Expression of Platelet Derived Growth Factor-A, C and Platelet Derived Growth Factor Receptor-alpha in the Ischemia Reperfusion Renal Failure Model / 대한신장학회잡지

BACKGOUND: Platelet-derived growth factor (PDGF) is a widely expressed growth factor with both mitogenic and chemotactic activities in many connective tissue cell types. There are four members of PDGF family; PDGF-A, PDGF-B, PDGF-C, PDGF-D. Their biological effects are mediated via two tyrosine kinase receptors, PDGF receptor-alpha and PDGF receptor-beta, and PDGF-mediated signaling is critical for development of many organ systems and acquired disease. The aims of this study were to determine the changes of PDGF-A, PDGF-C and PDGF receptor (PDGFR)-alpha expression in ischemia reperfusion acute renal failure model. METHODS: We examined the expression and localization of PDGF-A, PDGF-C and PDGF receptor-alpha protein using Western blot analysis and immunohistochemistry and PDGF-C mRNA using RNase protection assay after ischemia reperfusion renal failure model. RESULTS: PDGF-A expression showed no change after ischemia reperfusion injury. Proliferating cell nuclear antigen expression increased at day 2 after ischemia reperfusion injury. PDGF-C expression increased at day 2 after ischemia reperfusion injury, and was localized in tubular epithelial cells of outer medulla. PDGFR-alpha increased at day 2 after ischemia reperfusion injury, and was localized in tubular interstitium of outer medulla. CONCLUSION: These results indicated that PDGF-C and PDGF receptor-alpha may have an important role in the renal regeneration after ischemia reperfusion renal injury.

A case of multiple symmetric lipomatosis with acute renal failure due to pulmonary thromboembolism / 대한내과학회지

Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the presence of diffuse, non-tender, symmetric deposits of adipose tissue on the neck, back and upper part of the trunk. It has been reported that this disease could be associated with various metabolic abnormalities such as impaired glucose tolerance, hyperuricemia, alcohol consumption, type 4 hyperlipidemia, renal tubular acidosis and thyroid disorder. We present a case of type 2 MSL with pulmonary thromboembolism. He suffered sudden dyspnea and decreased urine output. The causes of dyspnea and acute renal failure (ARF) in this case were dehydration and hemodynamic disturbance due to pulmonary thromboembolism. After thrombolytic and fluid therapy, his condition was improved. He was discharged on warfarin medication and has remained asymptomatic for 12 months.

The Changes of Growth Hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor Binding Protein-3 Levels after Long-Term Dialysis Therapy / 대한신장학회잡지

The insulin-like growth factor-I(IGF-I) is a hormone that has growth stimulation and metabolic effects. Insulin-like growth factor binding proteins (IGFBPs) were known to be the most important factors that affect bioavailability of IGF. Thereby, the changes of IGFBPs may affect the bioavailability of IGF-I. Because growth hormone/IGF system may be affected by dialysis therapy, the changes of GH, IGF-1, IGFBPs levels after dialysis therapy can affect the bioavailability of IGF. To evaluate the changes of serum levels of IGF-I and IGFBP-3 after long-term dialysis therapy, we measured the serum IGF-I and IGFBP-3 levels in the patients on hemodialysis and on peritoneal dialysis. Eight patients undergoing peritoneal dialysis, 10 patients undergoing hemodialysis, and age-matched 10 normal control patients were studied. In patients on hemodialysis, the mean serum level of IGF-I before hemodialysis was 90.6+/-9.0 nanogram/mL, and after long-term hemodialysis was 130.9+/-31.0 nanogram/milliliter. The mean serum level of IGFBP-3 before hemodialysis was 14,549+/-7,815 microgram/liter, and after long-term hemodialysis was 5,726+/-883 microgram/liter. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term hemodialysis therapy. In patients on peritoneal dialysis, the mean serum level of IGF-I before peritoneal dialysis was 169.8+/-20.5 nanogram/milliliter, and after long-term peritoneal dialysis was 242.6+/-37.6 nanogram/mL. The mean serum level of IGFBP- 3 before peritoneal dialysis was 10,272+/-885 microgram/liter, and after ling-term peritoneal dialysis was 8,604+/-1,721 microgram/liter. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term peritoneal dialysis. We found that the level of IGF-1 before hemodialysis was lower then that of normal control group and the level of IGFBP-3 before hemodialysis or peritoneal dialysis was higher then that of normal control group. Our results suggested that the blood levels of growth hormone, IGF-I and IGFBP-3 may not be significantly affected by long-term dialysis therapy.

