The 70 adult patients with idiopathic membranous glomerulonephritis(IMGN), in whom renal biopsy has been performed at Keimyung University Dongsan Hospital, between January 1982 and December 1995 were studied for the clinical evolution of the disease and factors which might be involved in the development of chronic renal failure. There was 41 males and 29 females with a mean age of 41 years. Mean time from the onset to the renal biopsy was 13 months. The clinical presentations at the time of diagnosis were nephrotic syndrome(61.4%), asymptomatic urinary abnormality(21.4%), acute nephritic syndrome(14.3%), and recurrent gross hematuria(2.9%). During the mean follow-up period of 40+/-31 months, eleven(15.7%) of the patients developed chronic renal failure and five of them had end-stage renal disease. Five and ten years renal survival were 81.2% and 66.4%, respectively. In univariate analysis of clinical prognostic factors for progression to renal failure using Kaplan-Meier method, four parameters ; serum creatinine >or=1.4mg/ dL(p=0.011), hypoalbuminemia 2.5g/dL(p<0.01), heavyproteinuria >or=10.0g/day(p=0.036) and remission of proteinuria < 2.0g/24hr (p<0.01) were found to have predictive value. No effect was observed in the age, sex, steroid and/or immunosuppressive therapy, hypertension and serum total cholesterol concentration on prognosis. In univariate analysis of pathologic prognostic factors, interstitial fibrosis(p=0.036) and inflammation(p=0.011) were significant for predictive value.
Adult* ; Biopsy ; Cholesterol ; Creatinine ; Diagnosis ; Female ; Follow-Up Studies ; Glomerulonephritis, Membranous* ; Humans ; Hypertension ; Hypoalbuminemia ; Kidney Failure, Chronic ; Korea* ; Male ; Prognosis ; Proteinuria ; Renal Insufficiency

The patients with end stage renal disease show several complications such as artherosclerosis, anemia and increased susceptibility to infection by damage due to oxygen free radicals. Superoxide dismutase(SOD) is directly linked to the fate of the highly reactive oxygen metabolites. If there is an alteration in the activity of SOD, this alteration may contribute to the complications by reactive oxygen species in patients with end stage renal disease. In this experiment, SOD activity and the effect of cyanate on the activity of SOD was studied to understand the mechanism of several complications mediated by oxygen free radicals in patients with end stage renal disease. SOD activity in the plasma and erythrocytes from patients with end stage renal disease was significantly lower than those from healthy controls. It is known that underproduction of SOD leads to excess production of superoxide and reduced iron favoring hydroxyl radical formation. The results in this experiment suggest that there is an overproduction of superoxide anion in patients with end stage renal disease. The overproduction of superoxide anion may contribute the patients with end stage renal disease susceptible to oxidant damages. To evaluate if cyanate could carbamylate SOD, SOD was incubated with cyanate. The level of carbamylated SOD increased as the time of exposure to cyanate increased from 0 hour to 72 hours. Furthermore, the degree of carbamylation of SOD increased as cyanate concentration in the incubation media rose from 20mM to 1M. There appears to be a maximum degree of carbamylation at a concentration of 1,000mM cyanate. To test the hypothesis that in vitro carbamylation of SOD alters its biological activity, SOD activity was measured after incubation with cyanate. The activity of carbamylated SOD decreased as the time of exposure to cyanate increased from 0 hour to 72 hours. Furthermore, the activity of carbamylated SOD decreased as cyanate concentration in the incubation media rose from 20mM to 1M and when albumin was added to the reaction mixture, the loss of SOD activity was prevented. These results are consistent with the hypothesis that SOD is also carbamylated and lost biological activity in end stage renal disease patients by cyanate, and that the degree of carbamylation depends on both the concentration of cyanate and the length of exposure. Also, these suggest that albumin may prevent carbamylation of SOD at least in vitro condition.
Anemia ; Erythrocytes ; Free Radicals ; Humans ; Hydroxyl Radical ; Iron ; Kidney Failure, Chronic ; Oxygen ; Plasma ; Reactive Oxygen Species ; Superoxide Dismutase* ; Superoxides* ; Uremia

