Characteristics of Severe Hyponatremia in Hospitalized Patients; A Comparison according to the Presence of Liver Disease / 대한신장학회지

PURPOSE: Liver disease is one of the most common causes of hyponatremia and improper management of severe hyponatremia may result in serious complications. We evaluated the prevalence and clinical characteristics of severe hyponatremic patients according to the presence of liver disease in hospitalized patients. METHODS: We studied 12,729 hyponatremic patients during hospitalization in single tertiary referral hospital for 1 year. Hyponatremia was defined as serum sodium level <135 mmol/L and severe hyponatremia as < or =125 mmol/L at least twice. RESULTS: Of 12,729 hyponatremic patients, 711 (0.13%) patients had severe hyponatremia and 290 (40.8%) patients with severe hyponatremia had liver disease. The main cause of severe hyponatremia was liver failure (69.7%) in patients with liver disease and excessive administration of hypotonic fluid (37.3%) in non-liver disease patients. The administration of hypertonic saline was the most common treatment both in liver and non-liver disease group. In severe hyponatremic liver disease patients, the serum sodium level was lower (128.8+/-7.1 at admission, 127.1+/-8.4 at discharge vs 132.1+/-7.5, 131.5+/-8.3 mmol/L) and the duration of severe hyponatremia (5 days vs 3 days) was longer than those in non-liver disease group. Of 589 patients with severe hyponatremic patients who had been treated for the sodium correction, 261 patients were recovered from severe hyponatremia to normal range of serum sodium, and lower correction rate was observed in liver disease group. CONCLUSION: Liver failure was the most common cause of severe hyponatremia in hospitalized patients. Severe hyponatremia in patients with liver disease had poor clinical outcomes.

Correlationship between Homocysteine and Cardiac Troponin-I with Left Ventricular Hypertrophy in End-Stage Renal Disease Patients / 대한신장학회잡지

BACKGROUND: Cardiovascular disease is the main cause of death in chronic renal failure patients. Left ventricular hypertrophy (LVH) is an independent risk factor for mortality of patients in ESRD and hemoglobin (Hb), hypercholesterolemia and CRP as associated factors for LVH. This study was conducted to determine weather the total homocysteine and cardiac troponin in ESRD patients is related to the LVH as the independent mortality factor of ESRD. METHODS: We assessed the baseline disease status and laboratory variables including total homocysteine and cardiac troponin in 90 patients (58 hemodialysis and 32 peritoneal dialysis). Also, we analyzed the left ventricular mass index (LVMI) and ejection fraction(EF) on echocardiography. RESULTS: The causes of renal disease patients were 32 cases (36%) of diabetic nephropathy, 29 cases (32%) of chronic glomerulonephritis, 26 cases (29%) of hypertensive nephropathy, 2 cases (2%) of polycystic kidney disease and 1 case (1%) of unknown cause. Mean age of patients (male/female: 44/46) was 52.2+/-12.46 years and duration of dialysis was 28.4+/-23.40 months. The prevalence of LVH was 76 cases (84%). The age (52.8+/-11.87 years vs 43.6+/-12.68 years, p<0.05), mean homocysteine levels (18.58 micromol/L, [13.06-21.86 micromol/L] vs 13.12 micromol/L, [11.78-13.47 micromol/L], p<0.01), cardiac troponin-I concentrations (0.1 ng/mL, [0-0.6 ng/mL] vs 0 ng/mL, [0-0.01 ng/mL], p<0.05) and CRP (2.42+/-3.54 mg/dL vs 0.56+/-0.37 mg/dL, p<0.05) were higher on LVH patients than normal LV mass patients. In a multiple logistic regression analysis, including age, duration of dialysis, mode of dialysis, diabetes, hypertension, cTn-I, homocysteine and CRP, both elevation of cTn-I and homocysteine were associated with a 2.91 folds increase in the incident risk of LVH (Odds ratio 2.91, 95% CI 1.14-7.42, p=0.026). LVMI positively correlated with homocysteine (r=0.507, p<0.01), cardiac troponin-I (r=0.339, p<0.01) and CRP (r=0.403, p<0.05). CONCLUSION: High levels of homocysteine and cardiac troponin-I appear together with increased left ventricular mass in patients with ESRD. Regular study of homocysteine, cardiac trophonin-I and CRP levels on ESRD patients will be predictors of LVH and useful markers on prevention of cardiovascular complication.

