No abstract available.
Humans ; Peritonitis*

BACKGROUND: Intraperitoneal(IP) vancomycin has been widely used for the treatment of peritonitis or exit-site infection associated with continuous ambulatory peritoneal dialysis(CAPD). However, some previous reports in the literature have suggested that IP administration of certain vancomycin may be associated with chemical peritonitis in CAPD patients. METHODS: Between 1 February 1994 and 1 February 1997, 35 consecutive CAPD patients requiring treatment with intraperitoneal vancomycin for either exit-site infection or peritonitis in the Yeungnam University Hospital were recruited retrospectively into the study. We compared retrospectively the incidence of chemical peritonitis after using two different preparations of vancomycin from different pharmaceutical companies, namely vancocin CP(R) and vancomycin(R). RESULTS: Thirty-three cases(all 26 cases given vancocin CP(R) and 7 out of the 9 cases given vancomycin(R)) showed improvement. None of them developed fever, abdominal pain or cloudy dialysate. Out of the 9 cases given IP vancomycin(R), two who currently did not have abdominal pain and cloudy dialysis effluent develolped these symptom and sign at 5 and 6 hours after administration of IP vancomycin. The chemical peritonitis may be secondary to prolonged contact of the peritoneal membrane with one or more of the impurities present in vancomycin preparation. CONCLUSION: In summary, it is necessary for the nephrologists to be aware of the possible chemical peritonitis which can be caused by the impurities of certain brand of vancomycin.
Abdominal Pain ; Dialysis ; Fever ; Humans ; Incidence ; Membranes ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Vancomycin*

Sirenomelia, also known as the mermaid syndrome, is a rare and usually lethal congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations. Early antenatal sonogram allows for earlier, and less traumatic termination of pregnancy, but usually it is impared by severe oligohydramnios related to bilateral renal agenesis. We diagnosed a sirenomelia with severe oligohydramnios at early second trimester after amnioinfusion and terminated. We report a case with a brief review of the literature.
Ectromelia* ; Female ; Humans ; Lower Extremity ; Oligohydramnios ; Pregnancy ; Pregnancy Trimester, Second

BACKGROUND: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MTEHODS: We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months (pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus (MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with reinsertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration : 14.0 months) The rates of ESI were more reduced after using mupirocin than before (l per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.
Abscess ; Anti-Bacterial Agents ; Catheters* ; Ciprofloxacin ; Disinfection ; Follow-Up Studies ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Recurrence ; Rifampin ; Staphylococcus aureus

BACKGROUND AND OBJECTIVES: B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. Early diagnosis of congestive heart failure (CHF) and assessment of the left ventricular end diastolic pressure (LVEDP) are thought to be important in the diagnosis, treatment and follow up of patients with CHF. SUBJECTS AND METHODS: Between March, 2002 and November, 2002, 50 patients, who were admitted for treatment and hemodynamic monitoring, were studied. For the BNP measurement, 3 to 5ml blood samples were collected into tubes containing EDTA. The BNP was measured with a fluorescence immunoassay kit (Triage, Biosite, San Diego, U.S.A.). Cardiac Catheterization was performed for the assessment of the LVEDP. RESULTS: Of the 50 subjects, 34 with CHF had a mean BNP level of 483.1+/-77.8 pg/mL, whereas those without CHF had a level of 79.2+/-24.0 pg/mL. The difference between the groups was statistically significant (p=0.005). A significant positive correlation was seen between the BNP and the LVEDP (r=0.53, p=0.001). The correlation between the BNP and the left ventricular ejection fraction (LVEF) was not statistically significant (r=-0.226, p=0.198). CONCLUSION: The plasma BNP was significantly increased in CHF, and might reflect the LVEDP. Further study will be required to see whether the BNP is a useful parameter for the staging and treatment of CHF.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Early Diagnosis ; Edetic Acid ; Estrogens, Conjugated (USP)* ; Fluorescence ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles ; Hemodynamics ; Humans ; Immunoassay ; Natriuretic Peptide, Brain* ; Plasma ; Stroke Volume ; Ventricular Pressure

