• Journal of Life Science
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• v.28 no.2
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• pp.240-246
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• 2018

Efferent and afferent sympathetic nerves are closely related to the development of hypertension and heart failure. Catheter-based renal sympathetic denervation (RDN) is implemented as a strategy to treat resistant hypertension. We investigated whether RDN procedure causes inflammatory damage on myocardium in the early phase of sympathetic denervation. Twenty-five female swine were divided into 3 groups: normal control (Normal, n=5), sham-operated control (Sham, n=5), and RDN groups (RDN, n=15). The RDN group was further subdivided into 3 subgroups according to the time of sacrifice: immediately (RDN-0, n=5), 1 week (RDN-1, n=5), and 2 weeks (RDN-2, n=5) after RDN. There were no significant changes in the clinical parameters between the normal control and sham-operated group using contrast-media. In the myocardium, inflammatory cytokines, $IL-1{\beta}$ and $TNF-{\alpha}$ increased at the first week, and then decreased at the second week after RDN. Anti-inflammatory cytokine, IL-10 increased immediately, and then decreased at the second week after RDN. Caspase-1 activity and apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) expression increased immediately after RDN until the second week. However, nucleotide-binding oligomerization domain, leucine rich repeat and pyrin domain containing protein 3 (NLRP3) expression did not show any significant differences among the groups. The RDN can cause acute myocardial inflammation through activation of caspase-1 and $IL-1{\beta}$. We should pay attention to protecting against early inflammatory myocardial damage after RDN.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.646-650
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• 2003

Many surgical techniques for ischemic mitral regurgitation (IMR) have been used with their excellent results and advantages. Here, we report our simple posterior annuloplasty techniques using vascular graft strip with their early results. Material and Method: Twenty two patients (13 male) underwent the operations for IMR (excluding the papillary muscle rupture) from December 2001 to January 2003. Preoperative risk factors were low ejection fraction (<35％, n=9), hypertension (n=13), diabetes (n=9), and renal failure (Cr>2.5, n=4). The wide dissection beneath the both vena cavae and interatrial groove after bicaval cannulation enabled the easy exposure of mitral valve even in the small left atrium. After eight or nine interrupted sutures in posterior annulus for anchoring the 6 mm width vascular graft strip, symmetric (n=8) or asymmetric (n=14) annuloplasty were done. Combined surgeries were CABG (n=21), Dor procedures (n=3), tricuspid valve annuloplasty (n=1), Maze operation (n=1), and aorto-right subclavian artery bypass (n=1). Result: Except for one surgical mortality, all the patients were doing well and the mean grade of regurgitation was decreased from 2.95 to 0.88, however the ejection fraction had not changed significantly just before discharge. Post-operative valve function evaluated before discharge revealed no residual regurgitation in 8 (including 1 patient with mild stenosis due to over reduction), minimal in 11, mild in 2, and mild to moderate regurgitation in 1. One patient who had ischemic cardiomyopathy and renal failure died of the arrhythmia during the hemodialysis. Conclusion: These observations suggest that the annuloplasty with vascular graft strip could be a safe and cost effective techniques for ischemic mitral regurgitation. However, the long term evaluation for the mitral valve function should be defined for the final conclusion.

• Sleep Medicine and Psychophysiology
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• v.14 no.2
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• pp.99-106
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• 2007

Objective: Restless legs syndrome (RLS) is known to be associated with chronic renal failure (CRF) patients on hemodialysis, however the prevalence of RLS in CRF patients on hemodialysis is variable due to different diagnostic criteria or dialysis technique. A few reports have indicated the association between RLS symptom and lower life quality in CRF patients on hemodialysis. This study aims to investigate the prevalence of RLS and its association with the quality of life in CRF patients of a single dialysis unit in Korea. Methods: A total of 83 Korean CRF patients on hemodialysis in the Korea University Hospital were examined. International Restless Legs Syndrome Study Group (IRLSSG) criteria and International Restless Legs Scale (IRLS) were used to determine the diagnosis and severity of RLS. Questionnaires including Athens Insomnia Scale (AIS), Epworth sleepiness scale (ESS), and Medical Outcome Study Form-36 (SF-36) were administered to all the patients for the assessment of sleep and quality of life. Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) were also measured for depression and status of mental illness by psychiatrist. Results: Of the 83 patients, 31 (37.3%) patients were found to have RLS and 43 (51.8%) patients met at least one of the RLS diagnostic criteria. The AIS (t=2.40, p=0.019), ESS (t=2.41, p=0.018), HDRS (t=3.85, p<0.001) and CGI (t=3.52, p=0.001) were higher in the subjects with RLS compared to other subjects. The SF-36 scores were significantly lower in the patients with RLS except physical functioning and bodily pain. Total (p=0.005), physical component (p=0.019), and mental component scores (p=0.019) of SF-36 were significantly lower in patients with more severe RLS symptoms. Conclusion: There was significant relationship between RLS and poor quality of sleep and life. More severe RLS symptom was proven to be an important factor to make a quality of life worsen.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.17 no.3
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• pp.92-95
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• 2017

