Mono-therapy versus dual-therapy as transcellualr K shifting agents for acute therapy of hyperkalemia on maintenance hemodialysis / 대한내과학회지

OBJECTIVES: We evaluate the efficacy of transcellualr K-lowering effect at 1 hour following mono-therapy compared to that of dual-therapy , and aimed to find the sage and rapid method for acute therapy of hyperkalemia before dialysis in 10 ESRD patients with maintenance hemodialysis. METHOD: For ten patients of end stage renal failure with body weight between 55 and 65 Kg and a predialysis plasma potassium greater than 5.5 mEq/L, we studied in three separated phases separated from one another by at least 1 week. After 1 hour following mono-therapy (2mEq/Kg of NaHCO3 in interavenous infusion, 10 units of regular insulin with 50ml of 50% glucose in i.v. push, or 15mg of salbutamol in nebulizer) or dual therapy(NaHCO3 + Insulin with glucose, NaHCO3 + salbutamol, or salbutamol + insulin with glucose) for hyperkalemia, we compared the efficacy and safety of each transcellular K shifting methods. RESULTS: Bicarbonate infusion induced a signigicant raise in plasma bicarbonate and pH from baseline values in both mono-therapy and dual-therapy without any significant difference each other. Among mono-therapeutic regimens, bicarbonate alone failed to lower plasme K from baseline levels (-0.1+/-0.15 mEq/L, P=NS) whereas two other regimens effectively lowered plasma K (-0.62+/-0.06 mEq/L in insulin with glucose, -0.57+/-0.04 mEq/L in salbutamol, P vs. basal <0.05 in both). The K-lowering effects in the three combined regimeds of dual therapy were more prominent as compared to that of three regimens of monotherapy (-0.96+/-0.08 mEq/L in NaHCO3 + salbutamol, -1.20+/-0.6 mEq/L in NaHCO3 + insulin with glucose, and -1.20+/-0.10 mEq/L in salbutamol + insulin with glucose, respectively)(P<0.05). Two patients in monotherapy with salbutamol alone were resistant to the hypokalemic effect, however in dual therapy with simultaneous administration of salbutamol and bicarbonate resolved it. Also, hypoglycemia (<60mg/dL of fasting glucose) was noted in 4 patients in mon-therapy of insuli with glucose alone, 2 in dual-therapy of insulin with glucose + NaHCO3, but none in insulin with glucose + salbutamol. CONCLUSION: Dudal-therapeutic regimens lowered plasma potassium more effectively than mono-therapeutic regimens, and among them, the combination of insulin with glucose plus salbutamol could be recommended as an efficacious and safe modality in the acute therapy of hyperkalimia in ESRD patients.

A Case of AILD-like T Cell Lymphoma with Monoclonal Gammopathy / 대한혈액학회지

We report a case of 74 year old man presented with generalized lymphadenopathy with hepatosplenomegaly. Lymph node biopsy revealed angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) and most areas of lymph node were replaced with large atypical lymphocytes which were revealed to be T cells by immunohistochemistry. All together, the patient was diagnosed as AILD-like T cell lymphoma with bone marrow involvement. The patient presented monoclonal gammopathy (IgG lambda) without any evidence of plasma cell dyscrasia or secondary amyloidosis. After three cycles of combination chemotherapy including cyclophosphamide, prednisone, vincristine and doxorubicin, the patient achieved partial remission with decreased level of serum and urine monoclonal protein.

Centrilobular Distribution of Ethylnitrosourea-Induced Hepatocellular Foci in the Mouse / 대한간학회지

BACKGROUND/AIMS: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. METHODS: Nine B6C3F1 mices were given I.p. injection of ENU (60 ug/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. RESULTS: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15+112.39 p m (Mean+ SD), but that of randomly selected 104 points was 291.73+157.98pm (Mean+5D) (Students t-test, p<0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85+149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87+145.79 pm (Mean+SD)(Students t-test, p<0.0005). CONCLUSION: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins.

Clinical Significance of the Correlation of Serum Procollagen I and III Propeptide Concentrations in Chronic Liver Diseases / 대한간학회지

