Leptin, which is a plasma protein produced by the obese gene, is expressed and secreted by adipocytes. The clearance of lepdn from the circulation is unknown. But, markedly elevated serum leptin concentrations have recently been reported in patients with chronic renal failure. The purpose of the present study was to investigate plasma leptin concentration of patients with chronic renal failure and evaluate the factors affecting plasma leptin levels. Plasma leptin, insulin, and body mass index were determined in 34 patients with chronic renal failure and 55 control subjects. The plasrna leptin concentrations were not significantly different between patients with chronic renal failure and control subjects (9.4+/-11.8 vs 4.9+/-4.2ng/ml, P>0.05). The serum leptin concentrations were not significantly higher in both male and female CRF patients compared with control subjects (3.96+/-5.72 vs 2.48+/-1.65, P=0.1947, 17.07+/-14.02 vs 7.49+/-4.63ng/ml, P=0.07, respectively). And, there was no significant correlation between serum creatinine and plasma leptin. However, there was significant correlation between plasma leptin concentration and insulin level (P<0.05). We fit a multiple linear regre- ssion analysis with plasma leptin level as the dependent variable in CRF. Sex (male vs female) (P< 0.001) and insulin (P=0.004) were independently associated with plasma leptin level in CRF. These results suggested that plasma leptin level was regulated or affected by multiple factors inclu- ding sex and insulin resistance. Additional study is required to evaluate relationship between plasma leptin and insulin resistance in chronic renal failure.
Adipocytes ; Body Mass Index ; Creatinine ; Female ; Humans ; Insulin ; Insulin Resistance ; Kidney Failure, Chronic* ; Leptin* ; Male ; Plasma*

Polymyositis is an inflammatory, autoimmune disease of the skeletal muscle characterized by symmetrical, proximal muscle weakness, elevated muscle enzymes, and characteristic features on electromyogram and muscle biopsy. The kidneys are generally spared and myoglobinuric renal failure is very rare in polymyositis. There have been infrequent reports of polymyositis developing myoglobinuric renal failure secondary to rhabdomyolysis. The flare-up may occur in polymyositis, usually manifest within several weeks to months of achieving a remission. But, rhabdomyolysis and myoglobinuric renal failure was a very rare feature of the relapse of polymyositis. We present a case report of patient with polymyositis who initially presented and relapsed as rhabodomyolysis that lead to myoglobinuric, oliguric renal failure and required transient dialytic support.
Autoimmune Diseases ; Biopsy ; Humans ; Kidney ; Muscle Weakness ; Muscle, Skeletal ; Polymyositis ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Rhabdomyolysis ; Scleroderma, Diffuse*

Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel. The enterprise stent was first anchored to the vessel of the posterior cerebral artery on one side. The remaining portion was spanned into a looped microcatheter to the opposite branch while pushing the stent. The Neuroform Atlas stent was passed directly through the looped segment of the microcatheter at the M2 branch and spanned horizontally by unsheathing. Under horizontal stenting, complete coil embolization was achieved without immediate or delayed complications in both cases. This novel technique presents a viable option for stent-assisted coiling within an optimal anatomy.
Aneurysm* ; Catheters ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm ; Posterior Cerebral Artery ; Steam ; Stents*

BACKGROUND: Tuberculosis (TB) is a major health problem, and accurate and rapid diagnosis of multidrug-resistant (MDR) and extended drug-resistant (XDR) TB is important for appropriate treatment. In this study, performances of solid and liquid culture methods were compared with respect to MDR- and XDR-TB isolate recovery and drug susceptibility testing. METHODS: Sputum specimens from 304 patients were stained with Ziehl-Neelsen method. Mycobacterium tuberculosis (Mtb) isolates were tested for recovery on Löwenstein-Jensen (LJ) medium and the BacT Alert 3D system. For drug susceptibility testing of Mtb, isolates were evaluated on M-KIT plates and the BacT Alert 3D system. RESULTS: The recovery rates were 94.9% (206/217) and 98.2% (213/217) for LJ medium and the BacT Alert 3D system, respectively (kappa coefficient, 0.884). The rate of drug resistance was 13.4% for at least one or more drugs, 6.0% for MDR-TB and 2.3% for XDR-TB. M-KIT plate and BacT 3D Alert 3D system were comparable in drug susceptibility testing for isoniazid (97.7%; kappa coefficient, 0.905) and rifampin (98.6%; kappa coefficient, 0.907). Antibiotic resistance was observed using M-KIT plates for 24 of the total 29 Mtb isolates (82.8%). CONCLUSION: The liquid culture system showed greater reduction in the culture period, as compared with LJ medium; however, drug susceptibility testing using M-KIT plates was advantageous for simultaneous testing against multiple drug targets.
Diagnosis ; Drug Resistance ; Drug Resistance, Microbial ; Extensively Drug-Resistant Tuberculosis ; Humans ; Isoniazid ; Korea* ; Methods ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin ; Sputum ; Tertiary Care Centers* ; Tuberculosis

