Erratum: Association of serum uric acid level with coronary artery stenosis severity in Korean end-stage renal disease patients Volume 36, Issue 3, September 2017, Pages 282–289

Hye Yun Jeong and Hye Jeong Cho contributed equally to the above study as co-first authors.

Association of serum uric acid level with coronary artery stenosis severity in Korean end-stage renal disease patients

BACKGROUND: Hyperuricemia is common in end-stage renal disease (ESRD) patients, and many previous studies have reported the associations between hyperuricemia and adverse cardiovascular outcomes, which are the major cause of death in such patients. We investigated the relationship between serum uric acid level and the severity of coronary stenosis in ESRD patients on maintenance hemodialysis (MHD). METHODS: Among 721 patients who started MHD treatment, 102 underwent coronary angiographic tests complaining of chest discomfort that was new at initiation of MHD. We collected data on uric acid level and coronary artery luminal diameter, defining luminal diameter narrowing of more than 50% in any major coronary artery as critical-stenosis. RESULTS: We detected critical coronary artery stenosis in 52 (57.8%) patients. The mean uric acid level was 6.6 ± 2.2 mg/dL, and that was significantly higher in the critical-stenosis group (4.9 ± 1.4 mg/dL vs. 7.8 ± 2.0 mg/dL, P < 0.001). The only independent predictor of critical-stenosis in multivariate analysis was serum uric acid level (P < 0.001). CONCLUSION: High serum uric acid was associated with severe coronary artery stenosis in Korean ESRD patients. Hyperuricemia is a readily modifiable factor, and appropriately preventing it could provide significant benefits in ESRD patients.

Clinical Analysis of Hemodialysis Vascular Access: Comparision of Autogenous Arterioveonus Fistula & Arteriovenous Prosthetic Graft

BACKGROUND: Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts. MATERIAL AND METHODS: A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method. RESULTS: The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1. 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency's risk factor was age. CONCLUSION: Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.

An Isolated Aneurysm of the Common Iliac Artery in a Patient on Hemodialysis / 대한내과학회지

An isolated aneurysm of the iliac artery is a very rare disease that can occur as the result of atherosclerotic degeneration, mycosis, trauma, medial necrosis, fibrodysplasia, or Marfan syndrome. This abnormality is often asymptomatic, and it has a potential risk of rupture. Since patients with chronic renal failure on hemodialysis have many comorbid conditions, the risk of rupture is increased. Here, we report the case of an isolated common iliac artery aneurysm that was caused by atherosclerosis in a patient on hemodialysis, and we review the relevant literature.

A Fatal Case of Disseminated Tuberculosis Coincident with Measles-Rubella Vaccination / 한국역학회지

The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

A Case of Acute Lung Injury Caused by Tetrafluoroethylene Inhalation / 결핵및호흡기질환

Tetrafluoroethylene is a colorless gas that can be used to synthesize a variety of fluoride compounds by polymerization (e.g., Teflon). Fluoride compounds have many applications in industry. There are several reports of inhalation injury from the pyrolytic product of fluoride compounds. When the polymer is heated under the conditions of inadequate ventilation, the fumes can cause polymer fume fever or pulmonary edema which manifested as symptoms such as fever, chill, profuse sweating, cough and dyspnea. However there are no reports of a direct lung injury caused by tetrafluoroethylene. We report a case of a 27-year-old male presented with acute lung injury after inhaling concentrated tetrafluoroethylene. He complained of cough and dyspnea after the accidental inhalation of tetrfluoroethylene at his workplace. The symptoms improved without any complications after conservative treatment with oxygen and steroid.

A Case of Protein Losing Enteropathy Caused by Primary Intestinal Lymphangiectasia / 대한소화기내시경학회지

Primary intestinal lymphangiectasia is a rare congenital cause of protein losing enteropathy that is characterized by chronic diarrhea, generalized edema, ascites, hypoproteinemia, hypoalbuminemia, and lymphopenia. We encountered an 18-year-old woman who suffered from longstanding diarrhea and progressive leg edema. The laboratory findings showed the typical features of this disorder. The presence of enteric protein loss was documented with the 24 hour fecal clearance of alpha(1)-antitrypsin and (99m)Tc human serum albumin scintigraphy. A duodenoscopy and biopsy showed scattered white spots and markedly dilated lymphatics in the tips of the villi, respectively. The patient's clinical symptoms improved after placing her on a high protein and low fat diet with medium chain triglyceride supplements.

