No abstract available.
Brain Death* ; Ultrasonography, Doppler, Transcranial*

No abstract available.
Infarction* ; Retrospective Studies*

No abstract available.
Acid-Base Equilibrium* ; Acidosis*

BACKGROUND: The antidiuretic action of oxytocin in human has been controversial. To investigate whether oxytocin directly acts on water balance in human, we evaluated the parameters of urinary concentration in response to administration of oxytocin in ten healthy male volunteers. METHODS: Oxytocin was infused intravenously at a rate of 20 mU/hour for 2.5 hours and urine was collected during the last 2 hours of oxytocin infusion. Changes in urine volume, urine osmolality, excretions of urine electrolytes and free water clearance after the administrartion of oxytocin were compared with the baseline data. RESULTS: The changes in the levels of serum electrolytes and osmolality after the administration of oxytocin were not significant compared with the baseline data. The volume of 2 hours' urine were 446+/-75 mL and 289+/-53 mL in the basal state and after the administration of oxytocin, respectively. The urine osmolality was increased significantly by the infusion of oxytocin(427+/-63 mOsm/kg) compared with that in the basal state(223+/-25 mOsm/kg)(p < 0.05). The free water clearance was 110+/-51 mL/2 hours in the basal state and decreased significantly to -57+/-51 mL/2 hours(p < 0.05). CONCLUSION: We conclude that administration of oxytocin to normal men enhances urinary concentration, evidenced by increased urinary osmolality and decreased free water clearance. In human, oxytocin may play an important role in the regulation of renal water excretion as an antidiuretic hormone.
Electrolytes ; Humans ; Male ; Osmolar Concentration ; Oxytocin* ; Volunteers ; Water

BACKGROUND AND OBJECTIVES: It has been well known that the Braunwald classification is an appropriate clinical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the classification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. MATERIALS AND METHOD: 148 patients (M 85, F 63, age 61+/-10) with suspected unstable angina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. RESULTS: Unstable angina was diagnosed in 95 patients (64%). Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75%) and 2 (2%) deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1%) myocardial infarction/death and 12 (13%) revascularizations occurred. Cardiac event rate (death, myocardial infarction or revascularization) was not different during hospitalization and 6 months follow-up period among subgroups of severity class. CONCLUSION: Clinical outcome should be reevaluated after early coronary intervention to predict cardiac event in patients with unstable angina.
Angina, Unstable* ; Classification ; Diagnosis ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Ratio

Mineralocorticoids influences on acid-base homeostasis by the regulation of urine acidification. But its mechanism of acion is not well known in human. This study compared the acid-base status and the indices of urine acidification before and after mineralocorticoid administration in human, and analyzed the effect of mineralocorticoids on human acid-base homeostasis. We administered 9a-fludrocortisone in 6 chronic renal failure patients and 6 normal controls 0.5mg daily for 7 days. The results were as following: 1) After administration of 9a-fludrocortisone in patients group, serum aldosterone level changed from 120.2+/-71.0pg/mL to 44.8+/-32.2pg/mL(mean+/-SD, p< 0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 24.6+/-12.3 mmol/day to 43.7+/-19.0 (p<0.05), but there were no change in urine pH and urine anion gap, Serum potassium level decreased from 5.5+/-0.7mBq/L to 4.1+/-0.5mEq/L (p<0.05), and TTKG increased from 3.9 to 8.9(p<0.05). 2) After administration of 9a-fludrocortisone in control group, serum aldosterone level changed from 99.7+/-44.5pg/mL to 25.1+/-3 mL(p<0.05). Serum HCO- level was not changed. Urine ammonium excretion was incresed from 44.3+/-21.6mmoVday to 76.3+/-19.6(p<0.05), but there were no change in urine pH and urine anion gap. Serum potassium level decreased from 4.8+/-0.5mEq/L to 3.9+/-0.2mHq/L(p< 0.05), but there was no change in TTKG. 3) No patient or control showed any discomfort after 9-fludrocortisone administration, and there was no elevation in diastolic blood pressure, increase in body weight, electrolyte abnormality. In summary, after 9alpha-fludrocortisane administration, urinary ammonium excretion increased in both patients and control group, and this phenomenon occured with correction of hyperkalemia without urine pH change. This result implies urinary ammonium excretion increase by mineralocorticoid. In human increase in renal distal acidification by mineralocorticoid is due to increase in renal ammoniagenesis rather than stimulation on proton excretion.
Acid-Base Equilibrium ; Aldosterone ; Ammonium Compounds* ; Blood Pressure ; Body Weight ; Homeostasis ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Kidney Failure, Chronic ; Mineralocorticoids ; Potassium* ; Protons