Up-regulation of Cathelicidin in Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary secretions and the secreted IgA in the secretions play a critical role in maintaining oral health via innate host defense mechanism. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. LL-37, an antimicrobial peptide, is the only Cathelicidin protein so far identified in humans. The purpose of this study was to examine the expression of Cathelicidin in human salivary glands and to investigate upregulation of Cathelicidin in inflammatory conditions. MATERIALS AND METHOD: Reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, of which 10 were normal and 10 were chronic sialadenitis. RESULTS: Cathelicidin mRNA transcripts were detected in the normal salivary glands and chronic sialadenitis. The level of Cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. Cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. CONCLUSION: The results indicate that Cathelicidin might play an important role in the innate host defense of human salivary glands.

Wegener's Granulomatosis Involving Nasal Cavity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Wegener's granulomatosis is a chronic multisystem vasculitis. The otolaryngologist has an important role in the early diagnosis of Wegener's granulomatosis because of the high incidence of nasal involvement. In this study, we analyze seven cases of Wegener's granulomatosis involving nasal cavity and describe clinical features, laboratory findings, treatments and outcomes. MATERIALS AND METHOD: Selected for this study were 7 inpatients with Wegener's granulomatosis treated at the department of otolaryngology of Korea University Medical Center from January, 1985 and December, 2002. Their clinicopathologic records were reviewed retrospectively. RESULTS: The nasal manifestations included nasal crusting, nasal obstruction, serous and bloody nasal discharge, septal perforation and saddle nose. All patients showed positive cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and an elevated erythrocyte sedimentation rate (ESR). Wegener's granulomatosis was confirmed by the results of nasal mucosal biopsy performed in all patients. CONCLUSION: If multiple and large biopsy sites were selected properly, the diagnostic efficacy of nasal biopsy in Wegener's granulomatosis may increase and it may help early diagnosis since nasal mucosa is the most commonly affected site in Wegener's granulomatosis and nasal cavity is an easily accessible biopsy site.

A Case of Collision Tumor: Bronchogenic Squamous Cell Carcinoma in Cervical Hodgkin Disease / 대한이비인후과학회지

In the head and neck fields, collision tumor is very rare, especially in the cervical lymph node. Clinical and pathological findings are reported concerning a 56-year-old woman with Hodgkin disease and metastatic bronchogenic squamous cell carcionma within the right supraclavicular lymph node. The primary site of squamous cell carcinoma was diagnosed by transbronchial lung biopsy. Each component retains its own biologic characteristics, so the most suitable treatment must be determined on a case-by-case.

A case of carbamazepine induced acute interstitial nephritis / 대한내과학회지

Acute interstitial nephritis often caused by drugs and infection. Interstitial nephritis by drugs is a kind of idiosyncratic reaction and is caused independently of dosage. This disease developed within several days or weeks after taking medicine but improved if discontinue medication. Adrenocortical hormone may shorten the period of disease if renal dysfunction continued. Acute interstitial nephritis by carbamazepine that is used for epilepsy cure is rarely reported. A 49-year-old male was admitted to our hospital because of skin rash and decreased urine volume which developed 10 days ago. Patient was diagnosed intracranial hemorrhage 6 months ago and was taking carbamazepine because of tingling sensation to lower extremity before 2 months. At admission, blood pressure 120/80 mmHg, hemoglobin 12.6 g/dL, WBC 232,000/mm3, eosinophil count 2,790/mm3, platelet 166,000/mm3. Urine findings indicated protein 1+, blood 2+ and eosinophil was observed in microscopic examination. Abdominal sonography showed increase of both kidney size, shade of renal cortex and Resistance index (RI). Renal biopsy showed inflammatory cell consisted of lymphocyte, eosinophil in parenchyme was seen with tubular necrosis partially. Renal function was improved after carbamazepine withdrawal and adrenocortical hormone medication.

Spindle Cell Lipoma: Report of a Oral Tongue Lesion with Literature Review / 대한이비인후과학회지

Spindle cell lipoma is a relatively rare adipocytic neoplasm that accounts for about 1.5% of adipocytic tumors. This tumor is found in the subcutaneous tissue of the neck, shoulder, or back in most cases. The affected sites of the oral cavity include tongue, buccal mucosa, floor of the mouth, palate, and alveolar ridge. As far as we know, there have been 16 cases of intraoral spindle cell lipoma reported in the literatures, and among them, only seven cases were reported as oral tongue lesion. Spindle cell lipoma is histologically characterized by the presence of an admixture of mature fat cells, uniform spindle cells and short bundles of collagen associated with the spindle cells. In this article, we report, with the review of the literature, a case of spindle cell lipoma occurring in the tongue of a 45-year-old male.