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Biomedical subjects

H Suh

Publications and source records attributed to H Suh.

At least 91 records · Page 5Linked to original sources
PubMed1994

Comparison of quality of life in hemodialysis and peritoneal dialysis patients.

This study was designed to compare severity of illness and quality of life variables in chronic peritoneal dialysis (PD) and hemodialysis (HD) patients. The patient sample consisted of 63 PD patients (38 male, 25 female; mean age 54.5 years) and 35 HD patients (23 male, 12 female; mean age 54.9 years). Disease severity was greater in in-center HD patients than in PD patients (p < 0.008), although there were no significant differences in functional status as measured by the Karnofsky Index between HD patients (68.6 +/- 2.3) and PD patients (71.9 +/- 1.7). While both patient groups reported the same number of overall physical symptoms. HD patients reported significantly greater overall discomfort from symptoms than PD patients (p < 0.008). In terms of psychological adjustment, analyses revealed that 22 PD patients (36.7%) and 9 HD patients (25.7%) were classified as clinically depressed. PD patients reported higher anxiety scores than HD patients (p < 0.02) and lower positive mood scores (p < 0.021). HD patients were more severely ill and appeared to suffer from physical symptomatology to a greater degree than PD patients, although they were not more impaired in terms of functional status. Moreover, HD patients showed better psychological adjustment along several dimensions when compared to PD patients. One reason for this finding may be that PD patients experience greater distress, and isolation due to a lack of social support from similar others and medical staff in comparison to in-center HD patients.

Female↗
PubMed1994

Vascular disease outcome and thrombocytosis in diabetic and nondiabetic end-stage renal disease patients on peritoneal dialysis.

STUDY OBJECTIVE: to evaluate vascular disease and its outcome in association with thrombocytosis in chronic peritoneal dialysis (PD) patients. DESIGN: the study was designed to investigate possible correlations between severity of vascular disease and thrombocytosis in PD patients. SETTING: tertiary-referral university hospital. PATIENTS AND METHODS: serial blood platelet levels were measured in 53 stable PD patients (32 male, 21 female; mean age 55 years; mean duration of PD 19 months) between January 1991 and July 1992. Twenty-four patients were diabetic and 29 were nondiabetic. Mean duration of PD was 23 and 36 months in diabetic and nondiabetic patients, respectively. Severity of coronary arterial disease (CAD), carotid arterial disease (CNS), and peripheral arterial disease (PAD) was assessed using the Craven et al. (1991) ESRD Severity Index, a measure of organ dysfunction. Functional status was assessed using the Karnofsky Performance Status Index (KPSI). RESULTS: eighteen out of 53 PD patients (34%) had platelet counts exceeding 300,000/mm3 for six months or longer. Thirteen of 24 diabetic PD patients (54%) had thrombocytosis. Blood platelets were significantly (p < 0.01) higher in diabetic (324,000 +/- 27,000/mm3) than in nondiabetic PD (236,000 +/- 11,000/mm3) patients. In the PD group as a whole, a positive correlation was observed between blood platelet and serum cholesterol (r = 0.5, p < 0.001), blood platelet and PAD (r = 0.5, p < 0.001), and blood platelet and CAD (r = 0.35, p < 0.05). No correlation was found with age or duration of PD. In diabetic PD patients, blood platelet counts correlated significantly with PAD (r = +0.5, p < 0.01) and CAD (r = +0.4, p < 0.05) indexes. No correlation was observed between blood platelet and CNS or KPS indexes. In nondiabetics, no correlation was observed between blood platelet and CAD, PAD, CNS, or KPS indexes. CAD, PAD, and KPS indexes were significantly higher in diabetics compared to nondiabetics. CONCLUSIONS: thrombocytosis, particularly in diabetic PD patients, appears to be associated with the severity of PAD and CAD.

Cholesterol↗
PubMed1994

Abdominal wall hernias in ESRD patients receiving peritoneal dialysis.

