We analysed retrospectively pharmacokinetic parameters of gentamicin and amikacin in 44 and 58 Korean pediatric patients, respectively, with normal renal function. Pharmacokinetic parameters were calculated from two concentrations in serum by method of Sawchuck. There was wide individual variation in peak serum concentrations of gentamicin and amikacin, Administration of the usually recommended doses yielded subtherapeutic concentrations in 47% and 82%, respectevely, of patients in the peak concentrations of gentamicin and amikacin. The volumes of distribution of gentamicin and amikacin in children of over 1 year of age were 0.37+/-0.13L/kg and 0.41+/-0.13L/kg which are greater than those reported from the western countries. We conclude that the wide individual variation and high frequency of subtherapeutic levels in the peak concentrations of gentamicin and amikacin obtained by usually recommended dosage as well as the narrow safety margin of these drugs necessitate monitoring of serum concentration and adjustment of individual dosage regimen early in the course of treatment with aminoglycosides.
Amikacin* ; Aminoglycosides ; Child* ; Gentamicins* ; Humans ; Pharmacokinetics* ; Retrospective Studies

BACKGROUND: Pitted keratolysis is a superficial bacterial infection which usually affects the pressure bearing areas of the feet. Some bacterial organisms were identified as etiologic agents, including Corynebacterium species, Micrococcus species and Dermatophilus congolensis. However, in Korea, studies to prove the causative organisms have not been performed. OBJECTIVE: We performed this study to identify causative organisms of pitted keratolysis in Korea. METHOD: Twelve normal healthy men and 27 pitted keratolysis patients were enrolled. We cultured the scraped specimens of the stratum corneum and identified the cultured organisms. We compared the cultured organisms of pitted keratolysis group with those of control group. We also compared the distribution of cultured organisms in pitted keratolysis with and without tinea pedis. RESULT: Micrococcus species and Corynebacterium species were identified in pitted keratolysis group much more frequently than in normal control group. In most cases of pitted keratolysis combined with tinea pedis, the identified organisms were Micrococcus species. CONCLUSION: Micrococcus species and Corynebacterium species are thought to be the major causative organisms of pitted keratolysis in Korea. Micrococcus species might play a certain antagonistic role, especially in patients of pitted keratolysis with tinea pedis.
Bacterial Infections ; Corynebacterium ; Foot ; Humans ; Korea ; Male ; Micrococcus ; Tinea Pedis

The classic presentation of renal cell carcinoma (pain, hematuria, and flank mass) occurs in a minority of patients and often is indicative of advanced disease. Common sites of metastatic renal cell carcinoma are lung, soft tissues, bone, and liver. Paranasal sinus is an unusual site for metastasis of renal cell carcinoma. One 73-year-old male presented to Soonchunhyang University Seoul Hospital with melena. Renal cell carcinoma with metastasis to duodenum was diagnosed by computed tomography (CT). He underwent right radical nephrectomy and Whipple's operation. Positron emission tomography/CT was performed postoperatively, and then metastasis to maxillary sinus was found by accident. He was treated with molecular targeted therapy (pazopanib hydrochloride 800 mg).
Aged ; Bone and Bones ; Carcinoma, Renal Cell* ; Duodenum ; Electrons ; Hematuria ; Humans ; Liver ; Lung ; Male ; Maxillary Sinus* ; Melena ; Molecular Targeted Therapy ; Neoplasm Metastasis* ; Nephrectomy ; Seoul

BACKGROUND: Massive release of glutamate plays an important role in ischemic neuronal injury, and modification of this process may provide neuroprotection. We studied the protective effects of the N- methyl-D-aspartate receptor antagonist ketamine on hind limb motor function and glutamate receptor of gene expression in an experimental model of spinal cord ischemia. METHODS: Transient spinal cord ischemia was induced by 15 min of thoracic aortic occlusion in 24 anesthetized Sprague-Dawly rats. Rats were randomly assigned to one of three treatment groups (n = 8 each): C group, no intervention; K30 group, ketamine 30 mg/kg intravenously; or K50 group, ketamine 50 mg/kg intravenously. Normothermia (38degreesC) was maintained during ischemia. After spinal ischemia neurologic function was evaluated immediately and after 1, 2 and 3 hours. After 3 hours rats were euthanized and spinal cords were removed for the assay of NMDAR and mGluR5 mRNA. RESULTS: Neurologic outcome was better in the K30 group than the C or K50 group (P < 0.05). The NMDAR mRNA expression of the K30 and K50 group were greater than those of the C group. The mGluR5 mRNA expression increased after spinal ischemia. There were no differences between groups. CONCLUSIONS: In this study demonstrated that treatment with ketamine 30 mg/kg intravenously before ischemia increases tolerance of spinal cord motor neurons in a period of normothermic ischemia.
Animals ; Extremities ; Gene Expression* ; Glutamic Acid* ; Ischemia ; Ketamine* ; Models, Theoretical ; Motor Neurons ; Neurons ; Rats* ; Receptors, Glutamate* ; RNA, Messenger ; Spinal Cord ; Spinal Cord Ischemia