OBJECTIVE: The use of methotrexate for the treatment of cervical pregnancy is now common practice. Our study was performed to determine the risk factors when the primary methotrexate treatment of cervical pregnancy was failed. METHODS: From January 1985 to December 1999, we studied 32 women with cervical pregnancies who were treated with methotrexate intramuscularly according to a repeated intramuscular injections protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, the size of the gestational mass, fetal cardiac activity, and the presence of fluid in the peritoneal cavity were measured. This findings were analyzed and compared by means of the chi-square test, Fisher exact test, and student's t-test between the success and failure. RESULTS: There was no relation between the women's age, parity, the size of the conceptus, or the presence of fluid in the peritoneal cavity and the efficacy of treatment. A cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of >or= 10,000mIU/ml, fetal cardiac activity was considered to be associated with a higher failure rate of primary methotrexate treatment. CONCLUSION: Among cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the important factors associated with failure of treatment with methotrexate.
Chorionic Gonadotropin ; Female ; Humans ; Injections, Intramuscular ; Methotrexate* ; Parity ; Peritoneal Cavity ; Pregnancy* ; Risk Factors

PURPOSE: There is increasing consideration about the preemptive transplantation, transplantation without any preceding dialysis, as a one of options of a renal replacement therapy (RRT). This study evaluates a beneficial effect on recipient and allograft survival of preemptive transplantation and compares the outcome to that according to the dialysis modality and duration. METHODS: All patient who had received a kidney transplant from a living donor in the Seoul National University Hospital (SNUH) between January 1990 and October 2004 are included in this retrospective study. Patients were subdivided into three groups; preemptive transplant group (group 1, n=47), hemodialysis group (group 2, n=307) and peritoneal dialysis group (group 3, n=52). RESULTS: The characteristics of each groups were not statistically different except recipient age. Ten-year patient survival was 97.8% in PE group, but is not significantly higher than in HD (89.4%) and in PD (90.7%) groups. However, 10-year graft survival was higher in PE group than in HD group (p<0.05; 100%, 74.7% respectively). The differential effect of pretransplant dialysis duration on graft survival was prominent if the patients had been on the pretransplant dialysis for more than 42 months (p<0.05; 10-year graft survival; PE, 100% and dialysis more than 42 months, 77.9% respectively) Compared with HD group as a pre-transplant dialysis modality, PD group showed better patient and graft survival rate, but not statistically significant. CONCLUSION: Depending on the above results, we may suggest PE or PD being a superior pre-transplant modality than HD. And we should be considerate of choosing treatment modality and duration before transplantation.
Allografts ; Dialysis* ; Graft Survival* ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Peritoneal Dialysis ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Seoul ; Transplants*

OBJECTIVES: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. METHODS: We measured urine NH' by enzymatic determination, UOG(=0.5 X [urine osmolality-{2 X (Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4+/-1.6mmol/L ) with AGMA. RESULTS: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p<0.05) in the acute(35.6+/-7.7mmol/L) than in the chronic(3.8+/-0.9mmol/L) group. The UOG was higher (p<0.05) in the acute(73.2+/-18.9mmol/L) than in the chronic(6.3+/-8.7mmol/L) group, but the UAG had no difference between the two groups. When both groups of the patients were considered together, urine NH concentration correlated with the UOG (r=0.90, p<0.01), but not with the UAG. While the patients with lower urine NH4+ excretion(<30mmol/d) had the UOG<40mmol/L, those with higher urine NH' excretion(>40mmol/d) had the UOG>40mmol/L. CONCLUSION: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.
Acid-Base Equilibrium* ; Acidosis* ; Ammonium Compounds* ; Humans ; Ketosis

No abstract available.
Glomerulonephritis, Membranous* ; Lower Extremity* ; Small Cell Lung Carcinoma* ; Thrombosis*