The study was designed to investigate the incidence of abdominal wall hernias (AWH) and related outcome in all end-stage renal disease (ESRD) patients who started peritoneal dialysis (PD) from January 1989 to December 1993. Between January 1989 and December 1993, a total of 158 ESRD patients (93 male, 65 female) entered our home program and were treated with peritoneal dialysis (PD) over 2789 patient-months. All PD catheters were placed in the lateral by two dedicated surgeons. AWH detected at the time of PD catheter placement was repaired simultaneously. The hernia repair was done using a polypropylene mesh. Inguinal hernias were noted by patients as a mass or discomfort. Umbilical and incisional hernias were observed during clinic visits. Twenty-one (13.3%) abdominal wall hernias were observed in 20 patients (12.7%). Eight (38.1%) inguinal hernias occurred in 8 male patients. Six inguinal hernias were repaired. PD was resumed after a mean of 12 days of hernia repair. Two patients resumed PD in 8 and 14 days without dialysis. One patient transferred to hemodialysis (HD) due to catheter malfunction. No complications occurred related to inguinal hernias. Ten (47.6%) umbilical hernias were observed in 10 patients (7 male, 3 female). The strangulation of umbilical hernias occurred in 2 patients, which required emergency small bowel resection and hernia repair. Both cases were complicated by candida peritonitis and enterobacter peritonitis, requiring PD catheter removal, and patients were then transferred to HD. Three (14.3%) incisional hernias were observed in 3 male patients. Two incisional hernias were repaired. No relation between AWH and PD modalities (CAPD/CCPD/IPD) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Structure of the amplified 5-enolpyruvylshikimate-3-phosphate synthase gene in glyphosate-resistant carrot cells.

The structure of amplified 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) DNA of carrot suspension-cultured cell lines selected for glyphosate resistance was analyzed to determine the mechanism of gene amplification in this plant system. Southern hybridization of the amplified DNA digested with several restriction enzymes probed with a petunia EPSPS cDNA clone showed that there were differences in fragment sizes in the amplified DNA from one highly resistant cell line in comparison with the parental line. Cloning of the EPSPS gene and 5' flanking sequences was carried out and two different DNA structures were revealed. A 13 kb clone contained only one copy of the EPSPS gene while a 16 kb clone contained an inverted duplication of the gene. Southern blot analysis with a carrot DNA probe showed that only the uninverted repeated DNA structure was present in all of the cell lines during the selection process and the inverted repeat (IR) was present only in highly amplified DNA. The two structures were present in about equal amounts in the highly amplified line, TC 35G, where the EPSPS gene was amplified about 25-fold. The presence of the inverted repeat (IR) was further verified by resistance to S1 nuclease hydrolysis after denaturation and rapid renaturation, showing foldback DNA with the IR length being 9.5 kb. The junction was also sequenced. Mapping of the clones showed that the size of the amplified carrot EPSPS gene itself is about 3.5 kb. This is the first report of an IR in amplified DNA of a target enzyme gene in selected plant cells.

3-Phosphoshikimate 1-Carboxyvinyltransferase↗
PubMed1993

Peritoneal dialysis with trained home nurses in elderly and disabled end-stage renal disease patients.

This study was designed to investigate trained home nurses in the care of elderly and disabled end-stage renal disease (ESRD) patients receiving peritoneal dialysis (PD) in all the patients who entered our home program between January 1989 and December 1992. We trained nursing staff from nursing agencies to do PD. A weekly nursing summary including daily vitals, PD flow sheet, medications, and progress notes was sent to the home program. The trained nurses were also utilized temporarily during acute deterioration of patients or partners resulting in the inability to do PD. Eleven patients were female, 10 were male, with a mean age of 62 years (range 30-81 years). Ten patients (48%) had diabetes mellitus. Thirteen patients performed continuous ambulatory peritoneal dialysis (CAPD) and 8 patients continuous cycling peritoneal dialysis. Five patients required home nurses temporarily for a period of 1-8 weeks until the patients became independent. Two patients were transferred to incenter hemodialysis, one because of insurance and one because of fungal peritonitis. One patient recovered renal function after 22 months of PD. Thirty-three episodes of peritonitis occurred over 417 patient-months (one episode/13 patient-months). Three patients needed catheter removal secondary to Candida peritonitis. Hospitalization rate and duration of stay were lower (1 admission/6 patient-months) than patient-months without home nurses (1/4 patient-months). The main causes of these admissions were diabetic complications (38%), cardiac disease (20%), and peritonitis (14%). In conclusion, our experience suggests that elderly and disabled patients on PD with home nurses have a favorable outcome even with multiple, comorbid conditions.

