The effects of high glucose concentration, angiotensin II and its blockers on the production of IL-6 and fibronectin in cultured human mesangial cells / 대한내과학회지

BACKGROUND: Diabetic nephropathy is a leading cause of end-stage renal disease and is charaterized by activation of some growth factors (e.g., angiotensin II, endotelin-1, IL-8, and TGF-beta) and deposition of extracellular matrix proteins. Both ACE inhibitors and AT1 receptor blockers partially prevent renal hypertrophy in diabetes. Recently, IL-6 is thought to act as an autocrine growth factor for the mesangial cells. Angiotensin II (Ang II) is one of the noninflammatory stimulators of IL-6 release from mesangial cells. IL-6 have been implicated in glomerulonephritis, including mesangioproliferative glomerulonephritis. IL-6 may be associated with renal damage, especially mesangioproliferative diabetic nephropathy. However, little is known about the pathogenetic relations between IL-6 and diabetic nephropathy. METHODS: To evaluate the effects of high glucose concentration, Ang II and its blockers on IL-6 and fibronectin production, human mesangial cells were cultured in various conditions. Normal concentration (100 mg/dL) and high concentration of D-glucose (450 mg/dL), Ang II (10(-7)M), high glucose with Ang II, captopril (10(-6)M), and losartan (10(-6)M) were added. After 48 hours, IL-6 and fibronectin concentration in the supernatant were measured by ELISA method. RESULTS: The effects of various conditions on the production of IL-6 and fibronectin in cultured human mesangial cells were as follows: 1. The concentration of IL-6 in the supernatant was significantly low in high glucose group (9.9+/-0.2 pg/mL) compared to that in control group (18.0+/-6.2 pg/mL) (p<0.05), and there was no difference in the supernatant concentration of fibronectin between the groups of high glucose and control. 2. The concentration of IL-6 in the supernatant of Ang II group (28.0+/-5.0 pg/mL) was significantly higher than that in control group (18.0+/-6.2 pg/mL) (p<0.05), and there was no difference in the supernatant concentration of fibronectin between the groups of Ang II and control. 3. In the supernatant of high glucose with Ang II group, the concentration of IL-6 (20.0+/-4.0 pg/mL) was significantly higher than that of high glucose group (9.9+/-0.2 pg/mL) (p<0.05), and the concentration of fibronectin (3,100+/-50 pg/mL) was significantly higher than that of control group (2,840+/-290 pg/mL) (p<0.05). 4. The concentration of IL-6 in the supernatant was significantly lowered after the addition of captopril (10.7+/-1.8 pg/mL) and losartan (9.3+/-2.4 pg/mL) in high glucose with Ang II group (20.0+/-4.0 pg/mL) (p<0.05). 5. The concentration of fibronectin was significantly lowered after the addition of captopril (2,640+/-30 pg/mL) and losartan (2,440+/-230 pg/mL) in high glucose with Ang II group (3,100+/-50 pg/mL) (p<0.05). 6. There was no difference in the concentration of supernatant IL-6 and fibronectin between the groups of captopril and losartan. CONCLUSION: High glucose concentration decreases and Ang II increases the production of IL-6 by cultured human mesangial cells. Captopril and losartan decrease the production of IL-6 and fibronectin which have been stimulated by high glucose concentration and Ang II. These drugs may be useful in the treatment of renal disease, especially diabetic nephropathy, in which Ang II and high blood glucose are cooperative in the progression of nephropathy.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

