BACKGROUND: Human high density lipoprotein (HDL) is known to stimulate endothelin-1 (ET-1) production through the phospholipase C (PLC)/Ca2+/ protein kinase C (PKC) pathway. Calcium channel blockers may be involved in the decrease of HDL- induced ET-1 production. This study was designed to evaluate whether HDL-induced ET-1 production was affected by Ca2+ channel blockers in cultured human proximal tubular cells (PTC). METHODS: The human PTC were obtained from human nephrectomized tissues, and cultured in six different media, which were bovine serum free (SF) DMEM/F12 medium alone, and five other SF DMEM/F12 media with 200 microgram/ml of HDL, with 200 microgram/ml of HDL and each 10 micrometer of diltiazem, nifedipine, and verapamil solved in 100% ethanol 0.1 volume%, and with 200 microgram/ml of HDL and 0.1 volume% of 100% ethanol as a control. After 24 hours of exposure, ET-1 in the supernatant was measured by radioimmunoassay, and ET-1 level in each well were marked as pg ET-1/mg cell protein/ 24 hr in consideration of cell count. RESULTS: In SF medium, ET-1 production was 1.803+/-0.295pg/mg cell protein/24 hr. In SF medium with 200 microgram/ml of HDL, ET-1 production significantly increased from 1.803+/-0.295 to 10.860+/-0.476 pg/mg cell protein/24 hr (P<0.05). In SF medium with 200 microgram/ml of HDL and 100% ethanol 0.1 volume%, ET-1 production significantly decreased from 10.860+/-0.476 to 6.700+/-1.273pg/mg cell protein/ 24 hr (P<0.05). In SF media with 200 microgram/ml of HDL and each 10 micrometer of diltiazem, nifedipine, and verapamil solved in 100% ethanol 0.1 volume%, ET- 1 production was decreased from 6.700+/-1.273 to 4.043+/-1.550 by diltiazem (P<0.05), to 3.260+/-0.752pg/ mg cell protein/24 hr by verapamil (P<0.05), and to 4.414+/-1.567pg/mg cell protein/24 hr by nifedipine (P=0.067). CONCLUSION: These results suggest that the HDL- induced ET-1 production in cultured human PTC was significantly decreased by diltiazem and verapamil, and it seemed to be decreased by nifedipine.
Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Cell Count ; Diltiazem ; Endothelin-1* ; Ethanol ; Humans* ; Lipoproteins ; Nifedipine ; Protein Kinase C ; Radioimmunoassay ; Type C Phospholipases ; Verapamil

No abstract available.
Tomography, X-Ray Computed*

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

Nonunion of fractures of forearm bone occurs frequently. These patients usually suffer from pain and functional disturbance of the hand and forearm. With the introduction of compression plate for the treatment of nonunion at the Campbell Clinic in 1959, a modification of the Nicoll graft was advised. The authors analysed 23 cases of the nonunion of forearm bone, in which military injured patients were admitted and treated by bone graft with internal fixation using various devices in Department of Orthopaedic Surgery of Korea Veterans Hospital from Sep. 1983 to Aug. 1988.
Forearm ; Hand ; Hospitals, Veterans ; Humans ; Korea ; Military Personnel ; Transplants

External fixation was improved in its material, design and techniques as a specific method of open fracture treatment. Seventy-three, tibial open fracture, patients were treated with external fixator in Korea Veterans Hospital from January 1983 to April 1988. Each fixation method was divided into two types;one-plane unilateral frame and one-plane bilateral frame. 1. The duration of external fixation was 14.3 weeks in averge, 15.4 weeks in one plane unilateral frame and 13.2 weeks in one plane bilateral frame. 2. Secondary operation for bony union was performed 19 cases in one plane unilateral frame and 8 cases in one plane bilateral frame. 3. The union time was 23.6 weeks in average, 26.8 weeks in one plane unilateral frame and 21.4 weeks in one plane bilateral frame. 4. The common complications were delayed union and nonunion (7 cases) and pin tract infection (5 cases) in one plane unilateral frame, and pin tract infection ( 9 cases), joint stiffness (4 cases) and delayed union and nonunion (3 cases) in one plane bilateral frame. 5. External fixation gave rigid fixation and easy wound access, but did not give excellent bony union. 6. One plane bilateral frame showed more or less better result than one plane unilateral frame except some complications.
External Fixators ; Fractures, Open ; Hospitals, Veterans ; Humans ; Joints ; Korea ; Methods ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Identifying symptom clusters of acute myocardial infarction (AMI) and their clinical significance may be useful in guiding treatment seeking behaviors and in planning treatment strategy. The aim of this study was to identify clusters of acute symptoms and their associated factors that manifested in patients with first-time AMI, and to compare clinical outcomes among cluster groups within 1-year of follow-up. SUBJECTS AND METHODS: A total of 391 AMI patients were interviewed individually using a structured questionnaire for acute and associated symptoms between March 2008 and June 2009 in Korea. RESULTS: Among 14 acute symptoms, three distinct clusters were identified by Latent Class Cluster Analysis: typical chest symptom (57.0%), multiple symptom (27.9%), and atypical symptom (15.1%) clusters. The cluster with atypical symptoms was characterized by the least chest pain (3.4%) and moderate frequencies (31-61%) of gastrointestinal symptoms, weakness or fatigue, and shortness of breath; they were more likely to be older, diabetic and to have worse clinical markers at hospital presentation compared with those with other clusters. Cox proportional hazards regression analysis showed that, when age and gender were adjusted for, the atypical symptom cluster significantly predicted a higher risk of 1-year mortality compared to the typical chest pain cluster (hazard ratio 3.288, 95% confidence interval 1.087-9.943, p=0.035). CONCLUSION: Clusters of symptoms can be utilized in guiding a rapid identification of symptom patterns and in detecting higher risk patients. Intensive treatment should be considered for older and diabetic patients with atypical presentation.
Acute Coronary Syndrome ; Biomarkers ; Chest Pain ; Cluster Analysis ; Fatigue ; Humans ; Myocardial Infarction ; Regression Analysis ; Thorax ; Surveys and Questionnaires

