A Case of Renal Infarct Developed in Acute Pancreatitis / 대한신장학회지

A renal infarct is too rare a disease for early diagnosis and treatment. Furthermore, it presents nonspecific symptoms in many patients. Cardiac diseases such as valvular heart disease and arterial fibrillation are the most common causes of renal infarct. Vascular disease such as renal artery dissection or aortic dissection, trauma, inflammation, vasculitis, malignancy and antiphospholipid syndrome have been also known as possible causes of renal infarct. In acute pancreatitis, adjacent vessels can be involved, and were reported to induce splenic infarction, portal vein thrombosis and superior mesenteric vein thrombosis etc. However, the renal infarct from renal artery involvement in acute pancreatitis has not yet been reported. In our case, a 46 year old male patient had an abdominal trauma due to an in-car accident to develop a rupture of pancreatic tail. The progression of acute pancreatitis caused the inflammation of left renal artery, leading to renal artery obstruction. We report a case of renal infarct developed in acute pancreatitis.

The Catheter Removal of Polymicrobial Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) / 대한신장학회잡지

Polymicrobial peritonitis is a relatively uncommon complication and it's clinical characteristics, risk factor and optimal managernent remain controversial. To identify indications for catheter removal in polymicrobial peritonitis, we reviewed the 340 episodes that occured in 168 patients of CAPD peritonitis during past 7 years to identify those. Polymicribial peritonitis was the 18 epoisodes in 18 patients of all peritonitis. First, 18 patients with polymicrobial peritonitis (P-P) did not show significant differences in the demographic features compared to 130 patients with single organism peritonitis (S-P). In contrast to Staphylococcus in S-P, the most common causative organisrn in P-P was pseudomonas (23%). Also sgnificantly more catheters were removed in P-P than S-P (P=0.001). Second, we cornpared group I, the patients responded to antibiotics only, and group II, those who needed catheter removal. The group I was 7 (39%) and the group II was 11 (61%). No patient of group I died and two patients of group II died. Between group I and group II, there were no significant differences in the demographic features. However, patients whose dialysate-WBC counts were below 100 at 3rd day after start of antibiotics were more significantly frequent in group I than group II. Among combination of causative organisms in P-P, most of Pseudornonas (6/9) and fungus (4/4) were treated by catheter removal. In conclusion, more catheters were removed in P-P than S-P. When dialysate WBC at 3rd day after start of antibiotics were over 100 and causative organism included pseudomonas or fungus in P-P, catheter removal was needed. We suggest that the kinds of organisms isolated and early response to antibiotics influence on the outcome of polymicrobial peritonitis.