No abstract available.
Arthroscopy* ; Knee* ; Magnetic Resonance Imaging*

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

Nitric oxide (NO) elevates intracellular calcium. But the actions of calcium in NO-induced cell death are not well understood. This study was carried out to investigate the signal transduction pathways of calcium and NO-induced cytotoxicity in H9c2 cardiac myoblasts by using NO donor compounds such as sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine (SNAP). Pretreatment of intracellular calcium chelating agent (BAPTA/AM) or L-type calcium channel blockers (nicardipine, nifedipine, diltiazem and veraparmil) or T-type calcium channel blocker (flunarizine) blocked SNP-induced cytotoxicity respectively only in a three hours. However, thapsigargin (TG), which inhibits endoplasmic reticulum dependent Ca(2+)-ATPase and thereby increases cytosolic Ca(2+), augmented SNP-induced cytotoxicity. The protective effect of BAPTA/AM was inhibited by treatment of protein synthesis inhibitor, cyclohexamide. In addition, pyrrolidine dithiocarbamate (PDTC), NF-kB inhibitor, attenuates the protective effect of BAPTA/AM against SNP-induced cytotoxicity. It is indicated that the protective effect of BAPTA/AM against NO-induced cytotoxicity might be due to the expression of protein related to activation of NFkB. From these results, it is concluded that SNP-induced cytotoxicity is mediated by calcium in a 3 hours via down regulation of protein expression rleated to activation of NFkB.
Calcium Channels, L-Type ; Calcium Channels, T-Type ; Calcium* ; Cell Death ; Cytosol ; Diltiazem ; Down-Regulation ; Endoplasmic Reticulum ; Humans ; Myoblasts, Cardiac* ; NF-kappa B ; Nifedipine ; Nitric Oxide ; Nitroprusside ; S-Nitroso-N-Acetylpenicillamine ; Signal Transduction* ; Thapsigargin ; Tissue Donors

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*

BACKGROUND AND OBJECTIVES:Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position. MATERIALS AND METHOD:In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed. RESULTS:The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation. CONCLUSION:These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.
Acceleration ; Axis, Cervical Vertebra ; Diagnosis ; Exercise Test ; Eye Movements ; Head ; Humans ; Otolithic Membrane ; Reflex* ; Reflex, Vestibulo-Ocular ; Semicircular Canals

We present a case of liposarcoma related with minimal change nephrotic syndrome. A 49-year-old woman was admitted due to generalized edema and a palpable mass at epigastric area. Her laboratory data were as follows : serum creatinine 0.6mg/dl, BUN 7mg/dl, serum total protein 3.6g/dl(albumin 0.6 g/dl) serum total cholesterol 299mg/dl, 24 hour-urine protein 5.1g. A CT scan of the abdomen revealed huge adult head sized mass(15X10X15cm) consisted with mixed pattern of well enhancing solid, cystic and fat portion which is located between the liver and the stomach. A kidney biopsy showed minimal change nephropathy. At explo-laparostomy the tumor was well differentiated liposarcoma. After operation and steroid therapy, her proteinuria and hypoalbuminemia were a little improved. And then radiation therapy(daily 180 cGy, 5 fx/wk, upto 5040cGy/28 fx/42 day) was done. Complete remission of liposarcoma was followed by regression of the nephrotic syndrome. After radiation therapy, her laboratory data were serum total protein 6.7g/dl (albumin 4.3g/dl), total cholesterol 170mg/dl, 24 hour-urine protein 0.3g. She has been maintained complete remission of the nephrotic syndrome by steroid maintenance dose.
Abdomen ; Adult ; Biopsy ; Cholesterol ; Creatinine ; Edema ; Female ; Head ; Humans ; Hypoalbuminemia ; Kidney ; Liposarcoma* ; Liver ; Middle Aged ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Proteinuria ; Stomach ; Tomography, X-Ray Computed

BACKGROUND: There are some studies concerning fasting insulin and insulin resistance in normal healthy Korean adults, but none exists especially for adolescence. Therefore, we investigateck insulin resistance and its related factors in adolescence. METHODS: We analyzed 582 10th grade high school students. Height, weight, abdominal circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, hemoglobin were measured. Fasting state and parent's and student's previous medical history were guestioned. We used Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) as an indicator of insulin resistance. RESULTS: By HOMA-IR 2.15, the subjects were divided into the insulin sensitive and the resistant groups. Two groups showed significant differences in body mass index, systolic diastolic blood pressure, fasting glucose, fasting insulin, total cholesterol and abdominal circumference (P <0.05). HOMA-IR was strongly related to the body mass index (r=0.53) and abdominal circumference (r=0.52), but weakly related to the total cholesterol (r= 0.20). According to logistic regression analysis of HOMA-IR, the odds ratio of the body mass index was 1.17 and that of abdominal circumference was 1.06 (P <0.05). CONCLUSION: HOMA-IR showed strong relationship with body mass index, abdominal circumference, but showed weak relationship with total cholesterol. There was no significant correlation with the parent's diabetic medical history. Therefore we conclude that in adolescence the body mass index or the abdominal circumference is far more important factor than the parent's diabetic history.
Adolescent* ; Adult ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Logistic Models ; Odds Ratio ; Seoul*

There are many complications following gastrectomy and one of the most frequent complications is anastomosis site leakage. Postoperative leakage is a serious complication in patients after they undergo gastric surgery. It can lead to the progressive deterioration in the patient's condition and quality of life and the mortality rate is nearly 60%. We encountered a case of a 75 year-old man who had the leakage of the jejunal end of the Roux limb after total gastrectomy. We performed treatment of the leakage endoscopic clipping and detachable snaring. Hemoclips were fixed at the margin of both sides of the lesion. A detachable snare was used to bind both hemoclips, so the interval was made narrow. After snare binding, five hemoclips were used for final closure of the small interval. After treatment, the leakage of the afferent loop end was completely stopped. He resumed an oral intake and was discharged without complications.
Extremities ; Gastrectomy ; Humans ; Quality of Life ; SNARE Proteins

The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract.
Spinal Cord Compression/complications/*diagnosis/pathology ; Pyramidal Tracts/*pathology ; *Magnetic Resonance Imaging ; Humans ; Hematoma/complications/*diagnosis/pathology ; Female ; Diffusion Magnetic Resonance Imaging/*methods ; Cerebral Hemorrhage/complications/*diagnosis/pathology ; Adult

Although infectious diseases are frequent in systemic lupus erythematosus, salmonella osteomyelitis is rarely reported. We here report an unusual case of salmonella osteomyelitis with osteonecrosis in a patient with systemic lupus erythematosus. A 29-year old woman with systemic lupus erythematosus was admitted to our hospital because of a painful swelling of right knee joint. She had been taking steroid and cyclophosphamide for 4 months because of diffuse membranous proliferative lupus nephritis. MRI showed both osteonecrosis of the right distal femur and osteomyelitis of the right proximal tibia. The abscess culture demonstrated almonella species (non typhoidal). The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone.
Abscess ; Adult ; Ceftriaxone ; Communicable Diseases ; Cyclophosphamide ; Drainage ; Female ; Femur ; Humans ; Knee Joint ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Magnetic Resonance Imaging ; Osteomyelitis* ; Osteonecrosis* ; Salmonella Infections ; Salmonella* ; Tibia