ABSTRACT
Transurethral resection syndrome (TURS) is one of the complications of endoscopic transurethral operation with irrigation fluid. TURS comprehensively refer to several clinical symptoms and signs caused by intravascular absorbtion of irrigation fluid, hypertension, bradycardia, arrhythmia, respiratory distress, hypotension, confusion, blindness, seizure, coma, hyponatremia, and hypoosmolarity. TURS is mainly known as the complication of the transurethral resection of prostate (TURP), and rarely found in the procedures such as transurethral resection of bladder tumor (TUR-BT), hysteroscopy, cystoscopy, and arthroscopy. Only a few cases of TURS after TUR-BT have been reported. The patients on maintenance hemodialysis were restricted in the amount of water intake for volume control. They were susceptible to the absorption of irrigation fluid during TUR-BT since they had anuria. We hereby report the 2 cases maintenance hemodialysis patients who were led to TURS after TUR-BT.
Subject(s)
Humans , Absorption , Anuria , Arrhythmias, Cardiac , Arthroscopy , Blindness , Bradycardia , Coma , Cystoscopy , Drinking , Hypertension , Hyponatremia , Hypotension , Hysteroscopy , Kidney Failure, Chronic , Renal Dialysis , Seizures , Transurethral Resection of Prostate , Urinary Bladder , Urinary Bladder NeoplasmsABSTRACT
The definition of C1q nephropathy has been categorized since 1985. However, the clinical correlation and pathophysiology has not yet been fully revealed. Therefore, the treatment of C1q nephropathy has not been established. Our subject was a 23 year-old female patient with both leg edema and oliguria, who was presented with weight gain. Renal biopsy confirmed C1q nephropathy. Prednisolone and cyclosporine therapy was selected for treatment. After 2 weeks of treatment, the patient lost 8 kg of body weight and all laboratory examination results were normalized. Both leg edema and oliguria were resolved. After 21 weeks of regular follow-up, she stopped the medicine by herself. Eight weeks later, the patient came to the Emergency room because both leg edema recurred. Same regimen was administered for 3 weeks, and complete remission was achieved again.
Subject(s)
Female , Humans , Biopsy , Body Weight , Cyclosporine , Edema , Emergencies , Follow-Up Studies , Leg , Oliguria , Porphyrins , Prednisolone , Weight GainABSTRACT
While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
Subject(s)
Humans , Male , Middle Aged , Abdominal Abscess , Biopsy , Brain , Brain Abscess , Drainage , Laparotomy , Neurologic Manifestations , Peritonitis , Peritonitis, Tuberculous , Pleurisy , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
BACKGROUND: Silent myocardial ischemia is often found in old diabetics. Many diagnostic tools are used for diagnosis of angina. But these tools are difficult to use in primary care. Therefore we have planned to investigate the change of electrocardiography in old diabetics, using resting electrocardiogram which is available for primary care. METHOD: 67 patients with ST-T change group and 262 patients with control group were included in this study. Patients with chest pain or heart problem were excluded. The resting electrocardigraphy is examined by standard 12 lead electrocardiogram. RESULTS: There are differences of diabetes, HDL-cholesterol between ST-T change group and control group. Diabetes and HDL- cholesterol are significant factors that change ST-T wave in the resting electrocardigraphy. CONCLUSION: ST-T change of old diabetics without chest pain is more frequent than non diabetics. That means myocardial ischemia and requires treatment at secondary or third medical center. In conclusion, regular electrocardigraphy monitoring at primary care should be required in old diabetics.
Subject(s)
Humans , Chest Pain , Cholesterol , Diabetes Mellitus , Diagnosis , Electrocardiography , Heart , Myocardial Ischemia , Primary Health Care , ThoraxABSTRACT
Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory demyelinating disease of central nervous system, and is related to allergic or immune-mediated reaction to systemic viral infection or vaccination, which is usually self limited monophasic illness. As the clinical manifestations or laboratory findings is nonspecific, it is diagnosed by brain magnetic resonance imaging (MRI) showing multiple foci of increased T2 signal within white matter. We report the clinical and radiologic imaging findings in a 36-year-old man in whom acute disseminated encephalomyelitis developed after serologically proven herpes infection combined with liver abscess. His clinical course, despite without corticosteroid or plasmapheresis because of liver abscess, was shown spontaneous remission.