PURPOSE: Idoxifene is currently entering phase II clinical trials for the treatment of advanced breast cancer. The radiolabeled idoxifene using 123I provides an opportunity for clinical pharmacology with single photon emission computed tomography (SPECT). The purpose of this study was to prepare radiolabeled idoxifene using 123I and to determine its cell uptake of breast cancer cell line. MATERIALS AND METHODS: With a view to evaluating new anticancer drugs, we are investigating the novel antiestrogen pyrrolidino- 4-iodotamoxifen (idoxifene). [123I]Idoxifene has been prepared in no-carrier-added form using a tributyl stannylated precursor which has been synthesized by means of (2-chloroethoxy)benzene with (+/-)-2- phenylbutanoic acid on the basis of previously reported standard methods. The biodistribution and dynamic behavior of the compound were investigated using the comparative breast cancer cell line, MCF-7 (estrogen receptor-positive) and MDA-MB-468 (non-estrogen receptor). RESULTS AND CONCLUSION: Acylation of (2-chloroethoxy)benzene with (+/-)-2-phenylbutanoic acid gave the versatile ketone (81%) which reacted with 1,4-diiodobenzene to give triphenylethylene as a mixture of E and Z geometric isomers, which were separated by the recrystallization in ethanol. The E-isomer was treated with pyrrolidine to give idoxifene (67%). In order to incorporate radioactive iodine into the 4-position, the 4-stannylated precursor was prepared (30%). The yield of radioiodination was 90-92% with a high radiochemical purity greater than 98%. The ratio of tumor uptake of the breast cancer cell line between MCF-7 and MDA-MB-468 was about 1.7.
Acylation ; Breast Neoplasms* ; Breast* ; Cell Line ; Estrogen Receptor Modulators ; Ethanol ; Iodine ; Pharmacology, Clinical ; Tomography, Emission-Computed, Single-Photon

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.
Allografts ; Biopsy ; Cadaver* ; Cyclosporine ; Deglutition Disorders ; Epithelial Cells ; Esophagitis* ; Esophagoscopy ; Esophagus ; Female ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Mouth ; Nausea ; Prednisolone ; Prognosis ; Proteinuria ; Steroids ; Tissue Donors ; Ulcer

The risk of tuberculosis in renal transplant recipients may be related to immunosuppressive therapy, and it continues to complicate transplantation in the cyclosporine era. Extrapulmonary manifestation and dissemination also common clinical findings in the transplant recipients. Intestinal tuberculosis that develops with the involvement of other organs is common. We present a case of tuberculous intestinal perforation in the living-related donor renal transplant recipient. A 42-year-old male was admitted because of sudden onset acute abdomen. In April 1995, he received allograft kidney from HLA-identical sister following treatment with cyclosporine-A and low-dose steroids. Allograft function was stable over the next 36 months. About 3 years later, multiple cervical lymph node swelling was observed. Initial lymph node biopsy was performed, which showed granulomatous lesions with positive AFB stain. The patient was treated with antituberculous therapy regimen included isoniazid, ethambutol and rifampicin for a month. A ultrasonography and CT of the abdomen showed multiple adhesions in the peritoneum and enlargement of the mesenteric lymph nodes. A laparatomy finding was inflammatory thickening of the bowel wall in the terminal ileum with necrotic perforation. The involved terminal ileum was removed together with end-to-end anastomosis and peritoneal lavage was done. The patient was improved two weeks after surgical laparotomy.
Abdomen ; Abdomen, Acute ; Adult ; Allografts ; Biopsy ; Cyclosporine ; Ethambutol ; Humans ; Ileum ; Intestinal Perforation* ; Isoniazid ; Kidney ; Kidney Transplantation* ; Laparotomy ; Lymph Nodes ; Male ; Peritoneal Lavage ; Peritoneum ; Rifampin ; Siblings ; Steroids ; Tissue Donors ; Transplantation ; Tuberculosis ; Tuberculosis, Lymph Node ; Ultrasonography

