PURPOSE: To investigate the incidence and predictive factors associated with the development of chronic kidney disease (CKD) in patients undergoing curative surgery for renal cell carcinoma. MATERIALS AND METHODS: From 2003 to 2010, we retrospectively investigated 108 patients undergoing partial nephrectomy or radical nephrectomy (RN) for renal tumors with a preoperative glomerular filtration rate (GFR)> or =60. The GFR was calculated by use of the four-variable modification of diet in renal disease (MDRD) formula. CKD was defined as an estimated GFR (eGFR) less than 60 mL/min per 1.73 m2. Demographic and clinicopathologic parameters were evaluated by using the chi-square and Student t-tests and multivariate regression analysis to determine the variables independently associated with the development of postoperative CKD. RESULTS: Of the 108 patients without preoperative CKD, CKD developed in 43 patients (39.8%). In the analysis of clinical factors between patients with and those without CKD development, gender, body mass index, diabetes mellitus, hypertension, and tumor size were not significant clinical factors. Statistical significance for CKD development was found for age of 60 years or greater (p=0.013), decreased preoperative eGFR (p<0.001), and RN group (p<0.001). In the multivariate analysis, decreased preoperative eGFR (p=0.001) and RN group (p=0.002) were significant independent predictors. CONCLUSIONS: The results of our study show that decreased preoperative renal function and RN were significant independent predictors of postoperative CKD. In patients who had a relatively decreased preoperative eGFR, especially when estimated by use of the MDRD formula, nephron-sparing surgery should be considered for the treatment of small renal tumors.
Body Mass Index ; Carcinoma, Renal Cell* ; Diabetes Mellitus ; Diet ; Glomerular Filtration Rate ; Humans ; Hypertension ; Incidence ; Multivariate Analysis ; Nephrectomy ; Renal Insufficiency* ; Renal Insufficiency, Chronic ; Retrospective Studies

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The purpose of this study was to assess the interrelationship of maximal step length (MSL) measurement as protective strategies and risk factors of falls. METHODS: The study population consisted of 149 community-dwelling people (> or = 60 yrs). Demographic data, depression degree (GDS-short form), fatigue degree (revised Chalder's fatigue scale) were reviewed by self-recorded questionnaire. K-MMSE, MSL, US and TUG were done when they visited our clinic. We examined whether MSL was correlated with the six leg-directions and was related to other measures to evaluate fall risk. To examine the association between MSL and other variables, we analyzed data by T-test, ANOVA and multiple regressions. RESULTS: The MSLmean correlated highly with each leg- direction MSL (correlation coefficient, r=0.771~0.941, P<0.01), US (r=0.392, P<0.01) and TUG (r=-0.608, P<0.01). The MSL(mean/L) (MSL(mean), leg length adjusted) correlated strongly with frequent fall (P=0.005). Also, the MSL(mean/L) had a tendency to be low in the elderly, females, in those with regular exercise, widowed or divorced, DM, stroke, dementia suspicion, inclination toward depression, arthritis and frequent falls, but higher score on fatigue groups. Age (P<.001), sex (P=0.001), DM (P<.001), frequent falls (P= 0.017), dementia suspicion (P=0.016), and arthritis (P= 0.024) variables were related with MSL(mean/L) when we examined these variables by multiple regression analysis. CONCLUSION: MSL was correlated highly with other functional performance test and DM, age, sex, frequent fall, dementia suspicion, and arthritis variables for fall risk.
Adult ; Aged ; Arthritis ; Dementia ; Depression ; Divorce ; Fatigue ; Female ; Humans ; Leg ; Risk Factors ; Stroke ; Widowhood ; Surveys and Questionnaires

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The purpose of this study was to assess the interrelationship of maximal step length (MSL) measurement as protective strategies and risk factors of falls. METHODS: The study population consisted of 149 community-dwelling people (> or = 60 yrs). Demographic data, depression degree (GDS-short form), fatigue degree (revised Chalder's fatigue scale) were reviewed by self-recorded questionnaire. K-MMSE, MSL, US and TUG were done when they visited our clinic. We examined whether MSL was correlated with the six leg-directions and was related to other measures to evaluate fall risk. To examine the association between MSL and other variables, we analyzed data by T-test, ANOVA and multiple regressions. RESULTS: The MSLmean correlated highly with each leg- direction MSL (correlation coefficient, r=0.771~0.941, P<0.01), US (r=0.392, P<0.01) and TUG (r=-0.608, P<0.01). The MSL(mean/L) (MSL(mean), leg length adjusted) correlated strongly with frequent fall (P=0.005). Also, the MSL(mean/L) had a tendency to be low in the elderly, females, in those with regular exercise, widowed or divorced, DM, stroke, dementia suspicion, inclination toward depression, arthritis and frequent falls, but higher score on fatigue groups. Age (P<.001), sex (P=0.001), DM (P<.001), frequent falls (P= 0.017), dementia suspicion (P=0.016), and arthritis (P= 0.024) variables were related with MSL(mean/L) when we examined these variables by multiple regression analysis. CONCLUSION: MSL was correlated highly with other functional performance test and DM, age, sex, frequent fall, dementia suspicion, and arthritis variables for fall risk.
Adult ; Aged ; Arthritis ; Dementia ; Depression ; Divorce ; Fatigue ; Female ; Humans ; Leg ; Risk Factors ; Stroke ; Widowhood ; Surveys and Questionnaires

