A Case of Rhabdomyolysis, Acute Renal Failure, and Acute Hepatitis Due to Carp Bile Ingestion / 대한신장학회잡지

Sevral cases of acute renal failure and acute hepatitis after ingestion of raw carp gall bladder have been reported. We experienced for the first time 1 case of acute renal failure and acute hepatitis associated with rhabdomyolysis, which has not been seen in previous studies, after ingestion of the raw carp gall bladder. Serum creatine phosphokinase, myoglobin and urine myoglobin were increased and 99mTc-MDP bone scan showed diffusely increased uptake of isotope in soft tissue of whole body. The other laboratory data corresponded to acute tubular necrosis and acute toxic hepatitis. The kidney pathology showed the recovery phase of acute tubular necrosis. Etiologic factor for rhabdomyolysis was not found except carp gall bladder. We considered that carp gall bladder was etiologic factor for rhabdomyolysis and that rhabdomyolysis acted as agravatting factor for developing acute tubular necrosis due to carp bile toxicity in this case.

Clinical Significance of Total Fibronectin in Patients with Rheumatoid Arthritis / 대한류마티스학회지

A study on fibronectin, which is synthesized in response to inflammatory process of joint destruction, can be of great value in identifying the mechanism of inflammation or disease activity of rheumatoid arthritis (RA). This study attempts to measure the concentrations of total fibronectin in synovial fluid of patients with RA and osteoarthritis (OA), and compare it with the clinical disease activity parameters of RA available. A total 68 patients suffering from knee pain and joint effusion was examined. Synovial fluids of thirty-eight RA patients and thirty OA patients were measured by using monoclonal fibronectin antibody. Cross-sectional analysis was undertaken to correlate the fibronectin levels of the RA patients with the clinical disease activity parameters available. RESULTS: 1. Mean synovial fibronectin level of RA (148.4+/-72.6 microgram/ml) was significantly higher than that of OA (39.5+/-16.9 microgram/ml)(p<0.001). 2. The fibronectin levels in RA do not seem to have significant relationship with the parameters such as disease duration, the duration of morning stiffness, Ritchie index, ESR, CRP, and rheumatoid factor. CONCLUSION: In conclusion, the synovial total fibronectin concentration can clearly distinguish RA from OA. However, it would be unlikely to be used as a parameter of disease activity.

Risk Factors for Early Rebleeding after Initial Endoscopic Hemostasis in Patients with Bleeding Peptic Ulcers / 대한소화기내시경학회지

BACKGROUND/AIMS: Rebleeding rate after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20-30%. Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. METHODS: We reviewed 99 patients who presented with bleeding peptic ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessel) between the patients who bled early (n=22) and who didn't bleed (n=77) within 5 days. RESULTS: The statistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (> or =2) (p=0.031), volume of transfusion (> or5 units) (p=0.001), size of ulcer (>1 cm) (p=0.038), multiple ulcers (p=0.020), presence of blood clots on ulcer base (p=0.012), stigmata (active bleeding and visible vessels) (p=0.010), size of exposed vessel (>1 mm) (p<0.0001). In multivariate analysis, volume of transfusion (odds ratio[OR] 14.4), size of ulcer (OR 11.7), multiple ulcers (OR 5.5) and size of exposed vessel (OR 13.2) were significant risk factors. CONCLUSIONS: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early identification of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers, bleeding stigmata and size of exposed vessel over 1 mm can predict the prognosis of peptic ulcer bleeding.