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1. Long-term Outcomes of Parathyroidectomy in Kidney Transplant Recipients with Persistent Hyperparathyroidism

Author

Chih Yu Yang, Po Yu Tseng, Wu Chang Yang, and Der Cherng Tarng

Subjects
Adult, Male, Parathyroidectomy, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, medicine.medical_treatment, Urology, Renal function, lcsh:RC870-923, Kidney transplantation, lcsh:Dermatology, medicine, Humans, Retrospective Studies, Hyperparathyroidism, business.industry, General Medicine, Middle Aged, lcsh:RL1-803, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Transplant Recipients, Pulse pressure, Surgery, Hospitalization, Transplantation, Treatment Outcome, Blood pressure, lcsh:RC666-701, Nephrology, Kidney Failure, Chronic, Calcium, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Glomerular Filtration Rate, Kidney disease
Abstract

Background/Aims: Hyperparathyroidism (HPT) is a common complication of chronic kidney disease and contributes to hypertension and cardiovascular risks. Successful kidney transplantation corrects abnormal mineral metabolism, but persistent HPT is still observed in up to 25% of patients one year after transplantation despite renal function improvement. The purpose of this study was to examine the long-term effects of parathyroidectomy (PTX) on blood pressure (BP) and graft function in patients with persistent post-transplant HPT. Methods: This is a retrospective study of renal allograft recipients at a single institute. Records from all the patients who received kidney transplantation at the Taipei Veterans General Hospital between 2004 and 2012 were reviewed and enrolled 19 patients who underwent PTX for persistent post-transplant HPT. Preoperative and postoperative clinical and biochemical data were compared. Matched controls (n = 19) in the corresponding time span were enrolled for graft function comparisons. Results: The mean systolic BP (127.7 ± 14.3 to 119.5 ± 12.7 mmHg, p = 0.028, 1 year after PTX; 127.7 ± 14.3 to 117 ± 12.4 mmHg, p = 0.007, 2 years after PTX) and pulse pressure (PP) (51.3 ± 10.7 to 44.3 ± 11.6, p = 0.019 1 year after PTX; 51.3 ± 10.7 to 44.9 ± 12.5 mmHg, p = 0.028, 2 years after PTX) reduced significantly at 1 year and 2 years of follow-up. However, no significant change of diastolic BP was observed. The improvement of SBP, DBP and PP was not correlated with the reduction of serum calcium level 1 year after PTX. The estimated glomerular filtration rate decreased significantly from 74.0 ± 20.5 mL/min/1.73m2 preoperatively to 68.2 ± 24.8 mL/min/1.73 m2 12 months after PTX but recovered at 15 months and lasted to 2 years after PTX. The all-cause hospitalization rate 1 year after PTX tended to be higher than that 1 year before PTX (105.3 versus 47.4 per 100 patient-years; RR, 2.22; 95 % CI: 0.97-5.54), but there was no significant difference between them. Conclusions: Our study demonstrated systolic BP and PP reduced 2 years after PTX and there was no significant difference between the peri-operative all-cause hospitalization rates. In addition, kidney allograft function impaired temporarily 12 months after PTX, but recovered 15 months after PTX.

Published
2015

2. Parathyroidectomy Reduces Intradialytic Hypotension in Hemodialysis Patients with Secondary Hyperparathyroidism

Author

Chih Yu Yang, Der Cherng Tarng, Chia Jen Shih, and Wu Chang Yang

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Mean arterial pressure, medicine.medical_treatment, Blood Pressure, lcsh:RC870-923, Intradialytic hypotension, End stage renal disease, End-stage renal disease, Renal Dialysis, Internal medicine, lcsh:Dermatology, medicine, Humans, Dialysis, Aged, Parathyroidectomy, Ejection fraction, business.industry, General Medicine, Middle Aged, lcsh:RL1-803, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Secondary hyperparathyroidism, Blood pressure, lcsh:RC666-701, Nephrology, Cardiology, Arterial stiffness, Kidney Failure, Chronic, Female, Hyperparathyroidism, Secondary, Hemodialysis, Hypotension, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Secondary hyperparathyroidism is associated with vascular calcification and arterial stiffness in patients with end-stage renal disease. The aim of this study was to analyze the frequency of intradialytic hypotension (IDH) and cardiovascular function before and after parathyroidectomy (PTX) in maintenance hemodialysis patients. Methods: We compared predialytic and intradialytic blood pressure, left and right ventricular ejection fraction (LVEF and RVEF), and cardiothoracic ratio 1 month before PTX, and 6 and 12 months after PTX. IDH was defined as a decrease in systolic blood pressure ≥ 20 mmHg or a decrease in mean arterial pressure ≥ 10 mmHg. Results: At the time of PTX, the mean age of the patients was 57.4 ± 12.0 years, and the mean dialysis vintage was 12.2 ± 5.8 years. At baseline, 6 months, and 12 months after PTX, the average numbers of sessions disturbed by IDH during 13 dialysis sessions (1 month) were 6.4, 3.9 (p < 0.016 vs. baseline), and 4.0 sessions (p < 0.037 vs. baseline, p = 0.801 vs. 6 months), respectively. LVEF and RVEF were improved significantly after PTX. Furthermore, volume status was also improved, as evidenced by the significantly greater ultrafiltration volume and reduced cardiothoracic ratio. Conclusions: Hemodialysis patients with severe secondary hyperparathyroidism are more likely to achieve normotensive and euvolemic status after PTX, probably through improved heart function and reduced IDH episodes.

