ABSTRACT
Renovascular hypertension is the most common cause of curable hypertension. The exact prevalence of renovascular hypertension is not known, and the diagnosis is probably missed in many patients. It is important to recognize this condition in clinical practice, first, because it is a correctable form of secondary hypertension, and second, it is a reversible cause of renal failure in some patients. The Basic lesion of renovascular hypertension is stenosis of the renal artery caused usually by either one of the two most common etiologies, atherosclerosis or fibromuscular dysplasia. Other known causes of renovascular hypertension include aneurysm, embolism, arterio venous fistula, neurofibromatosis, tumor, hematoma, foreign body induced compression, and trauma. Its treatment can be divided into surgical intervention, percutaneous transluminal balloon angioplasty, and medical therapy. Recently, selective embolization has been introduced as a useful alter native therapeutic modality in the management of arterio venous fistula and aneurysm. We report a case of delayed renovascular hyper-tension in stab injury induced renal artery-IVC fistula and its renal artery aneurysm in a 20 year-old man. Embolization of the renal arterio venous fistula was achieved by inserting a detachable balloon, and embolization of the renal aneurysm and lumbar artery pseudoaneurysm was performed using micro-eo-ils. Arteriogram immediately after embolization con- firmed complete occlusion of the ancurysm and closure of the arterio venous fistula. After the procedure, improvement of blood pressure was noted in the patient who is currently being followed-up on an out-patient basis.
Subject(s)
Humans , Young Adult , Aneurysm , Aneurysm, False , Angioplasty, Balloon , Arteries , Atherosclerosis , Blood Pressure , Constriction, Pathologic , Diagnosis , Embolism , Fibromuscular Dysplasia , Fistula , Foreign Bodies , Hematoma , Hypertension , Hypertension, Renovascular , Neurofibromatoses , Outpatients , Prevalence , Renal Artery , Renal InsufficiencyABSTRACT
The relationship between malignancy and membranous nephropathy remains unresolved exactly, but it was suggeste d that nephrotic syndrome can be menifested as a prodrome to underlying malignancy. It has been reported that membranous nephropathy is associated with malignancy, however, a few cases were reported in Korea. We recently experienced a patient with stomach cancer which was detected during the follow-up of the membranous nephropathy. Proteinuria and microsopic hematuria disappeared after subtotal gastrectomy. We concluded that the stomach cancer might be a cause of glomerulonephritis in this case.
Subject(s)
Humans , Follow-Up Studies , Gastrectomy , Glomerulonephritis , Glomerulonephritis, Membranous , Hematuria , Korea , Nephrotic Syndrome , Proteinuria , Stomach Neoplasms , StomachABSTRACT
The number of patients and long-term survival rates of chronic renal failure have been increasing since the development of renal replacement therapy. Therefore, continuous follow-up observation on an outpatient basis, vascular access for dialysis and the determination of when to start dialysis have clinical significance associated with the prognosis of these patients. Presently, there is little clinical data about chronic renal failure patients such as, clinical features at initial dialysis, the presence or absence of neph-rologist follow-up, and the types and timing of vas-cular access. The goal of this study therefore was to investigate the clinical features at initial dialysis, presence or absence of follow-up, types and timing of vascular access in 80 patients retrospectively. The results are as below ; 1) The mean age of the patients was 47.8+/-14.0 years, and there were 47 male and 33 female patients. 2) Seventeen patients(21.3%) had DM as an underlying disease and 63 patients(78.79%) were non-diabetic patients. 3) At the initial dialysis, the diabetic patients had an average BUN of 79.2 +/- 29.6mg/dl, average Cr of 7.82.0mg/dl and an average Ccr of 10.0+/-7.0ml/min. The non-diabetic patients had the following averages ' BUN 118.7 +/- 37.9mg/dl, Cr 15.36.3mg/dl and Ccr 5.5 +/- 4.3ml/min. 4) The initial meeting with a nephrologist prior to dialysis occured as follows : in the diabetic group, 13 patients(76.596) met their nephrologist 12 months before, 3 patients(17.6%) 1 month before, one patient(5.9N) met the specialist one to 3 months before and no one had meeting 4 to 12 month before their dialysis. In the non-diabetic group, 36 patients(63.296) initially visited a nephrologist 12 months before, 16 patients (28.1M) one month before, 3 patients(5.3%) one to 3 months before and 2 patients(3.5%) had a meeting 4 to 12 months before the first dialysis. 5) The timing of native arteriovenous fistula for- mation was as follows; In the diabetic group, 10 patients(66.7%) had an A-V fistula constructed imme- diately upon admission, 2 patients(13.3%) had one constructed one to 3 months before, 2 patients(13.396) had one made 4 to 12 months before, one patient (6.7%) had a fistula created one week to one month before, and no one had a fistula formed 12 months before their initial dialysis. In the non-diabetic group, 36 patients(69.2%) had an A-V fistula constructed on admission ll patients(21.2%), one week to one month before 2 patients(3.8%), one to 3 rnonths before 2 patients(3.8%), 4 to 12 months before - one patient(1.9%) had the fistula created 12 months before initial dialysis. From these results, we learned that the time interval between either the patient's first meeting with his/her nephrologist or initial referral for renal replacement and vascular access preparation for hemodialysis was much longer than what is currently known. In conclusion, prompt referral to a nephro-logist early in the course of the disease and proper education of the patient by the nephrologist can lead to timely initiation of dialysis at a lower serum creatinine and higher Ccr levels which will reduce mortality, morbidity, and hospital care cost.