The objectives of this investigation were to evaluate biomechanical factors in the atherosclerotic process using human in vivo hemodynamic parameters and computed numerical simulation qualitatively and quantitatively. The three-dimensional spatial patterns of steady and pulsatile flows in the left coronary artery were simulated, using a finite volume method. Coronary angiogram and Doppler ultrasound measurement of the proximal left coronary flow velocity were performed in humans. Inlet wave velocity distribution obtained from in vivo data of the intravascular Doppler study allowed for input of in vitro numerical simulation. Hemodynamic variables, such as flow velocity, pressure and shear stress of the left anterior descending coronary bifurcation site were calculated. We found that there were spatial fluctuation of flow-velocity and recirculation areas at the curved outer wall of the left anterior descending coronary artery, which were due to the differences of flow-velocity and shear stress, especially during the declaration phase of pulsatile flow. This study suggests that rheologic properties may be a part of the atherogenic process in the coronary bifurcated and curved areas.
Biomechanics ; Blood Flow Velocity/physiology ; Blood Pressure/physiology ; Coronary Arteriosclerosis/physiopathology* ; Coronary Arteriosclerosis/etiology* ; Coronary Vessels/physiopathology* ; Hemodynamics/physiology* ; Homeostasis/physiology ; Human ; Models, Cardiovascular* ; Pulsatile Flow ; Stress, Mechanical

OBJECTIVES: Due to the heterogeneous receptor distribution and changes of receptor status over time, the biochemical measurement of estrogen receptor status of biopsy specimens is not sufficient to diagnose breast cancer. As a result, I-123 labeled estradiols have been applied for the diagnosis. The purpose of this study was to develop a suitable radioligand for imaging estrogen receptor-positive human breast tumors. METHODS: Among the various estradiol derivatives, 17alpha-[123I]iodovinyl estradiol ([123I]IVE) has been prepared from 17alpha-ethynyl estradiol. Labeling of E-17alpha-[123I]iodovinyl estradiol (E-[123I]IVE) was carried out using peracetic acid with [123I]NaI and Z-[123I]IVE labelling was archived using chloamine- T/HCl solution with [123I]NaI. Labeling yield was determined by silica thin-layer chromatography (TLC) and radiochemical purity was measured by high performance liquid chromatography (HPLC). The biodistribution of E-[123I]IVE was measured in immature female rats at 60 min, 120 min and 300 min after injection. RESULTS: The labeling yield of two isomers was 92% and 94% (E-[123I]IVE and Z-[123I]IVE, respectively). The radiochemical purity was more than 98% after purification. The highest uptake was observed at 120 min in uterus (3.11% ID/g for E-[123I]IVE). CONCLUSION: These results suggest the possibility of using E-[123I]IVE as an imaging agent for the evaluation of the presence of estrogen receptor in patients with breast cancer.
Animals ; Biopsy ; Breast Neoplasms ; Chromatography, Liquid ; Chromatography, Thin Layer ; Diagnosis ; Estradiol* ; Estrogens ; Female ; Humans ; Peracetic Acid ; Rats ; Silicon Dioxide ; Uterus

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a kind of most common hepatic disease having wide pathologic spectrum and has been increasingly recognized as an important disorder because it may progress to end stage of liver disease. In spite of several foreign reports about clinical aspects of NAFLD, there are not enough reports analyzing large group for long times in Korea. We have examined the prevalence and associatd factors for NAFLD in health screen examinees from January 1997 to June 2003. METHODS: The results of 29,781 health screen examinees were analyzed retrospectively. Prevalence of alcoholic and nonalcoholic fatty liver was computed and associating factors were analyzed statistically. RESULTS: Overall prevalence of NAFLD was 18.6% and higher in the groups of age over 50 years. NAFLD was more preponderant in male. Age, body mass index, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and abnormal serum low density lipoprotein, high density lipoprotein, ALT level were independently associated factors with presence of NAFLD in logistic regression analysis. CONCLUSIONS: The prevalence of NAFLD and tendency of associated factors were similar to Western world. To prevent development of this common hepatic disorder which may results in end stage liver disease, prevention and control of obesity, diabetes, hyperlipidemia must be important.
Alcoholics ; Body Mass Index ; Diabetes Mellitus ; End Stage Liver Disease ; Fatty Liver* ; Humans ; Hypercholesterolemia ; Hyperlipidemias ; Hypertriglyceridemia ; Korea ; Lipoproteins ; Liver Diseases ; Logistic Models ; Male ; Obesity ; Prevalence* ; Retrospective Studies ; Western World

