1.Recycling of Cervical Artificial Disc for the Symptomatic Adjacent Segment Disorder Combined with Instability on Total Disc Replacement Area: A Case Report.
Eun Hyun IHM ; Ho Yeol ZHANG ; Jeong Yoon PARK ; Kook Hee YANG
Korean Journal of Spine 2010;7(3):206-211
The authors describe the revision case of a 58-year-old man who presented with pain in the neck and both shoulders after C4-5 cervical total disc replacement (C-TDR) and C5-6 anterior cervical discectomy and fusion (ACDF), and in whom there was evidence of instability with sagittal translation at the C4-5 TDR level and of a herniated cervical disc (HCD) at the left side of C3-4. The revision surgery was performed as follows: previous plate removal at the C5-6 level, artificial disc removal and ACDF at the C4-5 level with cage and previous plate insertion, and TDR at the C3-4 level using the previously implanted C4/5 artificial disc. If instability develops at the level of an artificial disc, we perform additional posterior fusion or anterior removal of the artificial disc and fusion. However, if we encounter combined adjacent segment disc disease, we may reuse the unstable segment artificial disc at the adjacent segment and perform salvage anterior fusion on the unstable segment. This is the first report issued on the management of instability after previous C-TDR involving a switch to ACDF and the use of new TDR at the adjacent level. Furthermore, we conceptually recommend a solution to an emerging problem of adjacent segment disease due to the heterotopic ossification(HO) after C-TDR.
Diskectomy
;
Humans
;
Middle Aged
;
Neck
;
Ossification, Heterotopic
;
Recycling
;
Shoulder
;
Total Disc Replacement
2.Effects of Lipoxygenase Inhibitor on Diabetic Nephropathy in Rats: Decreasing Proteinuria and Preserving Renal Function.
Hyun Chul CHUNG ; Il Young KIM ; Seo Rin KIM ; Jungmin SON ; Dong Won LEE ; Sang Heon SONG ; Eun Young SEONG ; Ihm Soo KWAK ; Soo Bong LEE
Korean Journal of Nephrology 2011;30(5):452-458
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.
Animals
;
Blood Urea Nitrogen
;
Creatinine
;
Diabetic Nephropathies
;
Dimethyl Sulfoxide
;
Injections, Intraperitoneal
;
Injections, Subcutaneous
;
Kidney
;
Lipoxygenase
;
Nordihydroguaiaretic Acid
;
Oxidative Stress
;
Proteinuria
;
Rats
;
Rats, Sprague-Dawley
;
Safrole
;
Streptozocin
3.The correlation of microalbuminuria and glomerular filtration rate in normotensive patients with type 2 diabetes mellitus.
Seoung Jae AN ; Yoo Suck JUNG ; Sung Jin KIM ; Eun Hoe KWON ; Hyun Chul JUNG ; Soo Bong LEE ; Ihm Soo KWAK ; Ha Yeon RHA
Korean Journal of Medicine 2002;62(4):436-443
BACKGROUND: Diabetic nephropathy is one of the major causes of end-stage renal disease. Microalbuminuria predicts not only progressive renal disease, but also increased cardiovascular morbidity and mortality. But, the relationship between urinary albumin excretion rate (UAER) and glomerular filtration rate (GFR) remains an unresolved issue. In order to investigate the early renal function abnormalities, UAER and GFR were assessed and their relationship was examined in normotensive patients with type 2 diabetes mellitus (DM). METHODS: Between January 1997 and June 2001, in a cross sectional study of 112 normotensive patients with type 2 DM not showing overt proteinuria and thirty healthy subjects served as control group. According to UAER, type 2 DM patients were divided into normoalbuminuria group and microalbuminuria group. The GFR was measured using 99mTc-DTPA renal scan. Clinical values in type 2 DM patients and control subjects were compared using one-way analysis of variance (ANOVA) with Scheffe's F test. In type 2 DM patients, Univariate Chi-square analysis was used to evaluate the prevalence of diabetic retinopathy and the differences in anti-diabetic treatment. Pearson correlation coefficients were used to demonstrate a strength of an association between UAER and other variables including GFR. RESULTS: Three groups were well matched with regard to gender, age and body mass index. There were no significant differences in disease duration and anti-diabetic treatment in type 2 DM patients. The GFR in microalbuminuric patients was significantly higher than in normoalbuminuric patients (124.0 17.6 vs 102.9+/-15.5 mL/min/1.73 m2, p<0.05). The prevalence of diabetic retinopathy in microalbuminuric patients was significantly higher than in normoalbuminuric patients (53.8% vs 24.7%, p<0.05). Only there was significant positive correlation between log UAER and GFR (r=0.303, p<0.05). CONCLUSION: As in type 1 DM patients, there was a significant relationship between UAER and GFR in normotensive type 2 DM patients without overt proteinuria.
