A Comparative Study on Aqueous Chitosan Solution and Various Submucosal Injection Fluids Using a Three-Dimensional Sensor

Background/Aims@#Chitosan, a natural polymer widely used in the biomaterials field, has been proposed as a potential submucosal injection solution. The purpose of this study was to compare the performance and efficacy of aqueous chitosan solution and commercialized submucosal injection fluids using a three-dimensional sensor and to evaluate the efficacy of the measured parameters. @*Methods@#Normal saline (0.9% NaCl), as a control, Eleview ® (Poloxamer 188), Blue Eye TM (0.4% hyaluronic acid), and aqueous chitosan solution (2.0%) were injected into the submucosa of porcine stomachs ex vivo. The mucosal elevation height, elevated surface area, and angle of the tangent of the submucosal fluid cushion were measured using a three-dimensional sensor. The rates of change for each variable were calculated, and the correlation between parameters was analyzed. Tissue specimens were stained with hematoxylin and eosin. @*Results@#All variables exhibited the highest values under chitosan injection. The mucosal elevation height rate of change differed significantly between normal saline and chitosan solution (p=0.024). The elevated surface area rates of change for normal saline and Eleview® were significantly different from those for TS-905 and chitosan solution (p=0.006 and p=0.009, respectively). Further, height, area, and angle showed a positive correlation (p<0.001). A histological examination revealed an even distribution of aqueous chitosan within the submucosa without tissue damage. @*Conclusions@#Aqueous chitosan was superior to normal saline and Eleview® and was noninferior to TS-905. A three-dimensional sensor and the measured parameters were effective and useful for evaluating the performance of submucosal fluids.

Korean clinical practice guidelines for preventing transmission of coronavirus disease 2019 (COVID-19) in hemodialysis facilities

Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease that is caused by the novel virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). COVID-19 has become pandemic since December 2019, when the first case developed in Wuhan, China. Patients receiving hemodialysis are more vulnerable to viral transmission because their immune functions are impaired and they receive treatment within a narrow space. Calling on previous experience with Middle East Respiratory Syndrome during the 2015 outbreak, the joint committee of the Korean Society of Nephrology and the Korean Society of Dialysis Therapy quickly formed a COVID-19 task force team to develop a manual before the first index case was diagnosed in the hemodialysis unit. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within hemodialysis facilities, which were developed to protect patients, healthcare workers, and caregivers from this highly transmissible virus. The areas of infection control covered by these guidelines include standard precautions, performing dialysis therapy for confirmed or suspected cases, performing cohort isolation for contact patients, and disease monitoring and contact surveillance. We hope these guidelines help healthcare workers and hemodialysis patients around the world cope with the COVID-19 pandemic.

Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS) in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.

Low Non-NMDA Receptor Current Density as Possible Protection Mechanism from Neurotoxicity of Circulating Glutamate on Subfornical Organ Neurons in Rats

The subfornical organ (SFO) is one of circumventricular organs characterized by the lack of a normal blood brain barrier. The SFO neurons are exposed to circulating glutamate (60~100 microM), which may cause excitotoxicity in the central nervous system. However, it remains unclear how SFO neurons are protected from excitotoxicity caused by circulating glutamate. In this study, we compared the glutamate-induced whole cell currents in SFO neurons to those in hippocampal CA1 neurons using the patch clamp technique in brain slice. Glutamate (100 microM) induced an inward current in both SFO and hippocampal CA1 neurons. The density of glutamate-induced current in SFO neurons was significantly smaller than that in hippocampal CA1 neurons (0.55 vs. 2.07 pA/pF, p0.05). These results demonstrate that glutamate-mediated action through non-NMDA glutamate receptors in SFO neurons is smaller than that of hippocampal CA1 neurons, suggesting a possible protection mechanism from excitotoxicity by circulating glutamate in SFO neurons.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

Serum Globotriaosylceramide Assay as a Screening Test for Fabry Disease in Patients with ESRD on Maintenance Dialysis in Korea

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.

Relatioship between Dialysis Adequacy and Anemia in Patients with Hemodialysis / 대한신장학회잡지

BACKGROUND: Chronic anemia inceases cardiovascular risk and its related mortality in patients with undergoing maintenance hemodialysis. To resolve the issue of anemia due to diminished synthesis of erythropoietin (EPO), regular injection of parenteral recombinant human EPO was adopted in most dialysis center. But we are not aware of previous reports of the relationship between modality or intensity of dialysis and anemia with EPO resistancy. For these reasons, we investigated the relation between the adequacy of dialysis and the response of EPO in end stage renal disease (ESRD) patients who were receiving maintenance hemodialysis at least for three months in same condition. METHODS: We studied prospectively 57 adult ESRD patients with hemoglobin below 11 g/dL. RESULTS: 13 patients showed the under dialysis, and there was no differences in clinical features with the control groups, except the ratio of gender. At the beginning of the study, the control groups who received adequate dialysis showed better nutritional state. The groups who had received under dialysis showed the increment of 37% in Kt/V from 3.02+/-0.79 to 4.21+/-0.24 (p< 0.01), Hb from 8.98+/-0.79 to 9.34+/-0.97 g/dL (p< 0.01), and Hct from 26.44+/-2.38 to 27.31+/-2.95% (p< 0.05) after increase of the dialysis doses. CONCLUSION: Based on above results, we concluded that the patients with EPO could be improved in chronic anemia by means of increased dialysis doses.

A Case of Intussuscepting Hemangioma of the Ileum

Intussusception in an adult is an uncommon condition. In contrast to the condition occuring in infants and children in adults, it is usually secondary to an intraluminal tumor. Hemangioma is a very rare cause of intussusception. The most frequent symptoms of intussuscepting hemangioma of the gastrointestinal tract are cramping abdominal pain, vomiting and melena. The treatment is usually resection. We experienced a case of hemangioma in the ileum with intussusception. After laparotomy and resection of the ileal segment, end to end anastomosis was performed.

A Case of Chryseobacterium (Flavobacterium) meningosepticum Peritonitis in a Patient on CAPD / 대한신장학회잡지

Peritonitis remains the leading cause of morbidity and technique failure for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Chryseobacterium meningosepticum is the most common pathogen for humans among Chryseobacterium species and a few cases of CAPD peritonitis caused by C. meningosepticum were reported in the world. We experienced a case of CAPD peritonitis by C. meningosepticum in Ewha Womans University Hospital, Seoul, Korea. A 52-year-old diabetic woman on CAPD was admitted with turbid peritoneal fluid. She was suffered from three episodes of peritonitis. Effluent was cloudy with a cell count of 1,620 WBC/ mm3 (94% neutrophils, 4% lymphocytes). Effluent cultures obtained on 6th hospital day revealed a mixed growth of C. meningosepticum and P. aeruginosa. Tenckhoff catheter was removed due to persistent cloudy effluent till 9th hospital day. We herein report a case of peritonitis caused by C. meningosepticum and review the literature of similar cases of peritonitis.

A Case of Severe Hypokalemia Induced by Chronic Furosemide Abuse / 대한신장학회잡지

A 46-year-old woman was admitted to emergency room for muscle weakness and repiratory difficulty. She was taking furosemide (4 tablets per day : 160 mg/day) without physician's prescription. Her blood pressure was 90/50 mmHg and her heart rate 74/ min. Her laboratory finding showed a low serum potassium concentration (0.9 mmol/L), CK 368 IU/L, creatine 1.6 mg/dL. The result was rechecked and confirmed. Electrocardiography showed a dip in the ST segment, prolonged QTc, 1st degree AV block and 2 : 1 AV block. Echocardiography was normal. Abdominal CT scan show right lower pole calyceal stones without nephrocalcinosis. Treatment was initiated consisting of intravenous potassium chloride. Hypokalemia was overcome in 3 days. Kidney biopsy showed hypokalemic nephropathy - interstitial nephrosis, vacuolar change of tubule, proliferation of juxtaglomerular apparatus. Paralytic ileus, rebound pleural effusion, glucose intolerance, elevation of CK were associated findings. After correction of hypokalemia, her symptoms and electrocardiographic findings returned to normal.

