An Insertion/deletion polymorphism in angiotensin converting enzyme gene has been considered the important regulator of ACE activity in plasma and tissue. The deletion allele of this gene is associated with higher ACE activity, which ultimately increased angiotensin II formation. It is possible that alteration of ACE polymorphism might be contribute to development of end stage renal disease and cardiovascular disease where RAS system is implicated in disease process. This study determined the distribution of ACE genotype in 122 end stage renal disease patients and in a group of 101 healthy controls. Also we evaluated the difference of allele frequency in the hemodialysis patients with or without cardiovascular disease. ACE genotype was determined by polymerase chain reaction technique from the PBMC leukocytes of the patients. The results were as follows; 1)Patients population consisted of 122 hemodialysis patients and male to female ratio was 66:56, mean age was 54.3+/-12.8 years old. Mean duration of dialysis treatment was 52.5+/-37.5 months and the underlying disease of ESRD were diabetic nephropathy in 78 cases, chronic glomerulonephritis in 29 cases, hypertension in 8 cases, other disease in 7 cases. 2)In the contol patients, male to female ratio was 52:49, mean age was 46.1+/-15.1 years old. The age and sex distribution between ESRD and control group was not significantly different. 3)Of the total hemodialysis patients, 26.2% showed the II genotype, 35.2% of ID genotype and 38.6% of DD genotype. In the contol group, the frequency of each genotype was 20.8% of II, 55.4% of ID and 23.8% of DD genotype. The frequency of DD genotype was significantly higher in ESRD group than control group(p<0.05). 4)In the ESRD patients, 72 patients(59%) had the LVH and 23 patients(18%) had the ischemic heart disease. The genotype distribution in ESRD patients according to the presence of LVH or ischemic heart disease did not show any significant difference. The frequency of each genotype in the patients with LVH showed 22.2%(II), 43.1%(ID), 34.7%(DD), and 32.8%(II), 37.5%(ID), 29.7%(DD) in the patients without LV et al.:Angiotensin Converting Enzyme Polymorphism in Patients with End Stage Renal Disease- H. In the aspect of ischemic heart disease, the frequency of ACE genotype was 27.3%(II), 45.5% (ID), 27.3%(DD) in the group of ischemic heart disease, compared with the ditribution of 31.5 %(II), 40%(ID), 32.6%(DD) in the patients without ischemic heart disease. From the above results, it was concluded that insertion/deletion polymorphism in angiotensin converting enzyme gene, especially DD genotype, may be important in the pathogenesis of progression to end stage renal disease. There was no significant difference in I/D polymorphism according to the presence or absence of cardiovascular complications
Alleles ; Angiotensin II ; Angiotensins* ; Cardiovascular Diseases ; Diabetic Nephropathies ; Dialysis ; Female ; Gene Frequency ; Genotype ; Glomerulonephritis ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Leukocytes ; Male ; Myocardial Ischemia ; Peptidyl-Dipeptidase A* ; Plasma ; Polymerase Chain Reaction ; Renal Dialysis ; Sex Distribution

We report a case of Serratia marcescens peritonitis in a 45-year-old man with insulin-dependent diabetes mellitus undergoing continuous ambulatory peritoneal dialysis (CAPD). The patient presented with abdominal pain and cloudy dialysate. Empiric antibiotic therapy was initiated intraperitoneally with cefazolin and ceftazidime for 5 days. Cultures of the dialysate revealed S. marcescens, and the treatment was subsequently changed to gentamicin and ceftazidime. Oral ciprofloxacin was also added. The patient's abdominal pain and the dialysate white blood cell (WBC) count, however, did not improve. The indwelling CAPD catheter was therefore removed. This is an unusual case report in the Korean literature of S. marcescens peritonitis in a patient receiving CAPD.
Abdominal Pain ; Catheters ; Cefazolin ; Ceftazidime ; Ciprofloxacin ; Diabetes Mellitus, Type 1 ; Gentamicins ; Humans ; Leukocytes ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Serratia ; Serratia marcescens