An association of carcinoid tumors with another primary neoplasm has been reported in 17~53% of cases, with an especially high incidence of adenocarcinomas. However, simultaneous association of a gastric carcinoid tumor with a gastric adenocarcinoma as a synchronous double primary cancer is extremely rare. We report a case of a synchronous double primary cancer associated with a gastric carcinoid and early gastric cancer in a 63-year-old male patient.
Adenocarcinoma ; Carcinoid Tumor ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; Stomach Neoplasms

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

Renal angiomyolipoma is a rare entity, usually associated with tuberous sclerosis. Until a few years ago it was almost impossible to arrive at a correct diagnosis preoperatively, and most of the case underwent nephrectomy with the wrong diagnosis of renal carcinoma. Recently, abdominal computerized tomography and renal sonography have made it possible to reach the correct preoperative diagnosis in many cases, and thus to avoid unnecessary nephrectomies. We herein present a case of bilateral renal angiomyolipoma with tuberous sclerosis which was preoperatively diagnosed by abdominal ultrasound and CT. A 54 years old woman was admitted with pain on the left flank since 4 months ago. She has had multiple erythematous papules on the face, a small nodule like fibroma on the right third toe. Laboratory findings were normal range. Abdominal ultrasound revealed multiple, variable sized homogenous hyperechogenic mass in the both kidney. Abdominal CT scan showed multiple, variable sized low dense mass in both kidney. Biopsy specimens of the mass of the left kidney revealed fibronecrotic material and blood clots, in which was no evidence of malignancy. Biopsy specimen from the face revealed adenoma sebaceum.
Angiomyolipoma* ; Biopsy ; Diagnosis ; Female ; Fibroma ; Humans ; Kidney ; Middle Aged ; Nephrectomy ; Reference Values ; Toes ; Tomography, X-Ray Computed ; Tuberous Sclerosis* ; Ultrasonography

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

PURPOSE: The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. MATERIALS AND METHODS: SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15%. RESULTS: During the follow-up period (mean, 15.3+/-3.2 months), no early thrombotic reocclusions occurred within 30 days, but in-stent restenosis developed in 78 limbs. The primary patency rates at 6, 12, 18, and 24 months were 78%, 66%, 42%, and 22%, respectively, and the secondary patency rates were 85%, 72%, 58%, and 58%, respectively. TASC II C or D lesions, stent length >8 cm, number of patent tibial arteries and diabetes were significantly associated with reintervention. CONCLUSION: The midterm results of stenting for SFA occlusive disease were disappointing because the primary and secondary patency rates at two years were 22% and 58%, respectively. Reintervention after SFA stenting remains a major problem, particularly in patients with diabetes mellitus or long TASC II C or D lesions.
Ankle Brachial Index ; Constriction, Pathologic ; Diabetes Mellitus ; Endovascular Procedures ; Extremities ; Femoral Artery* ; Follow-Up Studies ; Humans ; Stents* ; Tibial Arteries

To investigate the influence of first six-month mean for serum biochemical markers, albumin, cholesterol, triglyceride, inorganic phosphate, BUN, creatinine, on survival in hemodialysis, we retrospectively analyzed the 57 patients who were monitored from the start of HD for more than 6 months between January 1988 and December 1995. Exclusion criteria were as follows: transfer to CAPD, transplantation or another dialysis center, HD for less than 6 months, non-compliant, death due to malignant disease, accident and self-withdrawal. The patients were divided into two groups according to the demographic characteristics and the median value of first six-month mean for serum biochemical markers. The mean age was 46.7+/-11.7 year, male-to female ratio was 1.6:1, diabetics were 12 (21.1%), and mean follow-up duration was 39.0+/-26.4 months. Among them 30 patients (52.6%) were died. Diabetic patients had significantly lower 1 year (63.6 vs. 88.8%, p<0.05) and 3 year survival rate (19.1 vs. 62.2%, p<0.05) than non-diabetic patients. Low serum albumin(<3.5g/dl), low serum cholesterol(<130mg/dl) and low serum P (<5.0mg/dl) groups were significantly lower 1 and 3 year survival rate than high serum albumin (63.6 vs. 97.0%; 25.5 vs. 74.6%, p<0.05), cholesterol (71.4 vs. 88.0%; 38.1 vs. 60.8%, p<0.05) and p (71.9 vs. 96.3% ; 47.1 vs. 62.9%, p<0.05) groups, respectively. There were no differences in survival rate according to sex, BUN, TG, and creatinine. By Cox's proportional hazard model, low serum albumin(odds ratio 1.98), cholesterol(odds ratio 1.60), and P(odds ratio 2.09) group were independent risk factors for early death. Low serum albumin level at the start of HD maintained during the follow-up period. Cholesterol and P showed similar results. In conclusion, basal serum biochemical markers associated with visceral protein depletion such as low serum albumin, cholesterol and P seem to be early predictors of mortality in hemodialysis patients.
Biomarkers* ; Cholesterol ; Creatinine ; Dialysis ; Female ; Follow-Up Studies ; Humans ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory ; Proportional Hazards Models ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Survival Rate ; Triglycerides