A case of sclerosing encapsulating peritonitis presenting a huge pseudocyst formation in end stage renal failure on the maintenance hemodialysis / 대한내과학회지

Sclerosing encapsulating peritonitis(SEP) is now a well-recognised, but uncommon complication of chronic ambulatory peritoneal dialysis(CAPD). The etiology is unclear, but SEP is believed to be multifactorial. The most important factors seem to be the length of time on peritoneal dialysis and previous episodes of peritonitis. Anorexia, nausea, vomiting, weight loss, abdominal pain, and a reduction of the ability of the peritoneum to act as a dialyzing membrane are the usual presenting problems. We experienced one case of SEP presenting a huge pseudocyst in the patient of end stage renal failure on the maintenance hemodialysis for 5 years, even though he had a history of CAPD for 5 years. So we report this case with review of the literature.

Hearng loss in chronic renal failure patients / 대한내과학회지

OBJECTIVES: Hearing loss, mainly a sensorineural hearing loss (SNHL), was frequently observed in patient with chronic renal failure. Although several causes and prevalence of this hearing loss had been proposed, the etiology and prevalence are still controversial. The purpose of the present study was another study to determine the prevalence, type and comparative degree of hearing loss in chronic renal failure according to various parameters. METHODS: Subjects for this study were 39 patients with hemodialysis and 10 chronic renal failure patients before hemodialysis. Pure tone audiometry was performed and pure tone average(PTA) was estimated. At same time, pure tone threshold were estimated at the range from 250 to 500(low frequency range), from 1000 to 2000(middle frequency range) and from 4000 to 8000 Hz(high frequency range). Significant hearing loss of PTA as well as the significant loss in pure tone threshold of each frequency range was defined when the loss of hearing ability was 25dB more than the normal value. The effect of alteration in age, sex, hemoglobin, lipid profile, duration of hemodialysis, underlying diseases and ototoxic drugs were evaluated. RESULT: 1) The main type of hearing loss was SNHL and it was asymptomatic and progressive. The prevalence of SNHL by means of PTA was 76% in the patient with chronic renal failure. The SNHL of high frequency range(89%), SNHL of middle frequency range(18%) and SNHL of low frequency range (45%) were observed on the basis of the pure tone threshold. 2) There was no significant difference of SNHL according to various parameters of sex, hemoglobin, lipid profile, BUN, and underlying diseases except age. 3) The patients under hemodialysis exhibited the more SNHL over all frequency ranges than those without hemodialysis and there was the more SNHL in patients of more than 2 years of hemodialysis and those of less than 2 years of hemodialysis 4) Furosemide was significantly ototoxic in patients with chronic renal failure. CONCLUSION: The type of hearing loss was mainly sensori-neural and high tone loss. The degree was slight to moderate. The prevalence was the higher than expected. Regular hemodialysis treatment seems to affect hearing loss during even 2 years of treatment. Therefore, hearing loss appeared to be related to the duration of hemodialysis. The more precise and regular audiometric monitorings were recommanded in hemodilalysis patients.

A Case of Acute Myelogenous Leukemia during Pregnancy / 대한암학회지

The incidence of acute leukemia in pregnancy is rare. The treatment of acute leukemia during pregnancy is complicated and therapeutic options must be made with each individual patient. Complete remission can now be achieved in 60 to 70% of previously untreated adults with acute myelogenous leukemia (AML). Antileukemic chemotherapy can be administered safely during the second and third trimesters. Cytarabine (ara-C) and anthracycline has not been associated with birth defect. When a pregnant woman presents with acute leukemia, chemotherapy should be recommended as vigorously as in the non- pregnant woman. We reported a case of AML during pregnancy. The patient recieved induction chemotherapy with ara-C and idarubicin. The baby was delivered at 33 weeks of gestation and had transient neutropenia. The mother received consolidation chemotherapy after achievement of complete remission.

Immature Reticulocyte Count as an Indicator of Erythropoiesis in CRF / 대한신장학회잡지

Transfusion requirement or hemoglobin level has been a major indicator of the erythropoiesis of CRF patients. However, the more objective and earlier detectable parameters to monitor the erythropoiesis has been required. We investigated the significance of immature reticulocyte count(IRC) with flowcytometry in CRF patients as a convenient index of erythropoietin(EPO) therapy. We evaluated CRF patients undergoing hemodialysis(n=35) and normal control group(n=14). The 26 patients of CRF have been under EPO therapy, the others(n=9) have not been under therapy. 1) The response of IRC to EPO therapy : IRC increased daily 4.95% in average upto 3rd day and decreased daily 3.7% in average since then. 2) The similar IRC was maintained in similar hemoglobin state : IRC, total reticulocyte count(TRC) and hemoglobin were compared between CRF patients with low dose EPO therapy and those who weren't needed EPO administration from the beginning. 3) The increase of IRC depends on the dose of EPO : 4) Correlation between IRC and other hematologic parameters : IRC was significantly correlated with TRC and serum iron level(R value : 0.736, 0.522 respectively). Taken together, these results suggest that maintenance of IRC level, 8-10%, was necessary at a minimum to obtain 8g/dL of hemoglobin level. However, IRC level could be readjusted more than 20% with higher EPO therapy to maintain 8g/dL of hemoglobin in severe case. In conclusion, the measurement of IRC in CRF is clinically more objective, useful, earlier indicator for estimating erythropoiesis than hemoglobin and TRC.