In maintenance dialysis patients, death is most often due to cardiac disease. The common causes of death in nondiabetic dialysis patients are congestive heart failure. Relation between taurine and cardiac contractility had been reported in animal studies. Uremic patients have taurine deficiency and this may induce impairment in cardiac contractility. We performed this study to evaluate the relationship between plasma taurine concentration and left ventricular(LV) function by echocardiography in clinically stable 23 hemodialysis(HD) patients. HD patients had significantly lower plasma taurine concentrations(29.1+/-9.4 micromol/L) compared to control(57.6+/-17.5 micromol/L). There were significant correlations between plasma taurine concentrations and fractional shortening(FS)(r=0.422, P<0.05), and taurine and LV end-diastolic diameter(LVEDD)(r=-0.531, P<0.01). By partial correlation analysis of controlling hematocrit, this correlations were maintained between taurine and LVEDD(r=-0.46, P<0.05) and there was a tendency of correlation between taurine and FS(r=0.37, P=0.09). There was a significant correlation between plasma taurine concentrations and normalized protein catabolic rate(NPCR)(r=0.42, P<0.05), insulin-like growth factor 1(IGF-I)(r=0.43, P<0.05) and prealbumin(r=0.54, P<0.05). Group I in whom plasma taurine concentrations were below median value had significantly lower FS(29.7+/-8.2 vs. 38.5+/-8.0%, P<0.05) and higher LVEDD(57.7+/-4.7 vs. 53.1+/-3.0mm, P<0.05) and LV mass index(299.2+/-73.1 vs. 192.4+/-49.7g/m2, P<0.05) than group II in whom plasma taurine concentrations were above median value. On linear multiple regression analysis, plasma taurine concentrations and diastolic blood pressure were independently correlated with FS. In conclusion, taurine deficiency may be one of the factors affecting LV dysfunction in maintenance HD patients.
Animals ; Blood Pressure ; Cause of Death ; Dialysis ; Echocardiography ; Heart Diseases ; Heart Failure ; Hematocrit ; Humans ; Plasma* ; Renal Dialysis* ; Taurine* ; Ventricular Dysfunction, Left*

Necrotizing fasciitis is a relatively uncommon infectious disorder where a bacterial organism penetrates the subcutaneous tissues and superficial fascia, ultimately causing necrosis of vast areas of soft tissue. Although invasive Streptococcus spp., most commonly group-A streptococci, is the most frequent cause of this disorder, in a single organism-infection, necrotizing fasciits caused by Klebseilla pneumoniae is becoming more frequently reported, perhaps due to the recent increase in the frequency of diabetes and liver diseases. Necrotizing fasciitis caused by K. pneumoniae is usually secondary to hematogenous dissemination, most commonly caused by trauma or liver abscess and usually results in multiple organ failure. The progression of the disease is so rapid that the mortality rate is high despite aggressive surgical intervention and extensive use of antibiotics at an early disease stage. Here we report a case of necrotizing fasciitis caused by hematogenously spread K. pneumoniae from incompletely treated chronic otitis media in a patient with alcoholic liver cirrhosis and diabetes.
Anti-Bacterial Agents ; Fasciitis, Necrotizing* ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Cirrhosis, Alcoholic ; Liver Diseases ; Liver Diseases, Alcoholic ; Mortality ; Multiple Organ Failure ; Necrosis ; Otitis Media* ; Otitis* ; Pneumonia ; Streptococcus ; Subcutaneous Tissue

