Recombinant human erythropoietin(rHuEPO) therapy has been associated with new onset or exacerbated hypertension. But there are debates on the mechanism for the new onset or exacerbated hypertension after rHuEPO. We have studied the effects of rHuEPO on intradialytic changes in plasma concentration of vasoactive substances. The plasma concentrations of vasoactive substances were investigated before and after hemodialysis in 15 nondiabetic patients with chronic renal failure. The hemodialysis were performed for 210 to 300min by using bicarbonate dialysate. A hemophan dialyzer was used. Blood pressure were measured every 30 min by using Centrysystem(R)3 BP monitor. Patients were grouped into two groups; one was EPO group treated with rHuEPO(n=7, 4000-6000U/week for more than 3 months) and the other was Non-EPO group (n=8, treated without rHuEPO). beta-endorphin, motilin and mean arterial blood pressure(MABP) were unchanged in the EPO group. In contrast, in the Non-EPO group, an increase in beta-endorphin(154.4 +/- 46.3 to 208.3 +/- 68.1pg/mL, p < 0.05) and a decrease in motilin(221.1 +/- 43.1 to 70.6 +/- 7.1pg/mL, p < 0.05) occurred. MABP decreased gradually until 3 hours after start of hemodialysis in these groups. Arginine vasopressin decreased in both groups. But angiotensin II, endothelin-1 and atrial natriuretic peptide were unchanged in both groups. These results indicate that rHuEPO administration have effects on the intradialytic changes in plasma concentration of vasodialtors during bicarbonate hemodialysis. Moreover, the above results suggest that rHuEPO administration may have effects on hemodynamic stability and gastrointestinal function during bicarbonate hemodialysis.
Angiotensin II ; Arginine Vasopressin ; beta-Endorphin ; Blood Pressure ; Endothelin-1 ; Erythropoietin* ; Hemodynamics ; Humans* ; Hypertension ; Kidney Failure, Chronic ; Motilin ; Plasma* ; Renal Dialysis

OBJECTIVE: The accurate evaluation of dry weight followed by hemodialysis is very important. So far, dry weight has been clinically estimated by using diagnostic parameters such as weight changes during dialysis, blood pressure, extremity edema, pulmonary edema, and chest X-rays. However, these methods result in frequent trials and errors because of the low accuracy. Recently, new methods have been attempted in a non-invasive way of determining dry weight. Bioelectric impedance method has been reported to be highly related to hemodynamic parameters before and after hemodialysis, and plasma atrial natriuretic peptide(ANP) and cyclic guanosine 3', 5'-monophosphate(cGMP) concentrations have been known to represent the amount of blood. In this study, we compared and analyzed the method of dry weight evaluation followed by hemodialysis by using multifrequency bioelectric impedance method(BIA method) and biochemical index(ANP method and cGMP method). METHODS: Subjects consisted of seventeen patients who had received maintenance hemodialysis. Using multifrequency bioelectric impedance method before and after hemodialysis, a RTBW/RECF ratio in the right lower extremity was measured. Plasma ANP and cGMP concentrations were measured by collecting blood in arterial port. RESULTS: 1)Changes before and after hemodialysis: Post- dialysis weight decreased by 2.1+/-0.22kg. A RTBW/ RECF ratio significantly decreased from 0.3525+/-0.004 pre-dialysis to 0.3292+/-0.002 post-dialysis(p< 0.01). Plasma cGMP concentration(pmol/mL) significantly decreased from 23.9+/-4.4 pre-dialysis to 8.8+/-3.4 post-dialysis(p<0.01), and plasma ANP concentration(pg/mL) significantly decreased from 315+/-64 pre-dialysis to 222+/-71 post-dialysis(p<0.05). The extent of weight loss was not associated with above three parameters after dialysis. 2)The relationship between RTBW/RECF ratios and biochemical parameters:No relationship was noted between two parameters before dialysis, while a significant relationship was observed with plasma cGMP concentrations or plasma ANP concentrations after dialysis(r=0.705, p<0.01; r=0.653, p<0.01, respectively). 3)The measure of agreement in estimation of dry weight after dialysis(kappa value):Although the consistencies of a BIA method and a cGMP method were good(kappa=0.64), the consistency between a BIA method and an ANP method was low(kappa=0.21), and the consistency between a cGMP method and an ANP method was almost negligible(kappa=0.09). CONCLUSION: In conclusion, RTBW/RECF ratio or plasma cGMP concentration can be used, but plasma ANP concentration is not suitable for evaluating dry weight after dialysis.
Atrial Natriuretic Factor ; Blood Pressure ; Dialysis ; Edema ; Electric Impedance* ; Extremities ; Guanosine ; Hemodynamics ; Humans ; Lower Extremity ; Plasma ; Pulmonary Edema ; Renal Dialysis ; Thorax ; Weight Loss