Primary tumors arising from the spermatic cord are very rare. Mesothelioma derives from the mesothelial cells lining the serous membrane, such as the pleura, peritoneum, and tunica vaginalis of testis. Paratesticular malignant mesothelioma (MM), which usually presents as a hydrocele or intrascrotal mass, accounts for 0.3% to 1.4% of MMs. MMs of the spermatic cord account for less than 10% of paratesticular MMs. We report a case of MM of the spermatic cord in a 65-year-old man who primarily presented to the hospital with a left inguinal mass. Following the diagnosis after surgery, he was found to have a contralateral right inguinal mass and died in 6 months. Despite their rare occurrence in the spermatic cord, MMs need to be suspected, especially in patients with a history of asbestos exposure.
Aged ; Asbestos ; Humans ; Mesothelioma ; Peritoneum ; Pleura ; Serous Membrane ; Spermatic Cord ; Testis

Cryoglobulinemia is the presence of globulins in the serum that precipitate on exposure to cold temperatures (cryoglobulins). Pulmonary complications of cryoglobulinemia include interstial infiltration, impaired gas exchange, small airway disease and pleurisy. Only one other acute respiratory distress syndrome(ARDS) case has been described in patients with cryoglobulinemia. A 55-years old man was admitted with dyspnea. He had been diagnosed as being a hepatitis B virus antigen carrier 15 years age. On the first admission, chest radiography showed a bilateral pleural effusion and a patchy infiltration on both lungs. On protein-and immuno-electrophoresis, cryoglobulinemia was confirmed. The patient was treated with corticosteroid and plasmapheresis. Forty-five days after the diagnosis, the patient complained of progressive dyspnea and showed a diffuse bilateral pulmonary infiltration on chest radiography. Despite intensive care with mechanical ventilation, the patient died as consequence of hypoxemia and multiple systemic organ failure. On a pathologic examination of the postmortem lung biopsy, multiple necrotizing vasculitis and increased infiltration of the lymphocytes and monocytes were observed. In conclusion, ARDS developed as a result of pulmonary hemorrhage due to cryoglobulinemia-associated vasculitis.
Anoxia ; Biopsy ; Cold Temperature ; Cryoglobulinemia ; Diagnosis ; Dyspnea ; Globulins ; Hemorrhage ; Hepatitis B virus ; Humans ; Critical Care ; Lung ; Lymphocytes ; Monocytes ; Plasmapheresis ; Pleural Effusion ; Pleurisy ; Radiography ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Thorax ; Vasculitis

In 2009, infection with the liver fluke Clonorchis sinensis (C. sinensis) was classified as "carcinogenic to humans" (Group 1) based on its involvement in the etiology of cholangiocarcinoma by the International Agency for Research on Cancer. However, little is known about the descriptive epidemiology of cholangiocarcinoma in Korea. We examined incidence trends of intrahepatic and extrahepatic cholangiocarcinomas, using data from the Korea National Cancer Incidence database for 1999-2005. The prevalence of C. sinensis infection was estimated from a recent population-based survey in rural endemic areas. Cholangiocarcinoma incidence rates are currently rising, even while primary liver cancer incidence rates are decreasing. Annual percent changes in cholangiocarcinoma incidence rates were 8% for males and 11% in females. Known areas of C. sinensis endemicity showed high incidence rates of cholangiocarcinoma. The positivity of C. sinensis eggs in stool samples from endemic areas was more than 25% of adults tested during 2005-2008. From a meta-analysis, the summary odds ratio for cholangiocarcinoma due to C. sinensis infection was 4.7 (95% confidence interval: 2.2-9.8). Approximately 10% of cholangiocarcinomas in Korea were caused by chronic C. sinensis infections. More specific policies, including health education and an extensive effort for early detection in endemic areas, are needed.
Adult ; Aged ; Aged, 80 and over ; Animals ; Bile Duct Neoplasms/*epidemiology/parasitology ; Bile Ducts, Intrahepatic/parasitology/*pathology ; Cholangiocarcinoma/*epidemiology/parasitology ; Clonorchiasis/*epidemiology ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication resulting in mortality and renal graft failure. PTLD is a heterogeneous disorder, which causes different clinical forms of disease from non-specific viral syndrome to malignant lymphoma and has various etiologies, clinical features, and treatment strategies. Here, we report on a patient who had a PTLD in the hilum of a transplanted kidney at 5 months after renal transplantation. The PTLD resulted in hydronephrosis of the transplanted kidney and graft dysfunction by local urinary tract obstruction. Despite treatment including immunosuppression reduction and rituximab administration, we removed the transplanted kidney from the recipient because the PTLD did not respond to the therapy.
Humans ; Hydronephrosis ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Lymphoma ; Lymphoproliferative Disorders* ; Mortality ; Rituximab ; Transplants ; Urinary Tract*