Adult↗
PubMed1993

Peritoneal dialysis in elderly end-stage renal disease patients.

This study was designed to investigate the outcome of all elderly patients older than 65 who started peritoneal dialysis (PD) between January 1989 and December 1992. One hundred and twenty end-stage renal disease (ESRD) patients commenced PD at our institution between January 1989 and December 1992. All the patients who started, completed PD training, and remained on PD for more than one month were included in the study. Of these, 30 patients were elderly (more than 65 years old) with a mean age of 72 years (range 66-81 years). The total number of patient-months observed was 2035, of which the elderly represented 454 patient-months. Twenty-five percent (30 of 120 patients) were elderly. The causes of ESRD were diabetes mellitus in 6 patients (20%), glomerulonephritis in 6 (20%), atheroembolic disease in 4 (13.3%), hypertension in 2 (6.7%), and unknown etiology in 10 (33.3%) patients. Sixteen patients performed continuous ambulatory peritoneal dialysis (CAPD) and 14 patients continuous cycling peritoneal dialysis (CCPD). Five patients required private home nurses for multiple medical problems and for PD. Mean duration of peritoneal dialysis per patient was 15 months. Four patients were transferred to incenter hemodialysis, one each because of failure to thrive, insurance, catheter malfunction, and fungal peritonitis. One patient recovered renal function after 22 months of PD. Twenty-one episodes of peritonitis occurred over 454 patient-months (1 episode/22 patient-months). In conclusion, the elderly patients on PD have a favorable outcome even with multiple comorbid conditions.

Adolescent↗
PubMed1993

Thrombocytosis in diabetic and nondiabetic end-stage renal disease patients on peritoneal dialysis.

This study was designed to measure blood platelet levels in patients on peritoneal dialysis (PD) and to compare platelet levels between diabetic and nondiabetic PD patients. Serial blood platelet levels were measured in 53 stable PD patients (32 male, 21 female; mean age 55 years; mean duration of PD 19 months) and 45 stable hemodialysis (HD) patients (30 male, 15 female; mean age 53 years; mean duration of HD 9 months) between January 1991 and July 1992. Twenty-four patients were diabetics, and 29 patients were nondiabetics receiving PD. Ten patients were diabetics, and 35 were nondiabetics receiving HD. Serial blood platelet levels were measured with an automated Coulter counter. Eighteen of 53 PD patients (34%) had platelet counts exceeding 300,000/mm3 for 6 months or longer. Thirteen of 24 diabetic PD patients (54%) had thrombocytosis. Blood platelets were significantly (p < 0.01) higher in diabetic (324 +/- 27 x 10(3)/mm3) than nondiabetic PD (236 +/- 11 x 10(3)/mm3) patients. No significant difference was observed in platelet count between diabetic type I (366 +/- 43 x 10(3)/mm3) and type II (282 +/- 29 x 10(3)/mm3) PD patients. A positive correlation was observed between blood platelet and serum cholesterol (r = 0.5, p < 0.001), blood platelet, and serum calcium (r = 0.4, p < 0.002), and blood platelet and WBC (r = 0.7, p < 0.001). No correlation was found with age or duration of PD. In conclusion, diabetic PD patients have elevated blood platelet levels that may contribute to occlusive vessel disease.

Calcium↗
PubMed1993

Pulse intravenous calcitriol therapy of secondary hyperparathyroidism in peritoneal dialysis patients.

