PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Age Distribution ; Arteriovenous Fistula* ; Constriction, Pathologic ; Female ; Fistula ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

PURPOSE: The hepatolithiasis and associated cholangitis result in liver atropy, biliary stricture, liver abscess and intrahepatic malignancy, and a hepatic resection should be performed in such cases. The technical difficulty and accompanied inflammation with a hepatic resection frequently cause postoperative complications. Therefore, the factors affecting the postoperative complications were evaluated. METHODS: Twenty one patients, with hepatolithiasis that had received a hepatectomy at the Department of Surgery, Eulji University Hospital between March 2001 and January 2003, were reviewed. RESULTS: The postoperative complications were intraabdominal abscess (7 cases), pleural effusion (3 cases), wound complication (3 cases), T-tube site leakage (1 case), cardiac arrest (1 case), acute pancreatitis (1 case), hepatitis A (1 case) and delayed gastric emptying (1 case). The overall complication rate was 57% (12/21 patients) and the most common complication was an intraabdominal abscess (7 cases). The factors that may affect these complications were analyzed. Preoperative percutaneous transhepatic biliary drainage (PTBD) increased the postoperative complications, which was statistically significant (p=0.027). Especially, preoperative PTBD and hepaticojejunostomy increased the rate of an intraabdominal abscess, which was statistically significant (p=0.026, p=0.008). CONCLUSION: With hepatolithiasis requiring hepatic resection there is a need to avoid unnecessary preoperative PTBD and bypass surgery for the reduction of postoperative complications, including an intraabdominal abscess. Conversely, it is considered important to remove every stone and avoid needless bypass surgery under an operation and for a hepatic resection to be performed after removing PTBD, where possible.
Abscess ; Cholangitis ; Constriction, Pathologic ; Drainage ; Gastric Emptying ; Heart Arrest ; Hepatectomy ; Hepatitis A ; Humans ; Inflammation ; Liver ; Liver Abscess ; Pancreatitis ; Pleural Effusion ; Postoperative Complications* ; Wounds and Injuries

BACKGROUNDS/AIMS: This study focuses on the pathogenesis of inflammatory reaction and cell necrosis in patients with chronic viral hepatitis and examines the possible effects of follicular dendritic cells, HLA-DR and CD8+ presenting lymphocytes by analyzing their expression and the histological activity index (HAI) in liver tissues. METHODS: Liver biopsy specimens were obtained from 59 patients with chronic hepatitis B and from 26 patients with chronic hepatitis C. The expressions of dendritic cells, HLA-DR and CD8+ presenting lymphocytes were determined by immunohistochemical stain. RESULTS: The incidence of lymphoid follicle and/or lymphoid aggregates in portal tracts of the liver was higher in chronic hepatitis C than it was in chronic hepatitis B (84.6% vs. 15.3%, p=0.000). Follicular dendritic cells were exclusively expressed within lymphoid follicles and/or lymphocyte aggregates in portal areas. HLA-DR restricted cells were mainly observed in portal and periportal areas as well as in the area of piecemeal necrosis. CD8+ lymphocytes were diffusely expressed in portal and periportal areas and within intralobular parenchymal sinusoids. The expression of dendritic cell and HLA-DR was more frequently observed in moderate chronic hepatitis than in mild chronic hepatitis. While that of CD8+ lymphocyte expression was more frequent in severe chronic hepatitis with a high HAI score. CONCLUSIONS: The follicular dendritic cells may trap viral antigens in intraportal lymphoid follicle and present them to HLA-DR and CD8+ presenting lymphocytes. It is suggested that the associated expression of dendritic cells, HLA-DR and CD8+ presenting lymphocytes in liver tissues may play one of the biological role in immune injury in chronic viral hepatitis.
Antigens, Viral ; Biopsy ; Dendritic Cells* ; Dendritic Cells, Follicular ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; HLA-DR Antigens* ; Humans ; Incidence ; Liver ; Lymphocytes* ; Necrosis