Published
2013

3. Gene Polymorphisms of Interleukin-10 and Tumor Necrosis Factor-α Are Associated with Contrast-Induced Nephropathy

Author

Chih-Ching Lin, Shing-Jong Lin, Tse-Min Lu, Chao Fu Chang, Wu Chang Yang, and Ming Yi Chung

Subjects
Male, Pathology, medicine.medical_specialty, medicine.medical_treatment, Contrast-induced nephropathy, Contrast Media, Inflammation, urologic and male genital diseases, Polymorphism, Single Nucleotide, Nephropathy, Pathogenesis, Percutaneous Coronary Intervention, Text mining, Gene Frequency, Confidence Intervals, Odds Ratio, medicine, Humans, Prospective Studies, neoplasms, Aged, Aged, 80 and over, Analysis of Variance, Tumor Necrosis Factor-alpha, business.industry, Acute kidney injury, virus diseases, Percutaneous coronary intervention, Acute Kidney Injury, Middle Aged, medicine.disease, female genital diseases and pregnancy complications, Interleukin-10, Interleukin 10, surgical procedures, operative, Nephrology, Case-Control Studies, Creatinine, Female, medicine.symptom, business, Biomarkers
Abstract

Background/Aims: Contrast-induced nephropathy (CIN) is the third most common cause of hospital-acquired acute renal failure. However, the pathogenesis of CIN remains unclear. This study evaluated the role of anti-inflammatory cytokine interleukin-10 (IL-10) and pro-inflammatory cytokine tumor necrosis factor-α (TNF-α) gene polymorphisms as CIN susceptibility markers after percutaneous coronary intervention (PCI). Methods: Four IL-10 tag SNPs (rs1554286, rs3021094, rs3790622, rs1800896) and three TNF-α tag SNPs (rs1799964, rs1800630, rs1800629) were analyzed by MALDI-TOF mass spectrometry in 53 CIN patients and 455 control subjects. Serum IL-10 and TNF-α were detected using ELISA. Results: When compared to controls, the CIN patients showed increased frequencies of CC (rs1554286) and AG+GG (rs1800896) genotypes in IL-10 and GA+AA (rs1800629) genotype in TNF-α (OR = 2.24 (1.13–4.44), p = 0.018; OR = 2.61 (1.30–5.26), p = 0.005, and OR = 2.11 (1.08–4.09), p = 0.025, respectively). Baseline serum IL-10 levels in CIN patients were significantly lower (1.02 ± 1.14 vs. 2.78 ± 4.73 pg/ml, p = 0.008). Patients with CIN had a higher rate of decline in renal function than those without CIN (0.89 ± 1.67 vs. 0.30 ± 0.95 ml/min/1.73 m2 per month, p = 0.002). Significantly higher rates of decline in creatinine clearance were noted in patients with TNF-α (rs1800629) GA+AA than GG genotype (0.88 ± 1.83 vs. 0.36 ± 0.70, p = 0.03), and with IL-10 (rs1800896) AG+GG than AA genotype (1.28 ± 2.14 vs. 0.33 ± 0.90, p < 0.001). Conclusions: Gene polymorphisms of IL-10 and TNF-α are associated with CIN risk and long-term renal outcome after PCI. More prospective studies are needed to confirm our results.

Published
2013

4. Severe Proteinuria Secondary to Amyloidosis Requiring Bilateral Renal Artery Embolization

Author

Yee-Yung Ng, Wu Chang Yang, Wen-Sheng Liu, Chun-Tung Yeh, Szu-Yuan Li, and Hsiuo-Shan Tseng

Subjects
Microbiology (medical), medicine.medical_specialty, Proteinuria, Respiratory distress, business.industry, medicine.medical_treatment, Immunology, Renal function, Amyloidosis, urologic and male genital diseases, medicine.disease, Anasarca, Surgery, Published: June, 2012, Chronic kidney disease, Renal artery embolization, medicine, Immunology and Allergy, Anuria, Hypoalbuminemia, Hemodialysis, medicine.symptom, business, Dialysis
Abstract

In the case reported here, after prolonged medical therapy resistance, severe proteinuria subsided following bilateral renal artery embolization (RAE). Thereafter, respiratory distress, anasarca edema, muscle mass, and serum albumin level improved after regular hemodialysis. Although RAE is reported to be a safe and effective therapeutic procedure, it is rarely used for severe proteinuria with prolonged medical therapy resistance. The limited use of bilateral RAE for nephrological purposes may be partly related to its tendency to destroy renal function, which results in anuria and subsequent regular dialysis. However, delayed RAE could cause the patient to reach a life-threatening cachexic state and could increase the risk of morbidity and mortality due to severe proteinuria-induced hypoalbuminemia. Our case and selected previous reports reveal important information for physicians and patients while discussing prognoses and considering the pros and cons of bilateral RAE.

