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In a edentulous patient, various methods can be employed for prosthetic treatment using implants, such as implant-supported fixed prostheses, overdentures, hybrid prostheses, and implant assisted removable partial denture. In this case, in a patient with moderate to severe chronic periodontitis requiring full arch extractions, implants were strategically placed using computer-guided surgery. In the maxilla, due to inadequate bone quality and quantity leading to insufficient initial stability, delayed loading was implemented, and interim prosthesis was used during the osseointegration period. In the mandible, stable initial stability was achieved, allowing for immediate loading to reduce patient discomfort.Primary stability is considered the most crucial factor for obtaining immediate loading, so a thorough clinical and radiological evaluation of the remaining alveolar bone quantity and quality must be conducted before surgery.
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Objective@#Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis. @*Methods@#Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck’s depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function. @*Results@#RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V. @*Conclusion@#Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.
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BACKGROUND: Hyperuricemia is associated with the development and progression of chronic kidney disease (CKD) as well as cardiovascular diseases. However, there is no consistent recommendation regarding the treatment of asymptomatic hyperuricemia (AHU) in CKD patients. Here, we surveyed Korean physicians’ perceptions regarding the diagnosis and management of AHU in CKD patients. METHODS: Questionnaires on the management of AHU in CKD patients were emailed to regular members registered with the Korean Society of Nephrology. RESULTS: A total of 158 members answered the questionnaire. Among the respondents, 49.4%/41.1% were considered hyperuricemic in male CKD patients whereas 36.7%/20.9% were considered hyperuricemic in female CKD patients when defined by serum uric acid level over 7.0/8.0 mg/dL, respectively. A total of 80.4% reported treating AHU in CKD patients. The most important reasons to treat AHU in CKD patients were renal function preservation followed by cerebro-cardiac protection. Majority of respondents (59.5%) thought that uric acid-lowering agents (ULAs) were the most effective method for controlling serum uric acid levels. Approximately 80% chose febuxostat as the preferred medication. A total of 32.3% and 31.0%, respectively, initiated ULA treatment if the serum uric acid level was more than 8.0 or 9.0 mg/dL, respectively. In addition, 39.2% and 30.4% answered that target serum uric acid levels of less than 6.0 or 7.0 mg/dL, respectively, were appropriate. The two major hurdles to prescribing ULAs were concerns of adverse reactions and the existing lack of evidence (i.e., the absence of Korean guidelines). CONCLUSION: Most Korean physicians treat AHU in CKD patients to prevent CKD progression and cerebro-cardiovascular complications.
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Feminino , Humanos , Masculino , Doenças Cardiovasculares , Diagnóstico , Correio Eletrônico , Febuxostat , Hiperuricemia , Métodos , Nefrologia , Insuficiência Renal Crônica , Inquéritos e Questionários , Ácido ÚricoRESUMO
BACKGROUND: Transforming growth factor-beta (TGF-beta) is a multifunctional cytokine involved in immune disorders, cancer, asthma, lung fibrosis, and chronic kidney disease, and its signal pathways are considered crucial mediators of a variety of cellular processes. In addition, several recent studies have reported that TGF-beta receptor (TGF-betaR) gene polymorphism is associated with chronic kidney disease. However, the association between end-stage renal disease (ESRD) and the TGF-beta gene polymorphism has not been sufficiently investigated. In this study, we hypothesized that polymorphisms of the TGF-beta ligands or their receptors may be related to ESRD. METHODS: We assessed the relationship between four single-nucleotide polymorphisms (SNPs) in the TGF-betaR2 and TGF-beta2 genes and ESRD, in 312 patients with ESRD and 258 controls. RESULTS: Compared with the control participants, the frequencies of the TGF-betaR2 (rs764522*C) and TGF-betaR2 (rs3087465*G) alleles were significantly higher in the patients with ESRD. Genotyping analysis demonstrated that two SNPs in TGF-betaR2 of the four SNPs included in the study were significantly associated with ESRD in the codominant 1 [rs764522, odds ratio (OR)=1.65; rs3087465, OR=1.63], dominant (rs764522, OR=1.63; rs3087465, OR=1.57), and log-additive (rs764522, OR=1.54; rs3087465, OR=1.39) models after adjusting for age and sex. CONCLUSION: We suggest that TGF-betaR2 polymorphisms (rs764522 and rs3087465) increase the risk of development of ESRD.
