ABSTRACT
Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although impaired tissue oxygenation is usually responsible for the rise in lactate production, lactic acidosis could be caused by drugs including metformin and the nucleoside reverse-transcriptase inhibitors. Linezolid, an oxazolidinone antibiotic, is currently indicated to treat serious infections caused by vancomycin-resistant enterococcus and other gram-positive organisms. A 74-year old woman was found to have pyogenic vertebral osteomyelitis and treated with linezolid. Thirty-one days after linezolid therapy, she developed severe lactic acidosis. We report a case of lactic acidosis associated with prolonged linezolid therapy.
Subject(s)
Female , Humans , Acetamides , Acidosis , Acidosis, Lactic , Enterococcus , Lactic Acid , Metformin , Osteomyelitis , Oxazolidinones , Oxygen , LinezolidABSTRACT
Cervical spinal epidural abscess, caused by fish bone injury and a secondary infection by Eikenella corrodens which is part of the normal flora, has not been reported. A 72-yr-old man came to the hospital with pain in his posterior neck and both shoulders for 2 months. He also was experiencing weakness on his right side for 3 days. A fish bone had been stuck in his throat for about 2 months. Neurological examination revealed right hemiparesis, hypesthesia on the left extremities and neck stiffness. Laboratory findings showed an elevated ESR/CRP and leukocytosis, and magnetic resonance imaging revealed a retropharyngeal abscess and cervical myelitis. The patient was treated with emergency surgical decompression and antibiotics. A fish bone was removed from the C3-C4 intervertebral disc space. In the culture of chocolate blood agar and 5% sheep blood agar plate, E. corrodens was detected as a causative organism.
Subject(s)
Male , Humans , Animals , Aged , Gram-Negative Bacterial Infections/diagnosis , Foreign Bodies/complications , Food/adverse effects , Fishes , Epidural Abscess/diagnosis , Eikenella corrodens/isolation & purification , Decompression, Surgical , Bone and Bones , Anti-Bacterial Agents/administration & dosageABSTRACT
BACKGROUND: Acoustic stimulation of the saccule can evoke the vestibulocolic reflex and the inhibitory potential can be measured in the ipsilateral sternocleidomastoideus as a vestibular evoked myogenic potential (VEMP). We investigated the saccular dysfunction in patients with Meniere's syndrome by using VEMP, and correlated the findings with those of other vestibular function tests. METHODS: Thirty-six patients, 29 with Meniere's disease and 7 with delayed endolymphatic hydrops, underwent interictal VEMP. Eight patients reported Tumarkins otolithic crisis. The patients also had a bithermal caloric test, testing of the subjective visual vertical (SVV), and brainstem auditory evoked potentials (BAEP) in addition to pure tone and speech audiometry. RESULTS: Abnormal VEMP was observed in 21 (58.3%) patients. All the patients with abnormal VEMP showed decreased amplitude or absence of VEMP in the lesion side. Three of them also exhibited delayed p13 or n23 latency. The VEMP was abnormal in four of the 13 patients with normal calorics, 13 of the 21 with normal SVV, and 11 of the 21 with normal BAEP. The abnormal VEMP was more common in patients with delayed endolymphatic hydrops (71.4%) and Tumarkins otolithic crisis (75.0%), but without statistical significance. CONCLUSIONS: VEMP detects saccular dysfunction in Meniere's syndrome. The abnormal VEMP in some patients with normal calorics, SVV or BAEP suggests differential involvement of the vestibular subsystem in Menieres syndrome especially in the early stage.
Subject(s)
Humans , Acoustic Stimulation , Audiometry, Speech , Caloric Tests , Endolymphatic Hydrops , Evoked Potentials, Auditory, Brain Stem , Meniere Disease , Otolithic Membrane , Reflex , Saccule and Utricle , Vestibular Function TestsABSTRACT
Myasthenia gravis is an acquired autoimmune disorder characterized clinically by the weakness of skeletal muscles and fatigability on exertion. Autoimmune diseases such as systemic lupus erythematosus, autoimmune thyroiditis, rheumatoid arthritis, Sj?gren syndrome and polymyositis may be associated with myasthenia gravis. However, there are only a few reports of transverse myelitis with myasthenia gravis. We report a case of myasthenia gravis with recurrent transverse myelitis.