PURPOSE: To evaluate the radiological and clinical results of cementation of a polyethylene liner into a well-fixed metal shell in revision total hip arthroplasty. MATERIALS AND METHODS: From November 2001 to April 2006, 11 cases (10 patients) were included in this study. There were 5 males (6 cases) and 5 females with a mean age of 54.3 years. The mean follow-up period was 35.2 months. The acetabular shells were stable and their position was acceptable in all cases. Pre-existing screws were removed and screw holes were filled with allogenic bone. The inner surface of the metal shells and convex backside of the liners were roughened with a burr. The clinical results were evaluated using the Harris hip score (HHS) and the radiological results with evidence of a positional change in the acetabular cup and liner, and the progression of osteolysis around the cup. RESULTS: The mean HHS was 69.5 points preoperatively and 89.2 at the last follow up. There was no change in the cup and liner position or progression of the osteolytic lesion around the femoral or acetabular components. CONCLUSION: Cementation of a polyethylene liner into a well-fixed metal shell showed satisfactory results in revisional total hip arthroplasty with a short term follow-up period.
Arthroplasty ; Cementation ; Female ; Follow-Up Studies ; Hip ; Humans ; Male ; Osteolysis ; Polyethylene

BACKGROUND/AIMS: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis. METHODS: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4+/-9.5 y, mean+/-SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated. RESULTS: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS > or =6: LSM > or =17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4. CONCLUSIONS: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.
Adult ; Area Under Curve ; *Elasticity Imaging Techniques ; Female ; Hepatic Veins/physiopathology ; Humans ; Liver Cirrhosis/pathology/*ultrasonography ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Severity of Illness Index ; Spleen/anatomy & histology ; Splenic Vein/physiology

BACKGROUND/AIMS: Angiotensin receptor blockers (ARBs) inhibit activated hepatic stellate cell contraction and are thought to reduce the dynamic portion of intrahepatic resistance. This study compared the effects of combined treatment using the ARB candesartan and propranolol versus propranolol monotherapy on portal pressure in patients with cirrhosis in a prospective, randomized controlled trial. METHODS: Between January 2008 and July 2009, 53 cirrhotic patients with clinically significant portal hypertension were randomized to receive either candesartan and propranolol combination therapy (26 patients) or propranolol monotherapy (27 patients). Before and 3 months after the administration of the planned medication, the hepatic venous pressure gradient (HVPG) was assessed in both groups. The dose of propranolol was subsequently increased from 20 mg bid until the target heart rate was reached, and the candesartan dose was fixed at 8 mg qd. The primary endpoint was the HVPG response rate; patients with an HVPG reduction of >20% of the baseline value or to <12 mmHg were defined as responders. RESULTS: The mean portal pressure declined significantly in both groups, from 16 mmHg (range, 12-28 mmHg) to 13.5 mmHg (range, 6-20 mmHg) in the combination group (P<0.05), and from 17 mmHg (range, 12-27 mmHg) to 14 mmHg (range, 7-25 mmHg) in the propranolol monotherapy group (P<0.05). However, the medication-induced pressure reduction did not differ significantly between the two groups [3.5 mmHg (range, -3-11 mmHg) vs. 3 mmHg (range, -8-10 mmHg), P=0.674]. The response rate (55.6% vs. 61.5%, P=0.435) and the reductions in mean blood pressure or heart rate also did not differ significantly between the combination and monotherapy groups. CONCLUSIONS: The addition of candesartan (an ARB) to propranolol confers no benefit relative to classical propranolol monotherapy for the treatment of portal hypertension, and is thus not recommended.
Adolescent ; Adult ; Aged ; Antihypertensive Agents/*therapeutic use ; Benzimidazoles/*therapeutic use ; Blood Pressure ; Drug Therapy, Combination ; Female ; Humans ; Hypertension, Portal/complications/*drug therapy ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Propranolol/*therapeutic use ; Prospective Studies ; Tetrazoles/*therapeutic use ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: Liver stiffness measurement (LSM) has been proposed as a non-invasive method for estimating the severity of fibrosis and the complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence of portal hypertension, but its invasiveness limits its clinical application. In this study we evaluated the relationship between LSM and HVPG, and the predictive value of LSM for clinically significant portal hypertension (CSPH) and severe portal hypertension in cirrhosis. METHODS: LSM was performed with transient elastography in 59 consecutive cirrhotic patients who underwent hemodynamic HVPG investigations. CSPH and severe portal hypertension were defined as HVPG > or =10 and > or =12 mmHg, respectively. Linear regression analysis was performed to evaluate the relationship between LSM and HVPG. Diagnostic values were analyzed based on receiver operating characteristic (ROC) curves. RESULTS: A strong positive correlation between LSM and HVPG was observed in the overall population (r2=0.496, P<0.0001). The area under the ROC curve (AUROC) for the prediction of CSPH (HVPG > or =10 mmHg) was 0.851, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for an LSM cutoff value of 21.95 kPa were 82.5%, 73.7%, 86.8%, and 66.7%, respectively. The AUROC at prediction of severe portal hypertension (HVPG > or =12 mmHg) was 0.877, and the sensitivity, specificity, PPV, and NPV at LSM cutoff value of 24.25 kPa were 82.9%, 70.8%, 80.6%, and 73.9%, respectively. CONCLUSIONS: LSM exhibited a significant correlation with HVPG in patients with cirrhosis. LSM could be a non-invasive method for predicting CSPH and severe portal hypertension in Korean patients with liver cirrhosis.
Adult ; Aged ; Alcohol-Related Disorders/complications ; Area Under Curve ; *Elasticity Imaging Techniques ; Female ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Hypertension, Portal/*complications/*diagnosis ; Linear Models ; Liver Cirrhosis/*complications/*diagnosis/pathology ; Male ; Middle Aged ; ROC Curve ; Republic of Korea ; Sensitivity and Specificity