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Humanos , Alelos , Asma , Fibrose , Doenças do Sistema Imunitário , Falência Renal Crônica , Ligantes , Pulmão , Razão de Chances , Polimorfismo de Nucleotídeo Único , Receptores de Fatores de Crescimento Transformadores beta , Insuficiência Renal Crônica , Transdução de Sinais , Fator de Crescimento Transformador beta , Fator de Crescimento Transformador beta2RESUMO
Posterior reversible encephalopathy syndrome (PRES) is neurotoxicity characterized by brain imaging findings of reversible subcortical vasogenic edema. Clinical manifestations include seizure, altered mental status, focal neurologic deficit, and headache. Tacrolimus, a potent immunosuppressant, is related to increased risk of PRES in transplantation recipients. We report on a case of PRES in a 48-year-old female kidney transplantation recipient who received immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. On postoperative day 14, she complained of moderate to severe headache which did not respond to usual analgesics. Magnetic resonance imaging showed high signal intensity on T2-weighted images and fluid-attenuated inverse recovery imaging in both parieto-occipital areas. The condition was improved after changing immunosuppressant from tacrolimus to sirolimus.
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Feminino , Humanos , Pessoa de Meia-Idade , Analgésicos , Calcineurina , Edema , Cefaleia , Terapia de Imunossupressão , Transplante de Rim , Rim , Imageamento por Ressonância Magnética , Neuroimagem , Manifestações Neurológicas , Síndrome da Leucoencefalopatia Posterior , Prednisolona , Convulsões , Sirolimo , TacrolimoRESUMO
Catecholamine secretory traits were significantly heritable, as were stress-induced blood pressure changes. Tyrosine hydroxylase (TH) is the rate-limiting enzyme in catecholamine biosynthesis. In the tyrosine hyroxylase promoter, significant associations were found for urinary catecholamine excretion and for blood pressure response to stress. TH promoter haplotype 2 (TGGG) showed pleiotropy, increasing both norepinephrine excretion and blood pressure during stress. In hypertension, 2 independent case-control studies (1,266 subjects with 53% women and 927 subjects with 24% women) replicated the effect of C-824T in the determination of blood pressure. Chromogranin A (CHGA) plays a fundamental role in the biogenesis of catecholamine secretory granules. Changes in the storage and release of CHGA in clinical and experimental hypertension prompted us to study whether genetic variation at the CHGA locus might contribute to alterations in autonomic function, and hence hypertension and its target organ consequences such as hypertensive kidney disease (nephrosclerosis). Systematic polymorphism discovery across the human CHGA locus revealed such regulatory regions as the proximal promoter and 3'-UTR. In chromaffin cell-transfected CHGA 3'-UTR and promoter/luciferase reporter plasmids, the functional consequences of the regulatory/non-coding allelic variants were documented. Variants in both the proximal promoter and the 3'-UTR displayed statistical associations with hypertension and hypertensive end stage renal disease. Therefore, I would like to review the common genetic variation in TH and CHGA as a cause of inter-individual variation in sympathetic activity, and ultimately blood pressure and hypertensive kidney disease.
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Feminino , Humanos , Pressão Sanguínea , Estudos de Casos e Controles , Cromogranina A , Variação Genética , Genômica , Haplótipos , Hipertensão , Rim , Nefropatias , Falência Renal Crônica , Norepinefrina , Plasmídeos , Sequências Reguladoras de Ácido Nucleico , Vesículas Secretórias , Tirosina , Tirosina 3-Mono-Oxigenase , Biogênese de OrganelasRESUMO
BACKGROUND: Donor Action (DA) is a well-known program used to evaluate the potential of organ donors and to survey hospital attitudes toward organ donation in a region or nation. DA has not yet been fully implemented in Korea. METHODS: We collected medical information on expired patients from 9 hospitals in Yeoung-nam province. We also passed out Hospital Attitude Survey questionnaires in those same 9 hospitals. We reviewed the medical records of the expired patients in the neurological and neurosurgical critical care units from January 1, 2009 to December 31, 2009. Data was analyzed with a DA system database. RESULTS: A total of 704 patients were enrolled. Altogether, 307 patients (43.6%) were potential donors, and 26 patients (6.5%) were reported to an to organ procurement organization. Among the potential donors, a family approach was taken with 33 patients (10.7%), and family consent was obtained in 26 cases (8.5%). Organ donation was done with 24 patients (7.8%). Among the potential donors, 88.6% of them were not identified as potential donors. Hospital attitude surveys were given to 417 hospital staff members. A positive attitude towards organ donation was shown in 85%. However, only 55.4% of hospital staff agreed on the concept of brain death. CONCLUSIONS: Among the processes of organ donation, identifying a potential donor is a critical step to increase organ donation.
