PURPOSE: This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. METHODS: A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. RESULTS: The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5+/-15.9 days (mean+/-SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. CONCLUSION: The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.
Catheters ; Cross Infection ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Logistic Models ; Prognosis ; Retrospective Studies ; Risk Factors ; Sepsis ; Staphylococcus aureus ; Umbilical Arteries ; Vascular Access Devices

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.
Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Pressure ; Body Mass Index ; Child ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatty Liver ; Female ; Glucose ; Hematologic Tests ; Hospitals, General ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hyperlipidemias ; Hypertension ; Liver Function Tests ; Male ; Obesity ; Prevalence

BACKGROUND: Xenotransplantation in discordant species results in immediate and irreversible hyperacute rejection due to natural antibodies, IgM. With this, antibody depletion is one option to reduce hyperacute rejection, we investigated the effect of PCPP (postcentrifugal plasmapheresis) on the depletion of natural antibodies and the effect of antibody titer on xenograft survival. MATERIAL ANDMETHOD: Outbred swines (n=4) weighing 10~20 kg were used as donors and mongrel dogs (n=4) weighing 25~30 kg were used as recipients. Recipient canines underwent plasmapheresis (COBE TPE Laboratories, Lakewood. CO, USA). Pre-transplantation PCPP was performed on day - 2 and day 0. There were three groups (Group 0: no PCPP, Group 1: 1 pla sma-volume (PV) at day 2 and 2 PV at day 0, Group 2: 2 PV at day - 2 and 2 PV at day 0). A swine heart was heterotopically transplanted into a recipient's abdominal infrarenal aorta and inferior vena cava. Mean percent depletion of total IgM and IgG in plasma of the recipients was calculated. Serum albumin, elecctrolyte, complement activity and coagualtion factors were measured. Histopathologic examination of heart specimens was performed. RESULT: Mean percent depletion of IgM and IgG were 95.7+/-1.2%, 80.5+/-2.4% in the group 2 at the end of PCPP. The percent depletion of serum albumin concentration was decreased from 2.8 to 1.4 g/dL in the group 1 and 3.0 to 1.5 g/dL in the group 2. Complement hemolytic activity was decreased in group 1 and 2, but returned to normal level within 24 hours. Complement hemolytic activity was reduced to 10% of pre-PCPP level in group 2. Serum fibrinogen decreased to 20% or less and was recovered within 24 hours in group 2. Antithrombin III decreased but less than fibrinogen. PT and aPTT were sometimes but not always prolonged during plasmapheresis. After plasmapheresis, PT and aPTT were prolonged beyond the measurable level. D-dimer was not found during PCPP, but appeared and maintained from 10 minutes after transplantation. Graft survival time was 5 min in group 0, and it was 90+/-0 min in the group 2. Histopathologic changes were more typically characterized by edema, hemorrhages, thrombosis in all groups at the end of experiment. CONCLUSION: PCPP effectively removed immuoglobulins and reduced the titer of natural antibodies, as a result, significantly prololonged swine heart xenograft survival.
Animals ; Antibodies ; Antithrombin III ; Aorta ; Complement System Proteins ; Dogs ; Edema ; Fibrinogen ; Graft Rejection ; Graft Survival ; Heart ; Hemorrhage ; Heterografts* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Models, Animal ; Plasma ; Plasmapheresis ; Serum Albumin ; Swine ; Thrombosis ; Tissue Donors ; Transplantation, Heterologous* ; Vena Cava, Inferior

