Notice of Retraction: Occupational asthma caused by several kinds of herb materials / 대한내과학회지

No abstract available.

Flow Measurement in the Hemodialysis Vascular Conduit for Surveillance of Internal Arteriovenous Fistula: A Trend Analysis

PURPOSE: We have already reported on a new method to calculate the intra-vascular conduit flow rate based on Bernoulli's theory for maintaining surveillance of the arteriovenous fistula (AVF) function. To assess the clinical validity of our methods, we examined a trend analysis on the calculated flow rate in hemodialysis vascular conduits. METHODS: From a total of 27 cases of native AVFs that were at least 3 months after construction, we measured the AVF flow rate (Q(D)) with Doppler ultrasonography first. When Q(D) was below 600 ml/min, a fistulogram was taken. The intra-vascular conduit static pressure (ps) was measured, and the flow rate (Q(a)) was calculated every month with using the mean arterial pressure. The patients with a decreased Q(a) of more than 10% over 3 months were referred for a diagnostic fistulogram. RESULTS: Twenty-seven AVFs were studied after 29.5+/-28.5 (4~120) months of operation. The mean Q(D) was 980.6+/-501.6 (144~2,230) ml/min. In 6 patients who showed a Q(D) less than 600 ml/min, 4 pathologic lesions were found on the diagnostic fistulogram: juxta-anastomosis stenosis (n=3) and a draining venous stenosis (n=1). Three patients who showed a Q(a) decrement were confirmed as having a draining venous stenosis. However, any unpredictable thrombosis with proximal stenosis (n=2) couldn't be detected. CONCLUSION: Q(a) represents the narrowing of the draining vein of an internal AVF. However, arterial or venous narrowing that is proximal to the arterial puncture site couldn't be detected with the calculated intra-conduit flow rate. The development of new methods that can detect proximal vascular stenosis and that can be used in combination with our method is anticipated in the near future.

A Case of Minimal Change Disease Presenting Bilateral Popliteal Arterial Thrombosis / 대한신장학회잡지

Thrombosis is one of the important complications of nephrotic syndrome. The mechanism of vascular thrombosis in nephrotic syndrome is under debate, but the hypercoagulable state is regarded as a predisposing factor to that. Most of vascular thrombosis in nephrotic syndrome have occurred in veins. Arterial thrombosis is relatively uncommon and often related with steroid or diuretic use. We experienced a case of bilateral popliteal arterial occlusion due to femoral arterial thrombosis as the first presentation of nephrotic syndrome. A 59-year old male patient was admitted with complaints of pain on left lower extremity for five days. The diagnosis of thrombosis in left popliteal artery was made by arterial angiography. The emergent thrombolytic therapy and anticoagulation was performed. During anticoagulation, another episode of bilateral popliteal arterial occlusion was occurred once again. He had heavy proteinuria, and renal pathology revealed minimal change disease. There was no recurrence of thrombosis for 1 year after treatment with steroid and warfarin.

Development of Simple Flow Measurement in the Vascular Access Conduit Based on the Bernoulli's Theory

PURPOSE: Early detection of arteriovenous fistula (AVF) dysfunction in hemodialysis patients and prompt corrective procedures reduces the AVF thrombosis rates and lengthens access survival. We tried to develop a new simple and cheap bedside measurement technique based on the Bernoulli's theory. METHOD: From a total of 20 case of vascular accesses for hemodialysis, of at least 3 months of construction, we twicely measured the AVF flow rate (QD) with Doppler ultrasonography and vascular conduit pressure. Four kinds of pressure were measured: tubing set free from dialysis machine and positioned on the patient's bed (PrF), two kinds of artificial stenosis made with tourniquet (PrS1, PrS2), pump flow rate at 100ml/min (Pr100), and pump off (Pr0). We calculated the flow rate of vascular conduit (QF) with PrF and mean arterial pressure on Bernouli's equation, and QF was compared with QD. RESULT: AVF was 26.0+/-28.6 (3~108) months after operation, with five cases (including 2 PTFE grafts) using brachial artery. PrF was closely correlated with Pr100 (R2=0.914), and inversely correlated with QD (R2=-0.026). QF was poorly correlated with QD (R2=0.003). There was no statistical difference in the double pressure measurement (P>0.05), but there was differenence in QD (P<0.05). When artificial stenosis was made, the pressures increased, and the calculated flow rates decreased in every patients. Thrombosis or stenosis was detected in all patients with decrement of QF, but not in all with decrement of QD. CONCLUSION: Pressure measurement and calculated flow rate in dialysis vascular conduit represent alterations of AVF flow rate. However its value in long-term follow up awaits further study with accurate constant number.

