Sodium concentration in the hemodialysis solution has been increased to prevent intradialytic hypotension after highly effective and shortened time hemodialysis(HD) was introduced in the late 70's. Many authors have pointed out that the high concentration in the dialysate sodium HD may be one of causes of increasing difficulty in the management of hypertension in HD patients. Sodium profiling hemodialysis (SPHD) is a modified form of high sodium dialysate HD. Even though sodium concentration is decreased progressively to the conventional level during the HD session, the time-averaged sodium concentration is usually higher compared to that of conventional HD. To evaluate the effect of dialysate sodium concentration on interdialytic blood pressure(BP) control, we conducted a cross over study. Eleven patients showing more than four episodes of intradialytic hypertension per month were studied(5 male, 6 female; 52+-13 years). All subjects underwent 8-week conventional HD(CHD)(dialysate Na+ 138mEq/L X 4 hour) and 8-week step-down SPHD(Na+ 150mEq/L X 2 hours> OR =140 X 1> OR =138 X 1) on the order of random assignment. At the end of each peiords, interdialytic 24-hour BP were measured by 24-hour Ambulatory BP monitor(ABPM : 90207, Space Labs, USA). 1) Time-averaged sodium concentration in dialy sate were 138mEq/L during SPHD and 144.5mEq/L during CHD. Pre HD serum sodium were not significantly different between two periods but post HD serum sodium and intradialytic increase of serum sodium significantly higher during SPHD period 138.1+/-0.5 v 141.1+/-0.6mEq/L, 0.5+/-0.6 v 2.6+/-0.4mEq/L, p<0.05). Dry weight was determined before the start of study and not changed throughout the study periods. Interdialytic weight gain and the amount of ulfrafiltration required to maintain the determined dry weight were significantly higher during SPHD period compared to those during CHD period(2.5+/-0.5 v 3.6+/-0.6 kg, 2.6+/-0.8 v 3.6+/-0.8kg, p<0.01). 2) The frequency of interdialytic hypotension was significantly reduced during SPHD period(23.9 v 15 %, p<0.01). But the frequency of symptoms requiring intervetion such as ultrafiltration adjustment or saline infusion was not different between two periods. Thirst during interdialytic period was significantly frequent during SPHD(37.8 vs 30% 138.1+/-0.5 v 141.1+/-0.6mEq/L, 0.5+/-0.6 v 2.6+/-0.4mEq/L, p<0.05). 3) Day-time, night-time and 24 hour mean systolic BP measured by 24 hour ABPM were significantly higher during SPHD period(149.2+/-4.8, 144.3+/-3.6, 146.6+/-4.1mmHg) than during CHD period(140.1+/-4.8, 133.0+/-4.1, 136.4+/-4.6mmHg, p<0.01). Day-time, night-time and 24 hour mean diastolic BP were also significantly higher during SPHD period(82.6+/-1.5, 84.1+/-1.4, 86.1+/-1.4mmHg) than during CHD period (78.7+/-2.2, 79.6+/-2.3, 81.8+/-2.2mmHg, p<0.05). 4) Systolic load and diastolic load by the criteria of higher than 150/90mmHg throughout the day increased significantly from 21.1+/-7.0 and 18.2+/-6.3% during CHD period to 41.7+/-9.9 and 28.4+/-4.7% during SPHD period. Diurnal difference was not different between the two periods but a significant number of dippers(36.4%) converted to nondipper during SPHD period. Our results shows SPHD increases interdialytic BP and its load. It also adversely alter diurnal variation and dipping status. The additional sodium load and an consequent excessive interdialytic weight gain aassociates with SPHD might contribute to this findings.
Blood Pressure* ; Female ; Humans ; Hypertension ; Hypotension ; Male ; Renal Dialysis* ; Sodium* ; Thirst ; Ultrafiltration ; Weight Gain

Simultaneous bilateral proximal femoral fractures are extremely rare, and a few have been reported in and outside the country. It may have various causes, and most cases were associated with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, and anti-epileptic medications. We experienced a case of simultaneous bilateral proximal femoral fractures after generalized tonic-clonic seizure in a 70-year-old female. Herein, we report it with a review of the literature.
Aged ; Female ; Femoral Fractures ; Femur Neck ; Hip ; Hip Fractures ; Humans ; Seizures