BACKGROUND: Diagnosis of RTA (renal tubular acidosis) is not easy due to its nonspecific and various manifestations. To find out the clues to diagnosis, we investigated initial manifestations, laboratory features and clinical course of RTA patients. METHODS: Thirty-seven patients with RTA type I or II, whose follow-up period was over 6 months were included in the study. We reviewed their medical records retrospectively. RESULTS: Male to female ratio was 5:32 and the average age at the time of diagnosis was 38.7 (15~60). Twenty-five patients had RTA type I, nine had type II, and three had both. The average follow-up period was 6.4 years. Initial manifestations were asthenia (54%), nausea (46%), urinary stone (24%), paresthesia (24%), lower extremity weakness (22%), and paralysis (11%). Underlying diseases at the time of diagnosis include Sjogren's syndrome (14%), SLE (8%), drug-induced nephropathy (11%), diabetic nephropathy (5.4%), Sjogren's syndrome combined with SLE (2.7%), and medullary sponge kidney (2.7%). Laboratory tests revealed acidosis with hypokalemia (59%), acidosis without hypokalemia (14%), and hypokalemia without acidosis (24%). The level of total CO2 was 22 mmol/L or lower in 27 patients. The Na:Cl ratio on the average was 1:1.26 and for 33 patients below 1:1.35. Renal function deteriorated in 8 patients and 7 of them had underlying diseases. Urinary stone developed in 2 patients with RTA type I. CONCLUSION: When patients with nonspecific symptoms show decreased levels of serum total CO2, potassium, or Na:Cl ratio, RTA should always be considered.
Acidosis ; Acidosis, Renal Tubular* ; Asthenia ; Diabetic Nephropathies ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypokalemia ; Lower Extremity ; Male ; Medical Records ; Medullary Sponge Kidney ; Nausea ; Paralysis ; Paresthesia ; Potassium ; Retrospective Studies ; Sjogren's Syndrome ; Urinary Calculi

BACKGROUND: Common complications after hematopoietic stem cell transplantation(HCT) include sepsis, graft versus host disease(GVHD), veno-occlusive disease(VOD), drug-induced nephrotoxicity, and acute renal failure(ARF). Prior studies report that the presence of ARF affects prognosis. However, we are unaware of such reports on the incidence of ARF after HCT in Koreans, and whether or not the development of ARF is related to prognosis. The purpose of our study was to investigate the cause of ARF after HCT and its relation to prognosis. METHODS: 163 patients received HCT at Seoul National University Hospital since 1985, of which, 107 were available for review. RESULTS: ARF after HCT developed in 52 patients (48.6%). In the three clinical causes, VOD, sepsis, and GVHD, risk factor related to the development of ARF was preexisting VOD. Logistic regression confirmed this association(odds ratio 4.4). The causes of ARF were different according to the periods it developed, and cyclosporin nephrotoxicity was the main cause through the whole period after HCT. The overall survival was worse in the ARF group(60 vs 73 %; p < 0.05). ARF group was split into two groups : patients whose peak serum creatinine levels were below 3.0 mg/dL(mild ARF group) and those who were above 3.0 mg/dL(severe ARF group). Severe ARF group had worse survival than mild ARF group and patients without ARF(p < 0.01). CONCLUSION: VOD, sepsis, GVHD after HCT increase the risk of the deveolopment of ARF, but cyclosprin nephrotoxicity is the main cause of ARF. Severe ARF is a factor influencing the prognosis of patients who received HCT.
Acute Kidney Injury* ; Cell Transplantation* ; Creatinine ; Cyclosporine ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Incidence ; Logistic Models ; Prognosis* ; Renal Insufficiency ; Risk Factors ; Seoul ; Sepsis ; Transplants*

PURPOSE: This study was implemented to investigate the prevalence of proteinuria and its combined morbidity in apparently normal adults. METHODS: We examined the mass screening data of Health Promotion Center in Seoul National University Hospital from May 1, 1995 to February 11, 2000. The random urine samples of all screenees were examined by dipstick test. Among them 22,595 adults(men 11,737 and women 10,858) who didn't take anti- hypertensive medication and whose fasting blood sugar <126 mg/dL were included in this analysis. RESULTS: The prevalence of proteinuria was 6.7% in men and 3.6% in women. Risk factors for proteinuria by simple correlation analysis were age, sex, body weight, systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood urea nitrogen, serum creatinine, total cholesterol and smoking. As the degree of proteinuria increased, the systolic and diastolic blood pressures also increased significantly and creatinine clearance significantly decreased above the '++' level of proteinuria. Probability of proteinuria was calculated at each blood pressure level graded by JNC VI. With the increase of the level of blood pressure, the probability of proteinuria increased significantly between normal and high normal, high normal and hypertension1, and hypertension 2 and hypertension 3 level. Creatinine clearance and blood pressure level showed negative correlation. When total screenees were divided to proteinuria and no proteinuria groups, proteinuria group showed significant decrease of creatinine clearance in high normal and hypertension 1 level. CONCLUSION: Our results suggest that proteinuria in the apparently normal adults is not a benign condition, and it can be accompanied by significantly increased blood pressures and decreased renal function.
Adult* ; Blood Glucose ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Cholesterol ; Creatinine ; Fasting ; Female ; Health Promotion ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence* ; Proteinuria* ; Risk Factors ; Seoul ; Smoke ; Smoking