Subject(s)
Arthritis, Rheumatoid , Autoimmune Diseases , Lupus Erythematosus, Systemic , Muscle, Skeletal , Myasthenia Gravis , Myelitis, Transverse , Polymyositis , Thyroiditis, AutoimmuneABSTRACT
A 54-year-old woman presented with sudden headache and diplopia. Brain MRI demonstrated a space-occupying lesion within the pituitary fossa. Histological analysis revealed pituitary lymphoma. Bone marrow biopsy and abdominopelvic CT showed no evidence of the lymphoma. Pituitary lymphoma should be included in the differential diagnosis of pituitary mass even in non-immunosuppressed patients.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Bone Marrow , Brain , Diagnosis, Differential , Diplopia , Headache , Lymphoma , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Carotid artery intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and an elevated total homocysteine level is an early biochemical marker of atherosclerosis. But there are few reports about serum homocysteine level and carotid IMT between ischemic stroke, hypertensive intracerebral hemorrhage (HICH) and control group. METHOD: We studied about 173 patients with ischemic stroke, HICH and control group. Carotid IMT was defined as the mean of IMT measured by B-mode ultrasonography. Serum homocysteine level was measured by fluorescence polarization immunoassay method in fasting state. We compared serum homocysteine level and carotid IMT between ischemic stroke, HICH and control group. In statistics, One-Way ANOVA was used. RESULTS: A significant increase in carotid IMT was noted in ischemic stroke and HICH compared with that in the control group (p<0.05), whereas there was no significant differences in carotid IMT between ischemic stroke and HICH. The serum homocysteine level of ischemic stroke was significantly higher than that of control group (p<0.05). But there were no significant differences between HICH and control group, HICH and ischemic stroke. CONCLUSIONS: In our study, we thought a carotid IMT of ischemic stroke, HICH and serum homocysteine level in ischemic stroke can be used as early diagnostic marker. Therefore, our results address the need of further prospective clinical studies in patients with ischemic stroke and HICH in order to evaluate a possible diagnostic ability of carotid IMT and serum homocysteine level.
Subject(s)
Humans , Atherosclerosis , Biomarkers , Carotid Arteries , Carotid Intima-Media Thickness , Cerebral Hemorrhage , Fasting , Fluorescence Polarization Immunoassay , Homocysteine , Intracranial Hemorrhage, Hypertensive , Stroke , UltrasonographyABSTRACT
Persistent trigeminal artery (PTA) can be associated with hypoplasia of the proximal basilar and ipsilatereal vertebral artery. This can predispose adults to posterior circulation ischemia by a low flow state. A 40 year-old male presented with diplopia, dizziness and motor weakness in all extremities. He had no conventional risk factors of ischemic stroke. In brain Magnetic Resonance Imaging (MRI), acute infarction was observed in medulla, pons and cerebellum. PTA was also discovered with hypoplasia of vertebrobasilar system in brain Magnetic Resonance Angiography (MRA).
Subject(s)
Adult , Humans , Male , Arteries , Brain , Cerebellum , Cerebral Infarction , Diplopia , Dizziness , Extremities , Infarction , Ischemia , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Pons , Risk Factors , Stroke , Vertebral ArteryABSTRACT
Bilateral posterior ischemic optic neuropathy (PION) has rarely been documented in chronic renal failure (CRF). A 78-year-old woman with CRF, who had undergone hemodialysis for 14 years, was admitted due to rapidly progressive visual loss. Her pupils were unreactive to light, but ocular motility and fundoscopic examinations were normal. A brain MRI with angiogram revealed no abnormality and a VEP showed no wave formation bilaterally. Intravenous corticosteroid therapy was conducted without improvement. We report a case of bilateral PION associated with CRF, presumably due to chronic hypotension and anemia occurring during hemodialysis.