BACKGOUND: The present study examined whether a blockade of nitric oxide (NO) synthesis affects the regulation of aquaporin (AQP) water channels in rats subjected to renal ischemia/reperfusion (I/R). METHODS: Renal I/R was experimentally induced by clamping the left renal artery for 60 minutes in rats. The rats were kept for 7 days thereafter, during which they were supplied with tap water containing NG-nitro-L-arginine methyl ester (L-NAME, 100 mg/L). The expression of AQP1-3 was determined in the kidney by Western blot analysis. RESULTS: In renal I/R injury, the expression of AQP2 was significantly decreased. The treatment with L-NAME further diminished the expression of AQP2. Although the expression of either AQP1 or AQP3 was not significantly altered in the kidney subjected to I/R, it was also significantly decreased by the treatment with L-NAME. CONCLUSION: It is suggested that endogenous NO system should play a role in the regulation of AQP water channels in rat kidney subjected to I/R injury.
Animals ; Aquaporins* ; Blotting, Western ; Constriction ; Ischemia ; Kidney* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Rats* ; Renal Artery ; Reperfusion

PURPOSE: We validate the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system for gastric cancer and propose a new staging system that reflects the prognostic significances of each of T and N category. METHODS: Data from 5,957 patients who underwent curative gastrectomies from 2000 to 2007 at 4 university hospitals in Daegu Metropolitan city in Korea were analyzed for the validation of the 7th AJCC/UICC staging system for gastric cancer. The hazard ratios of the respective T and N categories were estimated and converted to weightings and summated to make prognostic score (P-score). Homogeneity and stage grouping were determined according to the P-scores. RESULTS: In the 7th AJCC/UICC staging system for gastric cancer, poor discrimination was noted between stages IIB and IIIA (P = 0.152). In addition, heterogeneity in stage IIB (P = 0.021) and a small gap in 5-year survival rates (1.7%) between stages IA and IB were noted. A new proposed staging system was generated on the basis of P-scores and demonstrated more discrimination between stages and more homogeneity within stages. The new staging system reflects the different prognostic impacts of N3a and N3b. CONCLUSION: Several controversial issues of the 7th AJCC/UICC staging system for gastric cancer were reconfirmed in the present analysis. The TNM system based on P-score appears to be more scientifically accurate than the 7th AJCC/UICC staging system for gastric cancer.
Daegu ; Discrimination (Psychology) ; Gastrectomy ; Hospitals, University ; Humans ; Joints ; Korea ; Population Characteristics ; Retrospective Studies* ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in this population. The present study was aimed whether CRP, an important inflammatory marker, might be associated with cardiovascular risk in dialysis patients. METHODS: We performed retrospective study in 77 dialysis patients. Patients were divided into the elevated CRP group (>8 mg/L, n=11) and the normal CRP group (8 mg/L) showed significant higher cardiovascular events (by chi-squre test, p=0.032). BMI, smoking, alcohol, dialysis modality, lipid parameters, BUN, serum creatinine, serum protein, serum albumin and seurm TIBC did not show significant difference between two groups. Correlation between CRP and other biochemical parameters was analysed. Only ESR was positively correlated with CRP. In a subsequent analysis, elevated CRP group had significantly higher cardiovascular risk (by stepwise logistic regression method, odd ratio = 6.59;95% CI, 1.13 to 38.28). CONCLUSION: These results suggest that CRP level is correlated with cardiovascular risk in dialysis patients.
Atherosclerosis ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases* ; Creatinine ; Dialysis* ; Ferritins ; Humans ; Inflammation ; Logistic Models ; Male ; Mortality ; Peritoneal Dialysis ; Renal Dialysis ; Retrospective Studies ; Serum Albumin ; Smoke ; Smoking

