Systemic sclerosis is a generalized connective tissue disorder. It is characterized by fibrosis, degenerative changes and vascular lesions affecting the skin, joints, skeletal muscles and multiple internal organs. Clinical renal disease in systemic sclerosis ranges from scleroderma renal crisis to more subtle abnormalities. Scleroderma renal crisis is characterized by malignant hypertension and rapidly progressive renal failure. It can be successfully treated with angiotensin converting enzyme inhibitors, but remains the most feared complication of systemic sclerosis. We have experienced a 57 year old female patient who visited emergency room with a sudden onset of mental deterioration, azotemia and oliguria. She was under symptomatic treatment for Raynaud's phenomenon for 2 years. Renal biopsy of the patient showed onion-skin configuration in the interlobular arteries which is characteristic of scleroderma renal crisis. She proceded to maintenance hemodialysis despite a angiotensin converting enzyme inhibitor treatment. We report a case of SRC with a brief review of literature.
Angiotensin-Converting Enzyme Inhibitors ; Arteries ; Azotemia ; Biopsy ; Connective Tissue ; Emergency Service, Hospital ; Female ; Fibrosis ; Humans ; Hypertension ; Hypertension, Malignant ; Joints ; Middle Aged ; Muscle, Skeletal ; Oliguria ; Peptidyl-Dipeptidase A ; Renal Dialysis ; Renal Insufficiency ; Scleroderma, Systemic ; Skin

No abstract available.
Arthritis

Purpose of this study was to investigate the biomechanical fates of the partial thickness tear of the rotator cuff in rabbit, and try to provide guideline of treatment for the partial thickness tear of the rotator cuff tendon. Infraspinatus tendons of fifty rabbits were used for study. The rabbits were divided into three groups, twenty for one-third resection(superficial partial resection group), twenty for two-thirds resection(deep partial resection group) and ten for control group. Extraarticular portion of the infraspinatus tendons of the rabbits were resected partially with one-third or two-thirds thickness for each experimental group. We sacrificed five rabbits of each experimental group at 3, 6, 9, and 12 weeks after the resections, and five rabbits for the control group at 6 and 12 weeks. Average maximal load per area of the infraspinatus tendons was measured by tension test. There was significant difference between the deep partial resection group, 5.3 and 6.3 N/emat 6 and 12 weeks respectively, and the control group, 13.2 N/mm(P<0.05). There was no difference between the control and superficial partial resection group, 12.8 and 14.1 N/mm at 6 and 12 weeks, respectively. Shallow partial tears might be healed spontaneously. Deep partial tears would not be healed naturally. When surgical treatment is indicated for deep partial tears of the rotator cuff, tendon repair, rather than debridement, would provide more predictable results.
Debridement ; Rabbits* ; Rotator Cuff* ; Shoulder ; Tendons

BACKGROUND: Recombiant human erythropoietin (epoetin) has greatly contributed to improvement of the anemia of chronic renal failure patients on hemodialysis. However, the reduced erythropoietic effect to epoetin and its high cost have induced lots of supplementary treatments. Therefore, we performed a prospective study to evaluate the effects of adjuvant low-dose androgen therapy in patients using a lower-dose of epoetin than the commonly recommended dose on anemia and the nutritional parameters. METHODS: 17 patients of hemoglobin (Hgb) less than 9 g/dL even after being treated with 1,000 U epoetin subcutaneously (s.c.) 3 times per week on a stable status for more than 6 months, who were on hemodialysis at our institution were examined. They were injected with the same dose of epoetin s.c. and nandrolone decanoate 100 mg intramuscularly (i.m) weekly for another 6 months. Blood test was performed every month before therapy for 6 months and after therapy for 6 months and the mean values were reviewed for comparison. RESULTS: Hgb (7.75+/-0.9 vs 8.99+/-1.39 g/dL, p < 0.01) and hematocrit (Hct) (23.68+/-2.85 vs 26.66+/-3.91%, p < 0.01) were apparently changed before and after adjuvant therapy. Hgb and Hct, weekly dose of epoetin were not statistically different in 9 male patients before and after adjuvant therapy. The weekly dose of epoetin was not statistically different in 8 female patients, but Hgb and Hct (8.02+/-0.6 vs 9.72+/-1.31 g/dL, 24.54+/-1.7 vs 28.74+/-3.06%, p < 0.01) were statistically different before and after adjuvant therapy. In comparison between male and female groups, weekly doses of epoetin and nandrolone decanoate were significantly greater in the female group than the male group (epoetin; 50.66+/-6.23 vs 61.18+/-8.76 U/kg/week, nandrolone decanoate; 1.69+/-0.2 vs 2.04+/-0.29 mg/kg/week, p < 0.05). CONCLUSION: Our data show that the adjuvant androgen therapy is effective for the anemia of hemodialysis patients who did not recover from anemia even after being continuously treated with low-dose epoetin.
Adult ; Anabolic Steroids/*administration & dosage/blood ; Anemia, Aplastic/blood/*drug therapy ; Chemotherapy, Adjuvant ; Erythropoiesis/drug effects ; Erythropoietin, Recombinant/*administration & dosage/blood ; Female ; Human ; Kidney Failure, Chronic/blood/drug therapy ; Male ; Middle Age ; Nandrolone/*administration & dosage/blood ; Nutritional Status ; Prospective Studies ; *Renal Dialysis

