OBJECTIVE: So called "lumbar dorsal ramus syndrome(LDRS)" is known to have low back pain(LBP) with buttock and/or leg pain, and considered one of the causes of chronic LBP. The radiofrequency facet rhizotomy (RFFR) is known to be effective treatment for the selected patients with chronic LBP. The goal of this study is to evaluate the therapeutic effectiveness of RFFR in patients with LDRS. METHODS: LDRS is mainly diagnosed by way of blocking the lumbar dorsal ramus with local anesthetics. Their accompanied spinal conditions are sprain, stenosis, HNP, and fracture. These patients underwent unilateral or bilateral RFFR at L4, L5, and S1 levels, from August, 1999 to May, 2000. Results were graded at the end of follow up as excellent, good, fair, and poor. Successful result was considered when excellent or good grades were obtained. RESULTS: Total number of patients received RFFR was 75. The number of LDRS with sprain was 46(8.5% of patients with sprain). Mean age and male to female ratio were 51.8+/-16.7 and 1:1.4, respectively. Mean follow up period was 340.0+/-232.2 days(1month - 2years). Characteristic tender points were posterior superior iliac crest, anterolateral aspect of inferior thigh, posterior aspect of femoral head, and medial side of heel. The success rate at the last follow-up in total patients and patients with sprain were 73.3% and 87.0%, respectively. Other combined spinal conditions except sprain seemed to have undesirable influence on the result of RFFR(p<0.05). CONCLUSION: RFFR is fairly effective treatment for LDRS, especially for the patient with sprain. Combined spinal conditions other than sprain are poor prognostic factors.
Anesthetics, Local ; Buttocks ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Head ; Heel ; Humans ; Leg ; Male ; Rhizotomy* ; Sprains and Strains ; Thigh

BACKGROUND: Erectile dysfunction (ED) is prevalent among patients with diabetes mellitus and impaired renal function. To estimate the prevalence of ED in diabetic nephropathy and to identify its risk factors, we carried out a survey of patients with diabetic nephropathy attending Chonnam University Hospital. METHODS: The presence of ED was assessed among 106 type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy using its self- administered International Index of Erectile Function (IIEF). ED was also classified into five validated severity levels, ranging from none (22-25), mild (17-21), mild/moderate (12-16), moderate (8-11), through severe (5-7). Logistic regression was used to examine associations between ED and other medical conditions. RESULTS: The mean age was 45.30+/-8.57 years in patients without ED and 58.53+/-8.46 years in patients with ED. The prevalence of any level of ED was 72% using IIEF. An independent t-test and chi-square demonstrated age, smoking, smoking duration, degree of nephropathy, coronary heart disease, neuropathy, diabetic foot, and retinopathy to be associated with the presence of any level of ED. Patients with ED had lower serum levels of hemoglobin, albumin, triglyceride, HDL-cholesterol and higher serum levels of BUN in unadjusted analyses compared with patients without ED. A multivariable logistic regression demonstrated age, serum creatinine concentration, and renal replacement therapy to be independently associated with the presence of any level of ED. CONCLUSION: ED is extremely prevalent among type 2 diabetic patients with microalbuminuria or overt diabetic nephropathy or renal replacement therapy. Increased age and serum creatinine concentration, and renal replacement therapy were associated with higher prevalence of ED.
Coronary Disease ; Creatinine ; Diabetes Mellitus ; Diabetic Nephropathies* ; Diabetic Neuropathies ; Erectile Dysfunction* ; Foot ; Humans ; Jeollanam-do ; Logistic Models ; Male ; Prevalence ; Renal Replacement Therapy ; Risk Factors ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in this population. The present study was aimed whether CRP, an important inflammatory marker, might be associated with cardiovascular risk in dialysis patients. METHODS: We performed retrospective study in 77 dialysis patients. Patients were divided into the elevated CRP group (>8 mg/L, n=11) and the normal CRP group (8 mg/L) showed significant higher cardiovascular events (by chi-squre test, p=0.032). BMI, smoking, alcohol, dialysis modality, lipid parameters, BUN, serum creatinine, serum protein, serum albumin and seurm TIBC did not show significant difference between two groups. Correlation between CRP and other biochemical parameters was analysed. Only ESR was positively correlated with CRP. In a subsequent analysis, elevated CRP group had significantly higher cardiovascular risk (by stepwise logistic regression method, odd ratio = 6.59;95% CI, 1.13 to 38.28). CONCLUSION: These results suggest that CRP level is correlated with cardiovascular risk in dialysis patients.
Atherosclerosis ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases* ; Creatinine ; Dialysis* ; Ferritins ; Humans ; Inflammation ; Logistic Models ; Male ; Mortality ; Peritoneal Dialysis ; Renal Dialysis ; Retrospective Studies ; Serum Albumin ; Smoke ; Smoking

Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low- molecular weight heparin anti-coagulant therapy. We report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephropathy with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus and hypertension for 15 years. In July 2002, he was admitted to our hospital because of unstble angina and left pleural effusion. He was treated with dalteparin sodium and aspirin for unstable angina. On the second hospital day, he was refered to division of nephrology for diabetic nephropathy. Laboratory data on admission included white blood cell count of 4,500/mm3, hemoglobin 9.6 g/dL, platelet count 294,000/mm3, BUN 58.1 mg/dL, serum creatinine 4.1 mg/dL, blood glucose 178 mg/dL, hemoglobin A1c 5.9%, PT 13.9 sec (INR: 1.09), and aPTT 50 sec. On days 6 through 8, he had lower back pain, lower extremity pain and neuropathy, anemia and hypotension. Abdominal ultrasound showed 6 x 6 cm-sized well marginated mixed echogenic lesion in psoas muscle and fluid collection in retroperitoneal cavity. Magnetic resonance imaging (MRI) showed increased signal intensity and thickening of the right psoas muscle including 4.7 x 2.3 x 2.1 cm-sized cytic lesion and 6.2X5.3X3.7 cm-sized cystic lesion on the lateral portion of right psoas muscle in T2-weighted images. Percutaneous drainage of cystic lesion was performed by right lateral approach. Hemodialysis was begun without heparinization. Abdominal CT showed 5.5X5 cm-sized high attenuated lesion in right psoas muscle and 5X3 cm, 3X2 cm, 4.5 x 2.5 cm, 4 x 2.5 cm-sized heterogenous, slightly high attenuated lesions in the right lower abdomen and cul-de-sac in the scans with no enhancement. He was treated by conservative therapy. He recovered gradually. Patients with kidney diseases receiving low molecular weight heparin (dalteparin, enoxaparin, etc.) should be closely monitored to prevent serious bleeding complications. The possibility of retroperitoneal hematoma should be considered, whenever symptoms including lower back pain, inguinal pain, leg pain, anemia, or hypotension occured during the lower molecular weight heparin anticoagulant therapy. To our knowledge, this is the first reported case of retroperitoneal hematoma in a patient during dalteparin sodium (Fragmin(R)) anticoagulant therapy.
Abdomen ; Aged ; Anemia ; Angina, Unstable ; Aspirin ; Blood Glucose ; Creatinine ; Dalteparin* ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies* ; Drainage ; Enoxaparin ; Hematoma* ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension ; Hypotension ; Kidney Diseases ; Leg ; Leukocyte Count ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Molecular Weight ; Nephrology ; Platelet Count ; Pleural Effusion ; Psoas Muscles ; Renal Dialysis ; Tomography, X-Ray Computed ; Ultrasonography

Diabetic muscle infarction (DMI) is a rare condition occurring in subjects with long-standing complicated diabetes mellitus. We report DMI in a 65-year-old man with type 2 diabetes mellitus undergoing continous ambulatory peritoneal dialysis (CAPD) with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus for 21 years. In 1997, he reached end-stage renal disease and had received on renal replacement therapy with CAPD since then. In June 2002, he presented with sudden and spontaneous onset of severe pain in the right thigh region. He was afebrile, and the right thigh was swollen and tender but not erythematous. Laboratory data on admission included white blood cell count of 15, 800/mm3, hemoglobin 9.0 g/dL, platelet count 264, 000/mm3, BUN 102.3 mg/dL, serum creatinine 9.9 mg/dL, fasting blood glucose 85 mg/dL, postprandial 2 hours blood glucose 162 mg/ dL, hemoglobin A1C 5.84%, ESR 125 mm/h (it was 52 mm/h one month earlier), CRP 18.9 mg/dL, and normal levels of creatinine kinase. Magnetic resonance imaging (MRI) showed asymmetry of the muscle in T1-weighted images and increased signal intensity involving the medial portion of right thigh (adductor longus, adductor magnus, vastus intermedius muscle, etc) in T2-weighted images with no contrast enhancement. Radioisotope venography of the ileo-femoral veins was normal, excluding deep venous thrombosis as a cause. The right thigh was explored surgically and a biopsy taken from the vastus intermedius muscle was consistent with chronically inflammed scar tissue with no evidence of malignancy. A biopsy taken from the vastus intermedius muscle showed hemorrhagic necrosis of skeletal muscle, with lymphcytic infiltration. Most of the blood vessels appeared normal. The swelling resolved spontaneously following a few weeks of bedrest and analgesia. To our knowledge, this is the first reported case of DMI in patients undergoing renal replacement therapy in Korea.
Aged ; Analgesia ; Bed Rest ; Biopsy ; Blood Glucose ; Blood Vessels ; Cicatrix ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Humans ; Infarction* ; Kidney Failure, Chronic ; Korea ; Leukocyte Count ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Necrosis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Phlebography ; Phosphotransferases ; Platelet Count ; Quadriceps Muscle ; Renal Replacement Therapy ; Thigh ; Veins ; Venous Thrombosis