BACKGROUD: To study the prevalence of abnormalities found in routine preoperative eletrocardiograms (ECGs) and to analyze abnormal ECG findings in different age groups. METHODS: 9,709 patients undergoing elective surgery requiring anesthesia at Busan Paik Hospital from January to December 2002 were retrospectively studied. Preoperative ECGs were analyzed in terms of age, sex and specific abnormal ECG findings that might alter anesthetic management. RESULTS: 1,683 of 9,709 patients (17.3%) had abnormal electrocardiogram findings. The incidences of ventricular hypertrophy, bundle branch block, myocardial ischemia, arrhythmia, myocardial infarction and atrioventricular block were 5.3%, 4.1%, 3.9%, 2.5%, 1.0% and 0.5%. Those over 75 years, 43% had abnormal findings and the incidence of myocardial ischemia, arrhythmia and ventricular hypertrophy were 11.7%, 9.7% and 8.7%. CONCLUSIONS: The prevalence of unexpected preoperative ECG abnormalities among elective surgery patients is high, especially among older patients. Given the wealth of information provided by preoperative ECG at low cost, ECG is necessary to establish the components of routine preoperative assessment for cardiovascular disease, especially for older adults.
Adult ; Anesthesia ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bundle-Branch Block ; Busan ; Cardiovascular Diseases ; Electrocardiography* ; Humans ; Hypertrophy ; Incidence* ; Mass Screening* ; Myocardial Infarction ; Myocardial Ischemia ; Prevalence ; Retrospective Studies

PURPOSE: Previously, Epstein-Barr virus (EBV) infection was diagnosed by serological examination; currently, many EBV antigen detection methods have been developed and applied clinically for diagnosing EBV infection. To delineate the clinical characteristics of EBV infection, clinical and laboratory findings were evaluated for patients who tested positive in EBV polymerase chain reaction (PCR). METHODS: EBV PCR was conducted in 352 patients admitted to the pediatric ward from January 2004 to December 2006, with more than 2 clinical signs such as fever (> or =37.5degrees C), exudative throat infection, lymphadenopathy, hepatitis of unknown etiology, and splenomegaly. The EBV viral gene was detected by PCR in 115 patients (32%), and the clinical characteristics of these patients were evaluated. Laboratory findings such as leukocytosis, thrombocytopenia, atypical lymphocyte, and alteration in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in peripheral blood were examined. The EBV-specific immunoglobulin M antibody (EBV-IgM Ab) was also tested. RESULTS: Most of the children were younger than 8 years (89%), and the male to female ratio was 1.3:1. Exudative throat infection and fever (> or =37.5degrees C) were observed in all patients. Cervical lymph node enlargement was seen in 36 patients (31%); leukocytosis (WBC> or =10,000/mm3), in 54 patients (47%); and atypical lymphocyte (> or =20%), in 28 patients (24%). EBV-IgM Ab was positive in 33 patients (29%). The younger patients had higher ALT levels and higher incidence of positive EBV-IgM Ab than the older patients. CONCLUSION: The cumulative number of patients diagnosed to have EBV infection by PCR increased markedly for those under 8 years. ALT was higher and EBV-IgM Ab was detected more in younger patients with EBV infection.
Alanine Transaminase ; Aspartate Aminotransferases ; Child ; Epstein-Barr Virus Infections ; Female ; Fever ; Genes, Viral ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Incidence ; Leukocytosis ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Male ; Pharynx ; Polymerase Chain Reaction ; Splenomegaly ; Thrombocytopenia

In this study, we developed the protopype of QA phantom for image QA including an additional component for image based radiation treatment system. The new phantom considered two main parts: Image quality and fusion accuracy. Image quality part included for daily CT number linearity and spatial resolution, and fusion accuracy part designed to simulate a simple translation-rotation setting. The CT scans of the phantom obtained from conventional CT, MVCT of Tomotherapy unit, and both image sets were satisfied the recommendation of spatial resolution. This phantom was simple and efficient for daily imaging QA, and it is important to provide a new concept of verification of image registration.

