Urea reduction ratio (URR) and Kt/Vurea are objective parameters of dialysis delivery in hemodialysis patients and correlate with nutritional status and patient outcome. URR and Kt/Vurea depend on postdialysis blood urea nitrogen (BUN). In patients with severe postdialysis urea rebound (PDUR), these parameters do not accurately reflect dialysis adequacy. We measured PDUR 30 minutes after dialysis in 26 chronic stable hemodialysis patients. The impact of PDUR on dialysis delivery assessed by URR and Kt/Vurea and the independent factors affecting on PDUR were evaluated. All patients had been dialyzed for 4 hours thrice a week using hemophan membrane. 1) The mean age of patients was 48.6+/-14.8 years and sex ratio was 1:2.3. The mean duration of hemodialysis was 42.7+/-45.0 months. Primary renal diseases were chronic glomerulonephritis 11 (42.3%), diabetic nephropathy 7 (26.9%), and hypertension 4 (15.4%). 2) The mean blood flow was 209.2+/-17.4ml/min. URR, Kt/Vurea, and nPCR using immediate postdialysis BUN were 60+/-7%, 1.13+/-0.21, 1.09+/-0.28g/kg/ day, respectively. The mean recirculation rate was 4.4+/-2.3%. 3)The mean PDUR was 12.2+/-4.6% (range:6-22 %). URR, Kt/Vurea, and nPCR using BUN 30 minutes after dialysis were 55+/-7%, 0.99+/-0.18, and 1.02+/-0.25 g/kg/day, respectively and were significantly lower than those using immediate postdialysis BUN (P<0.05). 4) When the patients were divided according to the degree of PDUR (low PDUR group:<12%, high PDUR group: > or = 12%), high PDUR group was significantly higher than low PDUR group in hematocrit (27.0+/-2.6 vs. 23.5+/-3.6%, P=0.008), URR (64.3+/-5.4 vs. 55.8+/-6.8%, P=0.002), Kt/Vurea (1.26+/-0.17 vs. 1.03+/-0.18, P=0.002), and total recirculation rate (5.6+/-2.7 vs. 3.6+/-1.7%, P=0.05). There were no differences in age, sex, postdialysis body weight, ultrafiltration rate, blood flow, serum albumin, predialysis BUN, creatinine, and nPCR. 5) In multiple regression analysis, the independent factors affecting on PDUR were Kt/Vurea (beta=0.546, P<0.001), recirculation rate (beta=0.422, P<0.001), and hematocrit (beta=0.366, P=0.0017). In conclusion, we think that PDUR should be considered in hemodialysis patients when estimating dialysis delivery, especially if they had high Kt/ Vurea, recirculation rate, and hematocrit.
Blood Urea Nitrogen ; Body Weight ; Creatinine ; Diabetic Nephropathies ; Dialysis* ; Glomerulonephritis ; Hematocrit ; Humans ; Hypertension ; Membranes ; Nutritional Status ; Renal Dialysis* ; Serum Albumin ; Sex Ratio ; Ultrafiltration ; Urea*

This study was carried out to investigate the light and electron microscopic findings of the livers of rats after an intraperitoneal injection of cadmium chloride. The Sprague-Dawley rats were intraperitoneally injected with cadmium chloride dissolved in water, once a day for three days. These animals were sacrificed at 1, 3, 8, and 24 hr after the last injection. Control groups of the rats were also sacrificed in the same manner. The liver was extirpated and examined by both light and electron microscopy. The results obtained are as follows: The parenchyma of the liver shows focal neutrophilic infiltration and spotty necrosis. The hepatocytes show fatty change, ballooning degeneration, swelling of the endoplasmic reticulum and mitochondria, increase numbers of secondary lysosomes and residual bodies. Focal patic venules and sinusoids of the liver are congested. The Kupffer cells are increase in number. Therefore, it can be concluded that the cadmium is directly acted to hepatocytes resulting in cellular injuries and deposits in the fat droplets of the cytoplasm of the hepatocytes, not Ito cells as previously suggeted.
Rats ; Animals

The Inyo nail is a new intramedullary device for the treatment of the lateral malleolus. fracture of the ankle with the advantage of rigid fixation. The authors have experieced 16 cases of the Inyo nailing for the ankle fracture and fallowed more than 1 year in the 11 of them. Two groups of patients were evaluated; Group I was treated with the Inyo nail and Group II was treated by conventional technique. The following results were obtained; 1. The Inyo nail was suitable for treatment of type A & B fractures of the ankle. 2. Group I patients resumed their preinjury ROM of the ankles and activity earlier than Group II. 3. The results in the radiographic rating and fuctional criteria were excellent in those cases of Group I than those of Group II.
Ankle Fractures ; Ankle ; Humans

The symphysis pubis is a nonsynovial amphiarthrosis in which the bodies of the two pubic bones are united by a fibrocartilaginous disk. This forms subsidiary tie arches that augment femorsacral arch in the erect position, ischiosacral arch in the sitting position. In normal state the symphysis is strong enough not to be separated. We experienced 5 cases of separated symphysis pubis developed during labor at the Catholic Hospital from January 1987 to December 1988. The duration of follow-up was between 12 and 19 months without any residual symptom after conservative treatment.
Follow-Up Studies ; Pubic Bone

Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Twenty-four fractures of the calcaneus in the twenty-two patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type 1(non-displaced), Type 2(displaced) and Type 3(comminuted). There were one Type 1, fourteen Type 2, and nine type 3 fractures, all of which were treated with open reduction, internal fixation, with or without bone graft. The length of follow-up ranged from eighteen to thirty-six months(mean, 23 months). the results were fraded by a predetermined point system. The one Type 1 had an excellent result. Of the fourteen Type 2 fractures, four had and excellent result; seven good result; two fair; and one poor. Of the nine Type 3 fractures, two had good; three fair; and four poor result. On the basis of our study, we believed that open reduction and internal fixation was a good method of treatment for the displacce or mildly comminuted intra-articular fractures of the cal-caneus.
Calcaneus ; Classification ; Follow-Up Studies ; Humans ; Intra-Articular Fractures ; Methods ; Prognosis ; Tomography, X-Ray Computed ; Transplants