A Case of Condyloma Acuminatum Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by the human papillomavirus. In gastrointestinal practice, we generally encounter this disease in the anal canal but rarely in the rectum during a colonoscopy. There are many therapeutic options for CA including chemical or physical destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, long duration of therapy, bleeding, release of potentially infectious aerosols, scarring etc. With argon plasma coagulation (APC), which is more available than lasers in gastrointestinal practice, a high frequency current flows through the argon plasma to the tissue, allowing well-controlled superficial tissue destruction without any direct contact between the probe and the tissue. We present a case of anal CA that was treated successfully with APC during a colonoscopy with no recurrence during the follow up.

Gadolinium-enhanced Three-dimensional Magnetic Resonance Angiography in the Evaluation of Potential Renal Donors for Laparoscopic Donor Nephrectomy: Is it Alternative or Supplementary Tools to Intraarterial Digital Subtraction Angiography? / 대한신장학회잡지

BACKGOUND: The assessment of renal vasculature should be performed by an appropriate imaging technique before kidney transplantation. The current standard technique is intra-arterial digital subtraction angiography. Digital subtraction renal angiography (DSA) is associated with multiple problems. Three dimensional (3D) gadolinium enhanced magnetic resonance angiography (Gd-enhanced MRA) has been suggested as a potential technique due to its noninvasive nature. The aim of this study was to evaluate the accuracy of Gd-enhanced MRA of potential live donors before renal transplantation. METHODS: From September 2002 to September 2004, forty potential live kidney donors were evaluated using Gd-enhanced MRA and intraarterial DSA. Concordance rate and kappa were calculated in 38 transplantations except 2 patients who could not be operated after preoperative evaluation. Gd-enhanced MRA findings were compared with conventional DSA and surgical findings as the reference method respectively. RESULTS: In five donors, the findings at surgery were discrepant with Gd-enhanced MRA findings (concordance rate=86.8%) and conventional DSA findings (concordance rate=86.8%). Two accessory arteries initially were missed by Gd-enhanced MRA. They were depicted retrospectively by discussion with a radiologist, which was radiologic reporting error. There were no adverse events during the Gd-enhanced MRA procedure. None of the findings missed by Gd-enhanced MRA resulted in deleterious consequences at laparoscopic nephrectomy for the donor and graft. CONCLUSION: We demonstrated that Gd-enhanced MRA is an accurate, minimally invasive technique for assessing the live donors before renal transplantation. Clinical feedback and optimization of imaging techniques should be continued to improve accuracy rate in preoperative assessment of potential live donors who are candidates for laparoscopic nephrectomy.

The Clinical Evaluation of Anomalous Bronchi Arising From The Trachea and Main Bronchi / 결핵및호흡기질환

OBJECTIVES: To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. METHODS: 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. RESULTS: Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. CONCLUSION: Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

Ventilatory Dynamics according to Bronchial Stenosis in Bronchial Anthracofibrosis / 결핵및호흡기질환

BACKGROUND: Bronchial anthracofibrosis usually manifest as a form of obstructive airway disease, and can be accompanied by parenchymal diseases such as pneumonia, and pulmonary tuberculosis. This study investigated the ventilatory dynamics according to the severity of bronchial stenosis in patients with bronchial anthracofibrosis. Method : One hundred and thirteen patients with bronchial anthracofibrosis that was confirmed by bronchoscopy and who had undergone a pulmonary function test were enrolled in this study group. The correlation coefficients between the pulmonary functional parameters and the number of lobes with bronchial stenosis were investigated. RESULTS: The incidence of ventilatory dysfunction was 56(49.6%) for obstructive, 8(7.1%) for restrictive, 2(1.8%) for mixed, and 47(41.6%) for a normal pattern. The FEV1/FVC, FEF25~75%, FEF25%, FEF50%, FEF75%, and PEF showed a significant negative correlation (p<0.05) and the Raw had a significant positive correlation with the number of lobes with bronchial stenosis(p<0.001). CONCLUSION: These findings suggest that the most common abnormality of the ventilatory function in bronchial anthracofibrosis is an obstructive pattern with a small airway dysfunction according to the severity of bronchial stenosis.

