Favored serum albumin level and ICF volume after use of 1.1% aminoacid based peritoneal dialysis(PD) solution

Aminoacid based PD solution (AAD) has been shown to induce positive nitrogen balance and improve nutritional markers of malnourished patients. But its effcets on body fluid composition and various nutritional markers are contradictory. Nutritional markers may influenced by patient's ECF volume status. So we evaluate effects of AAD on nutritional markers and body composition by analysis using multi-frequency bioimpedance analyzer. 35 PD patients(>6months duration of CAPD) were prospectively randomized to 17 AAD(Nutrineal, one time use/day) and 18 GD group(keep their glucose based PD solution). After 3 months follow up, AAD group showed marginally increased body weight and fat mass, decreased ECF volume(12.45±0.54Lvs 12.10±0.57L, p=0.06), no changed ICF volume(22.2±0.9Lvs 22.3±0.9L, p>0.05) and marginally increased drainage volume(8.77±0.76Lvs 9.12±0.83L, p=0.09). AAD group also showed favored several markers include nPCR(1.59±0.07vs 1.98±0.08, p=0.00), BUN and albumin level (3.54±0.11 vs 3.74±0.11, p=0.02). Although serum albumin level was increased, correction with ECF volume(albumin level X ECF volume) makes it no difference (43.45±2.13vs 44.80±2.28, p=0.14). Furthermore △albumin vs △ECF showed negative correlation pattern(r=-0.46, p=0.07) that means serum albumin change was influenced by ECF volume change. In conclusion, AAD treatment improved markers of better nutritional status. However the change in serum albumin level was influenced by patient's ECF volume status, which can partially explain contradictory effect of aminoacid based PD solution on serum albumin level

Paradoxical response during antituberculous therapy in a patient discontinuing infliximab: a case report

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Angiographic analysis of the lateral intercostal artery perforator of the posterior intercostal artery: anatomic variation and clinical significance

PURPOSEKnowledge of the anatomic variations of the posterior intercostal artery (PICA) and its major branches is important during transthoracic procedures and surgery. We aimed to identify the anatomic features and variations of the lateral intercostal artery perforator (LICAP) of the PICA with selective PICA arteriography.METHODSWe retrospectively evaluated 353 PICAs in 75 patients with selective PICA arteriography for the following characteristics: incidence, length (as number of traversed intercostal spaces), distribution at the hemithorax (medial half vs. lateral half), and size as compared to the collateral intercostal artery of the PICA.RESULTSThe incidence of LICAPs was 35.9% (127/353). LICAPs were most commonly observed in the right 8th–11th intercostal spaces (33%, 42/127) and in the medial half of the hemithorax (85%, 108/127). Most LICAPs were as long as two (35.4%, 45/127) or three intercostal spaces (60.6%, 77/127). Compared to the collateral intercostal artery, 42.5% of LICAPs were larger (54/127), with most of these observed in the right 4th–7th intercostal spaces (48.8%, 22/54).CONCLUSIONWe propose the clinical significance of the LICAP as a potential risk factor for iatrogenic injury during posterior transthoracic intervention and thoracic surgery. For example, skin incisions must be as superficial as possible and directed vertically at the right 4th–7th intercostal spaces and the medial half of the thorax. Awareness of the anatomical variations of the LICAPs of the PICA will allow surgeons and interventional radiologists to avoid iatrogenic arterial injuries during posterior transthoracic procedures and surgery

Clinicopathological Risk Factors and Biochemical Predictors of Safe Discharge after Total Thyroidectomy and Central Compartment Node Dissection for Thyroid Cancer: A Prospective Study

To determine the clinicopathological risk factors and reliable biochemical predictors of the development of hypocalcemic symptoms after total thyroidectomy on the basis of serum calcium and intact parathyroid hormone (PTH) levels measured 1 hour after surgery, a prospective study was performed on 817 patients who underwent a total thyroidectomy with central compartment node dissection (CCND) due to well-differentiated thyroid cancer. We evaluated the correlations between hypocalcemic symptom development and clinicopathological factors. And the predictability for hypocalcemic symptom development of intact PTH cut-offs (<10 pg/mL and <20 pg/mL, resp.) according to serum calcium level subgroup was analyzed. Female gender (P<0.001) was the only independent risk factor for hypocalcemic symptom development in multivariate regression analysis. The negative predictive value (NPV) of intact PTH, signifying nondevelopment of hypocalcemic symptoms, was higher than the positive predictive value (PPV) which signified development of hypocalcemic symptoms. In addition, when we applied the different adoption of the intact PTH cut-off according to serum calcium level, we could obtain more increased NPVs. A female gender and the application of more specific cut-offs for intact PTH according to the serum calcium levels measured 1 hour after surgery may help the patients to be more safely discharged

Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

<p>Abstract</p> <p>Background</p> <p><it>Raoultella planticola </it>was originally considered to be a member of environmental <it>Klebsiella</it>. The clinical significance of <it>R. planticola </it>is still not well known.</p> <p>Case presentation</p> <p>We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by <it>R. planticola</it>. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement.</p> <p>Conclusions</p> <p><it>R. planticola </it>had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.</p

Association between periodontitis and hemorrhagic stroke among Koreans: A case-control study

Background: Several studies suggested that periodontitis is a risk factor for stroke, but the relationship between periodontitis and hemorrhagic stroke has not been widely reported. This study aims to evaluate the association between periodontitis and hemorrhagic stroke and to identify the risk group for this association. Methods: We recruited 165 patients who were diagnosed via computed tomography brain imaging as having had a hemorrhagic stroke and 214 non-stroke control subjects for a case-control study. All participants underwent a clinical periodontal examination using clinical attachment level (CAL) as amarker. Information about sociodemographic factors, behavioral factors, systemic health, and a familial history of systemic health was gathered through an interview using structured questionnaires. The association between periodontitis and hemorrhagic stroke was evaluated using multivariate logistic regression analyses with adjustment for age, gender, income, education, hypertension, diabetes, body mass index, cardiac disease, familial hypertension history, familial diabetes history, familial cardiac disease history, smoking, and alcohol consumption. Subgroup analyses were also performed to investigate potential risk groups. Results: After controlling for potential confounders, periodontitis (CAL ≥6 mm) was found to be significantly associated with hemorrhagic stroke (odds ratio: 2.5; 95% confidence interval: 1.1 to 5.6), but this association did not exhibit a dose-dependent response for periodontitis (percentile of sites of periodontal pockets with CAL ≥5 mm among total probed pockets). The association between periodontitis (CAL ≥6 mm) and hemorrhagic stroke was significant for males, patients who had a lower income than control subjects, obese patients, and patients without diabetes. Conclusions: Periodontitis may be an independent risk factor for hemorrhagic stroke. Risk groups include males, patients without diabetes, and obese subjects

Comparison of Egg Positive Rates of Enterobius vermicularis among Preschool Children in Three Korean Localities

This survey was performed to investigate and compare egg positive rates (EPRs) of Enterobius vermicularis among preschool children in 3 Korean localities (Chuncheon-si, Inje-gun, and Paju-si) in 2008. A total of 7,048 preschool children were examined. Overall, the total EPR was 4.0%; the EPR was the highest in Chuncheon-si (5.6%), followed by Inje-gun (4.5%) and Paju-si (3.4%). The EPR of boys (4.9%) was higher than that of girls (3.1%). The EPR significantly increased with age, with the highest observed in 5~7-year-olds. These findings demonstrate that E. vermicularis infection is widely prevalent among preschool children in Chuncheon-si, Inje-gun, and Paju-si, Republic of Korea