A Case of Overlapping Syndrome of Primary IgA Nephropathy and Membranous Nephropathy / 대한신장학회잡지

We report a rare case of primary glomerular disease with overlapping IgA nephropathy and membranous nephropathy in a 52 year-old man. Clinically, The patient showed microscopic hematuria and proteinuria and had no underlying disorders such as hepatitis B, hepatitis C, drug exposure, SLE or other immunologic diseases. Histologically, glomeruli showed focal cellular proliferartione and electron deposits in the mesangium and concomittant subepithelial deposits. Immunofluorescence revealed IgA depositions in a mesangium and IgG depositions along the glomerular capillary walls, like those of typical membranous nephropathy. These findings suggest the primary glomerular disease overlapping of two different glomerular changes. The patient showed still persistent proteinuria, but have preserved renal function with administrations of ACE inhibitors and diuretics after two years.

A Case of Overlapping Syndrome of Primary IgA Nephropathy and Membranous Nephropathy / 대한신장학회잡지

We report a rare case of primary glomerular disease with overlapping IgA nephropathy and membranous nephropathy in a 52 year-old man. Clinically, The patient showed microscopic hematuria and proteinuria and had no underlying disorders such as hepatitis B, hepatitis C, drug exposure, SLE or other immunologic diseases. Histologically, glomeruli showed focal cellular proliferartione and electron deposits in the mesangium and concomittant subepithelial deposits. Immunofluorescence revealed IgA depositions in a mesangium and IgG depositions along the glomerular capillary walls, like those of typical membranous nephropathy. These findings suggest the primary glomerular disease overlapping of two different glomerular changes. The patient showed still persistent proteinuria, but have preserved renal function with administrations of ACE inhibitors and diuretics after two years.

Predictive value of troponin l and myoglobin in patients with unstable coronary artery disease / 대한내과학회지

BACKGROUND: Patients with unstable angina or non Q wave myocardial infarction still have an elevated risk for subsequent cardiac events. Therefore early assessment of the risk of future cardiac events is important. In this study, prognostic value of troponin l and myoglobin was evaluated and compared with other known early available risk indicators. METHODS: Serum troponin l and myoglobin were measured at presentation and 8 hours, 16 hours, and 24 hours thereafter in 126 patients with unstable angina (n=70) or non Q myocardial infarction (n=56) from Jan 1998, through Feb 2000. Echocardiography was performed with calculation of wall motion score index. The incidence of cardiac death or myocardial infarction was compared between patients with normal troponin l, myoglobin and abnormal ones, respectively. RESULTS: (1) At 6 months, 1 death (2.2%) and 1 myocardial infarction (2.2%) occured in the 45 unstable angina patients with normal troponin l compared with 3 deaths (12.0%) and 8 myocardial infarctions (32.0%) in the 25 unstable angina patients with elevated troponin l. (2) At 6 months, 1 death (1.7%) and 3 myocardial infarctions (5.2%) occured in the 58 unstable angina patients with normal myoglobin compared with 3 deaths (25.0%) and 6 myocardial infarctions (50.0%) in the 12 unstable angina patients with elevated myoglobin.(3) When the analysis was limited to patients with normal baseline troponin l (< or = 0.4 ng/dl: n=45), increased myoglobin level remained significantly associated with increased incidence of cardiac deaths or myocardial infarction compared with normal myoglobin level (16.7% vs 0%). (4) Together with age, diabetes, wall motion score index, troponin I and myoglobin levels were identified as independent prognostic variables for myocardial infarction or cardiac death in a multivariate logistic regression analysis. (5) The maximal troponin l and myoglobin value obtained during the first 24 hours provides independent and important prognostic information regardless of whether the patient is classified as having unstable angina or non Q wave myocardial infarction. CONCLUSION: The maximum troponin l and myoglobin obtained during the first 24 hours provides independent and important prognostic information in patients with unstable angina or non Q wave myocardial infarction.

Agenesis of the Right Lobe of the Liver / 대한간학회지

Agenesis of the right lobe of the liver is an extremely rare anomaly of the liver, and few cases are reported in the literature. Most of the patients with this anomaly are accompanied by additional anormalies such as retrohepatic or suprahepatic gallbladder and other biliary tract diseases, including cholelithiasis, carcinoma of the gallbladder and portal hypertension. The diagnosis of this rare anatomical variant was established by ultrasonography and computed tomography. The radiological findings, clinical presentation, and differential diagnosis are reviewed.

The 5 Years Follow Up Study on Serum Total Cholesterol Levels in Normal Adult Korean Male Workers Resident in Pohang / 대한내과학회지

OBJECTIVES: The serum total cholesterol is supposed to be increased as dietary pattern is westernized recently in our country. We studied the longitudinal change of serum total cholesterol levels in normal adult Korean male workers and analyzed the influence of lifestyle on change of serum total cholesterol levels. METHODS: The 7677 healthy adult male workers were studied during recent 5years(1992 and 1997). Those who suffered from hypertension, diabetes mellitus, ischemic heart disease, nephritis were excluded. Those who ingested antilipidemic drugs were also excluded. Serum total cholesterol were measured by the same enzymatic method and their levels were analyzed during fasting state. Data on lifestyle were obtained using self administered questionnaires. RESULTS: 1) The serum total cholesterol levels increased by 9.45+/-23.99mg/dl(1.89mg/dl per year) between 1992 and 1997 surveys. 2) The increment of serum total cholesterol levels was most prominent in the twenties (3.45mg/dl per year) and less prominent in 5th, 6th decades. 3) A change of 1kg/m2 in body mass index contributed a change of 3.449mg/dl in serum total cholesterol. 4) The change of body mass index(BMI) was most significantly correlated with that of serum total cholesterol levels among the influencing variables.( =3.449 p=0.0001 r2=0.035) 5) The changed value of serum total cholesterol levels was significantly correlated with smoking and exercise, however, was not significantly correlated with the amount of alcohol ingestion. CONCLUSION: The serum total cholesterol levels increased by 9.45mg/dl(1.89mg/dl per year) during recent 5 years. The increment of serum total cholesterol levels was more prominent in younger age group. The changed value of BMI was most strongly correlated with that of serum total cholesterol levels of all influencing variables.

A case of Rifampin-induced Acute Renal Failure / 영남의대학술지

Rifampin is common drug to treat tuberculosis. Rifampin induced acute renal failure, hemolytic anemia and thrombocytopenia is rare and severe complication. We have experienced a case of rifampin induced acute renal failure, hemolytic anemia and thrombocytopenia. Forty-six years old male was suffered from reactivation of pulmonary tuberculosis, and had to medicate antituberculosis drugs including rifampin(600mg/day). Seven years ago, antituberdulosis medication were successfully administered to treat pulmonary tuberculosis without any side effects of drugs. But eight days after readministration of rifampin, fever, abdominal pain, vomiting, oliguria, elevated BUN and creatinine were developed. And thrombocytopenia was also identified after administration of rifampin. The patient was recovered slowly after discontinuation of rifampin & intensive medical care. The renal function was normalized at 55 days after cessation of rifampin. The renal pathologic findings were interstitial nephritis and acute tubular necrosis. And, the rifampin dependent antibodies were identified by indirect antiglobulin test in the presence of rifampin. So we report this case with a brief review of literature.