Arteriovenous Fistula Formation Using Microscope Rather than Surgical Telescope

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.

Cough Syncope due to Atrioventricular Block / 대한내과학회지

We report the case of a 52-year-old man who had two syncopal episodes associated with coughing. Other than essential hypertension, he had no organic disease of the heart or lungs. Transient complete atrioventricular block following coughing was detected by electrocardiographic telemonitoring while resting. During that time, the patient experienced near-syncope similar to his previous syncopal episodes. He was treated successfully with permanent pacemaker implantation.

A Case of Pulmonary Artery Pseudoaneurysm Treated by Embolization / 대한내과학회지

Pulmonary artery pseudoaneurysm (PAP) is a rare complication of septic pneumonia. It is potentially fatal because of the risk of massive hemoptysis. Treatment of PAP involving massive hemoptysis is by embolization or surgery. However, the progression of PAP after embolization has not been reported. A 59-year-old male who was recovering from septic pneumonia experienced massive hemoptysis. Computed tomography (CT) revealed PAP of the right pulmonary artery with surrounding consolidation, suggesting active hemorrhage. The patient was successfully treated with embolization of the right pulmonary artery. During outpatient follow-up, the amount of radiopaque embolized material gradually decreased on chest radiography. At 14 months after embolization, both the PAP and embolized material had disappeared on chest CT.

Three Cases of Minimal Change Nephrotic Syndrome in Patients with Type 2 Diabetes / 대한신장학회지

Diabetic nephropathy is a common and serious complication of diabetes characterized by persistent proteinuria, hypertension and a progressive decline of renal function. However, non-diabetic renal disease can be present in diabetic patients and differential diagnosis of treatable disease is important. Minimal change nephrotic syndrome is characterized by normal light microscopic finding and effacement of foot process in electron microscope, but foot process effacement is not specific and it can be present in the glomeruli of the most glomerulopathy including diabetic nephropathy. Therefore, pathologic diagnosis of minimal change nephrotic syndrome combined with diabetic nephropathy is very difficult. However, we could exclude other glomerulopathy and diagnose minimal change nephrotic syndrome by clinical features in three type 2 diabetic patients with diabetic nephropathy and have successfully treated with corticosteroid.

A Case of Crescentic Glomerulonephritis Superimposed on Membranous Glomerulopathy / 대한신장학회지

Membranous glomerulopathy (MGN) is a common cause of nephrotic syndrome in adults. Renal failure gradually develops in patients with MGN and crescentic glomerulonephritis (CGN) superimposed on MGN is a rare cause of acute renal failure. In most cases patients showed nephrotic syndrome with acute renal failure. We report a 33-year-old woman with azotemia but with no other symptoms such as nephrotic syndrome she had been diagnosed to have MGN 15 months before. There seemed to be no other cause of azotemia. Renal biopsy was performed and revealed CGN on existing MGN. She was treated with immunosuppression treatment and azotemia was improved. When unexplained azotemia develops in patients with MGN, we should promptly investigate superimposed conditions including CGN. In CGN superimposed on MN, a potentially reversible condition with appropriate immunosuppression therapy should be considered.