ABSTRACT
Idiopathic membranous nephropathy is a common cause of nephrotic syndrome, and has been reported as a cause of idiopathic primary glomerulonephropathy in up to 90% of patients. However, the treatment options remain controversial. We report two cases of idiopathic membranous nephropathy that were treated with rituximab. A 54-year-old man and a 64-year old man were admitted for rituximab therapy. They had previously been treated with combinations of immunosuppressive agents including cyclophosphamide, cyclosporine, mycophenolate, and steroids. However, the patients' heavy proteinuria was not resolved. Both patients received rituximab therapy, 2 weeks apart. After several months of follow-up and a second round of rituximab treatment for each patient, their proteinuria decreased and partial remission of disease was achieved in both patients.
Subject(s)
Humans , Middle Aged , Antibodies, Monoclonal, Murine-Derived , Cyclophosphamide , Cyclosporine , Follow-Up Studies , Glomerulonephritis, Membranous , Immunosuppressive Agents , Nephrotic Syndrome , Proteinuria , Steroids , RituximabABSTRACT
Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.
Subject(s)
Aged , Humans , Male , Allopurinol/adverse effects , Antimetabolites/adverse effects , Bile Duct Diseases/chemically induced , Bile Ducts, Intrahepatic/drug effects , Cholestasis/chemically induced , Drug Eruptions/pathology , Granuloma/chemically induced , Chemical and Drug Induced Liver Injury/pathology , Kidney Failure, Chronic/complicationsABSTRACT
A previously healthy 44-year-old woman who was diagnosed as having dermatomyositis suddenly developed severe dyspnea while being in the state of improved condition of muscle weakness. Interstitial lung disease was found on high resolution computed tomography (HRCT). In spite of the treatment with the immune-modulating agent (high dose steroid, cyclophosphamide, immunoglubulin and cyclosporine), her condition deteriorated further and rapidly, leading to death. More intensive agent such as FK506 would be necessary in those cases of dermatomyositis-related interstitial lung disease that have poor prognostic factors.
Subject(s)
Adult , Female , Humans , Cyclophosphamide , Dermatomyositis , Dyspnea , Lung Diseases, Interstitial , Muscle Weakness , TacrolimusABSTRACT
Pneumatosis cystoides intestinalis is an uncommon condition of unknown etiology, characterized by the presence of multiple gas filled cysts in the gastrointestinal tract. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical, pulmonary, and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. The condition has been associated with the therapeutic uses of lactulose, steroids, and various cancer chemotherapeutic regimens. Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. There are three previous case reports suggestive of lactulose causing pnumatosis intestinalis. We report a case of recurrent pneumatosis cystoides intestinalis associated with benign recurrent pneumoperitoneum developed probably secondary to lactitol therapy.
Subject(s)
Adult , Female , Humans , Cathartics/adverse effects , Pneumatosis Cystoides Intestinalis/diagnosis , Pneumoperitoneum/complications , Recurrence , Sugar Alcohols/adverse effects , Tomography, X-Ray ComputedABSTRACT
Metastatic tumors of the patella are rare, espicially metastasis of the head and neck carcinoma to the patella is exceedingly rarer still. We experienced a case of patellar metastatic cancer from laryngeal squamous cell carcinoma and report the clinical, radiographic and pathologic findings in detail.
Subject(s)
Carcinoma, Squamous Cell , Head , Larynx , Neck , Neoplasm Metastasis , PatellaABSTRACT
PURPOSE: We report the differences of the clinical outcome of various types of plantar fasciitis patients who were treated with conservative methods, and their sonographic findings. MATERIALS AND METHODS: 37 patients, 50 cases with the diagnosis of plantar fasciitis were available for review. The average age was 47.5 years (range: 22-78) and the average follow-up period was 15.8 months (range: 4-23) . Both feet of 30 plantar fasciitis patients and those of 30 healthy volunteers were evaluated with ultrasound. We treated the patients with stretching of Achilles tendon and plantar fascia, rest, nonsteroidal anti-inflammatory drugs, inserts and night splint. RESULTS: Clinical results were classified as good (resolution of symptoms) for 59.5%, fair (continued symptoms but no limitation of activity or work) for 35.1%, and poor (continued symptoms limiting activity or changing work status) for 5.4%. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis (range: 3.2-8.0 mm, average: 5.1 mm, SD: 1.12) than in their asymptomatic heels (range: 1.3-5.0 mm, average: 3.5 mm, SD: 0.78) and in the control group (range: 1.8-5.0 mm, average: 3.0 mm, SD: 0.71) (p< 0.0001) . CONCLUSION: In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechoic. And there is a higher risk for continued symptoms in patients with bilateral symptoms and those who have symptoms for a prolonged period before seeking medical attention. Therefore plantar fasciitis is thought that it should be vigorously treated as soon as possible before the permanent change of plantar fascia.