Published
2012

5. Pentoxifylline Inhibits Transforming Growth Factor-Beta Signaling and Renal Fibrosis in Experimental Crescentic Glomerulonephritis in Rats

Author

Tun-Jun Tsai, Yung-Ming Chen, Hui Y. Lan, Xiao-Ru Lan, Wu Chang Yang, and Yee-Yung Ng

Subjects
Male, endocrine system, Pathology, medicine.medical_specialty, Phosphodiesterase Inhibitors, Rat model, Smad2 Protein, Kidney, urologic and male genital diseases, Models, Biological, complex mixtures, Pentoxifylline, Glomerulonephritis, Transforming Growth Factor beta, Fibrosis, Renal fibrosis, medicine, Animals, Smad3 Protein, Rats, Wistar, biology, Crescentic glomerulonephritis, business.industry, Renal inflammation, Transforming growth factor beta, medicine.disease, Rats, Disease Models, Animal, Nephrology, Immunology, biology.protein, Signal transduction, business, Signal Transduction, medicine.drug
Abstract

Background/Aims: Pentoxifylline (PTX) has been shown to inhibit renal inflammation in a rat model of crescentic glomerulonephritis. The present study investigated the role of PTX in renal fibrosis in rats with crescentic glomerulonephritis. Methods: A rat model of accelerated anti-glomerular basement membrane glomerulonephritis was induced and treated with PTX or vehicle control for 3, 7, 14 and 28 days. The therapeutic effect and mechanism of PTX on renal fibrosis were examined by Northern blot and immunohistochemistry. Results: Diseased rats treated with vehicle control developed a severe crescentic glomerulonephritis with progressive renal fibrosis identified by a marked accumulation of α-SMA+ myofibroblasts and collagen matrix. This was associated with tubular epithelial-myofibroblast transition as evident by de novo expression of α-SMA and a loss of E-cadherin on damaged tubular epithelial cells. Further studies revealed that severe renal fibrosis was associated with upregulation of renal TGF-β1 and activation of TGF-β/Smad signaling, which was blocked by treatment with PTX. Conclusions: PTX may be an anti-fibrosis agent capable of inhibiting renal fibrosis in a rat model of crescentic glomerulonephritis. Blockade of TGF-β1 expression and Smad2/3 activation may be a mechanism by which PTX inhibits renal fibrosis.

Published
2008

6. Contents Vol. 92, 2002

Author

Sun Woo Lim, Choung Soo Kim, Bertalan Fodor, Yukihiko Kawasaki, Hirofumi Matuoka, Tadao Oohara, Shozo Hosokawa, Y. Asano, Su-Kil Park, Izzet Yavuz, Yasuhide Nakashima, K. Tamba, E. Kusano, Jung Ho Cha, A. Concheiro Guisan, Seval Izdes, Giuseppe Rizzuto, Kaori Kanegae, Yasuo Imanishi, Sumiko Homma, Chul Woo Yang, Sadayoshi Ito, A. Sturiale, Müjdat Yenicesu, Toshiaki Makino, Cheri V. Barrett, Toshihiko Miwa, Yasuro Kumeda, Chin-Huang Chen, Nora Klenk, Chun-Cheng Hou, Hitoshi Suzuki, J. Charles Jennette, Cüneyt Ensari, Shoji Nogae, Won Seok Yang, Ju Young Jung, Ken Farrington, Massimino Senatore, Hitoshi Goto, Tülin Gümüş, Mükerrem Safali, Yi-Hong Chou, Yoshiyuki Tomiyoshi, Ottó Árkossy, Ronald J. Falk, Jorge Isaac, Gilbert Deray, Ruriko Nozawa, Gloria A. Preston, N. Frisina, Abdülgaffar Vural, Junzo Suzuki, Shigeru Nakai, Masaaki Inaba, Toshikatsu Shimizu, J.A. Camacho Diaz, Magdolna Aleksza, Wei-Ming Hsu, Akihiko Osajima, Magali Ciroldi, Petra Marchand, Erzsébet Ladányi, Hirofumi Anai, Sacit Turanli, Hyung Wook Kim, T. Rengarajan, Patrizia Colombo, M. Suzuki, Y. Watanabe, Wu-Chang Yang, Yasuhiro Akai, Masahito Tamura, F. Corica, Eri Muso, Koichiro Homma, L. Garcia Garcia, Jürgen Floege, Xixin Wu, Motoaki Miyazono, A. Gimenez Llort, Laurence Fardet, Motoshi Hattori, F. Floccari, Aquiles Jara, Yoshihiko Saito, Eveline Sowa, Zeki Odabaşi, Yoko Fujino, Song Lin, Vincent Launay-Vacher, Júlia Széll, Lee-Moi Thien, Silvia Pierangeli, Koji Harada, Jaime Pereira, Akane Kurisu, Nai-Phon Wang, Tomoko Nakamura, R. Ravichandran, Susumu Makino, Mária Takács, Marcela Vasquez, Masahiro Okazaki, Yuri Ozawa, Yong Soo Kim, G. Di Pasquale, Chiew H. Kong, A. Ruello, Hassane Izzedine, Takeshi Suda, Luigia Costantini, Itsuro Kazama, Tsen-Tsai Chen, A. Favaloro, A. Romeo, M. Sommer, Ryuichiro Konda, Hiroshi Shiraga, Hideo Nakai, Soon Bae Kim, J. Gerth, Michele Buemi, G. Anastasi, Oliviero Filiberti, Sándor Sipka, Tatsuya Nakatani, Takahiko Nagahama, Keiji Fujiwara, Kyoko Kitauchi, Masayuki Iwano, Narutoshi Kabashima, Satoru Kawaguchi, Takanobu Sakemi, Yasushi Asano, Carla Peona, Akira Owada, Satish M. Rao, Sigeyuki Takeda, Naoko Matsumoto, Jung Sik Park, Tsung-Hsiu Wang, Michiko Suzuki, Hidehiro Kakizaki, Masao Kanauchi, Aranka Koós, Iván Palomo, Yasuhiro Komatsu, Mari Michimata, Pasqualina Cecere, Kayser Caglar, Y. Oyama, Sang Koo Lee, Giovanna Piccini, Lin Shan, Deniz Ayli, O. Iimura, M. Buemi, Mitsunobu Matsubara, Takao Saruta, J. Vila Cots, Yee-Yung Ng, Katsuya Nonomura, Toru Shinzato, Eiji Kusano, Masako Iwamoto, G. Stein, Shigehisa Aoki, Masuhisa Nakamura, Takeshi Kanda, G. Cutroneo, U. Eismann, Qiu Mingcai, Toshio Hashimoto, Ulf Janssen, Masamiki Miwa, Susan L. Hogan, Takayuki Ota, Kosei Segawa, A. Vila Santandreu, Mayumi Nagata, Yutaka Imai, Omac Tufekcioglu, Yoshiyuki Matsuo, Heinfried H. Radeke, David A. Alcorta, An S. De Vriese, Takahiko Ono, Paik-Seong Lim, Gisho Honda, Arnold J. Felsenfeld, Katsumi Ito, Chang-Linct Yang, M. Imai, Yutaro Hayashi, Koichi Hayashi, Bum Soon Choi, C. Aloisi, Enikő Sárváry, Cecilia Chacón, Wan Young Kim, Marcelo Alarcón, Tsutomu Araki, Byung Kee Bang, Jin Kim, Huaji Chen, Shigeo Suzuki, Gabriella Lakos, Attila Nagy, Yoshiki Nishizawa, C. Ito, Can Li, Fuad S. Shihab, Yuujiro Watanabe, A O Phillips, Toshihiko Hata, Kenji Maeda, Lesley C Dinwiddie, Eiji Ishimura, Shin Suda, Antonio Nicoletti, Chui-Mei Tiu, Norio Kurumatani, Seung Hun Lee, and Ning Liu

