Quantitative Analysis of Swallowing Function Between Dysphagia Patients and Healthy Subjects Using High-Resolution Manometry

OBJECTIVE: To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia. METHODS: Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined. RESULTS: VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia. CONCLUSION: We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.

A case of chinese herb nephropathy induced by aristolochia fangchi / 대한내과학회지

Chinese herb nephropathy (CHN) is characterized by progressive tubulointerstitial nephritis and development of renal failure in a couple of years after diagnosis. Aristolochic acid (AA) is believed to be associated with the development of CHN. The authors report a case of CHN in which AA in the herb regimen was identified by high-performance liquid chromatography (HPLC). A 32-year-old female presented with nausea, vomiting and generalized weakness. She had been taking Chinese herbs for symptomatic care. Clinical and laboratory examinations revealed Fanconi syndrome, renal failure, and severe anemia. Renal biopsy showed severe tubulointerstitial nephritis with moderate tubular atrophy and interstitial fibrosis. She developed end-stage renal failure 4 months after diagnosis. The herb she had been taking was Aristolochia fangchi. HPLC technique was used to identify AA and to measure its concentration in the herb. From the clinical and laboratory data, the patient was diagnosed with CHN caused by aristolochic acid.

Clinical Features Of Patients With Hyperphosphatemia Following Administration Of Phosphate-Containing Laxatives / 대한내과학회지

BACKGROUND: Oral sodium phosphate (NaP) is currently used for colon preparation prior to colonoscopy or barium enema because of its convenience and efficacy. It can cause transient hyperphosphatemia and should be considered potentially dangerous in the presence of renal impairment. METHODS: A retrospective study was done in 48 patients (32 patients with normal renal function and 16 patients with azotemia : serum creatinine >or= 1.4 mg/dL) with hyperphosphatemia (serum phosphate >or= 6 mg/dL or 50% increase in baseline) who were administered NaP solution as bowel preparation at Seoul National University Hospital in the period of January 2000 to June 2003. RESULTS: The patients' mean age was 60 years (range, 25-85 years). The increase of serum phosphate was 5.3 +/- 3.1 mg/dL (7.6 +/- 4.4 mg/dL in azotemia group vs. 4.2 +/- 1.2 mg/dL in normal renal function group). Serum calcium and potassium concentration decreased significantly, while serum sodium level increased significantly. There were no significant differences in serum chloride, total CO2, blood urea nitrogen and creatinine. The product of calcium and phosphate increased from 33.0 +/- 11.3 mg2/dL2 to 74.0 +/- 28.7 mg2/dL2 (to 93.0 +/- 39.8 mg2/dL2 in azotemia group). Only 8 patients ingested the recommended dose of oral NaP with an appropriate time interval. The symptomatic adverse events were numbness in 3 patients and carpopedal spasm in 1 patient. 12 patients underwent CaCO3 or amphojel administration and 1 patient needed hemodialysis as a treatment of hyperphosphatemia. Serum phosphate returned to baseline level at 1.3 +/- 0.6 day (1.8 +/- 0.8 day in azotemia group vs. 1.0 +/- 0.3 day in normal renal function group). CONCLUSION: NaP is inappropriate for patients who may be at an increased risk for phosphate intoxication, especially patients with impaired renal function. Even to healthy adult without renal disease, NaP should be ingested the recommended dose with an appropriate time interval.

Sclerotherapy of Renal Cysts in Korean ADPKD Patients / 대한신장학회잡지

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.