Comparison of Absorption Profile between Microemulsion and Non-microemulsion Cyclosporine in Stable Renal Transplant Recipients and Therapeutic Drug Monitoring / 대한신장학회잡지

BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.

A Case of Anti-Glomerular Basement Membrane Antibody Disease without Pulmonary Hemorrhage / 대한신장학회잡지

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis is a rare autoimmune disease. It is characterized by acuterenal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 mg/dL, Hb was 10.2 g/dL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & C1q deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal: <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.

H+ -ATPase Pump Defects of Distal Renal Tubular Acidosis as Initial Manifestation of Systemic Lupus Erythematosus / 대한신장학회잡지

Systemic lupus erythematosus (SLE) is a multisystem disease with marked variability in its manifestation. Tubulointerstitial involvement is well recognized in SLE. But usually the tubular dysfunction is latent and usually presents after diagnosis of SLE. We report a 20 years old female whose initial symptom of SLE was distal renal tubular acidosis (RTA). She presented with severe muscle weakness at emergency room with laboratory fingding consistent with distal RTA. After several months she developed fever, arthritis, serologic fingding which was compatible to diagnose SLE. We report a case whose initial symptom of SLE had been distal RTA.

Sensitization rate of Trichophyton spp. allergen in various allergic diseases and identification of its allergens with immunoblotting / 천식및알레르기

BACKGROUND: Trichophyton is one of the most common genera of dermatophytes. It has been reported that Trichophyton spp. might be one of the causative allergens in patients with asthma, rhinitis, urticaria and angioedema. OBJECTIVES: To analyze the sensitization rate of Trichophyton, to determine serum specific IgE antibody, and to confirm Trichophyton as a causative antigen in patients with allergic diseases. METHODS: A total of 1,806 patients were enrolled in this study. Skin prick test was performed with 50 common inhalant allergens and 20 food allergens. Serum specific IgE antibodies were determined by ELISA using Trichophyton mentagrophytes antigen in 60 patients among positive skin responders to Trichophyton antigens and in 20 controls. For evaluation of cross-reactivity between Trichophyton and other fungal species, competitive ELISA inhibition test was performed. SDS-PAGE and IgE-immunoblot analysis using T. mentagrophytes antigen were applied in 7 patients with high specific IgE titers. RESULTS: 102 patients (5.7%) showed positive response to T. mentagrophytes on skin prick test, and six patients showed isolated positive responses. Serum specific IgE increased according to skin reactivity (p<0.05). SDS-PAGE and IgE-immunoblot showed 10 IgE-binding components (11, 17, 27, 32, 35, 38, 42, 48, 49, 51 kDa) within Trichophyton extracts. Trichophyton-ELISA inhibition test showed dose-dependent inhibitions with additions of Trichophyton antigens, while minimal inhibitions were noted with additions of Fusarium, Alternaria, Aspergillus and Clados- porium. CONCLUSIONS: Trichophyton could induce IgE sensitization in allergy patients. The sensitization rate on skin prick test was 5.7%. Trichophyton antigen should be included in skin prick test battery to screen causative agents for allergy patients.