Subjects
Traditional medicine, business.industry, Medicine, business
Published
2002

7. Subject Index Vol. 92, 2002

Author

Satoru Kawaguchi, Takanobu Sakemi, Ken Farrington, Itsuro Kazama, Yukihiko Kawasaki, Hidehiro Kakizaki, Masao Kanauchi, Toshihiko Hata, Y. Oyama, Sang Koo Lee, Mitsunobu Matsubara, Hiroshi Shiraga, T. Rengarajan, Patrizia Colombo, Kenji Maeda, Takao Saruta, Masaaki Inaba, Eiji Kusano, Oliviero Filiberti, Erzsébet Ladányi, Shigehisa Aoki, Sumiko Homma, Sadayoshi Ito, Abdülgaffar Vural, Hitoshi Suzuki, Hyung Wook Kim, Yasuhiro Akai, F. Corica, Takahiko Ono, Koji Harada, Giovanna Piccini, Yoshiyuki Tomiyoshi, Gilbert Deray, Sun Woo Lim, Sándor Sipka, Sigeyuki Takeda, Masayuki Iwano, Takeshi Kanda, Aquiles Jara, Júlia Széll, Arnold J. Felsenfeld, Cecilia Chacón, Zeki Odabaşi, Yoko Fujino, Yasuro Kumeda, Nora Klenk, Chin-Huang Chen, Lesley C Dinwiddie, Qiu Mingcai, Satish M. Rao, Iván Palomo, Hitoshi Goto, Choung Soo Kim, Akane Kurisu, Pasqualina Cecere, Eiji Ishimura, Hirofumi Anai, Bertalan Fodor, Jorge Isaac, Yong Soo Kim, Paik-Seong Lim, Gisho Honda, Tatsuya Nakatani, Toru Shinzato, Antonio Nicoletti, M. Imai, Masuhisa Nakamura, Mükerrem Safali, Byung Kee Bang, Fuad S. Shihab, U. Eismann, Michiko Suzuki, Yuujiro Watanabe, Toshikatsu Shimizu, Luigia Costantini, Lin Shan, Deniz Ayli, M. Buemi, Shigeo Suzuki, J. Vila Cots, Gabriella Lakos, Vincent Launay-Vacher, Carla Peona, Akira Owada, Aranka Koós, Yoshihiko Saito, Yasuhide Nakashima, Jin Kim, Huaji Chen, Akihiko Osajima, Petra Marchand, Mari Michimata, Masako Iwamoto, Yee-Yung Ng, Toshio Hashimoto, J. Gerth, G. Anastasi, Chui-Mei Tiu, R. Ravichandran, G. Cutroneo, J.A. Camacho Diaz, Magdolna Aleksza, Song Lin, Susan L. Hogan, A O Phillips, Kayser Caglar, Eri Muso, Shin Suda, Koichiro Homma, Y. Watanabe, Wu-Chang Yang, Katsuya Nonomura, Attila Nagy, Cheri V. Barrett, Sacit Turanli, Susumu Makino, Norio Kurumatani, Yoshiki Nishizawa, Yutaka Imai, Seung Hun Lee, Ning Liu, Takahiko Nagahama, Ulf Janssen, F. Floccari, Lee-Moi Thien, Nai-Phon Wang, Jürgen Floege, Chiew H. Kong, G. Stein, A. Romeo, Xixin Wu, Ryuichiro Konda, Izzet Yavuz, Soon Bae Kim, Müjdat Yenicesu, Masahiro Okazaki, Y. Asano, Su-Kil Park, C. Aloisi, Takayuki Ota, Mayumi Nagata, Giuseppe Rizzuto, Wan Young Kim, Masamiki Miwa, Yuri Ozawa, Mária Takács, Chang-Linct Yang, A. Ruello, Kaori Kanegae, Yasuo Imanishi, Marcela Vasquez, Kyoko Kitauchi, A. Sturiale, Motoaki Miyazono, Toshiaki Makino, Gloria A. Preston, David A. Alcorta, Yasushi Asano, Hideo Nakai, Kosei Segawa, Yutaro Hayashi, A. Vila Santandreu, A. Gimenez Llort, Laurence Fardet, G. Di Pasquale, Yoshiyuki Matsuo, Takeshi Suda, Naoko Matsumoto, Masahito Tamura, Jung Sik Park, K. Tamba, Koichi Hayashi, E. Kusano, Omac Tufekcioglu, Chun-Cheng Hou, Toshihiko Miwa, J. Charles Jennette, Cüneyt Ensari, Yasuhiro Komatsu, Shoji Nogae, Won Seok Yang, Ju Young Jung, A. Favaloro, Jung Ho Cha, Enikő Sárváry, Ottó Árkossy, Ronald J. Falk, C. Ito, Junzo Suzuki, Marcelo Alarcón, Can Li, O. Iimura, Motoshi Hattori, Keiji Fujiwara, Chul Woo Yang, Silvia Pierangeli, Jaime Pereira, Tsutomu Araki, Shigeru Nakai, L. Garcia Garcia, Heinfried H. Radeke, An S. De Vriese, M. Sommer, Michele Buemi, Katsumi Ito, Massimino Senatore, Narutoshi Kabashima, Bum Soon Choi, Tülin Gümüş, Yi-Hong Chou, Ruriko Nozawa, N. Frisina, Wei-Ming Hsu, Magali Ciroldi, Hirofumi Matuoka, Tadao Oohara, Shozo Hosokawa, A. Concheiro Guisan, Seval Izdes, M. Suzuki, Eveline Sowa, Hassane Izzedine, Tsen-Tsai Chen, Tomoko Nakamura, and Tsung-Hsiu Wang