Body Mass Index
;
Diabetes Mellitus, Type 2*
;
Diabetic Nephropathies
;
Diabetic Retinopathy
;
Glomerular Filtration Rate*
;
Humans
;
Kidney Failure, Chronic
;
Mortality
;
Prevalence
;
Proteinuria
4.Hemodynamic Benefits of Atrio-Biventricular Pacing in Open Chest Dogs.
Sang Hyun IHM ; Tai Ho RHO ; Eun Ju CHO ; Seung Won JIN ; Hee Yeol KIM ; Chong Jin KIM ; Ki Bae SEUNG ; Jang Seong CHAE ; Jae Hyung KIM ; Sun Jo HONG ; Kyu Bo CHOI
Korean Circulation Journal 2001;31(4):420-426
BACKGROUND AND OBJECTIVES: The ventricular pacing electrodes are customarily placed into the right ventricular muscle because there is easily accessible. However detailed physiologic studies have shown that the single stimulation of right ventricular sites causes dysynchronous ventricular contraction due to early depolarization of the right ventricle and delayed depolarization of the left ventricle. In contrast, normal human ventricular activation, which is conducted by the Purkinje system, spreads transmurally from the endocardium to multiple paraseptal epicardial regions and results in more synchronous contraction of the ventricle. Therefore, the hypothesis that producing biventricular activation by simultaneously pacing ventricles across the septum might confer hemodynamic benefits over those of conventional right ventricular pacing. The purpose of this study was to evaluate the acute hemodynamic changes of different pacing modes (right ventricular : RV, biventricular : BV, atrio-right ventricular : A-RV, and atrio-biventricular : A-BV pacing). MATERIALS AND METHOD: In 9 open chest dogs anesthetized with alpha-chloralose, sinus node crushing was done, and then hemodynamic data (QRS width, femoral arterial pressure : FAP, pulmonary arterial pressure : PAP, and Cardiac output : CO) were acquired after 5 minutes of pacing at a fixed rate during each pacing mode. RESULTS: Results were as follow : 1. BV pacing significantly increased cardiac output compared with RV pacing (P<0.01). BV pacing significantly shortened QRS width compared with RV pacing (P<0.01). 2. A-BV pacing significantly increased cardiac output compared with A-RV pacing (P<0.01). A-BV pacing significantly shortened QRS width compared with A-RV pacing (P<0.01). 3. A-RV pacing significantly increased systolic pulmonary arterial pressure and cardiac output compared with BV pacing (P<0.01). CONCULSION: These results support the use of atrio-biventricular pacing to improve acute hemodynamic performance.
Animals
;
Arterial Pressure
;
Cardiac Output
;
Cardiac Resynchronization Therapy*
;
Chloralose
;
Dogs*
;
Electrodes
;
Endocardium
;
Heart Ventricles
;
Hemodynamics*
;
Humans
;
Sinoatrial Node
;
Thorax*
5.A case of myocardial infarction in the minimal change nephrotic syndrome.
Sang Heun SONG ; Woo Chul LEE ; Sung Min PARK ; Eun Young SEOUG ; Jun Hyup ANN ; Dong Won LEE ; Soo Bong LEE ; Hyun Chul JUNG ; Ihm Su KWAK ; Ha Youn RHA
Korean Journal of Medicine 1998;55(5):946-950
The authors report the case of a 25 year old woman with a chronic corticosteroid-refractory nephrotic syndrome complicated by myocardial infarction. The thromboembolism, especially acute myocardial infarction, is the most serious complication of nephrotic syndrome. Until now many mechanisms have been studied about thromboem bolism including coronary artery disease in nephrotic syndrome, but not clear. Hypercoagulability and prolonged hyperlipidemia are known as the principal contributing factors in this complication. In addition, use of steroid as therapeutic trial and hypovolemic state induced by vigorous diuretics will affect the thromboembolism, too. In this case, several coagulation abnormality and prolonged hyperlipidemia are observed. On admission day, this patient had deep vein thrombosis and then was complicated by pulmonary thromboembolism. Despite of anticoagulant and thrombolytic therapy, she experienced acute myocardial infarction on fourth day after admission. After onset of myocardial infarction, by thrombolytics and prolonged anticoagulant therapy, this nephrotic patient was relieved and discharged without other serious complication. We recommend anticoagulant and antiplatelet agent therpy in risky patient of nephrotic syndrome. We present this case with review of literature.