Coronary-artery Calcium Scores Using Electron Beam CT in Patients with Chronic Renal Failure

We evaluated the risk of coronary-artery disease in patients with chronic renal failure (CRF) by measuring the coronary-artery calcium scores with electron beam CT (EBCT). A total of 81 CRF patients were divided into three groups; pre-dialysis (group I, n=35), hemodialysis (group II, n=31) and peritoneal dialysis (group III, n=15). The several serum biochemical markers and calcium score levels by EBCT were determined. The Ca x P products were significantly higher in groups II (p 400 was significantly higher than the 66 patients with a score < or =400 (p<0.01). The calcium score was significantly higher in the 15 patients with cardiovascular complications than in the 66 patients without cardiovascular complications (628.9+/-904.8 vs. 150.4+/-350.9, p<0.01). EBCT seemed to be a good diagnostic tool for evaluating the risk of coronary-artery disease ''noninvasively'' in CRF patients who are at increased risk of cardiovascular morbidity and mortality.

The Relationship between the Histological Findings and beta ig-h3 in IgA Nephropathy / 대한신장학회잡지

BACKGROUND: TGF-beta is involved in the pathogenesis of various kidney diseases characterized by glomerulosclerosis and tubulointerstitial fibrosis. It is reported that urinary TGF-beta reflects the grade of interstitial fibrosis in glomerular disease. Here, we evaluated the relationship between the histological findings and beta ig-h3 in IgA nephropathy. METHODS: In patients with IgA nephropathy, we measured blood pressure (BP), serum creatinine, 24-hour urinary protein excretion (UTp), creatinine clearance (Ccr), serum and urine beta ig-h3 levels, and urine TGF-beta levels at the time of renal biopsy. Histologic findings were semiquantitively scored according to the extent of glomerulosclerosis (GG), tubulointerstitial fibrosis (TIG) and hyaline arteriolosclerosis (HA) by the criteria suggested by To. Semiquantitive scoring of immunohistochemistry for beta ig-h3 was done. RESULTS: Mean BP 95.4+/-14.5 mmHg, serum creatinine 1.06+/-0.35 mg/dL, 24-hour UTp 1, 423+/-1, 439 mg/day, and Ccr was 97.84+/-59.73 mL/min. The number of patients that showed GG 3 were 5, GG 2 was 1, GG 1 were 12. And, the number of patients that showed TIG 3 were 2, TIG 2 were 5, TIG 1 were 11. HA was shown in 4 patients. beta ig-h3 immunostaining was observed in glomerular Bowman's capsules and basement membrane of proximal tubules. The degree of beta ig-h3 immunostaining was positively correlated with the degree of glomerulosclerosis (r=0.72, p<0.001), interstitial fibrosis (r=0.91, p<0.001), serum creatinine (r=0.592, p<0.05) and Ccr (r=-0.626, p<0.05), but not with 24-hour UTp. Serum and urine beta ig-h3 levels did not correlate with any of these parameters. CONCLUSION: Renal beta ig-h3 expression in patients with IgA nephropathy may be related to glomerulosclerosis and interstitial fibrosis. However, urinary beta ig-h3 levels did not represent the pathologic changes of IgA nephropathy. Long-term study to measure renal beta ig-h3 expression and urinary beta ig-h3 is required to elucidate the roles of beta ig-h3 in IgA nephropathy.

Epidemiologic Investigation on an Outbreak of Cholera in Gyeongsangbuk-do, Korea, 2001 / 예방의학회지

