Eales disease is an uncommon idiopathic vasoproliferative retinal disease that primarily affects the peripheral retina. We experienced a 17-year-old male patient who was referred to our clinic because of retinal hemorrhage at the superior temporal quadrant of his left eye. After excluding other causes of branch retinal vein occlusion with medical evaluation, the primary branch retinal vein occlusion was diagnosed. During the follow-up period, retinal vasculitis developed in the peripheral retina of his both eyes along with rapid development of the neovascularization in the left eye. Eales disease was diagnosed. In spite of scattered laser photocoagulation, vitreous hemorrhage eventually occurred, requiring pars plana vitrectomy. We emphasize the occurrence of the branch retinal vein occlusion in young patient with Eales disease.
Adolescent ; Follow-Up Studies ; Humans ; Light Coagulation ; Male ; Retina ; Retinal Diseases ; Retinal Hemorrhage ; Retinal Vasculitis ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Vitrectomy ; Vitreous Hemorrhage

N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a useful marker for left ventricular (LV) dysfunction in patients without kidney disease. This study was conducted to clarify the relationship between NT-proBNP and LV systolic function in patients with decreased renal function. We studied 256 chronic kidney disease (CKD) patients, patients on dialysis were excluded. The median glomerular filtration rate was 24 (13-36) mL/min/1.73 m(2) and the median NT-proBNP was 4,849 (1,310- 19,009) pg/mL. The prevalence of LV systolic dysfunction increased from the lower to the upper NT-proBNP quartiles (I, 17%; II, 34%; III, 61%; and IV, 72%; p<0.001 for trend). The NT-proBNP quartile was an independent predictor of LV systolic dysfunction after adjustment for renal function, compared with quartile I: II, odds ratio (OR) 3.99 (95% confidence interval [CI],1.34-11.93); III, OR 11.28 (95% CI, 3.74-33.95); and IV, OR 36.97 (95% CI, 11.47-119.1). Area under the curve and optimum cut points for NT-proBNP to detect LV systolic dysfunction were 0.781 and 2,165 pg/mL in CKD stage 3, 0.812 and 4,740 pg/mL in CKD stage 4, and 0.745 and 15,892 pg/ mL in CKD stage 5. The NT-proBNP level was a predictor of LV systolic dysfunction in CKD patients. Optimum cut points should be stratified according to renal function.
Aged ; Area Under Curve ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/*complications/pathology ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Peptide Fragments/diagnostic use ; Prevalence ; Protein Structure, Tertiary ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/complications/diagnosis ; *Ventricular Function, Left

Though the 2009 worldwide influenza A (H1N1) pandemic has been declared to have ended, the influenza virus is expected to continue to circulate from some years as a seasonal influenza. A rapid antigen test (RAT) can aid in rapid diagnosis and allow for early antiviral treatment. We evaluated the clinical usefulness of RAT using SD Bioline Influenza Antigen Test(R) kit to detect the influenza virus, considering various factors. From August 1, 2009 to October 10, 2009, a total of 938 patients who visited the outpatient clinic at Korea University Guro Hospital with influenza-like illnesses were enrolled in the study. Throat or nasopharyngeal swab specimens were obtained from each of the patients. Using these specimens, we evaluated the influenza detection rate by rapid antigen test based on the real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) method. In comparison with rRT-PCR, the sensitivity and specificity of the RAT were 44.0% and 99.9%, respectively. The cyclic threshold values of RAT negative specimens were higher than RAT positive specimens (30.1+/-3.1 vs. 28.3+/-3.9, p=0.031). The sensitivity of the RAT kit was higher in patients who visited clinics within two days of symptom onset (60.4% vs. 11.1%, p=0.026). The results of this study show that the RAT cannot be recommended for general use in all patients with influenza-like illness because of its low sensitivity. The RAT may be used, only in the settings with limited diagnostic resources, for patients who visit a clinic within two days of symptom onset.
Antigens, Viral/genetics ; Humans ; Influenza A Virus, H1N1 Subtype/genetics/immunology/*isolation & purification ; Influenza, Human/*diagnosis/virology ; Reagent Kits, Diagnostic ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity ; Time Factors