There is no sport in which the knee does not play an integral role. Blazina described the clinical aspects and treatment of the “jumper's knee”. A jumper's knee is a tendinitis of the patella or less frequently quadriceps tendon at the inferior or superior pole of the patella, respectively. It is typically encountered in athletes who are involved in some type of repetitive activity such as jumping, climbing, kicking, or running. the pathology is still ill understood and further date on the etiology and treatment are scarce. Fourty seven cases of patella tendinitis were analyzed in clinical aspects. Results of the study are as follows: l. Of the 47 cases, male were 9 or 19.1%, female were 38 or 80.9%. 2. Complained pain on proximal pole of patella were 11 or 23.4%, both pole were 9 or 19.1%, distal pole were 27 or 57.4%. 3.0f 47 cases, 22 cases or 46.8% were Grade I, 20 cases or 42.5% were Grade II, 4 cases or 8.5% were Grade III, 1 case or 2.1% was Grade IV. 4. 1 case, Grade IV, was confirmed fracture on distal pole of patella by radiologic examination. 5. The Grade I & II patients had subsided an improved by a few days rest, Quadriceps and Hamstrings setting exercise, Ice massage and medication.
Athletes ; Female ; Humans ; Ice ; Knee ; Male ; Massage ; Patella ; Pathology ; Running ; Sports ; Tendinopathy ; Tendons

Of 35 patients with 38 knees treated using simple excision method for Osgood-Schlatter lesion, had a distinct and separate ossicle at the tibial tubercle. All ossicles were attached to the distal part of the undersurface of the ligamentum patellae and were separated from the tuberosity by a bursa or scar tissue. Surgical excision of ossicle along with adjacent bursa was satisfactory and simplest procedure to relieve the symptoms, did not respond to conservative treatment.
Cicatrix ; Humans ; Knee ; Methods ; Patellar Ligament

Patients with chronic renal failure, generally, sufferred from normocytic normochromic anemia caused by decreased level of erythropoietin. But, secondary erythrocytosis has been reported in patients with several renal diseases; renal artery stenosis or throm- bosis, polycystic kidney disease, bilateral hydronephrosis, etc. We report one case of chronic renal failure combined with polycythemia vera. The case was 32 year-old man whose chief complaints were dyspnea, back pain, itching sensation, headache. 6 month ago, the laboratory examination showed only proteinuria and hematuria without deterioration of renal function. The renal function was aggravated with an accelerated course, and bone marrow examination revealed hypercellularity (erythroid predominance), and renal biopsy showed the finding of the end stage of renal disease which may be originated from IgA nephropathy.
Adult ; Anemia ; Back Pain ; Biopsy ; Bone Marrow Examination ; Dyspnea ; Erythropoietin ; Glomerulonephritis, IGA* ; Headache ; Hematuria ; Humans ; Hydronephrosis ; Immunoglobulin A* ; Kidney Failure, Chronic* ; Polycystic Kidney Diseases ; Polycythemia Vera* ; Polycythemia* ; Proteinuria ; Pruritus ; Renal Artery Obstruction ; Sensation

The testicular feminization is the most common type of male pseudohermaphroditism. Mutation of androgen receptor gene impairs normal sexual differentiation in genetic male (46, XY) and subsequently develops secondary female characteristics. We report three cases of complete testicular feminization syndrome with normal development of female external genitalia, but with blindly ended vagina and inguinal or pelvic masses. Microscopic examination of the testes and their adnexa had three components: 1) A testis composed of immature tubules, prominent Leydig cells and a spindle cell stroma resembling ovarian stroma with hamartomatous nodule or Sertoli cell adenoma, 2) a white, whorled, firm, smooth muscle body in the medial pole of the testis, and 3) a lateral adnexal cysts of varying sizes.
46, XY Disorders of Sex Development ; Adenoma ; Androgen-Insensitivity Syndrome* ; Cryptorchidism* ; Disorders of Sex Development ; Female ; Genitalia ; Humans ; Leydig Cells ; Male ; Muscle, Smooth ; Receptors, Androgen ; Sex Differentiation ; Testis ; Vagina

Cerebral infarcts rarely occur following head injury. Carotid artery dissection is usually proposed mechanism in such cases. We experienced a case of middle cerebral artery (MCA) infarct occurred just after head trauma without evidence of vascular abnormality. A 59-year-old male was transported to the emergency room immediately after traffic accident. He had right zygomatic fracture without neck injury. Left hemiparesis was noticed, and brain CT revealed hyperdense MCA sign in the right side. His neurologic status deteriorated over 2 days, and brain MRI showed total right MCA infarct with midline shift. Cerebral angiography was unremarkable. Two months later he had improved so much, but left hemiparesis with right MCA infarction re-developed. We suggest head trauma immediately can induce cerebral infarct without neck vessel injury, and in differential diagnosis of focal neurologic deficit after trauma, cerebral infarct as well as hemorrhage or contusion must be considered.
Accidents, Traffic ; Brain ; Carotid Arteries ; Cerebral Angiography ; Contusions ; Craniocerebral Trauma* ; Diagnosis, Differential ; Emergency Service, Hospital ; Head* ; Hemorrhage ; Humans ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Middle Cerebral Artery* ; Neck ; Neck Injuries ; Neurologic Manifestations ; Paresis ; Zygomatic Fractures