Vitamin D Status and Vitamin D Receptor Gene Polymorphisms Are Associated with Pelvic Floor Disorders in Women

OBJECTIVES: To investigate if vitamin D receptor (VDR) gene polymorphisms and circulating vitamin D levels are associated with pelvic floor disorders (PFDs). METHODS: In this case-control study, 25-hydroxy-vitamin D (25[OH]D) serum levels were analyzed in 47 females with PFDs and 87 healthy females (controls), respectively. The VDR gene polymorphisms were determined by using polymerase chain reaction and performing digestions with 4 restriction enzymes i.e., ApaI, TaqI, FokI, and BsmI. Vitamin D levels of patients were divided into 0.05). However, there was a significant difference in the distribution of vitamin D levels between study group and controls using Pearson's χ2 test (30 ng/mL: 87.2%, 12.8%, and 0% in the study group and 75.9%, 16.1%, and 8.0% in controls, respectively, P < 0.05). Taken together, our observations suggest that vitamin D levels could be associated with PFDs and that 2 polymorphisms (i.e., ApaI and BsmI) in the VDR gene may contribute to an increased prevalence of PFDs in women with insufficient levels of vitamin D. CONCLUSIONS: Examining vitamin D levels and performing a VDR genotype analysis may be helpful for assessing PFD risk.

Effects of Cross-Linking Agents on the Stability of Human Acellular Dermal Matrix

PURPOSE: Human acellular dermal matrix(ADM) is widely used in the treatment of congenital anomalies and soft tissue deficiencies. But it is rapidly degraded in the body and does not provide satisfactory results. There is a need to improve collagen fiber stability through various methods and ultimately regulate the speed of degradation. METHODS: The ADMs were added with various cross- linking agents called glutaraldehyde, dimethyl 3,3'-dithiobispropionimidate to produce cross-linked acellular dermal matrices. 1,4-butanediol diglycidyl ether solution was applied with a pH of 4.5 and 9.0, respectively. The stability of cross-linked dermal matrix was observed by measuring the shrinkage temperature and the degradation rates. The cross- and non-cross linked dermis were placed in the rat abdomen and obtained after 8, 12 and 16 weeks. RESULTS: The shrinkage temperature significantly increased and the degradation rate significantly decreased, compared to the control(p<0.05). All of cross- linked dermises were observed grossly in 16 weeks, but most of non-cross linked dermis were absorbed in 8 weeks. Histologically, the control group ADM was found to have been infiltrated with fibroblasts and most of dermal stroma were transformed into the host collagen fibers. However, infiltration of fibroblasts in the experiment was insignificant and the original collagen structure was intact. CONCLUSION: Collagen cross-linking increases the structural stability and decreases degradation of acellular dermis. Therefore, decrease in body absorption and increase in duration can be expected.

Preterm delivery between 34-36weeks of gestation; Is it danger? / 대한산부인과학회잡지

OBJECTIVE: We performed this study to determine the safety and danger of preterm delivery at gestational age 34-36 weeks through antenatal profiles, neonatal conditions, neonatal morbidities. METHODS: We reviewed our antenatal and neonatal data between December 1999 and April 2001 to determine the morbidities of infants delivered at gestational age 34-36 weeks using x2test and Fisher's exact test. RESULTS: 1. Mean age was 30.8+/-4.58yrs and mean gravida was 2.68+/-1.56. Preterm premature rupture of membrane was higher in preterm delivery at gestational age 34 and 35weeks(respectively 58.6%, 50%). There was no difference in using tocolytics but, antenatal steroid treatment for prevention of respiratory distress syndrome(RDS) was most frequent in gestational age 34weeks.(20.68%). 2. There was no difference in the risk factor of preterm labor at each group. 3. 1-minute Apgar score<7 was significantly more frequent in neonates at gestational age 34weeks but neonatal weight and meconium staining were not different. 4. The rate of neonatal intensive care unit(NICU) admission was significantly higher in neonates delivered at gestational age 34weeks(93.1%), and RDS occurred in 3 cases delivered at gestational age 34weeks(10.34%). 2 cases delivered at gestational age 34 weeks needed the use of ventilator. CONCLUSION: Our study shows significant differences in neonatal morbidities between 34weeks and the others. In particular, all cases of Respiratory distress syndrome(n=3) occur in neonates delivered at 34weeks gestation not receiving antenatal steroid treatment and neonatal morbidities at 35 and 36weeks of gestation were not different with full term gestation.

