Collagenomas, or connective tissue nevi of the collagen type, are hamartomatous growths of otherwise normal collagen. They are divided into two groups: the inherited form that contains familial cutaneous collagenoma and shagreen patches in tuberous sclerosis, and the acquired form that contains eruptive collagenoma and isolated collagenoma. Among them, isolated plantar collagenoma with a cerebriform appearance is a relatively rare type of connective tissue nevus. It has been described as one of the major skin findings in Proteus syndrome. We present an unusual case of acquired isolated plantar collagenoma presenting as cerebriform hyperplasia, which was not associated with Proteus syndrome.
Collagen ; Connective Tissue ; Hyperplasia ; Nevus ; Proteus Syndrome ; Skin ; Tuberous Sclerosis

BACKGROUND/AIMS: The value of hydration with sodium bicarbonate and N-acetylcysteine (NAC) in the prevention of radiocontrast-induced nephropathy is questionable. This study investigated whether sodium bicarbonate hydration with or without NAC has a more protective role in the prevention of radiocontrast-induced nephropathy than saline hydration with or without NAC. METHODS: We prospectively studied 100 patients with significant proteinuria (> or = 500 mg/d), azotemia (serum creatinine > or = 1.5 mg/dL), or diabetes mellitus who were undergoing coronary angiography using iodixanol, a nonionic iso-osmolar contrast agent. Patients were assigned randomly to receive saline infusion (S, n = 24), saline infusion plus NAC (S + NAC, n = 20), sodium bicarbonate infusion (B, n = 25), and sodium bicarbonate plus NAC (B + NAC, n = 31). Contrast-induced nephropathy was defined as an increase of 25% or more in the serum creatinine within 48 hours of contrast exposure. RESULTS: There were no significant group differences in age, sex, and basal serum creatinine. Contrast-induced nephropathy occurred in 20 patients (20%) and its incidence was not significantly different among the groups; four from group S, five from group S + NAC, five from group B, and six from group B + NAC. The incidences were not significantly different when compared between S and B, irrespective of the use of NAC (21 vs. 20%), and when compared according to the presence of pre-existing azotemia (19 vs. 20%). CONCLUSIONS: The efficacy of sodium bicarbonate hydration in the prevention of contrast-induced nephropathy seems comparable to that of saline hydration, and it was not improved by the addition of NAC.
Acetylcysteine ; Acute Kidney Injury ; Azotemia ; Contrast Media ; Coronary Angiography ; Creatinine ; Diabetes Mellitus ; Humans ; Incidence ; Prospective Studies ; Proteinuria ; Sodium ; Sodium Bicarbonate ; Sodium Chloride ; Triiodobenzoic Acids

Catecholamines are among the first molecules that displayed a kind of response to prolonged or repeated stress. It is well established that long-term stress leads to the induction of catecholamine biosynthetic enzymes such as tyrosine hydroxylase (TH) and dopamine beta-hydroxylase (DBH) in adrenal medulla. The aim of the present study was to evaluate the effects of ginseng on TH and DBH mRNA expression. Repeated (2 h daily, 14 days) immobilization stress resulted in a significant increase of TH and DBH mRNA levels in rat adrenal medulla. However, ginseng treatment reversed the stress-induced increase of TH and DBH mRNA expression in the immobilization-stressed rats. Nicotine as a ligand of the nicotinic acetylcholine receptor (nAChR) in adrenal medulla stimulates catecholamine secretion and activates TH and DBH gene expression. Nicotine treatment increased mRNA levels of TH and DBH by 3.3- and 3.1-fold in PC12 cells. The ginseng total saponin exhibited a significant reversal in the nicotine-induced increase of TH and DBH mRNA expression, decreasing the mRNA levels of TH and DBH by 57.2% and 48.9%, respectively in PC12 cells. In conclusion, immobilization stress induced catecholamine biosynthetic enzymes gene expression, while ginseng appeared to restore homeostasis via suppression of TH and DBH gene expression. In part, the regulatory activity in the TH and DBH gene expression of ginseng may account for the anti-stress action produced by ginseng.
Adrenal Medulla ; Animals ; Catecholamines ; Dopamine ; Dopamine beta-Hydroxylase ; Down-Regulation ; Gene Expression ; Homeostasis ; Immobilization ; Nicotine ; Panax ; PC12 Cells ; Rats ; Receptors, Nicotinic ; RNA, Messenger ; Saponins ; Tyrosine ; Tyrosine 3-Monooxygenase

