Cardiac and Pulmonary Management Status of Duchenne Muscular Dystrophy in South Korea Based on Data From the National Health Insurance Database

Background@#and Purpose The purpose of this study was to determine the cardiac and pulmonary management status of patients with Duchenne muscular dystrophy (DMD) in South Korea based on the Korean National Health Insurance database. @*Methods@#This study used data of patients with code G71.0 in the National Health Information database, and also those with the special case of code V012. Cardiac function was assessed based on whether echocardiography and 24-h electrocardiography were performed, as well as the frequency of these investigations. Furthermore, information on the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), and beta blockers (BB) in the drug benefit list was checked. Medical charge records were also checked regarding the prescription of respiratory functional assessments and treatments. @*Results@#The diagnostic criteria were met by 479 patients, with 41% of these patients receiving a cardiac evaluation, 29.8% being prescribed ACEi at 14.4±3.7 years of age, 59.5% undergoing pulmonary function tests, and 42.1% received pulmonary rehabilitation. The age at receiving ventilator support was 19.4±2.7 years. The frequency of cardiac and respiratory function tests increased with age, but the interval between tests was longer than the recent DMD care recommendations. The trend of taking ACEi, ARB, and BB for cardiac management in South Korea did not change during the study analysis period. @*Conclusions@#The findings of this study will contribute to recognizing the current status and the importance of applying an anticipatory approach to cardiopulmonary function in DMD patients.

Development of in vitro produced porcine embryos according to serum types as macromolecule

This study was conducted to establish an in vitro maturation (IVM) system by selection of efficient porcine serum during porcine in vitro production. To investigate the efficient porcine serum (PS), different types of PS [newborn pig serum, prepubertal gilt serum (PGS), estrus sow serum, and pregnancy sow serum] were used to supplement IVM media with or without gonadotrophin (GTH) and development rates of parthenogenetic activation (PA) and in vitro fertilization (IVF) embryos were then compared. The maturation rates of the PGS group was significantly higher when GTH was not added. Additionally, during development of PA embryos without GTH, the PGS group showed significantly higher cleavage and blastocyst formation rates. Moreover, the cleavage rates of IVF embryos were significantly higher in the PGS group, with no significant differences in the blastocyst formation. However, when GTH was supplemented into the IVM media, there were no significant differences among the four groups in the cleavage rates, development rates of the blastocyst, and cell number of the blastocyst after PA and IVF. In conclusion, PGS is an efficient macromolecule in porcine IVM, and GTH supplementation of the IVM media is beneficial when PS is used as macromolecule, regardless of its origin.

Effects of Lipoxygenase Inhibitor on Diabetic Nephropathy in Rats: Decreasing Proteinuria and Preserving Renal Function / 대한신장학회지

PURPOSE: Oxidative stress leads to an increased production of lipoxygenase derivatives in diabetic nephropathy. Thus, we hypothesized that lipoxygenase inhibitor, nordihydroguaiaretic acid (NDGA), ha the effects of decreasing proteinuria and preserving renal function in streptozotocin (STZ)-induced diabetic rats. METHODS: 45 Sprague-Dawley rats were divided into three groups; (A) treatment with lipoxygenase inhibitor, NDGA in diabetic nephropathy rats, (B) treatment with dimethyl sulfoxide (DMSO) as a vehicle in STZ-induced diabetic rats, (C) normal control group with subcutaneous injection of normal saline. Diabetes was induced by a single intraperitoneal injection of STZ (65 mg/kg) in rats of group A and B. After the 4th week of STZ injection, NDGA (10 mg/kg) and DMSO were given subcutaneously for another 4 weeks in group A and B respectively. RESULTS: The NDGA-treated diabetic rats exhibited significantly decreased urinary albumin excretion. Serum creatinine and blood urea nitrogen concentrations were increased in both group A and B, and tend to be higher in group B than group A. Twenty-four-hour urine creatinine clearances were increased in both group A and B after injection of STZ. Pathologic alterations of kidney were observed after injection of STZ, and then attenuated after administration of NDGA. CONCLUSION: These results suggest the potential of lipoxygenase inhibitor as a complementary therapy for the prevention and treatment of diabetic nephropathy.

