Urea reduction ratio (URR) and Kt/Vurea are objective parameters of dialysis delivery in hemodialysis patients and correlate with nutritional status and patient outcome. URR and Kt/Vurea depend on postdialysis blood urea nitrogen (BUN). In patients with severe postdialysis urea rebound (PDUR), these parameters do not accurately reflect dialysis adequacy. We measured PDUR 30 minutes after dialysis in 26 chronic stable hemodialysis patients. The impact of PDUR on dialysis delivery assessed by URR and Kt/Vurea and the independent factors affecting on PDUR were evaluated. All patients had been dialyzed for 4 hours thrice a week using hemophan membrane. 1) The mean age of patients was 48.6+/-14.8 years and sex ratio was 1:2.3. The mean duration of hemodialysis was 42.7+/-45.0 months. Primary renal diseases were chronic glomerulonephritis 11 (42.3%), diabetic nephropathy 7 (26.9%), and hypertension 4 (15.4%). 2) The mean blood flow was 209.2+/-17.4ml/min. URR, Kt/Vurea, and nPCR using immediate postdialysis BUN were 60+/-7%, 1.13+/-0.21, 1.09+/-0.28g/kg/ day, respectively. The mean recirculation rate was 4.4+/-2.3%. 3)The mean PDUR was 12.2+/-4.6% (range:6-22 %). URR, Kt/Vurea, and nPCR using BUN 30 minutes after dialysis were 55+/-7%, 0.99+/-0.18, and 1.02+/-0.25 g/kg/day, respectively and were significantly lower than those using immediate postdialysis BUN (P<0.05). 4) When the patients were divided according to the degree of PDUR (low PDUR group:<12%, high PDUR group: > or = 12%), high PDUR group was significantly higher than low PDUR group in hematocrit (27.0+/-2.6 vs. 23.5+/-3.6%, P=0.008), URR (64.3+/-5.4 vs. 55.8+/-6.8%, P=0.002), Kt/Vurea (1.26+/-0.17 vs. 1.03+/-0.18, P=0.002), and total recirculation rate (5.6+/-2.7 vs. 3.6+/-1.7%, P=0.05). There were no differences in age, sex, postdialysis body weight, ultrafiltration rate, blood flow, serum albumin, predialysis BUN, creatinine, and nPCR. 5) In multiple regression analysis, the independent factors affecting on PDUR were Kt/Vurea (beta=0.546, P<0.001), recirculation rate (beta=0.422, P<0.001), and hematocrit (beta=0.366, P=0.0017). In conclusion, we think that PDUR should be considered in hemodialysis patients when estimating dialysis delivery, especially if they had high Kt/ Vurea, recirculation rate, and hematocrit.
Blood Urea Nitrogen ; Body Weight ; Creatinine ; Diabetic Nephropathies ; Dialysis* ; Glomerulonephritis ; Hematocrit ; Humans ; Hypertension ; Membranes ; Nutritional Status ; Renal Dialysis* ; Serum Albumin ; Sex Ratio ; Ultrafiltration ; Urea*

We have presented three cases of Ritter's disease appearing on 11, 14, and 14 days old boys respectively. Staphyloccccus albus was cultured from bullar contents of case 1 and 2, and coaguIase positive staphylococcus from case 3. These patients were successfully treated with systemic and topical antimicrobials.
Humans ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus

No abstract available.
Submandibular Gland* ; Tuberculosis*

BACKGROUND: Patients with sinus rhythm, the left atrial appendage(LAA) appeared as a vigorously contracting structure and the blood flow patterns of LAA showed biphasic configuration. However, patients with AF rhythm the blood flow showed irregular or no configuration in doppler echocardiographic study. The purpose of this study is to evaluate relationship between the blood flow patterns of LAA with the presence of spontaneous contrast(SC) and thrombi in LAA. METHODS: We performed TEE and TTE simultaneously to 58 consecutive patients who had native mitral valve disease or mitral prosthesis. Spontaneous contrast(SC) and the presence and location of LAA thrombi were evaluated during TEE and left atrial dimension(LAD) & ejection fraction(EF) were evaluated during TTE. We divided the whole subjects into three groups according to the blood flow patterns ; regular pattern(Group 1), irregular pattern(Group 2), no flow pattern(Group 3). RESULTS: 1) Blood flow within the left atrial appendage is divided with three groups among of them, atrial fibrillation have two blood flow patterns. 2) Peak prositive & negative flow velocity within LAA in AF rhythm groups were slower than normal sinus rhythm group.(p<0.01) 3) Left atrial dimension in group 3 is significantly larger than others groups.(p<0.01) 4) Spontaneous contrast(SC) with LAA could be detected in 2(6.8%) of the 29 patients of group 1, 6(31.5%) of the 19 patients of group 2, 10(100%) of the 10 patients of group 3. Incidence of SC within LAA in group 3 is significantly higher than others groups. 5) LAA thrombi could be detected in 1(3.4%) of the 29 patients of group 1, 1(5.2%) of the 19 patients of group 2, 3(30%) of the 10 patients of group 3. Incidence of LAA thrombi is significangly higher than other groups. CONCLUSIONS: We can suggest that blood flow within LAA is divided into three groups according to the blood flow patterns, and spontaneous contrast and thrombi in LAA were closely related with the blood flow pattern.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Humans ; Incidence ; Mitral Valve ; Prostheses and Implants

