No abstract available.
Hemorrhagic Fever with Renal Syndrome* ; Humans ; Proteinuria*

Permanent vascular access is a prerequisite for successful treatment of patients with chronic hemodialysis. Although a number of strategies including native and synthetic arterio-venous fistulae are performed to create vascular access, they are often not available due to peripheral vascular diseases which are common in patients with diabetes and elderly patients. So, in spite of technical advance, vascular access for hemodialysis remains a significant problem confronting the nephrologists. Recently, Permcath(R) (double lumen silicone rubber catheter) has been introduced and can provide temporary access in patients whose native fistulas have not yet matured and permanent access in patients who have difficulty in creating a arterio-venous fistula. We investigated the availability and the clinical outcome of use of Permcath(R) as temporary or permanent vascular access. Total 16 catheters were placed in 14 patients who were admitted in Chung-Ang University Hospital between April, 1993 to March, 1996. Clinical course of the patients and outcome of the catheters were observed, retrospectively. The mean age of the 14 patients was 56 9 (39-67) years. The indications were exhausted peripheral access, poor vascular system for conventional access operation, and limited life expectancy. The median survival of the catheters was 80 weeks with a range of one week to 113 weeks. The one-year actuarial catheter survival rate was 67% and 44% at 2 year. The most common complication during use of Permcath(R) was infection, occurred in 5 patients (31.2%). The 5 catheters were removed because of complications of catheter such as infection or malfunction. We suggest that the Permcath(R) is a safe and durable temporary vascular access for patients with poor vascular system anticipating a long duration for arterio-venous fistula maturation and permanent access for patients who have exhausted peripheral access sites.
Aged ; Catheters ; Fistula ; Humans ; Life Expectancy ; Peripheral Vascular Diseases ; Renal Dialysis ; Retrospective Studies ; Silicone Elastomers ; Survival Rate

No abstract available.

No abstract available.
Endothelial Cells* ; Hantaan virus* ; Humans* ; Umbilical Veins*

Norcardia is an aerobic, gram-positive, AFB positive filamentous organism which is frequently branching. Nocardial infection is usually opportunistic and is found in immunosuppressed patients during transplantation or anti-cancer chemotherapy. With the increasing number of AIDS, nocardial infection have been increasingly recognized as a serious human infection. Among patients on peritoneal dialysis, Nocardia is a rare cause of peritonitis : only one case has been reported in Korea. It is extremely important to make an early and correct diagnosis and treatment with susceptible antibiotics. We report here a case of nocardial peritonitis associated with Continuous Ambulatory Peritoneal Dialysis(CAPD) which was resistant to trimethoprim/sulfamethoxazole and has treated successfully with imipenem and amikacin.
Amikacin ; Anti-Bacterial Agents ; Diagnosis ; Drug Therapy ; Humans ; Imipenem ; Korea ; Nocardia ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis*

Malaria infection is not uncommon in Korea these days, but there was no report of malaria infection in the patients who had been transplanted his or her kidney. With the immunosuppression, the atypical findings are frequent and make prompt diagnosis difficult. We report a case of malaria which showed atypical clinical course but treated successfully with conventional anti-malarial drug therapy. A 37 year old male patient were transplanted his kidney in Sep. 1997. He was admitted because of fever, which lasted 40 - 50 min every afternoon for 27 days. Numerous trophozoites were found on his peripheral blood smear, which was diagnosed as vivax malaria. Chloroquine and primaquine were given, and fever subsided next day. The patients has been stayed afebrile thereafter. We reported a case of malaria in the renal transplanted patient with the review of literatures.
Adult ; Chloroquine ; Diagnosis ; Drug Therapy ; Fever ; Humans ; Immunosuppression* ; Kidney Transplantation ; Kidney* ; Korea ; Malaria* ; Malaria, Vivax ; Male ; Plasmodium vivax ; Primaquine ; Trophozoites

It is well recognized that malnutrition is one of the most important reversible factors contributing to mortality in hemodialysis patients. Until recently, highprotein diets were recommended for hemodialysis patients in an attempt to increase the synthesis of albumin and to promote the anabolism of body protein. However, the appropriateness of this recommendation has recently been questioned. This study investigated the effects of low and high protein intakes on the levels of serum albumin, total protein, BUN, and creatinine in 28 hemodialysis patients fed sequentially 1.0g(LPG) or 1.5g(HPG) protein and 30-35kcal/kg/ ideal body weight for four weeks. The HPG diet was associated with a significant increase in the levels of serum albumin, total protein, BUN, and creatinine however, the LPG diet was not. The serum levels of triglyceride and total cholesterol were in the normal range and did not changed by the diets. The levels of serum Hb, iron, and transferrin were lower than the normal values and did not changed by these two diets. Though individual considerations are recommended, it is possible that the high protein diet could increase the levels of serum albumin and total protein of the hemodialysis patients in Korea.
Cholesterol ; Creatinine ; Diet ; Diet, Protein-Restricted ; Humans ; Ideal Body Weight ; Iron ; Korea ; Malnutrition ; Metabolism ; Mortality ; Nutritional Status* ; Penicillin G Benzathine ; Reference Values ; Renal Dialysis* ; Serum Albumin ; Transferrin ; Triglycerides

