Two Cases of Refractory Pseudomembranous Colitis that Healed Following Fecal Microbiota Transplantation / 대한내과학회지

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.

The Experience and Competence of Physicians Who Provide Emergency Health Care at Public Health Sub-Centers on Remote Islands in Korea / 農村醫學 地域保健

OBJECTIVES: To investigate the experience and competence of physicians providing emergency medical services at public health sub-centers on remote Korean islands. METHODS: This study enrolled 79 doctors who work at public health sub-centers on remote Korean islands. Data were collected in December 2009 via self-administered e-mail questionnaires. The response rate was 44.3%. RESULTS: Emergent situations occurred at most (58.68%) of the public health sub-centers that were surveyed in December 2009. An average of 1.92 cases required treatment by public health physicians. Only 20.25% of the physicians were specialists in emergency medicine, while the remainder were general practitioners (GPs) without clinical experience as emergency doctors. We also found that the physicians we surveyed had insufficient knowledge of emergency medical care. At some health centers only one doctor was available, and there was no medical team in holiday, although most of the physicians indicated that the ideal number of doctors per center was two or three. In cases of emergency, patients were often sent to the mainland by ship without receiving first-aid treatment. The public health sub-centers lacked the necessary medical equipment to save lives in emergencies and lacked escort systems for emergency patients. CONCLUSIONS: The Korean government should address the importance of providing emergency care in remote areas. Health administrators should provide suitable manpower, medical equipment, guidelines for emergency medicine, and education for public health physicians on remote islands.

Enhanced Atrial Natriuretic Peptide and Nitric Oxide System Following the Treatment with Caffeine in Rats / 대한신장학회잡지

PURPOSE: The present study was aimed to examine whether caffeine alters the local regulation of atrial natriuretic peptide(ANP) and nitric oxide(NO) systems in the kidney. METHODS: Male Sprague-Dawley rats were treated with caffeine, consisting of a single oral bolus(0.2%, 1 mL/kg) followed by supplementation in drinking water(0.2%) for 1 day. Rats treated the same without caffeine served as control. The tissue expression of ANP mRNA was determined by reverse transcription-polymerase chain reaction. Tissue levels of nitrite/nitrate were determined. The expression of aquaporin(AQP)-1 and AQP2 proteins was determined by Western blot analysis. RESULTS: Following the treatment with caffeine, the expression of ANP mRNA was increased in the kidney. The renal tissue nitrite/nitrate level was also increased by caffeine-treatment. On the other hand, the expression of AQP1 and AQP2 proteins was not significantly altered. CONCLUSION: The enhanced activities of local ANP and NO systems may in part be causally related with the caffeine-induced natriuresis and diuresis, while AQP channels are not involved.

Clinical characteristics and outcomes of fatigued patients in a university hospital based family practice, Korea

BACKGROUD: Fatigue is one of the most common problems encountered in family practice but its diagnosis and management are neither standardized nor simphfied. This basehne study was conducted to find out the clinical characteristics, dinical courses, and outcomes of fatigued patients. METHODS: This study included 163 fatigued patients who visited a department of a university hospital based family practice due to fatigue as their primary or secondary complaint. We dassified fatigue which persisted for more than 6 months as acute fatigue, less than 6 months as acute fatigue. Retrospective review of medical record was used to collect all rehted dinical characteristics and telephone interview was done to follow the course and outcomes of fatigue. RESULTS: Of the total 163 fatigued patients, 105 patients(64.4%) were men. Fifty two patients(31.9 %) visited the dinic for complete health check up due to fatigue. The rate of response to telephone interview was 62.6%. Fifty five patients(33.7%) were acute fatigue, 75 patients(46.0%) chronic fatigue, and 33 patients (20.2%) unknown duration of fatigue. Accordirg to the causes of fatigue, 11.7% of patients corresponded to organic cause, 60.7% psychiatric cause, 27.6% unknown cause. Specified organic causes of fatigue, chronic hepatitis was the most common disease followed by alcohol liver disease, arthritis, anemia, viral syndrome and hyperthyroidism As psychiatric causes af fatigue, stress was the most common cause followed by overwork, alcohol abuse, depression, and anxiety. Reassurance and observation(71.8%), drug tberapy(17.8%) were the mast common treatments. Those who felt their function decreased below 50% were 7.6% of total 102 patients. On the survival analysis, 58.2% of acute fatigue patients, 62.4% of chronic fatigue patients, 67.0% of unknown patients had fatigue for 2 years since the initial visit. CONCLUSIONS: As the cause af fatigue in a family practice, psychiatric causes were more frequent than organic causes. As psychiatric causes of fatigue, stress was the most common cause followed by overwork and alcohol abuse. Only one third of the fatigued patients had improved two years later.

