Composite grafting remains a technique which is used reluctantly and without great hope of success. In the recent two years, unexpectedly good result of composite graft was gained from 30 cases. The purpose of our study is to identify factors influencing success and to overlook long-term problems from a cosmetic and a functional view point. A retrospective review and a questionnaire about 30 fingers of 29 patients which were operated for composite graft at Kyongju hospital of Dongguk university from March 1997 to February 1999 were carried out. In all cases of composite grafting, tie-over dressing and heat lamp were applied and left for five days. And following result and conclusion were obtained. 1. 24(80%) of 30 finger tips replaced as composite graft were survived completely or partially. 2. At children with an age range 1 to 14, the survival rate (100%) of composite grafted tips was higher than that (75%) at adults. So, patient's age was important factor for success. 3. The type of injury was more important factor than the level of amputation. The survival rate(100%) of tips to cutting injury was higher than that(75%) of tips to crushing injury. 4. The delay in time from amputation and replacement did not significantly correlate with the survival rate. But, all tips replaced within 3 hours were survived completely or partially. 5. Even if partial necrosis on grafted tips was present, a result of long-time conservative treatment with minimal debridrement was excellent. Especially in children, the tips with conservative treatment showed normal appearance, several months later. 6. Cosmetic and functional results were better in child group and in groups with higher survival rate. Most common problem in cosmetic aspect was a short digit and that in functional aspect was a tender tip. 7. As a heat lamp increased blood supply, we could obtain better outcome.
Adult ; Amputation ; Bandages ; Child ; Fingers ; Gyeongsangbuk-do ; Hope ; Hot Temperature ; Humans ; Necrosis ; Surveys and Questionnaires ; Retrospective Studies ; Survival Rate ; Transplants*

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies

Endpgenous bacterial endophthalmitis develops mainly in a extremely ill patient or a immunologically compromised patient. As reported earlier, early suspicion and careful diagnostic evaluation and early aggressive treatment are important to treat endophthalmitis and prevent poor visual acuity. The authors experienced a case of endogenous endophthalmitis developed from pneumonia in chronic alcoholics patient. The pathogen was proved to be a Staphylococcus aureus by the culture of specimen obtained from the aqueous. Systemic, topical, subconjunctival and intravitreal antibiotic therapy were done, but the patient's eye progressed to phthisis state.
Alcoholics* ; Endophthalmitis* ; Humans ; Pneumonia ; Staphylococcus aureus ; Visual Acuity

BACKGROUND: The clinical characteristics and significance of peritoneal fluid eosinophilia (PFE) in patients on continuous ambulatory peritoneal dialysis (CAPD) in Korea were uncertain. The present study was performed to clarify the clinical characteristics of PFE in our CAPD patients. METHODS: Between January 2000 and December 2001, we analyzed retrospectively the clinical data of 112 patients on CAPD at two renal centers. RESULTS: The mean period of the observation was 12.6+/-6.7 months, and the total number of peritoneal effluent sampling was 1, 024 (10.5/patient-year). PFE was found in 4.4% of patients. The incidence of PFE was 4.25 per 100 patients/year. Sixty percent of patients with PFE experienced within 2 weeks of initiation of dialysis. The duration of PFE episode varied from 1 to 4 days with the mean value of 2.8 days. All PFE episodes except one patient with abdominal pain treated by oral prednisolone had no symptoms and was spontaneously resolved. The only distinction between the patients with PFE and those without was concomitant peripheral blood eosinophilia (80.0% vs. 15.8%, p=0.0027). Other factors such as age, sex, primary renal disease, bacterial peritonitis, previous use of heparin or antibiotics, blood in peritoneal fluid, and allergic history were not significantly different between the two groups. CONCLUSION: The majority of PFE episode in CAPD patients developed within 2 weeks of initiation of dialysis and spontaneously resolved without treatment. Peripheral blood eosinophilia was a good predictor of PFE.
Abdominal Pain ; Anti-Bacterial Agents ; Ascitic Fluid* ; Dialysis ; Eosinophilia* ; Heparin ; Humans ; Incidence ; Korea ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prednisolone ; Retrospective Studies