BACKGOUND: The purpose of the study was to evaluate the effect of aminonguanidine on the inhibition of advanced glycosylation end product (AGE) formation and the expression of peritoneal vascular endothelial growth factor (VEGF). Then we analyzed the functional and morphological alterations of peritoneal membrane during long-term PD in rats. METHODS: Male Sprague-Dawley rats were randomly divided into 3 groups:group I (n=6), control rats with PD catheter but not dialyzed; group II (n=9), rats dialyzed with 4.25% glucose solution for all exchanges; group III (n=9), rats dialyzed with 4.25% glucose solution containing aminoguanidine (25 mg/kg) for all changes. Dialysis changes were performed 3 times a day with 25 mL/each exchange for 12 weeks. Immunostaining was performed using a monoclonal anti-AGE antibody and a polyclonal anti-VEGF antibody. One-hour peritoneal equilibration test were performed at every 4-week for the comparison of peritoneal transport characteristics. RESULTS: Expressions of peritoneal AGE and VEGF in dialyzed groups (group IIand III) were higher compared to control group. The level of AGE immunostaining in group III was significantly lower than in the group II. But peritoneal VEGF expression did not differ between the dialyzed groups. In dialyzed groups, D/DO glucose was significantly lower whereas D/P urea was significantly higher than in the control group. On linear regression analysis, peritoneal AGE and VEGF accumulation were directly correlated with D/DO glucose and D/P urea nitrogen. But there was no statistical significance in D/DO glucose and D/P urea nitrogen between the dialyzed groups. CONCLUSION: Peritoneal accumulation of AGE and VEGF increased with time on CAPD in dialyzed groups. Intraperitoneal aminoguanidine was greatly suppressed peritoneal AGE accumulation but no attenuated long-term dialysis related peritoneal hyperpermeability. The VEGF formation may be one of the several mediators resulting the functional deterioration of the peritoneal membrane in long-term peritoneal dialysis.
Animals ; Catheters ; Dialysis ; Glucose ; Glycosylation* ; Humans ; Linear Models ; Male ; Membranes ; Nitrogen ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Rats ; Rats, Sprague-Dawley ; Urea ; Vascular Endothelial Growth Factor A

PURPOSE: Hemorrhagic fever with renal syndrome (HFRS) is an acute febrile disease caused by Hantaan virus. It is believed that various kinds of inflammatory mediators and cytokines might be involved in its pathogenesis. METHODS: We studied the expression of adhesion molecules, including ICAM-1 and VCAM-1 on Hantaan virus-infected human umbilical vein endothelial cells (HUVECs) with ELISA. RESULTS: Hantaan antigen increased gradually 48 hours after virus infection, ICAM-1 increased rapidly 3 hours after virus infection and VCAM-1 increased rapidly 4 hours after infection, a little later than ICAM-1. The patterns of the change of reaction were similar between the different concentrations of virus solution that had been adsorbed on HUVECs, but the expression of ICAM-1 or VCAM-1 was greater when HUVECs were infected with stock virus rather than when infected with tenfold diluted virus. CONCLUSION: We report the quantification using ELISA of ICAM-1 and VCAM-1 expression of HUVECs that have been infected by Hantaan virus. Increase of their expression would play an important role in the pathogenesis of HFRS.
Cytokines ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Hantaan virus* ; Hemorrhagic Fever with Renal Syndrome ; Human Umbilical Vein Endothelial Cells* ; Humans* ; Intercellular Adhesion Molecule-1* ; Vascular Cell Adhesion Molecule-1*

PURPOSE: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality. METHODS: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics. RESULTS: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086). CONCLUSIONS: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Barium ; Colon* ; Diagnosis* ; Diverticulitis* ; Diverticulitis, Colonic ; Diverticulum ; Enema ; Follow-Up Studies ; Humans ; Laparotomy ; Length of Stay ; Lost to Follow-Up ; Recurrence ; Retrospective Studies ; Ultrasonography