Gitelman's sydnrome is a heritable renal disorder characterized by hypomagnesemia, hypokalemia and hypocalciuria. As compared to those with Bartter's syndrome, reduced urinary excretion of calcium and magesium wasting are essential features of Gitelman's syndrome. Interestingly, we have experienced a case of 32-year old man with a mixed type of Gitelman's syndrome and Bartter's syndrome, which includes normomagnesemia, normal renal magnesium excretion, and hypocalciuria. Herein we report the case of atypical Gitelman's syndrome with brief review of related literature.
Adult ; Bartter Syndrome ; Calcium ; Gitelman Syndrome* ; Humans ; Hypokalemia ; Magnesium*

The aim of this paper was to propose a new method of bimaxillary orthognathic surgery planning and model surgery based on the concept of 6 degrees of freedom (DOF). A 22-year-old man with Class III malocclusion was referred to our clinic with complaints of facial deformity and chewing difficulty. To correct a prognathic mandible, facial asymmetry, flat occlusal plane angle, labioversion of the maxillary central incisors, and concavity of the facial profile, bimaxillary orthognathic surgery was planned. After preoperative orthodontic treatment, surgical planning based on the concept of 6 DOF was performed on a surgical treatment objective drawing, and a Jeon's model surgery chart (JMSC) was prepared. Model surgery was performed with Jeon's orthognathic surgery simulator (JOSS) using the JMSC, and an interim wafer was fabricated. Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, and malar augmentation were performed. The patient received lateral cephalometric and posteroanterior cephalometric analysis in postretention for 1 year. The follow-up results were determined to be satisfactory, and skeletal relapse did not occur after 1.5 years of surgery. When maxillary and mandibular models are considered as rigid bodies, and their state of motion is described in a quantitative manner based on 6 DOF, sharing of exact information on locational movement in 3-dimensional space is possible. The use of JMSC and JOSS will actualize accurate communication and performance of model surgery among clinicians based on objective measurements.
Congenital Abnormalities ; Dental Occlusion ; Facial Asymmetry ; Follow-Up Studies ; Freedom ; Humans ; Incisor ; Malocclusion ; Mandible ; Mastication ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Sagittal Split Ramus ; Recurrence

BACKGROUND/AIMS: New definitions of acute kidney injury (AKI) have recently emerged. Some studies have suggested that duration of AKI is an additional predictive parameter for mortality. Here, we evaluated whether AKI duration was predictive of long-term mortality in patients with hospital-acquired acute kidney injury (HAAKI). METHODS: We prospectively enrolled patients who developed HAAKI at an urban university hospital, from September 2007 to August 2008 and followed them until December 2011. Patients were divided into two groups by duration of the AKI (1 to 5 days vs. > or = 6 days), and long-term mortality was compared. RESULTS: HAAKI developed in 1.2% of patients during the enrollment period. The median follow-up period was 240 days (interquartile range, 53 to 1,428). In 42.3% of patients (n = 52), the AKI lasted 1 to 5 days, while it lasted > or = 6 days in 57.7% (n = 71). Survival analysis showed that a longer duration of AKI increased the risk of death. Long-term survival was significantly different in the two groups. CONCLUSIONS: The duration of AKI influenced mortality rates in hospitalized patients. Thus, AKI duration is a parameter affecting mortality in HAAKI.
Acute Kidney Injury/diagnosis/etiology/*mortality/therapy ; Aged ; Female ; *Hospitalization ; Hospitals, University ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Risk Factors ; Time Factors

BACKGROUND: In vitro detection of the allergen-specific IgE antibody (sIgE) is a useful tool for the diagnosis and treatment of allergies. Although multiple simultaneous allergen tests offer simple and low-cost screening methods, these platforms also have limitations with respect to multiplexibility and analytical performance. As an alternative assay platform, we developed and validated a microarray using allergen extracts that we termed “GOLD” chip. METHODS: Serum samples of 150 allergic rhinitis patients were used in the study, and the diagnostic performance of the microarray was compared with that of AdvanSure (LG Life Sciences, Daejun, Korea) and ImmunoCAP (Phadia, Uppsala, Sweden). Standard IgE samples were used for the quantitative measurement of sIgEs. RESULTS: The microarray-based assay showed excellent performance in the quantitative measurement of sIgEs, demonstrating a linear correlation within the range of sIgE concentrations tested. The limit of detection (LOD) was lower than 0.35 IU/mL, which is the current standard for the LOD cut-off. The assay also provided highly reproducible sets of data. The total agreement percentage of positive and negative calls was 92.2% compared with ImmunoCAP. Moreover, an outstanding correlation was observed between the microarray and the ImmunoCAP results, with Cohen's kappa and Pearson correlation coefficient values of 0.80 and 0.79, respectively. CONCLUSIONS: The microarray-based in vitro diagnostic platform offers a sensitive, reproducible, and highly quantitative method to detect sIgEs. The results showed strong correlations with that of ImmunoCAP. These results suggest that the new allergen microarray can serve as a useful alternative to current screening platforms, ultimately becoming a first-line screening method.
Biological Science Disciplines ; Diagnosis ; Humans ; Hypersensitivity* ; Immunoglobulin E ; In Vitro Techniques* ; Limit of Detection ; Mass Screening ; Methods ; Rhinitis, Allergic

