Relationship between Bone Mineral Density, Erythropoiesis, and Calcium-Phosphorus-Parathyroid Hormone Status in End-stage Renal Disease Patients

OBJECTIVES: Abnormal bone turnover and mineralization is the characteristic of the end-stage renal disease (ESRD) patients receiving dialysis treatment. Reduced bone mineral density (BMD) has been reported in ESRD patients in many recent studies. Recent study has demonstrated hypoxia increases the loss of bone mass whereas the use of erythropoietin (EPO) increases bone marrow mesenchymal stem cell in vitro, which is the commonly found in ESRD patients. The objective of the present study is to analyze the relationship between erythropoiesis and calcium, phosphorus, parathyroid hormone (PTH) status in ESRD patients. METHODS: This study was a cross-sectional analysis of 183 ESRD patients (78 males, 105 females) on dialysis with mean age of 52 +/- 13 years and mean dialysis duration of 3.4 +/- 3.0 years. Duration and dose of EPO administration, hemoglobin, serum ferritin, and iron were checked in all subjects. BMD was evaluated by DXA. RESULTS: Age was negatively, and body weight and c-calcium positively associated with spine and femur neck and total hip BMD. Hemoglobin was positively correlated with femur neck and total hip BMD. Total dose of EPO, iPTH, and alkaline phosphatase had no significant association with BMD. However, according to tertile of serum PTH concentration, BMD were worst in third tertile group. In multivariate linear regression analysis, age, weight, and serum PTH affect BMD. CONCLUSIONS: BMD was independently related with age and weight. Hemoglobin correlated positively with femur neck and total hip BMD. However, treatment with EPO had no association with BMD. Increased PTH was related with reduced BMD.

Graves' disease detected by myalgia / 대한내과학회지

Graves' disease is commonly associated with a variety of muscle abnormalities from muscle weakness, paralysis to exophthalmopathy. There are several reports of Graves disease associated with polymyositis and myasthenia gravis. It is generally uncommon that muscle enzyme is increased in patients with hyperthyroidsm without polymyositis. We report thyrotoxic myopathy presented as myalgia without muscle weakness but with increased muscle enzyme, which was improved by anti-thyroid drug. A 33 year-old man developed severe proximal myalgia and headache. The creatinine kinase level was elevated. But there was no specific finding in electromyography. Muscle biopsy showed increased number of mitochondria and decreased glycogen content. There was no inflammatory cell infiltration. Diagnosis of hyperthyroidism due to Graves' disease was made, followed by the treatment with prothiouracil 300 mg per day. Five day after the treatment, myalgia improved, and serum CPK was decreased. He never complain myalgia after thyroid function was normalized.

Estimated Magnitude of an Outbreak of Vibrio parahaemolyticus Enteritis in Inchon, Korea / 감염

BACKGROUND: There are several reports on outbreaks of V. paraphaemolyticus enteritis, however, these are only complicated cases or microbiologic surveillance in marine environment. We experienced an outbreak associated with eating flavored crabs and investigated the magnitude of the outbreak on a large scale located in Inchon. METHOD: We took medical history and stool cultures from patients with diarrhea, visited the Inha University Hospital from September 14 to September 30, 1998. Pulsed-field gel electrophereis of isolates from stool culture performed to identify the relation. We counted the number of diarrheal patients visited the emergency rooms of 5 other general hospitals and 9 private clinics in Inchon from August 16 to September 30, 1998. We bought 6 crabs and 2 flavored crabs at a nearby market and cooked 6 crabs flavored at our hospital. Cultures from the flavored crabs stored at a refrigerator were done daily for consecutive 5 days. RESULTS: The outbreak began on September 5 and ended on September 29, 1998. The numbers of patients visiting ERs of 6 general hospitals and private clinics during outbreak were estimated 1,033 and 4,530, respectively. All 8 crabs revealed Vibrio spp., but identification up to species level was not possible. Pulsed-field gel electrophoresis of 12 isolates showed different patterns and suggested different sources. CONCLUSION: In 1998, an outbreak estimated more than 5,000 patients of V. parahaemolyticus enteritis occurred in Inchon, Korea. Because the magnitude of food-associated enteritis is enormous, that surpass the number which we assumed from clinical practice, early report and prompt investigation of such cases are necessary.