Adult
;
Coronary Artery Disease
;
Diuretics
;
Female
;
Humans
;
Hyperlipidemias
;
Hypovolemia
;
Myocardial Infarction*
;
Nephrosis, Lipoid*
;
Nephrotic Syndrome
;
Pulmonary Embolism
;
Thromboembolism
;
Thrombolytic Therapy
;
Thrombophilia
;
Venous Thrombosis
6.Characteristics and Management of Residual or Slowly Recurred Intracranial Aneurysms.
Eun Hyun IHM ; Chang Ki HONG ; Yu Shik SHIM ; Jin Young JUNG ; Jin Yang JOO ; Seoung Woo PARK
Journal of Korean Neurosurgical Society 2010;48(4):330-334
OBJECTIVE: Residual aneurysm from incomplete clipping or slowly recurrent aneurysm is associated with high risk of subarachnoid hemorrhage. We describe complete treatment of the lesions by surgical clipping or endovascular treatment. METHODS: We analyzed 11 patients of residual or recurrent aneurysms who had undergone surgical clipping from 1998 to 2009. Among them, 5 cases were initially clipped at our hospital. The others were referred from other hospitals after clipping. The radiologic and medical records were retrospectively analyzed. RESULTS: All patients presented with subarachnoid hemorrhage at first time, and the most frequent location of the ruptured residual or recurrent aneurysm was in the anterior communicating artery to posterior-superior direction. Distal anterior cerebral artery, posterior communicating artery, and middle cerebral artery was followed. Repositioning of clipping in eleven cases, and one endovascular treatment were performed. No residual aneurysm was found in postoperative angiography, and no complication was noted in related to the operations. CONCLUSION: These results indicate the importance of postoperative or follow up angiography and that reoperation of residual or slowly recurrent aneurysm should be tried if such lesions being found. Precise evaluation and appropriate planning including endovascular treatment should be performed for complete obliteration of the residual or recurrent aneurysm.
Aneurysm
;
Angiography
;
Anterior Cerebral Artery
;
Arteries
;
Follow-Up Studies
;
Humans
;
Intracranial Aneurysm
;
Medical Records
;
Middle Cerebral Artery
;
Reoperation
;
Retrospective Studies
;
Subarachnoid Hemorrhage
;
Surgical Instruments
7.Aminoglycoside Nephrotoxicity Using 99mTc-DTPA Renal Scan.
Sang Heun SONG ; Sung Min PARK ; Eun Young SUNG ; Dong Won LEE ; Soo Bong LEE ; Woo Chul LEE ; Hyun Chul JUNG ; Chang Won LEE ; Ihm Soo KWAK ; Ha Yeon RHA
Korean Journal of Nephrology 1999;18(3):416-421
Aminoglycoside has a broad-spectrum bactericidal activity and especially excellent effect on gram negative bacteria. But, its harmful effect is existed about kidney and ear. Among these, many studies were done about aminoglycoside nephrotoxicity. Until now, many authors have been reported its incidence was 4.45-45%. We needed parameters monitoring about nephrotoxicity. So, our study was done using 99mTc-DTPA renal scan to evaluate nephrotoxicity. We enrolled forty patients who admitted due to infection. 32 patients received Netilmicin and 8 patients Isepamicin. Mean duration and dosage were 8 days, 200mg daily. We accomplished 99mTc-DTPA renal scan, 24hr urine study and blood sampling before starting antibiotics. After mean 8 days, same procedure was repeated. Aminoglycoside nephrotoxicity(defined as 50% GFR reduction) was presented in only one patient. She didn't have risky factor, such as hepatic dysfunction, hypotension, previous renal problem. However, duration was longer than other patients(13 days). GFR was fallen by 25-50% in 6 patients. This finding represent nephrotoxic effects of aminoglycoside indirectly. Above 6 patients had not any characteristics compared to other 33 patients. In addition to renal scan, sodium excretion was increased compared to pre-antibiotics, and glomerular filtration rate using 99mTc-DTPA renal scan was positively correlated with 24hr urine creatinine clearance, GFR by Cockcroft & Gault equation. I conclude that aminoglycoside has nephrotoxic effect when used for longer period. Thus, I suggest that DTPA renal scan including other many renal monitoring method has usefulness in revealing aminoglycoside nephrotoxicity.
