It is important to maintain normal calcium concentration especially ionized calcium concentration in chronic renal failure patients on hemodialysis. The direct measurement of ionized calcium is less commonly used due to a lack of automated equipment as well as the cost of laboratory equipment. Numerous formulas for adjusted total calcium and calculated ionized calcium are used in clinical practice. We examined the relationship between direct measured ionized calcium and total calcium, corrected total calcium, calculated ionized calcium (formula of Nordin et al) in 53 chronic renal failure patients on hemodialysis. The results were as follows; 1) In predialysis group, plasma total and ionized calcium levels were 2.36+/-0.26, 1.04+/-0.21mmol/L respectively, and higher than normal controls. The correlations between plasma ionized calcium and total calcium, calculated ionized calcium, corrected total calcium were r=0.72 (P=0.0001), r=0.81 (P=0.0001), r=0.65 (P=0.0001) respectively. The plasma ionized calcium level was not correlated with the level of albumin, pH, phosphate, parathyroid hormone. 2) The plasma total and ionized calcium levels were significantly increased with hemodialysis and values were 2.49+/-0.14mmol, 1.14+/-0.14mmol/L respectively. The correlation between ionized and total calcium was r=0.41 (P=0.0021). These results suggested that the calculated ionized calcium (formula of Nordin et al) and total calcium can be used to predict the plasma ionized calcium level in chronic renal patients on hemodialysis.
Calcium* ; Humans ; Hydrogen-Ion Concentration ; Kidney Failure, Chronic ; Parathyroid Hormone ; Plasma ; Renal Dialysis*

The 5 year survival rate after surgical resection for stage III non-small cell lung cancer(NSCLC) remains short, only 10-19%. Radiotherapy seems to show some benefit for local control, but it does not reflect to prolongation of survival, as distant metastasis prevails. Vinblastine is one of the most active agent against NSCLC. 5-Fluorouracil(5-FU) and cisplatin are synergistic in anti-cancer activity in adenocarcinoma of gastrointestinal tract and squamous cell cancer of head and neck. We initiated a phase II trial for advanced NSCLC to determine the effect of FVP regimen in response rate, survival and toxicities. The therapy consisted of 5-FU 500mg/m2/12 hours continious IV infusion for 36 hours from day 1, vinblastine 3mg/m2 IV bolus day 1 and 2, cisplatin 75mg/m2 IV infusion over 2 hours day 1 and it was repeated every 3 weeks. Among the 45 patients entered into this study, 40 patients were evaluable for response. The objective response rate was 50%(CR;1/40, 2.5% PRi19/40, 47.5%). The median survival of all the patients was 42.9 weeks(8.4+ - 140.6 weeks); the responding patients survived longer than the non-responders(mediansurvival; 54.4 weeks vs 29.7 weeks, p<0.05). The toxicities of this regimen were acceptable but 1 patient died of pneumonia associated with granulocytopenia. We concluded that the FVP regimen is effective in the treatment of advanced non-small cell lung cancer and a prospective randomized trial and long- term follow up is warranted.
Adenocarcinoma ; Agranulocytosis ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Dronabinol* ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Follow-Up Studies ; Gastrointestinal Tract ; Head ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Neoplasms, Squamous Cell ; Pneumonia ; Radiotherapy ; Survival Rate ; Vinblastine

Protein and energy malnutrition are common in dialysis patients. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increased morbidity and mortality in both hemodialysis and peritoneal dialysis. To validate subjective global assessment(SGA) in dialysis patients we compared subjective global assessment with objective measurements(anthropometry, bioelectrical impedance, biochemical measurements) in 54 chronic hemodialysis patients. We divided patients into three groups(SGA1, SGA2, SGA3) according to modified subjective global assessment performed by an observer. Body weight, %IBW, BMI, TSF, MAC, nPCR were different significantly among three groups. SGA was related objective measurements such as body weight, %IBW, BMI, %Fat, TSF, MAC, nPCR(p<0.001). Multiple regression analysis showed that the relationship of SGA(as a dependent variable) with objective measurement(covariate) was stronger(multiple r=0.789, R2=60%) than the relationship found with univariate analysis. In other words, since no single objective method can be considered a gold standard of nutritional assessment, our data show that subjective global assessment is a clinically adequate method for assessing nutritional status in maintenance hemodialysis patients.
Body Weight ; Dialysis ; Electric Impedance ; Humans ; Malnutrition ; Mortality ; Nutrition Assessment ; Nutritional Status ; Peritoneal Dialysis ; Renal Dialysis*