BACKGROUND/AIMS: The optimal time point for initiating renal replacement therapy in patients with end-stage renal disease remains controversial. The primary objective of our study was to determine the effects of residual renal function at the beginning of renal replacement therapy on the mortality of patients with end-stage renal disease. METHODS: We retrospectively studied the clinical outcomes in patients (n=210) with end-stage renal disease who underwent renal replacement therapy at our hospital between 2000 and 2005; all patients were followed for more than 1 year. We used the Modification of Diet in Renal Disease equation to estimate residual renal function. RESULTS: Of the 210 patients who received renal replacement therapy, 108 were treated with hemodialysis and 102 were treated with peritoneal dialysis. Thirty-three patients died, and the mean survival period was 37.3+/-17.7 months. The survival rates were compared based on the estimated glomerular filtration rate; no difference in survival rates was observed (p=0.27). Subgroup analysis in the hemodialysis group showed that patients who began chronic dialysis at a lower estimated glomerular filtration rate had higher mortality rates (p<0.05); patients treated with peritoneal dialysis showed no significant difference in mortality rate (p=0.50). CONCLUSIONS: Although there was no difference in the mortality rate based on residual renal function, hemodialysis patients with a lower estimated glomerular filtration rate showed a higher mortality rate than those with a higher estimated glomerular filtration rate.
Female ; Follow-Up Studies ; Glomerular Filtration Rate/*physiology ; Humans ; Kidney Failure, Chronic/*mortality/physiopathology/therapy ; Korea/epidemiology ; Male ; Middle Aged ; Prognosis ; Renal Dialysis/*methods ; Retrospective Studies ; Survival Rate/trends ; Time Factors

No abstract available.

PURPOSE: Diabetic macular edema is one of major causes leading to visual loss and it is difficult to be quantified. We investigated a volumetric quantification of retinal thickness change before and after focal laser photocoagulation with Heidelberg Retina Tomograph (HRT). METHODS: Ten patients who were diagnosed as diabetic retinopathy with clinically significant macular edema (CSME) in only one eye and treated with focal laser photocoagulation were studied. The opposite eyes which had no CSME were studied as control group. In the eyes which had CSME, the volume above reference plane (VARP) bounded by three consecutive circle centered at the fovea (diameter 1, 2, and 3 mm) were measured. The retinal thickness of control group was also measured with the same method. We performed focal laser photocoagulation for the eyes which had CSME and measured VARP at 1, 2, and 3 months after laser treatment. RESULTS: Three months after laser treatment, the VARP of treated eyes measured in each diameter was significantly decreased, however, there was no significant difference in control group. There was no significant difference in visual acuity change between before and 3 months after laser treatment. CONCLUSION: From the above results, we concluded that HRT could be used to quantify the change of diabetic macular edema before and after laser treatment.
Diabetic Retinopathy ; Humans ; Light Coagulation* ; Macular Edema* ; Retina ; Retinaldehyde ; Visual Acuity

No abstract available.
Necrosis*

No abstract available.
Gemfibrozil* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory*

Atrial flutter is and infrequent, but potentially unstable tachyarrythmia that occurs in pediatric ages. Transesophageal atrial pacing was used for treatment of 10 episodes of atrial flutter in 7 patients. At the time of atrial flutter conversion, patients were 6 days to 14 years old. 6 patients had associated with congenital heart disease. The atrial cycle length of atrial flutter ranged from 140 to 280 msec with variable atrioventricular conduction. Transesophageal atrial pacing was performed using a bipolar 4 F transesophageal electrode catheter. Atrial flutter conversion was accomplished with stimulation bursts using about 5 seconds of stimuli, 10 msec in duration at 20 to 27 mA. Pacing cycle length was 45 to 110 msec less than the atrial cycle length of tachycardia in 6 episodes. But in a neonate, underdrive pacing converted atrial flutter to sinus rhythm. Conversion attempts were unsuccessful on 2 occasions. Transesophageal atrial pacing is a safe and effective, minimally invasive technique for treatment of atrial flutter in infants and children.
Adolescent ; Atrial Flutter* ; Catheters ; Child* ; Electrodes ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn ; Tachycardia