Subject(s)
Female , Humans , Male , Arteriovenous Fistula , Creatinine , Dialysis , Education , Fistula , Follow-Up Studies , Kidney Failure, Chronic , Mortality , Outpatients , Prognosis , Referral and Consultation , Renal Dialysis , Renal Replacement Therapy , Retrospective Studies , Specialization , Survival RateABSTRACT
Niemann-Pick disease is a storage disease characterized by accumulation of sphingomyelin and other lipids, mainly in the reticuloendothelial system. We experienced a case of type A Niemann-Pick disease in a 18-month-old male infant. He showed dyspnea, marked hepatosplenomegaly and developmental retardation. Fundoscopic examination revealed cherry red spots in both macula. Bone marrow aspirates showed characteristic foam cells. Autopsy finding revealed that liver, spleen, lung, lymph node and brain were involved. Reticular infiltration was shown on chest X-ray. We reported a case of type A Niemann-Pick disease with a brief review of the related literature.
Subject(s)
Humans , Infant , Male , Autopsy , Bone Marrow , Brain , Dyspnea , Foam Cells , Liver , Lung , Lymph Nodes , Mononuclear Phagocyte System , Niemann-Pick Disease, Type A , Niemann-Pick Diseases , Prunus , Spleen , ThoraxABSTRACT
When dysfunction of two or more endocrine glands occurs in association with circulating organ specific antibodies directed against the involved glands, the term polyglandular autoimmune (PGA) syndrome is applied. This syndrome is usually classified into three groups. The autoimmune nature of this disease has been based on the presence of lymphocytic infiltration of the affected glands, organ specific autoantibody in serum, cellular immune defects and association with HLA DR/DQ genes. A 12-year-old girl developed PGA syndrome, type III manifesting Grave's disease and insulin-dependent diabetes mellitus. The thyroid microsomal Ab, TSH receptor Ab and pancreatic islet cell Ab were positive. She should be observed for the possible development of adrenal insufficiency and/or other autoimmune disease.
Subject(s)
Child , Female , Humans , Adrenal Insufficiency , Antibodies , Autoimmune Diseases , Diabetes Mellitus, Type 1 , Endocrine Glands , Islets of Langerhans , Receptors, Thyrotropin , Thyroid GlandABSTRACT
Much has been learned of the pathogenesis and pathophysiology of the toxic shock syndrome (TSS) since the initial description in 1978 by Dr. James K, Todd. The clinical illness is defined by the criteria listed in the case definition formulated for epidemiologic studies. With the advent of widespread recognition of TSS, there have been numerous published reports describing the clinical and laboratory findings, primarily in menstruating females. And there have been also reported about six cases in Korea. Moreover, TSS is uncommon in the prepubertal age group and no case report in infant in Korea. We experienced two cases of TSS in infants aged 11/2 yrs and 9 months associated with respiratory infection-pneumonia, pyopneumothorax and localized skin abscess that were confused with Kawasaki disease (KD). The diagnosis was made on the basis of clinical features and laboratory findings, and the cases met the Centers of Disease Control case definition of TSS. And thus we report these cases and review related literatures.