PURPOSE: Periods of L-T4 withdrawal and low iodine diet, which are required prior to the treatment and tracking tests that take place after a thyroidectomy, can be of a long duration and cause suffering for patients. The purpose of this study, conducted in South Korea, was to confirm if periods of L-T4 withdrawal and low iodine diet can be shortened by using TSH level prediction. By inquiring into the correlation between TSH level and serum Tg level, and measurement of the amount of iodine present in urine during the low iodine diet period, a thyroglobulin (Tg) cutoff level can be predicted. METHODS: total of 168 patients were included as research subjects. In each case, L-T4 was suspended 3-4 weeks prior to conducting radioactive iodine ablation and 131I scan, and then a low iodine diet was carried out for 2-4 weeks. Serum TSH, Tg and anti-Tg antibodies were measured on the second week of L-T4 withdrawal, and the spot urine Iodine/Creatinine ratio was measured on the second and fourth week after treatment. RESULTS: Three weeks after L-T4 withdrawal, TSH levels increased to over 30μIU/ml in 97.2% of the patients, and serum thyroglobulin levels also increased with TSH level to over 30μIU/ml. There was no measured difference in the amount of iodine in the subject's urine during the low iodine diet period. CONCLUSION: It was found that L-T4 withdrawal can be reduced to 3 weeks or less, and that the Tg cutoff level differs according to TSH level. Based on these results, we suggested that the low iodine diet period can be reduced to 1-2 weeks.
Antibodies ; Diet ; Humans ; Iodine* ; Korea ; Research Subjects ; Thyroglobulin* ; Thyroidectomy ; Thyrotropin*

PURPOSE: Extrathyroidal extension (ETE) is one of the risk factors to be considered when deciding on operation extent and radioiodine ablation in differentiated thyroid carcinoma. Ultrasonography (USG) is the most widely used imaging modality in preoperative evaluation of thyroid carcinoma; however, few studies regarding accuracy of USG in preoperative evaluation of ETE have been reported. In this study, we investigated the accuracy of preoperative USG in detection of ETE and evaluated other risk factors associated with permanent ETE. METHODS: We reviewed the medical records of 349 consecutive patients who underwent curative thyroidectomy for differentiated thyroid carcinoma. Preoperative USG findings according to percent of contact and disruption of thyroid capsule were evaluated and compared with the permanent pathology. Clinicopathologic characteristics were investigated for assessment of the risk factors associated with ETE. RESULTS: ETE was identified in permanent pathology of 68 (19.5%) patients. When we defined the ETE on preoperative USG as more than 25% contact with the adjacent capsule, the positive predictive value (PPV) and negative predictive value (NPV) were 43.03% and 90.73%, respectively. Size of the nodule and preoperative USG findings with the percent of contact with adjacent capsule and capsule disruption showed an association with ETE on permanent pathology. However, in multivariate analysis, only size of the nodule and capsule disruption on USG were identified as risk factors for prediction of ETE on permanent pathology. CONCLUSION: Capsule disruption on preoperative USG can provide useful predictive information about permanent ETE. Another risk factor associated with ETE was size of nodule in differentiated thyroid carcinoma.
Humans ; Medical Records ; Multivariate Analysis ; Pathology ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

PURPOSE: The clinical importance and characteristics of papillary thyroid microcarcinoma (PTC) are still under debate, and the criteria for appropriate treatment have yet to be established. In this study, we attempted to examine the appropriate extent of surgery and the desirability of prophylactic lymph node (LN) dissection through identification of factors influencing LN metastasis and capsular invasions. METHODS: We reviewed the medical records of 176 consecutive biopsy-proven PTC patients. The clinical and pathological prognostic factors including LN metastasis and capsular invasion were analyzed. Chi-square test and independent sample T-test were used for statistical analysis. RESULTS: The median age of patients was 47-years-of-age (range 23~80 years). Among 108 patients who underwent central LN dissection, 38 (35.8%) patients showed LN metastasis. Univariate analysis revealed that male patients showed significantly more LN metastasis than female patients and lymphovascular invasion significantly affected LN metastasis. Twenty-eight (14.8%) patients showed capsular invasion. Tumor size, especially tumors ≥5 mm in diameter, and tumor multiplicity were significantly associated with capsular Invasion. Lymphatic or venous invasion also affected the occurrence of capsular invasion. CONCLUSION: Patients who are male, have a tumor larger than 5 mm in diameter, or multiple tumors are more likely to develop LN metastasis or capsular invasions. These factors could help us to decide the extent of thyroidectomy and to select patients who need prophylactic LN dissection.
Female ; Humans ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Retrospective Studies* ; Thyroid Gland ; Thyroidectomy

