No abstract available.
Humans ; Renal Insufficiency, Chronic*

Perigraft seroma is uncommon complication of polytetrafluoroethylene(PTFE) grafts applied as an arteriovenous shunt for hemodialysis. It is a collection of clear, sterile fluid confined to nonsecretory fibrous pseudomembrane, most commonly localized around the middle and distal portion of graft. The possible etiologic factors of perigraft seroma include poor graft incorporation, mechanical graft damage caused by alcohol and povidone-iodine, intraoperative streching of the graft, variations in quality control at the time of manufacture and contributing factors such as anemia and coagulopathy in uremia. The best strategy for management of perigraft seroma is not clear. spiration or drainage alone is not effective, and some authors advocate graft removal. We report a case of perigraft seroma around arterial end of PTFE graft along with a brief review of the literatures.
Anemia ; Drainage ; Humans ; Polytetrafluoroethylene ; Povidone-Iodine ; Quality Control ; Renal Dialysis* ; Seroma* ; Transplants ; Uremia

Mucocuaneous Lymph Node Syndrome(Kawasaki disease) is a new diseae entity that was first described by Kawasakiin 1967. It occures predominantly in children less than 5yrs old and acute febrile illness, which is mucocutaneousinvolvment associated with swelling of cervical lymph nodes. The coronary artery aneurysms have been revealed 20–30% of patients with Kawsaki disease. The authors report a case of multiple coronary artery aneurysms inKawasaki disease which was diagnosed by a coronary arteriography.
Aneurysm ; Angiography ; Child ; Coronary Vessels ; Humans ; Lymph Nodes ; Mucocutaneous Lymph Node Syndrome

BACKGROUND: Recently, it was suggested that sleep disorders, like sleep apnea and periodic limb movements during sleep, are associated with the cardiovascular complications and outcomes seen in ESRD patients. This study investigated the association between sleep disturbances, including nocturnal hypoxemia, and myocardial damage in ESRD patients. METHODS: We conducted a cross-sectional study of 15 hemodialysis patients (age=50+-8 years, M: F= 11: 4, diabetes=6) who were classified as at high risk of sleep disturbance using the Epworth Sleepiness Scale and Sleep Disorders Questionnaire. Overnight polysomnographic studies were performed in these 15 patients to evaluate sleep parameters. The predialysis serum concentration of cardiac troponin T (cTnT) was measured as a marker of myocardial damage. RESULTS: Apnea+hypopnea index >5, which is a diagnostic criterion of sleep-related breathing disorder, was found in 12 (80%) patients. Several sleep parameters were associated with cTnT concentration. Sleep efficiency and lowest oxygen saturation decreased (p<0.05 and p=0.06, respectively), and average desaturation increased (p<0.05) with increasing cTnT concentration. Spearman's Rho, which was used to assess the relationships between the severity of sleep apnea and clinical parameters, showed that apnea+hypopnea index and oxygen desaturation index were negatively correlated (both p<0.01) with the serum concentration of uric acid. In multivariate analysis, the uric acid concentration was also independently associated with apnea+hypopnea index and oxygen desaturation index. CONCLUSION: Elevated concentration of cTnT was associated with poor sleep efficiency and severe oxygen desaturation during sleep, and the serum concentration of uric acid was lower in patients with severe sleep apnea.
Anoxia ; Cross-Sectional Studies ; Extremities ; Humans ; Kidney Failure, Chronic* ; Multivariate Analysis ; Oxygen ; Renal Dialysis ; Respiration ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Troponin T ; Uric Acid ; Surveys and Questionnaires