Effects of LDL and Oxidized LDL on Mesangial Cell Proliferation and ICAM-1 Expression / 대한내과학회지

OBJECTIVES: As one of the studies for the contribution of hyperlipidemia to the pathogenesis of glomerulosclerosis, this study was performed to evaluate the effects of low density lipoprotein(LDL) and oxidized LDL on mesangial cell proliferation and intercellular adhesion molecule-1 (ICAM-1) expression. METHODS: Oxidized-LDL and cell-treated LDL were prepared from LDL by incubation with copper sulfate and mesangial cells, respectively. They were each co-incubated with human mesangial cells. The effects of LDL, oxidized-LDL and cell-treated LDL on mesangial cell proliferation were estimated by measuring the uptake of [3H]-thymidine and counting the cell numbers under phase contrast microscopy. The expression of ICAM-1 on mesangial cells was examined by indirect immunofluorescence method. RESULTS: LDL increased the uptake of [3H]-thymidine by mesangial cells at 10 g/mL returning to control levels at 50 g/mL, and decreased [3H]-thymidine uptake at 100 g/mL of LDL concentration. Also, mesangial cell numbers decreased at 100 g/mL of LDL concentration. In contrast, oxidized LDL decreased [3H]-thymidine uptake starting at 1 g/mL, and decreased mesangial cell numbers starting at 10 g/mL of oxidized-LDL concentration, in a concentration-dependent manner. Cell-treated LDL above the concentration of 10 g/mL caused a concentration- dependent increase in [3H]-thymidine uptake. LDL at certain concentrations increased mesangial cell ICAM-1 expression. CONCLUSION: These results that low concentration of LDL stimulate and high concentration of LDL and oxidized LDL inhibit human mesangial cell proliferation may be the in vitro evidence of lipid mediated glomerulosclerotic injury.

Role of mononuclear cells of IgA nephropathy on ICAM-1 expression in mesangial cells

OBJECTIVES: To investigate the possible role of mononuclear cells and their products in the pathogenesis of IgA nephropathy, in vitro expression of ICAM-1 on cultured mouse mesangial cell (MC) was examined after stimulation with mononuclear cell culture supernatant from patients with IgA nephropathy. METHODS: Peripheral blood mononuclear cells (PBMC) were isolated and cultured from 18 patients with primary IgA nephropathy, 8 normal controls and 5 patients with non-IgA nephropathy (FSGS 1, MGN 3, MPGN 1). ICAM-1 expression on cultured mouse MC by TNF-alpha, IL-1 beta and culture supernants of PBMC were analyzed using a cell ELISA method. The concentration of IL-1 beta and TNF-alpha in culture supernatants was measured by using a commercially available radioimmunoassay kit. RESULTS: Addition of human recombinant TNF-alpha induced an increased ICAM-1 expression in a dose-dependent manner. The expression of ICAM-1 was further increased after co-stimulation with TNF-alpha and IL-1 beta. Addition of PBMC culture supernatants into mouse MC induced significantly higher expression of ICAM-1 by supernatants from the patients with IgA nephropathy compared with that from normal controls. The concentration of TNF-alpha and IL-1 beta in supernatants from the patients with IgA nephropathy was significantly higher than that from those with non-IgA nephropathy. CONCLUSION: TNF-alpha and IL-1 released from mononuclear cells induced the up-regulation of ICAM-1 expression and this may be related to the immune pathogenesis of IgA nephropathy.

