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*

Sodium is the principal solute in the extracellular compartment and the major component of serum osmolality. In normal persons in the steady state, sodium homeostasis is achieved by a balance between the dietary intake and the urinary output of sodium, whereas in intermittent hemodialysis patients, sodium balance depends on dietary intake and sodium removal during hemodialysis. Thus, the main goal of hemodialysis is to remove precisely the amount of sodium that has accumulated during the interdialytic period. Sodium removal during hemodialysis occurs via convective (~78%) and diffusive losses (~22%) between dialysate and plasma sodium concentration. The latter (the sodium gradient) is an important factor in the 'fine tuning' of sodium balance during intermittent hemodialysis. Most use fixed dialysate sodium concentrations, but each patient has his/her own plasma sodium concentrations pre-hemodialysis, which are quite reproducible and stable in the long-term. Thus, in many patients, a fixed dialysate sodium concentration will cause a persistent positive sodium balance during dialysis, which could possibly cause increased thirst, interdialytic weight gain, and mortality. Several methods will be discussed to reduce positive sodium balance, including sodium alignment.
Dialysis ; Homeostasis ; Humans ; Osmolar Concentration ; Plasma ; Renal Dialysis ; Sodium ; Thirst ; Weight Gain

Internuclear ophthalmoplegia (INO) is characteristic of lesions of the medial longitudinal fasciculus (MLF) between the third and sixth cranial nerve nucleus. Bilateral INO is due to bilateral lesions of MLF. We present here one case of bilateral INO in tuberculous meningitis.
Abducens Nerve ; Ocular Motility Disorders* ; Tuberculosis, Meningeal

Obstructive pathology at epididymis, was deferens or seminal vesicle is a common cause of male infertility. To decide upon a suitable operative procedure it is helpful to localize the site of the blockage by means of a simple biochemical examination of the seminal fluid. The semen content of L-carnation and a-glucosidase has been measured in subjects consulting for evaluation of their fertility. The results were as follows . 1. Mean value of a-glucosidase activity was 1345fU/mg prot. in normospermia group(n : 20), 987uU/mg prot., in oligozoospermia group(n : 15), 833uU/mg prot. in azoospermia group(n : 15) and 290uU/mg prot. in post vasectomy group(n : 10), and approximately 40% of azoospermia and oligozoospermia group showed low levels in the spectrum of post vasectomy group. 2. Mean value of L-carnitine content was 0.71 mM in normospermia group, 0.43 nM in oligozoospermia group, 0.30 mM in azoospermia group and 0.22 mM in post vasectomy group, and approximately 50% of azoospermia and oligozoospermia group showed low levels in the spectrum of post vasectomy group. 3. a-glucosidase activity was positively correlated with sperm density(r = 0.532) and sperm motility(r =0.530). 4. L-carnitine content was positively correlated with sperm density(r =0.502) and sperm motility(r =0.511). 5. A close correlation(r=0.546) was found between both parameters over the range of azoospermia to normal zoospermia. Our results indicate that these two epididymal markers might thus be useful in the hands of the practicing andrologist who has to determine precisely the site of dysfunction in the reproductive system which leads to infertility.
Azoospermia ; Carnitine ; Diagnosis* ; Epididymis ; Fertility ; Hand ; Humans ; Infertility ; Infertility, Male* ; Male ; Male* ; Oligospermia ; Pathology ; Semen ; Seminal Vesicles ; Spermatozoa ; Surgical Procedures, Operative ; Vasectomy

No abstract available.
Humerus*

The antihypertensive effects of single daily dose of long-acting propranolol(Inderal LA(R)) were observed in 29 cases of essential hypertension, and the results were as follows; 1) Age distribution of the cases was from 39 years to 72 years with the mean age of 51.3. And there were 13 female and 16 male patients. 2) Mean value of the hypotensive effects in systolic and diastolic blood pressure were 22.9 mmHg, and 11.5 mmHg, respectively. 3) The results of the antihypertensive effects were as follows; good 31.0%, fair 34.5%, poor 20.7%, and failure 13.8%. 4) The decrement of heart rate with long-acting propranolol was 9.3 per minute in average. 5) 1 case of nausea and 2 cases of lassitude were noted, but these symptoms were subsided spontaneously with continous medication.
Age Distribution ; Blood Pressure ; Fatigue ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Nausea ; Propranolol

In 1971, Harris introduced a metal backed acetabular cup to allow replacement of worn polyethylene cups and it has been popularly used now. In metal backed acetabular cup, dissociation between metal shell and polyethylene liner usually occurs with hip dislocation. We report a case of dissociation of polyethylene liner in metal bacded cup not associated with hip dislocation.
Acetabulum ; Hip Dislocation ; Hip ; Polyethylene

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.
Rare Diseases ; Spinal Cord Diseases ; Spinal Cord*

Secondary lymphedema is an acquired condition resulting from damage to or obstruction of previously normal lymphatic channels, resulting in interstitial accumulation of protein-rich fluid, subsequent inflammation, adipose tissue hypertrophy, and finally fibrosis. It usually develops from infection, trauma, or malignancy or is a malignancy related to therapy. It has been rarely reported after a femoral vein cannulation procedure. We report a case of secondary lymphedema in a lower extremity after a femoral vein cannulation trial in a patient with chronic kidney disease.
Adipose Tissue ; Catheterization ; Catheters ; Femoral Vein ; Fibrosis ; Humans ; Hypertrophy ; Inflammation ; Lower Extremity ; Lymphedema ; Renal Insufficiency, Chronic

Patients with chronic renal failure, generally, sufferred from normocytic normochromic anemia caused by decreased level of erythropoietin. But, secondary erythrocytosis has been reported in patients with several renal diseases; renal artery stenosis or throm- bosis, polycystic kidney disease, bilateral hydronephrosis, etc. We report one case of chronic renal failure combined with polycythemia vera. The case was 32 year-old man whose chief complaints were dyspnea, back pain, itching sensation, headache. 6 month ago, the laboratory examination showed only proteinuria and hematuria without deterioration of renal function. The renal function was aggravated with an accelerated course, and bone marrow examination revealed hypercellularity (erythroid predominance), and renal biopsy showed the finding of the end stage of renal disease which may be originated from IgA nephropathy.
Adult ; Anemia ; Back Pain ; Biopsy ; Bone Marrow Examination ; Dyspnea ; Erythropoietin ; Glomerulonephritis, IGA* ; Headache ; Hematuria ; Humans ; Hydronephrosis ; Immunoglobulin A* ; Kidney Failure, Chronic* ; Polycystic Kidney Diseases ; Polycythemia Vera* ; Polycythemia* ; Proteinuria ; Pruritus ; Renal Artery Obstruction ; Sensation