Bacterial peritonitis remains one of the major problem in patients undegoing CAPD, resulting in massive mesothelial cell (MC) death, remesothelialization failure, fibrosis and sclerosis. Since the preservation of the functional integrity of peritoneal membrane as a dialyzing organ is essential, complete resolution and adequate remesothelialization are necessary. This study was performed to investigate the effects of peritonitis on the number, secretory and regulatory function of MC. Subjects were nine episodes of peritonitis in 7 CAPD patients (M:F 5:2, mean age 48 years, mean CAPD duration 46 months). Dialysate CA125 and phospholipid were measured as markers of MC mass, and we also check the level of IL-6 and TNF-alpha, specific cytokines which can be detected in dialysate effluent. The concentrations of above mentioned substances were measured from the first cloudy bag, and thereafter overnight effluent were collected daily during the course of peritonitis and 4 weeks after discontinuation of antibiotics. Dialysate CA125 reached a peak in 2nd day of peritonitis and showed a second peak in 7th day. Other substances also showed a sharp increase on 1st day of peritonitis, returned to the baseline value rapidly. No differences in changes in the dialysate CA125, phospholipid and cytokine levels were noted according to the causative organism. There was no significant correlation between the values of MC marker and cytokines. In one patients who experienced 3 consecutive peritonitis with one-month interval, there was no second peak in dialyste CA125 level, and phospholipid remained the lowest level. He finally died due to sclerosing peritonitis and sepsis. In conclusion, MC markers and cytokines in peritoneal effluent can be used to follow the effects of inflammation in the peritoneal cavity. CA125 can be regarded both as a marker of MC damage and regeneration. Therefore, regular follow-up of CA125 during peritonitis can be an indicator to adequate treatment and remesothelialization.
Anti-Bacterial Agents ; Cytokines ; Dialysis* ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Interleukin-6* ; Membranes ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Regeneration ; Sclerosis ; Sepsis ; Tumor Necrosis Factor-alpha*

Peritoneal permeability of CAPD patients generally affects the ultrafiltration volume, dialytic protein loss, plasma protein level and eventual prognosis of individual patients. However, the precise mechanisms to govern the peritoneal transport rate are poorly understood. Intraperitoneal prostaglandin(PG), synthesized by peritoneal mesothelial cell(MC), appears to play a significant role in control of peritoneal permeability. We investigated MC synthesis of PGEz and active metabolite of prostacyclin, 6-keto-PGF< by radio-immunoassay following exposure to different concentrations of D-glucose(30, 60 & 90mM/L), commercial unused dialysate(1.5% glucose Dianeal(R), Baxter) & overnight dwell dialysate for 1 to 48 hours in the absence or presence of IL-1 8 (1ng/ml) & TNF-a (1ng/rnl). We also assessed the effect of cyclooxy-genase inhibitor(1 pg/ml of indomethacin) on PG synthesis of MC. Cultured human peritoneal MC was seeded at a density of 5xl(P/well in 12-well plate. After growth arrest for 48 hours following confluency, MCs were exposed to control media(serum restricted Hams F12) or various experimental conditions. At specific time points, MC supernatants were removed, centrifuged at 12,000Xg and then stored at -70C until PG assay. Exposure of MC to serum-free Hams F12 media (5mM/L of glucose) resulted in a constitutive synthesis of PGEz and 6-keto-PGF> . Concentrations of PGEz and 6-keto- PGFr in supernatant of MC culture were not changed with time after exposure to high glucose(30, 60, 90mM/L of D-glucose) compared to control media. Exposure of MC with unused commercial peritoneal dialysate or drained dialysate for 2 hours stimulated significant releases of PGEz & 6-keto-PGF>. Stimulation with IL-l and TNF-a induced a significant increase in PGEz from 2 hours after exposure and showed a time-dependent increase up to 48 hours. Combined stimulation of drained dialysate with IL-1P and TNF-a to mimic the intraperitoneal condition of peritonitis was associated with a greater increase in PGEp and 6-keto-PGF, compared to each stimulation alone. Treatment of MC with indomethacin(1 pg/ml) inhibited cytokine-stimulated PGEz increase. In conclusion, stimulation of MC with commercial peritoneal dialysate or cytokine induced PG synthesis, indicating the possible mechanism of intraperitoneal PG to participate in an increased peritoneal perme-ability by peritoneal dialysis process itself and es- pecially during the peritonitis.
Epoprostenol ; Glucose ; Humans* ; Interleukin-1 ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Permeability ; Plasma ; Prognosis ; Prostaglandin-Endoperoxide Synthases* ; Ultrafiltration

No abstract available.
Echocardiography, Doppler, Pulsed* ; Humans

Oncogenous or tumor-induced rickets is recognized as Vitamin D-resistant hypophosphatemic rickets that heals after excision of a coexisting tumor in either bone or soft tissue. Its pathogenesis is not clarified, but it has been suggested that the tumor elaborates a homoral substance inhibiting tubular reabsorption of phosphate or that the tumor inhibits the synthetic process of 1, 25-dihydroxcholecalciferol. We present two cases of vitamin D-resistant rickets, one associated with intrasseous well-differentiated osteosarcoma in the pelvis and the other associated with fibrosarcoma of distal femur. The case with low grade osteosarcoma showed immediate improvement of rickets after excision of the tumor, but the case with fibrosarcoma showed no improvement after amputation and was fatally terminated 5 months later due to lung metastasis.
Amputation ; Femur ; Fibrosarcoma ; Lung ; Neoplasm Metastasis ; Osteosarcoma ; Pelvis ; Rickets ; Rickets, Hypophosphatemic ; Vitamins

