The Characteristics and Related Factors with Severe Uremic Pericarditis / 대한신장학회잡지

BACKGOUND: Although the incidence has decreased markedly, mortality from uremic pericarditis still remained high at 8-10% due to hemodynamic compromise. Moreover, it is difficult to diagnose and discriminate from other causes of pericarditis such as tuberculous pericarditis in its early stage. The aim of this study was to analyze the factors that were related to the development of uremic pericarditis and factors that could distinguish it from other causes of pericarditis. METHODS: Eighteen patients who received pericardiocentesis due to uremic pericarditis from 1996 to 2005 in Korea university hospital were enrolled. All patients were diagnosed as severe uremic pericarditis by echocardiography. And as a comparison group, 37 patients with tuberculous pericarditis and 20 patients with malignant pericarditis were also enrolled. Analysis of the factors that were related to the development of uremic pericarditis or comparison of clinical, biochemical factors in uremic, tuberculous or malignant pericarditis were also done. RESULTS: In uremic pericarditis, the proportion of patients with peritoneal dialysis was higher (55.6%). The amount of pericardial effusion showed a positive correlation with the duration of dialysis, whereas showed negative correlation with hemoglobin and cholesterol levels. Pericardial fluid ADA was significantly higher in tuberculous pericarditis and pericardial fluid glucose was higher in uremic pericarditis. No specific factors that were related to the development of pericardial tamponade were identified. CONCLUSION: The development of severe uremic pericarditis might be related to poor nutritional status. In the early stage, ADA and glucose levels in pericardial fluid could be useful in distinguishing uremic pericarditis from tuberculous pericarditis. Prospective studies that enroll large patient population can be helpful in identifying factors that are related to the development of uremic pericarditis or tamponade.

Changes of CA125 and PIIINP (Procollagen-3-N-terminal Peptide) in Peritoneal Dialysis Patients with Low GDP Solution / 대한신장학회잡지

BACKGROUND: The bioincompatability of the conventional peritoneal dialysis can be partly attributed to the presence of GDPs, which are generated during the heat sterilization. Formation of GDPs can be significantly reduced by the use of multi-chamber bag systems because high concentrated glucose is separated from alkaline lactate. In order to investigate whether multi-chamber bag system can improve the in vivo biocompatibility, we performed a randomized, prospective study comparing the multi-chamber bag system with the conventional PD system, measuring CA125 and PIIINP levels in the effluent dialysates as well as the other clinical and biochemical parameters. METHODS: Forty five patients who were stable on CAPD were enrolled randomly assigned to experiment group (n=27), and control group (n=18). Overnight effluent was collected for measurement of CA125 and PIIINP and the other clinical, biochemical parameters were compared including the number of peritonitis, the ultrafiltration volume. RESULTS: In patients treated with the multiple chamber bag system, there were significantly higher levels of CA125 and PIIINP from 1 month. No clinical and biochemical parameters influenced on their levels. The incidence of peritonitis or ultrafiltration volume did not differ between the two groups. CONCLUSION: Using the low GDP solution resulted in a better preservation of peritoneal mesothelial mass and an improvement of local peritoneal homeostasis, which are supposed to contribute to the biocompatibility of peritoneal dialysis fluid.

Three Cases of Ticlopidine-induced Cholestatic Hepatitis

Ticlopidine hydrochloride is world-wide used antiplatelet agent that inhibit ADP pathway. Its clinical side effects are the change of the blood picture, allergic skin reaction and gastrointestinal symptoms. We report three patients with severe cholestatic hepatitis caused by ticlopidine. They developed jaundice about 20days after taking ticlopidine (500 mg/day). Infectious and immunological etiologies were excluded by serology. There was no history of alcohol or drug abuse. Their symptoms were gradually subsided for a few months after discontinuing ticlopidine.

