Sleep disturbance and restless legs syndrome (RLS) among uremic patients is known to be high, but data on the prevalence, clinical significance, and causative factors are limited. A semiquantitative sleep and RLS questionnaire was distributed to 62 chronic hemodialysis(HD) patients. 74.5N had sleep complaints and frequent awakening was the most frequent specific sleep complaints followed by daytime sleepiness. Presence of diabetes mellitus(DM), RLS, depres- sion, high CRP level, low intact parathyroid hormone level, low subjective global assessment score, and short HD duration were associated with more sleep complaints. 58.3N had RLS and presence of DM, low serum albumin level were also associated with more severe RLS. But Kt/V, protein catabolic rate, hematocrit, plasma bicarbonate level, use of erythropoietin and sleep medication were not associated with sleep complaints and RLS. Sleep problems and RLS are comrnon in HD patients and seem to be associated with malnutrition. Presence of DM, de- pression, and RLS are likely to contribute the high prevalence of sleep disturbance.
Erythropoietin ; Hematocrit ; Humans ; Malnutrition ; Parathyroid Hormone ; Plasma ; Prevalence ; Renal Dialysis* ; Restless Legs Syndrome ; Serum Albumin ; Surveys and Questionnaires

Echocardiographic study was performed in 31 cases with dilated cardiomyopathy and 31 normal persons. measurement values of the aortic valve and root echocardiogram were compared with those in normal. The resuts were followings. 1. There were 22 males and 9 females of 31 cases with dilated cardiomyopathy whose average ages were 53 years. 2. LAD 3.86+/-0.76cm, AoD/LAD ratio 0.74+/-0.21 in dilated cardiomyopathy were significantly changed with those in normal(p<0.01). 3. C-E slope 2.14+/-0.68 cm in dilated cardiomyopathy was significantly decreased with that in normal(p<0.01). 4. cAoD 3.24+/-0.50 cm, AoPWT 0.46+/-0.14 cm in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 5. cAVD 1.56+/-0.29cm, cAvD/mAvD ratio 0.79+/-0.10 in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 6. AvOT or ET 0.24+/-0.03 sec. in dilated cardiomyopathy was significantly shortened with that in normal(p<0.01).
Aortic Valve ; Cardiomyopathy, Dilated* ; Echocardiography* ; Female ; Humans ; Male

No abstract available.
Iron* ; Mesangial Cells* ; Perfusion*

No abstract available.
Heart, Artificial*

No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A* ; Korea*

OBJECTIVE: To assess the impacts of stroke on sexual activities and functioning of patients with stroke and to study the associations of clinical and psychosocial factors with sexual changes following stroke. METHOD: Ninety-seven patients with stroke were interviewed and completed questionnaire concerning their prestroke and poststroke coital frequency, sexual satisfaction, and sexual functions such as erection, ejaculation, and vaginal lubrication. RESULTS: Sexual activities such as coital frequency and sexual satisfaction were decreased in patients after stroke. Sexual dysfunctions including impotence (68%), a decline in ejaculation (66.7%), and a decline in vaginal lubrication (89.5%) were high. Subjective reasons for decreased sexual life after stroke were denial of spouse, impotence, decreased libido, no opportunity of sexual activity due to hospitalization or no sexual partner, fear of relapse, physical discomfort due to hemiparesis and so on. Comparing sexual group with no sexual group after stroke, there were different in age (p=0.040), brain lesion site (p=0.036), prestroke coital frequency (p=0.048), erectile ability (p=0.005), and ejaculation (p<0.001). CONCLUSION: The decline in sexual activities and functioning was due to interpersonal, physical, psychological factors among patients following stroke.
Brain ; Coitus ; Denial (Psychology) ; Ejaculation ; Erectile Dysfunction ; Hospitalization ; Humans ; Libido ; Lubrication ; Male ; Paresis ; Psychology ; Surveys and Questionnaires ; Recurrence ; Sexual Behavior ; Sexual Partners ; Spouses ; Stroke