Pyriform sinus fistula (PSF) is a persistent embryologic third or fourth pharyngeal pouch, which typically presents as a congenital sinus tract that originates from the pyriform sinus. PSF is among the most uncommon congenital malformation of the neck. The usual clinical manifestations are either acute thyroiditis or abscess, usually on the left side of the neck. We report a case of PSF in a 9-year old female with a left cervical abscess who had been diagnosed by barium esophagogram and treated endoscopically by injection of histoacryl.
Abscess ; Barium ; Child ; Enbucrilate* ; Female ; Fistula* ; Humans ; Neck ; Pyriform Sinus* ; Thyroid Gland ; Thyroiditis

PURPOSE: It is well known that linear growth in diabetic children is closely related to metabolic control and age of onset. Some studies showed growth retardation in diabetic children regardless of the degree of metabolic control, whereas others reported no growth impairment. Until now, no study has been done comparing linear growth between type 1 and type 2 diabetic children. Therefore, we compared the growth and weight status between type 1 and type 2 diabetic children. METHODS: 145 children with type 1 DM and 27 patients with type 2 DM were studied. Their growth status in height standard deviation score(HTSDS), obesity according to standard weight for height and body mass index(BMI), and HbA1c level at onset, 6 months, 1 year, 3 years and 5 years after treatment were compared. RESULTS: There was no distinct correlation in HTSDS in type 1 and type 2 DM, but in type 2 DM obesity according to standard weight for height and BMI was higher than in type 1 DM. deltaHTSDS 5 years after treatment of diabetic children with poor glycemic control were significantly decreased(P<0.05), but there was no significant correlation between HbA1c and obesity according to standard weight for height and BMI. CONCLUSION: There is no significant correlation between the type of diabetes and growth status, but the poor glycemic controled group showed a significant decrease in deltaHTSDS. These data suggest that the growth of diabetic children could be impaired in the case of poor glycemic control and long duration of diabetes.
Age of Onset ; Child* ; Diabetes Mellitus* ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Humans ; Obesity

The congenital ball-and-socket ankle joint is a rare condition and is associated with congenital shortening of the lower extrimity and various skeletal abnormalities of the foot. This disease entity was reported in the German literature by Politzer in 1931 and in the English literature by Lamb in 1958. Several series have been reported since, suggesting that the condition may not be as rare as generally thought. This case is, to our knowledge, the first reported in this country.
Ankle Joint ; Ankle ; Foot

OBJECTIVE: To evaluate whether the basal serum luteinizing hormone (LH) levels in the presence of normal serum follicle stimulating hormone (FSH) are useful as a prognostic indicator of ovarian response to controlled ovarian hyperstimulation (COH). METHODS: From January 1997 to January 1999, 91 infertile women with tubal factor who had undergone in vitro fertilization and embryo transfer (IVF-ET) were enrolled in the present study. COH was performed using long protocol of gonadotropin-releasing hormone (GnRH) agonist. All patients included in this study had blood samples drawn on cycle day 2 or 3 prior to COH for measurement of basal FSH and LH. Women who had other infertility factors or high basal FSH levels (> or = 8.5 mIU/ml) were excluded from this study. The results of COH and IVF-ET were compared between two groups according to the level of basal LH (low LH group [< 3mIU/ml] vs. control group [> or = 3mIU/ml]). RESULTS: Patient's characteristics were comparable in both groups except basal LH level. The number of ampules and duration of exogenous gonadotropins required were significantly higher in the low LH group than those in the control group (p<0.001; p<0.005, respectively). The number of follicles > or = 14mm diameter on the day of human chorionic gonadotropin (hCG) injection was significantly less in the low LH group than that in the control group (p<0.001). The serum estradiol level on the day of hCG injection was also significantly lower in the low LH group, with 1115.5 +/- 380.9 pg/ml compared with 1340.6 +/- 403.0 pg/ml in the control group (p<0.005). There were significantly lower numbers in oocytes retrieved, oocytes fertilized and embryos frozen in the low LH group than those in the control group (< 0.001; < 0.001; <0.005, respectively). However, there was no difference in the fertilization rate between the two groups. The clinical pregnancy rate per cycle seemed to be lower in the low LH group, but the difference did not achieve significance (26.2% vs 39.7%). There were no differences in the miscarriage rate and multiple pregnancy rate between the two groups. CONCLUSION: This study demonstrates that the low basal LH levels ( < 3 mIU/ml) could be predictive of low ovarian response to COH and poor IVF results.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Lutein* ; Luteinizing Hormone* ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple

Although an elevation of serum uric acid level is often associated with kidney disease, cardiovascular disease and metabolic syndrome, it remains controversial whether hyperuricemia per se is a true risk factor for the development or aggravation of these diseases. Recent studies have demonstrated the independent role of uric acid in progression of renal disease and the development of new-onset hypertension and diabetes. Furthermore, lowering uric acid in these patients is found to stabilize renal function and decrease cardiovascular morbidity, suggesting the causative role of uric acid in renal, cardiovascular and metabolic disease, rather than an incidental association. In this manuscript, recent understanding about the role of uric acid in the development and/or aggravation of renal, cardiovascular and metabolic diseases will be reviewed based on the results from epidemiologic, clinical and experimental studies.
Cardiovascular Diseases ; Humans ; Hypertension ; Hyperuricemia ; Kidney Diseases ; Metabolic Diseases ; Risk Factors ; Uric Acid

OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis