BACKGROUND AND OBJECTIVES: The assessment of left ventricular (LV) diastolic function is important in chronic renal failure because abnormal LV diastolic function has been frequently described in patients on maintenance hemodialysis both during the dialysis and in the dialysis-free interval despite the normal LV systolic function. But the echocardiographic indexes of LV diastolic function is known to be affected by several factors such as loading condition, LV compliance and heart rate. The purpose of this study is to investigate the effect of hemodialysis on the echocardiographic indexes of left ventricular diastolic function in chronic renal failure. Materials AND METHODS: We examined transmitral flow velocity, pulmonary venous flow velocity, and mitral annulus velocity in 20 patients (15 men and 5 women, average 50+/-14, range 19-69 years) of chronic renal failure with normal LV systolic function by echocardiography before and after hemodialysis. RESULTS: 1)According to the body weight change (from 59.5+/-8.3 to 57.2+/-8.1 kg, p=0.0001), after hemodialysis, inferior vena cava dimension (from 18+/-4 to 13+/-5 cm, p=0.0001), left ventricular end-diastolic dimension (from 57+/-6 to 53+/-7 cm, p=0.0001), and left ventricular outflow tract (LVOT)-time velocity integral (TVI, from 26+/-5 to 23+/-5 cm, p=0.004), which reflect intravascular blood volume, decreased significantly. 2)The peak velocity of early transmitral flow (E, from 0.79+/-0.14 to 0.64+/-0.11 m/s, p=0.0001), the peak velocity of late transmitral flow (A, from 0.84+/-0.21 to 0.78+/-0.21 m/s, p=0.011), and E/A ratio (from 0.99+/-0.25 to 0.87+/-0.27, p=0.007) decreased significantly, and deceleration time (DT, from 241+/-48 to 267+/-59 ms, p=0.055) showed tendency of prolongation after hemodialysis. 3)Peak systolic velocity of pulmonary venous flow decreased significantly after hemodialysis (from 0.65+/-0.11 to 0.59+/-0.12 m/s, p=0.042). 4)The difference between duration of reversal flow of pulmonary vein and duration of transmitral flow during atrial contraction (ADD) did not change significantly after hemodialysis (from 5+/-31 to 1+/-29 ms, p=0.502), and did not correlate with the change of peak velocity of early transmitral flow during hemodialysis (DMVE, r=0.390, p=0.089). 5)The peak early diastolic velocity (Ean, from 0.07+/-0.02 to 0.06+/-0.02 m/s, p=0.002) and Ean/the peak late diastolic velocity (Aan) ratio (from 0.78+/-0.27 to 0.62+/-0.19, p=0.003) of medial annulus of mitral valve decreased significantly after hemodialysis. CONCLUSION: Hemodialysis, which reduces LV preload by fluid removal, changes the echocardiographic indexes of left ventricular diastolic function in chronic renal failure. Preload condition need to be accounted for when we evaluate the LV diastolic function with echocardiography.
Blood Volume ; Body Weight Changes ; Compliance ; Deceleration ; Dialysis ; Echocardiography* ; Female ; Heart Rate ; Humans ; Kidney Failure, Chronic* ; Male ; Mitral Valve ; Pulmonary Veins ; Renal Dialysis* ; Vena Cava, Inferior

No abstract available.
Female* ; Humans ; Urinary Incontinence*

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) reduces the intracellular Ca2+ concentration ([Ca2+]i) in smooth muscle cells, whereas the effect of NO on [Ca2+]i in endothelial cells is still controversial. Therefore, the effect of NO on the [Ca2+]i, and its mechanism in mouse aortic endothelial cells (MAEC) and human umbilical vein endothelial cells (HUVEC) were examined. MATERIALS AND METHODS: In primary cultured MAEC and HUVEC, cells were loaded with fura 2-AM and [Ca2+]i and measured using a microfluorometer. RESULTS: The NO donor, sodium nitroprusside (SNP), reduced the [Ca2+]i in 72% of the cells tested (n=100). In the remaining cells, the effect of SNP was biphasic, or the [Ca2+]i was increased. In addition, the membrane-permeable cGMP, 8-bromo cGMP, decreased the [Ca2+]i. The effects of SNP and 8-bromo cGMP were inhibited by the soluble guanylate cyclase inhibitor, 1H-[1,2,4] oxadiazole[4,3-a]quinoxalin-1-one (ODQ), and the cGMP-dependent protein kinase inhibitor, KT5823, respectively. In contrast, in the presence of 8-bromo cGMP or ODQ, SNP increased the [Ca2+]i. CONCLUSION: These results suggest that NO inhibits the [Ca2+]i through a cGMP-dependent mechanism and increases the [Ca2+]i through a cGMP-independent mechanism.
Animals ; Cyclic GMP ; Endothelial Cells* ; Endothelium ; Guanylate Cyclase ; Human Umbilical Vein Endothelial Cells ; Humans ; Mice ; Myocytes, Smooth Muscle ; Nitric Oxide ; Nitroprusside ; Protein Kinases ; Tissue Donors

Congenital adrenal hyperplasia is inherited disorder of adrenal steroidogenesis. 21-hydroxylase deficiency is the most commone enzymatic defect and is divided into classic and late-onset or nonclassic forms. Both classic non-classic 21-hydrozylase deficiencies are inherited in a recessive manner as allelic variants. But it is rare that happened in twin infants. Chief complaints of affected twins in our case were ambiguous genitalia, hyperpigmentation and dehydrations. They were revealed into hyponatremia, hyperkalemia and increased amount of serum progesterone, 17-hydroxyprogesterone and urinary 17-ketosteroid excretion and were administered with DOCA, 9alpha-fluorohydrocortisone, hydrocortisone to control the electrolyte imbalance. And now, both of them are going to normal ratio of weight gain and body growth.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital* ; Desoxycorticosterone Acetate ; Disorders of Sex Development ; Humans ; Hydrocortisone ; Hyperkalemia ; Hyperpigmentation ; Hyponatremia ; Infant ; Progesterone ; Steroid 21-Hydroxylase* ; Twins* ; Weight Gain

Rheumatoid arthritis is a chronic inflammatory systemic disease of young or middle aged adults, characterized by destructive and proliferative changes in the synovial membrane, periarticular structures, skeletal muscle and perineural sheath. Eventually, the joints are destroyed, ankylosed and deformed. Therfore, the aim of treatment is to keep the inflammatory process at a minimum, thereby preserving the joint motion, maintaining the health of muscle supplying motor power about the joint and preventing secondary joint stiffness and deformity. Surgical treatment in rheumatoid arthritis has progressed and there have been advances in the relief of pain and increase in the range of motion. Among them the results of total knee arthroplasty (TKA) have improved steadily during the past decade due to refinements in design, fixation, and surgical technique. At orthopedic department of seoul national university hospital, we performed 31 total knee replacement in 18 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1988. Following results were obtained. 1. Knee score increased from 37.8 to 76.9. 2. Tibio-femoral angle was corrected from 0.9° valgus to 5.3° valgus. 3. Conplications were peroneal nerve palsy in 3 knees, instability in 1 knee, tuberculous arthritis in 1 knee. 4. In 25 out of 31 knees, good functional results were obtained.
Adult ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Middle Aged ; Muscle, Skeletal ; Orthopedics ; Paralysis ; Peroneal Nerve ; Range of Motion, Articular ; Seoul ; Synovial Membrane

BACKGROUND AND OBJECTIVES: Transesophageal echocardiography (TEE) allows a detailed evaluation of the structure and function of the left atrial appendage (LAA) by two-dimensional imaging and Doppler interrogation of appendage flow. LAA dysfunction has been associated with spontaneous echo contrast (SEC), thrombus formation and thromboembolism. The purpose of this study was to define normal heart reference values of LAA maximal forward velocity (LAAV), and to correlate LAAV with cardiac rhythm, mitral valve disease severity, SEC grade and left atrial thrombi development. SUBJECTS AND METHODS: LAA volume measurement and pulse Doppler evaluation of LA appendage flow during TEE were undertaken in 95 subjects; 32 patients with normal heart and 63 patients with various cardiac diseases. RESULTS: Mean LAAV was 87.1+/-26.7 cm/s, mean LAA maximal backward velocity 66.0+/-15.0 cm/s and mean LAA volume 2.2+/-1.2 mL in those patients with normal heart (n=32). There was a negative correlation between LAAV and SEC grade, mitral stenosis severity, LA size and LAA volume. Among those patients with atrial fibrillation, LAAV was lower in the subgroup with LA thrombi than in the subgroup without thrombi (14.9+/-8.1 cm/s (n=16), vs. 29.7+/-21.2 cm/s (n=33), p<0.01). CONCLUSION: Reduced LAAV, SEC and mitral stenosis are all associated with LAA thrombus formation in patients with atrial fibrillation.
Atrial Appendage* ; Atrial Fibrillation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart ; Heart Diseases ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Reference Values ; Thromboembolism ; Thrombosis