A Comparative Study of Three Connector Systems in Continuous Ambulatory Peritoneal Dialysis(CAPD) Related Peritonitis / 대한내과학회지

OBJECTIVES: The purpose of the present study was to compare the general condition of peritonitis through a study of three connector systems : The Straight transfer set with Spike-and-Pork system(SPS), The Straight transfer set with Luer-Lock system(SLS), and The Y-set with Two Bag system(YS). METHODS: We reviewed our experience with 134 patients from 1988.1 to 1995.12. According to various kinds of connector system, we divided cases into 3 groups : The SPS(1988. 1-1991. 3) was used on 55 patients(mean age 47+/-2, M:F=30:25); The SLS(1991.4-1993.8) on 45 patients(mean age 55+/-1, M:F=30:15); and The YS(1993.9-1995.12) on 34 patients(mean age 49+/-5, M:F=15:19). RESULTS: 1) Total CAPD duration was 1.22 patient year in SPS, 1.08 in SLS, and 0.96 in YS. The incidence of peritonitis is 1.71 episodes per patient year in SPS, 1.03 in SLS, and 0.61 in YS. 2) Among the causative organisms of peritonitis, coagulase negative Staphylococcus was most common in the three groups(SPS:10.4%, SLS:10%, YS:20%). In SPS and SLS, S. aureus(7.7%, 8%), Pseudomonas(6.5%, 8%), E. coli(5.2%, 6%) were present in decreasing order. In YS, Pseudomonas (15%), S. aureus(15%), E. coli(10%) were present in decreasing order. There were no growth of organisms in 55.9% of SPS, 38% of SLS, and 30% of YS. 3) The probability of experiencing the first peritonitis at 1, 3, 6, and 12 months was 21.4%, 21.4%, 21.4%, and 23.9% respectively in SPS, 3.4%, 34.5%, 34.5%, and 10.3% respectively in SLS, and 0%, 28.5%, 35.7%, and 28.5% respectively in YS. 4) In the response to the treatment of peritonitis, 59.7% of the peritonitis episodes in SPS, 72% in SLS, and 85% in YS were cured with antibiotics. In 37.7% of the peritonitis episodes in SPS, 24% in SLS, and 10% in YS, the catheter was removed due to fungal, tubercolous, recurrent, or peritonitis not responding to antibiotics. 2 patients in SPS, 2 patients in SLS, and 1 patient in YS died due to peritonitis. 5) The catheter survival rate at 3, 6, 12 months was 72%, 63.6%, and 40% respectively in SPS, 89%, 78.3%, and 46.7% respectively in SLS, and 94%, 85.3%, and 76.6% respectively in YS. CONCLUSION: Our study suggests that there is a relationship between the development of connector system and a decrease of peritonitis in CAPD.

A Clinical Analysis of Pancreatic Pseudocysts

A pancreatic pseudocyst is a fluid-filled cystic structure without a true epithelial lining that is associated with the pancreas or pancreatic duct. Its walls are composed of fibrous and granulation tissue. Pancreatic pseudocysts occur in 2~10% of patients with pancreatic disease. The most common cause of a pancreatic pseudocyst is an alcoholic pancreatitis. Treatment of a pancreatic pseudocyst is composed of conservative and surgical treatment. The objective of this study was to improve the prognosis for patients with a pancreatic pseudocyst by suggesting the most appropriate treatment method and the timing for the treatment. The clinical courses of 57 patients with pancreatic pseudocysts who were treated at the Department of Surgery, College of Medicine, Chung Ang University from January 1975 to December 1995 were retrospectively reviewed. The sex and the age distributions, the etiology, the clinical manifestations, the diagnostic methods, and the treatments and their results were analyzed. The result are as follows: The sex ratio of males to females was 1.7 : 1. The most prevalent age groups were the third and the fourth decades. The most common cause of pancreatic pseudocysts was alcoholic pancreatitis. The frequent symptoms were abdominal pain and an abdominal mass. The most valuable diagnostic tests were ultrasonography and abdominal computerized tomography. The locations of the pancreatic pseudocysts were the tail, the body, and the head in order of frequency. The applied surgical methods were internal drainage, external drainage, and resection. The mortality rate was 5.3%. The mortality and the morbidity rates were different according to the treatment method and the timing of the treatment. Based on these results, it is undesirable that surgical treatment be delayed to expect maturation of cystic wall. The most appropriate timing for surgical treatment is a stable state after inflammation has subsided.