Immunohistochemical Analysis of MHC Class 2 (HLA-DR / DP), ICAM-1, CD68(+) Macrophage Expression in Gastric Adenocarcinoma / 대한암학회지

PURPOSE: Gastric adenocarcinoma is the most common malignant tumor in Korea and immunochemotherapy can be alternative method of the treatment for it. So we evaluated several immunologic markers, Major Histocomatibility (MHC) Antigen and Intercellular Adhesion Molecule (ICAM)-1 which play an important roles in cellular immune response of the host to the tumar cells, HLA-DR/DP antigens, one of the MHC class II which is expressed in various conditions, CD 68 antigen which are also important factor in immune response to the tumor cells. MATERIALS AND METHODS: We compared the expression of MHC class II (HLA-DR/DP) antigens, ICAM-1 and the number of tumor-infiltrating macrophages presenting CD68 antigen in formalin-fixed paraffin-embedded tissue sections of 95 gastric adenocarcinomas using immunohistochemistry. In addition to analyze the relationship between expression of these antigens in gastric adenocarcinoma, histolopathologic findings such as tumor invasion, regional lymph node metastasis and histologic differentiation are evaluated. RESULTS: The rate of HLA-DR/DP expression was 60% and strongly associated with tumor differentiation, invasion and regional lymph node metastasis. ICAM-1 was expressed in 15% and slightly increased in well-differentiated carcinoma. The lack of expression of ICAM-1 was observed in high invasive tumor (T 4). CD 68(+) macrophages counts were significantly increased in around the tumor cells, compared to normal epithelia. HLA-DR/DP expression and infiltrating CD 68(+) macrophage numbers were significantly associated (p<0.05), but there was no correlationship between ICAM-1 and CD 68(+) macrophage numbers. CONCLUSION: It was considered that enhanced expression of HLA-DR/DP antigens, ICAM-1 and CD68(+) macrophages in gastric adenocarcinomas may be an immunophenotypic deviation. HLA-DR/DP and CD68(+) macrophages infiltration showed correlationship with tumor invasion and regional lymph node metastasis, that they may be used as a prognostic factor of the tumor growth.

A case of Late Occlusion of Femoro-Post Tibial PTFE Graft due to Ectopic Bone Formation

The ectopic bone formation is a condition in which mature lamellar bone is formed in tissues that do not normally ossify, which was first described by Riedel in 1883. It has been observed at sites of chronic infection, hemorrhage, fibrous scarring or contracture. The pathophysiology of ectopic bone formation is not clearly identified but has complex and multifaceted causes, which resulted to differentiate the non-circulating pluripotent mesenchymal cells to osteoblastic stem cells. The local environment conditions of trauma, disruption of soft tissues and periostium, bone debris, hematoma, damaged muscle, uncommitted fibroblasts are suspected to be one of the causes of this condition. Comparing to simple soft tissue calcification, the ectopic bone has all the morphologic and biochemical characteristics of orthotopic bone, which is subjected to turnover and even has the ability for bone marrow formation. A case of late occlusion in a femoro-post. tibial PTFE graft about 5 months after vascular reconstruction due to ectotopic bone formation, which is confirmed by pathology around the graft is presented. After excision of the ectopic bone around the inflow vascular anastomosis site with re-vascularization, the patient was free from the ischemic leg symptoms. We reported a case of occlusion of vascular anastomosis site by ectopic bone formation with review of literature.

