Cartilage tissue engineering for craniofacial reconstruction

Severe cartilage defects and congenital anomalies affect millions of people and involve considerable medical expenses. Tissue engineering offers many advantages over conventional treatments, as therapy can be tailored to specific defects using abundant bioengineered resources. This article introduces the basic concepts of cartilage tissue engineering and reviews recent progress in the field, with a focus on craniofacial reconstruction and facial aesthetics. The basic concepts of tissue engineering consist of cells, scaffolds, and stimuli. Generally, the cartilage tissue engineering process includes the following steps: harvesting autologous chondrogenic cells, cell expansion, redifferentiation, in vitro incubation with a scaffold, and transfer to patients. Despite the promising prospects of cartilage tissue engineering, problems and challenges still exist due to certain limitations. The limited proliferation of chondrocytes and their tendency to dedifferentiate necessitate further developments in stem cell technology and chondrocyte molecular biology. Progress should be made in designing fully biocompatible scaffolds with a minimal immune response to regenerate tissue effectively.

Role and mission of the Committee of Health, Korean Medical Association

Recently, some medical issues in Korea have become social issues, and even political issues. Therefore, the responsibility of doctors to embrace socio-medical issues has increased. In response to this need, the Korean Medical Association is building up its Committee of Health. The mission of the Committee of Health of the Korean Medical Association is to identify and/or develop appropriate responses to those medical issues that have harmful effects on health. The committee is comprised of five action committees: those for socio-medical issues, health information issues, food issues, cruel issues, and environmental issues. These individual committees will devise plans for how to respond to and treat such issues, and also engage in various activities with not only medical societies, but also with social, legal and public communication groups.

Anti-adhesive Agent (Guardix-SG®) Does Not Influence the Drainage Volume after Thyroid Cancer Surgery / 대한내분비외과학회지

PURPOSE: This study was conducted to investigate whether the use of HA-CMC solution in thyroid surgery influences drainage amount and hospital stay. METHODS: Between November 2012 and December 12, 147 patients with thyroid cancer who underwent total thyroidectomy with central compartment neck dissection were analyzed retrospectively. The patients were divided into four groups; those with or without HA-CMC solution application and high or low output drainage. RESULTS: There were no differences in hospital stay and mean total drainage between the with and without HA-CMC solution application groups (P=0.230, P=0.732). The mean hospital stay was 2.2±0.4 days for the low output of drainage group and 3.1±0.6 days for the high output drainage group (P<0.001). There was no significant difference in the use of HA-CMC solution (41.1% vs. 56.8%, P=0.070). CONCLUSION: The use of HA-CMC solution in thyroid cancer surgery might not increase drainage amount and make hospital stay longer.

The Efficacy of Discharge Instructions Provided by a Tablet Personal Computer for Aiding the Comprehension and Satisfaction of Patients with Ureteral Stones

PURPOSE: This study was conducted in order to evaluate the possibility of improving the comprehension and satisfaction of patients discharged after receiving discharge instructions using a tablet personal computer (tablet PC), compared with conventional discharge instructions. METHODS: A randomized, prospective, consecutive, exploratory study was conducted on patients with ureteral stones in an emergency department (ED). The patients' objective comprehension, satisfaction, and subjective comprehension regarding their discharge instructions were compared with regard to discharge instruction (traditional verbal method, N=53 versus tablet PC method, N=53). RESULTS: No statistically significant differences in age, gender, or level of education were observed between the two groups. The mean number of correct answers regarding ureteral stones on the questionnaire was 2.35+/-1.02 in the conventional group (CG) and 3.37+/-0.9 in the tablet PC group (TG) (p0.05). The subjective comprehension score was 7.42 in the CG and 7.8 in the TG (p>0.05). CONCLUSION: Objective comprehension of ureteral stones showed improvement in the group with discharge instructions provided by the tablet PC. However, satisfaction and subjective comprehension did not show improvement.