Subjects
Index (economics), business.industry, Statistics, Medicine, Subject (documents), business
Published
2002

8. Tuberculosis in Maintenance Dialysis Patients

Author

Hua Chang Fang, Hsiao Min Chung, Shang Jyh Hwang, Kang Ju Chou, Kuan Jen Bai, and Wu Chang Yang

Subjects
Male, medicine.medical_specialty, Tuberculosis, medicine.medical_treatment, Population, Taiwan, Renal Dialysis, Internal medicine, Epidemiology, medicine, Humans, education, Dialysis, Uremia, education.field_of_study, business.industry, Incidence (epidemiology), Mortality rate, Age Factors, medicine.disease, Surgery, Female, Hemodialysis, business, Kidney disease
Abstract

In this investigation, we tried to find the incidence and characteristics of tuberculosis (TB) in dialysis patients previously found only in a small number of cases. We collected the cases of newly diagnosed TB patients in Taiwan during 1997. Simultaneously, all dialysis patients were collected and matched with the TB cases to identify the dialysis patients who had also contracted TB. The annual incidence of the dialysis population was 493.4/100,000, 6.9 times that of the general population (71.1/100,000). The annual incidence for the male dialysis population was 573.3, the incidence was 479.2 for the female dialysis population. The incidence for the general population was 97.1 and 43.7/100,000, respectively. Although the 1-year mortality rate due to TB (1.7 vs. 1.9%, p > 0.05) was similar in both populations, the non-TB mortality was much higher in the dialysis population than that in the general population (25.6 vs. 11.1%, p < 0.05). Finally, the 1-year mortality rate of dialysis patients with TB is 3.3 times higher than that in dialysis patients without TB (27.3 vs. 8.3%, p < 0.05). The findings suggest that uremia modifies the behavior of TB, jeopardizes female and younger dialysis patients, poses a higher risk of extrapulmonary dissemination, and predicts a higher overall mortality.

Published
2001

9. An Occult Cause of Arteriovenous Access Failure: Central Vein Stenosis from Permanent Pacemaker Wire

Author

Chiao Lin Chuang, Tung Po Huang, Der Cherng Tarng, and Wu Chang Yang

Subjects
medicine.medical_specialty, business.industry, Fistula, medicine.medical_treatment, medicine.disease, Occult, Surgery, Stenosis, Catheter, medicine.anatomical_structure, Nephrology, Radiological weapon, medicine, Hemodialysis, business, Vein, Complication
Abstract

Central vein stenosis is an indolent and underestimated complication of permanent pacemaker placement. It leads to serious problems in hemodialysis patients when arteriovenous (AV) fistulae/grafts were created at the ipsilateral arm. We, herein, reported 3 cases of AV access failure resulting from permanent pacemaker-related central vein stenosis. The pathogenesis, clinical manifestations, radiological findings, and therapeutic solution on this issue are discussed. It is mandatory to place the AV fistula/graft and permanent pacemaker wire on the opposite side for prevention of the high risk of AV access failure.