BACKGROUND: Cisplatin (CP), an antitumor agent widely used in the treatment of cancers, has nephrotoxicity. This side effect is closely related to oxidative stress. In the present study, we attempted to reduce CP-induced nephrotoxicity in rats by administering melatonin, an antioxidant. METHODS: Male Sprague-Dawley rats were divided into different groups and were treated as follows: (1) saline control; (2) CP (16 mg/kg, i.p.); (3) CP plus melatonin (10 mg/kg, i.p.). The rats were sacrificed at the 6th day after CP treatment. To evaluate renal damage, BUN, serum creatinine, creatinine clearance and microscopic examination were done. Hydrogen peroxide which is one of the oxygen free radicals, and malondialdehyde which is known as a marker of the oxygen free radical mediated injury, and the activities of the antioxidant enzymes such as superoxied dismutase, catalase, and glutathione peroxidase were also measured. RESULTS: CP-treated rats showed the increase of BUN, serum creatinine, malondialdehyde, hydrogen peroxide and superoxide dismutase (SOD) in kidney. And CP-treated rats also showed the decrease of creatinine clearance and catalase levels. CP-treated rats showed severe tubular necrosis in proximal convoluted tubules under the light microscopic examination. The light microscopic finding and all of the parameters except SOD were restored in the rats injected with CP plus melatonin than those with CP alone. SOD level was higher in the rats injected with CP plus melatonin than that with CP alone. CONCIUSION: These results suggest that melatonin suppresses CP-induced nephrotoxicity by suppressing the production of reactive oxygen species via the activation of SOD and catalase.
Animals ; Catalase ; Cisplatin* ; Creatinine ; Free Radicals ; Glutathione Peroxidase ; Humans ; Hydrogen Peroxide ; Kidney ; Male ; Malondialdehyde ; Melatonin* ; Necrosis ; Oxidative Stress ; Oxygen ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Superoxide Dismutase

BACKGROUND: Ventricular assist devices(VADs) are being used for patients in postcvardiotomy cardiogenic shock status bridge to cardiac transplant settings and in post-myocardial infarction cardiogenic shock. The VAD which was developed at the Deparment of medical engineering in Dankook University College of Medicine was a pneumatically driven device and can maintain pulsatile flow. The goal of this study is to develop animal experimental models using the VAD and to clarify the reliability and hemodynamic property adequacy of end organ perfusion durability and severity of thrombotic-hemolytic tendency of the device. MATERIAL AND METHOD: The pneumatic VAD was applied to 8 adult female lambs, We examined some hemodynamic parameters such as arterial blood pressure pulmonary capillary wedge pressure(pcwp) pulmonary artery pressure(PAP) left atrial pressure hour urine output cardiac index VAD flow EKG to determine the reliability of the VAD and hemodynamic compatibility of the experimental animals within 24 hours of experiment. We also observed the end organ perfusion durability of the VAD and thrombotic-hemolytic property of the VAD after 24 hours of VAD insertion. RESULT: We could monitor all hemodynamic parameters including pcwp PAP cardiac index EKG, adn hour urine as true clinical settings. We observed that the reliability of the VAD was excellent and the hemodynamic property of the experimental animal and end organ perfusion were adequate within 24 hours of experiment. In four lambs surviving 24 hours after insertion the reliability of the VAD and end organ perfusion were excellent and no thrombotic-hemolytic tendency was noted. However after 15 days of experiment the diaphragm of the VAD was torn and it was recommende that the durability of the VAD should be extended. CONCLUSION: e conclude that the pneumatic VAD developed at Dankook University Biomedical Engineering has good hemodynamic property and low thromboembolic tendency and presents adequate end organ perfusion but we noted that the durability of the device should be expanded further. It will be possible to do more reliable experiment in the future according to the animal experimental method developed in this study especially with the heart failure models.
Adult ; Animal Experimentation* ; Animals* ; Arterial Pressure ; Atrial Pressure ; Biomedical Engineering ; Capillaries ; Diaphragm ; Electrocardiography ; Female ; Heart Failure ; Hemodynamics ; Hemolysis ; Humans ; Infarction ; Perfusion ; Pulmonary Artery ; Pulsatile Flow ; Shock, Cardiogenic ; Thrombosis