PURPOSE: The use of thyroidectomy has increased as a diagnostic technique for thyroid disease. However, performance of a, thyroidectomy is accompanied with complications. Post-thyroidectomy complications include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, infection, and thyroid storm. The aim of this study was to determine the clinical incidence and to evaluate complications after a thyroidectomy, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and scaring, following a retrospective review of cases. METHODS: From July 2004 to May 2006, 661 consecutive patients that had undergone a thyroidectomy were identified. Through a retrospective review, we evaluated the incidence and type of complications, including recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scaring. RESULTS: 1) Recurrent laryngeal nerve palsy was a very serious complication, but had a very low incidence. Eight cases out of 661 cases developed and most of the cases developed after a total thyroidectomy. 2) Hypocalcemia was the most common complication. Each incidence of hypocalcemia of methods of thyroid surgery was significant (P= 0.019) but, thyroid disease did not have significant difference (P=0.071). 3) The incidence of postoperative hematoma was 2.74% (18/655). Graves’ disease was more predominant than other diseases. CONCLUSION: Post-thyroidectomy complications and cosmetic problems include recurrent laryngeal nerve palsy, hypocalcemia, hematoma, and postoperative scar. An understanding of the incidence and review of complications after a thyroidectomy may reduce their incidence.

BACKGROUND: The urinary protein to creatinine ratio in a single voided random urine sample has been widely used as an estimation of 24 hour urine protein excretion because of inconvenience and frequent collection errors during timed collection of 24 hour urine. But the protein to creatinine ratio also showed frequent estimating error, overestimation or underestimation. We thought that protein to creatinine ratio adjusted by daily creatinine excretion estimated by Cockroft-Gault equation can be more accurate than protein to creatinine ratio and compared them as follows. METHODS: This study consisted of 81 patients whose 24 hour urine protein excretion and random spot urine protein to creatinine ratio were measured concomitantly. There was no significant change of body weight or serum creatinine change around the study day. The modified protein to creatinine ratio could be estimated from the measured protein to creatinine ratio in a random spot urine sample by multiplying the ratio by the expected daily creatinine excretion estimated by Cockroft-Gault equation. These results were compared with well collected 24 hour urine protein. RESULTS: The difference between protein to creatinine ratio and 24 hour urine protein was 0.87+/-1.13, on the other hand, the difference between modified protein to creatinine ratio and 24 hour urine protein was 0.52+/-0.65 (p<0.05). Correlation coefficients between protein to creatinine ratio, modified protein to creatinine ratio and 24 hour urine protein were 0.877, 0.957 respectively. CONCLUSION: The protein to creatinine ratio modified by the expected daily creatinine excreation rate calculated by Cockfort-Gault equation was more accurate than simple protein to creatinine ratio.
Body Weight ; Creatinine* ; Hand ; Humans

We evaluated gastric emptying time (GET) by using Tc99m-sulfur colloid gastric emptying scintigraphy in 11 patients with CAPD (6 male, 5 female) and 14 healthy volunteers. We investigated the effect of dialysate dwelling on GET by studying twice, once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full), and the relationship between body surface area (BSA) and delayed gastric emptying. 1) The mean of gastric emptying rate in 120 minute in patients with CAPD when drained (67.8+/-13.4%) was not different from that in healthy volunteers (65.4+/-8.6%) 2) The mean of gastric emptying rate in 120 minute when full (55.6+/-14.6%) was significantly lower than that when drained (67.8+/-13.4%) (P<0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. 3) The BSA (1.5+/-0.11m2)of patients who had extremely delayed GET from normal to abnormal range was smaller than that (1.74+/-0.22m2) of patients who had minimal delayed or unchanged GET when full. This study showed the patient with CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwelling, especially in the patients who has less than 1.5m2 of body surface area. Therefore, we suggest that intermittent nocturnal peritoneal dialysis or a small volume of dialysate may be considered for the patient with small body surface area based on the adequacy.
Abdomen ; Body Surface Area ; Colloids ; Gastric Emptying* ; Healthy Volunteers ; Humans ; Male ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Radionuclide Imaging