BACKGROUND: The annual prevalence of foot ulcer in Korea is 99.5 per 100,000 people with diabetes and 49.8 cases among them go through amputation. Moreover, amputation due to uncontrolled infection accounts for 50% of all non-traumatic limb amputations. Therefore, reliable microbiological documentation is important. MATERIALS AND METHODS: We enrolled 74 patients with diabetic foot infection, who referred to Korea University Hospital from September 2006 to March 2007. Deep tissue biopsies were taken from the base of ulcer after surgical debridement and cleansing at admission. We analyzed the microbiological differences according to the sex, age, type and duration of diabetes, glycemic control, presence of neuropathy or angiopathy, diabetic nephropathy, osteomyelitis, transcutaneous oxygen tension and prior antibiotic use. RESULTS: Gram-positive aerobic bacteria were the most common organisms isolated (76.4%), followed by Gram-negative aerobic bacteria (33.3%) and fungus (2.0%). Of the Gram-positive aerobes, methicillin-resistant Staphylococcus aureus (MRSA) was found most frequently (29.4%). The clinical and laboratory findings showed no significant clinical differences between gram-positive and gram-negative infections. Moreover, there was no difference in clinical findings between methicillin-susceptible and methicillin-resistant S. aureus infections. Mixed infection was not common (average, 1.2 organisms with each diabetic foot infection). Of note, mixed infection was more frequently found in patients with prior antibiotic use. CONCLUSION: MRSA was the most common pathogen in diabetic foot infection among patients referred to tertiary hospital. There was no significant difference of clinical and laboratory findings with regard to gram stain results and methicillin resistance in S. aureus. Mixed infection was not common, but broad spectrum antibiotics are recommended for severe diabetic foot infection with prior antibiotic exposure.
Amputation ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Biopsy* ; Coinfection ; Debridement ; Diabetic Angiopathies ; Diabetic Foot* ; Extremities ; Foot Ulcer ; Fungi ; Gram-Negative Aerobic Bacteria ; Humans ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Oxygen ; Prevalence ; Tertiary Care Centers ; Ulcer

BACKGROUND: The annual prevalence of foot ulcer in Korea is 99.5 per 100,000 people with diabetes and 49.8 cases among them go through amputation. Moreover, amputation due to uncontrolled infection accounts for 50% of all non-traumatic limb amputations. Therefore, reliable microbiological documentation is important. MATERIALS AND METHODS: We enrolled 74 patients with diabetic foot infection, who referred to Korea University Hospital from September 2006 to March 2007. Deep tissue biopsies were taken from the base of ulcer after surgical debridement and cleansing at admission. We analyzed the microbiological differences according to the sex, age, type and duration of diabetes, glycemic control, presence of neuropathy or angiopathy, diabetic nephropathy, osteomyelitis, transcutaneous oxygen tension and prior antibiotic use. RESULTS: Gram-positive aerobic bacteria were the most common organisms isolated (76.4%), followed by Gram-negative aerobic bacteria (33.3%) and fungus (2.0%). Of the Gram-positive aerobes, methicillin-resistant Staphylococcus aureus (MRSA) was found most frequently (29.4%). The clinical and laboratory findings showed no significant clinical differences between gram-positive and gram-negative infections. Moreover, there was no difference in clinical findings between methicillin-susceptible and methicillin-resistant S. aureus infections. Mixed infection was not common (average, 1.2 organisms with each diabetic foot infection). Of note, mixed infection was more frequently found in patients with prior antibiotic use. CONCLUSION: MRSA was the most common pathogen in diabetic foot infection among patients referred to tertiary hospital. There was no significant difference of clinical and laboratory findings with regard to gram stain results and methicillin resistance in S. aureus. Mixed infection was not common, but broad spectrum antibiotics are recommended for severe diabetic foot infection with prior antibiotic exposure.
Amputation ; Anti-Bacterial Agents ; Bacteria, Aerobic ; Biopsy* ; Coinfection ; Debridement ; Diabetic Angiopathies ; Diabetic Foot* ; Extremities ; Foot Ulcer ; Fungi ; Gram-Negative Aerobic Bacteria ; Humans ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Oxygen ; Prevalence ; Tertiary Care Centers ; Ulcer