OBJECTIVES: This study was carried out to investigate the cause, magnitude and transmission route of the cholera outbreak in 2001. METHODS: The study population were those persons who ingested foods at the restaurant, were confirmed as cholera patients, had symptoms of diarrhea and served as workers at the restaurant. A questionnaire survey and microbiological examinations on the microbes isolated from rectal swabs were conducted. Of the cases, 316 food histories were surveyed by an analysis of the restaurant menu. RESUJLTS: There were 139 confirmed cases of cholera reported in Korea in 2001. Of these, 104 were related to the restaurant. By region, Gyeongsangbuk-do had the highest incidence with 91 cases. Of these 91 cases, 74 had ingested foods at the restaurant, 2 were employees and 3 were secondary infection cases within the families. The results of the odds ratio analysis of the 316 persons having ingested foods at the restaurant were as follows: sandwiches 5.07 (95% CI, 1.85-14.59), soybean curd 2.45 (95% CI, 1.09-5.56), noodles 2.34 (95% CI, 1.24-4.42), steamed squid 2.01 (95% CI, 1.17-3.47) and vinegared rice 1.82 (95% CI, 1.08-3.09). It was certain the restaurant in question was the cause of the 2001 outbreak. CONCLUSIONS: We suspected that more than one restaurant employee contaminated foods served at the restaurant. In addition, eating raw fishes purchased at the Pohang Fisheries infected the employees of the restaurant. There is a possibility that these raw fishes were themselves contaminated by cholera bacilli in the sea.

Epidemiologic Investigation on an Outbreak of Cholera in Gyeongsangbuk-do, Korea, 2001 / 예방의학회지

OBJECTIVES: This study was carried out to investigate the cause, magnitude and transmission route of the cholera outbreak in 2001. METHODS: The study population were those persons who ingested foods at the restaurant, were confirmed as cholera patients, had symptoms of diarrhea and served as workers at the restaurant. A questionnaire survey and microbiological examinations on the microbes isolated from rectal swabs were conducted. Of the cases, 316 food histories were surveyed by an analysis of the restaurant menu. RESUJLTS: There were 139 confirmed cases of cholera reported in Korea in 2001. Of these, 104 were related to the restaurant. By region, Gyeongsangbuk-do had the highest incidence with 91 cases. Of these 91 cases, 74 had ingested foods at the restaurant, 2 were employees and 3 were secondary infection cases within the families. The results of the odds ratio analysis of the 316 persons having ingested foods at the restaurant were as follows: sandwiches 5.07 (95% CI, 1.85-14.59), soybean curd 2.45 (95% CI, 1.09-5.56), noodles 2.34 (95% CI, 1.24-4.42), steamed squid 2.01 (95% CI, 1.17-3.47) and vinegared rice 1.82 (95% CI, 1.08-3.09). It was certain the restaurant in question was the cause of the 2001 outbreak. CONCLUSIONS: We suspected that more than one restaurant employee contaminated foods served at the restaurant. In addition, eating raw fishes purchased at the Pohang Fisheries infected the employees of the restaurant. There is a possibility that these raw fishes were themselves contaminated by cholera bacilli in the sea.

Usability of HHIE S as a screening test of hearing imairment in the Korean elderly

BACKGROUND: Hearing impairment is one of the most common physical handicaps of the aged. This diseases has recently attracted such amount of social attention and understanding as never attracted several years ago, and high degree of achievement was made with regard to screening test method, diagnosis, treatment and rehabilitation. However, unfortunately, even now, not enough attention is being paid upon early discovery hearing handicap for patients frequently encountered in clinics. Therefore, as a screening test method of senile hypacusis, we were to apply "Hearing Handicap Inventory for the Elderly Screening Version" (HHIE S) inquiries in Korea and studied the usability, sensitivity, specificity, positive predictive value and negative predictive value and cutoff point of this method. METHODS: This study was performed for 120 persons over the age of 60, who visited general health screening centers of one university hospital located in Seoul, during the period of October 1997 through to March 1999. HHIE S questionnaires were used and pure tone audiometry was performed to generate gold standard. RESULTS: Only 110 out of 120 initial subjects were included in the study because of incomplete questionnaire answers by excluded 10 subjects. We defined gold standard of hearing handicap to be (1) lower than 40 dB of hearing capability of both ears to frequency between 1000 Hz and 2000 Hz or (2) lower than 40 dB of hearing capability of an ear to frequency between 1000 Hz and 2000 Hz, as determined by pure tone audiometry. Assuming cutoff point of HHIE S as 4 points, the sensitivity and specificity resulted to be 80% and 67% each. Assuming cutoff point of HHIE S as 6 points, the sensitivity and specificity were 76% and 78% each. At 8 points, the percentages were 64% and 80%. At 10 points, the percentages were 64% and 85%. As a result of this study, the appropriate cutoff point is 6 points. In order to specify the correlation between questionnaire result and pure tone audiometry, we performed 500 Hz, 1000 Hz and 2000 Hz audiometry which are within conversational range, calculated arithmetic mean from the results, and inspected correlation between the resultant mean of the better performing ear and questionnaire resultant points. The correlation coefficient was 0.612 and Chronbach's alpha, as a measurement of internal consistency of the questionnaire was 0.9044. CONCLUSION: HHIE S proved to be useful in screening hearing handicap in the Korean elderly.