The use of osseointegrated implants is an accepted procedure for the treatment of Total, or partial edentulism and offers good predictability of long-term success. Osseointegration implies a firm and direct interlocking between vital bone and screw-shaped titanium implants. There should be not to interposed tissue between fixture and bone. This study was undertaken to assess the clinical condition, complication, and prosthodontic aftercare of different implant systems. One hundred fifty-nine patients treated with a total of 503 endosseous implants (364 Steri-oss threaded type, 69 Integral cylinder with HA coated type, 35 Steri-oss threaded with HA coated type, 21 Steri-oss cylinder with HA coated type and 14 3i implant type), Most of the implant were placed in type B and C bone quantity and type 2 and 3 bone quality according to Lekhorm and Zarb. The success rate of Steri-oss threaded type during healing and function was 92%, Steri-oss threaded type with hydroxyapatite coated was 91%, Steri-oss cylinder type with hydroxyapatite coated was 90%, Integral cylinder type with hydroxyapatite coated was 90% and 3i implant type was 93%. One hundred twenty-nine patients had been treated with implant prosthesis. 79 of these patients had received a fixed type prosthesis and 50 patients had received a removable type prosthesis. There were no differences between the implant systems with regard to age, gender. Failures were associated with poor bone quality, smaller implant sizes, a surgical installation technique and stress distribution when in function. Visual analgoue scales recorded as satisfied results functionally and esthetically, but 15% dissatified with chewing ability.
Aftercare ; Dental Implants* ; Durapatite ; Humans ; Mastication ; Mouth Rehabilitation* ; Mouth* ; Osseointegration ; Prostheses and Implants ; Prosthodontics ; Titanium ; Weights and Measures

Atypical polypoid adenomyoma(APA) is a rare benign polypoid tumor arising in the uterine endometrium which was first designated by Mazur in 1981. Microscopic examination reveals architecturally and cytologically atypical endometrial glands separated by intersecting fascicles of smooth muscle cells. The tumor can be misdiagnosed as endometrial adenocarcinoma with myometrial invasion, especially on microscopic examination of a curettage specimen. However a granulation tissue-like stromal response is absent and the smooth muscle in APA is more cellular than that of normal myometrium. We are reporting 2 cases of APA of the uterine endometrium which are 1.5 cm and 1.7 cm in size, respectively, in a 30 and a 22 year-old women. This is the first report in Korean literature using the immunohistochemical staining for smooth muscle actin and desmin.
Female ; Humans ; Adenocarcinoma

Phylloides tumor is very similar to giant fibroadenoma in that they have benign appearance in breast radiologic image. Fibroadenoma has no malignant potential, but phylloides tumor is locally recurrent, invasive and may occasionally metastasize. It thus appears that evaluation of the differential point of the two tumor groups by radiologic study is very important. We retrospectively compared sonographic find;.ngs of 6 cases of phylloides tumor with those of 4 cases of fibroadenoma, which proved pathologically in Ye mgnam University Hospital from 1984 to 1986. The mean age of the patients were 31.8 years old(from 14 to 41 years old) in phylloides tumor and 28.8 years old (from 17 to 40 years old) in giant fibroadenoma, respectively. The viewpoints of this analysis were size, shape and contour of the masses, internal echo pattern, posterior enhancement, and especially the existence of peripheral cyst or septal band echo. We found that diffenentiation of these two tumors by sonography was difficult. But peripheral cyst was found only in phylloides tumor and septal band echo was found largely in giant fibroadenoma. Although the existence of peripheral cyst or septal band echo in the breast mass was not pathognomonic findings, we suggest that the existence of septal band echo is preferential finding to fibroadenoma, and peripheral cyst is preferential finding to phylloides tumor.
Breast ; Diagnosis, Differential* ; Fibroadenoma* ; Humans ; Retrospective Studies ; Ultrasonography