Published
2001

10. Spiral Computed Tomographic Angiography – A New Technique for Evaluation of Vascular Access in Hemodialysis Patients

Author

Mei-Han Wu, Jia-Hwang Wang, Yee-Yung Ng, Wu Chang Yang, Yao-Ping Lin, Michael Mu Huo Teng, Tung Po Huang, Rheun-Cheun Lee, and Jy-Kang Liou

Subjects
Adult, Male, medicine.medical_specialty, Noninvasive imaging, medicine.medical_treatment, Vascular access, Kidney, Renal Artery Obstruction, Renal Veins, Arteriovenous Shunt, Surgical, Renal Dialysis, Image Processing, Computer-Assisted, medicine, Humans, cardiovascular diseases, Spiral, Aged, Aged, 80 and over, Surgical approach, medicine.diagnostic_test, business.industry, musculoskeletal, neural, and ocular physiology, Angiography, Angiography, Digital Subtraction, Digital subtraction angiography, Middle Aged, body regions, Computed tomographic angiography, Evaluation Studies as Topic, Nephrology, Kidney Failure, Chronic, Female, sense organs, Hemodialysis, Radiology, Tomography, X-Ray Computed, business, psychological phenomena and processes
Abstract

Spiral computed tomographic angiography (CTA), a new noninvasive imaging technique, was used to study 10 arteriovenous fistulas (AVF) in 9 hemodialysis patients. Digital subtraction angiography (DSA) was also performed as a gold standard for comparison. AVF stenosis was graded by a four-point scale: grade 0, well patency of supplying artery, anastomosis and drainage vein; grade 1

Published
1998

11. Lesser Sac Abscess Induced Relapsing Peritonitis in a CAPD Patient

Author

Chun-Cheng Hou, Chui-Mei Tiu, Yi-Hong Chou, Wu Chang Yang, Chin-Huang Chen, Chang-Linct Yang, and Yee-Yung Ng

Subjects
medicine.medical_specialty, Abdominal pain, business.industry, Continuous ambulatory peritoneal dialysis, Perforation (oil well), Abdominal Abscess, Peritonitis, Diverticulitis, medicine.disease, Lesser sac, Antibiotic coverage, Surgery, medicine.anatomical_structure, medicine, medicine.symptom, business
Abstract

Accessible online at: www.karger.com/journals/nef Dear Sir, Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). It is usually caused by poor technique, exit-site infection [1, 2], tunnel infection [3, 4], perforation of hollow viscera [5], diverticulitis [6, 7], colitis [8], or cholecystitis [9], etc. It is usually easily treated by effective and adequate antibiotics in most cases. However, it becomes complicated and protracted in some cases if the uncommon abdominal abscesses cannot be found and eradicated completely [10]. However, repeated episodes of peritonitis attributed to isolated lesser sac abscess have never been reported. Herein, we report a rare case of isolated lesser sac abscess formation following repeated episodes of peritonitis in a CAPD patient. The clinical condition improved dramatically after ultrasound-guided aspiration of the lesser sac abscess. A 38-year-old woman was under CAPD therapy for 57 months. She was admitted to hospital because of epigastric pain developed and progressed to diffuse abdominal pain in the morning. It was followed by turbid dialysate effluent. The white cell count (WBC) of the effluent was 480/cm3. The peritoneal effluent culture was positive for coagulase-negative staphylococcus (CNS). Three flushings of heparinized 1.5% Dianeal dialysate were given and followed by IP antibiotics (cefazolin loading 500 mg/l, maintenance 125 mg/l and tobramycin loading 8 mg/l, maintenance 4 mg/l) immediately. The cloudy effluent became clear and WBC decreased to 1/mm3 on the 4th day. The antibiotic therapy was administered for 2 weeks. Two months later, similar symptoms and peritonitis recurred. The WBC of the effluent was 2,900/mm3. The culture of the effluent also showed CNS, which was also sensitive to cefazolin and gentamicin. The three flushings and antibiotics as above were given for 2 weeks, even though the cloudy effluent became clear and WBC of the effluent declined to 37/mm3 on the second day. However, a 3rd episode of peritonitis relapsed 1 month later. Since then, the frequency of relapsing peritonitis has increased and the interval between peritonitis episodes has been shorter even under persistent antibiotic therapy (fig. 1). The symptoms of each episode presented similarly. The pathogen of each episode of peritonitis was CNS with the same bacterial sensitivity test. On physical examination, there was no erythema or discharge from the exit site, no evidence of acute tunnel infection, no rebound pain, and no Murphy’s sign. The WBC was 6,200/mm3 with 62% neutrophils. The hematocrit was 32%. Platelet count was 283,000/mm3. Serum biochemistry showed calcium 8.9 mg/dl (reference range: 8.4– 10.6), inorganic phosphate 4.0 mg/dl (2.1– 4.7), AST 20 U/l (5–45), ALT 3 U/l (0–40), amylase 221 U/l (!190), lipase 178 U/l (!190). Computed tomography (CT) of the whole abdomen before drainage of dialysate showed no evidence of diverticulitis, spaceoccupying lesions or enlarged lymph nodes. The upper gastrointestinal (UGI) and small intestine series did not show peptic ulcer or any abnormality. The subsequent Tc99mlabeled WBC scanning for detection of intraabdominal abscess showed a negative result. Abdominal sonography after dialysate drained out revealed fluid accumulation in the lesser sac. Because there were 4 other episodes of turbid effluents happening under the antibiotic coverage after the above examinations, a 2nd sonography of the whole abdomen after dialysate drained out was arranged which also revealed fluid accumulation, sized 3!2!1.5 cm in the lesser sac (fig. 2). At this time, ultrasound-guided aspiration of the lesser sac fluid was done with the finding of 15 cm3 of turbid aspirate. The aspirated fluid culture was positive for CNS. The bacterial sensitivity test was the same as before. Eight days later, follow-up CT of the whole abdomen after the dialysate drained out showed no evidence of focal fluid accu