A Case of Pancytopenia Caused by Sheehan's Syndorme Improved with Hormone Replacement Therapy / 대한내분비학회지

Postpartum ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, is well- established clinical entity. In anterior pituitary insufficiency, there is very often a normochromic or hypochromic anemia but pancytopenia secondary to the hypopituitarism is less common. We report a case of pancytopenia due to complete aplasia of the bone marrow associated with Sheehan's syndrome, in which hormone replacement therapy alone produced full hematological recovery.

A Case of Myelofibrosis Associated with Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis is thought to be a collagen disease induced by autoimmune mechanism of unknown etiology. Idiopathic myelofibrosis is a myeloproliferative disorder in which the large majority of patients is characterized by anemia, leucoerythroblastosis, splenomegaly, and bone marrow fibrosis with a predominance of megakaryocyte. In some patients autoimmune bone marrow damage has been claimed to be involved in the pathogenesis. A 76-year-old female patient was diagnosed to have rheumatoid arthritis 30 years ago and medicated intermittently. Three months ago, she started to take hydroxychloroquine 300mg/day, prednisolone 7.5mg/day and non-steroidal antiinflammatory drug. One month ago, white blood cell (WBC) count was 5,000/ microliter with the neutrophil count was 3000/ microliter, the hemoglobin (Hb) was 4.3g/dL, the platelet count was 95,000/ microliter and the reticulocyte count was 0.1%. The bone marrow biopsy had revealed hypercellular marrow with increased all hematopoietic element. At this time, the WBC count was 1,600/ microliter and the neutrophil count was 760/ microliter, the Hb was 2.7g/dL, the platelet count was 11,000/ microliter and the reticulocyte count was 0.2%. The bone marrow aspiration resulted in dry tap and the biopsy revealed fibrosis with marked degree of reticulin fibrosis and small numbers of hematopoietic cells.

A case of retroperitoneal fibrosis accompanying immune thrombocytopenic purpura / 대한내과학회지

Retroperitoneal fibrosis is a slowly progressing syndrome that is a part of a systemic fibrosing disease. Most causes are idiopathic, whereas the remainder are associated with methysergide ingestion, malignancy, or aneurysm of abdominal aorta. The pathogenesis is unclear, but the evidences supporting systemic autoimmune process are present, i.e. the apprearance of autoimmune antibodies, especially antinuclear antibody, positive direct or indirect Coombs' test, and the association with immune thrombocytopenia. Effective treatment with corticosteroid is another suggestion of autoimmune nature of this disease. We experienced a case of retroperitoneal fibrosis with immune thrombocytopenic purpura and positive antinuclear antibody. A 44-years old man who was in splenectomy state due to immune thrombocytopenic purpura for 15 years visited us for obstructive uropathy caused by retroperitoneal fibrosis. He was treated with double J catheter insertion in both ureters, and oral medication of corticosteroid and tamoxifen. Renal failure and thrombocytopenia was improved after treatment and the retroperitoneal fibrotic mass size decreased.

A Case of Broncholithiasis caused by Aspergillus / 결핵

Broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen and broncholithiasis is a relatively rare condition which related to late tissue response to healing granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. The prominent symptoms of broncholithiasis are coughing followed by hemoptysis and symptoms related to bronchial obstruction. The complications include bronchoesophageal fistula and aortotracheal fistula. We report one case of broncholithiasis caused by Aspergillus. The case was a 53 year-old house wife whose chief complaints were recurrent fever, chill and malaise. The chest film revealed an ovoid hazziness on the right middle lobe and chest CT scan showed consolidation of lateral segment of right middle lobe with calcified small low attenuated lesion in right middle lobe bronchus. Aspergillosis confirmed by pathology after bronchoscopic removal of impacted Aspergillus containing muddy plug from lateral segmental branch of right middle lobe bronchus.