This study was undertaken to evaluate high-dose intravenous (IV) calcitriol therapy in chronic peritoneal dialysis (PD) patients. Nine stable chronic PD patients (7 male, 2 female, mean age 54 years) with secondary hyperparathyroidism and a mean duration of PD of 33 months, were studied for 6 months. Pulse calcitriol was administered IV in dosages of 4-8 micrograms every 2 weeks. Eight patients received oral calcitriol prior to IV pulse. Five patients were on continuous ambulatory peritoneal dialysis, and 4 patients were on continuous cycling peritoneal dialysis. Seven patients were on low-calcium dialysate (2.5 mEq/L) and 2 on high-calcium dialysate (3.5 mEq/L). All patients received calcium acetate or calcium carbonate to control hyperphosphatemia during the study. Mean serum parathyroid hormone N-terminal (PTHN) levels (35.4 +/- 9.5 pg/mL) decreased significantly from premean serum PTHN levels (79.7 +/- 10.4 pg/mL). No significant changes were observed in premean serum total calcium, ionized calcium, and phosphorus levels and posttherapy levels. No correlation was observed between serum PTHN and serum calcium, 1,25(OH)2D3, serum aluminum, and duration of dialysis. No significant difference in total body calcium and total body bone mineral density (BMD) was observed between pre and post study periods. In conclusion, biweekly IV calcitriol therapy is effective in suppressing secondary hyperparathyroidism in PD patients.

Adult↗
PubMed1992

Chromosomal position of rearranging gene segments influences allelic exclusion in transgenic mice.

Formation of a complete immunoglobulin heavy-chain transcription unit involves the ordered rearrangement of variable (V), diversity (D), and joining (J) region gene segments. In antibody-producing cells, this process is regulated such that only one of two antibody genes is expressed. Experiments with transgenic mice suggest that this mechanism, known as allelic exclusion, is mediated through the membrane-bound form of the immunoglobulin heavy chain. However, in all transgenic lines produced to date exclusion of the endogenous genes by the transgene is incomplete. To characterize the molecular basis for this escape from regulation, we have examined the rearrangements of endogenous immunoglobulin heavy-chain genes. We find that a transgene that encodes the membrane-bound form of human IgM efficiently inhibits rearrangements of endogenous gene segments located at the 5' end of the heavy-chain locus. However, recombining elements found at the 3' end of the locus escape and continue to undergo recombination. A transgene that encodes the secreted form of the same immunoglobulin protein has no effect on recombination, regardless of position of the recombining segment in the chromosome. These results have important implications for our understanding of the control of allelic exclusion.

Alleles↗
PubMed1992

Regulation of prodynorphin gene expression in the hippocampus by glucocorticoids.

The regulation of prodynorphin gene expression by glucocorticoids in the hippocampus was examined in rats that were adrenalectomized (ADX) either 7, 30, 60 and 90 days prior to sacrifice. Peptide levels in the hippocampus of ADX rats were determined by radioimmunoassay and immunocytochemistry. Prodynorphin (PDYN) mRNA was measured by Northern blot analysis and in situ hybridization. A time-dependent decrease in dynorphin A(1-8)(DYN) levels in the hippocampus (18% at 7 days; 44% at 30 days; 58% at 60 days) of ADX rats was found, which was accompanied by a comparable decrease in the abundance of PDYN mRNA. An in situ hybridization analysis revealed that both the number of positively hybridized cells and the number of silver grains per cell were decreased in the dentate gyrus after ADX. The administration of dexamethasone after surgery reversed the peptide and mRNA attenuation induced by ADX. ADX had no effect on the expression of proenkephalin mRNA or [Met5]-enkephalin immunoreactivity in the hippocampus. Examination of thionin-counterstained tissue showed that the dentate granule cell layer was intact. The decrement of DYN expression in this system is proposed to have resulted from the removal of glucocorticoid input and not dentate granule cell loss. This study provides the strong evidence for a differential susceptibility of these two opioid peptides in the hippocampus to the removal of glucocorticoids. In addition, these data provide support for a potentially selective, glucocorticoid-permissive component in PDYN gene expression.