OBJECTIVE: The validity of olfactory bulbectomized rat as an animal depression model and the possibilities of the NMDA antagonist as an antidepressant would be evaluated by demonstrating structural alterations in their brain MRIs and histological findings of hippocampus. METHODS: Those 8-week old male Sprague-Dawley rats received either an olfactory bulbectomy or sham operation and volume changes at ventricles and caudate nucleus in their brain MRI were acquired at preoperation and postoperation. Those olfactory bulbectomized rats received either memantine, an uncompetitive NMDA antagonist, or normal saline, a placebo, and their brain structural changes in MRI were acquired. At preoperation, postoperation, and postmedication each one of the rats with sham-operation, with memantine, and with placebo was sacrificed to acquire histological impressions. RESULTS: 1) Comparison of the volume changes between preoperation and postoperation showed statistical significance; the volumes of the left and right lateral ventricles (p=0.007, p=0.008) and the third ventricle (p=0.003) increased significantly but the volumes of left and right caudate nucleus decreased (p=0.014, p=0.032), compared to that of the controls. 2) After 6-weeks of memantine administrations, the OB rats revealed more definite recovery in brain MRIs statistically than the controls: the volumes of left and right ventricles and left and right caudate nucleus (p=0.004, p=0.03 ; p=0.04, p=0.05). 3) The hippocampus histological findings of the olfactory bulbectomy showed frequently eosinophilic cytoplasm and hyperchromatic nucleus with shrinkage in CA3. After memantine intake, the hippocampus histological findings returned to nearly normal and showed mixtures of normal cell and abnormal neuron cell. CONCLUSION: The OB models would be valid as an animal model of depression and alterations in their brain MRI images after administrations of NMDA antagonist could be an indicator of antidepressant effects.
Animals ; Brain ; Caudate Nucleus ; Cytoplasm ; Depression* ; Eosinophils ; Heart Ventricles ; Hippocampus ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Male ; Memantine* ; Models, Animal ; N-Methylaspartate ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Third Ventricle

BACKGROUND: The objective of the present study was to assess the efficacy and safety of iron sucrose by determining the subsequent change in hemoglobin (Hgb), hematocrit (Hct), transferrin saturation (TAST), serum ferritin values and blood pressures in hemodialysis patients receiving Epoetin. METHODS: A total of 19 adult patients who had been receiving hemodialysis three times a week at Chonnam Natinal University Hospital were assigned. Their Hgb level was less than 10 g/dL and their serum ferritin level was less than 100 ng/mL, and/or TSAT was less than 20%. Iron sucrose was administered as 1,000 mg in 10 divided doses diluted in 100 mL normal saline over the last 60 minutes during hemodialysis with a one-time prior test dose of 20 mg on 10 consecutive dialysis sessions. Iron sucrose dosage was adjusted to 25-100 mg/week depending on serum ferritin level, and TSAT in the following 3 months. Epoetin administration was stopped due to insurance regulation when Hgb level was more than 10 g/dL and Hct level was more than 30 %. To evaluate efficacy of iron sucrose, assessment of serum iron parameters and anemia indices was determined just before the first dose (baseline), at 1 month after the first dose (loading) and then, monthly for 3 months (maintenance). To evaluate safety of iron sucrose, we recorded blood pressure 1 hour before and at the time of completion of iron sucrose injection, and also recorded blood pressure during observation sessions before dialysis and at intervals of 2 hours and 4 hours after starting dialysis. We determined routine serum chemistry and hematologic results at 1 month after the first dose and compared results with those obtained at baseline. RESULTS: 1,000 mg iron surcose injection in 10 divided dose (loading) produced a significant rise in Hgb, Hct, serum iron, serum ferritin, TSAT, MCV and MCH at 1 month after first dose (respectively p<0.001, p<0.001, p<0.01, p<0.001, p<0.01, p<0.01, p< 0.01). During the following maintenance period of 3 months, Hgb, Hct, serrum ferritin, and TSAT level remained more elevated than at baseline respectively. In 19 enrolled patients, we experienced no serious adverse drug reactions and no significant changes in intradialytic blood pressure associated with iron sucrose administration. Serum albumin concentrations was higher at 1 month than at base line and however, changes in other serum chemistry and hematologic results were not statistically significant. CONCLUSION: Intravenous iron sucrose administration is an efficient and safe method to supply iron in end-stage renal disease patients receiving Epoetin with iron deficiency, who are undergoing hemodialysis.
Adult ; Anemia ; Blood Pressure ; Chemistry ; Dialysis ; Drug-Related Side Effects and Adverse Reactions ; Ferritins ; Hematocrit ; Humans ; Insurance ; Iron* ; Jeollanam-do ; Kidney Failure, Chronic ; Renal Dialysis* ; Serum Albumin ; Sucrose* ; Transferrin