Published
2002

12. Acknowledgement to the Reviewers

Author

Yasuro Kumeda, Nora Klenk, Itsuro Kazama, Shin Suda, Ryuichiro Konda, Soon Bae Kim, Satish M. Rao, Iván Palomo, Toru Shinzato, Ken Farrington, Masayuki Iwano, Yukihiko Kawasaki, A. Sturiale, Ronald J. Falk, Yoshiyuki Tomiyoshi, Gilbert Deray, U. Eismann, Masaaki Inaba, Silvia Pierangeli, Marcela Vasquez, L. Garcia Garcia, Yasuhide Nakashima, Hitoshi Suzuki, Aquiles Jara, Júlia Széll, G. Di Pasquale, Takeshi Suda, Jaime Pereira, Lin Shan, Deniz Ayli, M. Buemi, Yee-Yung Ng, Masahito Tamura, Akane Kurisu, Satoru Kawaguchi, Takanobu Sakemi, Hidehiro Kakizaki, Masao Kanauchi, Y. Oyama, J. Vila Cots, A. Favaloro, Ulf Janssen, Kosei Segawa, Yoshiyuki Matsuo, Mükerrem Safali, Susumu Makino, Massimino Senatore, Tülin Gümüş, Yi-Hong Chou, Yong Soo Kim, G. Stein, J.A. Camacho Diaz, Magdolna Aleksza, A. Romeo, Masako Iwamoto, Ruriko Nozawa, Akihiko Osajima, Y. Asano, Keiji Fujiwara, G. Cutroneo, T. Rengarajan, Patrizia Colombo, Su-Kil Park, Hiroshi Shiraga, Oliviero Filiberti, Eri Muso, Koichiro Homma, Jürgen Floege, Sigeyuki Takeda, Takahiko Ono, Arnold J. Felsenfeld, Takayuki Ota, A. Vila Santandreu, N. Frisina, Wei-Ming Hsu, Magali Ciroldi, Choung Soo Kim, Bertalan Fodor, Mari Michimata, Lee-Moi Thien, Nai-Phon Wang, Masahiro Okazaki, Yuri Ozawa, Petra Marchand, J. Charles Jennette, Motoshi Hattori, Xixin Wu, Chin-Huang Chen, Izzet Yavuz, Pasqualina Cecere, A. Ruello, Omac Tufekcioglu, Heinfried H. Radeke, Cheri V. Barrett, Kyoko Kitauchi, Jin Kim, Zeki Odabaşi, Yoko Fujino, Hitoshi Goto, Huaji Chen, Hideo Nakai, M. Imai, An S. De Vriese, Hirofumi Matuoka, Seung Hun Lee, Ning Liu, Attila Nagy, Yoshiki Nishizawa, Carla Peona, Akira Owada, Aranka Koós, Katsumi Ito, Tadao Oohara, Shozo Hosokawa, M. Suzuki, Bum Soon Choi, Aled O. Phillips, Yasuhiro Komatsu, Kayser Caglar, M. Sommer, Sun Woo Lim, Michele Buemi, Tsung-Hsiu Wang, Giovanna Piccini, Toshihiko Hata, Luigia Costantini, Tomoko Nakamura, Y. Watanabe, Wu-Chang Yang, Katsuya Nonomura, Masuhisa Nakamura, Narutoshi Kabashima, Kenji Maeda, J. Gerth, Toshihiko Miwa, Sang Koo Lee, Eveline Sowa, Masamiki Miwa, G. Anastasi, Mitsunobu Matsubara, Takao Saruta, A. Concheiro Guisan, Seval Izdes, Susan L. Hogan, Shigehisa Aoki, Antonio Nicoletti, Lesley C Dinwiddie, Fuad S. Shihab, Paik-Seong Lim, Eiji Kusano, Gisho Honda, Takahiko Nagahama, Yuujiro Watanabe, Yutaka Imai, Enikő Sárváry, Yasushi Asano, Eiji Ishimura, Yoshihiko Saito, Mayumi Nagata, Takeshi Kanda, Toshio Hashimoto, F. Floccari, Qiu Mingcai, Naoko Matsumoto, Michiko Suzuki, C. Aloisi, Wan Young Kim, Chui-Mei Tiu, Cecilia Chacón, David A. Alcorta, Jung Sik Park, Hassane Izzedine, Mária Takács, Tsen-Tsai Chen, Byung Kee Bang, Koichi Hayashi, Junzo Suzuki, Motoaki Miyazono, A. Gimenez Llort, Giuseppe Rizzuto, Kaori Kanegae, Yasuo Imanishi, Norio Kurumatani, Toshiaki Makino, Chang-Linct Yang, Yutaro Hayashi, Jung Ho Cha, Song Lin, Chul Woo Yang, Won Seok Yang, Marcelo Alarcón, Müjdat Yenicesu, Tsutomu Araki, Gloria A. Preston, O. Iimura, Jorge Isaac, Toshikatsu Shimizu, C. Ito, Can Li, Hirofumi Anai, Tatsuya Nakatani, Shigeo Suzuki, Gabriella Lakos, Cüneyt Ensari, Shoji Nogae, Ottó Árkossy, Vincent Launay-Vacher, R. Ravichandran, K. Tamba, E. Kusano, Shigeru Nakai, Sacit Turanli, Chun-Cheng Hou, Ju Young Jung, Chiew H. Kong, Erzsébet Ladányi, Hyung Wook Kim, Yasuhiro Akai, F. Corica, Koji Harada, Sumiko Homma, Laurence Fardet, Sadayoshi Ito, Abdülgaffar Vural, and Sándor Sipka

Subjects
Medical education, business.industry, Acknowledgement, Medicine, business
Published
1998