Comparison of left ventricular hypertrophy between hypertensives and chronic renal disease patients: Echocardiographic Study / 대한내과학회지

OBJECTIVES: Left ventricular hypertrophy (LVH) is one of the most common echocardiographic findings and an important prognostic factor for cardiovascular mortality in hypertensives and chronic renal failure patients. To evaluate the prevalence and the types of LVH, and left ventricular systolic and diastolic functions as worsening of renal function, and to elucidate the risk factors for LVH, we performed this study retrospectively in normal populations, hypertensives, and renal failure with or without hemodialysis. METHODS AND SUBJECTS: We recruited the study population among the patients who had taken echocardiography at Pun-Dang CHA Hospital from July, 1995 to June, 1997. They are consisted of 54 patients for normal control, 53 patients of hypertensives, 31 patients of mild renal failure with less than 4.5 mg/dl of serum creatinine (Group I), 29 patients of moderate renal failure with more than 4.5 mg/dl of serum creatinine (Group II), and 47 patients of end stage renal disease with hemodialysis (Group III). The echocardiography was performed with all standard strategies including 2 dimension, M mode, and Doppler signals. RESULTS: 1) Among the baseline characteristics, the body mass index only significantly increased in hypertensives compared with group II and III.2) The prevalences of LVH in each groups were 5.6% in control group, 49.1% in hypertensives, 83.8% in group I, 89.7% in group II, and 100% in group III respectively. And the pevalences of concentric LVH were 5.6%, 43.3%, 41.9%, 34.5%, and 25.5% and those of the eccentric hypertrophy were 0.0%, 5.7%, 41.9%, 55.2%, and 74.5% respectively. The prevalence of eccentric hypertrophy increased according to deterioration of renal function.3) The left ventricular mass index was significantly higher in hypertensives, Group I, Group II, and Group III than normal control and the left ventricular volume index was greater in all renal failure patients compared with controls and hypertensives.4) In pre-hemodialysis renal failure patients, the types of LVH were consisted of 8 of normal heart (Group A), 23 of concentric LVH (Group B), and 29 of eccentric LVH (Group C). The systolic blood pressure and mean arterial pressure were significantly higher in group C than group A but there was no significant difference between group C and B. The RBC volume was significantly decreased in group B and C compared with group A. The echocardiographic end diastolic interventricular septal thickness and posterior wall thickness were significantly thicker in group B than others but end diastolic LV dimension, LV mass index, and LV volume index were significantly increased in group C than group B and A. The LV ejection fraction and fractional shortening as markers of LV systolic function in group C revealed the lowest level among three groups. The E velocity among the Doppler study profiles was significantly higher in group C than others.5) In hemodialysis group, all the patients had any types of LV hypertrophic changes. The concentric LVH group (group B) had significantly higher systolic blood pressure and mean arterial pressure than eccentric LVH (group C) but there was no difference in diastolic blood pressure between two groups. The echocardiographic interventricular septum and posterior wall were thicker in group B than group C but end diastolic LV dimension and LV volume were significantly higher in group C than group B.6) The LV mass index in pre-hemodialysis group had positive relationship with blood pressure and serum urea nitrogen level and the LV volume index was positively correlated with systolic blood pressure and mean blood pressure.7) The LV mass index in hemodialysis group had positive relationship with age and systolic blood pressure and LV volume index was positively correlated with serum urea nitrogen level but negatively correlated with blood pressure. CONCLUSION: The prevalence of LVH was much higher in renal failure group than hypertenssives and the proportion of eccentric LVH was increased with worsening of renal function. Although the arterial hypertension is the most important risk factor for LVH, this finding suggested existence of other contributing risk factors for LVH in chronic renal failure, which included uremia, anemia, and age.

Bone Mineral Density and Markers of Bone Turnover in Patients with End-Stage Renal Failure on Starting Hemodialysis / 대한신장학회잡지