Content analysis of the contributions about health care in the newspapers

BACKGROUND: It is important for the health care provider, particularly primary care physicians as gatekeepers of health care, to understand the social interests and needs toward health care. This study was done to find ways to deal with public opinion by analyzing the contributions of health care in the newspapers. METHODS: Two hundred twenty four contributions about health care were sorted out in the three national newspapers during one calendar year from January to December, 1996. These contributions were coded by themes and subjects according the content analysis and qualitative text interpretation. RESULTS: The contributions were classified into three categories, medical insurance, and hospital services, and health care policies. Forty four contributions of medical insurance category were coded into 5 themes and 18 subject. Fifty eight contributions of hospital services category were coded into 3 themes and 31 subjects. One hundred twenty two contributions of medical insurance category were coded into 8 themes and 32 subjects. The themes and subjects were listed and findings were described qualitatively. The characteristics of public opinions about health care were diversity, conflicting interests, plentifulness of complaints and discontent, and finally, infrequency of alternative proposals for problem solving. How to deal with public opinions were discussed. CONCLUSIONS: We can recognize the public attitude of health care and complaints of patients and consumers of health care by analyzing the contributions in the newspapers. These data can be used to develop ways of primary care physicians to deal with patients' needs.

Peritoneal Equilibration Tests on Continuous Ambulatory Peritoneal Dialysis patients / 대한내과학회지

OBJECTIVES: The peritoneal equilibration test(PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. This study focuses on the evaluation of characteristics of peri toneal solute transport rates and physical and serological factors affecting peritoneal transport rate performed in our continuous ambulatory peritoneal dialysis(CAPD) patients due to guide adequate peri toneal dialysis form. METHODS: We analyzed 95 PET results which had been tested on the 28th day of CAPD and physical and serological values, such as age, sex, diabetes mellitus, height, weight, body surface area, arterial blood pressure, blood urea nitrogen, creatinine, glucose, cholesterol, triglyceride, total protein, albumin, hematocrit, hemoglo bin, sodium, potassium, phosphate which had been ob tained on the day of PET. RESULTS: 1) According to transport rate, high transport rate group was 9 cases(9.5%), high average transport group 26 cases(27.4%), low average transport rate group 32 cases(33.6%), and low transport rate group 28 cases (29.5%) respectivly. 2) The average of 4hour D/PCr was 0.60, 4hour D/Do glucose was 0.46, and drain volume was 2480ml. Thus the average of peritoneal solute transport rate of total patients was low average transport rate. 3) Factors affecting peritoneal solute transport rate were age, body surface area, plasma albumin, serum creatinine and triglyceride level. CONCLUSION: These findings suggest that high dose peritoneal dialysis form should be used in our CAPD patients because most of them have low average peritoneal transport rate, and age, body surface area, plasma albumin, serum creatinine, and triglyceride level should be consid ered when select the adequate peritoneal dialysis form.