Skin reactivity and specific IgE sensitization to Tetranychus urticae and identification of IgE binding components / 천식및알레르기

BACKGROUND AND OBJECTIVES: Tetranychus urticae(TU) is a widely distributed parasitic mite found on fruit trees and green house flowers. A recent investigation demonstrated that TU inhalation causes allergic asthma even in non-farmers. We tried to evaluate skin reactivity and specific IgE sensitization to TU, identify IgE binding components, and evaluate allergenic rela- tionship with house dust mite(HDM). MATERIALS AND METHODS: We carried out skin prick test with TU in 1806 respiratory allergy patients over 1 year living in urban and rural areas. ELISA was performed for detection of specific IgE antibody. To evaluate the cross allergenicity between TU and HDM, ELISA inhibition test was carried out with two kinds of pooled sera ; serum pool A included patients' sera sensitized to both TU and HDM, and serum pool B included sera sensitized only to TU. To identify IgE binding components, SDS-PAGE followed by IgE-immunoblot were applied. RESULTS: 358 patients(19.8%) showed positive response(A/H > or = 2+) on skin prick test. Twelve patients showed isolated positive response to TU. Specific IgE was detected in sixty patients(54.5%) out of 110 sensitized patients. ELISA inhibition test using two sera pools (A and B) showed significant inhibitions by TU with minimal inhibitions by HDM. SDS-PAGE and IgE-immunoblot with patients' individual sera sensitized to both TU and HDM showed 10 IgE binding components (67kD, 29kD, 27kD, 10kD, 14kD, 39kD, 46kD, 35kD, 72kD, 77kD) and two(67kD and 29kD) were bound to IgE in more than 50% of sera tested. In patients' sera sensitized only to TU, nine IgE binding components(67kD, 10kD, 14kD, 29kD, 39kD, 46kD, 72kD, 77kD, 9kD) were found and two(67kD and 10kD) were bound to IgE in more than 50%. CONCLUSION: Of allergy patients visiting the Allergy Clinic, 19.8% were sensitized to TU and specific IgE was detected in 54.5% of them. No cross allergenicity was noted between TU and HDM. Eleven IgE binding components and three (67kD, 10kD and 29kD) major allergens were identified.

Acute Hyperphosphatemia and Hypocalcemia Following the Administration of Phosphate-containing Laxatives in Patients with End Stage Renal Disease / 대한신장학회잡지

Oral or rectal sodium phosphate(NaP) preparation is commonly used for the colonic cleansing. Since the sole route of excretion of absorbed phosphate is renal, diminished renal function will limit the ability to excrete a sudden phosphate load. To date, about 20 adult cases of hyerphosphatemia associated with oral or rectal sodium phosphate solution have been reported, but not a single case in Korea to our knowledge. We report two cases of hyperphosphatemia and hypocalcemia after the administration of NaP(Colclean(R)) to reemphasizes the potential hazard of sodium phosphate bowel preparation in patients with compromised renal function.

A Case of Rheumatoid Arthritis Associated with Renal Amyloidosis and Crescentic Glomerulonephritis / 대한신장학회잡지

A case of renal amyloidosis with crescentic glomerulonephritis associated with rheumatoid arthritis is described. A 60-year-old female with 15 years' history of rheumatoid arthritis developed nephrotic syndrome followed by rapid deterioration of renal function. Glomerular amyloid deposition and sclerotic change was present in kidney biopsy specimen and crescentic change was found in 85% of the glomerulus. Electron microscopic finding of glomerulus showed randomly oriented, rigid-appearing, long nonbranching fibrils. The patient was treated with intravenous high-dose methylprednisolone pulses combined with intravenous cyclophosphamide followed by oral corticosteroids. Three months after the above treatment, renal function gradually improved, reaching serum creatinine level to 2.5 mg/dL. But the nephrotic range proteinuria persisted.

The Clinical Experience of Hemodialyzer Reuse / 대한신장학회잡지

The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.

