No abstract available.
Bilirubin* ; Humans ; Infant, Newborn*

BACKGROUND: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. METHODS: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). RESULTS: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). CONCLUSION: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.
Cardiovascular Diseases ; Dialysis* ; Electronic Health Records ; Heart Diseases ; Humans ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Incidence ; Kidney Failure, Chronic ; Kidney* ; Mortality ; Retrospective Studies ; Sevelamer*

PURPOSE: The concept of gingival biotype has been used as a predictor of periodontal therapy outcomes since the 1980s. In the present study, prospective and controlled experiments were performed to compare periodontal pocket depth (PPD) reduction and gingival shrinkage (GSH) after scaling and root planing (SRP) according to gingival biotype. METHODS: Twenty-five patients diagnosed with chronic periodontitis participated in the present study. The PPD and GSH of the labial side of the maxillary anterior teeth (from the right canine to the left canine) were evaluated at baseline and 3 months after SRP. Changes in the PPD following SRP were classified into 4 groups according to the gingival thickness and initial PPD. Two more groups representing normal gingival crevices were added in evaluation of the GSH. The results were statistically analyzed using the independent t-test. RESULTS: In the end, 16 patients participated in the present study. With regard to PPD reduction, there were no significant differences according to gingival biotype (P>0.05). Likewise, sites with a PPD of over 3 mm failed to show any significant differences in the GSH (P>0.05). However, among the sites with a PPD of under 3 mm, those with the thin gingival biotype showed more GSH (P<0.05). CONCLUSIONS: PPD changes after SRP were not affected by gingival biotype with either shallow or deep periodontal pockets. GSH also showed equal outcomes in all the groups without normal gingival crevices. The results of SRP seem not to differ according to gingival biotype.
Chronic Periodontitis ; Dental Scaling ; Humans ; Periodontal Pocket ; Prospective Studies ; Root Planing* ; Tooth

BACKGROUND AND OBJECTIVES: We report our initial experience with percutaneous transvenous closure of atrial septal defects (ASD). MATERIALS AND METHOD: Between September 1997 and May 2000, we attempted transcatheter closure of ASD in 18 patients using CardioSEALTM (8), STARFlexTM (4) and Amplatzer septal occluder (6). The ages of patients ranged from 4.5-64.8 (mean 32.8) years, body weight ranging from 16-76 (mean 51) kg, Qp/Qs ratio from 1.3-3.4 (mean 2.2). RESULTS: Embolization of device occurred in two patients; right pulmonary artery in one and left atrium in the other. In one patient, the device slipped into the right atrium before detachment. After retrieval of the device, the defect seemed too large for transcatheter closure. There were no other complications apart from a transient aggravation of pre-existing atrial premature beats in two patients. There was no significant size difference between the data measured by transthoracic and transesophageal echocardiography. The stretched ASD diameter was larger (5.1 3.2 mm) than the size measured by transesophageal echocardiography. In the remaining 15 patients, complete closure of defects was confirmed by transthoracic echocardiography on the 1 day or 1 month follow-up. During the same period, transcatheter closure of patent foramen ovale(PFO) was also attempted in 7 patients with stroke. The guidewire could not be passed in 2 of the patients. In the other 5 patients, transcatheter closure was successfully performed without any problems. Though the follow-up period may have been short, no patients were found with further stroke attack. CONCLUSION: Transcatheter closure of ASD can be performed with high efficiency and safety if patient selection is adequate. The indication for ASD closure can be extended to patients with larger defects. Transcatheter closure of PFO is an easy and safe procedure, but the indications of PFO closure in patients with stroke is still unclear. Further evaluation is necessary for long-term results.
Body Weight ; Cardiac Complexes, Premature ; Echocardiography ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Patient Selection ; Pulmonary Artery ; Septal Occluder Device ; Stroke

No abstract available.
Humans

Although the most of mushroom poisoning have a clinical menifestation of mild to moderate gastroenteritis, some mushroom may cause a serious illness; acute renal failure, hepatic necrosis. We experienced two cases of acute renal failure complicated by the poisoning of amanita virosa. Amanita virosa have a amatoxin. Amatoxin deteriorate hepatocytes, renal tubular cells, intestinal mucosal cells, and pancreas. They were transferred from local hospital for renal failure management. On admission, blood urea nitrogen and serum creatinine were highly elevated. We diagnosed acute renal failure complicated by poisoning of amanita virosa. In one case, renal function was further deteriorated compared with initial laboratory findings after creatinine was normalized at fifth day. Thus, we did a kidney biopsy. Light microscopy and EM showed interstitial inflammation and moderate tubular atrophy. They were recovered with the supportive management. We report two cases of mushroom poisoning-induced acute renal failure with review of literature.
Acute Kidney Injury* ; Agaricales ; Amanita* ; Atrophy ; Biopsy ; Blood Urea Nitrogen ; Creatinine ; Gastroenteritis ; Hepatocytes ; Inflammation ; Kidney ; Microscopy ; Mushroom Poisoning ; Necrosis ; Pancreas ; Poisoning* ; Renal Insufficiency

