BACKGROUND: Aside from its well known peripheral antihypertensive effects, calcium also lowers blood pressure, when administered into the cerebral ventricle. The present study was aimed to determine whether the central depressor response to calcium is mediated by a stimulation of endogenous L-arginine-nitric oxide (NO) pathway. METHODA: Mean arterial pressure (MAP) and heart rate (HR) were continuously recorded from the femoral artery in anesthetized rats. Administration of calcium was performed into the right lateral cerebral ventricle. The effects of N G-nitro-L-arginine methyl ester (L-NAME) on the cardiovascular response to calcium were examined. RESULTS: Intracerebroventricular (ICV) injection of calcium consistently produced a decrease in MAP and HR. The depressor and bradycardiac responses to calcium showed a dose-dependent fashion. Pretreatment with a calcium channel blocker, diltiazem (1 micromol, ICV), attenuated cardiovascular responses to calcium. ICV infusion (1 microl/min) of L-NAME (200 microgram/kg and 20 microgram/kg/min for 60 min) increased MAP without significant changes in HR. Chronic ingestion of L-NAME (5 mg/100 ml in drinking water, 4 weeks) also increased the systolic blood pressure as compared with control. The depressor effect of ICV calcium was significantly diminished in acute or chronic L-NAME treated rats. CONCLUSION: These findings suggest that the central depressor response to calcium, at least in part, is NO-dependent.
Animals ; Arterial Pressure ; Blood Pressure ; Calcium Channels ; Calcium* ; Cerebral Ventricles ; Diltiazem ; Drinking Water ; Eating ; Femoral Artery ; Heart Rate ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Rats

Hypertensive encephalopathy is a medical disorder, which occurs with sudden increase of blood pressure (BP). The MRI findings of hypertensive encephalopathy are diffuse hyperintensity on T2-weighted images, predominantly within the cortex and subcortical white matter of the parieto-occipital lobe. The brainstem is rarely involved. Diffusion-weighted images do not show any abnormalities. We report two patients with hypertensive encephalopathy whose MRI showed exclusive brainstem involvement. They improved rapidly after BP control.
Blood Pressure ; Brain Stem* ; Humans ; Hypertensive Encephalopathy ; Magnetic Resonance Imaging

Hypertensive encephalopathy is a medical disorder, which occurs with sudden increase of blood pressure (BP). The MRI findings of hypertensive encephalopathy are diffuse hyperintensity on T2-weighted images, predominantly within the cortex and subcortical white matter of the parieto-occipital lobe. The brainstem is rarely involved. Diffusion-weighted images do not show any abnormalities. We report two patients with hypertensive encephalopathy whose MRI showed exclusive brainstem involvement. They improved rapidly after BP control.
Blood Pressure ; Brain Stem* ; Humans ; Hypertensive Encephalopathy ; Magnetic Resonance Imaging

No abstract available.
Choledochal Cyst*

We report the case of a 58-year-old man who developed multiple cerebral infarctions after ingesting accidently a 5% hydrogen-peroxide detergent solution. A 3~5% hydrogen peroxide solution is commercially available as an oxidant and detergent. Neurologic examination of this patient revealed grade III weakeness in both upper and lower limbs and bilateral positive Babinski signs. CT and MRI revealed bilateral multiple brain infarctions in the anterior and the middle vascular territories. The likely mechanism of pathogenesis must be paradoxical cerebral air embolism. Decompression through Nasogastric tube and hyperbaric oxygenation therapy were used to treating this patient. In spite of our intensive care, the patient expired 21days after ICU admission.
Brain Infarction ; Cerebral Infarction ; Decompression ; Detergents ; Eating* ; Embolism, Air* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Hyperbaric Oxygenation ; Critical Care ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Reflex, Babinski

PURPOSE: AST-120 is known to delay progression of chronic kidney disease (CKD) when combined with other proven therapy. AST-120 is an oral adsorbent for uremic toxin, such as indoxyl sulfate from the gastrointestinal tract. There have been a lot of studies to show its effect in other countries, but there are few studies done in Korea yet. METHODS: 195 patients were included in the study (mean age, 64+/-14 years; diabetes mellitus (DM), 104 patients; male, 130 patients). The patients with CKD who started AST-120 and maintained the medication for at least 6 months were enrolled. The patients' laboratory results for 6 months before and after administrating AST-120 was surveyed. Then the rate of patients' renal functional deterioration was compared before and after AST-120. In addition, adverse effects during the medication were surveyed. RESULTS: There were no statistically significant differences in laboratory data between before and after AST-120 administration. But, after administrating AST-120, the renal deterioration slope has blunted significantly from -0.0123+/-0.0318 to -0.0013+/-0.0184 dL/mg/month (p<0.01) in 1/sCr and from -1.1423+/-2.3906 to 0.0639+/-1.3825 ml/min/1.73m2/month (p<0.01) in estimated glomerular filtration rate (eGFR). There were no differences between DM and non-DM patients in the effect of AST-120, as well as ages over 70 and below 70. There were no serious adverse effects during medication. CONCLUSION: This study showed that AST-120 had additive effect on retarding the CKD progression when combined with established therapy regardless of DM and ages without serious adverse effects.
Carbon ; Diabetes Mellitus ; Gastrointestinal Tract ; Glomerular Filtration Rate ; Humans ; Indican ; Indoles ; Kidney Failure, Chronic ; Korea ; Male ; Oxides ; Renal Insufficiency, Chronic

