A Case of Emphysematous Pyelonephritis in Which Intrarenal Gas Persistently Appeared over 1 month: Experience of Successful Management by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and life-threatening necrotizing infection of the renal parenchyma that requires prompt diagnosis and early treatment. It is associated with gas-forming coliform bacteria, and is characterized by the presence of gas within the renal parenchyma. The clinical picture and gas pattern should be monitored carefully before a surgical desion is made. If there is persistence of gas on serial x-rays despite aggressive therapy, prompt surgical therapy is recommended. We herein present 1 diabetic patient with emphysematous pyelonephritis who responded to medical treatment alone. The presence of gas was confirmed by CT scan and Escherchia coli was isolated in both urine and blood cultures. The patient was treated with antibiotics alone. Although the clinical signs and laboratory findings were improved, intrarenal gas persistently appeared over 1 month. CT scan 2 month after medical treatment revealed absence of gas in the renal parenchyma.

A Case of Prolonged Oliguric Phase over One Month in a Patient with Hemorrhagic Fever with Renal Syndrome / 대한신장학회잡지

Hemorrhagic fever with renal syndrome(HFRS) is characterized clinically by five distinct phases; febrile, hypotensive, oliguric, diuretic and convalescent phases. The oliguric phase usually lasts for three to six days. We here report a case of prolonged oliguric phase over one month in a patient with HFRS. A 36-year-old man developed oliguric acute renal failure due to HFRS. He commenced hemodialysis on the 2nd days of hospitalization. The oliguric phase was prolonged over one month. The endocrinologic study showed nomal range of plasma ACTH, cortisol, thyroid hormone and slight elevation of plasma atrial natriuretic peptide at oliguric phase. Kidney biopsy showed mononuclear cell infiltrate and associated edema in the interstitium. Diuresis appeared at the 43th days of hospitalization, but it was inadequate. To enhance diuresis and recovery of renal function, he was treated with steroid. Five days after steroid treatment, massive diuresis appeared and serum creatinine decreased to 1.2mg/dL at the 5 months after onset of the disease.

A Case of Metastatic Malignant Melanoma of the Liver Resulting from Choroidal Melanoma / 대한소화기내시경학회지

If there are multiple masses in the liver and a history of melanoma removed from the skin or other sites, a possible diagnosis could be that the multiple masses in the liver are in that metastatic lesions originating from the primary site of the previously removed melanoma. Although ocular melanoma is not as common as the cutaneous melanoma, it is the most common malignant ocular neoplasm. The metastatic patterns of the two mela-nomas are different. The ocular melanoma spreads to the liver exclusively at an early stage. If laboratory results, CT, arteriography, and MRI suggest a metastatic malignant melanoma of the liver, the diagnosis can be confirmed by laparoscopy and aspiration needle biopsy. The treatment of the ocular melanoma with metastasis to liver has been local resection, hepatic artery embolization, or systemic chemotherapy. Those treatment modalities, how-ever, have failed to improve the survival rates, and the metastatic malignant melanoma remains to be an incurable disease. A case is reported of a metastatic malignant melanoma of the liver in a 57-year-old male patient, that was discovered 4 years after an enucleation of a choroidal melanoma of the right eye.

An unusual case of acute multifocal bacterial nephritis / 대한내과학회지

Acute multifocal bacterial nephritis is a severe form of acute renal infection in which heavy leucocytic infiltrates occurs throughout kidney. Therefore, in contrast to uncomplicated acute pyelonephritis, it frequently causes acute renal failure. We here report an unusual case of acute multifocal bacterial nephritis which caused acute real failure and massive proteinuria. A 44-year old man was referred to our hospital because of high fever and both flank pain and non-oliguric acute renal failure. He had pyuria and massive proteinuria(5.87g/day), and serum creatinine level of 3.6mg/dL. We initially suspected hemorrhagic fever with renal syndrome. But immunofluorescent antibody for Hantavirus was negative and E. coli was isolated at urine. Computed tomography showed multifocal areas of wedge-shaped low densities in both kidneys. Kidney biopsy revealed tubulointerstitial infiltration of leucocyte without glomerular change. After treatment of antibiotics, proteinuria completely disappeared and serum creatinine level decreased to 1.0mg/dL.