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Humanos , Encéfalo , Cuidados Críticos , Coreia (Geográfico) , Prontuários Médicos , Inquéritos e Questionários , Obtenção de Tecidos e Órgãos , Doadores de TecidosRESUMO
Tuberculosis is recognized as one of the most important complications in an organ transplant recipient. Rifampin has become a standard agent in the treatment of tuberculosis. While rifampin is well tolerated in most patients, adverse effects, including serious forms of toxicity, have been reported. Some of these adverse effects include liver toxicity and various immunologic reactions such as skin rashes, eosinophilia, and interstitial nephritis. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy in a renal transplant patient. We should not ignore other causes of interstitial nephritis in a renal transplant patient.
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Humanos , Eosinofilia , Exantema , Transplante de Rim , Fígado , Nefrite Intersticial , Rifampina , Transplantes , TuberculoseRESUMO
BACKGROUND: Due to the shortage of kidney donation, deceased donor kidney from the expended criteria donor has been used as an alternative. For this, deceased donor scoring system was suggested by Nyberg and his colleagues. We evaluated the Nyberg's scores with 77 patients who received deceased donor kidney. METHODS: We reviewed the records of 77 patients who received deceased-donor kidney transplantation between January, 1, 2003 and Augst, 31, 2008 in Pusan,Paik hospital. Renal function was estimated by Cockroft-Gault equation at 6 month, 1 year, 2 year after transplantation and creatinine reduction ratio on post-transplant day 2 (CRR2). RESULTS: The mean age of deceased donor was 41.1+/-10.4 (male: n=55; female: n=22) and the mean last eGFR before procurement was 72.6+/-4 and HLA mismatching was 3.46+/-1.4. Renal function at 6 months was associated with donor age and last eGFR before procurement. Deceased donor score was ranged from 2 to 26. The number of each grade using the score system by Nyberg et al was 18 in A, 39 in B, 19 in C. The score showed negative correlation with eGFR at 6 months, 1 year and 2 years (P<0.05), but the R-square values were low. There were significant differences between group A+B and C in CRR2 and eGFR at 2 years. CONCLUSIONS: This study showed that donor age is the most important factor in the deceased donor scoring system.
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Humanos , Creatinina , Rim , Transplante de Rim , Doadores de Tecidos , TransplantesRESUMO
PURPOSE: It was well known that transforming growth factor (TGF)-beta1 plays a pivotal role in interstitial fibrosis and loss of podocyte. We explored the effects of exogenous administration of TGF-beta1 latency-associated peptide (LAP) in a model of renal fibrosis induced by unilateral ureteral obstruction (UUO) and examined whether TGF-beta1 LAP can inhibit apoptosis of podocyte. METHODS: Twenty four male BALB/c mice were unilaterally obstructed of proximal ureters by ligation. Half of the mice with operation and half of 8 control were administered recombinant human LAP intraperitoneally. One to three mice per group were euthanized on days 3, 7, 14, and 21 after operation for observation of renal fibrosis and apoptosis of podocyte. RESULTS: Interstitial fibrosis was less severe in LAP-treated group. Obstructed kidneys from LAP- untreated mice had more glomerular apoptotic podocytes (TUNEL assay) compared to LAP-treated mice at day 7, 14, and 21 after operation. CONCLUSION: Intraperitoneal administration of TGF-beta1 LAP prevents the loss of podocyte & renal damage partially up to day 14 after operation.