Though noticeable technological advances related to hemodialysis (HD) have been made, unfortunately, the survival rate of dialysis patients has yet to improve significantly. However, recent research findings reveal that online hemodiafiltration (HDF) significantly improves patient survival in comparison to conventional HD. Accordingly, the number of patients receiving online HDF is increasing. Although the mechanism driving the benefit has not yet been fully elucidated, survival advantages are mainly related to the lowering of cardiovascular mortality. High cardiovascular mortality among HD patients is seemingly attributable to the cardiovascular changes that occur in response to renal dysfunction and the HD-induced myocardial stress and injury, and online HDF appears to improve such secondary cardiovascular changes. Interestingly, patient survival improves only if the convection volume is supplied sufficiently over a certain level during online HDF treatment. In other words, survival improvement from online HDF is related to convection volume. Therefore, there is a growing interest in high-volume HDF in terms of improving the survival rate. The survival improvement will require a minimum convection volume of 23 L or more per 4-hour session for postdilution HDF. To obtain an optimal high convection volume in online HDF, several factors, such as the treatment time, blood flow rate, filtration fraction, and dialyzer, need to be considered. High-volume HDF can be performed easily and safely in routine clinical practice. Therefore, when the required equipment is available, performing high-volume HDF will help to improve the survival rate of dialysis patients.

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.
Adult ; Amebiasis/diagnosis ; Demography ; Drainage ; Female ; Human ; Incidence ; Liver Abscess/etiology/*pathology/physiopathology ; Male ; Mortality ; Serologic Tests ; Suppuration/microbiology

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder characterized by innumerable bilateral renal cysts. It has an prevalence rate of one in 200~1,000 individuals and is a relatively common cause of renal failure. As renal function deteriorates, overall renal size usually diminish in patients with chronic renal failure. However, renal size of patients with ADPKD usually continues to increase, even after the initiation of dialysis therapy, because numerous cysts replace renal mass. Attempted methods to reduce the size of enlarged kidneys have included needle aspiration and sclerotherapy, cyst decompression surgery, laparoscopic and surgical nephrectomy. The outcome of these therapy frequently has been suboptimal, and there is a need to develop a more effective therapy. We report a case of renal arterial embolization using 99% ethanol and lipiodol mixture for ADPKD in a hemodialysis pathient, which has not been previously reported.
Decompression ; Dialysis ; Ethanol* ; Ethiodized Oil* ; Humans ; Kidney ; Kidney Failure, Chronic ; Laparoscopy ; Needles ; Nephrectomy ; Polycystic Kidney, Autosomal Dominant* ; Prevalence ; Renal Dialysis* ; Renal Insufficiency ; Sclerotherapy

BACKGROUND AND OBJECTIVES: The sense of smell plays an important role in the quality of life. Loss of smell is common in the elderly and it results from respiratory diseases, certain disease states (Alzheimer disease, chronic renal failure (CRF), multiple sclerosis), medications, and surgical interventions. Many studies have shown a declining odor perception in the CRF patients. The objectives of the present study were to test odor identification ability in patients with CRF and the effect of hemodialysis on olfactory recognition, and to examine the possible correlations between smell identification test score and various clinical parameters. MATERIALS AND METHOD: We performed a case-control study comparing the Cross- Cultural Smell Identification Test (CC-SIT) scores of CRF patients with hemodialysis, and those without hemodialysis, and age-sex matched healthy controls. RESULTS: Healthy controls had significantly high CC-SIT scores compared to those of CRF patients without hemodialysis. No significant differences were observed in the CC-SIT scores between CRF patients with hemodialysis and healthy controls and in CRF patients before and after the hemodialysis session. No significant positive correlation was found between CC-SIT score and creatinine clearance in the dialysis group. CONCLUSION: Acute removal of uremic toxins by hemodialysis does not correct olfactory disturbances. Odor perception is severly impaired in patients with CRF and is related to the degree of renal impairment.
Aged ; Case-Control Studies ; Creatinine ; Dialysis ; Humans ; Identification (Psychology) ; Kidney ; Kidney Failure, Chronic* ; Odors ; Quality of Life ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Smell

Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheter-related infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were: 1) to analyze the causative pathogen; 2) to determine the appropriate treatment regimen and duration; and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culture-positive. The distribution of isolates was as follows : coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphylococcus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46 (50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Gram-positive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy with vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylococcal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.
Amikacin ; Catheter-Related Infections ; Catheters ; Cefazolin ; Coagulase ; Enterococcus ; Follow-Up Studies ; Fungi ; Humans ; Klebsiella ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Recurrence ; Serratia ; Staphylococcus aureus ; Tobramycin ; Vancomycin ; Xanthomonas

To determine the optimal administration route of calcitriol in CAPD patients with secondary hyperparathyroidism, we conducted a prospective study on 33 patients who performed CAPD for more than 6 months an d whose intact parathyroid hormone(iPTH) level was higher than 250pg/mL. The patients were randomized into 3 groups:IP(n=11); 1.0 microgram of calcitriol once daily via intraperitoneal route by overnight retention with dialysate, SC(n=11); 1.0 microgram of calcitriol three times a week via subcutaneous route, and PO (n=11); 1.0 microgram of calcitriol three times a week by ingestion. 11 out of 33 patients(6 in IP, 4 in SC, and 1 in PO) dropped out during the 6-months study period, and 5 among the 6 patients in IP were due to recurrent peritonitis. Biochemical data including calcium, phosphorus, iPTH, alkaline phosphatase, bone-specific alkaline phosphatase, osteocalcin and 1,25(OH)2D3 were measured regularly, and the data of 22 patients who had completed the 6-months study were analyzed. There was a statistically significant decrease in iPTH level(pg/mL) in the three groups after 6-months calcitriol therapy(IP; 812.0+/-276.7 vs. 354.7+/-129.4, PO; 571.8+/-330.7 vs. 159.6+/-192.3, SC; 786.1+/-535.0 vs. 551.8+/-729.9, respectively, P<0.05), but there were no differences in the percentage of decrease in iPTH from baseline values among the three groups. Alkaline phosphatase, bone- specific alkaline phosphatase and osteocalcin also decreased significantly in all three groups(IP; 50.1+/-14.6, 33.5+/-11.6, 52.3+/-10.9% of baseline value; SC; 80.9+/-14.8, 67.4+/-20.80, 54.4+/-11.1% of baseline value; PO; 48.8+/-24.4, 36.6+/-23.5, 54.2+/-11.6% of baseline value, respectively, P<0.05), but they were not different with each other. Among 22 patients who completed the 6-months study, hypercalcemia(Ca>=10.5 mg/dL) occurred in 7 patients(31.8%). IP(2/5, 40%) and SC groups(5/7, 71.4%) had significantly higher incidence of hypercalcemia than PO group(0/10, 0%) (P<0.05). IP group(2/5, 40%) also experienced significantly higher incidence of hyperphosphatemia than SC(1/7, 14.3%) and PO groups(1/10, 10%). Peritonitis occurred significantly more in IP than in SC and PO groups(P<0.05). In conclusion, calcitriol treatment resulted in a significant decrement in iPTH levels in CAPD patients and no significant differences were noted in the iPTH-suppressive effect of calcitriol according to the administration route. Because of higher incidence of peritonitis and hypercalcemia in IP and SQ groups, oral ingestion may be the most optimal route for calcitriol treatment in CAPD patients with secondary hyperparathyroidism.
Alkaline Phosphatase ; Calcitriol* ; Calcium ; Eating ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Incidence ; Osteocalcin ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Phosphorus ; Prospective Studies*