Subject(s)
Aged , Female , Humans , Anemia , Brain , Hypotension , Kidney Failure, Chronic , Magnetic Resonance Imaging , Mesons , Optic Nerve Diseases , Optic Neuropathy, Ischemic , Pupil , Renal DialysisABSTRACT
Herpes zoster is manifested by varicella zoster virus(VZV) that involve nerve ganglions. It may be self limited, but some may have complications or sequelae, such as postherpetic neuralgia, optic neuritis, external ocular motor nerve palsy, facial nerve palsy, encephalitis or hemiplegia. It usually involves posterior root ganglia, but there are few case reports involving multiple dermatome with meningitis simultaneously. We report a patient with herpes zoster meningitis involving with multiple dermatome. A 64 year-old female presented with intractable headache, vomiting, and multifocal skin eruptions. Physical examination showed multiple vesicular eruptions on right forehead and upper limb along the dermatomes of V1, C4, C5, C6, C7. There was no localizing or lateralizing sign except for neck stiffness. Brain CT showed no abnormal finding. In the CSF study, the opening pressure was 200 mmH2O and cell count was 36/mm3 in RBC, 1,043/mm3 in WBC(95% lympho-dorminant). The level of protein and glucose were 671mg/dL, 127 mg/dL(serumglucose 270 mg/dL), respectively. It was positive in VZV-PCR, and was negative in tumor marker studies. Under the diagnosis of Herpes zoster meningitis, she was treated and improved with antiviral agent(acyclovir). We report a patient with herpes zoster meningitis involving polydermatomes simultaneously.
Subject(s)
Female , Humans , Middle Aged , Brain , Cell Count , Chickenpox , Diagnosis , Encephalitis , Facial Paralysis , Forehead , Ganglia , Ganglion Cysts , Glucose , Headache Disorders , Hemiplegia , Herpes Zoster , Meningitis , Neck , Neuralgia, Postherpetic , Optic Neuritis , Paralysis , Physical Examination , Skin , Upper Extremity , VomitingABSTRACT
PURPOSE: To compare, in terms of their feasibility and normal range, 99mTc-DTPA renal perfusion imaging and renal perfusion imaging using harmonic ultrasound (US) with a microbubble contrast agent for the evaluation of renal perfusion after renal transplantation. MATERIALS AND METHODS: During a six-month period, thirty patients who had received a renal transplant underwent both 99mTc-DTPA renal perfusion imaging and renal perfusion imaging using harmonic US with a microbubble contrast agent. Sonographic renal perfusion images were obtained before and after a bolus injection of the microbubble contrast agent LevovistTM (SH U 508A; Schering AG, Berlin, Germany) every 3 seconds for 3 minutes. Sonographic renal perfusion images were converted into a renal perfusion curve by a computer program and Tpeak of the curve thus obtained was compared with that of the 99mTc-DTPA curve. RESULTS: Average Tpeak of the 99mTc-DTPA renal perfusion curve was 16.2 seconds in the normal group and 39.6 seconds in the delayed perfusion group, while average Tpeak of the sonographic renal perfusion curve was 23.7 seconds and 46.2 seconds, respectively. Tpeak of the sonographic renal perfusion curve showed a good correlation with that of the 99mTc-DTPA curve (correlation coefficient=0.8209; p=0.0001). The cut-off value of Tpeak of the sonographic renal perfusion curve was 35 seconds (sensitivity=90%, specificity=95%). CONCLUSION: In patients who have received a renal transplant, the findings of renal perfusion imaging using harmonic US with a microbubble contrast agent show close correlation with those of 99mTc-DTPA renal perfusion imaging. The optimal cut-off value of Tpeak of the sonographic renal perfusion curve was 35 seconds.
Subject(s)
Humans , Berlin , Kidney Transplantation , Microbubbles , Perfusion Imaging , Perfusion , Reference Values , UltrasonographyABSTRACT
PURPOSE: The spreading, orientation, and chemotaxis with the gradient of a chemoattractant of smooth muscle cells (SMCs) were studied on the micro-grooved substrata by the light, fluorescence and scanning electron microscopy. METHOD: Vertical-walled grooves were produced in silicon wafers by the micromachining technique. All grooves were 4~20micrometer deep and 10~80 micrometer wide. SMCs were cultured on each microgroove and examined under stereo-microscope. RESULT: Cell clusters were markedly oriented by all the grooved substrata examined. Time-lapse images acquired from CCD (Charge Coupled Device) showed that the grooves directed the migration of SMCs. There was no prominent difference in the migration speed of SMCs according to the grooves. All the cytoskeletal fibers were reorganized in the same direction with grooves. Especially the alignments of microtubule and intermediate filaments were distinguished in the SMCs on the micro grooves. CONCLUSION: These results could be applied to the analysis of vascular restenosis and the development of artificial blood vessels.