Although hypertension is a well-known risk factor for chronic kidney disease (CKD), the blood pressure (BP) at which antihypertensive interventions should be initiated remains to be determined. Therefore, we investigated the association between BP and CKD in treatment-naïve individuals. Methods: This prospective cohort study considered 7,343 individuals in the Korean Genome and Epidemiology Study who were not taking antihypertensive medications. Subjects were categorized into six groups according to their systolic BP (SBP) and five groups according to their diastolic BP (DBP). The primary outcome was incident CKD, which was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2 or the development of proteinuria. The secondary outcome was incident cardiovascular disease (CVD). Results: In the time-varying Cox models, the hazard ratios (95% confidence interval [CI]) for CKD were 1.39 (1.10–1.77) with SBP 130–139 mmHg, 1.79 (1.40–2.28) with SBP 140–159 mmHg, and 3.22 (2.35–4.40) with SBP ≥ 160 mmHg, compared with SBP 100–119 mmHg. In addition, the hazard ratios (95% CI) for CKD were 1.88 (1.48–2.37) with DBP 90–99 mmHg and 4.30 (3.20– 5.76) with DBP ≥ 100 mmHg, compared with DBP 70–79 mmHg. A significantly increased CVD risk was also observed in subjects with SBP ≥ 130 mmHg or DBP ≥ 90 mmHg. Conclusion: Our findings indicate that SBP ≥ 130 mmHg and DBP ≥ 90 mmHg are associated with an increased risk of CKD. Therefore, BP-lowering strategies should be considered starting at those thresholds to prevent CKD development.

OBJECTIVE: Based on the constant associations made between major depressive disorder (MDD) and alpha asymmetry, and MDD and suicide, this study aimed to examine the relationship between frontal alpha asymmetry and suicide in MDD patients. METHODS: Sixty-six MDD patients, of whom fifteen were male and fifty-one were female, were recruited. Independent groups were created based on the median score of frontal alpha asymmetry: the left dominant (LD) group and the right dominant (RD) group. The alpha band (8–12 Hz) and its sub-bands (i.e., low alpha band: 8–10 Hz; high alpha band: 10–12 Hz) were of interest. Source level alpha asymmetry was calculated as well. RESULTS: Suicidal behavior was positively correlated with the asymmetry indices of the low alpha band and the alpha band in the LD group and that of the high alpha band in the RD group. Source level analysis revealed positive correlations between suicidal behavior and the asymmetry index of the low alpha band in the LD group. CONCLUSION: Frontal alpha asymmetry, especially that of the low alpha band, might reflect the cognitive deficits associated with suicidal behaviors in MDD patients.
Cognition Disorders ; Depression ; Depressive Disorder, Major ; Electroencephalography ; Female ; Humans ; Male ; Suicide

Microvascular thrombosis is an uncommon pathological finding in deceased donor kidneys. It is associated with disseminated intravascular coagulation (DIC) after brain injury in the donor. Although DIC in deceased kidney donors is known to have no association with graft outcome, microvascular thrombosis with DIC in a donor can cause renal graft impairment. For this reason, some transplantation centers do not accept these kidneys. A 39-year-old female donor had a subarachnoid hemorrhage. After a short period of cardiopulmonary resuscitation, we applied extracorporeal membrane oxygenation to maintain hemodynamic stability. The laboratory data were consistent with DIC. The recipient was a 38-year-old male patient who had been undergoing hemodialysis for 7 years because of end-stage renal disease of unknown cause. Zero-time graft biopsy revealed multiple intraluminal fibrin thrombi without peritubular capillaritis. Delayed graft function occurred after transplantation, and hemodialysis was started. Graft renal biopsy was performed on the third day after transplantation. The percentage of intraglomerular fibrin thrombi had decreased, and no significant peritubular capillaritis or C4d staining was observed. The function of the transplanted kidney started to recover, and hemodialysis was discontinued on the 10th day after surgery without specific treatment. Follow-up biopsy performed 20 days after the transplantation revealed normal kidney with completely resolved fibrin thrombi. We report herein a case of microvascular thrombosis in renal allograft from a DIC donor.
Adult ; Allografts ; Biopsy ; Brain Injuries ; Cardiopulmonary Resuscitation ; Dacarbazine ; Delayed Graft Function* ; Disseminated Intravascular Coagulation* ; Extracorporeal Membrane Oxygenation ; Female ; Fibrin ; Follow-Up Studies ; Hemodynamics ; Humans ; Kidney ; Kidney Failure, Chronic ; Male ; Renal Dialysis ; Subarachnoid Hemorrhage ; Thrombosis* ; Tissue Donors* ; Transplants