No abstract available.
Empyema, Tuberculous* ; Lymphoma, Non-Hodgkin* ; T-Lymphocytes*

Objective: Dysphagia has been reported to occur in patients with inflammatory myopathy (IM). Although high-resolution impedance manometry (HRIM) provides precise information regarding the pharyngeal pressure, it has not yet been used for assessing dysphagia in routine clinical practice. This study determined whether the results of HRIM for evaluating deglutition disorders in patients with IM could reflect an abnormality that can’t be identified by a video fluoroscopic swallowing study (VFSS). Methods: We reviewed both VFSS and HRIM results of nine patients with IM, four of whom presented with globus sensation. Results: Cricopharyngeal muscle dysfunction was noted in all four patients with globus sensation, and the upper esophageal sphincter residual pressure (UESRP) was higher (≥8 mmHg) in the patients with pharyngeal residue.Using VFSS and HRIM, we demonstrated that dysphagia in patients with IM may arise owing to failed relaxation of UES or decreased hyolaryngeal excursion. Conclusion In conclusion, UES-RP values of ≥8 mmHg indicate the presence of pharyngeal residue and globus sensation in patients with IM. HRIM provided a comprehensive assessment of the mechanisms of dysphagia, and HRIM facilitated recognizing subtle abnormalities in pharyngeal contraction and UES function. HRIM can overcome the limitations of VFSS by allowing clinicians to perform objective measurements in patients with IM.

BACKGROUND: The aim of this study was to estimate the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Korea. In addition, we planned to do a performance analysis of the Registration Project of Type 1 diabetes for the reimbursement of consumable materials. METHODS: To obtain nationwide data on the incidence and prevalence of T1DM, we extracted claims data from July 2011 to August 2013 from the Registration Project of Type 1 diabetes on the reimbursement of consumable materials in the National Health Insurance (NHI) Database. For a more detailed analysis of the T1DM population in Korea, stratification by gender, age, and area was performed, and prevalence and incidence were calculated. RESULTS: Of the 8,256 subjects enrolled over the 26 months, the male to female ratio was 1 to 1.12, the median age was 37.1 years, and an average of 136 new T1DM patients were registered to the T1DM registry each month, resulting in 1,632 newly diagnosed T1DM patients each year. We found that the incidence rate of new T1DM cases was 3.28 per 100,000 people. The average proportion of T1DM patients compared with each region's population was 0.0125%. The total number of insurance subscribers under the universal compulsory NHI in Korea was 49,662,097, and the total number of diabetes patients, excluding duplication, was 3,762,332. CONCLUSION: The prevalence of T1DM over the course of the study was approximately 0.017% to 0.021% of the entire population of Korea, and the annual incidence of T1DM was 3.28:100,000 overall and 3.25:100,000 for Koreans under 20 years old.
Diabetes Mellitus, Type 1* ; Epidemiology* ; Female ; Humans ; Incidence ; Insurance ; Korea* ; Male ; National Health Programs ; Prevalence

Objective: The purpose of this study was to verify the hypothesis, by performing objective measurements, that tongue pressure will have an association with swallowing function in patients with Parkinson’s disease. It was also of interest whether measures of lingual function were consistent with reports of swallowing related quality of life. Methods: The subjects were 18 patients with Parkinson’s disease. Their tongue pressure was examined by using an Iowa oral performance instrument (IOPI). They all underwent video fluoroscopic swallowing study (VFSS) and they completed a Korean swallowing-quality of life questionnaire (K-SWAL-QOL). Tongue pressures were measured in the anterior (MTPa: maximal tongue pressure anterior) and posterior (MTPp: maximal tongue pressure posterior). The cutoff value of MTP was 34 kPa. Results: The average of tongue pressure was decreased in both anterior (MTPa=27.79±13.44 kPa) and posterior (MTPp=19.20±8.88 kPa), and MTPp of all the subjects was less than 34 kPa. For the MTPa, 11 patients were under 34 kPa (abnormal group) and 7 patients were above 34 kPa (normal group). The oral transit time (OTT) of the abnormal MTPa group was significantly delayed more than that of the normal group (P=0.006). On the correlation analysis, the MTPa and OTT, MTPa and penetration aspiration scale (PAS), MTPp and PAS showed significant negative correlations with each other. The MTP and the social, sleep and fatigue subscores of K-SWAL-QOL showed significant positive correlations. Conclusion In patients with Parkinson’s disease, lower tongue pressure was related to delayed oral transit time and a higher aspiration tendency. We expect the clinical usage of the easily measured tongue pressure to predict the swallowing function and help plan the correct treatment.