13. Editorial / Publisher’s Note

Author

Marcela Vasquez, G. Di Pasquale, Takeshi Suda, Mükerrem Safali, Akihiko Osajima, Petra Marchand, Itsuro Kazama, Sacit Turanli, Hirofumi Matuoka, Chang-Linct Yang, Luigia Costantini, F. Floccari, Tadao Oohara, Shozo Hosokawa, Chiew H. Kong, Yutaro Hayashi, Heinfried H. Radeke, An S. De Vriese, J. Gerth, G. Anastasi, Takahiko Ono, Shigehisa Aoki, Satoru Kawaguchi, Takanobu Sakemi, Sumiko Homma, Sadayoshi Ito, Toshihiko Hata, Katsumi Ito, Mária Takács, Kenji Maeda, Takahiko Nagahama, Kyoko Kitauchi, O. Iimura, Arnold J. Felsenfeld, Jorge Isaac, Masayuki Iwano, Yasuhide Nakashima, Bum Soon Choi, Hidehiro Kakizaki, Masao Kanauchi, Yoshihiko Saito, Masako Iwamoto, G. Cutroneo, Y. Oyama, Qiu Mingcai, Ken Farrington, Toshikatsu Shimizu, Cheri V. Barrett, Fuad S. Shihab, A. Concheiro Guisan, M. Imai, Abdülgaffar Vural, Antonio Nicoletti, Seval Izdes, Masahito Tamura, K. Tamba, Massimino Senatore, Masaaki Inaba, Erzsébet Ladányi, Lesley C Dinwiddie, Yong Soo Kim, Tülin Gümüş, E. Kusano, Toshio Hashimoto, Hyung Wook Kim, Eiji Ishimura, Shin Suda, Tatsuya Nakatani, Yi-Hong Chou, Susan L. Hogan, Jung Ho Cha, Ruriko Nozawa, Marcelo Alarcón, J.A. Camacho Diaz, Magdolna Aleksza, A. Favaloro, Yutaka Imai, Yasuhiro Akai, F. Corica, Yuujiro Watanabe, Chun-Cheng Hou, Shigeo Suzuki, Aquiles Jara, Gabriella Lakos, N. Frisina, Júlia Széll, Ju Young Jung, Wei-Ming Hsu, C. Aloisi, Keiji Fujiwara, Motoshi Hattori, Akane Kurisu, Tsutomu Araki, Yoshiyuki Tomiyoshi, Gilbert Deray, Wan Young Kim, Carla Peona, Akira Owada, Aranka Koós, Magali Ciroldi, Ronald J. Falk, Chul Woo Yang, Chui-Mei Tiu, Kayser Caglar, Koji Harada, Jaime Pereira, Song Lin, Tsung-Hsiu Wang, Katsuya Nonomura, Mari Michimata, Yasushi Asano, Masamiki Miwa, Giuseppe Rizzuto, Naoko Matsumoto, Norio Kurumatani, Seung Hun Lee, Ning Liu, Kaori Kanegae, Jin Kim, Yasuro Kumeda, Huaji Chen, Yasuo Imanishi, Jung Sik Park, Nora Klenk, M. Sommer, A O Phillips, Sang Koo Lee, J. Charles Jennette, Hideo Nakai, Hirofumi Anai, Michele Buemi, Cüneyt Ensari, Attila Nagy, Yoshiki Nishizawa, Toshiaki Makino, Shoji Nogae, Won Seok Yang, Mitsunobu Matsubara, Takao Saruta, Narutoshi Kabashima, Eiji Kusano, Yasuhiro Komatsu, Shigeru Nakai, Ottó Árkossy, Sun Woo Lim, Ryuichiro Konda, Chin-Huang Chen, Soon Bae Kim, Hitoshi Goto, Yukihiko Kawasaki, Takeshi Kanda, Cecilia Chacón, L. Garcia Garcia, J. Vila Cots, Kosei Segawa, T. Rengarajan, Patrizia Colombo, Vincent Launay-Vacher, Yoshiyuki Matsuo, R. Ravichandran, Hitoshi Suzuki, C. Ito, Tomoko Nakamura, Can Li, Y. Watanabe, Wu-Chang Yang, Hassane Izzedine, Tsen-Tsai Chen, Zeki Odabaşi, Yoko Fujino, Eri Muso, Koichiro Homma, M. Suzuki, Jürgen Floege, Paik-Seong Lim, Gisho Honda, Susumu Makino, Xixin Wu, Müjdat Yenicesu, Eveline Sowa, A. Sturiale, Giovanna Piccini, Y. Asano, Gloria A. Preston, A. Romeo, Su-Kil Park, Izzet Yavuz, Masuhisa Nakamura, Mayumi Nagata, Motoaki Miyazono, A. Gimenez Llort, Laurence Fardet, Choung Soo Kim, Bertalan Fodor, David A. Alcorta, Junzo Suzuki, Toshihiko Miwa, Lee-Moi Thien, Nai-Phon Wang, Masahiro Okazaki, Yuri Ozawa, Koichi Hayashi, Enikő Sárváry, A. Ruello, Byung Kee Bang, Sándor Sipka, Satish M. Rao, Iván Palomo, Silvia Pierangeli, Toru Shinzato, U. Eismann, Michiko Suzuki, Hiroshi Shiraga, Oliviero Filiberti, Sigeyuki Takeda, Ulf Janssen, Pasqualina Cecere, Takayuki Ota, Lin Shan, Deniz Ayli, M. Buemi, Yee-Yung Ng, A. Vila Santandreu, G. Stein, and Omac Tufekcioglu

Subjects
business.industry, Medicine, business, Classics
Published
2002

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