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by an ${\alpha}$-galactosidase A (GLA, MIM 300644) enzyme deficiency due to pathogenic variants in the ${\alpha}$-galactosidase A gene (GLA). The disease leads to accumulation of globotriaosylceramide (Gb3) and related glycophospholipids affecting nearly all major organ systems, with the primary sites damaged by Gb3 including renal glomeruli, myocardium, neurons of the dorsal ganglion and autonomic nervous system, and vascular endothelial and smooth muscle. Progressive deposition in these organ systems present with various clinical manifestations including acroparesthesia, renal failure and heart failure. Here, we report a Chinese male diagnosed with Fabry disease in his late $4^{th}$ decades showing improvement of acroparesthesia during enzyme replacement therapy (ERT). A 48-year-old Chinese man who presented with chronic recurrent severe burning pain in his fingers and toes since the age of 10, with worse involvement of the former visited to our clinic for further evaluation. His medical history included a transient ischemic attack aged 40 and diagnosed with stage 4-5 chronic kidney disease aged 47. In the family history, the patient's brother was found to be have Fabry disease 1 month before his visit. Except for his brother, all other members of the family are healthy. Based on his medical history and family history, he was strongly suspicious for Fabry disease. He was found to have a galactose-alpha-1,3-galactose level 4.96 (Reference range, 42.5-67.9) suggestive of Fabry disease. The followed sequencing of GLA coding region in our patient revealed hemizyosity for the mutation c.988C>T (Q330X) in Exon 7. Since ERT start, he showed significant improvement in his symptoms of burning sensation of fingers and toes. On the contrary, due to deteriorating kidney function even with ERT, he is considered for kidney transplantation. Despite of diagnostic delay until late 4th decades, ERT showed a potential improvement of acroparesthesia in our patient. However, late start of ERT can lead to poor outcome in multiorgan function. Therefore, early diagnosis with high index of suspicion followed by continuous ERT with regular monitoring have an impact on quality of life in Fabry disease.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1811-1815
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• 2014

Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ${\geq}$ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ${\geq}$ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/- 0.31 vs 3.1 +/- 0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.82-93
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• 1994

Clinical study was carried out on the 64 hemodialysis patients(HD) with chronic renal failure who had been treated from December 1992 to July 1993 in Yeungnam University Hospital. The following results were obitained. In hematologic parameters, MCH was $28.8{\pm}2.0pg$, and MCV was $92.4{\pm}4.7fl$. Result revealed normochromic and normocytic anemia. Mean values of serum ferritin were $657.4{\pm}292.0ng/ml$ in men and $511.5{\pm}370g$ in women. Mean valuses of serum iron were $145.5{\pm}63.7{\mu}g/dl$. Mean values of transferrin saturation was $61.6{\pm}28.4%$. Serum frerritin, serum iron and transferrin saturation were higher in HD group than normal reference. In erythropoeitin treatment group, Hb and Hct were significantly higher than non-erythropoietin treatment group. Amount of transfusion was significantly higher in non-erythropoietin treatment group than erythropoeitin treatment group(p<0.05). Values of iron, transferrin saturation were significantly higher in abnormal liver function test(LFT) hemodialysis group than normal LFT group(p<0.05). Transfusion amounts revealed positive correlation with ferritin(r=0.4675), transferrin satruation (r=0.3823) and iron(r=0.3386)(p<0.05). In conclusion, erythropoietin treatment cna reduce requirement of blood transfusion and transfusion related side effects such as iron overload, hemosiderosis and hemochromatosis.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.167-174
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• 2012

Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.

• Radiation Oncology Journal
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• v.13 no.4
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• pp.321-330
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• 1995

