ABSTRACT
The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet.
Subject(s)
Adult , Humans , Male , Anterior Cruciate Ligament/injuries , Arthroscopy/statistics & numerical data , Renal Insufficiency/etiology , Knee Joint/surgery , Postoperative Complications/etiology , Rhabdomyolysis/etiology , Tourniquets/adverse effectsABSTRACT
Oral sodium phosphate is commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. However, this substance is known to cause electrolyte abnormalities including hyponatremia. The hyponatremic patient usually presents with headache, nausea, vomiting and confusion, but can also present with non-cardiogenic pulmonary edema, seizure and rhabdomyolysis. However, non-cardiogenic pulmonary edema, seizure and rhabdomyolysis caused by hyponatremia associated with bowel preparation have only rarely been reported. We report a case of severe complications including non-cardiogenic pulmonary edema, seizure and rhabdomyolysis associated with hyponatremia following ingestion of sodium phosphate for colonoscopy in a 41-year-old healthy male.
Subject(s)
Adult , Humans , Male , Colon , Colonoscopy , Colorectal Surgery , Eating , Headache , Hyponatremia , Nausea , Phosphates , Pulmonary Edema , Rectum , Rhabdomyolysis , Seizures , Sodium , VomitingABSTRACT
Intestinal hemorrhage, perforation, obstruction, and fistula formation are the common complications associated with intestinal tuberculosis. However, these complications usually occurr in active stage of intestinal tuberculosis. A 45-year-old man was diagnosed as intestinal tuberculosis and received anti-tuberculosis medications for 9 months. After the end of treatment, intestinal lesion was cured. However a deformed appendiceal orifice due to hypertrophic sear resulting in symptomatic appendictis was noted. We report a case of acute appendicitis due to intestinal stricture after the successful treatment of intestinal tuberculosis.
Subject(s)
Humans , Male , Middle Aged , Acute Disease , Antitubercular Agents/therapeutic use , Appendicitis/diagnosis , Colonoscopy , Diagnosis, Differential , Tomography, X-Ray Computed , Tuberculosis, Gastrointestinal/complicationsABSTRACT
Lymphoproliferative disorders are among the most serious and potentially fatal complications of chronic immunosuppression in organ transplant recipients. Post-transplant lymphoproliferative disorder (PTLD) is the second common malignancy occurring in patients with kidney transplantation and has a high mortality rate. The pathogenesis of PTLD in most cases appears to be related to B cell proliferation induced by infection with Epstein-Barr virus (EBV) in the setting of chronic immunosuppression. The PTLD may present a solitary tumor around the hilum of transplant kidney, but it may not by easily considered as the cause of hydronephrosis in transplant kidney because the prevalence of PTLD is low and surgical complications such as lymphocele, stricture and hematoma that obstruct the transplant ureter are much more common. Early detection is important because reduction of immunosuppressive agents may reverse progression of the disease. Furthermore, several effective treatment options were recently introduced. Here we report a case of PTLD presenting with hydronephrosis, which was completely resolved by a multimodality therapeutic approach.
Subject(s)
Humans , Cell Proliferation , Constriction, Pathologic , Hematoma , Herpesvirus 4, Human , Hydronephrosis , Immunosuppression Therapy , Immunosuppressive Agents , Kidney Transplantation , Kidney , Lymphocele , Lymphoproliferative Disorders , Mortality , Prevalence , Transplants , UreterABSTRACT
Intravenous immunoglobulin (IVIG) therapy has been introduced to idiopathic dilated cardiomyopathy due to their antiviral and anti-inflammatory effects. But each study reported conflicting result and treatment regimen has not been clearly established. We experienced a case of 28-year-old woman with idiopathic dilated cardiomyopathy with severely depressed cardiac function. Its onset time was obvious within 1 month. Despite of conservative treatment of heart failure, sudden cardiac arrest was developed. We tried IVIG therapy, and her symptoms and cardiac function were improved after IVIG treatment.
Subject(s)
Adult , Female , Humans , Cardiomyopathy, Dilated , Death, Sudden, Cardiac , Heart Failure , Immunoglobulins , Immunoglobulins, IntravenousABSTRACT
Acute interstitial nephritis is an important cause of acute renal failure and result from immune mediated tubulointerstitial injury, initiated by medications, infections, and other variable causes. Since acute interstitial nephritis may present a variety of clinical and laboratory findings and progress more rapidly than expected and it is reversible with withdrawal of the etiologic drug or administration of steroid, its early detection is very important. Mycoplasma pneumoniae is a common pathogen in young-healthy adult but mycoplasma infection induced acute interstitial nephritis is rarely reported. Therefore considering mycoplasma infection as one possible cause of acute interstitial nephritis is clinically important. So we report a case of acute interstitial nephritis associated with mycoplasma infection.
Subject(s)
Adult , Humans , Acute Kidney Injury , Mycoplasma Infections , Mycoplasma pneumoniae , Mycoplasma , Nephritis, Interstitial , Pneumonia, MycoplasmaABSTRACT
The thrombotic microangiopathy associated with cyclosporine A after kidney transplantation is a detrimental complication that could lead to the loss of transplanted kidney. Although the pathogenesis is still unclear, the decrease in the activity of von Willebrand Factor (VWF)-cleaving metalloprotease that cleaves unusually large von-Willebrand factor (UL-VWF), such as disintegrin-like metalloprotease with thrombospondin type 1 repeats (ADAMTS) 13, and the inhibitory factors of ADAMTS 13 are reported. Therefore, we measured the activity of ADAMTS 13 and the inhibitory factors in a patient with thrombotic microangiopathy after kidney transplantation. A 28 year-old female patient with hemolytic anemia, thrombocytopenia and impaired renal function after the kidney transplantation was diagnosed as thrombotic microangiopathy after renal biopsy. The activity of ADAMTS 13 during the acute stage of thrombotic microangiopathy was reduced to 12%, but when the renal function returned to normal, ADAMTS 13 level returned to 100%. However, the autoantibody of ADAMTS 13 was not detected. The results from this study suggest that the pathogenesis of thrombotic microangiopathy associated with cyclosporine A after the kidney transplantation could be associated with the decrease in the activity of ADAMTS 13.
Subject(s)
Adult , Female , Humans , Anemia, Hemolytic , Biopsy , Cyclosporine , Kidney Transplantation , Kidney , Thrombocytopenia , Thrombospondins , Thrombotic Microangiopathies , von Willebrand FactorABSTRACT
Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer, featuring both hepatocellular and biliary epithelial differentiations. An intrahepatic tumor may be considered as a metastatic lesion. It has been suggested in the literature that the likelihood of metastasis in the cirrhotic liver is lower than that in the non-cirrhotic liver. A rare case of combined hepatocellular-cholangiocarcinoma and second primary colon adenocarcinoma in a 67-year-old male patient with liver cirrhosis is presented. Histologically, the intrahepatic mass was composed of a spindle cell sarcomatous component; a hepatocellular carcinoma component; and a cholangiocarcinoma component. There were focal transitional regions among the different components. Immunohistochemically, the cholangiocarcinoma component of the intrahepatic mass showed positive reactions for CK-7 but negative reactions for CK-20. The adenocarcinoma of the colon showed positive reactions for CK-20 but negative reactions for CK-7.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/pathology , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic , Carcinoma, Hepatocellular/pathology , Cholangiocarcinoma/pathology , Colonic Neoplasms/pathology , English Abstract , Liver Neoplasms/pathology , Neoplasms, Second Primary/pathologyABSTRACT
BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. RESULTS: The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. CONCLUSION: Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.