OBJECTIVE: Many patients has suffered from intradialytic hypo- or hypertension. These unsatisfactory control of blood pressure(BP) may be due to inadequate ultrafiltration during HD. In this study, segmental multifrequency BIA was used to estimate dry weight(DW). Then, ultrafiltration adequacy was evaluated according to the estimated DW. METHODS: Total body water resistance(RTBW) and extracellular fluid resistance(RECF) were measured on the right lower extremity in 36 maintenance HD patients(22 men and 14 women) and in 234 control subjects(171 men, 63 women). BP was measured every 30 minutes during HD. Patients with RTBW/ RECF ratio higher and lower than the mean+/-2SD of control subjects were considered to be over- and underhydrated, respectively. RESULTS: 1)RTBW/RECF ratio of control subjects was 0.3402+/-0.0062. 2)RTBW/RECF ratio of HD patients was 0.3650+/-0.0190 before and 0.3445+/-0.0150 after dialysis(P< 0.01). After dialysis, 28 out of 36(77.8%) patients were normovolemic(NV group), 7(19.4%) patients were overhydrated(OV group), and 1 patient(2.8%) was underhydrated. 3)BP changes during HD; In NV group, BP were increased significantly(P<0.05). But there was no change in OV group. In one underhydrated patient, a decrease in BP, albeit not significant, was noticed. 4)Body weight reduction rate(kg/hr) was higher in NV group(0.48+/-0.15) than in OV group(0.25+/-0.14)(P<0.01). CONCLUSION: Segmental multifrequency BIA may be useful as a method for estimating DW and evaluating ultrafiltration adequacy in maintenance HD patients.
Body Water ; Dialysis ; Extracellular Fluid ; Humans ; Hypertension ; Lower Extremity ; Male ; Renal Dialysis ; Ultrafiltration* ; Weight Loss

Hypokalemia is a common clinical problem. The kidney is responsible for long term potassium homoeostasis, as well as the serum potassium concentration. The main nephron site where K secretion is regulated is the cortical collecting duct, mainly via the effects of aldosterone. Aldosterone interacts with the mineralocorticoid receptor to increase sodium reabsorption and potassium secretion; the removal of cationic sodium makes the lumen relatively electronegative, thereby promoting passive potassium secretion from the tubular cell into the lumen through apical potassium channels. As a result, any condition that decreases the activity of renal potassium channels results in hyperkalemia (for example, amiloride intake or aldosterone deficiency) whereas their increased activity results in hypokalemia (for example, primary aldosteronism or Liddle's syndrome). The cause of hypokalemia can usually be determined from the history. If there is no apparent cause, the initial step is to see if hypokalemia is in associated with systemic hypertension or not. In the former group hypokalaemia is associated with a high mineralocorticoid effect or hyperactive sodium channel as in Liddle's syndrome. In hypertensive hypokalemic patients, measurement of the renin, aldosterone, and cortisol concentrations would be of help in differential diagnosis.
Aldosterone ; Amiloride ; Diagnosis, Differential ; Humans ; Hydrocortisone ; Hyperaldosteronism ; Hyperkalemia ; Hypertension ; Hypokalemia ; Kidney ; Mineralocorticoids ; Nephrons ; Potassium ; Potassium Channels ; Receptors, Mineralocorticoid ; Renin ; Sodium ; Sodium Channels

No abstract available.

This case report describes a patient with semipedunclated granuylar cell tumor(granular cell myoblastoma) of the proximal ascending colon removed by endoscopic polypectomy. A 39-year old femalie was visited to our hospital for intermittent abdominal pain and loose stool. Colonoscopic examination showed a semipedunclated lesion covered with yellowish white smooth mucosa in the proximal ascending colon. The tumor was removed by endoscopic polypectomy. The collected specimen was 0.9x0.8 cm in size. The cut surface of the specimen showed a white round firm tumor covered with mormal epithelium of the colon. Using immunohistochemical study, the tumor cells were to be positively stained by S-100 protein and negatively stained by desmin, which supports the concept of the Schwann cell origin of granular cell tumor. In Korea, 2 cases of granular cell tumor of the colon and rectum, which were treated by surgical removal, have been reported. This case in the first endoscopic polypectomy of granular cell tumor of the colon and retum in Korea. The endoscopic polypectomy is thought to be useful for the therapy of small pedunclated or semipedunclated granular cell tumor, intracolonic type.
Abdominal Pain ; Adult ; Colon ; Colon, Ascending* ; Desmin ; Epithelium ; Granular Cell Tumor* ; Humans ; Korea ; Mucous Membrane ; Rectum ; S100 Proteins

The authors developed a computerized documentation system to record and store all the data pertaining to an endoscopic examination of the upper digestive tract. The system was programmed using the database management system Clipper Version 5.01. It is easy and convenient to use due to advanced deaign of input screen using menu bars and pull down menu and windows. The system was designed to permit the easy storage and retrieval of data by personnel who lack computer skills and who may only have limited typing ability. Today this system has been in daily use for 1 year at the endoscopic units of 8 different branch hospitals of Catholic university,medical college. Overall the experience in these centers has been positive, with excelient or good participation. Characteristics of this system are a menu-driven system, data input by predefined list, instantaneous report generation, on line access to previous examination, late entry of yathologic regerts. and record retrieval, listing according to different criteria. For the description of endoscopic findings and diagnosis, structured input is maintained. All of the findings are chosen from predefined list using pop-up screen and also free text typing is allowed. Therefore time effort was not increased compared to conventional documentation. Structured input and the resulting categorical data affer several advantages.
Database Management Systems ; Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal* ; Gastrointestinal Tract ; Hospitals, Satellite ; Information Systems