The Korean Society of Nephrology (KSN) launched a nationwide official survey program about dialysis therapy in 1985. Nowadays, the accumulated data for 30 years by this "Insan Prof. Min Memorial end-stage renal disease (ESRD) Registry" program have been providing the essential information for dialysis clinical practice, academic nephrology research, and health management policy. We reviewed 30 years of data to identify important changes and implications for the future improvement of dialysis therapy in Korea. Hemodialysis patients, especially diabetics and elderly patients have increased in number very rapidly during recent years in Korea. The Korean prevalence rate of ESRD patients was about 70% of the United States and about 50% of Japan according to the international comparisons in the annual data report of United States Renal Data System. The blood pressure control, anemia control, and dialysis adequacy have continuously improved year by year. The importance of calcium and phosphorus control has also been increasing because of the increase in long-term dialysis patients. In addition, chronic dialysis complications should be closely monitored and dialysis modifications, such as hemodiafiltration therapy, might be considered. Because of the increase of private clinics and nursing hospitals in dialysis practice, the role of dialysis specialists and continuing education are thought to be essential. For strict cost-effective dialysis control of increasing elderly, diabetic, and long-term dialysis patients, the KSN ESRD patient registration should be run by the KSN and health ministry in cooperation, in which the dialysis fee reimbursement should be accompanied.
Aged ; Anemia ; Blood Pressure ; Calcium ; Dialysis ; Education, Continuing ; Fees and Charges ; Hemodiafiltration ; Humans ; Information Systems ; Japan ; Kidney Failure, Chronic* ; Korea ; Nephrology ; Nursing ; Peritoneal Dialysis ; Phosphorus ; Prevalence ; Renal Dialysis ; Specialization ; United States

Infantile hepatic hemangioendothelioma is a rare disorder. It is a benign entity and usually resolves spontaneously. Most patients present in infancy and early childhood. Because of its natural course and symptom onset, most cases are discovered during childhood. We experienced a rare case of infantile hepatic hemangioendothelioma in an adult.
Adult ; Hemangioendothelioma ; Humans ; Liver

OBJECTIVES: Endoscopic Ultrasonography (EUS) is widely used to diagnose upper gastrointestinal tract disease. In recent, it is reported that EUS is also goood diagnostic method to assess depth of invasion through rectal wall and lymph node involvement of rectal cancer. We performed EUS in preoperative rectal cancer patients and compared to post operative histologic findings to evaluate EUS diagnostic accuracy for rectal cancer staging system METHODS: 51 patients with rectal cancer were performed with EUS. They were diagnosed by endoscopic biopsy from August 1994 to June 1996 at Kangbuk Samsung Hospital. Their ages were 28 to 78 (mean: 55 years) and the male to female ratio was 2 : 1 (34/17). Olympus GF-UM3, EU-M3 EUS and 7.5/12 MHz transducer were utilized. EUS was performed by the deaerated water filling method. We have analyzed between preoperative EUS findings and postoperative biopsy findings in order to evaluate the accuracy of EUS. The accuracy of EUS was signified by percentage. RESULTS: 1) Endoscopic ultrasonographic accuracy for assessment of wall invasion of rectal cancer was as follows ; The accuracy of mucosal cancer was 50% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 2/4). Submucosal cancer was 100% (1/1). Muscularis propria cancer was 44% (4/9). The accuracy with penetration to subserosa (or perirectal fat tissue) was 97% (33/34). The accuracy with invasion to adjacent organ was 33% (1/3). The overall accuracy rate was 80% (41/51). 2) EUS accuracy of lymph node metastasis in rectal cancer was ; The sensitivity was 90% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 28/31). The specificity was 60% (12/20). 3) EUS diagnosis of modified Duke classification was ; The accuracy of A stage was 80% (patient numbers of EUS diagnosis/patient numbers of histologic dagnosis: 4/5). B1 stage was 60% (4/8). B2 stage was 33% (1/3). C1 stage was 0% (0/3). C2 stage was 86%(25/28). D stage was 33% (1/3). The overall accuracy rate was 69% (35/51). CONCLUSION: EUS is useful method to assess rectal cancer invasion through rectal wall and lymph node involvement. However, further refinements in instruments and the techniques is required for more improving diagnostic accuracy.
Biopsy ; Classification ; Diagnosis* ; Endosonography* ; Female ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis* ; Rectal Neoplasms* ; Sensitivity and Specificity ; Transducers ; Upper Gastrointestinal Tract ; Water