While the disease course of stress-induced cardiomyopathy (SIC) is usually benign, it can be fatal. The prognostic factors to predict poorer outcome are not well established, however. We analyzed the Acute Physiology And Chronic Health Evaluation (APACHE) II score to assess its value for predicting poor prognosis in patients with SIC. Thirty-seven consecutive patients with SIC were followed prospectively during their hospitalization. Clinical factors, including APACHE II score, coronary angiogram, echocardiography and cardiac enzymes at presentation were analyzed. Of the 37 patients, 27 patients (73%) were women. The mean age was 66.1 +/- 15.6 yr, and the most common presentation was chest pain (38%). Initial echocardiographic left ventricular ejection fraction (EF) was 42.5% +/- 9.3%, and the wall motion score index (WMSI) was 1.9 +/- 0.3. Six patients (16%) expired during the follow-up period of hospitalization. Based on the analysis of characteristics and clinical factors, the only predictable variable in prognosis was APACHE II score. The patients with APACHE II score greater than 20 had tendency to expire than the others (P = 0.001). Based on present study, APACHE II score more than 20, rather than cardiac function, is associated with mortality in patients with SIC.
*APACHE ; Aged ; Aged, 80 and over ; Chest Pain/etiology ; Echocardiography ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; ROC Curve ; Takotsubo Cardiomyopathy/*diagnosis/mortality ; Ventricular Function, Left

BACKGROUND: This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. METHODS: A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (> or = 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. RESULTS: The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. CONCLUSION: Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.
Aortic Valve ; Echocardiography ; Echocardiography, Transesophageal ; Electrocardiography ; Heart Valves ; Humans ; Hypertension ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Prevalence ; Sensitivity and Specificity ; Spondylitis, Ankylosing

BACKGROUND: This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. METHODS: A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (> or = 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. RESULTS: The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. CONCLUSION: Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.
Aortic Valve ; Echocardiography ; Echocardiography, Transesophageal ; Electrocardiography ; Heart Valves ; Humans ; Hypertension ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Prevalence ; Sensitivity and Specificity ; Spondylitis, Ankylosing

BACKGROUND/OBJECTIVES: Recent studies showed vitamin D deficiency is linked to chronic diseases in addition to skeletal metabolism which could threaten the elderly. We analyzed health conditions and socio-demographic factors associated with vitamin D deficiency in community dwelling people aged 65 years and older. SUBJECTS/METHOD: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 to 2012 were obtained. A total of 2,687 subjects aged 65 years and older were participated. The cutoff value of the Vitamin D deficiency was considered as serum 25-hydroxyvitamin D [25(OH)D] ≤ 20 ng/mL (50 nmol/L). RESULTS: The overall prevalence rate of vitamin D deficiency in the elderly was 62.1%. The factors such as female, obesity, metabolic syndrome, current smoker, and skipping breakfast were positively associated with vitamin D deficiency, but high intensity of physical activity and more than 9 hours of sleep duration were negatively associated with vitamin D deficiency (all P < 0.05). CONCLUSIONS: It is important that health professions know that the factors proved in this study are connected to vitamin D deficiency thus provide information and intervention strategies of vitamin D deficiency to old aged people.
Aged* ; Aging ; Breakfast ; Chronic Disease ; Female ; Health Occupations ; Humans ; Independent Living* ; Korea* ; Metabolism ; Motor Activity ; Nutrition Surveys ; Obesity ; Prevalence ; Risk Factors ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*