Adrenal Glands↗
PubMed1992

Multiple use of cycler set in cycler peritoneal dialysis.

STUDY OBJECTIVE: To evaluate the multiple use of cycler set with universal connector set. DESIGN: The study was designed to reuse the cycler set for two to three treatments, each of 16-24 hours using Pac-X or Pac-Xtra cycler and to continue to use the same set if the patient was disconnected for any reason. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: 204 ESRD patients on peritoneal dialysis (PD) admitted to University Hospital from January 1989 to July 1991 were studied. The patients were disconnected and reconnected in between or during PD treatments. Five-liter dialysate bags were used. All the fluid was either set initially or added as clinically indicated. RESULTS: 2491 cycler PD treatments were performed with Pac-X and Pac-Xtra cyclers using 940 cycler tubing sets. 1624 disconnections were made in between and 336 were made for radiological investigations, special procedure, physical therapy and surgery during PD treatments. No episode of peritonitis or mechanical failure occurred. The multiple use resulted in 62% reduction in cycler sets thereby reducing the disposable supplies and a substantial saving in the nursing time. CONCLUSIONS: The multiple use of cycler set with universal connector and manifold set was safe and economical in the patients undergoing cycler PD in the hospital setting.

Humans↗
PubMed1992

Exit-site/tunnel infection and catheter outcome in peritoneal dialysis patients.

STUDY OBJECTIVE: To study exit-site/tunnel infections and catheter outcomes in peritoneal dialysis patients. DESIGN: The study was designed to investigate exit-site (ESI)/tunnel infections (TI) and catheter losses in all chronic PD catheters inserted in ESRD patients from 9/88 to 9/91. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Seventy-three patients (40 males, 33 females) underwent 78 double-cuff coiled swan-neck catheter implantations surgically. The curettage of exit site was performed weekly for tunnel infection refractory to medical management. The subcutaneous cuff was excised in persistent ESI/TI. RESULTS: Fifty-nine episodes of ESI/TI in 34 patients were observed over 946 patient-months. Thirty-nine patients experienced no ESI/TI, 27 patients had one and seven had two or more episodes of ESI/TI. Four patients had five episodes of peritonitis associated with ESI/TI. Eight recurrent episodes of ESI/TI with S. aureus in 8 patients were treated successfully with Rifampin. Seven subcutaneous cuffs were excised successfully in 7 patients with tunnel infection, five with S. aureus and two with Pseudomonas aeruginosa. No catheter was removed due to ESI/TI or ESI/TI associated peritonitis. CONCLUSIONS: Aggressive exit site care including repeated curettage, excision of the subcutaneous cuff and appropriate antibiotics reduced significantly catheter losses related to ESI/TI.

Bacterial Infections↗
PubMed1992

Low calcium (2.5 mEq/l) and high calcium (3.5 mEq/l) dialysate in peritoneal dialysis patients.

STUDY OBJECTIVE: To compare the effects of low-calcium and high-calcium dialysate in stable ESRD patients on peritoneal dialysis (PD). DESIGN: Dialysate containing 2.5 mEq/l and 3.5 mEq/l calcium in combination with oral calcium salts as phosphate binders were evaluated. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Fifteen patients (6 male, 9 female) on low-calcium (2.5 mEq/l) and 15 patients (6 male, 9 female) on high-calcium (3.5 mEq/l) dialysate were studied for 6 months. All patients received calcium acetate or calcium carbonate to control hyperphosphatemia before the study. RESULTS: Serum calcium, phosphorus and albumin did not differ before and after between the two groups. Three patients in low-calcium and five in high-calcium group developed hypercalcemia. Three in low-calcium group and four in high-calcium group required sucralfate to control hyperphosphatemia and hypercalcemia. Mean dose of elemental calcium was 1152 mg/day in low-calcium group and 790 mg/day in high-calcium group. A negative correlation (r = -0.82, p < 0.005) was observed between serum calcium and PTH at the end of study period in the low-calcium group. No such relationship was observed in the high-calcium group. CONCLUSIONS: Degree and frequency of hypercalcemia appeared similar with low-calcium and high-calcium dialysate in peritoneal dialysis patients.