Cryptococcal Meningitis in Patients with or without Human Immunodeficiency Virus: Experience in a Tertiary Hospital

PURPOSE: Cryptococcal meningitis is a relatively common opportunistic infection in human immunodeficiency virus (HIV) patients and it can frequently occur in immunocompetent hosts without any apparent underlying disease. Nevertheless, little is known about cyptococcal meningitis in the Korean population. The purpose of this study was to evaluate the clinical features and initial laboratory findings of cryptococcal meningitis in patients with and without HIV at a tertiary care teaching hospital. MATERIALS AND METHODS: We performed a retrospective study at a tertiary care teaching hospital from January 2001 to December 2009. Eleven HIV positive patients and nine HIV negative patients were included. RESULTS: The most common symptoms were headache and fever in cryptococcal meningitis, and diabetic mellitus, end stage renal disease and liver cirrhosis were the main associated conditions in patients without HIV. Patients with HIV showed lower peripheral CD4+ cell counts (median: 9, range: 1-107) and a higher burden of cryptococcus than patients without HIV. There were no statistically significant differences in serum CRP level and other cerebrospinal fluid parameters between patients with HIV and without HIV. The in-hospital mortality was 10%, and recurrence of cyptococcal meningitis was observed in 3 patients with HIV and this occurred within 5 months of the first episode. CONCLUSION: Cryptococcal meningitis is fatal without treatment, therefore, rapid recognition of symptoms such as fever and headache and diagnosis is required to decrease the mortality. Recurrence of meningitis after treatment should carefully be followed up, especially in advanced HIV patients.

A Case of Postrenal Acute Renal Failure due to Hemorrhagic Cystitis / 대한신장학회지

Hemorrhagic cystitis (HC), a serious form of cystitis, is characterized by diffuse bladder mucosal inflammation with hemorrhage. The known causes of HC are radiation, chemotherapy, drug, and infection. But, most cases happen without definite etiology. Radiation induced HC can be developed at any time from 6 months to 10 years after pelvic irradiation therapy, and can appear as late as 2 decades. The complications of HC are anemia, chronic cystitis, and acute renal failure (ARF). However, HC- induced severe postrenal ARF is rare. We experienced a case of a postrenal ARF caused by hematoma in HC. A 55-year-old woman had past history of pelvic irradiation therapy for carcinoma of the cervix 13 years ago. She was initially treated by bladder catheterization and bladder irrigation with normal saline. HC and renal function were improved. However, HC was recurred shortly after stopping irrigation and serum creatinine was elevated again. Thus, we treated this patient successfully with both percutaneous nephrostomy and antegrade double J stent catheterization.

Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

Can Cilostazol Improve the Patency Rate of Native Arteriovenous Fistula in Hemodialysis Patients? / 대한신장학회지

PURPOSE: Vascular access failure is the most common reason for hospitalization among hemodialysis (HD) patients. Cilostazol, which has antiplatelet action and vasodialtory effects, significantly reduces the risk of restenosis after percutaneous coronary intervention in many patients. We conducted this study to evaluate the relationship between the use of antiplatelet agents, especially cilostazol, and arteriovenous fistula (AVF) patency in HD patients. METHODS: A total of 241 patients underwent native AVF creation from January 2001 to December 2008. Among these patients, we selected 86 patients excluding 38 patients (15.8%) with primary technical failure, 49 patients without complete data and 68 patients used cilostazol less than 1 month. Demographic characteristics, medication history and fistula failure rate were collected and analyzed to elucidate the effect of cilostazol to native AVF. RESULTS: From all groups, AVF failure occurred in 24 patients (27.9%). 28 patients received cilostazol (62.3 %) and mean duration of cilostazol therapy was 229.5+/-115.7 days. All patients were classified into two groups according to cilostazol (Cilostazol [n=28, 32.6%] vs. non-Cilostazol [n=58, 67.4%]. There was no statisticallly significant difference in failure rate between the two groups (32.1% vs. 25.9%, p=0.543). In diabetes group, patients who received statin have much lower AVF failure rate (0% vs. 32.4%, p=0.024). Logistic regression analysis showed that female was independent risk factor for access failure (HR 5.549, CI 1.104-27.877, p=0.037). CONCLUSION: Cilostazol and other antiplatelet agent had a no significant association with AVF patency. Female was an independent risk factor for access failure.

A Case of Metastatic Gastric Calcification in Acute Renal Failure / 대한신장학회지

In end stage renal disease, the precise mechanism of metastatic calcification remains unclear, except that it occurs with hyperphosphatemia, increased Ca x P product, and secondary hyperparathyroidism. It involves various organs such as lung, eye, stomach, kidney, and so on. A 62-year-old male patient, who had acute renal failure (ARF), developed gastric calcification in our institution. The ARF had been result of membranoproliferative glomerulonephritis (MPGN), and the metastatic calcification seemed to be caused by increased Ca x P product and hyperphosphatemia. This case shows that metastatic calcification could arise even in ARF.