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare tumor with 0.7% of all primary cervical malignancies. It may grossly range from no visible cervical lesion to a large exophytic cervical mass and histologically similar neoplasms occur in the nasopharynx. It has been classified as a subtype of squamous cell carcinoma. But, after reviewing the literature, this tumor is a distinct carcinoma of the cervix that differs from squamous cell carcinoma. LELC is composed of undifferentiated cells surrounded by a marked inflammatory infiltrate, characterized by plasma cells and lymphocytes in the stroma. It may represent a better prognostic group than the more common squamous cell carcinoma of the cervix because of lack of lymph node metastasis. Typically affects a younger population of women, is more prevalent in noncaucasian population (especially, those of Asian descent). However, it is not clearly understood, Epstein-Barr virus play in the pathogenesis of cervical LELC while humam papilloma virus (HPV) is a risk factor for squamous cell carcinoma. The prognosis is good only by surgical treatment. Radiation therapy also appears to be effective in eradicating localized, low-stage disease (radiosensitive). The authors have experienced one case of LELC of the uterine cervix. We report a case with a brief review.
Asian Continental Ancestry Group ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Female ; Herpesvirus 4, Human ; Humans ; Lymph Nodes ; Lymphocytes ; Nasopharynx ; Neoplasm Metastasis ; Papilloma ; Plasma Cells ; Prognosis ; Risk Factors

BACKGROUND: Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.
Abscess ; Anti-Bacterial Agents ; Catheters* ; Ciprofloxacin ; Disinfection ; Follow-Up Studies ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Recurrence ; Rifampin ; Staphylococcus

BACKGROUND AND METHODS: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). RESULTS: The results were as follows: 1) All patients received an antihypertensive drug before PD, but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis, mean arterial pressure(MAP) was significantlydecreased for the first 3 months, and this lasted for 1 year, and antihypertensive drug requirements were significantly decreased continuously up to 9 months(p<0.005). 3) After changing the modality from hemodialysis to peritoneal dialysis. MAP(mmHg, from 107.1+/-4.5 to 98.6+/-8.8, p<0.05), antihypertensive drug requirements(from 5.6+/-2.6, to 2.0+/-2.5, p<0.01) and erythropoietin dosages(Uint/week, from 4600+/-2660 to 2000+/-1630, p<0.05) were decreased. 4) Multiple logistic regression analysis showed that MAP(p<0.01) and daily ultrafiltration volume(p<0.05) can contribute to the determination of antihypertensive drug requirements. However the relationship between antihypertensive drug requirements and PET results or dialysis adequacy indices(weekly Kt/V. weekly creatinine clearance) was not revealed. CONCLUSION: In conclusion, the prescription of antihypertensive drugs should be considered according to daily ultrafiltration volume, especially during first year after initiating PD, and follow-ups for over a year may be needed.
Antihypertensive Agents ; Blood Pressure* ; Creatinine ; Dialysis ; Erythropoietin ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic* ; Logistic Models ; Peritoneal Dialysis* ; Prescriptions ; Renal Dialysis ; Ultrafiltration

Background: Previous studies have presented evidence to support the significant association between red meat intake and colon cancer, suggesting that heme iron plays a key role in colon carcinogenesis. Epigallocatechin-3-gallate (EGCG), the major constituent of green tea, exhibits anti-oxidative and anti-cancer effects. However, the effect of EGCG on red meatassociated colon carcinogenesis is not well understood. Objectives: We aimed to investigate the regulatory effects of hemin and EGCG on colon carcinogenesis and the underlying mechanism of action. Methods: Hemin and EGCG were treated in Caco2 cells to perform the water-soluble tetrazolium salt-1 assay, lactate dehydrogenase release assay, reactive oxygen species (ROS) detection assay, real-time quantitative polymerase chain reaction and western blot. We investigated the regulatory effects of hemin and EGCG on an azoxymethane (AOM) and dextran sodium sulfate (DSS)-induced colon carcinogenesis mouse model. Results: In Caco2 cells, hemin increased cell proliferation and the expression of cell cycle regulatory proteins, and ROS levels. EGCG suppressed hemin-induced cell proliferation and cell cycle regulatory protein expression as well as mitochondrial ROS accumulation. Hemin increased nuclear factor erythroid-2-related factor 2 (Nrf2) expression, but decreased Keap1 expression. EGCG enhanced hemin-induced Nrf2 and antioxidant gene expression.Nrf2 inhibitor reversed EGCG reduced cell proliferation and cell cycle regulatory protein expression. In AOM/DSS mice, hemin treatment induced hyperplastic changes in colon tissues, inhibited by EGCG supplementation. EGCG reduced the hemin-induced numbers of total aberrant crypts and malondialdehyde concentration in the AOM/DSS model. Conclusions We demonstrated that EGCG reduced hemin-induced proliferation and colon carcinogenesis through Nrf2-inhibited mitochondrial ROS accumulation.