Renal osteodystrophy is well recognized complication of end stage renal disease(ESRD) and is associated with a marked morbidity. To evaluate bone loss in renal osteodystrophy, we measured bone mineral density(BMD) in distal radius by quantitative computed tomography in 43 ESRD patients on starting hemodialysis(HD) and in 84 healthy controls matched for age and sex. We also measured intact parathyroid hormone(iPTH), serum total alkaline phosphatase(T-ALP), osteocalcin(OC) and urine deoxypyridinoline(U-DPD) as bone turn-over markers. 1) The mean age of ESRD patients and control groups were 49.8 and 49.7 years. M:F ratio were 1:1.1 and 1:1.3 on each groups. There was no significant differences on each groups. 2) Serum T-ALP and OC were 263.9+/-264.5U/L, 43.5+/-27.6ng/mL in ESRD patients and 167.4+/-46.6U/ L, 8.8+/-3.9ng/mL in control groups. These were significantly higher in ESRD patients(P<0.001, P< 0.001), while U-DPD were not significant difference on each groups(5.3+/-4.1 vs 5.4+/-1.9nM/mM. Cr.). 3) Serum iPTH and aluminum were 296.8+/-263.4pg/mL, 10.1+/-11.6ng/mL in ESRD patients. 4) Total density, trabecular density and cortical density were 340.4+/-83.6, 172.9+/-48.4, 477.2+/-123.5mg/ cm3 in ESRD patients and 393.2+/-49.1, 210.6+/-32.9, 541.3+/-76.2mg/cm3 in control groups. BMD was statistically significantly reduced in ESRD patients (P<0.001, P<0.001, P<0.001, respectively). Z score of total density and trabecular density were -0.62+/-1.12, -0.91+/-0.95 in ESRD patients and 0.19+/-0.68, 0.06+/-0.59 in control groups. It was significantly reduced in ESRD patients(P<0.001, P<0.001, P<0.001, respectively). 5) In ESRD patients, serum T-ALP, iPTH, OC, U-DPD were not correlated with BMD and Z score. But in control groups, serum OC was correlated inversly with BMD, and U-DPD was only correlated inversely with trabecular density. 6) In ESRD patients(n=22) who were having iPTH above 300pg/mL, serum OC and U-DPD were significantly higher than in ESRD patients(n=21) who were having iPTH below 300pg/mL(52.6+/-28.8ng/ mL, 6.8+/-5.1nM/mM.Cr. vs. 33.9+/-23.3ng/mL, 3.7+/-1.9 nM/mM.Cr. P<0.05, P<0.05 repectively). But serum aluminum, and T-ALP were not significant difference on each groups. BMD and Z score were also not difference on each groups. 7) In ESRD patients who were having iPTH above 300pg/mL, iPTH and serum OC were inversely correlated with BMD but U-DPD were only inversely correlated with trabecular density. In ESRD patients who were having iPTH below 300pg/mL, bone turn-over markers were not correlated with BMD. In ESRD patients on starting HD, BMD were significantly reduced, but serum T-ALP, OC, iPTH and U-DPD were not correlated with BMD. In ESRD patients who were having iPTH above 300 pg/mL, BMD were significantly inversely correlated with serum OC, iPTH.

Effects of Mixed Leukocyte Reaction, Hydrocortisone, or Cyclosporine A on Expression of Adhesion Molecules by Endothelial and Mesangial cells / 대한내과학회지

OBJECTIVES: ICAM-1, VCAM-1, and betal integrins mediate cell-cell or cell-matrix interactions. We investigated effects of mixed leukocyte reaction (MLR), cyclosporine A (CsA), or hydrocortisone (HC) on their expression by endothelial (EnC) and mesangial cells (MC). METHODS: MLR was performed with or without CsA or HC for 5 days. After adding 25N MLR supernatant, cytokines or CsA to MC or EnC, the expression of VCAM-1, ICAM-1, and alpha3beta1 and a501 integrins was examined by using cell surface enzyme immunoassays or flow cytometry. RESULTS: MLR supernatant induced a marked increase in the expression of ICAM-1 and VCAM-1 on MC or EnC(p<0.001). HC treatment during MLR effectively inhibited MLR-induced upregulation of VCAM-1 and ICAM-1 on both cells (p<0.005). HC had, however, no inhibitory effect on VCAM-1 expression when added with MLR supernatant to cells. CsA treatment during MLR caused a modest decrease in MLR-induced expression of VCAM-1 on EnC, but had no effect on that of ICAM-1. INFgamma or TGFbeta1 stimulated expression of VCAM-1, and INFgamma, IL-1beta, or TNF alpha expression of ICAM-1 on MC after 24 hr. INFgamma, or TGFbeta1 enhanced expression of alpha3beta1 or alpha5beta1 integrins on MC after 5 days. CsA caused a modest decrease in basal expression of VCAM-1, and also decreased the basal, or INFgamma, or TGFbeta1-induced expression of alpha3beta1 and alpha5beta1 integrins on MC. CONCLUSION: Alloreactive lymphocytes and monocytes upregulate expression of VCAM-1 and ICAM-1 on EnC and MC maybe by secretion of cytokines such as INFgamma, and facilitate leukocytes attachment and following renal or vascular injury. HC effectively prevent the upregulation of VCAM-1 and ICAM-1 by inhibiting the release of cytokines during MLR. CsA did not cause an increase in the expression of VCAM-1 and beta1 integrin.