PURPOSE: Kidney length and volume are important parameters in the diagnosis of kidney disease. There has been no study for kidney volume in Korea. Therefore, we investigated the normal kidney volume and length using multidetector-row computerized tomography (MDCT). METHODS: One hundred and twenty-three Koreans were scanned for various medical reasons by MDCT. We measured kidney volume with three dimensional reconstruction programs. In the coronal section, we measured the craniocaudal length of both kidneys. Cross sectional kidney size was defined the sum of both sides of the rectangle enclosing the kidney at the level of the renal (hilum) vessel. Patients were excluded when they have the estimated GFR, calculated by modification of diet in renal disease, less than 90 ml/min/1.73m2, diabetes, any urinary abnormalities, renal anatomical abnormality, renal artery disease, more than three cysts and larger than 3 cm of cyst. RESULTS: Kidney volumes were 177+/-34 mL for men and 146+/-28 mL for women. There were no volume differences among age groups. Kidney lengths were 10.5+/-0.9 cm for left and 10.0+/-0.8 cm for right. The cross sectional kidney size was 10.8+/-1.1 cm for left and 10.7+/-1.0 cm for right. There was a high correlation between the kidney volumes and the cross sectional sizes (r=0.80). CONCLUSION: We suggest the reference values for kidney volume and length using MDCT. Measurement of kidney volumes may be more helpful to determine diagnosis and treatment of chronic kidney disease as compared with that of simple measuring kidney length.
Adult ; Diet ; Female ; Glycosaminoglycans ; Humans ; Kidney ; Kidney Diseases ; Korea ; Male ; Reference Values ; Renal Artery ; Renal Insufficiency, Chronic

Antibody-mediated rejection (ABMR) is associated with poor renal allograft survival. It shows poor response to conventional treatment with plasmapheresis, rituximab, and intravenous immunoglobulin. Bortezomib, a proteasome inhibitor used for treatment of multiple myeloma, has recently been reported as a treatment alternative for recipient desensitization and ABMR. A 58-year-old man was diagnosed with mixed-type ABMR with donor specific antibodies and acute T cell-mediated rejection early after kidney transplantation. Conventional therapy was administered, including antithymocyte globulin, plasmapheresis, and rituximab; however, his condition was found to be refractory to these antihumoral therapies. Following administration of bortezomib, his serum creatinine level returned to baseline with stable graft function. His serum creatinine level remains stable at 1.3 mg/dL at 10 months posttransplantation. Bortezomib is effective for treatment of refractory ABMR following kidney transplantation.
Allografts ; Antibodies ; Antilymphocyte Serum ; Bortezomib ; Creatinine ; Humans ; Immunoglobulins ; Kidney Transplantation ; Kidney* ; Middle Aged ; Multiple Myeloma ; Plasmapheresis ; Proteasome Inhibitors ; Rituximab ; Tissue Donors ; Transplantation* ; Transplants

BK virus nephropathy has emerged as an important cause of renal allograft dysfunction. Reduction in immunosuppression is the mainstay of BK virus nephropathy treatment. However, decreasing immunosuppressive medications is not sufficient for treatment of BK virus nephropathy. Therefore, there is a need for other treatment strategies such as cidofovir, leflunomide, and intravenous immunoglobulin in combination with immunosuppression reduction. Ciprofloxacin has recently been reported to have antiviral activity and decrease BK viral load in kidney transplant recipients. These findings suggest that the use of ciprofloxacin represents a valuable treatment strategy in patients with BK virus nephropathy. Here, we report on our experience with three patients who developed presumptive BK virus nephropathy after kidney transplantation, who, after 2 months of ciprofloxacin treatment, showed disappearance of BK viremia and improvement in the estimated glomerular filtration rate. Ciprofloxacin may be considered an effective treatment option for BK viremia in kidney transplant recipients.
Allografts ; BK Virus ; Ciprofloxacin ; Glomerular Filtration Rate ; Humans ; Immunoglobulins ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Transplantation* ; Viral Load ; Viremia