Subject(s)
Adult , Humans , Brain , Central Nervous System , Demyelinating Diseases , Encephalomyelitis, Acute Disseminated , Liver Abscess , Liver , Magnetic Resonance Imaging , Plasmapheresis , Remission, Spontaneous , VaccinationABSTRACT
Crohn's disease is one of the chronic inflammatory disorders of unknown cause involving the gastrointestinal tract. The inflammation may occur in the colon, either alone or with small intestine. Crohn's disease has been associated with increased risk for coloretal carcinoma in patients with long-standing colitis, strictures and fistulae. Recently, we experienced a case of Crohn's disease complicating carcinoma in a 85 year old male. Ten years ago, he compained severe abdominal pain and diarrhea. and was detected colon obstruction and enteric fistula. But, he spontaneously improved. Recently, the patient was admitted complaining abdominal pain. He complaind abdominal pain and indigestion chronically and aggravated recently. He was examined with colonofibroscopy, and computered tomography, and carcinoma was detected at the site of Crohn's disease.
Subject(s)
Aged, 80 and over , Humans , Male , Abdominal Pain , Colitis , Colon , Colorectal Neoplasms , Constriction, Pathologic , Crohn Disease , Diarrhea , Dyspepsia , Fistula , Gastrointestinal Tract , Inflammation , Intestine, SmallABSTRACT
This study was performed to evaluate the factors influencing the Quality of Life(QOL) in hemodialysis patients. Authors surveyed and analyzed the questionnaires about social characteristics, symptom, social support, satisfaction with life and quality of life. With these questionnaires, authors compared the hemodialysis patients(N=240, >6 month with hemodialysis) with the control group(N=240). Additionally authors eva- luated the anemia state, nutritional state and dialysis effect, and then analyzed the correlation between these laboratory findings and quality of life in hemodialysis patients. The results were as follows ; 1) The mean age of control group was 33.4 +/- 8.2 yrs, and the patients group was 48.812yrs. 2) Of 294 patients, 73 had the religion(75.2%), 173 had studied above high school(58.8%), 211 were married(71.8%), and 94 were homemaker(3296). Economically, 130 of 294 patients(44.2M) were the middle classes. The patients without occupation were 121 of 294 patients(41.2M), while those with occupation were 77(26.1%) and remainder were housemaker. The patients with medical insurance were 59.9%, those with 1st Medicaid were 22.4%, and those with 2nd Medicaid were 17%. 3) The causes of ESRD were CGN(29.5%), DM (22.3%), etc. Total duration of hemodialysis was 51.4 43.8 months in average, and weekly hemodialysis time was 11.541.98 hours in average. Average BMI was 20.6 +/- 2.79, and in 236 of 294 patients(80.1%), EPO was injected. Of all the complication, 96(32.9%) was cardiovascular problem. Iron storage state was relatively good in all the patients, and the mean level of PTH-i was 174.3 +/- 307.9pg/dl, hemoglobin 8.5 +/- 1.3g/dl, cholesterol 161.536.6mg/dl, total protein 6.60.5g/dl, albumin 3.960.4g/dl. The URR was 65.36.9%, and KtV was 1.3 +/- 0.3. The comparison about laboratory finding between male and female was as followed; Hb. and albumin level was signifi- cantly higher in male compared with female patients, and cholesterol, URR and Kt/V was significantly higher in female than in male. 4) The result of statistic analysis about several variables and Questionnaires. (1) The subjective and objective instrument about QOL showed positive correlation, and the QOL was correlated positively to symptom, physical health state and social support. (2) Of social characteristics, the direct influencing factors for QOL were occupation, economic state, marriage state, and educational state, whereas in- direct factors were a fee for medical treatment and social support. In clinical and laboratory characteristics, the significant factors were age, DM, symptoms, albumin, pre-dialytic creatinine, sodium and calcium. The effect of dialysis did not correlate with QOL. In conclusion, to increase QOL in dialysis pa- tients, all of the community, family, and medical team should make an effort. Firsty, the concern and the support of the community about the dialysis patients should be promoted in social welfare and the opportunity of employment. Secondly, the patients should promote the self-reliance and self- efficacy to take a share of their role in the community and a family by their own efforts. Lastly, the medical team should make an effort to decrease the symptom, to correct the anemia and malnutrition, to treat the complication, and to promote the physical activity. Through these efforts, the health of patients will be elevated. Elevation of the patient's health will increase the possibility of employment and self-reliance, and subsequently will increase the economics. If so, the burden of a fee for the medical treatment will be reduced. Additionally, if social and familial support increase, the QOL of the dialysis patients will be better.