A Multi-Center Phase III Clinical Trial to Assess the Influence to Bleeding and Anticoagulant Effect of Nafamostat Mesilate (Futhan) in Hemodialysis Patients with High Bleeding-Risk / 대한신장학회잡지

BACKGROUND: Routine hemodialysis is performed with systemic anticoagulation, usually with heparin, to prevent thrombosis in the extracorporeal blood circuit. However, systemic anticoagulation can produce hemorrhagic complications in patients at high risk of bleeding. To minimize the risk of bleeding, a number of alternative regimens has been proposed, however, each of those methods has its own limitations and complication. METHODS: 58 hemodialysis patients at risk for bleeding due to previous surgery or hemorrhagic complication were treated with Futhan as regional anticoagulant and compared with that of low-dose heparin anticoagulation. There were 29 (50%) postoperative cases and 29 (50%) cases of hemorrhage from various sites. RESULTS: The exacerbation of bleeding by hemodialysis was noted in only 4% in heparin treated group and none in Futhan group. Clotting times at site A (intracorporeal circulation) were not prolonged with Futhan, whereas those of heparin were prolonged slightly, which is not statistically significant. Degrees of residual blood in the dialyzer and blood clottings in the venous drip-chamber were less in Futhan than in heparin group. Adverse reactions related to Futhan therapy were minor and the incidence of adverse reactions was comparable in both groups. CONCLUSION: Futhan is a safe and effective regional anticoagulant for hemodialysis especially for patients with high bleeding risk.

Intermittent Dialysis Dose in ARF / 대한신장학회잡지

No abstract available.

The Effect of alpha-MSH on Tumor Necrosis Factor-alpha and NFkappaB Activation in Cultured Human Proximal Tubular Cells during Simulated Ischemia / 대한신장학회잡지

BACKGROUND: Tumor necrosis factor a (TNF), potent proinflammatory cytokine, may be related with ischemia/reperfusion injury induced tubular cell inflammation and apoptosis. We examined TNF and its major nuclear transcriptional factor, NFkappaB activation in cultured human tubular cells in hypoxic condition and the effect of alpha-MSH, potent antiinflammatory agent, which have been reported to reduce renal I/R injury in rats. METHODS: Hypoxic culture condition was produced by oxidative pathway inhibitor (Antimycin 2 mM) and glycolytic pathway inhibitor (deoxy-D- glucose 2 mM and 10 mM) for 1 hour and re-oxygenation was performed by placing the cells in normal medium. The expression of TNF mRNA was studied by RT-PCR and NFkappaB DNA binding activity was analysed by Electomobility shift assays (EMSA) and cellular apoptosis was assessed by the terminal deoxynucleotidyl transferase-mediated dUTP biotin nick-end labelling (TUNEL) method and DNA laddering. These data were compared between the alpha-MSH and the vehicle-treated groups. RESULTS: Measured ATP level was 49% of control by luciferase-based assay kit. I/R injury caused an increase in TNF mRNA and NFkappaB activation and was accompanied by morphological evidence of apoptosis. alpha-MSH significantly reduced the degree of apoptosis, as well as TNF mRNA and NFkappaB activity (TNF/L19 mRNA ratio, vehicle/alpha-MSH: 105.15 +/- 16.5/18.75 +/- 0.85, p<0.05) (NFkappaB activity, vehicle/alpha-MSH: 5624/4803 densitometric index (DI), p<0.05). CONCLUSION: These findings suggest that alpha-MSH can decrease cellular apoptosis in hypoxic tubular cells and this protective effect of alpha-MSH may be related, in partially, with supression of TNF and NFkappaB activity.

Effects of Combination Therapy with Angiotensin Converting Enzyme Inhibitor and Angiotensin Receptor Blocker on the Injury of Renal Tubulointerstitium in an Unilateral Ureteral Obstruction Rat Model / 대한신장학회잡지

BACKGROUND: Unilateral ureteral obstruction(UUO) is an experimental model of tubulointerstitial injury, characterized by progression of interstitial fibrosis and tubular atrophy. In the pathogenic mechanism of renal injury, activation of renin-angiotensin system may play an important role. METHODS: We tested the hypothesis that tubulointerstitial injury begins with infiltration of macrophage, followed by enhanced expression of chemoattractants such as MCP-1 and osteopontin, which are affected by local angiotensin II activity. We examined the beneficial effects of ACEI and AT1RB and combination of these two drugs, with kidney after 5 days of ureter ligation. RESULTS: Monocyte/macrophage infiltration demonstrated by ED-1 staining was markedly increased in UUO group comparing to that of sham operared group, and it was reduced by administeration of ACEI, AT1RB and combination of both, but not statistically significant. MCP-1 mRNA expression increased significantly after 5 days of UUO. ACE inhibitor, enalapril treatment had suppressed significantly the MCP-1 mRNA expression level, but AT1RB, candesartan had not significance. Combination of both made no more reduction of MCP-1 mRNA level compared to ACEI alone. The other macrophage chemoattractant protein, osteopontin expression was examined by immunohistochemistry, and evaluated with image analysis. Marked up-regulated osteopontin expression was observed on the brushborder of proximal tubules after 5 days UUO. There was a great reduction of osteopontin expression in a enalapril treated group and more significant reduction was noted in the group, treated with combination of both. candesartan did not reduce osteopontin expression. CONCLUSION: This study suggest that activation of renin-angiotensin system has a major role in the pathogenesis of tubulointerstitial renal injury in UUO through expression of chemoattractants and infiltration of inflammatory cells. Blocking of this process may inhibit renal injury process and ACEI halts these process but AT1RB does not. Combination use of both drugs did not show more additive effect compare to ACEI use alone in the phase of early inflammatory process of renal injury.