BACKGROUND: Autosomal dominant polycystic kidney disease(ADPKD) is the most common hereditary renal disease in adults, and its major complaints include pain and abdominal fullness due to cyst expansion. So far, for the control of these symptoms, cyst ablation with ethanol or tetracycline, laparoscopic manipulations and surgical marsupialization have been used. METHODS: We used conventional ethanol(n=9) or n-butyl cyanoacrylate(NBCA) plus lipiodol solution (n=18) or both(n=3) for separate cysts as the sclerosing agent in 24 adult Korean ADPKD patients. And their clinical courses after treatment were evaluated. RESULTS: The male to female ratio was 8 : 16 and the mean age at the treatment was 50 yrs(S.D. 13.1). Causes for aspiration were pain in 14 and abdominal fullness in 7 patients and the range for the cyst diameters aspirated were 5-16 cm. Flank pain or discomfort were decreased subjectively in most cases except two. Mean arterial pressures(S.D.) (mmHg) before and after procedure were as follows 112(11.1)(basal), 96(9.6)(1 month) and 98(9.7)(6 month)(p < 0.05, paired-t test). Blood urea nitrogen levels(mg/dL) were not changed 6 month later[24 (12.1) vs. 22(14.6)]. There was no major complication such as bleeding or infection and no death and associated with procedure. There was no difference of therapeutic effect according to sclerosing agent. CONCLUSION: NBCA was as effective as conventional ethanol for sclerotherapy in ADPKD and cyst ablation therapy showed a BP-lowering effect in short-term period.
Adult ; Blood Urea Nitrogen ; Ethanol ; Ethiodized Oil ; Female ; Flank Pain ; Hemorrhage ; Humans ; Male ; Polycystic Kidney, Autosomal Dominant* ; Sclerotherapy* ; Tetracycline

PURPOSE: Fungal peritonitis is a fatal disease with a high mortality and morbidity to the peritoneal dialysis(PD) patients. This study was implemented to provide a guideline for the prevention and treatment of fungal peritonitis in PD patients by analyzing the clinical and microbiologic features of fungal peritonitis cases. METHODS: We analyzed retrospectively into the 15 cases(14 patients) of fungal peritonitis among 376 end stage renal disease(ESRD) patients who newly started PD in the Seoul National University Hospital from Jan. 1991 to Dec. 1999. RESULTS: The patients' age was 53.6+/-11.6 years (mean+/-standard deviation) and their male to female ratio was 12:3. They have been on PD for 29.2+/-27.7 months before the fungal peritonitis developed. Candida species was the most common etiologic agent, accounting for 10(62.5%) out of the 16 fungal organisms isolated from our patients. Among others were two Aspergillus, one Cryptococcus, one Penicillium, one Torulopsis, and one Trichosporon beigelii cases. Bacterial agents were isolated simultaneously in five fungal peritonitis cases. Peritoneal catheters were all removed no later than 72 hours after the diagnosis was made. Patients were given a single or combined therapy with amphotericin B, fluconazole, or flucytosine on the physician's choice. The outcomes of fungal peritonitis were as follows; 20% continued PD, 60% converted to HD and 20% died of fungal peritonitis. We made a comparative analysis between the fungal and bacterial peritonitis cases which developed in the same 5-year period, which showed significantly higher catheter removal and technique failure rates in the fungal cases. CONCLUSION: Fungal peritonitis is a rare but a fatal disease with a high mortality and a technique failure rate. Candida species was the most prevalent microorganism in our study.
Amphotericin B ; Aspergillus ; Candida ; Catheters ; Cryptococcus ; Diagnosis ; Female ; Fluconazole ; Flucytosine ; Fungi ; Humans ; Male ; Mortality ; Penicillium ; Peritoneal Dialysis* ; Peritonitis* ; Retrospective Studies ; Seoul ; Trichosporon