Purpose : To evaluate whether the early pulmonary irradiation can prevent or decrease the pulmonary damage and contribute to improve ultimate survival in paraquat lung. Materials and Methods : From Jun. 1987 to Aug. 1993, thirty patients with paraquat poisoning were evaluated. Fourteen of these patients were received pulmonary irradiation(RT). All of the patients were managed with aggressive supportive treatment such as gastric lavage, forced diuresis, antioxidant agents and antifibrosis agents. Ingested amounts of paraquat were estimated into three groups(A : minimal 50cc). Pulmonary irradiation was started within 24 hours after admission(from day 1 to day 11 after ingestion of paraquat). Both whole lungs were irradiated with AP/PA parallel opposing fields using Co-60 teletherapy machine. A total of 10Gy(2Gy/fr. x 5days) was delivered without correction of lung density. Results : In group A, all patients were alive regardless of pulmonary irradiation and in group C, all of the patients were died due to multi-organ failure, especially pulmonary fibrosis regardless of pulmonary irradiation. However, in group B, six of 7 patients($86{\%}$) with no RT were died due to respiratory failure, but 4 of 8 patients with RT were alive and 4 of 5 patients who were received pulmonary irradiation within 4 days after ingestion of paraquat were all alive though radiological pulmonary change. One patient who refused RT after 2Gy died due to pulmonary fibrosis. All 3 patients who were received pulmonary irradiation after 4 days after ingestion were died due to pulmonary fibrosis in spite of recovery from renal and hepatic toxicity Conclusion : It is difficult to find out the effect of pulmonary irradiation on the course of the paraquat lung because the precise plasma and urine paraquat concentration were not available between control and irradiation groups. But early pulmonary irradiation within 4 days after paraquat poisoning with aggresive supportive treatment appears to decrease Pulmonary toxicity and contribute survival in patients with mouthful ingestion of paraquat who are destined to have reversible renal and hepatic damage but irreversible pulmonary toxicity.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.239-246
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• 2008

Background: Aortic surgery for high risk patients has high mortality and morbidity rates, and the necessity of performing aortic surgery in cancer patients is questionable because of their short life expectancy. Endovascular repair of aneurysm repair can be considered for high risk patients and cancer patients because it has relatively lower invasiveness and shorter recovery times than aortic surgery does. Especially, percutaneous endovascular stent graft treatment is more useful for high risk patients because it does not require general anesthesia. Material and Method: From July 2003 to September 2007, twelve patients who had inoperable malignancy or who had a high risk of complication because of their combined diseases during aortic surgery underwent endovascular aortic aneurysm repair. he indications for endovascular repair were abdominal aortic aneurysm in 5 patients, descending thoracic aortic aneurysm in 6 patients and acute type B aortic dissection in one patient. The underlying combined disease of these patients were malignancy in 3 patients, respiratory disease in 6 patients, old age with neurologic disease in 6 patients, Behcet's iseae in one patient and chronic renal failure in one patient. Result: Stent grafts were inserted percutaneously in all cases. There were 4 hospital deaths and there were 3 delayed deaths during the follow-up periods. There were no deaths from aortic disease, except one hospital death. There were several complications: a mild cerebrovascular accident occurred in one patient, acute renal failure occurred in 2 patients and ischemic bowel necrosis occurred in one patient. Mild type I endoleak was observed in 2 patients and type II endoleak was observed in a patient after stent graft implantation. Newly developed type I endoleak was observed in a patient during the follow-up period. Conclusion: Percutaneous endovascular stent graft insertion is relatively safe procedure for high risk patients and cancer patients. Yet it seems that its indications and its long term results need to be further researched.

• Tuberculosis and Respiratory Diseases
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• v.57 no.1
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• pp.19-24
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• 2004

Background : It is difficult to differentiate between tuberculous pneumonia and Community Acquired Pneumonia, so the diagnosis and treatment of tuberculous pneumonia can be delayed frequently. In this study, we attempted to retrospectively evaluate the clinical and radiologic characteristics of tuberculous pneumonia. Methods : We conducted a retrospective analysis of clinical characteristics of 58 patients diagnosed with tuberculous pneumonia from Nov. 1997 to May 2001 at Korea university kuro hospital. Result : The male to female ratio was 1:1 and the mean age at diagnosis was $54.5{\pm}18.6$ years. Fifty five patients were confirmed microbiologically and three patients pathologically. There were 20 patients(34.5%) who had diabetes mellitus(8cases), chronic obstructive pulmonary disease(3cases), malignancy(3cases), bronchiectasis(2cases), chronic renal failure(1cases) or long term history of corticosteroid treatment(3cases). Many patients had multilobar infiltration in chest X-ray, dominantly in the lower lobe. thirty two patients(55.2%) had infiltration in more than 2 lobes and 5 patients in more than 4 lobes. The significant correlation between the diabetes mellitus and the infiltrated Rt lower lobe(RLL) was found on the borders of confidence limit.(P=0.07<0.1). There was significant correlation between woman and infiltrated lobe(RML, RLL, LLL) excluding the both upper lobe(P=0.029). Conclusion : We must consider tuberculous pneumonia when lobar pneumonia with consolidation resistant to antibiotics, especially in the patients who have diabetes mellitus, chronic obstructive pulmonary disease, malignancy, bronchiectsis, chronic renal failure or long term history of corticosteroid treatment.