The Clinical Experience of Hemodialyzer Reuse / 대한신장학회잡지

The major clinical advantages of dialyzer reuse are improved biocompatibility and a decrease in the frequency of the first use syndrome. Dialyzer reuse has made it possible to use biocompatible high flux membranes of the high price. Although dialyzer reuse in chronic hemodialysis patients is commonly practiced in the United States, it is not widely accepted in Korea. At Ajou University Hospital, we have reprocessed dialyzers since March 2000, and here we report our clinical experience for the 1st 8 weeks. We used high flux dialyzers with reprocessing practice in 24 chronic hemodialysis patients. Dialyzer reprocessing was performed by an automated machine(Renatron) using Renalin. We limited reuse upto 20 times, and we were able to reuse dialyzers upto this number in 17 patients. During the study period, no significant complication was observed as a result of the reuse program. Kt/Vurea and urea reduction ratio(URR) were not different between high and low flux dialyzers(1.41+/-0.29 vs 1.61+/-0.41 for Kt/Vurea and 66.70+/- 6.40% vs 65.69+/-5.63% for URR). In contrast, beta2-microglobulin(beta2M) reduction ratio and clearance were greater in high flux dialyzers than low flux dialyzers(p<0.001, -9.52+/-20.28% vs 42.00+/-8.61% for beta2M reduction ratio and 9.54+/-11.71mL/min vs 48.54+/-14.33mL/min for beta2M clearance). Kt/Vurea, URR, beta2M reduction ratio and beta2M clearance did not deteriorate with the increasing number of reuse. The predialysis values of beta2M decreased by 51% after 19 uses(p<0.001, 37.04+/-13.39 to 18.98+/-3.41mg/L). In summary, during the short pilot study period of 8 weeks, no significant clinical complication was encountered as a result of dialyzer reuse, and our results confirmed the effects of high flux dialyzers on removal of beta2M.

Occupational asthma caused by several kinds of herb materials / 대한내과학회지

There have been a few cases of occupational allergy caused by herb materials. In this study, we report a case of occupational asthma and rhinitis sensitized by six kinds of herb materials-Ostericum (Kangwhal), Angelica (Danggui), Cnidium (Chunkung), Pinellia (Banha), Zingerber (Kunkang) and Discoreae (Sanyak) in a pharmacist working at a pharmacy. The patient had shown negative responses to 80 common inhalant and food allergens, but strong positive responses to six herb material extracts, Kangwhal, Danggui, Chunkung, Banha, Kunkang and Sanyak, were noted on skin-prick test. Bronchoprovocation test showed a dual asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha and Sanyak were detected by enzyme-linked immunosorbent assay (ELISA) with no specific IgE binding to Kangwhal, Danggui and Kunkang extracts. In order to further characterize the allergic components of these three extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. One IgE binding components (60 kDa) were detected within Chunkung extract, two (10, 25 kDa) in Banha and four (33, 34, 65, 98 kDa) in Sanyak. It is suggested that Chunkung, Banha and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker. Further studies are needed to investigate the pathogenic mechanisms induced by Kangwhal, Danggui and Kunkang.

Effect of brain angiotensin II receptor antagonists and antisense oligonucleotide on drinking and renal renin in rats

The physiological roles of brain angiotensin II in mediating water deprivation-induced drinking and in regulating renal renin release were assessed in male Sprague-Dawley rats. Specific AT1 receptor antagonists, losartan and SK 1080, and antisense oligonucleotide (AS-ODN) directed to AT1 receptor mRNA were intracerebroventricularly (i.c.v.) administered in conscious unrestrained rats. When water was given 20 min after i.c.v. injection of AT1 receptor antagonists in 48-h water-deprived rats, losartan and SK 1080 produced approximatly 20% and 50% decrease in 1-h water intake, respectively. In contrast, i.c.v. treatment of the AS-ODN to AT1 receptor mRNA for 24-h did not alter 1-h water intake in 24-h water-deprived rats, but prevented the increase in overnight water intake after 24-h water-deprivation. Six-day i.c.v. treatment of AS-ODN did not alter either the basal plasma renin concentration or renal cortical levels of renin and renin mRNA. The present results suggest that endogenous brain Ang II plays an important role in thirst and water intake through AT1 receptors, but further studies are required to elucidate its regulatory role in renal renin synthesis.

Treatment with intravenous immunoglobulin in a case of adult onset Still's disease / 천식및알레르기

Adult onset Stills Disease (AOSD) is a systemic inflammatory disease characterized by spiking high fevers, arthritis, and an evanescent rash. Although many patients respond to nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid, some patients fail to do so or are found to be resistant and require high doses of corticosteroid which induce severe side effects. Recently, treatment with intravenous immunoglobulin (IVIG) has been reported to be effective in patients with AOSD who were refractory to NSAIDs. Here, we report a case of AOSD treated with IVIG with a review of the literature.