OBJECTIVE: Although cyclophosphamide (CYC) is effective for the treatment of diffuse proliferative lupus nephritis (DPLN) and severe membranous nephropathy (MN), it has serious adverse effects. Therefore, we evaluated our clinical observations with mycophenolate mofetil (MMF) for empirical treatment of DPLN and severe MN. METHODS: Seventeen patients with biopsy proven severe MN (n=8) and DPLN (n=9) received MMF for > or = 6 months as primary treatment (n=9) or subsequent maintenance therapy after CYC treatment (n=8). Treatment outcome was evaluated by random urine protein/creatinine ratio (UP/Cr) and serum creatinine (sCr) at the start and at 12 months and compared by the Wilcoxon signed-rank test. RESULTS: Overall, the mean (+/-SD) UP/Cr decreased in both MN (6.48+/-3.03 vs. 1.31+/-1.22, p= 0.016) and DPLN (3.77+/-2.34 Vs 0.83+/-0.53, p=0.043) patients. No significant change in serum Cr was detected in both MN and DPLN patients. Adverse events included nausea/abdominal discomfort (n=1) and menstrual irregularity (n=1). CONCLUSION: Short term empirical treatment with MMF in the majority of patients with severe MN and DPLN was well tolerated and effective in decrease of proteinuria and stabilization of renal function. Controlled clinical trials are necessary to define the role of MMF in the treatment of severe MN and DPLN.
Biopsy ; Creatinine ; Cyclophosphamide ; Glomerulonephritis, Membranous* ; Humans ; Lupus Nephritis* ; Proteinuria ; Treatment Outcome

Polyomavirus BK viral allograft nephritis is a great challenge in posttransplant management and graft survival because of difficulty in diagnosing and treatment. Initial treatment usually involves reducing immunosuppressive medications. However if concomitant acute rejection exist, it is more challenging in managing these patients, because acute rejection requires increase in immunosuppression. We present a case of a 35-year-old man who developed BK viral allograft nephritis and concomitant acute rejection 3 months after transplantation. BK viral allograft nephritis was missed in diagnosis and only pulse steroids for anti-rejection therapy was done. Initially, renal function was improved, but 4 months later, he presented with deterioration in renal function. Second renal biopsy showed BK allograft nephritis without rejection. BK viral DNA in plasma by PCR and urinary decoy cell were also positive. Reduction in immunosuppression by discontinuing mycophenolate mofetil stabilized the deterioration in renal function, however it failed to clear viremia.
Adult ; Allografts* ; Biopsy ; BK Virus* ; Diagnosis ; DNA, Viral ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation ; Nephritis ; Nephritis, Interstitial* ; Plasma ; Polymerase Chain Reaction ; Polyomavirus ; Steroids ; Viremia

OBJECTIVE: Although hemodialysis using heparin bound Hemophan (HBH-HD) has been reported to be a possible modality in patients at risk of bleeding, the efficiency and safety of HBH-HD is not certain. Therefore, we prospectively compared the safety and efficiency of HBH-HD with those of saline flushing HD (SF-HD) and HD using low dose heparin (LDH-HD) in 13 HD patients at risk of bleeding in a cross-over design. METHODS: The safety and efficiency were evaluated by measuring activated partial prothrombin time (aPTT) before and during HD, hemostasis time after needle removal, total blood compartment volume (TBCV) loss of dialyzer, urea clearance (K) and Kt/V. RESULTS: There was no difference in compression time needed to achieve hemostasis at puncture site after needle removal between HBH-HD, SF-HD and LDH-HD. During HBH-HD, there was a slight increase in aPTT at 15 min (50.6+/-4.5 sec), compared to predialysis levels (40.9+/-4.7 sec). In this cross- over study, aPTT during dialysis session was markedly higher in LDH-HD than those in HBH-HD or SF-HD (p<0.05). The loss of TBCV of the dialyzer was greater in SF-HD than HBH-HD or LDH-HD (17.4+/-1.9% vs. 12.4+/-1.4% vs. 10.1+/-1.8%). However, there was no difference in K (212.0+/-30.7 vs. 217.2+/-36.9 vs. 221.6+/- 29.5 mL/min) and Kt/V (1.22+/-0.12 vs. 1.24+/-0.16 vs. 1.26+/-0.18). CONCLUSION: We concluded that the safety and efficiency of HBH-HD are not different compared to SF-HD or LDH-HD and HBH-HD could an alternative hemodialysis method in patients at risk of bleeding.
Anticoagulants ; Cross-Over Studies ; Dialysis ; Flushing* ; Hemorrhage* ; Hemostasis ; Heparin* ; Humans ; Needles ; Prospective Studies ; Prothrombin Time ; Punctures ; Renal Dialysis* ; Urea