Relationship between Pruritus and Eosinophilia in Patients on Hemodialysis / 대한신장학회잡지

BACKGROUND: Pruritus is one of the most common complaints of patients with chronic renal failure undergoing hemodialysis. But its etiology is not clear, and there is no universally effective treatment. Recently we have experienced eosinophilia in hemodialysis patients suffering from pruritus. OBJECTIVE: The purpose of the this study was to evaluate the relationship between pruritus and eosinophilia in patients on hemodialysis. METHODS: We examined degree of pruritus and eosinophilia in 65 patients with end stage renal disease who were on hemodialysis from September 1996 to August 1997 in artificial kidney center of Chonbuk National University Hospital. The study was conducted by means of personal interview, physical examination, and review of medical records. The degree of pruritus was measured by scores from minimal 0 point to maximal 48 points and more than 5% or 500/mm3 eosinophils in peripheral blood was regarded as eosinophilia. RESULTS: 1)Incidence of each cutaneous symptoms were pruritus(61.5%), xerosis(35.4%), hyperpigmentation (30.8%), easy bruising(16.9%), nail change(12.3%), decreasing in sweating(10.8%), hypotrichosis(7.7%), and acne(4.6%). 2)Forty(61.5%) of 65 patients undergoing hemodialysis had pruritus, 32.3% in mild, 20% in moderate, and 9.2% in severe degree by pruritus score. 3)Nineteen(29.2%) of the 65 patients had eosinophilia:23.8%(5/21) of patients with mild pruritus, 30.7%(4/13) of patients with moderate pruritus, and 66.7%(4/6) of severe pruritus. It could be said that prevalence of eosinophilia was related to the severity of pruritus. 4)With repeated hemodialysis the severity of pruritus increased in 65%(26/40), decreased in 22.5% (9/40), did not change in 12.5%(5/40) of patients with pruritus. 5)Pruritus was not related to the serum calcium (Ca), inorganic phosphorus(PO4), CaxPO4 product, BUN, or creatinine. There was, however, significant correlations with the serum alkaline phohphatase. CONCLUSION: There was a positive correlation bet- ween the prevalence of eosinophilia and severity of pruritus in patients on hemodialysis.

A Case of Wernicke's Encephalopathy Caused by Hyperemesis Gravidarum Complicated with Thyroid Storm and Abnormal Liver Function / 대한내분비학회지

A 27-year-old woman developed Wemicke's encephalopathy in the 16th week of her first pregnaney. She had thyroid storm and abnormal liver function. Her thyrotoxic symptom and abncemal liver function was recovered after medication of antithyroid drug, steroid, hepatotonic drug and administration of thiamine(fursulthiamin), but the fetus was lost, Thereafter her thyroid function returned to normal and euthyroid state was maintained without medication of antithyroid drug, but her neurological defect was remained. We suggest that severe hyperemesis gravidarum is a possible risk factor of the thyroid storm and Wemicke's encephalopathy in patients with hyperthyroidism, and consider the check of the thyroid function. The need for parenteral thiamine supplementation and medication of antithyroid drug is warranted in patients with severe hyperemesis gravidarum which lasts longer than 3 weeks and abnormal thyroid function.

A Case Report of Neurilemmoma in the Bronchial Wall / 결핵

Neurilemmoma, also called schwanomma, neurinoma, and perineural fibroblastoma is a rare benign tumor originated from the schwann cell of nerve sheath. They occur commonly at 20-50 aged person and involved the head and neck and flexor surface of the extremity. Histologically, they are characterized by Antoni A and Antoni B tissue composed of high and low cellularity. Primary neurilemmoma involved in the bronchial wall is extremely rare and few cases have been reported previously. We experienced neurilemmoma of the bronchial wall in a 72 year old woman The pulmonary radiology showed the right middle lobe collapse with single lymphadenopathy, and bronchoscopic biopsy was performed to confirm the neurilemmoma.