Anti-Bacterial Agents
;
Creatinine
;
Ear
;
Glomerular Filtration Rate
;
Gram-Negative Bacteria
;
Humans
;
Hypotension
;
Incidence
;
Kidney
;
Netilmicin
;
Pentetic Acid
;
Sodium
8.Effects of Celecoxib and Nordihydroguaiaretic Acid on Puromycin Aminonucleoside-Induced Nephrosis in the Rat.
Dong Won LEE ; Ihm Soo KWAK ; Soo Bong LEE ; Sang Heon SONG ; Eun Young SEONG ; Hyun Chul CHUNG ; Byeong Yun YANG ; Min Young LEE ; Mee Young SOL
Journal of Korean Medical Science 2009;24(Suppl 1):S183-S188
The selective cyclooxygenase-2 (COX-2) and 5-lipoxygenase (LOX) inhibitors might inhibit prostaglandin synthesis and reduce proteinuria. The present study was designed to investigate the anti-proteinuric effects of nordihydroguaiaretic acid (NDGA) as compared with celecoxib in puromycin aminonucleoside (PAN) nephrosis rats. Fifty five male Sprague-Dawley rats were divided into 4 groups; A, normal control; B, PAN group; C, PAN+COX-2 inhibitor (celecoxib) group; and D, PAN+5-LOX inhibitor (NDGA) group. After induction of PAN nephrosis through repeated injections of PAN (7.5 and 15 mg/100 g body weight), rats were treated with celecoxib, NDGA, or vehicle for 2 weeks. Twenty four hour urine protein excretions were significantly lower in PAN+celecoxib and PAN+NDGA groups than in PAN group. Serum creatinine (SCr) concentrations and 24 hr urine creatinine clearances (CCr) were not significantly different in the four groups. Electron microscopy showed that podocyte morphology was changed after the induction of PAN nephrosis and was recovered after celecoxib or NDGA administration. Celecoxib significantly recovered the expressions of nephrin, CD2AP, COX-2, and TGF-beta. NDGA also recovered TGF-betaexpression, but did not alter the expressions of nephrin, CD2AP and COX-2. The present study suggested that celecoxib and NDGA might effectively reduce proteinuria in nephrotic syndrome without impairing renal function.
Animals
;
Anti-Inflammatory Agents, Non-Steroidal/pharmacology
;
Body Weight
;
Creatinine/blood
;
Cyclooxygenase Inhibitors/pharmacology
;
Male
;
Microscopy, Electron
;
Nephrosis/*chemically induced/drug therapy
;
Nordihydroguaiaretic Acid/*pharmacology
;
Podocytes/metabolism
;
Puromycin Aminonucleoside/pharmacology/*toxicity
;
Pyrazoles/*pharmacology
;
Rats
;
Rats, Sprague-Dawley
;
Sulfonamides/*pharmacology
;
Time Factors
9.The Usefulness of DEXA about Nutritional Assesment in Chronic Renal Failure.