TGF-beta and Fas Expression in Human Proximal Tubular Cell (HPTC) in the Presence of Proteinuria / 대한신장학회잡지

BACKGROUND: Glomerular diseases of diverse origins are characterized by heavy proteinuria and tubulointerstitial changes in pathology. Numerous studies have recently demonstrated that interstitial fibrosis and tubular atrophy are better predictors of renal disease progression compared with glomerular pathology. One of the important mechanisms of these tubulointerstitial injury is tubulointerstitial damage due to increased protein trafficking across the proximal tubular epithelial cells. We tested the hypothesis that tubular cells exposed to high concentration of protein express TGF-beta, which can be related to tubulointerstitial fibrosis, and Fas antigen, which can be associated with tubular cell apoptosis. METHODS: Cultured human proximal tubular cells were incubated with varying concentrations of BSA (1, 10 mg/mL) and nephrotic range proteinuria, due to diabetic nephropathy (1, 10 mg/mL), with or without inactivation of complement. After 24 hr-incubation period, the expressions of TGF-beta and Fas mRNA were examined by RT-PCR. RESULTS: The amount of expression of TGF-beta was increased in BSA 10 mg/mL group (0.78+/-0.12, p=0.016) and in diabetic proteinuria 10 mg/mL group (0.7+/-0.08, p=0.012) compared to control group which was incubated in medium alone (0.48+/-0.02), and the amount of expression of Fas was increased in BSA 10 mg/mL group (0.97+/-0.09, p=0.021) and showed increased tendency in diabetic proteinuria 10 mg/mL group (0.94+/-0.14, p=0.067) also. Furthermore, the anti TGF-beta antibody ameliorated the increased albumin-induced expression of Fas. CONCLUSION: Collectively, our results showed that protein overload increased the expression of TGF-beta & Fas, which can play an important role in tubulointerstitial atrophy by inducing apoptosis of renal tubular cells.

TGF-beta and Fas Expression in Human Proximal Tubular Cell (HPTC) in the Presence of Proteinuria / 대한신장학회잡지

BACKGROUND: Glomerular diseases of diverse origins are characterized by heavy proteinuria and tubulointerstitial changes in pathology. Numerous studies have recently demonstrated that interstitial fibrosis and tubular atrophy are better predictors of renal disease progression compared with glomerular pathology. One of the important mechanisms of these tubulointerstitial injury is tubulointerstitial damage due to increased protein trafficking across the proximal tubular epithelial cells. We tested the hypothesis that tubular cells exposed to high concentration of protein express TGF-beta, which can be related to tubulointerstitial fibrosis, and Fas antigen, which can be associated with tubular cell apoptosis. METHODS: Cultured human proximal tubular cells were incubated with varying concentrations of BSA (1, 10 mg/mL) and nephrotic range proteinuria, due to diabetic nephropathy (1, 10 mg/mL), with or without inactivation of complement. After 24 hr-incubation period, the expressions of TGF-beta and Fas mRNA were examined by RT-PCR. RESULTS: The amount of expression of TGF-beta was increased in BSA 10 mg/mL group (0.78+/-0.12, p=0.016) and in diabetic proteinuria 10 mg/mL group (0.7+/-0.08, p=0.012) compared to control group which was incubated in medium alone (0.48+/-0.02), and the amount of expression of Fas was increased in BSA 10 mg/mL group (0.97+/-0.09, p=0.021) and showed increased tendency in diabetic proteinuria 10 mg/mL group (0.94+/-0.14, p=0.067) also. Furthermore, the anti TGF-beta antibody ameliorated the increased albumin-induced expression of Fas. CONCLUSION: Collectively, our results showed that protein overload increased the expression of TGF-beta & Fas, which can play an important role in tubulointerstitial atrophy by inducing apoptosis of renal tubular cells.