The influencing Factors of Quality of Life in Hemodialysis Patients / 대한신장학회잡지

This study was performed to evaluate the factors influencing the Quality of Life(QOL) in hemodialysis patients. Authors surveyed and analyzed the questionnaires about social characteristics, symptom, social support, satisfaction with life and quality of life. With these questionnaires, authors compared the hemodialysis patients(N=240, >6 month with hemodialysis) with the control group(N=240). Additionally authors eva- luated the anemia state, nutritional state and dialysis effect, and then analyzed the correlation between these laboratory findings and quality of life in hemodialysis patients. The results were as follows ; 1) The mean age of control group was 33.4 +/- 8.2 yrs, and the patients group was 48.812yrs. 2) Of 294 patients, 73 had the religion(75.2%), 173 had studied above high school(58.8%), 211 were married(71.8%), and 94 were homemaker(3296). Economically, 130 of 294 patients(44.2M) were the middle classes. The patients without occupation were 121 of 294 patients(41.2M), while those with occupation were 77(26.1%) and remainder were housemaker. The patients with medical insurance were 59.9%, those with 1st Medicaid were 22.4%, and those with 2nd Medicaid were 17%. 3) The causes of ESRD were CGN(29.5%), DM (22.3%), etc. Total duration of hemodialysis was 51.4 43.8 months in average, and weekly hemodialysis time was 11.541.98 hours in average. Average BMI was 20.6 +/- 2.79, and in 236 of 294 patients(80.1%), EPO was injected. Of all the complication, 96(32.9%) was cardiovascular problem. Iron storage state was relatively good in all the patients, and the mean level of PTH-i was 174.3 +/- 307.9pg/dl, hemoglobin 8.5 +/- 1.3g/dl, cholesterol 161.536.6mg/dl, total protein 6.60.5g/dl, albumin 3.960.4g/dl. The URR was 65.36.9%, and KtV was 1.3 +/- 0.3. The comparison about laboratory finding between male and female was as followed; Hb. and albumin level was signifi- cantly higher in male compared with female patients, and cholesterol, URR and Kt/V was significantly higher in female than in male. 4) The result of statistic analysis about several variables and Questionnaires. (1) The subjective and objective instrument about QOL showed positive correlation, and the QOL was correlated positively to symptom, physical health state and social support. (2) Of social characteristics, the direct influencing factors for QOL were occupation, economic state, marriage state, and educational state, whereas in- direct factors were a fee for medical treatment and social support. In clinical and laboratory characteristics, the significant factors were age, DM, symptoms, albumin, pre-dialytic creatinine, sodium and calcium. The effect of dialysis did not correlate with QOL. In conclusion, to increase QOL in dialysis pa- tients, all of the community, family, and medical team should make an effort. Firsty, the concern and the support of the community about the dialysis patients should be promoted in social welfare and the opportunity of employment. Secondly, the patients should promote the self-reliance and self- efficacy to take a share of their role in the community and a family by their own efforts. Lastly, the medical team should make an effort to decrease the symptom, to correct the anemia and malnutrition, to treat the complication, and to promote the physical activity. Through these efforts, the health of patients will be elevated. Elevation of the patient's health will increase the possibility of employment and self-reliance, and subsequently will increase the economics. If so, the burden of a fee for the medical treatment will be reduced. Additionally, if social and familial support increase, the QOL of the dialysis patients will be better.

A Case of Simultaneous Bilateral Emphysematous Pyelonephritis and Cystitis / 대한내과학회지

Since the first clinical observation by Kelly and MacCallum, gas-forming infection of the urinary tract has been extensively studied. It is characterized by gas production within the urinary tract. The gas may often pass outside the urinary tract. Patients with this disorder invariably have uncontrolled diabetes mellitus and pos sibly associated obstructive uropathy. It is usually caused by aerobic bacteria, most commonly Escherichia coli. In the literature, the majority of cases were emphy sematous pyelonephritis alone or emphysematous cystitis separately. Bilateral renal involvement associated with emphysematous cystitis is very rarely seen and no case was reported yet in Korea. We report a case of bilateral emphysematous pye lonephritis and emphysematous cystitis which occured in 48-year-old diabetic patient simultaneously. It was caused by E. coli. The patient was cured by medical management alone.

Two Cases of Emphysematous Pyelonephritis in a Diabetic Patients: Experience of Successful Management by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Though the pathogenesis of this diseases is still poorly understood, radiographic demonstration of gas shadow in renal parenchyme and peri-nephric tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We report two cases of emphysematous pyelonephritis complicated in 62-year-old female and 48- year-old male patients with diabetes mellitus. Nephrectomies were not performed because of bilateral emphysematous pyelonephritis in one patient and of refusal of nephrectomy by the other patient. But patients were recovered completely on medical management.

A Clinical Study on Staphylococcus Aureus Bacteremia / 대한내과학회지

OBJECTIVE: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. METHODS: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. RESULTS: 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5+/-25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. CONCLUSION: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.

A case report of emphysematous pyelonephritis associated with renal adenoma in diabetic patient / 대한신장학회잡지

No abstract available.

Unusual case report as imported sparganosis / 감염

No abstract available.

A case of arthritis of hip joint caused by salmonella typhi / 감염

No abstract available.