Subject(s)
Blood Substitutes , Chemotaxis , Fluorescence , Intermediate Filaments , Microscopy, Electron, Scanning , Microtechnology , Microtubules , Muscle, Smooth , Myocytes, Smooth Muscle , SiliconABSTRACT
BACKGROUNDS: Malnutrition is common in patients with chronic renal failure(CRF) and various signs of malnutrition are strong predictors of increased morbidity and mortality. Monitoring of protein intake and nutritional status is therefore important in the clinical management of CRF patients. Few studies have demonstrated direct correlations among renal function, protein intake, and nutritional status in a prospective study although clinical experiences suggest such relationship. The aim of this study was to prospectively evaluate correlations between renal function, protein intake, and nutritional status during progressive renal failure. METHODS: A total of 431 studies on renal function, protein intake, and nutritional status was carried out in 282 patients with normal renal function and varying degrees of renal failure before beginning dialysis. Renal functional indices included weekly Kt/Vurea, total weekly creatinine clearance(Ccr, L/week/1.73m2), creatinine clearance(Ccr, mL/min/1.73m2), urea clearance(Curea, mL/min) and residual renal function(RRF, mL/min). Protein intake was assessed from the protein equivalent of total nitrogen appearance normalized by standard weight(nPNA, g/kg/day) by DOQI formula[nPNA(D)], Bergstr m formula 1[nPNA(B1)] and Bergstr m formula 2[nPNA(B2)]. Nutritional indices were fat free edema free body mass(FFEFBM, kg) by creatinine kinetics, %lean body mass(LBM, %) and serum albumin(g/dL). We evaluated correlations between renal function, protein intake and nutritional status by linear regression analysis. In a separate analysis, 237 studies from 94 patients with follow-up studies were analyzed for correlations among renal function, protein intake, and nutritional status. RESULTS: There was a highly significant correlation among weekly Kt/Vurea, weekly creatinine clearance, and residual renal function, among nPNA(D), nPNA (B1), nPNA(B2), and between FFEFBM and %LBM. Significant correlation was also observed between weekly Kt/Vurea and nPNA, between weekly Kt/ Vurea and FFEFBM, between weekly Kt/Vurea and %LBM, between nPNA and FFEFBM, and between nPNA and %LBM. The results were the same in patients with follow-up studies. CONCLUSION: These results clearly demonstrate that renal urea and creatinine clearance is closely correlated with protein intake and nutritional status in predialysis patients. With declining small solute clearances, protein intake decreased and nutritional status became worse. Starting dialysis before malnutrition becomes apparent may improve patient morbidity and mortality after dialysis.
Subject(s)
Humans , Creatinine , Dialysis , Edema , Follow-Up Studies , Kinetics , Linear Models , Malnutrition , Mortality , Nitrogen , Nutrition Assessment , Nutritional Status , Prospective Studies , Renal Insufficiency , UreaABSTRACT
Intensive insulin therapy effectively delays the onset and slows the progression of nephropathy in patients with IDDM. TGF- 0 has recently been implicated in the pathogenesis of diabetic nephropathy. We evaluated the effects of different level of glucose control with insulin therapy on the progression of diabetic nephropathy in age-matched control rats(C) and 3 groups of streptozotocininduced diabetic rats', high blood glucose diabetic rats without insulin therapy(HG), rnoderate glucose diabetic rats with insulin therapy(MG), and normal glucose diabetic rats with intensive insulin treatment (NG). Glomerular volume(VG) was measured using Image-Pro morphometric software, glomerular TGF- Bl mRNA expression by in situ hybridization, and glomerular expression of TGF-8 and type IV collagen proteins by immunohistochemical staining. VG was significantly higher in HG than in other groups in 12 weeks. Kidney weight(KW) was the highest while the body weight the lowest in HG of all groups in 12 weeks. Daily urine albumin excretion (UAE) increased with time in all groups but was significantly larger in HG than in all other groups in 12 weeks. MG also had significantly larger UAE than C in 12 weeks. There was no difference in VG, KW, and UAE between NG and C. Glomerular TGF-Bl mRNA expression was significantly higher in HG than in all the rest of the groups in 4 and 12 weeks. Glomerular expression of TGF-B and type IV collagen proteins was proportional to the levels of blood glucose, being the highest in HG in 12 weeks. There was little or no expression of TGF-0 1 mRNA and protein or type IV collagen protein in NG. Thus these results support the view that high blood glucose is the prerequisite for glomerular injury in diabetes mellitus and that the glomerular injury in diabetes mellitus is mediated, in part, by TGF-01 and suppressed by glucose control.