In Vitro IL-1, TNF and IL-6 Production of Peripheral Blood Mononuclear Cells Stimulated with Different Hemodiaysis Membranes / 대한내과학회지

OBJECTIVES: In order to evaluate the role of these cytokines in biological response induced by blood interaction with hemodialysis membranes. METHODS: We have investigated the IL-1, TNF and IL-6 concentrations in the supernatant of 24-hours cultured peripheral blood mononuclear cells (PBMC) without(spontaneous group) or with broken cuprophan or P1VMA membranes in 9 chronic hemodialyzed patients and 8 healthy controls. The blood samples were drawn before dialysis using following criteria: (a) in last dialytic treatment with PMMA membranes(HDEl), (b) after two weeks of dialytic treatment wih cuprophan membranes(HDE2). RESULTS: In the both of patient group(HDE1 and HDE2) and controls production of IL-l, TNF and IL-6 of PBMC stimulated with cuprophan or PMMA membrane particles was increased compared to those of spontaneous group. IL-1 production of HDE1 stimulated PMMA(99.31 +/- 30.15fmol/ml) was significantly higher compared to that of cuprophan(48.43 +/- 11.29fmol/ml), TNF production of HDE2 with cuprophan(114.86 +/- 38.5lfmoVml) was significantly high compared to that of spontaneous group(52.42 +/- 29.94fmol/ml). IL-6 production of HDE2(646.70 +/- 103.84fmol/ml) was significantly high compared to that of spontaneous group(385.88 +/- 87.03fmoVml). Comparing cytokine production of PBMC, there was a significant correlation between IL-1 and IL-6(r=0.78), IL-1 and TNF(r=0.78) and TNF and IL-6(r=0,76). CONCLUSION: Our results show that the interaction of cuprophan or PMMA membranes with blood increase the production of IL-1, TNF and IL-6. We suggest that in patients undergoing routine hemodialysis PBMC are primed by exposure to chronic stimulation.

Rahnella Aquatilis Bacteremia in a Hemodialysis Patient / 대한신장학회잡지

Rahnella aquatilis, an infrequently isolated gram-negative rod, is the only species of the genus Rahnella within the Enterobacteriaceae family. The organism's natural habitat is water, from which most isolates have been recoverd. Infecions in humans have only occasionally been reported, especially in immunocompromised patients. We reort a case of bacteremia caused by this organism in a hemodialysis patient.

Renal transplantation using ileal conduits in 3 cases / 대한이식학회지

No abstract available.

Effects of recombinant human erythropoietin on cardiac function and morphology in patients with chronic renal failure / 대한신장학회잡지

No abstract available.

Plasma concentrations and productions of IL-1, TNFalpha IL-6 by peripheral blood mononuclear cells in chronic hemodialyzed patients / 대한신장학회잡지

No abstract available.

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

No abstract available.

Renal vein thrombosis in patients with nephrotic syndrome / 대한신장학회잡지

No abstract available.

A successful throbolytic therapy in the thrombosis of right common iliac artery complicated from minimal change nephrotic syndrome / 대한신장학회잡지

No abstract available.

Effects of glucose, insulin and somatostatin on collagen production by glomerular mesangial cell / 대한신장학회잡지

No abstract available.

Immune complex-induced increases in collagen production by cultured mesangial cells modulated by dexamthasone and heparin / 대한신장학회잡지

No abstract available.