Nine Kinds of Tumor Markers in Patients on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회잡지

Tumor markers have been clinically used to monitor the progression of various tumors or to assess their response to therapy. We studied the effects of continuous ambulatory peritoneal dialysis(CAPD) on the serum levels of nine tumor markers; carcinoembryonic antigen(CEA), squamous cell carcinoma- related antigen(SCC), CYFRA 21-1, CA(carbohydrate antigen) 125, CA 19-9, -fetoprotein(AFP), prostate specific antigen(PSA), human chorionic gonadotropin (hCG) and CA 72-4.Serum tumor markers were measured in 68 persons without chronic renal failure (CRF) as controls, and 46 stable CAPD patients who did not present any evidences of neoplasia. The results were as followings: 1) Serum AFP, PSA, hCG and CA 72-4 levels were almost within normal limits in the peritoneal dialysis similar to normal control groups; positive values were 2.2%, 3.8%, 8.3% and 4.0%, respectively. 2) Serum tumor markers, which were raised in the peritoneal dialysis compared to normal controls, include; CEA (5.29+/-3.6 vs. 1.42+/-1.0, P<0.001); SCC (3.90+/-5.57 vs. 0.9+/-1.1, P<0.01); CYFRA 21-1 (5.45+/-3.2 vs. 1.80+/-1.5, P<0.001); CA 125 (31.22+/-40.8 vs. 17.91+/-11.7, P<0.001); CA 19-9 (24.25+/-18.3 vs. 14.41+/-12.1, P<0.01). Raised CEA, SCC, CYFRA 21-1, CA 19-9 and CA 125 levels were detected 50%, 75%, 88.6%, 21.6% and 20.0% of peritoneal dialysis patients. In conclusion, serum levels of CEA, SCC, CYFRA 21-1, CA 19-9, CA 125 cannot be used as prognostic indicators for patients with malignancy while undergoing peritoneal dialysis treatment, but the other tumor markers such as AFP, PSA, hCG and CA 72-4 can be used as reliable tumor markers for patients of peritoneal dialysis similar to normal healthy people.

Tumor Markers in Patients with Chronic Renal Failure / 대한내과학회지

OBJECTIVES: Tumor markers have been clinically used to diagnose and monitor the progression of various tumor or to assess their response to therapy. This study focuses on the evaluation of tumor markers in Chronic renal failure patients, compared with normal controls. METHODS: The following 9 kinds of serum tumor markers, such as carcinoembryonic antigen(CEA), squamaus cell carcinoma-related antigen(SCC), CYFRA 21-1, CA(carbohydrate antigen) 125, CA 19-9, alpha-fetoprotein(AFP), prostate specific antigen(PSA), human chorionic gonadotropin(hCG) and CA 72-4 were measured in 56 persons without chronic renal failure(CRF) as controls, in 132 patients with chronic renal failure(56 patients on conservative management, 41 patients on chronic hemodialysis, and 35 patients on CAPD) who did not present any evidences of neoplasia. RESULTS: 1) The mean level of CEA in CRF patients was significantly higher than that of controls(p<0.001), and that of CRF patients on hemodialysis was significantly higher than that of patients on conservative management(p<0.05). 2) The mean level of SCC in CRF patients was significantly higher than that of controls(p<0.001), and the mean levels of SCC did not differ significantly among three groups of CRF patients. 3) The mean level of CYFRA in CI4F patients was significantly higher than that of controls(p<0.001), and that of CRF patients on hemodialysis was significantly higher than those of patients on conservative management and on CAPD respectively (p<0.05). 4) The mean level of CA 125 in CRF patients was significantly higher than that of controls (p<0.001), and that of CRF patients on CAPD was significantly lower than that of controls(p<0.05). 5) Positive percent for CYFRA 21-1 in all CRF patients was 89.7%, and SCC 82.9%, CEA 60.3%, CA 125 48%, CA 19-9 22.4%, PSA 7.9%, CA 72-4 6.1%, hCG 4.7% and AFV 3.2% respectively. CONCLUSION: The present study shows that tumor markers such as CEA, SCC, CYFRA 21-1, CA 19-9 and CA 125 are elevated above reference values in a substantial number of patients according to the reference values commonly used in normal persons, making them unreliable for monitoring malignancies in uremic patients. While the other tumor markers such as AFP, PSA, hCG and CA 72-4 are reliable for the same purpose. These results must be taken into account when serum levels of tumor markers are measured in CRF patients