BACKGROUND: Recombinant human erythropoietin (rHuEPO) has become attractive option of anemia therapy in chronic hemodialysis patients, but the use of rHuEPO is primarily limited by its high cost. So, the current cost-containment policy renders valuable any strategies that enhances the erythropoietic response to rHuEPO, thus resulting in lower rHuEPO dosing. Before the widespread availability of rHuEPO, androgen was the mainstay of nontransfusional therapy for the anemia of end-stage renal failure. However, previous studies that used androgen to enhance the response to rHuEPO showed variable results. METHODS: We carried out a prospective study to examine the effect of adjuvant androgen on anemia and nutritional parameters in chronic hemodialysis patients using low-dose rHuEPO. Studies were performed in seventeen hemodialysis patients previously treated with low-dose rHuEPO (1,000 U rHuEPO subcutaneously three times a week), mean hemoglobin < 9.0 g/dL for 6 months (group A: before adjuvant androgen therapy). Same patients received the same dose of rHuEPO plus nandrolone decanoate 100 mg intramuscularly weekly for 6 months (group B: after adjuvant androgen therapy). RESULTS: Transferrin saturation, serum ferritin, intact serum parathyroid hormone, plasma aluminium, ALT, ESR, albumin, PCRn and Kt/V were not significantly changed before and after adjuvant androgen therapy. The increase in hemoglobin and hematocrit in the group B was statistically greater than in the group A, respectively (8.99+/-1.39 g/dL vs 7.75+/-0.90 g/dL; p=0.001, 26.66+/-3.91% vs 23.68+/-2.85%; p= 0.003, respectively). With the exception of mild discomfort at the injected site, there were no significant side effects from nandrolone decanoate. CONCLUSION: Adjuvant androgen in patients treated with low-dose rHuEPO is effective treatment for the anemia of poor responsive patients to low-dose rHuEPO and lower the economical cost compared with the higher dose rHuEPO treatment alone.
Anemia* ; Erythropoietin* ; Ferritins ; Hematocrit ; Humans ; Humans* ; Kidney Failure, Chronic ; Nandrolone ; Parathyroid Hormone ; Plasma ; Prospective Studies ; Renal Dialysis* ; Transferrin

The purpose of this study was to investigate the relationship among serum leptin, nutritional status, and the obesity indices of 55 obese children in Daegu and Kyungpook area. Obesity was defined as fat percentage that exceed 25% of body fat mass. Energy and nutritional status were tended to be low, and dietary intake of calcium and iron were less than any other nutrients in all the subjects. Especially, beverage intake of obese group was more than non-obese group. The leptin level were significantly correlated with %RDA of energy (0.41, p < 0.001), protein (0.44, p < 0.001), phosphate (0.40, p < 0.001), iron (0.37, p < 0.001), vitamin A (0.31, p < 0.01), thiamin (0.40, p < 0.001), riboflavin (0.26, p < 0.05), niacin (0.51, p < 0.001), and vitamin C (0.24, p < 0.05). The leptin level were significantly correlated with MAR (mean adequacy ratio, r = 0.43, p < 0.001) and INQ (index of nutrient quality) of thiamin (r = 0.22, p < 0.05). Multiple regression analysis showed that %RDA of niacin in obese group (R2 = 0.208, p = 0.001) and total subjects (R2 = 0.257, p = 0.000), MAR (p = 0.003) and INQ (p = 0.048) of niacin in obese group (R2 = 0.255) and MAR (p = 0.000) and INQ of Ca (p = 0.024) in total subjects (R2 = 0.231) may be important independent predictors to leptin level. MAR showed a significantly positive correlation with %fat (r = 0.42, p < 0.01), BMI (r = 0.46, p < 0.01), RW (r = 0.44, p < 0.01), WHR (r = 0.39, p < 0.01) and, %RDA (p < 0.05, p < 0.01). These data indicated relationships among leptin level, nutrient intake, %RDA, MAR, and INQ in children.
Adipose Tissue ; Ascorbic Acid ; Beverages ; Calcium ; Child* ; Daegu ; Gyeongsangbuk-do ; Humans ; Iron ; Leptin* ; Niacin ; Nutritional Status ; Obesity ; Riboflavin ; Vitamin A

