A Case of Severe Rhabdomyolysis with Acute Renal Failure after Doxylamine Overdose / 대한신장학회잡지

Doxylamine succinate is an over-the-counter drug widely used for treating insomnia. We experienced a case of severe rhabdomyolysis complicating acute renal failure after doxylamine overdose in a 24-year- old male. The maximum values of creatine kinase and creatinine level during hospitalization were 264,141 IU/L and 8.4 mg/dL, respectively. Oliguria and severe dyspnea occurred on the sixth hospital day and were treated with hemodialysis. Then, he recovered without any sequelae. To the best of our knowledge, the maximum creatine kinase level of 264,141 IU/L in the present case is the highest value among the case reports on doxylamine-induced rhabdomyolysis and this is the first case report in Korea of doxylamine-induced severe rhabdomyolysis accompanying oliguric acute renal failure and requiring treatment with hemodialysis.

EDTA-dependent Pseudothrombocytopenia Confirmed by Supplementation of Kanamycin: A Case Report

EDTA-dependent pseudothrombocytopenia (PTCP) is the phenomenon of a spurious low platelet count due to EDTA-induced aggregation of platelets. Since the failure to recognize EDTA-dependent PTCP may result in incorrect diagnosis and inappropriate treatment, the recognition of this phenomenon is very important. We report an insidious case of EDTA-dependent PTCP confirmed by supplementation of kanamycin to anticoagulant in a 53-year-old women. Although sodium citrate and heparin usually prevented the aggregation of platelets in EDTA-dependent PTCP patients, these anticoagulants failed in preventing PTCP in our case. EDTA-dependent PTCP was confirmed by the findings that the clumping of platelets on microscopic evaluation was found in EDTA-anticoagulated blood samples, whereas thrombocytopenia and platelet aggregation were not revealed in the sample supplemented with kanamycin.

Effect of Dialysis and Residual Renal Function on Olfactory Function in Patients with Chronic Renal Failure / 대한신장학회잡지

PURPOSE: The object of the present study were to clarify the effect of dialysis treatment and residual renal function on olfactory function of patients with chronic renal failure and to assess the correlations between the Cross Cultural Smell Identification Test (CC-SIT) scores and various clinical variables. METHODS: Ninety subjects were studied and divided four groups; age- and sex-matched healthy controls (Control, n=20), patients with varying degree of renal insufficiency but not on dialysis (Pre- dialysis, n=20), patients on CAPD (PD, n=22), and patients on hemodialysis (HD, n=28). We performed olfactory function test using the CC-SIT kit and compared the CC-SIT scores of each of the groups. RESULTS: The CC-SIT scores of each of the groups were; Control : 8.6+/-1.5, Pre-dialysis : 7.2+/-2.0, PD : 8.1+/-1.2, HD : 8.5+/-1.4. In Pre-dialysis group, the CC-SIT scores were significantly lower than Control group (p=0.01). But, no significant difference was observed in the CC-SIT scores between HD and PD group and control group (p>0.05). Creatinine clearance was positively correlated with the CC-SIT scores in control and Pre-dialysis group (r=0.58, p= 0.0001). Total Kt/V was positively correlated with the CC-SIT scores only in HD group (r=0.39, p= 0.03). But, no correlation was found between Kt/ Vurea, URR or residual renal function and the CC- SIT scores in HD and PD group (p>0.05). Age was negatively correlated with the CC-SIT scores only in Control group (r=-0.76, p=0.0001). CONCLUSION: Our results indicate that smell disturbance in patients with chronic renal faliure can be recovered by adequate dialysis treatment.

The Role of Lymphocyte Compartment and Cytokine in Coal Workers Pneumoconiosis / 결핵

BACKGROUND: Coal-worker's pneumoconiosis(CWP) is characterized by a chronic inflammatory lung reaction associated with macrophage accumulation in the alveolar spaces. CWP is usually divided into two stages : simpl e pneumoconiosis(SP) where there are a limited number of fibrotic lesions remain limited, with radiological opacities smaller than 1cm and progressine massive fibrosis(PMF), which is characterized by the development of a perifocal extensive fibrotix response of the lung and severws alterations in pulmonary function. In this study, the lymphocyte compartment and cytokine were evaluated by measuring the serum levels in the control, SP and PMF groups. METHODS: The coal workers selected for this study were employees(patients?) of the Tae-Baek and Dong-Hae hospital. All were men, 45-76 years old and the mean duration of their exposure to coal dust was 23.2 years in the lymphocyte compartment and 24.3 years in the cytokine checked group. According to the X-ray examination results, the patients were classified into either one of the SP, PMF categories. The normal controls examnied were 26-70 years old men. The serum cytokine levels were estimated by using an end point enzyme immunoassay technique. RESULTS: T lymphocyte, helper and suppressor T cells were highly related to pneumoconiosis in this study. A statistically significant decrease in the number of suppressor T lymphocytes was observed in this simple pneumoconiosis patients and at the same time, there was an increase in the lymphocyte index. However, there was no statistically defference in the serum cytokines levels among the SP, PMF and control groups. CONCLUSION: T lymphocyte, helper T, and suppressor T cells may be highly related to the development of CWP compared to the control group particularly in the early stage of pneumoconiosis. The changes obseved in the immunological system in patients with pneumoconiosis may lie at the bottom of the pathogenesis of fibrosis. Further study is needed to evaluated the lymphocyte compartment as a marker of pneumoconiosis developement in the early stage.

Symptomatic Eosinophilic Peritonitis in CAPD Treated with Low Dose of Oral Prednisolone / 대한신장학회잡지

Eosinophilic peritonitis is not uncommonly observed in patients on peritoneal dialysis. It typically occurs within the first 3 months after the initiation of peritoneal dialysis. Eosinophilic peritonitis is usually a benign and self-limiting process with the exception of fungal eosinophilic peritonitis. The use of oral or intraperitoneal steroids has been suggested only for patients with abdominal pain or with markedly turbid peritoneal effluent. We report a case of eosinophilic peritonitis with severe abdominal pain, which successfully resolved on treatment with single dose of oral prednisolone.

Effects of Carvedilol on Left Ventricular Function in Elderly Patients with Congestive Heart Failure

BACKGROUND AND OBJECTIVES: Neurohormonal compensation plays an important role on the pathophysiologic aspects of congestive heart failure (CHF). There is recent clinical evidence that beta blocker is beneficial in selected patients. However, there is little information regarding the effect of beta blocker on elderly patients. MATERIALS AND METHODS: 26 patients of CHF under stable condition by conventional management were selected and were divided into two age subgroup. Group 1 were more than 65 years (n=12) and group 2 were less than 65 years (n=14). From 12.5 to 25 mg/day of carvedilol was given according to the clinical condition. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular volume index (LVVI), ejection fraction (LVEF), E/A ratio and E wave deceleration time (EwDT) of mitral inflow doppler velocity were measured by echocardiographic examination before and 3 months after carvedilol trial. Six-minute walk distance were also measured. RESULTS: Between before and after carvedilol treatment, there were significant decrease of LVVI and sign-ificant increase of EF in group I and group II. The EwDT and 6 minute walk distance of both group were also increased significantly after carvedilol trial. The delta EF of group I is smaller than group II (4.1+/-5.7 vs 9.7+/-10.0, p<0.05). CONCLUSION: When compared to younger patients with CHF, the efficacy of carvedilol on LV function in aged patients was evident. Improved clinical conditions would be expected by using carvedilol in elderly patients with CHF.