BACKGROUND: Recombinant human erythropoietin (rHuEPO) is an established treatment for renal anemia. We aimed to determine that high dose subcutaneous epoetin alfa is as efficient and safe as usual dose for treating anemia in peritoneal dialysis patient. METHODS: Twenty four patients on CAPD were randomly assigned to either 10, 000 IU (high dose group, n=12) or 4, 000 IU (usual dose group, n=12) epoetin alfa regimen with variable interval for 24 weeks. If hematocrit was out of range (30-39%), the interval was changed within 50% of previous interval. RESULTS: Mean hemoglobin levels at randomization and after 12 weeks and 24 weeks were 11.4+/-1.3, 11.3+/-1.1, and 11.6+/-1.2 g/dL in high dose group compared with 10.8+/-0.8, 11.5+/-1.1, and 10.9+/-1.2 g/dL in usual dose group (p<0.05). The mean weekly epoetin alfa dosages at randomization and after 12 and 24 weeks were 93.2+/-45.3, 95.5+/-33.6, and 102.5+/-43.6 IU/kg in high dose group compared with 78.8+/-29.4, 75.9+/-20.6 and 75.5+/-39.7 IU/kg in usual dose group (p<0.05). But, interval in high dose group was two times as longer as usual dose group. Adverse events were generally mild and transient CONCLUSION: This study demonstrates that epoetin alfa 10, 000 IU is as efficient and safe as 4, 000 IU with similar weekly dose in CAPD patients. epoetin alfa 10, 000 IU administration reduces frequency of injections about one half.
Anemia ; Erythropoietin ; Hematocrit ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Random Allocation ; Epoetin Alfa

BACKGROUND: Recombinant human erythropoietin (rHuEPO) is an essential and well-established treatment for renal anemia. Rcently, clinicians have moved toward administration of high dose rHuEPO to reduce the inconvenience and time efficient.We aimed to determine whether high dose subcutaneous (SC) epoetin alfa is as efficient and safe as the usual dose for treating anemia in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Twenty-four patients on CAPD were randomly assigned to a high-usual dose group (n=12) and an usual-high dose group (n=12) with a variable interval for 48 weeks. Patients received 10 times treatments by scheduled visiting during Period I lasting 24 weeks and received 4 times treatments by scheduled visiting in Period II lasting 24 weeks by cross-over. The high dose was 10,000 IU and the usual dose was 4,000 IU epoetin alfa regimen. If hematocrit was out of the targeted range, 30~39%, the interval of epoetin alfa was changed within 50% of the previous interval. RESULTS: Fifteen patients, out of 24, completed the study (8 patients in the high-usual dose group; 7 patients in the usual-high dose group). Mean hemoglobin levels at randomization and after 12, 24, 36 and 48 weeks were 10.8+/-1.1, 11.5+/-0.9, 11.5+/-1.5, 11.4+/-1.5, 11.5+/-0.8 g/dL, respectively, in high-usual dose group compared with 11.2+/-0.8, 11.4+/-1.2, 11.2+/-0.9, 11.2+/-1.4, 11.4+/-0.9 g/dL, respectively, in usual-high dose group. The mean weekly epoetin alfa dosages at randomization and after 12, 24, 36 and 48 weeks were 83.6+/-38.1, 87.1+/-35.8, 89.4+/-34.2, 60.1+/-25.1, 62.8+/-30.7 IU/kg/week, respectively, in high-usual dose group compared with 69.8+/-31.6, 64.9+/-12.2, 69.9+/-46.1, 78.8+/-29.3, 75.9+/-16.4 IU/kg/week, respectively, in usual-high dose group. No statistically significant differences between the two groups were apparent for hemoglobin levels or mean weekly epoetin alfa dosages. Treatment interval at Period I and Period II were 13.3+/-5.3, 8.2+/-4.3 days in high-usual dose group compared with 7.0+/-2.5, 13.4+/-4.0 days in usual-high dose group with statistically significant differences. Treatment interval in high dose was about two times as longer as usual dose. Adverse events were generally mild and transient, and pain on injection site following subcutaneous administration was rarely reported. CONCLUSIONS: This study demonstrates that epoetin alfa 10,000 IU is as efficient and safe as 4,000 IU with a similar weekly dose in CAPD patients. Epoetin alfa 10,000 IU administration can reduce frequency of injections by about one half.
Anemia ; Cross-Over Studies* ; Erythropoietin ; Hematocrit ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Random Allocation ; Epoetin Alfa