BACKGROUND/AIMS: This study characterized the cisplatin nephrotoxicity occurring in patients treated with chemotherapy for lung cancer. METHODS: In all, 124 patients with lung cancer received cisplatin 70 mg/m2 on day 1 every three weeks for up to six cycles with preventive hydration using 3 L of 0.45% saline. Acute and chronic cisplatin nephropathy were defined as an increase in serum creatinine > or =30% at 3 weeks after each cisplatin administration and an increase in serum creatinine > or = 50% after the six cycles of chemotherapy, respectively. RESULTS: Acute cisplatin nephropathy occurred in 23 of 124, 8 of 110, 6 of 92, 10 of 68, 7 of 59, and 7 of 45 patients after the 1st to 6th cycle of chemotherapy, respectively. In all, 51 patients (51.5%) experienced acute cisplatin nephropathy. Chronic cisplatin nephropathy occurred in 25 out of 45 patients (55.5%). The occurrence of chronic cisplatin nephropathy was significantly associated with that of acute cisplatin nephropathy (p<0.01). In chronic cisplatin nephropathy, the serum creatinine increased to 1.82+/-1.18 mg/dL from the basal 0.82+/-0.11 mg/dL (p<0.01). It was 1.60+/-1.05 mg/dL at the end of the follow-up period (112+/-90 days). CONCLUSIONS: Despite prophylactic hydration, the incidence of cisplatin nephropathy in patients with lung cancer is still high. Acute cisplatin nephropathy may predispose patients to chronic cisplatin nephropathy, but the latter does not seem to be progressive.
Cisplatin ; Creatinine ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Renal Insufficiency

BACKGROUND: We aimed to investigate the possible factors determining reduction of dopaminergic drugs in patients who received bilateral subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS: We studied 33 consecutive Parkinson's disease (PD) patients who underwent bilateral STN DBS between March 2002 and April 2006. Patients were assessed at baseline and 6 months and 1 year after surgery. RESULTS: The dose of dopaminergic drugs was significantly decreased by 16.5% (p<0.05) and 14.9% (p<0.05), at post op 6 months and 12 months respectively. The reduction rate of dopaminergic drugs after bilateral STN DBS was positively correlated with the dopaminergic drug dosage at baseline (p<0.05) and was negatively correlated with the scores of "off"-period UPDRS II (p<0.05), III (p<0.001), and total UPDRS (p<0.001) at baseline. The difference of UPDRS scores between "on" and "off" periods on the levodopa challenge test was negatively correlated with the reduction rate of dopaminergic drug dosage after bilateral STN DBS (p<0.001). CONCLUSIONS: It is likely that the main determining factors for the reduction of dopaminergic drug dosages after bilateral STN DBS in advanced PD are the UPDRS III score during "off" periods, difference of the UPDRS III score between "on" and "off" periods on the levodopa challenge test and dose of dopaminergic drugs at baseline.
Deep Brain Stimulation ; Dopamine Agents ; Humans ; Levodopa ; Parkinson Disease ; Subthalamic Nucleus