Diarrea-associated hemolytic uremic syndrome (HUS) is very rare in adults. Few reports are available on clinical features and plasma exchange in adult patients with diarrhea-associated HUS in Korea. We retrospectively examined the records of five adult patients with diarrhea-associated HUS admitted to Samsung Seoul Hospital between January 1995 and December 1997. If the patient had neurologic abnormalities, or there was rapid clinical deterioration, with the hematocrit decreasing below 20%, the platelet count falling below 10,000/mm3, the creatinine concentration increasing above 5.0 mg/dl, plasma exchange was begun. There were 4 females and 1 male. Patients ranged in age from 16 to 61 years. All patients presented with diarrhea and abdominal pain, and 3 patients had bloody diarrhea. The mean time between the onset of diarrhea and thrombocytopenia was 4.4+/-1.9 days (range, 1 to 6). All patients received 7 to 24 plasma exchanges. The mean exchanged plasma volume was 1.1+/-0.2 times of patients own plasma volume. The pattern of clinical response to plasma exchange was initial normalization of platelet count (8.0+/-3.8 days), followed by normalization of LDH level (20.2+/-14.5 days) and creatinine concentration (25.8+/-13.8 days). Metabolic alkalosis developed in two patients undergoing daily plasma exchange. We successfully managed the metabolic alkalosis with continuous venovenous hemofiltration. The mean duration of hospitalization was 28.8+/-11.2days (range, 20 to 42). All patients successfully recovered without any sequale. Although this study is based on small case series, we suggested that plasma exchange may improve the outcome in adult diarrhea-associated HUS.
Abdominal Pain ; Adult* ; Alkalosis ; Creatinine ; Diarrhea ; Female ; Hematocrit ; Hemofiltration ; Hemolytic-Uremic Syndrome* ; Hospitalization ; Humans ; Korea ; Male ; Plasma Exchange* ; Plasma Volume ; Plasma* ; Platelet Count ; Retrospective Studies ; Seoul ; Thrombocytopenia

Cockcroft and Gault's formula is frequently used to estimate creatinine (Ccr) in clinical practice. To determine the accuracy of such estimation in Korean patients, we measured simultaneously, serum creatinine and 24-hour urinary creatinine excretion in 696 Korean patients (male:350, female:346). Measured Ccr was significantly different from estimated Ccr in several age groups and the decrease of creatinine excretion with age is less than Cockcroft and Gault's estimation. We assumed that this difference can be due to difference of the body habitus and difference of urinary creatinine excretion per body weight between different races. So we divided the sample population into two groups and derived the new formula in one group with regression analysis between age and 24 hour urinary creatinine excretion per body weight for estimation of Ccr as Cockcroft and Gault derived their formula and applied it to another group to compare the new formula with Cockcroft and Gault's formula in Korean patients. The new formula was Ccr (mL/min)=[ (260-age)x weight (kg)]/[160 x serumCr (mg/dL)] for male and Ccr (mL/min)-[ (236-age) x weight (kg)]/[180 x serum Cr (mg/dL)] for female. Predictive accuracy of the new formula was significantly better than the Cockcroft and Gault's formula in the other sample population and also in subgroup of the patients with azotemia.
Azotemia ; Body Weight ; Continental Population Groups ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Male