Upper urinary tract urothelial carcinoma (UTUC) is relatively uncommon. Radical nephroureterectomy with an ipsilateral bladder cuff excision has been the gold standard treatment for UTUC. However, recent advances in technology have made possible the increased use of endoscopic management for the treatment of UTUC. The definitive goal of endoscopic management of UTUC is cancer control while maintaining renal function and the integrity of the urinary tract. Endoscopic management includes both the retrograde ureteroscopic and antegrade percutaneous approaches. The endoscopic management of UTUC is a reasonable alternative for patients with renal insufficiency or a solitary functional kidney, bilateral disease, or a significant comorbidity that precludes radical surgery. Select patients with a functional contralateral kidney who have low-grade, low-stage tumors may also be candidates for endoscopic management. The careful selection of patients is the most important point for the successful endoscopic management of UTUC. It is crucial that patients are compliant and motivated, because a lifetime protocol of strict surveillance is necessary. Adjuvant topical therapy with Bacillus Calmette-Guerin or mitomycin C can be used after endoscopic management of UTUC in an attempt to reduce recurrence. In this article, we review current endoscopic techniques, indications for endoscopic treatment, clinical outcomes of endoscopic management, adjuvant topical therapy, and surveillance in patients with UTUC.
Bacillus ; Carcinoma, Transitional Cell ; Comorbidity ; Endoscopy ; Humans ; Kidney ; Mitomycin ; Recurrence ; Renal Insufficiency ; Ureteroscopy ; Urinary Bladder ; Urinary Tract

PURPOSE: This study was to compare the predictive validity of Norton Scale(1962), Cubbin & Jackson Scale(1991), and Song & Choi Scale(1991). METHOD: Data were collected three times per week from 48-72hours after admission based on the four pressure sore risk assessment scales and a skin assessment tool for pressure sore on 112 intensive care unit(ICU) patients in a educational hospital Ulsan during Dec, 11, 2000 to Feb, 10, 2001. Four indices of validity and area under the curve(AUC) of receiver operating characteristic(ROC) were calculated. RESULT: Based on the cut off point presented by the developer, sensitivity, specificity, positive predictive value, negative predictive value were as follows : Norton Scale : 97%, 18%, 35%, 93% respectively; Cubbin & Jackson Scale : 89%, 61%, 51%, 92%, respectively; and Song & Choi Scale : 100%, 18%, 36%, 100% respectively. Area under the curves(AUC) of receiver operating characteristic(ROC) were Norton Scale .737, Cubbin & Jackson Scale .826, Song & Choi Scale .683. CONCLUSION: The Cubbin & Jackson Scale was found to be the most valid pressure sore risk assessment tool. Further studies on patients with chronic conditions may be helpful to validate this finding.

BACKGROUND/AIMS: Stomach cancer is the most common malignancy and one of the leading causes of cancer-related death in Korea. The early diagnosis and treatment of gastric cancer are very important because the prognosis of early gastric cancer is excellent. Gastric screening may provide an opportunity to detect asymptomatic early gastric cancer. We analyzed the characteristics of gastric cancer diagnosed with a health screening test to evaluate the usefulness of a screening program for gastric cancer. METHODS: We retrospectively reviewed the clinicopathological characteristics of 111 gastric cancer patients diagnosed using gastric endoscopy as a gastric screening test at the Health Promotion Center of Kyungpook National University Hospital from July 1997 through December 2005. RESULTS: The incidence of gastric cancer was 0.38% and the mean patient age was 58.5 years old. The proportion of early gastric cancer was 73% of all gastric cancer. In 55 cases, constituting 49.6% of all gastric cancer and 68% of early gastric cancer, the lesions were confined to the mucosa. The most common macroscopic types were type IIc in early gastric cancer and Borrmann type 3 in advanced gastric cancer. There were significant positive correlations between lymph node metastasis and both the depth of tumor invasion and size of the lesion. The 5-year survival rates are 82.7% in total gastric cancer and 97.2% in early gastric cancer. CONCLUSIONS: Gastric cancer detected during health screening has a favorable prognosis because gastric cancer confined to the mucosa predominates and early gastric cancer detected at screening has a lower incidence of metastasis to regional lymph nodes.
Early Diagnosis ; Endoscopy ; Health Promotion ; Humans ; Incidence ; Korea ; Lymph Nodes ; Mass Screening ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

No abstract available.
Apoptosis* ; Prostate* ; Prostatic Hyperplasia*