Subject(s)
Female , Humans , Male , Anemia , Calcium , Cholesterol , Creatinine , Dialysis , Employment , Fees and Charges , Insurance , Iron , Kidney Failure, Chronic , Malnutrition , Marriage , Medicaid , Motor Activity , Occupations , Quality of Life , Renal Dialysis , Social Welfare , Sociology , Sodium , Surveys and QuestionnairesABSTRACT
Chylous ascites is extravasation of lymphatic fluid and retention in the peritoneal cavity due to traurna or obstruction of the lymphatic system. Chylous ascites is very rare complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) and is associated with trauma to the lymphatics during catheter insertion in the early stage of CAPD and repeated mild trauma to the lyrnphatics during longterm dialysis. Chylous ascites in the CAPD is suspected when the drained peritoneal fluid is milky white and confirmed by demonstration of the specific components of chyle, such as elevated triglyceride and low cholesterol than plasma and should be differentiated from pseudochyle and bacterial peritonitis. We report a case of chylous ascites in a patient undergoing CAPD at 2 months later of initiation of CAPD, which was not improved by conservative management. So CAPD catheter was removed and renal replacement therapy was changed to hemodialysis.
Subject(s)
Humans , Ascitic Fluid , Catheters , Cholesterol , Chyle , Chylous Ascites , Dialysis , Lymphatic System , Peritoneal Cavity , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Plasma , Renal Dialysis , Renal Replacement Therapy , TriglyceridesABSTRACT
Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma and may lead to acute renal failure secondary to myoglobinuria. The most sensitive marker of muscle cell damage is serum creatine kinase concentration. It was first described by Bywaters and Beall in association with crush injuries during the second world war, and since then it has been recognized as the cause of about 5 % of all cases of acute renal failure. But acute renal failure is extremely rare in diabetic patient with hyperosmolarity irrespective of the frequency of rhabdomyolysis. Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic hyperosmolar state with acute renal failure, secondary to rhabdomyolysis. We reported a case with diabetic hyperosmolar nonketotic coma who developed acute renal failure secondary to rhabdomyolysis and myoglobinuria in a 60 year old patient with review of the literatures.
Subject(s)
Humans , Middle Aged , Acute Kidney Injury , Coma , Creatine Kinase , Diuresis , Glucose , Muscle Cells , Muscle, Skeletal , Myoglobinuria , Necrosis , Plasma , Rhabdomyolysis , World War IIABSTRACT
We experienced a case of acute renal failure by oxalate poisoning in a 44-year-old Korean woman. She presented with hematemesis and epigastric pain after drinking of oxalate in a suicidal attempt. After admission, acute renal failure was developed and the patient was treated with hemodialysis. On renal biopsy, there were numerous calcium oxalate crystals which appeared clearly in Hematoxylin-eosin stained sections and were refractile under polarized light microscope. We report a case of acute renal failure by oxalate poisoning with review of the literature.
Subject(s)
Adult , Female , Humans , Acute Kidney Injury , Biopsy , Calcium Oxalate , Drinking , Hematemesis , Hyperoxaluria , Poisoning , Renal DialysisABSTRACT
OBJECTIVES: The aim of this study was to evaluate the prevalence and risk factors of hepatitis C virus(HCV) infection in patients on chronic hemodialysis. METHODS: We measured antibody to HCV using second generation enzyme immunoassay(ELISA) test or radioimmunoassay(RIA) and hepatitis B surface antigen, serum values of AST, ALT in 224 patients of six urban hemodialysis units. We also investigated some clinicai parameters such as age, sex, duration and frequency of hemodialysis, the amount of blood transfusion, and hemodialysis of infected patients on separate machines. RESULTS: 1) 33 of 224 patients(14.7%) were positive for HCV antibody. 2) The prevalence of HCV antibody were most significantly correlated with duration of hemodialysis and less significantly with frequency of hemodialysis, amount of blood transfusion but not correlated with age, sex and level of liver enzyme. 3) The prevalence of HCV antibody was significantly higher in a center which did not separate dialysis machine for HCV antibody positive patients than centers which did. CONCLUSION: Th prevalence of HCV antibody was most signficantly correlated with duration of hemodialysis. We suggest that environmental factor of hemodialysis unit may play major role in HCV infection of hemodialysis patients. So the importance of separate dialysis machine from HCV antibody positive patients should be emphasized.