsibility change (r = - 0.40) and change of ANP (r = -0.41). Left ventricular mass index was correlated with interdialysis weight gain (r=0.39, p<0.05), IVCe after hemodialysis (r=0.48, p < 0.05) in univariate analysis but not in multivariate analysis. CONCLUSION: Collapsibility index of inferior vena cava, IVC diameter and ANP changes reflect the volume change during the hemodiaylsis. Therefore IVC examination can be an objective parameter for volume change during hemodialysis. Postdialysis IVCe correlates weakly with left ventricular mass index but it cannot be an independant risk factor for left ventricular hypertrophy in our study.

Dupplex Doppler Sonography in Patients with Medical Renal Diseases: Correlation with Clinical and Histopathologic Findings

PURPOSE: To compare the RI (resistive index) of renal artery with serum creatinine level and histological change in 50 patients with renal parenchymal disease. MATERIALS AND METHODS: To measure RI in each patient, Doppler studies were performed three times in each kidney at the level of the interlobar arteries, and the average value of RI was taken. The study was performed 1-3 days after renal biopsy and the time interval between blood sampling for serum creatinine and duplex study was also 1-3 days. The RI of patients with renal disease was also correlated with patient's age, sex and serum creatinine level, and RI was also correlated with the degree of severity of glomerular, interstitial, and vascular change in the kidneys. Statistical analysis was performed using Student's t test and Pearson's correlation method. RESULTS: The RI of the normal control and renal disease group was 0.566+/-0.037 and 0.584+/-0.038, respectively with no statistical significance (p=0.444). In the group with renal disease, there was no significant correlation between RI and a patient's age, sex, and serum creatininelevel (p>0.05). RI was not significantly different between predominantly glomerular disease (n=45) and nonglomerular or mixed disease (n=5) (p=0.558), and did not correlate with the severity of glomerular sclerosis, interstitial fibrosis, or atherosclerosis (p>0.05). CONCLUSION: The authors conclude that RI is not helpful for the diagnosis and differential diagnosis of renal parenchymal diseases and does not correlate with serum creatinine levels. In order to define the role of the RI, further clinical experience with more cases is required.

Impaired homeostatic mechanism of potassium handling after acute oral potassium load in diabetes mellitus

Chronic stable diabetic patients (n = 6) were compared with healthy control subjects (n = 5) after acute oral intake of 50 mEq of potassium chloride (KCl) to investigate for possible derangements of homeostatic responses for acute term (3 hrs) to acute potassium load. Plasma renin activity (PRA), plasma aldosterone (PA), and transtubular potassium concentration gradient (TTKG) known as a useful semiquantative index of distal nephron potassium secretion were measured. All the baseline parameters were comparable between diabetic and non-diabetic subjects except for significantly reduced creatinine clearance in diabetics (mean +/- SEM, 105 +/- 4 vs. 85 +/- 5 ml/min, p 5.0 mEq/L). PRA did not show any significant changes, whereas PA was increased simultaneously with increments in serum potassium in both groups, with blunted increases in the diabetics. However, TTKG was increased prominently in control subjects (8.18 from 4.98), but only slightly in diabetic subjects (4.55 from 4.18), with statistical difference between the two groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial thrombosis associated with nephrotic syndrome; a case report and review (adult cases in the English literature)

The thromboembolic complications of nephrotic syndrome are reasonably common, including spontaneous peripheral venous and/or arterial, pulmonary arterial, and renal venous occlusions. However, in comparison to the relatively high incidence of the venous thromboembolic complications with hypercoagulable status, arterial thromboses have been reported much less and it was only 20 cases in the English literature so far. Furthermore, the most cases were pediatric patients rather than adults. Therefore, this report describes an adult nephrotic cases complicated by superior mesenteric artery thrombosis leading to death via catastrophic hospital course. Also, we reviewed the literature in English regarding cases of arterial thromboses in adult nephrotic patients with special interest to locations of thrombosis, underlying histopathologic types of glomerulopathy, and use of steroids or diuretics before its development.

The correlation between the kinetic indices and rehabilitation in the patients on maintenance hemodialysis / 대한내과학회지

No abstract available.

A case of Kaposi's sarcoma in transplant patient / 대한신장학회잡지

No abstract available.

The measurement of gastric emptying time in chronic renal failure patients with dysfunctional upper gastrointestinal symptoms and the effect of cisapride / 대한신장학회잡지

No abstract available.

Surgical complications of CAPD / 대한이식학회지

No abstract available.