A Case of Duodenal Leiomyosarcoma / 대한소화기내시경학회지

Leiomyosarcoma of small intestine is an uncommon tumor, comprising less than 20 percent of all primary malignant tumors of small intestine. Duodenal leiomyosarcoma is rare disease which amount to about 20 percent of all small bowel malignancy but potentially curable tumors often diagnosed at an advanced age, so its five-year survival following resection approximates 50% in reported series. Recently, several cases of leiomyosarcomas of duodenum were diagnosed by hypotonic duodenograhy in Korea. We experienced a woman with duodenal leiomyosarcoma that was diagnosed by endoscopic duodenal biopsy and received currative resection of the tumor(Whipple's operation). We report the case with review of the literatures.

A case of Roberts syndrome

Roberts syndrome is an autosomal recessive disorder accompanied by limb defects, craniofacial abnormalities, pre-and postnatal growth retardation. Patients with Roberts syndrome have characteristic premature separation of heterochromatin of many chromosomes and abnormalties in celldivision cycle. We have experienced a case of Roberts syndrome in an immature neonate The patients showed characteristic clinical features of multiple, severe facial mid-line clefts, and tetraphoco-amelia. The brief review of the literlature was made.

Cavernous Hemangioma of Lymph node: A case report with the review of literature

Primary hemangioma of the lymph node is an extremely rare vascular neoplasm, and only four cases on the subject have been reported in the literature. We describe a case of cavernous hemangioma in an axillary lymph node that was incidentally found in 70-year-old woman who underwent a modified radical mastectomy for infiltrating duct carcinoma of the left breast. Brief review of the literature regarding vasoformative lesions occupying lymph node is made with special regard to differential diagnosis from reactive-proliferative processes and other true neoplasms.

Primary Chondrosarcoma of the Lung: A case report

Primary chondrosarcoma of the lung is an extremely rare tumor, and classified into two types, tracheobronchial & lung variety. The tracheobronchial variety is usually localized and lacked lymph nodal or distant spread with good prognosis. The lung variety tends to be more invasive associated with mediastinal lymph node involvement and thoracic metastasis. Authors experienced a case of primary chondrosarcoma, lung variety, of the lung involving left lower lobe with thoracic metastasis, not yet reported in Korean literatures. The patient was 55-year-old Korean female and chief complaints were cough, dyspnea & chest pain. Pathologically, it was confused with the metastatic adenocarcinoma in the first pleural fluid cytology. But bronchoscopic biopsy revealed typical morphology of chondrosarcoma with concentric growth encircling the bronchial tree and partial destruction of the bronchiols, suggesting its primary origin. Later pleural biopsy and aspiration materials during ches tube insertion revealed also metastatic chondrosarcoma. Radiologic studies were also campatible findings to chondrosarcoma. After admision, the patient underwent progressively downhill course & expired at 31st hospital day.

Thymic Cysts: Two cases report

Thymic cyst is relatively rare tumor which usually occurs in the neck or mediastinum. Cervical thymic cyst is usually situated laterally and deep to the anterior border of the sternocleidomastoid muscle, simulating a branchial cyst. Thymic cyst of the mediastinum is usually detected incidentally and differential diagnoses include cystic degeneration of thymoma, and cystic teratoma. Two case of a cervical and a mediastinal thymic cysts were reported. The one was a cervical thymic cyst developed slowly growing mass in a 53-year-old male a for 10 years. The cyst was unilocular and measures 5.4x2.9x2.8 cm with columnar or squamous cell linings. The other is a mediastinal thymic cyst developed in a 37-year-old female with chest discomfort for 7 months. The cyst was uniocular and measures 2.8x2.2x2.0 cm. The epithelial lining of the cyst was largely desquamated and covered by macrophages with cholesterol granuloma. Involutional thymic stissue in their walls were noted in both cysts. In both cases presence of thymic tissue in the wall of the cyst thought to be the most important diagnostic feature.