The Catheter Removal of Polymicrobial Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회잡지

Polymicrobial peritonitis is a relatively uncommon complication and it's clinical characteristics, risk factor and optimal managernent remain controversial. To identify indications for catheter removal in polymicrobial peritonitis, we reviewed the 340 episodes that occured in 168 patients of CAPD peritonitis during past 7 years to identify those. Polymicribial peritonitis was the 18 epoisodes in 18 patients of all peritonitis. First, 18 patients with polymicrobial peritonitis (P-P) did not show significant differences in the demographic features compared to 130 patients with single organism peritonitis (S-P). In contrast to Staphylococcus in S-P, the most common causative organisrn in P-P was pseudomonas (23%). Also sgnificantly more catheters were removed in P-P than S-P (P=0.001). Second, we cornpared group I, the patients responded to antibiotics only, and group II, those who needed catheter removal. The group I was 7 (39%) and the group II was 11 (61%). No patient of group I died and two patients of group II died. Between group I and group II, there were no significant differences in the demographic features. However, patients whose dialysate-WBC counts were below 100 at 3rd day after start of antibiotics were more significantly frequent in group I than group II. Among combination of causative organisms in P-P, most of Pseudornonas (6/9) and fungus (4/4) were treated by catheter removal. In conclusion, more catheters were removed in P-P than S-P. When dialysate WBC at 3rd day after start of antibiotics were over 100 and causative organism included pseudomonas or fungus in P-P, catheter removal was needed. We suggest that the kinds of organisms isolated and early response to antibiotics influence on the outcome of polymicrobial peritonitis.

Circardian Variation of Premature Ventricular Complex in Dilated Cardiomyopathy

BACKGROUND: Circardian variation in the onset of cardiovascular events includig sudden cardiac death, myocardial infarction and ventricular arrhythmias has been discribed. The frequency of ventricular premature complexes has also been reported to demonstrate a pattern consisting of a daytime peak and nightime nadir. We tried to see if the same circardian pattern is found in dilated cardiomyopathy patients. We have also studed how various modifying factors such as left ventricular ejection fration and ACE inhibitor use may affect the circardian pattern. METHOD: 24-hour ambulatory electrocaridiographic monitorings were performed in 50 dilated cardiomyopathy patients and 20 control subjects. Patients were prospectively divided in 2 groups based on LVEF and ACE inhibitor use. RESULTS: In dilated cardiomyopathy patients, the expected morning increase in VPC frequency is absent and show a peak in evening. This pattern is not correlated with heart rate. Evening peak is more prominent in low LVEF group and ACE inhibitor non-user group. CONCLUSION: In dilated cardiomyopathy patients, VPC frequency show a peak in the evening.

Changes of Na-K ATPase during acute ischemic renal failure / 대한신장학회잡지

No abstract available.

Wegener's granulomatosis with ANCA / 대한신장학회잡지

No abstract available.

The Diagnostic Value of Computed Tomography in Herniated Intervertebral Disc / 대한정형외과학회잡지

The Computed Tomography is the most exact method to find out some diesase, soft tissue or musculoskeletal system. It is searching examination distinguishing normal structure and abnormal states in the spine and spinal canal. This is almost an absolute diagnostic method for spinal stenosis, and it has a special forte becasue it can distinguish the soft tissue around the spine. Thus we can distinguish metastatic cancer, herniated intervertebral disc, hypertrophy of the yellow ligament, and spine tumor very easily. Thirty-two cases of herniated intervertebral disc in lumbar spine were treated for 18 months from Jan. 1981 to Jun. 1982. Of thirty two cases, 18 cases were underwent CT scanning and 9 cases were underwent CT scanning and myelography. We obtained following results: 1. In the 18 cases taking a CT scan we found 6 cases of bulging annulus, 7 cases of herniated disc, one case each of facet syndrome, lateral recess syndrome, and three cases had normal finding. 2. In 9 cases taking CT scan, myelography and operation, 7 cases showed the same positive findings, but one case showed the positive CT scan and myelography, negative surgical exploration, and another case showed positive myelography, negative CT scan surgical exploration. 3. In 9 cases who took only a CT scan, there were 6 cases in which myelography was impossible or refused. Among these 6 cases 4 patients took operation and showed positive findings. 4. The diagnosis of herniated intervertebral disc by means of the CT scan has been made more accurately by the supplementary use of metrizamide and improvement of interpretation. a. When the patient refuses myelography. b. For discrimination of other diseases than herniated intervertebral disc. c. When the patient is allergic to iodine dyes used in myelography. As mention above, not only herniated intervertebral disc, but also many other diseases in spine can be diagnosed and we can decide that the herniated intervertebral disc surgery would by desirable with only the CT scan as nonivasive diagnostic test.