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Animais , Humanos , Masculino , Camundongos , Apoptose , Fibrose , Rim , Ligadura , Podócitos , Fator de Crescimento Transformador beta1 , Fatores de Crescimento Transformadores , Ureter , Obstrução UreteralRESUMO
BACKGROUND: Contrast induced nephropathy (CIN) is an important cause of acute renal failure in patients with renal dysfunction. We investigated whether oral NAC alone was sufficient to prevent CIN to the same extent as hydration in patients with renal dysfunction, and whether these treatments resulted in diffierences in the urinary excretion of nitric oxide, a vasodilator. METHODS: A total of 27 patients with renal dysfunction, who underwent radiographic examination with nonionic and low osmolar contrast, were randomly assigned to receive either NAC (600 mg orally twice daily; N=11) or 0.45% saline hydration (1 mL/kg/Hr; N=16) 12 hours prior to and 12 hours after the contrast procedure. We measured serum creatinine (sCr), fractional excretion of sodium (FENa), creatinine clearance (CCr), and urinary nitrite before and after contrast administration. RESULTS: The mean volume of contrast used was similar in the two groups (100.9+/-54.8 mL vs 114.7+/-38 mL; p=0.43), as was baseline sCr in the two groups (2.31+/-1.59 mg/dL vs 2.18+/-1.41 mg/dL; p=0.98). Treatment did not significantly affect the incidence of CIN, with 18.2% and 12.5% in the NAC group and hydration group, respectively (p=1.0). The urinary nitrite/creatinine ratio (micro mol/mg) was 1.26+/-0.57 and 1.43+/-0.64 at baseline and 48 hours after contrast exposure in the NAC group, respectively, and 0.80+/-0.40 and 1.18+/-0.60 in the hydration group, respectively, which were not significantly different. FENa increased significantly after contrast exposure in the NAC group compared with hydration group (p=0.04) CONCLUSIONS: NAC alone may prevent CIN. When bolus hydration is contraindicated in patients with renal dysfunction, administration of NAC alone may be sufficient.
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Humanos , Acetilcisteína , Injúria Renal Aguda , Creatinina , Incidência , Óxido Nítrico , SódioRESUMO
Gitelman's syndrome is a heritable renal disorder characterized by hypomagnesemia, hypokalemia and hypocalciuria. Interestingly, we have experienced one patient who had chronic hypotension, normal serum magnesium level, normal plasma ionized magnesium level, hypokalemia and hypocalciuria. Immunohistochemistry showed the absence of NCCT staining in renal tissues of the patient. We report the case of atypical Gitelman's syndrome with a brief review of related literature.
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Humanos , Síndrome de Gitelman , Hipopotassemia , Hipotensão , Imuno-Histoquímica , Magnésio , PlasmaRESUMO
Merkel cell carcinoma (MCC) is a rare, frequently lethal, primary neuroendocrine carcinoma of the skin. Histopathologically, it appears as a dermal nodule of small undifferentiated malignant cells. Historically, MCC was considered to be an eccrine carcinoma. Recognition of its neuroendocrine features later led to the hypothesis that it arose from Merkel cells in the skin, although recent evidences revisit the question of an epithelial origin. We recently experienced a Mercel cell carcinoma. So, we report a MCC case originated from skin in renal transplant patient who was administrated immunosuppressive agent.
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Humanos , Carcinoma de Célula de Merkel , Carcinoma Neuroendócrino , Transplante de Rim , Células de Merkel , Pele , TacrolimoRESUMO
BACKGROUND: Rhabdomyolysis is a serious and potentially lethal condition that can develop from a variety of nontraumatic causes. Recently, there have been several reports about rhabdomyolysis which developed after alcohol abuse, drug intoxication, or vigorous exercise, but no report about all spectrums of nontraumatic rhadomyolyis in Korea. So we undertook this study to evaluate the clinical characteristics and course of nontraumatic rhabdomyolysis in a single medical center. METHODS: Several clinical and laboratory data were collected and analyzed in 68 patients with nontraumatic rhabdomyolyis from January 2002 to December 2003. RESULTS: The patients consisted of 58 males and 10 females with mean age of 48.0 +/- 16.3 years. The etiologic factors of nontraumatic rhabdomyolysis were as follows: 21 cases of alcohol abuse (30.9%), 13 cases of muscle ischemia (19%), 9 cases of shock (13%), 7 cases of infection, 6 cases of drug intoxication, 3 cases of seizure, 2 cases of malignant hyperthermia, 2 cases of diabetic ketoacidosis, 1 case of vigorous exercise, 1 case of CO poisoning, 1 case of hypophosphatemia, and 2 cases of unknown causes. Among the 68 patients, forty four patients (64%) developed acute renal failure and seventeen patients (25%) died of sepsis, acute respiratory distress syndrome, pulmonary edema or underlying diseases exacerbation. Among the 44 patients in acute renal failure, eighteen patients (41%) had oliguria during follow-up period. Thirteen patients of them needed dialysis and sixteen patients of them (36.4%) died. Another developed complications were hepatic dysfunction (34%), disseminated intravascular coagulation (28%), hypocalcemia (28%), acute respiratory distress syndrome (26%), pneumonia (22%), pulmonary edema (21%), hyperphosphatemia (7%) and hyperkalemia (4%). CONCLUSION: Nontraumatic rhabdomyolysis with acute renal failure is a serious and potentially lethal condition. Optimal treatment depends on early recognition and intervention. A high clinical suspicion for the occurrence of rhabdomyolysis in the nontraumatic conditions can lead to quicker recognition and better patient care.