Microscopic polyangiitis is a systemic small vessel vasculitis, which, although primarily associated with necrotizing and crescentic glomerulonephritis and pulmonary capillaritis, often has cutaneous and muscul-oskelectal features. Microscopic polyangiitis is strongly associated with antineutrophil cytoplamic autoantibody that are a useful diagnostic serologic marker for the most common form of necrotizing vasculitis, and that have two patterns(C-ANCA and P-ANCA). We have experienced a case of microscopic polyangiitis with purpurae on both lower extrimities, C-ANCA positive and cresent formation on renal biopsy, which had no history of asthma and no pathologic evidence of granuloma. In our case, deterioration of renal function was recovered after steroid pulse therapy.
Antibodies, Antineutrophil Cytoplasmic ; Asthma ; Biopsy ; Glomerulonephritis ; Granuloma ; Microscopic Polyangiitis* ; Purpura ; Vasculitis

The purpose of this study was to investigate the relationship among eating habits, eating behaviors, obesity indices and serum leptin levels of 97 school children in the Daegu and Kyungpuk areas. The subjects consisted of 42 boys and 55 girls from the 4th and 5th grades. The prevalence rate of obesity was 63.6% in the males and 36.4% in the females. The nutritional status of the subjects was assessed using 24-hour dietary recalls and blood analyses. The mean serum leptin levels of the obese group (12.84 +/- 6.97 ng/ml) were significantly higher than those of the non-obese group (2.43 +/- 1.53 ng/ml)(p < 0.001). The mean eating behavior scores and MAR were significantly different in the two groups. Nutrient intakes were low and fell short of the RDA. Serum leptin levels showed a significant negative correlation with eating habit (r = -0.24) and eating behavior scores (r = -0.40)(p < 0.05, p < 0.001). It was speculated that nutritional intervention and education about the appropriate nutrient intake requirements of developing children might be necessary.
Child* ; Daegu ; Eating* ; Education ; Feeding Behavior* ; Female ; Humans ; Leptin* ; Male ; Nutritional Status ; Obesity* ; Prevalence

A previous report by this laboratory demonstrated that bacterial iron chelator (siderophore) triggers inflammatory signals, including the production of CXC chemokie IL-8, in human intestinal epithelial cells(IECs). Microarray-based gene expression profiling revealed that iron chelator also induces CC chemokie MIP-3alpha/CCL20. As CCL20 is chemotactic for the cells involved in host adaptive immunity, this suggests that iron chelator may stimulate IECs to have the capacity to link mucosal innate and adaptive immunity. The basal medium from iron chelator deferoxamine (DFO)-treated HT-29 monolayers was as chemotactic as rhCCL20 at equivalent concentrations to attract CCR6+cells. The increase of CCL20 protein secretion appeared to correspond to that of CCL20 mRNA levels, as determined by real-time quantitative RT-PCR. The efficacy of DFO at inducing CCL20 mRNA was also observed in human Peripheral Blood Mononuclear Cells (PBMCs) and in THP-1 cells, but not in Human Umbillical Vein Endothelial Cells (HUVECs). Interestingly, unlike other proinflammatory cytokines, such as TNF-alpha and IL-1beta, a time-dependent experiment revealed that DFO slowly induces CCL20, suggesting a novel mechanism of action. A pharmacologic study also revealed that multiple signaling pathways are differentially involved in CCL20 production by DFO, while some of those pathways are not involved in TNF-alpha-induced CCL20 production. Collectively, these results demonstrate that, in addition to some bacterial products known to induce host adaptive immune responses, direct chelation of host iron by infected bacteria may also contribute to the initiation of host adaptive immunity in the intestinal mucosa.
Adaptive Immunity* ; Bacteria ; Cytokines ; Deferoxamine ; Endothelial Cells ; Epithelial Cells* ; Gene Expression Profiling ; Humans* ; Interleukin-8 ; Intestinal Mucosa ; Iron* ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Veins