Blood recirculation in hemodialysis access is one of the factors decreasing dialysis efficiency. The purpose of this study was to evaluate access recirculation by the site of veins, length of catheters using the low-flow two-needle method in recently inserted temporary central vein catheterization used for hemodialysis in patients with chronic renal failure, and evaluate the reproducibility of low-flow method. A total of 56 measurements were performed in 15 chronic renal failure patients harboring 25 different catheters. Mean blood recirculation for the 56 measurements was 11.1+/-7.9%, it was significantly higher in the femoral catheters than in the subclavian catheters, reaching respective means of 17.9+/-6.5%, 5.2+/-2.3%. Blood recirculation rate was not different between 13.5cm and 19.5cm long subclavian catheters(5.3+/-2.7%, versus 5.5+/-1.7%), but was significantly higher in 13.5cm than in 19.5cm long femoral catheters(20.3+/-6.1% versus 13.3+/-4.8%, P=0.0067). Mean URR for the 56 dialysis sessions was 52.7+/-10.3%, it was significantly higher for sessions performed with subclavian than with femoral catheters(56.0+/-9.8% versus 48.8+/-9.7%, P=0.0088). An overall weak negative correlation of -0.42 was observed between blood recirculation and URR; the correlation was stronger for the sub-group of 19.5cm long femoral catheters, reaching -0.63. The obtained results were reproducible with a mean difference between two measurements in 18 cases of only 3.62+/-5.3% and a correlation of 0.68. The difference between blood recirculation rates in temporary femoral and subclavian catheters may be consequent to an anatomical factor. It may relate to the size of the vein, the blood probably having less possibility to recirculate near the tip of the catheter in a wider vein. In conclusion, femoral catheters particularily the shorter ones, are associated with significantly higher blood recirculation, and thus may consequently reduce the dialysis efficiency. In patients for whom dialysis dose is a priority, such as cases of intoxication for whom rapid and efficient toxic substance removal is mandatory, we think the subclavian catheters may become a first choice.
Catheterization ; Catheters* ; Dialysis ; Humans ; Kidney Failure, Chronic ; Renal Dialysis ; Veins

Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conservation surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherapy either simultaneously (n=37) or before (n=20) radiation therapy. Moist desquamation was the most common adverse effect which occurred in 46% (16/37) treated with concurrent chemotherapy and radiation therapy while 8 patients (38%) treated with sequential regimen had the finding. Difference between two groups was not statistically significant. Incidence of severe neutropenia (WBC>1,800) or abnormal elevation of liver enzymes was also not influenced by sequencing of adjuvant therapies. Arm edema was observed in 2 patients of concurrent group and was observed in 2 patients treated with sequential regimen. Two patients treated with concurrent regimen did not complete 6 cycles of chemotherapy while one patient with sequential regimen did not complete. Incidence of toxicity during chemotherapy was not altered by timing of radiation therapy. In conclusion, chemotherapy and radiation therapy can be given concurrently after breast conservation surgery in stage I or II breast cancer patients without increase of serious toxicity.
Arm ; Breast Neoplasms* ; Breast* ; Consensus ; Drug Therapy* ; Edema ; Humans ; Incidence ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies

The routine screening of patients for hypercalcemia has increased the incidence of hyperpa-rathyroidism, But, Primary hyperparathyroidism is relatively rare disease in korea. Especially, primary hyperparathyroidism caused by parathyroid chief cell hyperplasia has not been reported. The numbers of patients with bone disease, renal stones, other severe complication has declined, but the numbers of patients with psychiatric and neuromuscular disturbance or with asymptomatic disease has increased. We experienced a case with severe bone diseases due to primary hyperparathyroidism caused by parathyroid chief cell hyprepiasia which was confirmed through the mearsurement of serum calcium and parathyroid hormone, neck CT scanning and surgical exploration and which was managed by total parathyroidectomy with autotransplantation.
Asymptomatic Diseases ; Autografts ; Bone Diseases* ; Calcium ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary* ; Hyperplasia* ; Incidence ; Korea ; Mass Screening ; Neck ; Parathyroid Hormone ; Parathyroidectomy ; Rare Diseases ; Tomography, X-Ray Computed

Double primary cancer is defined as the case of primary malignant tumors, which must be arise in different sites and have a different histologic appearences. The number of reported cases of double primary malignant tumors has increased in recent and the occurrence of multiple primary cancers in the same individuals is one of the interesting subjects for investigation and research in relation to the carcinogenic mechanism and/or genetic factors. We have experienced a case with double primary malignant tumors of different site origins such as stomach adenocarcinoma and rectal adenocarcinoma, which were diagnosed by biopsies with gastro and colono fiberscopy. For its great rarity, we report this case with review of literatures.
Adenocarcinoma ; Biopsy ; Rectum* ; Stomach*