"Neuronal-like" Properties of Urothelium in Bladder

No abstract available.

Correlation of Valsalva Leak Point Pressure with Clinical and Urodynamic Characteristics in Women with Stress Urinary Incontinence

PURPOSE: To determine whether specific clinical and urodynamic characteristics can be used to identify women with stress urinary incontinence(SUI) due to intrinsic sphincteric deficiency, we assessed correlation between Valsalva leak point pressure(VLPP) and other clinical and urodynamic parameters. MATERIALS AND METHODS: A prospective analysis was performed of 108 patients who underwent urodynamic evaluation for complaints of urinary leakage. Intrinsic sphincteric deficiency (ISD) was defined as a VLPP of 60cmH2O or less at 150-250ml filling of the bladder. Anatomic incontinence(AI) was defined as a VLPP of 90cmH2O or high. Patients with VLPP between 60 and 90cmH2O were excluded in this study. All patients were evaluated with symptom grade(Stamey), duration of symptom, age, body weight, parity, functional urethral length(FUL) and maximum urethral closure pressure(MUCP). Correlation of VLPP and these parameters were computed. RESULTS: Of the 108 patients, 50 had ISD and 58 had AI. In ISD group, SUI was grade I in 14%, II in 48% and III in 38%. There were significant differences in the incidence between grade I and grade II or III. In AI group, SUI was grade I in 43%, II in 45% and III in 12%. There were significant differences between grade III and grade I or II. The two groups were similar in all other preoperative clinical and urodynamic characteristics. CONCLUSIONS: The only preoperative clinical index that can predict the presence of intrinsic urethral sphincter dysfunction, as defined by VLPP, was severity of symptom. Higher grades of stress urinary incontinence have a higher likelihood of a low VLPP.

Comparison of the Survival Rates of Spousal Kidney Transplantation and Parental Donor Kidney Transplantation / 대한이식학회지

PURPOSE: The continuing shortage of donors has escalated the waiting times for kidney transplantation in most nations. In instances where first-degree relatives of the patient are not appropriate, living unrelated transplantations are considered as the next possible choice. In this category, genetically unrelated but emotionally related spouses are always preferred for organ donation rather than both genetically and emotionally unrelated donors. The aim of this study was to compare the results of parental donor kidney transplantation with spousal kidney transplantation. METHODS: Patient and graft survival were assessed with the Kaplan- Meier curve and statistical significance was determined by log-rank comparisons. RESULTS: In the spousal group, 1-, 3-, and 5-year graft survival rate were 84.6%, 72.3%, and 66.3%, in the parental donor group, 89.2%, 75.4% and 62.3% respectively. 1-, 3-, and 5-year patient survival rate were 84.6%, 80.4%, and 71.5% in the spousal group and 97.3%, 94.3% and 90.6% respectively in the parental donor group. Survival rate of grafts from spouses was comparable to that of parental-donor grafts, despite the average of 4.1 HLA mismatches in the spousal group, as compared with one haplotype sharing in the latter group (P<0.001) and higher donor age in the parental donor group (P<0.001). The survival rates were similar in the wife-to-husband and the husband-to-wife groups. CONCLUSION: While providing the couple with a better quality of life, spousal kidney transplantation also enables the couple to share the joy of giving and receiving the "gift of life" from one another. We believe that transplantation from a healthy volunteer spouse is a good alternative resource to years of dialysis while waiting for another donor that may never appear, to increase the donor pool and reduce the increasing length of waiting lists.

Mizoribine in Living Donor Kidney Transplantation: Twenty Four-week Results of A Single Center, Pre-randomized, Open-label, Prospective, Comparative, Phase III Study / 대한신장학회잡지

No abstract available.