BACKGROUND/AIMS: This study aimed to develop and validate a risk prediction model for the development of hepatocellular carcinoma (HCC) in treatment-naïve patients receiving oral antiviral treatment for chronic hepatitis B (CHB). METHODS: We investigated 2,061 Korean treatment-naïve patients with CHB treated with entecavir as an initial therapy. A risk score model for HCC development was developed based on multivariable Cox regression model in a single center (n=990) and was validated using the time-dependent area under the receiver operating characteristic curve (AUROC) in three other centers (n=1,071). The difference of HCC development among risk groups (low, intermediate, and high) categorized by risk score was also investigated. RESULTS: The cumulative incidence rates of HCC at 5 years were 11.2% and 8.9% in the testing and validation cohorts, respectively. HCC-Risk Estimating Score in CHB patients Under Entecavir (HCC-RESCUE) is formulated as (age+15×gender [female=0 / male=1]+23×cirrhosis [absence=0 / presence=1]). The AUROCs at 1 year, 3 years, and 5 years were 0.82, 0.81, and 0.81, respectively, in the validation cohort. A significant difference of HCC development in each risk group was determined by the 5-year HCC risk score in the validation cohort (low risk group, 2.1%; intermediate risk group, 9.3%; high risk group, 41.2%, p<0.001). CONCLUSIONS: The study presents a new risk score model with a good ability to predict HCC development and determine high risk patients for HCC development consisting of readily available clinical factors in treatment-naïve CHB patients receiving entecavir.
Antiviral Agents ; Carcinoma, Hepatocellular* ; Cohort Studies ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Incidence ; Risk Assessment ; ROC Curve

The prevalence of sleep disorder is about 30% of the population. Common sleep disorders are insomnia, obstructive sleep apnea, narcolepsy, restless legs syndrome, rapid eye movement sleep behavior disorder and parasomnia. These sleep disorders lead various medical and mental complications. However, most sleep disorders are underdiagnosed and not treated appropriately. Sleep medicine is important for treating these sleep disorders and maintaining general healthy conditions. Specialized and comprehensive treatments for sleep disorder are important in sleep medicine.
Narcolepsy ; Parasomnias ; Prevalence ; REM Sleep Behavior Disorder ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Wake Disorders* ; Sleep Initiation and Maintenance Disorders

The incidence of infrarenal aneurym is about 6 percent after the age 60 years. A primary aortocaval fistula is present in less than 1% of all abdominal aortic aneurysms. Atherosclerotic abdominal aortic aneurysm account for about 90% of spontanous aortocaval fistula. The most common site of fistulation is the inferior vena cava. Until recently, surgical repair was the only method of treatment and was associated high incidence of morbidity and motality. With rapid development of aortic stent-graft technique, endovascular stent-graft repair may offer an alterative to the management of this often fatal condition. We report a case of 72-years old male with aortocaval fistula in the abdominal aorta, which was treated with endovascular stent-graft implantation. About 30 days before procedure, the patient diagnosed inferior acute myocardial infarction with triple vessel disease and also suffered from chronic obstructive pulmonary disease. After the stent-graft inserting, no further communication from aorta to inferior vena cava and improving symptoms and sign of congestive heart failure. He was discharged without complication, about 2 months after admission.
Aged ; Aneurysm ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Endovascular Procedures ; Fistula* ; Heart Failure ; Humans ; Incidence ; Male ; Myocardial Infarction ; Pulmonary Disease, Chronic Obstructive ; Rupture* ; Vena Cava, Inferior

Nesidiodysplasia encompasses increased, maldistributed, and/or, improperly regulated or programmed endocrine cells associated with a clinical endocrine dysfunction. It is a frequent cause of hyperinsulinemic hypoglycemia in neonates and infants, but rare in adults. A 63 year-old woman was admitted due to the loss of consciousness and intense sweating. Hyperinsulinemic hypogiycemia was diagnosed. Under the presumptive diagnosis of insulinoma, abdominal ultrasonography and CT scan were done, but no definite tumor was found. Only a suspicious gradient in insulin concentration was found around the body of the pancreas by percutaneous portal venous sampling. While an exploratory laparotomy was performed, an intraoperative sonography was done. As a result, cystic mass like lesion was found. Then mass enucleation was done. Pathologic examination of the enucleated pancreas revealed no mass and the characteristic nesidiodysplasia. However, after the operation, hypoglycemic symptoms were repeated. So we are instructing her to eat meals frequently.
Adult* ; Diagnosis ; Endocrine Cells ; Female ; Humans ; Hypoglycemia* ; Infant ; Infant, Newborn ; Insulin ; Insulinoma ; Laparotomy ; Meals ; Middle Aged ; Pancreas ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Ultrasonography ; Unconsciousness