OBJECTIVES: In order to devise the combination module transmitting bio signal and signal data remotely, as defect of wirewireless combination module was complemented by designing a single combination of wireless module and power supply module, a single system was implemented. METHODS: Currently in case of wireless transmission, it had various problems causing by some factors such as buildings, obstruction, and entanglement of wires and so on. In order to overcome problems of wireless transmission, a single combination module design was researched, which transmits vital signal and sign data using basic electric line installed in the inner building or between others. Even though it was also possible of wireless communication and the internet, in case of a power supply without them, it could be possible to transfer data to underground or top ground in the inner building without any special communication line. RESULTS: Bio signal data was transmitted through a power supply line, a noise problem occurred would be solved by the designed noise filter. The filter showed that noise was cut off about more than 90%. It was also confirmed that the used ECG signals was stably received on transmission experiment. An internal PCB antenna could make the system be wireless communication without the disclosure of an antenna. CONCLUSIONS: In this study, in order to implement a useful system transmitting bio signal and data through wire and wireless management for combination design of wireless module and electrical line module, bio signal transmission system was implemented by design of noise break filter circuit to reduce power noise and PCB internal antenna design.
Complement System Proteins ; Disclosure ; Electric Power Supplies ; Electrocardiography ; Internet ; Noise ; Vital Signs

PURPOSE: The prevalence of sexual dysfunction among male hemodialysis patients is high. The causes of sexual dysfunction in chronic renal failure are composed of physiological and psychological factors. We assessed the prevalence, severity and factors of sexual dysfunction among male patients undergoing hemodialysis using of International index of erectile function (IIEF). METHODS: A single center cross-sectional study of 57 male hemodialysis patients was conducted to the determinants of sexual dysfunction. All patients were required to complete questionnaires by themselves (IIEF and Beck depression inventory (BDI)) and biochemical and hematological parameters were obtained. RESULTS: Sexual dysfunction prevalence was 86.0% in erectile function, 94.7% in sexual intercourse satisfaction, 86.0% in orgasmic function, 96.5% in sexual desire, 96.5% in overall satisfaction. Age, serum albumin, BDI, Karnofsky index, calcium channel blocker were statistically associated with sexual activity. But a multiple logistic regression analysis demonstrated that BDI is independently associated with sexual activity. A linear multivariable regression analysis demonstrated that age, BDI, serum albumin are independently associated with sexual desire of IIEF. CONCLUSION: Sexual dysfunction among male hemodialysis patients is high. Depression is an independent factor of sexual dysfunction in male hemodialysis patients. Evaluation of depression must be included to properly manage sexual dysfunction.
Calcium Channels ; Coitus ; Cross-Sectional Studies ; Depression ; Humans ; Karnofsky Performance Status ; Kidney Failure, Chronic ; Logistic Models ; Male ; Orgasm ; Prevalence ; Renal Dialysis ; Serum Albumin ; Sexual Behavior ; Sexuality ; Surveys and Questionnaires

PURPOSE: Psychiatric problem such as depression and anxiety is prevalent and is associated with morbidity and mortality in hemodialysis patients. But it is difficult to assess and is undertreated. The aim of this study is investigating the prevalence and the risk factors for depression and anxiety among patients receiving maintenance hemodialysis. METHODS: We used the Hospital Anxiety and Depression scale (HADS. Korean version) as a screening test for 104 hemodialysis patients in a single center. Univariate analysis and mutltivariable logistic regression analysis were used to evaluate the association between the psychiatric problem (depression and anxiety) and other patients' factors (social economic factors and medical conditions). RESULTS: The mean age was 58.2+/-12.1 years and the causes of ESRD were diabetes mellitus (50%), hypertension (27.9%), chronic glomerulonephritis (8.7%), and other or unknown causes (14%). The prevalence of depression was 58.7%, and univariate analysis revealed that comorbidity index, Karnofsky index, serum creatinine, and age were statistically significantly correlated with depression. But Multivariable logistic regression analysis demonstrated that only Karnofsky index was independently associated with depression [odds ratio (OR)=5.834, p=0.007]. The prevalence of anxiety was 27.9% and only karnofsky index was significantly correlated with anxiety on both univariate and multivariable logistic regression analysis. CONCLUSION: Depression and anxiety were prevalent in hemodialysis patients. Poor performance status was highly associated with depression and anxiety.
Anxiety ; Comorbidity ; Creatinine ; Depression ; Diabetes Mellitus ; Glomerulonephritis ; Humans ; Hypertension ; Karnofsky Performance Status ; Kidney Failure, Chronic ; Logistic Models ; Mass Screening ; Prevalence ; Renal Dialysis ; Risk Factors