Phosphodiesterase Inhibitor Improves Renal Tubulointerstitial Hypoxia of the Diabetic Rat Kidney

BACKGROUND/AIMS: Renal hypoxia is involved in the pathogenesis of diabetic nephropathy. Pentoxifyllin (PTX), a nonselective phosphodiesterase inhibitor, is used to attenuate peripheral vascular diseases. To determine whether PTX can improve renal hypoxia, we investigated its effect in the streptozocin (STZ)-induced diabetic kidney. METHODS: PTX (40 mg/kg, PO) was administered to STZ-induced diabetic rats for 8 weeks. To determine tissue hypoxia, we examined hypoxic inducible factor-1alpha (HIF-1alpha), heme oxygenase-1 (HO-1), vascular endothelial growth factor (VEGF), and glucose transporter-1 (GLUT-1) levels. We also tested the effect of PTX on HIF-1alpha in renal tubule cells. RESULTS: PTX reduced the increased protein creatinine ratio in diabetic rats at 8 weeks. HIF-1alpha, VEGF, and GLUT-1 mRNA expression increased significantly, and the expression of HO-1 also tended to increase in diabetic rats. PTX significantly decreased mRNA expression of HIF-1alpha and VEGF at 4 and 8 weeks, and decreased HO-1 and GLUT-1 at 4 weeks. The expression of HIF-1alpha protein was significantly increased at 4 and 8 weeks in tubules in the diabetic rat kidney. PTX tended to decrease HIF-1alpha protein expression at 8 weeks. To examine whether PTX had a direct effect on renal tubules, normal rat kidney cells were stimulated with CoCl2 (100 microM), which enhanced HIF-1alpha mRNA and protein levels under low glucose conditions (5.5 mM). Their expressions were similar even after high glucose (30 mM) treatment. PTX had no effect on HIF-1alpha expression. CONCLUSIONS: PTX attenuates tubular hypoxia in the diabetic kidney.

Comparison of the Long-Term Outcome of Coronary Artery Bypass Grafting between Percutaneous Coronary Intervention in End Stage Renal Disease Patients / 대한신장학회지

PURPOSE: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. METHODS: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. RESULTS: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. CONCLUSION: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.

How Long Should We Monitor the Patient for Bleeding after Percutaneous Renal Biopsy? / 대한신장학회지

PURPOSE: Percutaneous renal biopsy (PRB) may become complicated by serious bleeding. Overnight observation after renal biopsy is a standard safety strategy. Although it was recently reported that outpatient observation is safe, appropriate observation time after the renal biopsy is still in debate. We evaluated prospectively the incidence, onset time and risk factors of hemorrhagic complications to determine the optimal duration of observation after PRB. METHODS: We enrolled 100 patients who underwent renal biopsy from October 2009 to April 2010 using the standard strategy. The biopsy was performed by two experienced nephrologists using 16-gauge spring-loaded biopsy gun under real-time ultrasound guidance. Serial color Doppler ultrasound was done immediately, 8 hours, 24 hours and 1 week after the PRB. RESULTS: The 32 patients experienced hemorrhagic complications (32.0%, 10 with gross hematuria, 26 with hematoma, and 4 with both), and 1 major complication occurred 3 days after PRB. Baseline serum creatinine of the patient with the major complication was 6.0 mg/dL. Serum creatinine and BMI were higher in complication group (p<0.05). Number of needle passes, blood pressure, and degree of edema and proteinuria were not related to the complication. In multivariate analysis, serum creatinine was the only significant risk factor of complication (p=0.007). Hemorrhagic complications developed in 9 patients (28.1%) between 8 and 24 hours after PRB, all of which were minor. CONCLUSION: The 8 hours' observation time after renal biopsy may be deemed appropriate for stable patients with normal creatinine.

Endoscopic Band Ligation for Non-variceal, Non-ulcer Gastrointestinal Hemorrhage and Post-polypectomy Hemorrhage / 대한소화기내시경학회지

BACKGROUND/AIMS: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gastrointestinal hemorrhage and post-polypectomy hemorrhage. METHODS: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were: Dieulafoy's lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post-endoscopic biopsy bleeding in 1. RESULTS: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy's lesion. The remaining case was early band detachment. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.

A Case of Primary Malignant Lymphoma of Trachea / 결핵

Primary malignant tumor of trachea is rare and often extensive at presentation and frequently causes life threatening airway obstruction. Primary extranodal lymphomas comprise about 10% of all malignant lymphomas. However, the primary malignant lymphoma of trachea is extremely rare. We presented here a case of 62-year-old male, was diagnosed as a primary extranodal lymphoma arising in the trachea with review of literature.