PURPOSE: Bone is the most common site of metastasis from breast cancer. An abnormal bone scan finding, however, is not specific in differentiation of bone metastasis from traumatic or inflammatory bone diseases. The purpose of this study was to identify clinical findings that could help evaluate the etiology of solitary costal hot spots on a bone scan. METHODS: The study included 32 patients (all women, mean age 51+/-1 years) showing solitary costal hot spots on postoperative bone scans performed between January 1998 and December 2002. In order to classify the etiology of solitary costal hot spots as non-malignant or malignant, all available clinical, scintigraphic, laboratory and other radiographic examinations were taken into consideration. RESULTS: The mean follow-up period was 42.5 months. Among 32 hot spots, 7 (21.8%) were metastatic, and the remaining 25 (78.2%) non-malignant. The mean period of first detection after operation was 17.0+/-16.3 months in the metastatic and 26.0+/-21.3 months in the non-malignant groups. The metastatic group was significantly associated with advanced breast cancer. In the localization of rib lesion, 20 (62.5%) of the solitary costal hot spots were in the anterior arc, 5 (15.6%) in the lateral arc and 7 (21.9%) in the posterior arc. In the group with a location at the anterior arc, 16 (80%) were non-malignant, whereas 4 (20%) were malignant. In those localized at the anterior arc, 12 (60%) were on ipsilateral and 8 (28%) were on contralateral. The difference between the hot spots in the ipsilateral and contralateral locations was not significant. The carcinoembryonic antigen (CEA) and CA15-3 were elevated: in 5 (51%) and 3 (43%) patients with metastatic spots, and in 4 (16%) and 1 (4%) patient with non-malignant lesions, which were significantly different. CONCLUSION: It was found that an advanced state of primary breast cancer and the increase of tumor markers (CEA and CA15-3) were the significant factors for the direction of the nature of solitary costal hot spots on postoperative bone scans in patients with breast cancer.
Bone Diseases ; Breast Neoplasms* ; Breast* ; Carcinoembryonic Antigen ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Ribs ; Biomarkers, Tumor

BACKGROUND/AIMS: Although mucosal mast cell tryptase is known to significantly increase intestinal permeability, the relationship between mucosal mast cells and intestinal permeability remains unclear. The objective of this study was to evaluate the correlation among intestinal permeability, tryptase activity and mucosal mast cell count. METHODS: Rectal biopsies from 16 patients with diarrhea-predominant irritable bowel syndrome (IBS-D) and 7 normal subjects were assessed for tryptase activity and macromolecular permeability using horseradish peroxidase in Ussing chambers. In addition, mucosal mast cell levels were immunohistochemically quantified via image analysis. RESULTS: Rectal biopsy of tissues from IBS-D patients showed significantly increased permeability compared with those from normal controls (0.644 +/- 0.08 and 0.06 +/- 0.00 ng/2 hr/mm2, P < 0.01). Tryptase activity was also substantially higher in rectal biopsy samples from IBS-D patients than those from normal controls (0.86 +/- 0.18 and 0.28 +/- 0.04 mU/mg protein, P < 0.05). Mucosal mast cell counts were not significantly different between the 2 groups (P > 0.05). However, correlation analysis revealed that only mucosal mast cell count was significantly correlated with intestinal permeability in IBS-D patients (r = 0.558, P < 0.05). CONCLUSIONS: This study demonstrated a positive correlation between the number of mucosal mast cells and intestinal permeability, suggesting that mucosal mast cells play an important role for increased intestinal permeability in patients with IBS-D.
Biopsy ; Diarrhea ; Horseradish Peroxidase ; Humans ; Irritable Bowel Syndrome ; Mast Cells ; Permeability ; Tryptases