Late Onset Nephrogenic Systemic Fibrosis in a Patient with Stage 3 Chronic Kidney Disease: a Case Report

Nephrogenic systemic fibrosis (NSF) is a progressive systemic fibrosing disease that may occur after gadolinium contrast exposure. It can lead to severe complications and even death.NSF is highly prevalent among patients with advanced chronic kidney disease (CKD). In this report, however, we describe the case of a patient with NSF that occurred during early CKD. A 65-year-old man with stage 3a CKD was transferred to our hospital because of lower extremity edema. The medical history revealed that he was exposed to gadolinium 185 days earlier, and the result of his tibial skin biopsy was consistent with NSF. The patient underwent a combined therapy with ultraviolet-A1 phototherapy and methotrexate and steroid therapy for 6 months. The combined therapy stopped the systemic progression of NSF.

Gitelman's Syndrome Associated with Chondrocalcinosis

Gitelman's syndrome (GS), a hereditary disease characterized by hypokalemia, hypomagnesemia, and hypocalciuria, is a salt-losing renal tubulopathy. Herein, we describe a case of a 28-year-old woman diagnosed with atypical GS accompanying chondrocalcinosis. One year ago, she presented with vomiting, hypokalemic metabolic alkalosis, and hypocalciuria, and was tested by diuretic challenge test. As a result, she was diagnosed with atypical GS with normomagnesemia and treated with spironolactone and potassium supplementation. Meanwhile, acute arthritis of the right 1st metatarsophalangeal joint occurred. On the radiographies of the knees, chondrocalcinosis was observed. To the best of our knowledge, this is the first report in Korea of GS with chondrocalcinosis. Antialdosterone therapy or magnesium supplementation is effective in preventing the progression of chondrocalcinosis; thus, early diagnosis and treatment of GS are important.

The Effect of Increased FIO2 before Removal of the Laryngeal Mask Airway on Postanesthetic Arterial Partial Oxygen Pressure / 대한마취과학회지

BACKGROUND: The administration of 100% oxygen at the end of general anesthesia before tracheal extubation has been shown to worsen postanesthetic pulmonary gas exchange. Because the laryngeal mask airway (LMA) and the endotracheal tube (ETT) are very different, it remains uncertain whether emergence on oxygen has the same results on lung function as ETT. Therefore, the aim of this study was to evaluate whether the use of 100% oxygen before LMA removal worsens gas exchange after inhalation or total intravenous general anesthesia. METHODS: Eighty ASA physical status I-II patients scheduled for elective surgery of the extremities were randomly assigned to receive either sevoflurane or propofol during general anesthesia with LMA. At the end of surgery, patients were randomized to an inspiratory fraction of oxygen of 0.3 in sevoflurane (n = 20), of 0.3 propofol (n = 20) or of 1.0 in sevoflurane (n = 20) or of 1.0 in propofol (n = 20) during emergence from anesthesia and LMA removal. Postoperative blood gas measurements were taken immediately and 60 min after arrival in the recovery room. RESULTS: No significant differences in PaO2 (propofol groups: 87.5 +/- 14.4 vs 88.5 +/- 10.5 mmHg, sevoflurane groups: 86.7 +/- 11.3 vs 90.7 +/- 9.9 mmHg) or alveolar - arterial oxygen tension difference (AaDO2) were found between the two groups at 30 min after LMA removal (propofol groups: 12.0 +/- 12.4 vs 10.3 +/- 8.3 mmHg, sevoflurane groups: 8.6 +/- 7.1 vs 7.1 +/- 9.4 mmHg). No differences were observed between the sevoflurane and propofol groups when FIO2 levels were similar. CONCLUSIONS: Breathing 100% oxygen during emergence from general anesthesia does not worsen postanesthetic pulmonary gas exchange when an LMA is used.