Sang Heun SONG ; Sung Min PARK ; Soo Bong LEE ; Eun Young SUNG ; Hyun Chul JUNG ; Woo Chul LEE ; Ihm Soo KWAK ; Ha Yeon RHA
Korean Journal of Nephrology 1999;18(2):258-264
It has been considered that the nutrition affects the mortality of chronic renal failure patients. Thus, several studies reported the method of examination about nutritional status in chronic renal failure patients. The purpose of the present study was to evaluate the nutritional status of 32 chronic renal failure patients, and recommend DEXA as a objective method. Thirty two chronic renal failure patients and 24 disease-free persons on kidney(control group) were included in this syudy. There were no difference in mean age, sex, weight, height, body mass index between two groups. We measured % total body fat, fat-free mass, limb fat, trunl fat, limb fat/trunk fat ratio with Hologic QDR 4500. The results were as follows. 1)% Total body fat of chronic renal failure patients was 20.7+/-7.9%. That was lower than 26.3+/-7.9% of control group(P<0.05). 2)Fat-free mass of chronic renal failure patients revealed lower result compared with control group. Each result was 40.2+/-12.2kg, 46.2+/-9.1kg(P<0.05). 3)Despite of no significant difference between two groups in ratio of limb fat and trunk fat, limb fat and trunk fat were statistically different(Limb fat:CRF-5.6+/-2.4kg, Control-7.1+/-1.9kg, Trunk fat:CRF- 5.2+/-3.0kg, Control-7.7+/-2.7kg)(P<0.05). 4)Triceps skinfold thockness was positively correlated with % total body fat, limb fat, trunk fat, and negatively correlated with fat-free mass. Mid- arm muscle area circumference had inverse relationship above(P<0.05). 6)Severe malnurished patients(SGA-C group) had lower result compared to mild-moderate malnurished patients(SGA-B group) about %TBF, LF,TF, total lymphocyte count. In addition to DEXA, we examined triceps skinfold thickness and mid-arm muscle area circumference. The result showed significant comparison between two groups, too. But albumin, cholesterol, potassium level was no statistical significant difference, except lymphcyte count. In conclusion, as suggested by above results, chronic renal failure patients has protein-calorie malnutrition. This nutritional status affects long-term survival of chronic renal failure patients. DEXA can give objective data accompanied with simple anthropometric measurement in nutriti onal status. Thus, we recommend DEXA as objective method of nutritional examination. In future, more precise method will be discovered, and that contribute more long-term survival of chronic renal failure patients.
Adipose Tissue
;
Arm
;
Body Height
;
Cholesterol
;
Equidae*
;
Extremities
;
Humans
;
Kidney Failure, Chronic*
;
Lymphocyte Count
;
Malnutrition
;
Mortality
;
Nutritional Status
;
Potassium
;
Protein-Energy Malnutrition
;
Skinfold Thickness
10.Angiotensin Receptor Blockers as an Alternative to Angiotensin-Converting Enzyme Inhibitors in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Sungmin LIM ; Eun Ho CHOO ; Ik Jun CHOI ; Sang Hyun IHM ; Hee Yeol KIM ; Youngkeun AHN ; Kiyuk CHANG ; Myung Ho JEONG ; Ki Bae SEUNG
Journal of Korean Medical Science 2019;34(45):e289-
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) are the first choice for the treatment of acute myocardial infarction (AMI), and angiotensin receptor blockers (ARBs) should be considered in patients intolerant to ACEIs. Although previous studies support the use of ARBs as an alternative to ACEIs, these studies showed inconsistent results. The objective of this study was to demonstrate the clinical impact of ARBs as an alternative to ACEIs in patients with AMI undergoing percutaneous coronary intervention (PCI). METHODS: The CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI (COREA-AMI) registry enrolled all consecutive patients with AMI undergoing PCI. The primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalization due to heart failure. RESULTS: Of the 3,328 eligible patients, ARBs replaced ACEIs in 816 patients, while 824 patients continued to use ACEIs and 826 patients continued to use ARBs. The remaining 862 patients did not receive ACEIs/ARBs. After the adjustment with inverse probability weighting, the primary endpoints in the first groups were similar (7.5% vs. 8.0%, hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.75–1.05; P = 0.164). Composite events were less frequent in the ACEI to ARB group than no ACEI/ARB group (7.5% vs. 11.8%, HR, 0.76; 95% CI, 0.64–0.90; P = 0.002). CONCLUSION: The alternative use of ARBs following initial treatment with ACEIs demonstrates comparable clinical outcomes to those with continued use of ACEIs and is associated with an improved rate of composite events compared to no ACEI/ARB use in patients with AMI undergoing PCI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682
Angiotensin Receptor Antagonists
;
Angiotensin-Converting Enzyme Inhibitors
;
Angiotensins
;
Heart Failure
;
Hospitalization
;
Humans
;
Myocardial Infarction
;
Percutaneous Coronary Intervention
;
Stroke