OBJECTIVES: Sleep disturbances are very common in hemodialysis (HD) patients with chronic renal failure (CRF). This study aimed to examine the characteristics of sleep disturbances, and to illustrate the relationship of sleep parameters with clinical parameters reflecting metabolic dysfunction in HD patients with CRF. METHODS: The Epworth Sleepiness Scale (ESS) and Sleep Disorders Questionnaire (SDQ) were administered in 26 HD patients with CRF. For fifteen patients with the risk of sleep disorder, nocturnal polysomnographic study (NPSG) and blood sampling were done. RESULTS: Among 15 patients, 14 patients (93%) were diagnosed as sleep disorders, sleep breathing disorder or periodic limb movements in sleep. Uric acid (UA) was positively correlated with sleep efficiency (r=0.571), and negatively correlated with waking after sleep onset, the amount of stage 1 sleep, and respiratory disturbance index (r=-0.515, -0.564, -0.646). Interleukin-6 was positively correlated with obstructive apnea index (r=0.661). CONCLUSION: In our study, the difficulty in maintaining sleep was found in HD patients with CRF. It also showed that increased UA was associated with improved sleep maintenance and decreased breathing disturbance during sleep. This might be related with antioxidant effect of UA in CRF. Further studies on total CRF patients including those without the risk of sleep disorder are necessary.
Antioxidants ; Apnea ; Extremities ; Humans ; Interleukin-6 ; Kidney Failure, Chronic* ; Surveys and Questionnaires ; Renal Dialysis* ; Respiration ; Sleep Wake Disorders ; Uric Acid

OBJECTIVE: It has been suggested that oxidative stress and inflammation are associated with the pathophysiology of sleep disorders in end-stage renal disease (ESRD) patients. We examined the relationship of the sleep variables reflecting sleep breathing disorder and limb movements during sleep with the clinical variables reflecting the metabolic abnormalities in ESRD patients receiving hemodialysis. METHODS: Nocturnal polysomnography was conducted in 30 ESRD patients (21 men, 9 women), who were receiving hemodialysis. Blood was sampled before hemodialysis for each patient in order to measure uric acid (UA), C-reactive protein (CRP), and interleukin-6 (IL-6). RESULTS: UA was correlated positively with the total sleep time (TST)(r=0.407) and negatively with the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI)(r=-0.377, -405). CONCLUSION: CRP was positively correlated with the limb movement index (LMI)(r=0.401). Our study showed that increased UA was related to decreased respiratory disturbance during sleep in ESRD patients receiving hemodialysis.
C-Reactive Protein ; Extremities ; Humans ; Inflammation ; Interleukin-6 ; Kidney Failure, Chronic ; Male ; Oxidative Stress ; Oxygen ; Polysomnography ; Renal Dialysis ; Respiration ; Sleep Wake Disorders ; Uric Acid

PURPOSE: This study was performed to investigate the relationship between serum vitamin D and parathyroid hormone (PTH) levels as well as to describe the prevalence and the risk factors of vitamin D deficiency (VDD) in Korean children. METHODS: Participants were 1,212 children aged 4 to 15 years, who visited Bundang CHA Medical Center (located at 37degreesN) between March 2012 and February 2013. Overweight was defined as body mass index> or =85th percentile. Participants were divided into 4 age groups and 2 seasonal groups. VDD was defined by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL. RESULTS: The level of 25OHD was significantly lower in overweight group than in normal weight group (17.1+/-5.1 ng/mL vs. 19.1+/-6.1 ng/mL, P<0.001). Winter-spring season (odds ratio [OR], 4.46; 95% confidence interval [CI], 3.45-5.77), older age group (OR, 1.60; 95% CI, 1.36-1.88), and overweight (OR, 2.21; 95% CI, 1.62-3.01) were independently related with VDD. The PTH levels were significantly higher in VDD group compared to vitamin D insufficiency and sufficiency group (P<0.001). In normal weight children, 25OHD (beta=-0.007, P<0.001) and ionized calcium (beta=-0.594, P=0.007) were independently related with PTH, however, these associations were not significant in overweight children. CONCLUSION: VDD is very common in Korean children and its prevalence increases in winter-spring season, in overweight children and in older age groups. Further investigation on the vitamin D and PTH metabolism according to adiposity is required.
Adiposity ; Body Mass Index ; Calcium ; Child* ; Humans ; Metabolism ; Overweight ; Parathyroid Hormone* ; Prevalence* ; Risk Factors* ; Seasons ; Vitamin D ; Vitamin D Deficiency*