BACKGROUNDS: N-acetyl-beta-D-glucosaminidase (NAG) is one of many enzymes that exist in the renal proximal tubular cells. It is said that functional impairment of renal tubule can be detected by checking NAG in the urine. But, it has never been known whether urinary NAG value can be used as a predictor for the prognosis of patients with glomerulonephritis. In this study, we evaluated the relationship between urinary NAG level and the degree of injury in cortical interstitium which has been known to influence the prognosis of renal function in glomerulonephritis closely. METHODS: Before renal biopsy was performed in each patient, urinary NAG(isoenzyme A and B), urinary beta2-microglobulin, serum blood urea nitrogen (BUN), serum creatinine, serum albumin, creatinine clearance and 24 hour urinary protein excretion were measured. Then, we calculated volume density of cortical interstitium [Vv(i/c)] in each specimen using point count morphometry method after getting a confirmative diagnosis from pathologist. Simple correlation analysis and multivariate regression analysis were carried out. RESULTS: The number of total patients was 32(male:16), whose median age was 60(32-80). Vv (i/c) had significant correlation with serum creatinine, creatinine clearance and serum BUN. But it was not correlated well with urinary NAG and urinary beta2-microglobulin. Urinary NAG concentration(2.131 2.549unit/mmol Cr) was higher than that of normal control and showed significant correlation with urinary beta2-microglobulin, serum albumin and 24 hour urinary protein excretion in patients. CONCLUSION: Urinary NAG had no significant correlation with Vv(i/c) that has been known as an important prognostic factor for the renal function in glomerulonephritis, but had significant correlation with urinary protein excretion. We concluded that urinary NAG was not regarded to be an appropriate marker for predicting the prognosis of renal function in patient with glomerulonephritis.
Acetylglucosaminidase ; Biopsy ; Blood Urea Nitrogen ; Creatinine ; Diagnosis ; Glomerulonephritis* ; Humans ; Prognosis ; Serum Albumin

BACKGROUND: A few articles reported that the plasma total homocysteine(tHcy) concentration of renal transplant recipients(RTR) was higher than that of normal controls, but lower than that of patients with chronic renal failure. But renal function of the RTR was variable, and plasma tHcy concentration of RTR with normal renal function was unknown. We compared plasma tHcy concentration of RTR with normal renal function to normal controls and evaluated the relation between folate concentration, the independent factor of plasma tHcy concentration, and plasma tHcy in patients with chronic renal failure in predialysis, hemodialysis(HD) and continuous ambulatory peritoneal dialysis(CAPD). METHODS: We measured fasting plasma level of total homocysteine by high-performance liquid chromatography and folate concentration in 36 predialysis CRF patients(Ccr<25mL/min), 37 HD patients, 28 CAPD patients, 41 RTR(serum creatinine< or =1.4mg/dL) and 37 healthy controls. RESULTS: 1)Mean(+/-SD) tHcy concentration in predialysis CRF(21.93+/-14.33micromol/L), HD(18.24+/-8.73micromol /L) and CAPD(17.16+/-7.8micromol/L) patients was significantly higher than that in controls (8.91+/-4.11micromol/L, P<0.05) but tHcy concentration of RTR group(8.99+/-3.99micromol/L)had no difference from that of normal controls 2)In predialysis patients, CAPD patients, and HD patients showed a significant negative correlation between serum folate and plasma tHcy concentrations (r=-0.18, p<0.05). 3)In predialysis, HD and CAPD patients, mean plasma folate concentration in patients with 1mg/ day-folate supplementation(20.41+/-15.65ng/mL) was higher than patients without 1mg/day-folate supplementation (10.20+/-8.24ng/mL)(p<0.05) and mean plasma tHcy concentration in patients with 1mg/day-folate supplementation (17.87+/- 7.94micromol/L) was lower than patients without 1mg/day-folate supplementation(21.87+/-13.35micromol/L)(p<0.05). CONCLUSION: Plasma tHcy concentration in RTR with normal renal function had no difference with that in normal controls. In predialysis, HD, and CAPD patients, plasma tHcy had negative correlation with plasma folate concentration and plasma tHcy in patients with 1mg folate supplementation, usual dose in chronic renal failure, was higher than that in patients without folate supplementation and lower than that in normal controls.
Chromatography, Liquid ; Fasting ; Folic Acid* ; Homocysteine* ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Peritoneal Dialysis, Continuous Ambulatory ; Plasma* ; Transplantation*