A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO(3)(-) <3.0 %) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren's syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren's syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren's syndrome in a patient with autoimmune thyroiditis.
Acidosis ; Acidosis, Renal Tubular ; Antibodies ; Female ; Humans ; Hypokalemia ; Hypothyroidism ; Korea ; Lower Extremity ; Muscle Weakness ; Potassium Chloride ; Potassium Citrate ; Sensation ; Sjogren's Syndrome ; Thyroid Gland ; Thyroiditis, Autoimmune ; Xerophthalmia ; Xerostomia

PURPOSE: We evaluated allele frequencies and distribution of surfactant protein A2(SP-A2) in Korean neonates in order to estimate the prevalence of RDS, to find out new SP-A alleles, and to establish new steroid therapy. METHODS: Genomic DNA was extracted from 71 neonates and served as a template in PCR for genotype analysis. SP-A gene-specific amplications and gene-specific allele determinations were performed using PCR-cRFLP methods. RESULTS: The distribution for the alleles of the SP-A2 gene in the study population was 1A, 1A0, 1A1, 1A2, 1A3, 1A5, 1A6, 1A7, 1A8, 1A9, 1A11, 1A12. The specific frequencies for the alleles of the SP- A2 gene in the study population were : 1A=11.3%, 1A0=38%, 1A1=12.7%, 1A2=9.2%, 1A5=15.5%, 1A7= 2.9%, 1A8=4.9%, 1A9=2.2%, others=3.3%. CONCLUSION: The frequency of 1A0 was higher than the other SP-A2 alleles in Korean neonates. This finding suggests that the prevalence of RDS in Korea may be low compared with other countries. However, this finding also suggests that Korean neonates have a high risk of infection.
Alleles* ; DNA ; Gene Frequency ; Genotype ; Humans* ; Infant, Newborn* ; Korea ; Polymerase Chain Reaction ; Prevalence

BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis. METHODS: In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A. RESULTS: During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 +/- 1.0 to 9.0 +/- 0.7, p = 0.002 vs. 1.3 +/- 0.1 to 1.1 +/- 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 +/- 45.8 pmol/mL at baseline to 124.9 +/- 82.2 pmol/mL at 6 months, p = 0.043). CONCLUSIONS: Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
Aged ; Analysis of Variance ; Ankle Brachial Index ; Arteries/*drug effects/physiopathology ; Biological Markers/blood ; Blood Pressure/drug effects ; Calcium/*administration & dosage/adverse effects ; Compliance ; Female ; Hemodialysis Solutions/*administration & dosage/adverse effects/chemistry ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulsatile Flow/*drug effects ; *Renal Dialysis ; Republic of Korea ; Time Factors ; Treatment Outcome ; alpha-2-HS-Glycoprotein/metabolism

Sodium hypochlorite (NaOCl) is commonly used as a disinfectant or bleaching agent. The ingestion of household bleach is often benign, with minimal irritating effect on the mucosa. Occasionally, however, it can be life-threatening. Here, we report an unusual case of acute poisoning involving household bleach with a near-fatal outcome that was treated with intense hemodialysis. A 42-year-old woman presented to the emergency room after ingesting 1 liter of 5% household bleach. Ten hours later, her metabolic acidosis, hypernatremia, hyperchloremia, and renal failure deteriorated gradually, despite aggressive medical treatment. Rapid, effective correction of the metabolic acidosis and electrolytes imbalance was needed and hemodialysis was performed immediately. After 3 days of dialysis, the laboratory imbalance was completely corrected.
Acidosis ; Adult ; Dialysis ; Eating ; Electrolytes ; Emergencies ; Family Characteristics ; Female ; Humans ; Hypernatremia ; Mucous Membrane ; Renal Dialysis ; Renal Insufficiency ; Sodium ; Sodium Hypochlorite