Effect of Dialyzer Membrane on TNF-alpha and Blood Coagulation System / 대한신장학회잡지

BACKGROUND: Blood-dialyzer membrane interaction in hemodialysis has the potential to activate blood coagulation and fibrinolysis, and it might elicit production of inflammatory cytokine such as TNF-alpha by monocytes activation. The aim of the present study was to; i) assess changes in coagulation status, fibrinolytic activity and plasma level of TNF-alpha during hemodialysis; ii) determine whether the extent of activation is dependent on the dialyzer material used. METHODS: Twenty-five end-stage renal failure patients who had undergone maintenance hemodialysis were included in the study. Patients were randomly divided into two groups; one using hemophan dialyzer membrane (n=13) and the other using polysulfone dialyzer membrane (n=12). On sixth dialysis session, blood samples were obtained before and at the end of hemodialysis. Thrombin-antithrombin complex (TAT) and D-dimer, each reflecting in vivo thrombin generation and fibrin degradation product respectively, were measured for coagulatory and fibrinolytic activity. Tissue plasminogen activator (tPA), plasminogen activator inhibitor-1(PAI-1), and fibrinogen were measured. Activated partial thromboplastin time (aPTT) was measured for efficancy of anticoagulant. Plasma level of TNF-alpha was also measured. RESULTS: During hemodialysis, plasma level of TNF-alpha did not change. Between hemophan dialysis and polysulfone dialysis group, the change in plasma level of TNF-alpha (delta TNF-alpha ) was not different. Significant changes were observed in aPTT, fibrinogen, TAT, D-dimer, tPA during hemodialysis (p0.05). However, the change in TAT (delta TAT) was significantly lower in polysulfone dialysis group (p=0.049). CONCLUSION: Hemodialysis enhances coagulatory activity despite the use of anticoagulant and also enhances fibrinolytic activity, which is likely the result of tPA release. In activation of coagulatory system, biocompatibility of polysulfone membrane is superior to that of hemophan membrane. Plasma level of TNF-alpha did not change during hemodialysis, further study should be considered.

Experience of Catheter Implantation for Continuous Ambulatory Peritoneal Dialysis and Catheter Related Complications

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.

Polymorphisms of Angiotensin Converting Enzyme and Plasminogen Activator Inhibitor-1 Genes in Diabetic Nephropathy and Macroangiopathy in NIDDM Patients / 대한신장학회잡지

BACKGROUND: Although development of DM nephropathy in NIDDM patients is associated with poorly controlled blood sugar level and hypertension, relationship of genetic factor is also emphasized. Recent studies showed that an insertion or deletion (I/D) polymorphism in the ACE gene and a 4/5- guanine tract polymorphism in the promotor region of the PAI-1 gene are associated with the myocardial infarction. The aim of this study were to determine the relationships of these polymorphism and substance activities to DM nephropathy and macroangiopathy. METHODS: 72 NIDDM patients who suffered from DM more than 6 years and 62 non-diabetic healthy control were evaluated. After extraction of DNA from peripheral blood, ACE and PAI-1 gene polymorphisms were determined by polymerase chain reac tion, SSCP electrophoresis and silver stain. Serum PAI-1 level was dctected by Immulyse PAI-1 ELISA kit(Bipool Sweden). RESULTS: Total 134 samples were evaluated and ACE genotype were DD 27(20%), ID 88(66%), and II 19(14%). PAI-1 genotype were 4G4G 26(19%), 4G5G 73(55%), and 5G5G 35(26%). The distribution of ACE and PAI-1 polymorphism according to presence or absence of nephropathy were DD 10, ID 32, II 8, 4G4G 9, 4G5G 31, and 5G5G 10 in DM nephropathy group and DD 3, ID 17, II 2, 4G4G 5, 4G5G 12, and 5G5G 5 in non-nephropathy group. There were no significant differences in the distribution of ACE and PAI-1 gene between the two groups. The distribution of ACE and PAI-1 polymorphism according to macroangiopathy were DD 6, ID 16, II 3, 4G4G 5, 4G5G 15, and 5G5G 5 in macroangiopathy group and DD 7, ID 33, II 7, 4G4G 9, 4G5G 28, and 5G5G 10 in non-macroangiopathy group. There were no significant differences in the distribution of ACE and PAI- 1 gene between macroangiopathy and non-macroangiopathy groups. Serum PAI-1 level according to PAI-1 gene and ACE gene polymorphism were 4G4G 47.99+/-19.73, 4G5G 40.19+/-18.49, 5G5G 40.37+/-20.99 ng/mL, DD 37.99+/-16.64, ID 44.80+/-20.35, and II 31.92+/-12.98 and had a tendency that is higher in 4G4G genotype. CONCLUSION: From the above results, we cannot define the relationships of ACE and PAI-1 gene polymorphism and PAI-1 activities to DM nephropathy and macrovascular complications of NIDDM patients, but prospective studies including more patients population will be required.