BACKGROUND: Gabapentin is a novel anti-epileptic drug, which is used in clinical practice to treat epilepsy. This drug is also used as an analgesic in pain patients. The antinociceptive effect of this drug was assessed using the formalin test in the rat. METHODS: In order to investigate the effects of gabapentin on the trigeminal nerve territory, we injected 0.5 % formalin into the upper lip. Adult, male, Sprague-Dawley rats received a 50mul subcutaneous injection of 5% formalin into one vibrissal pad and the consequent, facial grooming behavior was monitored. Consistent with previous investigations using the formalin model, animals exhibited biphasic nocifensive grooming (phase 1, 0-12 min; phase 2, 12-60 min). RESULTS: The intraperitoneal administration gabapentin 5 minutes prior to the formalin injection led to a significant, dose-dependent reduction in grooming time during phase 2. In high doses, gabapentin also reduced the time of grooming during phase 1. CONCLUSIONS: The Intraperitoneal injection of gabapentin has an analgesic effect in the facial formalin rat model and this analgesic effect increases dose-dependently.
Adult ; Animals ; Epilepsy ; Formaldehyde* ; Grooming ; Humans ; Injections, Intraperitoneal ; Injections, Subcutaneous ; Lip ; Male ; Models, Animal ; Pain Measurement* ; Rats ; Rats, Sprague-Dawley ; Trigeminal Nerve

BACKGROUND: Erectile dysfunction (ED) is prevalent among patients with diabetes mellitus and impaired renal function. To estimate the prevalence of ED in diabetic nephropathy and to identify its risk factors, we carried out a survey of patients with diabetic nephropathy attending Chonnam University Hospital. METHODS: The presence of ED was assessed among 106 type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy using its self- administered International Index of Erectile Function (IIEF). ED was also classified into five validated severity levels, ranging from none (22-25), mild (17-21), mild/moderate (12-16), moderate (8-11), through severe (5-7). Logistic regression was used to examine associations between ED and other medical conditions. RESULTS: The mean age was 45.30+/-8.57 years in patients without ED and 58.53+/-8.46 years in patients with ED. The prevalence of any level of ED was 72% using IIEF. An independent t-test and chi-square demonstrated age, smoking, smoking duration, degree of nephropathy, coronary heart disease, neuropathy, diabetic foot, and retinopathy to be associated with the presence of any level of ED. Patients with ED had lower serum levels of hemoglobin, albumin, triglyceride, HDL-cholesterol and higher serum levels of BUN in unadjusted analyses compared with patients without ED. A multivariable logistic regression demonstrated age, serum creatinine concentration, and renal replacement therapy to be independently associated with the presence of any level of ED. CONCLUSION: ED is extremely prevalent among type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy. Increased age and serum creatinine concentration, and renal replacement therapy were associated with higher prevalence of ED.
Coronary Disease ; Creatinine ; Diabetes Mellitus ; Diabetic Nephropathies* ; Diabetic Neuropathies ; Erectile Dysfunction* ; Foot ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Prevalence ; Renal Replacement Therapy ; Risk Factors ; Smoke ; Smoking ; Triglycerides

Diabetic muscle infarction (DMI) is a rare condition occurring in subjects with long-standing complicated diabetes mellitus. We report DMI in a 65-year-old man with type 2 diabetes mellitus undergoing continous ambulatory peritoneal dialysis (CAPD) with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus for 21 years. In 1997, he reached end-stage renal disease and had received on renal replacement therapy with CAPD since then. In June 2002, he presented with sudden and spontaneous onset of severe pain in the right thigh region. He was afebrile, and the right thigh was swollen and tender but not erythematous. Laboratory data on admission included white blood cell count of 15, 800/mm3, hemoglobin 9.0 g/dL, platelet count 264, 000/mm3, BUN 102.3 mg/dL, serum creatinine 9.9 mg/dL, fasting blood glucose 85 mg/dL, postprandial 2 hours blood glucose 162 mg/ dL, hemoglobin A1C 5.84%, ESR 125 mm/h (it was 52 mm/h one month earlier), CRP 18.9 mg/dL, and normal levels of creatinine kinase. Magnetic resonance imaging (MRI) showed asymmetry of the muscle in T1-weighted images and increased signal intensity involving the medial portion of right thigh (adductor longus, adductor magnus, vastus intermedius muscle, etc) in T2-weighted images with no contrast enhancement. Radioisotope venography of the ileo-femoral veins was normal, excluding deep venous thrombosis as a cause. The right thigh was explored surgically and a biopsy taken from the vastus intermedius muscle was consistent with chronically inflammed scar tissue with no evidence of malignancy. A biopsy taken from the vastus intermedius muscle showed hemorrhagic necrosis of skeletal muscle, with lymphcytic infiltration. Most of the blood vessels appeared normal. The swelling resolved spontaneously following a few weeks of bedrest and analgesia. To our knowledge, this is the first reported case of DMI in patients undergoing renal replacement therapy in Korea.
Aged ; Analgesia ; Bed Rest ; Biopsy ; Blood Glucose ; Blood Vessels ; Cicatrix ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Humans ; Infarction* ; Kidney Failure, Chronic ; Korea ; Leukocyte Count ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Necrosis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Phlebography ; Phosphotransferases ; Platelet Count ; Quadriceps Muscle ; Renal Replacement Therapy ; Thigh ; Veins ; Venous Thrombosis