About one tenth of all CNS neoplasms involves the brain. Due to their location in the ventricles they often present similar nonspecific clinical manifestation. Localization and differential diagnosis are dependent on radiological investigation. For the identification of specific CT characteristics of the intraventricular tumors and the differental diagnosis, we retrospectively analyzed 22 pathologically proved cases seen on CT. Important differential features included age and sex of the patient, the location within the ventricle, and the morpholgic appearance of the mass and density on CT before and after intravenous administration of contrast material. Meningiomas (4 cases) and a germinoma showed increased density on the precontrast CT scans, and demonstrated dense uniform enhancement of the postenhanced scan. Choroid plexus papillomas (3 cases) showed dense uniform contrast enhancement. Intraventricular neurocytomas (3 cases) demonstrated characteristic attachment to the septum pellucidum, confinement of the lateral and third ventricle, and calcification within the mass Colloid cysts (2 cases) showed characteristic location of anterosuperior aspect of the third ventricle. In conclusion, CT findings of intraventricular tumors are usually nonspecific. The location of the mass and the patient's age are the most helpful information in the differential diagnosis.
Administration, Intravenous ; Brain ; Colloid Cysts ; Diagnosis ; Diagnosis, Differential ; Germinoma ; Humans ; Meningioma ; Neurocytoma ; Papilloma, Choroid Plexus ; Retrospective Studies ; Septum Pellucidum ; Third Ventricle ; Tomography, X-Ray Computed

BACKGROUND: Coronary artery calcification is frequently seen in hemodialysis patients. The development and progression of coronary artery calcification is similar to osteogenesis, and a naturally occurring serum inhibitor of calcification may be involved. The aim of this study was to evaluate the relationship between coronary artery calcification, bone remodeling related factor, serum osteoprotegerin (OPG), calcification inhibitor and the serum fetuin-A levels in hemodialysis patients. METHODS: A total of 51 hemodialysis patient were assessed for their coronary artery calcium (CAC) scores with using multirow spiral computed tomography and measuring the serum OPG level, the serum fetuin-A level, the biochemical markers of inflammation, the lipid profile and the mineral metabolism. RESULTS: The mean serum OPG level was 3,561+/-1,160 pg/mL and the mean serum fetuin-A level was 28.5+/-4.1 mg/dL. The CAC scores were significantly correlated with the duration of dialysis (p=0.0225), hs-CRP (p=0.0392), serum phosphate (p=0.0341), Ca x P (p=0.0434), the serum OPG level (p=0.0026) and LDL-cholesterol (p=0.0438), after adjusting for age, gender, BMI, smoking history and the presence of diabetes. Multiple regression analysis showed that the CAC scores were significantly associated with the serum OPG level (p<0.0001) and the serum phosphate level (p=0.0003). The subgroup of the patients with a CAC score greater than 400 (the severe CAC group) had significantly higher OPG levels and lower fetuin-A levels than the groups of the patients with lower CAC scores. CONCLUSIONS: Our data suggest that the CAC scores in the patients undergoing hemodialysis were related with higher serum OPG and higher serum phosphate levels. The serum fetuin-A level was significantly lower in the patients with severe coronary artery calcification.
alpha-2-HS-Glycoprotein* ; Biomarkers ; Bone Remodeling ; Calcium ; Coronary Disease ; Coronary Vessels* ; Dialysis ; Humans ; Inflammation ; Kidney Failure, Chronic* ; Metabolism ; Osteogenesis ; Osteoprotegerin* ; Renal Dialysis ; Smoke ; Smoking ; Tomography, Spiral Computed

PURPOSE: To evaluate the specif!c radiologic findings of the dysgenesis of corpus callosum(CCD) on CT and/or MR images. MATERIALS AND METHODS: The authors reviewed retrospectively CT and/or MR images of 10 patients with CCD. After classifying CCD into partial and total type according to the degree of its development, we investigated structural abnormalities on CT and/or MR images resulting from or related to CCD and then associated anomaly. RESULTS: The most common findings of CCD on axial planes of CT and/or MR images were dilatation of posterior part of the lateral ventricles(8/10) and feature of the bodies of the both lateral ventricles(8/10) in parallel. Sagittal and coronal planes of MR demonstrated exact extent of dysgenesis of the corpus callosum(5/5) and radiating pattern of gyri in medial surface of cerebral hemisphere extending to the 3rd ventricle without interruption by cingulate sulcus(4/5). CONCLUSION:MR image of mid-sagittal plane appeared most useful in diagnosis of CCD because of its direct depiction of the whole length of corpus callosum. In most cases, however, CCD can be easily diagnosed with CT scan by characteristic findings of dilatation of the posterior part of lateral ventricles and paralleling of the lateral ventricles.
Cerebrum ; Corpus Callosum ; Diagnosis ; Dilatation ; Humans ; Lateral Ventricles ; Retrospective Studies ; Tomography, X-Ray Computed