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease. There are some reports in the literature concerning unilateral ADPKD. However, in adults, only a few cases of unilateral ADPKD with agenesis of contralateral kidney have been reported. We present a case of unilateral ADPKD with agenesis of contralateral kidney in a 66-yr-old man. Radiographic images showed the enlarged right kidney with multiple variable-sized cysts and the absence of the left kidney. The diagnosis of ADPKD was confirmed by the family screening. The patient received maintenance hemodialysis for endstage renal disease. We report a case of unilateral ADPKD associated with contralateral renal agenesis in a 66-yr-old male patient with a literature review.
Abdomen/pathology ; Aged ; Female ; Human ; Kidney/abnormalities* ; Male ; Pedigree ; Polycystic Kidney, Autosomal Dominant/diagnosis* ; Polycystic Kidney, Autosomal Dominant/pathology* ; Polycystic Kidney, Autosomal Dominant/physiopathology ; Radiopharmaceuticals/metabolism ; Technetium Tc 99m Dimercaptosuccinic Acid/metabolism

We evaluated the Standard Q COVID-19 Ag test for the diagnosis of coronavirus disease 2019 (COVID-19) compared to the reverse transcription-polymerase chain reaction (RT-PCR) test.We applied both tests to patients who were about to be hospitalized, had visited an emergency room, or had been admitted due to COVID-19 confirmed by RT-PCR. Two nasopharyngeal swabs were obtained; one was tested by RT-PCR and the other by the Standard Q COVID-19 Ag test. A total of 118 pairs of tests from 98 patients were performed between January 5 and 11, 2021. The overall sensitivity and specificity for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the Standard Q COVID-19 Ag test compared to RT-PCR were 17.5% (95% confidence interval [CI], 8.8–32.0%) and 100% (95% CI, 95.3–100.0%). Analysis of the results using RT-PCR cycle thresholds of ≤ 30 or ≤ 25 increased the sensitivity to 26.9% (95% CI, 13.7–46.1%), and 41.1% (95% CI, 21.6–64.0%), respectively.

Background: Co-infection with bacteria and severe acute respiratory syndrome coronavirus 2 may result in greater use of healthcare resources and a poor prognosis. Therefore, early selection and use of optimal antibiotics are essential. The direct rapid antibiotic susceptibility test (dRAST) can detect antibiotic resistance within 6 h of a Gram smear result. This study aimed to assess the effectiveness of dRAST for improving early selection of appropriate antibiotics for coronavirus disease 2019 (COVID-19) patients with bacteremia. Materials and Methods: This retrospective study included 96 blood culture-positive COVID-19 patients. Bacterial isolates and antimicrobial resistance profiles of each case were evaluated. Cases were divided into two groups based on whether they underwent conventional antibiotic susceptibility test (AST) or dRAST. The time to optimal targeted treatment for the two groups was investigated and compared. In addition, we examined the proportion of cases for which appropriate antibiotics were selected and broad spectrum antibiotics were administered at 72 h from blood sample collection. Results: The mean time to optimal targeted antibiotic treatment was shorter for the dRAST group [55.7; standard deviation (SD), 28.7 vs. 92.3; SD, 51.1 h; P = 0.041]. The proportion of cases receiving optimal targeted antibiotics 72 h after blood collection for culture was higher [6/10 (60.0%) vs. 10/25 (40.0%)] and the percentage receiving broad spectrum antibiotics at 72 h was lower [6/10 (60.0%) vs. 19/25 (76.0%)] in the dRAST group than in the conventional AST group. In terms of microbiology profile, the contamination rate was high (35.5%) and multidrug-resistant strains were common (63.2%) in COVID-19 patients with bacteremia. Conclusion Application of dRAST for selection of antibiotics to treat bacteremia in COVID-19 patients may enable earlier and optimal treatment. The high incidence of contamination and resistant organisms in blood cultures from COVID-19 patients suggest that dRAST may speed up appropriate targeted treatment.