No abstract available.
Meconium* ; Peritonitis* ; Ultrasonography*

BACKGROUND: Neointimal hyperplasia and thrombosis are the major factors responsible for vascular access occlusion. Previous studies suggested that the renin-angiotensin system has been implicated in the pathogenesis of neointimal hyperplasia and thrombosis. Recent studies have shown that angiotensin-converting enzyme (ACE) gene polymorphism may have a association with venous thrombosis. We conducted a retrospective case control study to determine the influence of ACE gene polymorphism on the progression of radiocephalic wrist arteriovenous fistulae (RCAVF). Also, we investigated the association between ACE polymorphism and various thrombotic factors in thrombosed and nonthrombosed subjects. METHODS: 56 patients (24 males and 32 females, mean age 49.8, age range 12-81) whose RCAVF had been maintained in good condition after 2 months of vascular access operation were included in this study. Lipoprotein (a), total cholesterol, C-reactive protein (CRP) and homocystein were measured before hemodialysis session in fasting state. Clinical data such as body mass index (BMI), cigarette smoking, hypertension, and diabetes were retrieved from patient's records. The ACE genotype was analyzed by the polymerase chain reaction (PCR). RESULTS: The incidence of diabetes and cigarette smoking were similar in the three genotypes. There were no significant differences in BMI, total cholesterol, lipoprotein (a), CRP and homocystein (p=0.551, 0.429, 0.279, 0.392, 0.124, respectively) among DD, ID and II genotypes. The percentage of the DD, ID and II genotypes were 16%, 43%, 41%, respectively. Compared with the ID and II genotypes, the proportion of the thrombosed AV shunts was larger in DD genotypes. But there was no statistically significant difference between ACE polymorphism and RCAVF thrombosis (x2=1.027, df=2, p=0.598). ACE polymorphism is shown to have no association with body mass index, blood level of total cholesterol, lipoprotein (a), CRP and homocystein. CONCLUSION: These results suggest that ACE polymorphism may have some influences on the vascular access occlusion in maintenance hemodialysis patients and have no relationship with body mass index, total cholesterol, lipoprotein (a), CRP and homocystein.
Arteriovenous Fistula* ; Body Mass Index ; C-Reactive Protein ; Case-Control Studies ; Cholesterol ; Fasting ; Female ; Genotype ; Humans ; Hyperplasia ; Hypertension ; Incidence ; Lipoprotein(a) ; Male ; Polymerase Chain Reaction ; Renal Dialysis* ; Renin-Angiotensin System ; Retrospective Studies ; Smoking ; Thrombosis ; Venous Thrombosis ; Wrist

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

BACKGROUND: Malnutrition in maintenance hemodialysis(HD) patients has been referred to underdialysis with low protein intake and to metabolic acidosis. However, the respective effects of underdialysis, protein intake and metabolic acidosis have not been clearly demonstrated. To evaluate the role of the dialysis dose, protein intake and metabolic acidosis on nutrition, we measured the predialysis serum HCO3, pH, serum albumin, PCRn, Kt/V, and BMI in 41 uremic patients on maintenance bicarbonate HD for 66.93+/-51.86 months. Patients with chronic liver diseases, malignancies, diabetes and cachexia were excluded. RESULTS: Mean age was 46+/-13 years; Kt/V, 1.22+/-0.27; PCRn, 0.90+/-0.16g/kg/day; serum albumin, 4.2+/-0.21g/dL; BMI, 20.47+/-2.09kg/m2; HCO3, 18.4+/-2.9mEq/L; Serum albumin showed a significant direct correlation with PCRn(p=0.001), and a significant inverse correlation with serum HCO3(r=0.43, p<0.01) but no correlation with Kt/V and BMI. PCRn showed a significant inverse correlation with serum HCO3(p<0.01), and a direct correlation with Kt/V(p<0.05). Multiple regression analysis confirmed the significant role of protein intake but not of Kt/V and serum bicarbonate, on serum albumin concentrations. Dividing patients into two groups, serum albumin was 4.05+/-0.34g/dL in those with HCO3 <20mEq/L and 3.95+/-0.24g/dL in those with HCO3 >or=20mEq/L. PCRn in the former was 0.94+/-0.6g/kg/day and in the latter 0.80+/-0.14g/kg/day(p<0.05). The role of PCRn appeared to be more important than metabolic acidodsis in determining the serum albumin levels. CONCLUSIONS: In patients hemodialyzed with relatively adequate Kt/V and whose serum bicarbonate levels maintained within mild acidosis range, PCRn may exert a detrimental effect on serum albumin concentration.
Acidosis ; Cachexia ; Dialysis ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Malnutrition* ; Renal Dialysis* ; Serum Albumin