BACKGROUND/AIMS: Most liver diseases lead to a pathobiochemical reaction termed liver fibrosis. Hepatic fibrosis is not a uniform phenomenon and it comprises increased deposition of the liver connective tissue components(collagen, noncollagenous glycoprotein, proteoglycan) in the intercellular space, leading to disturbances of intrahepatic blood flow and hindrance of exchange processes between blood and cells, Fibrosis can be determined by morphological examination o f the liver, but this approach cannot be used to assess accurately the activity of collagen synthesis at any given point in time, Thus, the development of biochemical markers of hepatic fihrosis might allow a promising diagnostic approach for the identification and quantitation of this process, Aminoterminal procollagen III pn) peptide(PIIINP) and carboxytermina1 procollagen I propeptide(PICP) are known as the most widely used parameter for evaluating liver fibrosis, but it is diAicult to find previous report discribing the correlation ot each other. To elucidate the clinical significance of the corretation of PICP(x) and PIIINP(y) concentrations in patients with chronic liver diseases, radioimmunoassay was employed in this investigation. METHODS: Sera tested were obtained from pathologically proven 43 patients;4 cases of fatly liver, 11 cases of chronic persistent hepatitis, 13 cases of chronic active hepatitis, l5 cases of liver cirrhosis. All the patients except 4 cases ot fatty liver were shown positivity of HBsAg. PICP and PIIlNP radioimmunoassay kits(Farrnos Diagnostica, Oulunsalo, Finland) wcre purchased for this study. RESULTS: In the patients among the three groups of chronic active hepatitis, liver cirrhosis, chmnic persistent hepatitis, the correlations were significant in orders(y= - 10.27 +0.l3938x, r=0.92286, p=0.000007;y=-1.185+0.06611x, r=0.73656, p=0.001737;y=1.1174+0.03273x, r=0.56879, p=0.067849). Four cases of fatty liver reveal no signiticant correlation (y=4,8671- 0,0079x, r= 0.1959, p=0.804054). CONCLUSION: 0n the basis of these data, we s st that the correlation of each showed a significant increase with heightening degree of inflammation, activity of diseases and fibrosis.

Evaluation of Angiogenin Concentrations using ELISA in Sera from the Patients with Chronic Liver Diseases / 대한간학회지

BACKGROUND: Liver fibrosis by the progression of the chronic processes of the liver diseases induces deforrned microcirculations of the hepatic lobules. And this eventually resolted in portal hypertension. On the other hands, angiogenic stimu4nt factors are physiologically activated in order to repair the tissue damage. Overexpression of angiogenic factors, however, can stimulate neovascularization as in a fonnation of the tumor that liberates uncontrolled overgrowing of the tumor cells. METHODS: To elucidate the dynamic changes of the serum concentration of angiogenin in chronic liver diseases, this study is intended to employ an ELISA in 44 pathologically proven patients. Quantikiae human angiogenin kit (R and D,systems Inc. Mmneapolis, MN) was used for this investigation. RESULTS: Mean value and standard error of angiogenin concentration (ng/ml) of the sera was 238.92+/-50.95 in 5 cases of chronic persistent hepatitis, 184.47+/-12.75 in 6 cases of chronic active hepatitis, 131.36+/-10.99 in 19 cases of liver cirrhosis, and 211.03+/-19.08 in 14 cases of hepatocellular carcinoma, respectively. Serum angiogenin level in the liver cirrhosis was significantly lower than in chronic persistent hepatitis(p=0.00336), and than in chronic active hepatitis(p=0.018673). Angiogenin concentration in hepatocellular carcinomas was significantly higher than the level of the liver cirrhosis investigated(p=0.00569). CONCLUSIONS: These data support that persistent inflammatory insults in the chronic hepatitis were compensated by the elevation of angiogenin but complete fibrosis as in liver cirrhosis showed the depressed level. And emerging of the hepatocellular carcinoma is accompanied by the elevated stimuli of angiogenin for the neovascularization.

A Case of Biphasic Pulmonary Blastoma / 결핵

Pulmonary blastoma is a primary lung tumor consisting of a mixture of immature embryonal-like mensenchymal and epithelial components and in some areas resemble embryonal lung tissue of up to 3-4 months gestational age. The tumor was first described in 1945 by Barrett and Barnard and again in 1952 by Barmard, who named it an embryoma of the lung which resembled fetal lung histologically, with glandular structures lined by non-ciliated epithelium and a surrounding stroma resembling mesenchyme. In 1961 Spencer renamed them Pulmonary blastoma as he believed they represented neoplasms similar in pathogenesis to nephroblastoma. The prognosis of these tumors is poor, and the clinical course is not readily predicted from histological appearance. Untill now, more than one hundred cases have been reported in the literature in the word and there is no report in Korea. We report a case of biphasic pulmonary blastoma, which ruptured spontaneously, in a 31-year-old young man who was presented as sharp pain under the right subscapular area.

A Case of Biphasic Pulmonary Blastoma / 결핵

Pulmonary blastoma is a primary lung tumor consisting of a mixture of immature embryonal-like mensenchymal and epithelial components and in some areas resemble embryonal lung tissue of up to 3-4 months gestational age. The tumor was first described in 1945 by Barrett and Barnard and again in 1952 by Barmard, who named it an embryoma of the lung which resembled fetal lung histologically, with glandular structures lined by non-ciliated epithelium and a surrounding stroma resembling mesenchyme. In 1961 Spencer renamed them Pulmonary blastoma as he believed they represented neoplasms similar in pathogenesis to nephroblastoma. The prognosis of these tumors is poor, and the clinical course is not readily predicted from histological appearance. Untill now, more than one hundred cases have been reported in the literature in the word and there is no report in Korea. We report a case of biphasic pulmonary blastoma, which ruptured spontaneously, in a 31-year-old young man who was presented as sharp pain under the right subscapular area.

Clinical Studies on Neonatal Jaundice and Exchange Transfusion

No abstract available.