BACKGROUND: To assess the adequacy of dialysis, serial urea kinetic modeling (single-pool Kt/V) is used. The main problems that lead to impaired delivery of dialysis prescriptions are inadequate blood flow, reduced treatment time and recirculation. If it is true that the shorter distance between two needles induces the more recirculation, short needle distance would reduce Kt/V. But, usually there is no access recirculation, because upstream access supply exceeds the demand of the blood pump. So we have a question about the relationship between recirculation and needle distance. METHODS: Thirty five chronic dialysis patients were enrolled. We measured access recirculation (a two-needle, slow/stop flow method) and Kt/V with needle distance of 2 cm, 5 cm, and 11 cm in each patient. Three dialysis session were done with each needle distance. Treatment time, dialyzer and blood flow rate were fixed during the study period. RESULTS: Access recirculation with needle distance of 2 cm was 5.37+/-7.53%, with needle distance of 5 cm, 4.26+/-5.69%, and with needle distance of 11 cm, 4.30+/-5.69%. There was no difference of recirculation between three distance. Kt/V with needle distance of 2 cm was 1.27+/-0.19, with needle distance of 5 cm was 1.26+/-0.19, and with needle distance of 11 cm was 1.23+/-0.18. There was no difference of Kt/V between three distance. CONCLUSION: There is no relationship between access recirculation and needle distance. We suggest that short distance between two needles does not increase recirculation and may not a cause of impaired delivery of dialysis prescription.
Dialysis ; Humans ; Needles* ; Prescriptions ; Renal Dialysis* ; Urea

A 21-year-old male was presented with sudden headache, fever, petechiae and neck stiffness. The diagnosis of meningococcal meningitis was confirmed by examination of cerebrospinal fluid. The clinical symptoms of the illness were improved after treatment of antibiotics. However the patient developed generalized edema, oliguria, azotemia, and heavy proteinuria in the recovery phase of illness. Low serum C3 level was also noted. A kidney biopsy was performed and showed the features of postinfectious glomerulonephritis and typical subepithelial humps on electron-microscopic examination. His symptoms and laboratory findings were improved, and C3 level returned to normal range after conservative treatment. We suggest that a complement deficiency should be ruled out in patients of glomerulonephritis developed during the recovery phase of meningococcal meningitis. C3 nephritic factor detection and renal biopsy should be carefully considered in these patients.
Anti-Bacterial Agents ; Azotemia ; Biopsy ; Cerebrospinal Fluid ; Complement C3 Nephritic Factor ; Complement System Proteins ; Diagnosis ; Edema ; Fever ; Glomerulonephritis* ; Headache ; Humans ; Kidney ; Male ; Meningitis ; Meningitis, Meningococcal* ; Neck ; Neisseria meningitidis ; Oliguria ; Proteinuria ; Purpura ; Reference Values ; Young Adult

OBJECTIVE: Positively charged N, N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH- HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and efficiency of HBH-HD in chronic renal failure patients at risk of bleeding. METHODS: During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer: GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250 mL/min. To evaluate safety of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n= 40). To evaluate the dialysis efficiency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). RESULTS: Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1, 057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean+/-SD, 49.8+/-10.5 sec) and HC (0.14+/-0.06 U/mL) at 15 min, compared to predialysis levels of 44.3+/-12.9 sec and 0.11+/-0.06 U/ mL, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean+/-SD, 17.2+/-9.6%), compared to R-HD (2.8+/-1.2%) (p< 0.0001). However, K and Kt/V value (mean+/-SD) were 136.9+/-14.6 mL/ min and 1.27+/-0.21 in HBH-HD and 137.6+/-18.4 mL/ min and 1.20+/-0.22 in R-HD, showing no significant difference (p>0.05). CONCLUSION: HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed carefully during HBH-HD.
Dialysis ; Hemorrhage* ; Heparin* ; Humans ; Kidney Failure, Chronic* ; Membranes ; Partial Thromboplastin Time ; Renal Dialysis* ; Urea