BACKGROUND: Ischemic heart disease has become more important in regard to mortality in hemodialysis patients. Although PTCA has been used for the treatment of ischemic heart disease, its result has little been reported in chronic renal failure(CRF) patients not in maintenance dialysis. We examined the therapeutic outcome of PTCA in CRF group in comparison with that in control group with normal renal function. METHODS: In a retrospective case-control study, 15 patients with CRF(Scr >or=1.4 mg/dL) were compared with 29 sex, age and diabetes mellitus matched controls without renal disease who had been randomly selected from the PTCA registry of our institution. Restenosis was evaluated by follow-up angiography or recurrent angina. Twenty-two PTCAs were performed over 26 stenotic lesions in CRF group, and thirty-nine PTCAs undergone over 56 lesions in control group. RESULTS: CRF group consisted of 11 men and 4 women with a mean age of 59.2+/-9.2(mean+/-SD) years and a mean serum creatinine of 3.8+/-2.4 mg/ dL. Cause of renal failure was diabetes mellitus in 11 cases(73%). Angiographic lesion success was confirmed in 17(65%) out of the 26 stenotic sites and stents were inserted successfully in the other nine lesions. Restenosis was confirmed by angiography in 10 lesions(38.5%) over a mean of seven months and suspected by recurrent angina in 6 lesions(23.1%), so overall restenosis rate was 61.6% in CRF group. Risk of restenosis was little different compared with control group in single- and double vessel disease, but increased up to 89% in triple vessel disease in CRF in contrast with control group. Among CRF group patients with serum creatinine >or=2.5 mg/dL showed much increased restenosis rate(77%) compared with those with serum creatinine <2.5 mg/dL (46%). CONCLUSION: Restenosis rate significantly increased in CRF patients who have multivessel disease or advanced renal failure, so other reperfusion therapy should be considered for them.
Angiography ; Angioplasty, Balloon, Coronary* ; Case-Control Studies ; Creatinine ; Diabetes Mellitus ; Dialysis ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic* ; Male ; Mortality ; Myocardial Ischemia ; Renal Dialysis ; Renal Insufficiency ; Reperfusion ; Retrospective Studies ; Stents

BACKGROUND: One of the major complications of liver transplantation is acute renal failure(ARF). The outcome in patients who develop postoperative renal failure has been dismal. But there are few reports on ARF after liver transplantation in Korea. The aim of this study was to determine the incidence, clinical characteristics, and prognosis of ARF in patients undergoing liver transplantation. METHODS: The records of 35 adult patients who received liver transplantation at the Seoul National University Hospital between october 1992 and June 2001 were reviewed retrospectively. RESULTS: 22 patients were male and 13 were female, with an age range of 15 years to 65 years(median, 49 years). The 35 recipients included 18 with liver cirrhosis, 10 with liver cirrhosis and hepatoma, 3 with hepatoma, 3 with fulminant hepatitis, and 1 with biliary atresia. Death occurred in 10 patients (29%) overall. ARF was developed in 25 cases(71%), and 8 cases(32%) expired. Among the 9 patients with peak serum creatinine level > or = 2.0 mg/dL, 7 patients expired. 2 patients required hemodialysis following liver transplantation and all of them expired. ARF was developed within 1day(0-39 days). Of 25 ARF cases, 21 cases of hypotension, 6 acute rejection, 10 spontaneous bacterial peritonitis(SBP), and 8 massive packed RBC transfusion were associated. Renal function at latest follow-up was improved in patients who were suffered with ARF. CONCLUSION: ARF is a frequent complication of liver transplantation, and the strategy of management and prevention of ARF needs to be developed.
Acute Kidney Injury ; Adult ; Biliary Atresia ; Carcinoma, Hepatocellular ; Creatinine ; Female ; Follow-Up Studies ; Hepatitis ; Humans ; Hypotension ; Incidence ; Korea ; Liver Cirrhosis ; Liver Transplantation* ; Liver* ; Male ; Prognosis* ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Seoul