BACKGROUND: Chronic discogenic pain is commonly intractable to various conservative treatments and anatomic correction through operation. Nowadays, a radiofrequency thermocoagualation technique applying the pathophysiologic mechanism that cause discogenic pain and the pathways of transmission of discogenic pain have been successfully tried. This study was performed to evaluate the efficacy of radiofrequecy thermocoagulation of the ramus communicans nerve in patients who suffered from intractable discogenic pain even after intradiscal electrothermal therapy. METHODS: The authors evaluated 13 cases in which radiofrequency thermocoagulation of the ramus communicans nerve was used for patients suffering from chronic discogenic pain even after intradiscal electrothermotherapy. Ten weeks after the procedure, we compared VAS scores of the pre- procedure and post-procedure state. RESULTS: Fifty-four percent of patients had an excellent decrease in the VAS score (VAS < 3). One patient complained of a mild motor weakness of the lower extremity but recovered completely by postoperative day 26. CONCLUSIONS: In the cases of intractable chronic discogenic pain, it is valuable to perform a rhizotomy of the ramus communicans nerve with radiofrequency.
Electrocoagulation ; Humans ; Lower Extremity ; Rhizotomy

BACKGROUND: The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). METHODS: In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. RESULTS: Mean SAAG of HA was >1.1(1.49+/-0.40) gm/dL, and mean concentration of total protein of HA was >2.5(4.26+/-0.58) gm/dL. The mean of weekly Kt/Vurea of patients with HA(2.61+/-0.85) was significantly lower than that of patients without HA(3.48+/-0.90)(p<0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p<0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p<0.05). CONCLUSION: It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.
Ascites* ; Exudates and Transudates ; Humans ; Inflammation ; Liver Function Tests ; Osmolar Concentration ; Renal Dialysis ; Retrospective Studies ; Urea*

BACKGROUND: Depression is common in chronic renal failure patients and usually associated with poor appetite. Malnutrition with poor appetite is known to be associated with increased mortality in chronic hemodialysis (HD) patients. So we evaluated the prevalence, risk factors of depression and effects of depression to nutritional status in chronic HD patients. METHODS: Sixty two HD patients (age 48.8+/-11.1 years, diabetes 29%) were investigated. Each patients were interviewed and completed the Beck depression inventory (BDI, 21 items, 0-3 point). To exclude the possible confounding effects of illness and treatment symptoms, cognitive depression index (CDI, a cognitive subset of 15 items selected from BDI) was used as a measure of depression. KT/V and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assesment (SGA), body mass index (BMI), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were also measured. RESULTS: Corrected BDI score (CDI score multiplied by 21/15) was 24.9+/-12.7 and the prevalence of depression (corrected BDI score > or = 21) was 64.5%. DM patients had higher CDI score than non DM patient (22.9+/-7.2 vs 15.6+/-9.0). In univariate analysis, CDI score was correlated with age (r=0.39, p<0.01), serum albumin (r=-0.37, p<0.005), nPCR (r=-0.30, p<0.05), SGA (r=-0.42, p<0.05), BMI (r=-0.28, p<0.05), TSF (r=-0.41, p<0.05) and MAMC (r=-0.50, p<0.01). In multivariate analysis, CDI score was the strongest correlate of nPCR, SGA, BMI, TSF and MAMC. But KT/V, hematocrit, erythropoietin usage, plasma bicarbonate, serum parathyroid hormone, c-reactive protein concentration and HD duration had no relationship with CDI score. CONCLUSION: The prevalence of depression in chronic HD patients was high. Diabetes and old agewere important risk factors for depression. It was also concluded that severity of depression was correlated with markers of malnutrition and depression could be a independent risk factor of malnutrition in chronic HD patients.
Appetite ; Body Mass Index ; C-Reactive Protein ; Depression* ; Equidae ; Erythropoietin ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Malnutrition ; Mortality ; Multivariate Analysis ; Neurobehavioral Manifestations ; Nutritional Status ; Parathyroid Hormone ; Plasma ; Prevalence ; Renal Dialysis* ; Risk Factors* ; Serum Albumin ; Skinfold Thickness

OBJECTIVE: Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. METHODS: The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. RESULTS: The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP<114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. CONCLUSION: Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.
Antihypertensive Agents ; Blood Pressure* ; Dialysis* ; Follow-Up Studies ; Guanosine Monophosphate ; Humans ; Hypertension ; Prevalence ; Renal Dialysis* ; Ultrafiltration