A Case of Rathke's Cleft Cyst Inflammation Presenting with Diabetes Insipidus

Rathke's Cleft Cyst (RCC), which is located at the intrasellar region, is considered to be the distended remnants of Rathke's pouch, an invagination of the stomodeum. Lined with columnar or cuboidal epithelium of ectodermal origin, RCC usually contains mucoid material and it is found in 13-22% of normal pituitary glands. The cyst rarely leads to the development of symptoms but, when it does, the most common presenting symptoms are headache, visual impairment, hypopituitarism and hypothalamic dysfunction. However, in some cases it presents symptoms of diabetes insipidus, decreased libido and impotence. Recently we experienced a case of RCC inflammation presenting with diabetes insipidus and treated with transsphenoidal surgery. To our knowledge, this is the first report of RCC presenting with symptoms of diabetes insipidus in Korea.

Peripheral Blood Mononuclear Cell Culture Supernatant Increase Fas Expression in human Proximal Tubular Cell After the Initiation of Hemodialysis in Chronic Renal Failure Patients / 대한신장학회잡지

Residual renal function rapidly declines after the initiation of hemodialysis and its mechanisms are supposed to be associated with frequent hypotensive episodes during hemodialysis and subsequent ischemic injury to remnant nephron, but blood-membrane interaction might play an important role because of its ability to activate complement system and other various humoral and cellular mechanisms. Blood monocytes are activated by complements, bacterial contaminants and activated monocytes are known to secrete multiple proinflammatory cytokines such as TNF-alpha, IL-1 beta. The expression of TNF-alpha and IL-1 beta in mRNA and protein level were examined by RT-PCR and ELISA respectively in patients with ESRD after the initiation of hemodialysis. Author also investigated the mRNA expression of Fas in human proximal tubular cell culture in the presence of TNF-alpha and PBMC culture supernatant before and after the initiation of hemodialysis. Compared to PBMC separated before the initiation of HD, the amount of cytokine mRNA from PBMC separated after the initiation of HD showed increased tendency from 0.97+/-0.2 to 1.12+/-0.28 for TNF-alpha(p=0.29), from 1.03+/-0.18 to 1.10+/-027 for IL-1 beta (p=0.54). TNF-alpha and IL-l beta protein level in PBMC culture supernatant also showed increased tendency from 2.25+/-0.5 to 4.254+/-3.77 for TNF-alpha (p=0.10), from 3.5+/-2.08 to 4.0+/-4.3 for IL-1 beta(p=0,25). TNF-alpha increased Fas mRNA expression dose-dependently compared to control but it was not statistically significant(p=0,37, 0.22). Compared to the the level of Fas expression in HPTC cultured in the presence of pre HD PBMC supernatant, the level of Fas expression increased significantly in the presence of post HD PBMC supernatant (0.64+/- 057 vs 1.05+/- 0.12, p=0.01). As a conclusion, cytokine gene expression and secretion can increase as a result of blood-membrane interaction and these might have some influence on the loss of residual renal function in CRF patients maintained on hemodialysis.

Curriculum Changes of Korea University College of Medicine / 한국의학교육

During last three decades, there has been many changes and innovations in the structure and process of medical education. The curriculum of Korea University College of Medicine, however, had sustained traditional curriculum, that is, discipline and lecture-oriented and focused on biomedical knowledges during the same period. Stimulated by educational innovations in other medical schools in Korea as well as in other countries, curricular changes has been occurred since late 1990 and new curriculum started in the year 2000 in Korea University. 12 integrated lectures, 8 elective programs for special areas such as medical informatics etc. introduced into the new curriculum. But, the large portion of new curriculum still includes department-centered lectures and total lecture hours are not much decreased. To cope with the explosion in medical scientific knowledge, longitudinal and horizontal integration between basic and clinical medical science is needed. Also, lectures should be diminished in number to allow for active learning to prepare self-directed lifelong learning doctors. Most of all, we should continuously innovate curriculum and gradually put new programs into preexisting curriculum with faculty's consensus.