A 61-year-old man was diagnosed with aortic stenoinsufficiency with periannular abscess, which involved the aortic root of noncoronary sinus (NCS) that invaded down to the central fibrous body, whole membranous septum, mitral valve (MV), and tricuspid valve (TV). The open complete debridement was executed from the aortic annulus at NCS down to the central fibrous body and annulus of the MV and the TV, followed by the left ventricular outflow tract reconstruction with implantation of a mechanical aortic valve by using a leaflet of the half-folded elliptical bovine pericardial patch. Another leaflet of this patch was used for the repair of the right atrial wall with a defect and the TV.
Abscess* ; Aortic Valve ; Debridement ; Endocarditis ; Humans ; Middle Aged ; Mitral Valve* ; Tricuspid Valve*

OBJECTIVES: EEG coherence could imply the connectivity between two different areas of the brain, which is known to be important in the pathophysiology of bipolar I disorder(BPD I) and schizophrenia. The authors investigated EEG coherence in patients with BPD I and schizophrenia to examine the connectivity of the neural circuit. METHODS: EEGs were recorded in 15 schizophrenia and 14 bipolar disorder patients, and 14 age-matched normal control subjects from 16 electrodes with linked-ear reference. Spectral parameters and coherence were calculated for the alpha bandwidth(8-13Hz) by a multi-channel autoregressive model using 20 artifact-free 2-seconds epochs and the differences were compared among three groups by two different statistical methods; F-test and Kruskal-Wallis test. Furthermore, when there were significant differences among three groups, Scheffe's multiple comparison tests were provided and Jonckheere-Terpstra tests for the ordered alternative were given. RESULTS: In the intra-hemispheric comparison, left frontal coherence was increased in order of control, BPD I and schizophrenia. In the inter-hemispheric comparison, 1) inter-prefrontal coherence in BPD I was significantly higher than in normal controls, and 2) inter-prefrontal coherence in schizophrenia was significantly lower than in controls. CONCLUSION: These results suggest that 1) both schizophrenia and BPD I are diseases having the abnormality of neural circuit connectivity in both frontal and prefrontal lobes, and 2) the abnormality is more severe in schizophrenia than in BPD I. Furthermore, the data support that a common pathogenetic process may reside in both schizophrenia and BPD I.
Bipolar Disorder* ; Brain ; Electrodes ; Electroencephalography* ; Humans ; Schizophrenia*

OBJECTIVES: To evaluate the drug interactions between aripiprazole and haloperidol, authors investigated plasma concentrations of those drugs by genotypes. METHOD: Fifty six patients with a confirmed Diagnostic and Statistical Manual of Mental Disorders 4th edition diagnosis of schizophrenia were enrolled in this eight-week, double blind, placebo-controlled study. Twenty-eight patients received adjunctive aripiprazole treatment and twenty-eight patients received placebo while being maintained on haloperidol treatment. Aripiprazole was dosed at 15 mg/day for the first 4 weeks, and then 30 mg for the next 4 weeks. The haloperidol dose remained fixed throughout the study. Plasma concentrations of haloperidol and aripiprazole were measured by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) at baseline, week 1, 2, 4 and 8. *1, *5, and *10 B alleles of CYP2D6 and *1 and *3 alleles of CYP3A5 were determined. The Student's T-test, Pearson's Chi-square test, Wilcoxon Rank Sum test and Logistic Regression analysis were used for data analysis. All tests were two-tailed and significance was defined as an alpha < 0.05. RESULTS: In the frequency of CYP2D6 genotype, *1/*10 B type was most frequent (36.5%) and *1/*1 (30.8%), *10B/*10B (17.3%) types followed. In the frequency of CYP3A5 genotype, *3/*3 type was found in 63.5% of subjects, and *1/*3 type and *1/*1 were 30.8% and 5.8% respectively. The plasma levels of haloperidol and its metabolites did not demonstrate significant time effects and time-group interactions after adjunctive treatment of aripiprazole. The genotypes of CYP2D6 and 3A5 did not affect the plasma concentration of haloperidol in this trial. No serious adverse event was found after adding aripiprazole to haloperidol. CONCLUSION: No significant drug interaction was found between haloperidol and aripiprazole. Genotypes of CYP2D6 and 3A5 did not affect the concentration of haloperidol after adding aripiprazole.
Alleles ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Diagnostic and Statistical Manual of Mental Disorders ; Aripiprazole ; Drug Interactions ; Genotype ; Haloperidol ; Humans ; Logistic Models ; Mass Spectrometry ; Piperazines ; Plasma ; Quinolones ; Schizophrenia ; Statistics as Topic