BACKGROUND: The quality control for genetic tests would be of great importance as the test volume and clinical demands increase dramatically. Diagnostic genetics subcommittee of KSQACL performed two trials for cytogenetics and molecular genetics surveys in 2009. METHODS: A total of 67 laboratories participated in the cytogenetic surveys, 30 laboratories participated in the FISH surveys, and 94 laboratories participated in the molsecular genetics surveys in 2009. RESULTS: Almost of them showed acceptable results. However, some laboratories showed unacceptable results for the karyotype nomenclature and detection of complex cytogenetic abnormalities in hematologic neoplasms, and most of them except one showed acceptable results in FISH surveys. The molecular genetics surveys included various tests: M. tuberculosis detection, hepatitis B (HBV) and C virus (HCV) detection and quantification, human papilloma virus (HPV) genotyping, Influenza A (H1N1) detection, gene rearrangement tests for leukemias and lymphomas, apolipoprotein E (APOE) genotyping, methylenetetrahydrofolate reductase (MTHFR) genotyping, hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), and genetic tests for achondroplasia (FGFR3), FMS-like tyrosine kinase 3 (FLT3), JAK2, BRAF, hereditary disorders such as spinal muscular atrophy, Huntington disease (HD), spinocerebellar ataxia (SCA), Prader-Willi/Angelman syndrome (PWS/AS), mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), myoclonic epilepsy ragged red fiber (MERRF), wilson disease (ATP7B) and cancer-associated genes (KRAS). Molecular genetic surveys showed excellent results in most of the participants. CONCLUSIONS: External quality assessment program for genetic analysis in 2009 was proved to be helpful in continuous education and evaluation of quality improvement.
Achondroplasia ; Acidosis, Lactic ; Apolipoproteins ; Breast ; Chromosome Aberrations ; Cytogenetics ; Epilepsies, Myoclonic ; fms-Like Tyrosine Kinase 3 ; Gene Rearrangement ; Hematologic Neoplasms ; Hepatitis B ; Hepatolenticular Degeneration ; Humans ; Huntington Disease ; Influenza, Human ; Karyotype ; Korea ; Leukemia ; Lymphoma ; Methylenetetrahydrofolate Reductase (NADPH2) ; Mitochondrial Encephalomyopathies ; Molecular Biology ; Muscular Atrophy, Spinal ; Ovarian Neoplasms ; Papilloma ; Quality Control ; Quality Improvement ; Spinocerebellar Ataxias ; Tuberculosis ; Viruses

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and theKorean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.