Brachial Plexus Injury due to Subclavian Artery Pseudoaneurysm following Subclavian Vein Hemodialysis Catheterization / 대한신장학회잡지

As percutaneous catheterization of central vein has become common procedure, many different complications have been reported. The common complications are infection, hemorrhage, pneumothorax, embolism and vascular injury associated with aneurysm. Aneurysm formation of the great vessel like subclavian artery is rare in patients undergoing central venipuncture. And brachial plexus injuries induced by iatrogenic pseudoaneurysm are quite rare. Despite low incidence, this complication account for a large portion of the serious disabilities and may result in debilitating or limb threatening condition if not diagnosed and treated promptly. We experienced the case of brachial plexus compression by subclavian pseudoaneurysm as a complication of subclavian vein catheterization for hemodialysis.

A case of membranoproliferative glomerulonephritis associated with a hydatidiform mole

We treated a 54-year-old woman who was suffering from membranoproliferative glomerulonephritis associated with a complete type of hydatidiform mole. The renal manifestations were proteinuria and hematuria. A renal biopsy, performed before gynecologic management, disclosed focal and segmental subendothelial deposits with a proliferation of the mesangial cell and showed irregularly thickened capillary loops by light and electronmicroscoy. Genralized edema, proteinuria and hematuria were completely recovered by suction and curettage of the hydatidiform mole with prophylactic chemotherapy. The clinical manifestation of earlier presented 3 cases have been the nephrotic syndrome. The common feature of them was a complete remission of the nephropathy after the removal of the hydatidiform mole. The relationship between the hydatidiform mole and glomerulonephritis remains unresolved at present. But we concluded that the hydatidiform mole might be a cause of glomerulonephritis in this case.

Clinical Features of Stroke in Patients Undergoing Maintenance Dialysis / 대한신장학회잡지

Cardiovascular and cerebrovascular diseases are important causes of death in patients receiving maintenance dialysis. Stroke occurred in high rate with the tendency to worsen prognosis. Also many patients with chronic renal failure(CRF) showed a high risk for stroke. From March 1985 to March 1999, at Wonju Christian Hospital, we investigated retrospectively risk factors, clinical appearance and prognosis for stroke in 20 patients with CRF who undergoing maintenance dialysis. The stroke occurred in nine male and eleven female with a mean age of 49.95+/-9.19 years. Seventeen patients underwent hemodialysis and three patients underwent peritoneal dialysis. Mean duration of dialysis was 50.05+/-34.68 months. Causes of CRF were as follows : 55% glomerulonephritis, 20% diabetes mellitus, 5% polycystic kidney and 20% unknown origin. At the time of stroke, serum protein level was 6.68+/-0.86mg/dL, albumin 3.38+/-0.87g/dL, cholesterol 160.25+/-43.34mg/dL, HDL-cholesterol 41.41+/-11.86mg/dL. All patients were on antihypertensive medication. Mean systolic blood pressure was 197+/-45mmHg, diastolic blood pressure 114+/-23mmHg. Systolic blood pressure of fourteen cases were more than 180mmHg. During hemodialysis, heparin dosage was an average 2425+/-371.48 IU. The types of stroke were intracerebral hemorrhage (ICH, 75%), subdural hematoma(10%), cerebral infarction(15%). One case developed both cerebral hemorrhage and subarachnoid hemorrhage. The sites of hematoma were basal ganglion-thalamus(60%), and subcortex(33.3%). Of these, nine cases had subsequent intraventricular hemorrhage(IVH). One case involved IVH only. The mean volume of hematoma was 66.42+/-29.92mL. Three cases of cerebral infarction developed in midcerebral arterial territory. Prognoses were as follows : Sixteen patients with cerebral hemorrhage died during hospitalization and one case has been monitored via outpatient department. One patient with cerebral infartion died during hospitalization and two have been discharged after symptom was improved. In conclusion, CRF patients undergoing maintenance dialysis showed higher incidence of ICH, unlike the recent studies which showed a higher rate of cerebral infarction to ICH in the general population. There was a higher incidence of stroke in patients whose blood pressure were poorly controlled. The most common site of ICH was basal ganglia and thalamus which was the same as in the general population. In many cases, it accompanied IVH and showed a higher mortality rate. Therefore, it is thought that aggressive blood pressure control is indicated to reduce mortality caused by stroke during maintenance dialysis.

A Case of Multiple Endocrine Neoplasia Neoplasia Type IIa Complicated by Acute Myocardial Infarction / 대한내분비학회지

MEN IIa is the rare disorder consisted of thyroid medullary carcinoma, pheochromocytoma, and hyperparathyroidism. We experienced the case in which 42 year-old male patient with thyroid medullary carcinoma and pheochromocytoma complicated by acute myocardial infarction. During the process of conventional treatment of acute myocardial infarction, paroxysmal hypertension occurred for several times. We sought for the cause of paroxysmal hypertension, and found pheochromocytoma by the radiologic imaging study and the biochemical study and we found the 4X4 cm sized neck mass by palpation. After stabilizing his blood pressure by the use of phenoxybenzamine, we removed the pheochromocytoma in right adrenal gland and the medullary thyroid cancer, by right adrenalectomy and total thyroidectomy respectively. Thereafter, his subjective symptoms and objective signs were improved. We report the case with review of literatures.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.

Contractile and relaxing responses of the contralateral renal artery in renovascular hypertensive rats / 대한내과학회지

Although only a small portion of patients with hypertension have renal hypertension, studies regarding renal hypertension may provide insight into the pathophysiology of essential hypertension. An increased vascular reactivity to vasoconstrictor substances has been observed both in clinical hypertension and in animal models of hypertension. This study was designed to evaluate the contractile and relaxing responses of the contralateral renal artery in renovascular hypertension and to provide an explanation of one of the mechanisms of renovascular hypertension. METHODS: In the first experiment, an experimental renovascular hypertension model was established by clipping the left renal artery of Sprague-Dawley rats. These rats were then divided into two groups of which one was given enalapril during one week post-operation before being terminated. Ring preparations of the contralateral side of the renal artery were obtained one week after the operation. The contraction of renal artery strips were induced by high potassium or norepinephrine, and the relaxation of them were produced by acetylcholine or sodium nitroprusside. The contractile and relaxing responses were recorded and compared with the data obtained from control group. In the second experiment, the rats received angiotensin converting enzyme inhibitor, 5mg percent enalapril in the drinking water for 7 days after induction of renal artery stenosis operation. Then, the contractile and relaxing responses were evaluated by the same method as control group. RESULTS: 1) The contralateral renal artery of renovascular hypertensive rats showed significantly increased contractile responses to the high potassium or norepinephrine as compared with that of control group (p<0.05). 2) Increased contractile reponses of the renal artery to the high potassium or norepinephrine were normalized to the control group level when enalapril was given. 3) The relaxing responses by acetylcholine were reduced on the contralateral renal artery in renovascular hypertensive rats as compared with that of the control group. However, no remarkable differences were noted between them with the sodium nitroprusside. 4) There were no significant differences in the acetylcholine or nitroprusside induced vasodilation response between enalapril-given renovascular hypertensive rats and control rats. CONCLUSION: These results suggest that endothelial dysfunctions may lead to renal hypertension and that enalapril(ACE inhibitor) may prevent the development of renal hypertension by maintaining endothelial function.