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Feminino , Humanos , Masculino , Injúria Renal Aguda , Alcoolismo , Cetoacidose Diabética , Diálise , Coagulação Intravascular Disseminada , Seguimentos , Hiperpotassemia , Hiperfosfatemia , Hipocalcemia , Hipofosfatemia , Isquemia , Coreia (Geográfico) , Hipertermia Maligna , Oligúria , Assistência ao Paciente , Pneumonia , Intoxicação , Edema Pulmonar , Síndrome do Desconforto Respiratório , Rabdomiólise , Convulsões , Sepse , ChoqueRESUMO
Hepatocellular cell carcinoma (HCC) is one of the most common and malignant neoplasm in the world. Waldenstrom's macroglobulinemia (WM) is a rare B-lymphocyte neoplasia characterized by monoclonal production of IgM Igs and by a marrow containing a diffuse infiltrate of plasmocytoid lymphocytes. A 67-year-old man was admitted because of multiple site pain, especially right flank and posterior neck pain. Physical examination showed hepatomegaly. Laboratory findings were as follows; total protein 8.6 g/dL, albumin 3.1 g/dL with monoclomal protein(IgM-lamda). Hepatitis C virus(HCV) infection was detected by polymerase chain reaction(PCR). Computed tomography and celiac angiography disclosed HCC. Aspiration biopsy of the liver revealed HCC. Magnetic resonance imaging showed compression fracture and epidural mass in cervical spines. Bone marrow examination revealed normocellularity with an increase of lymphoplasmacytic series. He was diagnosed as having WM and HCC. HCC is frequently associated with other malignancies. As the site of the extrahepatic primary cancer, the stomach ranked first. WM is also known for its association with an increased incidence of a second neoplasm, most of which are less differentiated lymphomas. but an association with a non-lymphoreticular malignancy is quite rare. We report first case of synchronous HCC with bone metastasis and WM (IgM,lamdatype) in korean with chronic hepatitis C.
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Idoso , Humanos , Angiografia , Linfócitos B , Biópsia por Agulha , Medula Óssea , Exame de Medula Óssea , Carcinoma Hepatocelular , Fraturas por Compressão , Hepacivirus , Hepatite C , Hepatite C Crônica , Hepatite Crônica , Hepatomegalia , Imunoglobulina M , Incidência , Fígado , Linfócitos , Linfoma , Imageamento por Ressonância Magnética , Cervicalgia , Metástase Neoplásica , Segunda Neoplasia Primária , Exame Físico , Coluna Vertebral , Estômago , Macroglobulinemia de WaldenstromRESUMO
Acute gastric anisakiasis is caused by gastric mucosal penetration from an Anisakis larvae. It occurs with those who ingest raw or inadequately cooked saltwater fish or squid containing anisakis. The clinical symptoms are severe abdominal pain, nausea, vomiting, diarrhea, and so on. A case of acute gastric Anisakiasis with massive hematemesis was presented. Initial endoscopic examination revealed an edematous or raised erosive lesion with a small blood clot-covered vessel in the fundus which was thought to be a stigmata of recent bleeding. The lesion was treated with an epinephrine-hypertonic saline injection, electrocoagulation, and an ethanol injection. A follow-up gastroscopy revealed an artificial coagulation-induced ulcer at the previous bleeding site. At the ulcer margin, a whitish linear worm was found with half of its body penetrating the gastric mucosa. The worm was removed using biopsy forceps and the patient was subsequently placed on a soft diet. The next day however, hematemesis recurred. Gastroscopic band ligation of the vessel was performed with a cessation of bleeding. Three weeks later, a gastroscopy determined that the ulcer had completely healed.