PURPOSE: The volume of thyroid cancer screening and subsequent thyroid fine-needle aspiration (FNA) have rapidly increased in South Korea. We analyzed the thyroid cancer diagnoses/thyroid FNA ratio according to the annual number of FNA to evaluate changes in the diagnosticefficiency of FNA. MATERIALS AND METHODS: This was a nationwide population-based retrospective cohort study. The overall thyroid cancer diagnoses/thyroid FNA ratio and annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratio were indirectly calculated using data obtained from the Korea Central Cancer Registry database and the Korean National Health Insurance Service claims database from 2004 to 2012. Pearson correlation analyses were performed to evaluate the strength of linear associations between variables. RESULTS: The number of thyroid FNA increased from 28,596 to 177,805 (6.2-fold increase) from 2004 to 2012. The overall thyroid cancer diagnoses/thyroid FNA ratio decreased from 36.5% in 2004 to 25.1% in 2012 and was negatively correlated to the number of FNA (R=‒0.977, p < 0.001). The annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratios (range, 15.3% to 30.7%) were always lower than the overall thyroid cancer diagnoses/thyroid FNA ratio in each year and also worsened according to the increase in the number of FNA (R=‒0.853, p=0.007). CONCLUSION: The diagnostic performance of both overall and annual incremental thyroid FNA worsened, whereas the number of thyroid FNA procedures increased. More sophisticated indications for FNA are required to improve its diagnostic efficiency, considering the increased burden of screening-detected thyroid nodules.
Biopsy, Fine-Needle ; Cohort Studies ; Korea ; Mass Screening ; National Health Programs ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

Anaplastic thyroid carcinoma (ATC) is difficult to distinguish from other cancers, especially when its pathological features are atypical for ATC or when the tumor is totally undifferentiated and occurs after a considerable lapse of time, in an area remote from the original site of the tumor. Here, we present two patients (68-year-old man and 56-year-old woman) with rare manifestations of ATC, which were initially thought to be other malignancies. Immunohistochemical tests, using various markers, failed to provide information about the origin of these tumors. However, both patients had a history of papillary thyroid carcinoma (PTC) from several years ago and BRAF mutations were observed in the undifferentiated tumors, as well as in the previous PTCs. Therefore, we could make a diagnosis of ATC derived from PTC. As such, BRAF mutation analysis may serve as a useful tool for ATC diagnosis in challenging ATC cases.
Diagnosis ; Humans ; Immunohistochemistry ; Middle Aged ; Thyroid Carcinoma, Anaplastic* ; Thyroid Neoplasms

Rhinovirus infection is typically associated with the common cold and has rarely been reported as a cause of severe pneumonia in immunocompetent adults. A 55-year-old previous healthy woman, who consumed half a bottle of alcohol daily, presented with respiratory failure after one week of upper respiratory infection symptoms. Radiography revealed bilateral, diffuse ground glass opacity with patchy consolidation in the whole lung field; bronchoalveolar lavage fluid analysis indicated that rhinovirus was the causative organism. After five days of conservative support, the symptoms and radiographic findings began to improve. We report this rare case of rhinovirus pneumonia in an otherwise healthy host along with a review of references.
Adult* ; Alcohol Drinking ; Bronchoalveolar Lavage Fluid ; Common Cold ; Female ; Glass ; Humans ; Lung ; Middle Aged ; Pneumonia ; Radiography ; Respiratory Insufficiency* ; Rhinovirus*

Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare. We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis. We report a case of extramedullary plasmacytoma of the pancreas diagnosed using EUS-FNA.
Biopsy, Fine-Needle* ; Bone Marrow ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Pancreas* ; Plasmacytoma*