PURPOSE: Infectious complications may remain a significant cause of morbidity and mortality following renal transplantation. This study was undertaken to investigate current status of infectious complications in renal transplant recipients. METHODS: Clinical data were retrospectively analyzed from 534 recipients who underwent kidney transplantation in Hanyang University Hospital from February 1986 to September 2006. RESULTS: 251 recipients (47%) had 390 episodes of infectious complications. Most patients (86.8%) suffer two or less episodes of infection. The skin and soft tissue (40.7%) infection was the most common over the whole post-transplant periods, and the most common causative organism was virus (55.2%). Among the bacterial infections, urinary tract (43%) was the most common site of infection. Among the viral infections, varicella-zoster virus was the most frequent. Increasing age at kidney transplantation (> or =40 years) was associated with the risk of infection within one month after transplantation. Both acute rejection and loss of allograft function were associated with the risk of infectious complications. The overall profile of infectious complications occurring after renal transplantation did not seem to be changed during the last two decades. However, the mortality rate associated with the infection showed a decreasing tendency over the past decade. CONCLUSION: Infectious complications are still important to affect the outcomes of kidney transplantation. Strategies to further reduce the infectious complications are necessary.
Bacterial Infections ; Follow-Up Studies ; Herpesvirus 3, Human ; Humans ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Retrospective Studies ; Skin ; Transplantation, Homologous ; Transplants ; Urinary Tract ; Viruses

The present study was performed to elucidate the hypocholesterolemic action of chitosan on the diet-induced hypercholesterolemia in rats. Male Sprague-Dawley rats (n=24) were fed with chitosan-free diet (Control), diets containing 2% or 5% chitosan for 4 weeks. Hypercholesterolemia was induced by adding 1% cholesterol and 0.5% cholic acid to all diets. Body weight gain and food intake of rats did not differ among the groups. The chitosan treated groups showed significant improvement in the plasma concentration of total cholesterol and LDL-cholesterol compared to the control group (p<0.05). Also, the chitosan treated groups decreased the liver concentration of total lipid and total cholesterol compared to the control group (p<0.05). The activity of hepatic cholesterol 7alpha-hydroxylase (CYP7A1), the rate-limiting enzyme in the conversion of cholesterol to bile acids, was increased by 123% and 165% for the 2% or 5% chitosan diets, respectively. These findings suggest that enhancement of hepatic CYP7A1 activity may be a mechanism, which can partially account for the hypocholesterolemic effect of dietary chitosan in cholesterol metabolism.
Animals ; Bile Acids and Salts ; Body Weight ; Chitosan* ; Cholesterol 7-alpha-Hydroxylase ; Cholesterol* ; Cholic Acid ; Diet ; Eating ; Humans ; Hypercholesterolemia* ; Liver* ; Male ; Metabolism ; Plasma* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Dyslipidemias ; Follow-Up Studies ; Heart* ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents

Systolic anterior motion of the mitral valve (SAM) is well known in the concentric left ventricular hypertrophy or post mitral valvuloplasty. However, SAM has not been reported in Off-pump coronary artery bypass surgery (OPCAB). Preoperatively, SAM in combination with a left ventricular outflow tract obstruction leads to severe cardiovascular destabilization. Moreover, a diagnosis of SAM is very important because the administration of conventional therapy to hypotension can aggravate SAM. We report a patient with un-identified left ventricular wall hypertrophy or mitral valve regurgitation, who was diagnosed with SAM by TEE during OPCAB. This report describes the diagnostic and therapeutic strategies for the perioperative management of SAM.
Coronary Artery Bypass, Off-Pump* ; Diagnosis ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Hypotension* ; Mitral Valve Insufficiency ; Mitral Valve*

Cyclophosphamide is frequently used for the treatment of severe lupus nephritis, but is very rarely associated with dilutional hyponatremia. Recently we experienced a case of water intoxication following low-dose intravenous cyclophosphamide. Five hours after one dose of intravenous pulse cyclophosphamide 750 mg, the patient developed nausea, vomiting, and general weakness. Serum sodium concentration revealed 114 mEq/L and her hyponatremia was initially treated with hypertonic saline infusion. Then her serum sodium concentration rapidly recovered to normal with water restriction alone. During the course of intravenous pulse cyclophosphamide therapy, one must be aware of the possibility of significant water retention.
Cyclophosphamide* ; Humans ; Hyponatremia ; Lupus Nephritis ; Nausea ; Sodium ; Vomiting ; Water Intoxication*