Effects of alpha-Melanocyte Stimulating Hormone on Apoptosis and Fas Expression in Ischemic Renal Injury in Rats / 대한신장학회잡지

Apoptosis frequently occurs in acute renal injury but molecular mechanisms responsible for this distinct form of cell death are largely unknown. Fas belongs to the TNF/nerve growth factor superfamily and engagement by Fas ligand induces apoptosis in various epithelial cells. To investigate the role of apoptosis and associated molecular mechanisms, we examined the occurrence of apoptosis and Fas expression as well as the therapeutic effect of alpha-MSH, a potent anti-inflammatory cytokine in ischemic ARF rat model as well as its effect on Fas expression. The expression of Fas was studied by western blot analysis and semiquantitative RT-PCR. Apoptosis was assessed by the TUNEL method and the degree of apoptosis and Fas expression, as well as biochemical, histological data were compared between the alpha-MSH and the vehicle treated groups in 40 minute renal artery clamping ischemic ARF rat models. Intraperitoneally administered alpha-MSH significantly reduced renal injury, measured by plasma blood urea nitrogen, creatinine level and the degree of tubular necrosis(106.5+/-13.3/54.7+/-5.45mg/dL for BUN, 1.77+/-0.29/1.03+/-0.06mg/dL for creatinine 24 hours after ischemia)(p=0.003, p=0.01), (5.4+/-1.94/2.6+/-0.7 for injury score 24 hours after ischemia)(p=0.01). Ischemia caused significant upregulation of Fas mRNA and protein and was accompanied by morphological evidence of apoptosis. alpha-MSH significantly reduced the degree of apoptosis, as well as Fas[(mean apoptotic cell : 23.7+/-12.5/11.0+/-5.7 per 200 field at 4 hours after ischemia(p=0.04), 31.6+/-24.7/18.1+/-11.5 per 200 field at 24 hours after ischemia(p=0.25)]. (Fas protein expression : sham : 1409+/-355DI(densitometric index)) 2818.3+/-1100/1306+/-643.4DI at 24 hours and 5541.5+/-1597.5/ 2866.7+/-788.9DI at 72 hours after ischemia)(p=0.07, 0.047). These results suggest that Fas upregulation induced tubular cell apoptosis may contribute to the pathogenesis of ischemic ARF and the beneficial effect of alpha-MSH is partially mediated by these inhibitory effects on Fas system.

Clinical Progression and Complications of Autosomal Dominant Polycystic Kedney Disease in Korea / 대한신장학회잡지

Autosomal dominant polycystic kidney disease (ADPKD) is one of most common hereditary disorders that is potentially fatal. To elucidate clinical and genetic characteristics of ADPKD in Korea, 166 patients were analyzed retrospectively. The results were as follows ; 1) The male-to-female ratio was 83: 83, and age of patients was 4813(meanSD) years. 6496 of patients have a family history of the ADPKD. 2) Most common symptom was flank and ab- dominal pain. In urinalysis, proteinuria(42%), hematuria(18%) were found. Other organ involvement included hepatic cysts(58%), pancreatic cysts(8%) and splenic cyst(296). 3) The age at diagnosis was 44% 12 years. Hypertension was observed in 65%, the age of detection was 45% 11 years. Azotemia was observed in 36%, the age of detection was 52 +/- 11 years. 4) Echocardiography showed left ventricular hypertrophy 5896(19/33), valve regurgitation 1596(5/33) and mitral valve prolapse 3%(1/33). Cerebrovascular events occurred in 14 patients(8.4%), and 6 patients confirmed cerebral aneurysm rupture. 5) 29 patients(17%) reached end stage renal fail- ure(ESRD), the age was 53 +/- 10 years. The provability of being alive and not having ESRD was 88% by age 50, 76% by age 58, and 48% by age 65. Sex and hepatic cyst were not associated significantly with the course of renal function(p>0.05). 6) 15 patients(9%) died, the age of death was 55 +/- 12 years. 6 patients died after reaching ESRD. The cause of death were was cancer(4), cerebrovascular event(3), cessation of dialysis(2), sudden death (2), liver cirrhosis(1), sepsis(1), suicide(1) and unknown(1). Results of our study revealed the complications of ADPKD in Korea, hypertension 6596, ESRD 17% and cerebrovascular event 8%. Functional survival was 88M by age 50, 76% by age 58, and 48M by age 65. The extrarenal manifestations are more important contributors to mortality than renal manifestations of ADPKD.

Perioperative Evaluation of the Renal Disease

No abstract available.

Perioperative Evaluation of the Renal Disease

No abstract available.