A case of acute pyelonephritis complicated with renal vein thrombosis / 대한내과학회지

A 57-year-old woman who had a history of diabetes was admitted due to fever and left flank pain. Acute pyelonephritis was diagnosed by clinical findings including left costovertebral area tenderness, positive urine and blood cultures. Subsequent abdominal computed tomography demonstrated multiple abscess pockets in the left renal parenchyme and ipsilateral renal vein thrombosis. She was fully recovered after treatment with antibiotics, low-molecular weight heparin and low-dose aspirin for six weeks. Our case emphasizes that renal vein thrombosis could be complicated in acute pyelonephritis, especially in patients with diabetes. It is reasonable to speculate that factors such as hemoconcentration caused by fever and osmotic diuresis and compression of renal vascular pedicle by renal abscess might have had a role in inciting the renal vein thrombosis.

Acute Pyelonephritis: Clinical Study and Consideration about Inpatient Therapy / 대한내과학회지

BACKGROUND: In the present-day life, it is the conspicuous trend toward nuclear families and women have engaged in occupation. Therefore the patients have a load with taking care of children and living socially from inpatient therapy of acute pyelonephritis (APN). As a result of these, author intended to set up criteria of inpatient therapy, and reported the clinical study and status of resistance to antibiotics in APN. METHOD: I analyzed 316 patients with APN retrospectively. I analyzed their clinical features, resistance to antibiotics, result of treatment, and the cost of inpatient and outpatient therapy. And to set up the criteria about inpatient therapy, multiple factors which may influence prognosis were evaluated by univariate analysis and linear regression analysis. RESULT: Of the 316 cases, 19 were male and 297 were female. The average count of clinical state was 5.2+/-1.7. The patients with underlying causes were 113 (32.6%). The 16 of 21 cases with hydronephrosis or hydroureter on sonography carried out intravenous pyelography, 13 (81.2%) cases had abnormal finding. The most common pathogen is E.coli. The resistance to ampicillin, Trimethoprim/sulfamethoxazole, and cephalothin increased progressively. The usually used antibiotics were 2nd-generation cephalosporin, aminoglycoside, and oral cephalosporin or quinolone. Considering the univariate analysis, 1) on the group with underlying causes, they were older age, had longer duration of admission and treatment. On the group with UTI history, they had more underlying causes and had higher clinical state. On the group with abnormal finding on sonography, they were older age and higher clinical state, had more WBC count and longer duration of admission and therapy. 2) On the group without underlying causes, the group above 38 years-old had longer duration of admission, but there was no difference in other variances. On both groups of 38.5degrees C in body temperature and on both groups of the mild or moderate and severe clinical state, there was no difference in all variances. The group above 12,000/ml on WBC count had higher body temperature only. The group with renal swelling on sonography had higher WBC counts, higher clinical status, and longer duration of admission and treatment, but had no difference in age and body temperature. 3) In linear regression analysis on the group with normal renal size on sonography and without underlying causes, the age vs the duration of admission and WBC count, the body temperature vs the duration of admission, the clinical state vs the duration of admission had positive correlation, but low r-value, and there was no correlation in other relations. CONCLUSION: The resistance to antibiotics had increasing trend in Korea. The criteria for inpatient therapy of acute pyelonephritis on visit are following; severe clinical state and 1) underlying causes in history taking, or 2) recurrent urinary tract infection on past history, or 3) abnormal finding or enlarged kidney finding on sonography. We think that they should be admitted and had parenteral antibiotics to be relieved the severe generalized symptoms and confirmed the underlying cause, and in other cases, they can be treated by oral antibiotics in outpatient Department.

A Case of Hypertension Secondary to Paraganglioma of the Posterior Mediastinum

Functional paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system that causes symptoms and signs of episodic catecholamine release. It has not been reported in Korea. We experienced a case of a 17 years old man with a history of diaphoresis and paroxysmal hypertension refractory to therapy since 14 years old. Urinary execretion of catecholamine and its metabolites were elevated. Computed tomography(CT) scan revealed high density mass located on the posterior mediastinum in the area of the right fifth intercostal space. At thoracotomy, a 3X3X4cm sized lesion was resected and confirmed as a paraganglioma.

A Study on Left Ventricular Mass in Patients with Hypertension

Hypertension is a well known causative factor of congestive heart failure and other cardiovascular disease, and usually induce myocardial hypertrophy. Recent study shows that some antihypertensive drugs may reduce the hypertrophied cardiac mass reversibly. And over the past some decades, increasing attention was focused on these drugs. These drugs include methyldopa, angiotensin converting enzyme inhibitor, calcium channel inhibitor, beta-adrenergic blocker, but diuretics and vasodilators were known not to reduce the hypertrophied ventricular mass. In this study, 46 hypertensive patients were managed by captopril, atenolol, or hydrochlorothiazide monotherapy. And wer estimated and follow up LV mass by echocardiography during 3 months. Captopril and atenolol group showed LV mass reduced, but hydrochlorothiazide group did not. LV mass was reduced more in captopril group than in atenolo group. In conclusion, we have been impressed by this study that diuretics monotherapy for hypertension shoud be reconsidered. And we concluded that drugs which can reduce myocardial mass shoud be chosen to control hypertension as a monotherapeutic drug or a additive drug.