Calcium↗
PubMed1992

Iron dextran treatment in peritoneal dialysis patients on erythropoietin.

STUDY OBJECTIVE: To evaluate maintenance parenteral iron dextran in chronic peritoneal dialysis (PD) patients receiving erythropoietin (rHuEPO). DESIGN: Parenteral iron dextran was investigated in PD patients with poor response to rHuEPO and/or side effects of oral iron. SETTING: Tertiary-referral university hospital PATIENTS AND METHODS: Seven ESRD patients (five males and two females) were studied. A test dose of 25 mg iron dextran was given before starting a maintenance dose. Iron dextran 100 mg was given intramuscular weekly or biweekly. Six patients received rHuEPO and one patient was on decadurabolin. RESULTS: Hematocrits increased significantly (p < 0.01) from 29 +/- 2% to 38 +/- 2% and serum ferritin increased from 267 +/- 104 to 660 +/- 104 ng/dl after iron dextran. Serum albumin increased from 3.1 +/- 0.3 to 3.6 +/- 0.2 g/dl (p < 0.05). No patient developed an anaphylactic reaction or delayed reaction. Mean duration of parenteral iron dextran treatment was 7 +/- 1 months. Mean dose of erythropoietin was reduced significantly (p < 0.05) from 119 +/- 20 units/kg/week to 87 +/- 20 units/kg/week before and during fifth month of iron dextran therapy. CONCLUSIONS: Weekly/biweekly maintenance intramuscular iron dextran injection was effective and safe iron supplemental therapy in PD patients with poor response or side effects to oral iron.

Adult↗
PubMed1990

Normal recombination substrate VH to DJH rearrangements in pre-B cell lines from scid mice.

To further analyze the VDJ recombination defect in lymphoid pre-B cells from mice with severe combined immune deficiency (scid mice), we have assayed the ability of Abelson murine leukemia virus (A-MuLV) transformed pre-B cells from scid mice to rearrange a recombination substrate in which inverted VH to DJH joins activate a selectable (gpt) gene. In unselected populations, substrate rearrangements occurred frequently, but were aberrant and probably analogous to the aberrant rearrangements observed at endogenous scid Ig gene loci. In contrast, populations of scid pre-B lines selected for gpt activity within the substrate contained mostly "normal" VH to DJH joins within the introduced substrate. These findings demonstrate that scid pre-B cells can make normal joins at low efficiency and are discussed with respect to the potential mechanism of the scid defect and the occurrence of Igs in leaky scid mice.

Abelson murine leukemia virus↗
PubMed1990

Separate elements control DJ and VDJ rearrangement in a transgenic recombination substrate.

We describe transgenic mice that carry an antigen receptor gene minilocus comprised of germline T cell receptor (TCR) beta variable gene elements (V, D and J) linked to an immunoglobulin (Ig) C mu constant region gene with or without a DNA segment containing the Ig heavy chain transcriptional enhancer (E mu). Transgenic constructs lacking the E mu-containing segment did not undergo detectable rearrangement in any tissue of six independent transgenic lines. In contrast, transgenic constructs containing this DNA segment underwent rearrangement at high frequency in lymphoid tissues, but not other tissues, of four independent lines. Analyses of purified B and T cells, as well as B and T cell lines, from transgenic animals demonstrated that the E mu-containing segment within the construct allowed partial TCR gene assembly (D to J) in both B and T cells. However, complete TCR gene rearrangement within the construct (V to DJ) occurred only in T cells. Therefore, we have demonstrated elements that can control two separate aspects of TCR beta VDJ rearrangement within this construct. One lies within the E mu-containing DNA segment and represents a dominant, cis-acting element that initiates lymphoid cell-specific D beta to J beta rearrangement; various considerations suggest this activity may be related to that of the E mu element. The second element provides T cell-specific control of complete (V beta to DJ beta) variable region gene assembly; it correlates in activity with expression of the unrearranged V beta segment.

Animals↗