Subject(s)
Humans , Achilles Tendon , Diagnosis , Fascia , Fasciitis, Plantar , Follow-Up Studies , Foot , Healthy Volunteers , Heel , Splints , UltrasonographyABSTRACT
PURPOSE: To determine the incidence of asymptomatic bacteriuria in Korean preschool children, we performed national survey. MATERIALS AND METHODS: We surveyed kindergardens in seven representative cities of Korea. Before performing urine culture, we selected children by urine dipstick screening method(leukocyte esterase and nitrite test). And we analysed the incidence according to sex, age and socioeconomic status. RESULTS: Total registered population was 2,239 children and male to female ratio was 1.16. Overall, asymptomatic bacteriuria was found in 1.03%(23 children). In the male the incidence was 0.3%(3 children) and in the female it was 2.0%(19 children). Less than 4 years old children showed higher incidence (2.9%) than those of any other age groups, such as, 0.5% in 4, 1.1% in 5 and 1.3% in 6 years old. High, middle and low socioeconomic status groups showed the incidence as 0%, 0.9% and 1.4%, respectively The number of leukocyte esterase positive children was 184(8.2%) and that of nitrite positive children was 115(5.1%). Among them urine culture was performed in 175children and 23 children showed significant bacteriuria(colony count> 100,000/ml), so predictability of asymptomatic bacteriuria by dipstick test was 13.1% Radiologic study was performed in 9 children who had bacteriuria, but none of them showed urological abnormalities. CONCLUSIONS: From the above data, we found that asymptomatic bacteriuria is more common in female, younger age and lower socioeconomic status among the Korean preschool children. Considering cost-benefit aspects of the screening for asymptomatic bacteriuria, however, we should re-evaluate the necessity of our study on these particular age groups.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Bacteriuria , Incidence , Korea , Leukocytes , Mass Screening , Social ClassABSTRACT
PURPOSE: Ethanol is known to induce bladder neck contraction so that it may cause acute urinary retention in patients with benign prostatic hyperplasia. We investigated whether ethanol has a-sympathomimetic effects in the bladder neck. MATERIALS AND METHODS: 36 New Zealand rabbits weighing from 2.5-3.0kg were used for this experiment. The rabbits were sacrificed by air embolism and the urinary bladder was immediately removed. The urinary bladder was dissected free from surrounding tissues and divided into the bladder body and neck in oxygenated Tyrode's solution. The bladder neck muscle strips were taken and the contractile responses to electrical field stimulation(2, 4, 8, 16 and 32Hz) and phenylephrine(1 mM), adenosine triphosphate(ATP, 100mM) and KCI(100mM)were measured. RESULTS: The frequency-response curve by electrical stimulation in ethanol pretreated Tyrode's solution were attenuated, but tonic contractions were not affected. ATP induced contraction was also attenuated. Ethanol showed relaxing effects in the contractile responses elicited by phenylephrine and KCI. CONCLUSIONS: From these studies, ethanol is shown to exert direct inhibitory action on bladder neck contraction presumably by lowering the calcium sensitivity of the smooth muscle in the rabbit.
Subject(s)
Humans , Rabbits , Adenosine , Adenosine Triphosphate , Calcium , Electric Stimulation , Embolism, Air , Ethanol , Muscle, Smooth , Neck Muscles , Neck , Oxygen , Phenylephrine , Prostatic Hyperplasia , Urinary Bladder , Urinary RetentionABSTRACT
Percutaneous nephrostomy was done in 18 cases for ureteral obstruction secondary to advanced pelvic malignancy from Jan.1990 to Apr.1993. The most common site of the primary malignancy was cervix ( 77% ). The mean survival time after diversion was 4.2 months ; 22.2% (4/18) of the patients lived more than 6 months, and 1 patient is alive at 4 months. In 4 patients the renal function was not improved, whose mean survival time was 1.4 months. We consider that close. periodic follow-up is mandatory to detect the ureteral obstruction in patients With malignant pelvic tumor and early management may improve the survival time. The patients who had previously urinary diversion for unilateral ureteral obstruction should be evaluated periodically for contralateral renal function. However, the exact criteria for the selection of patients for urinary diversion is, not obvious.
Subject(s)
Female , Humans , Cervix Uteri , Follow-Up Studies , Nephrostomy, Percutaneous , Pregnenolone Carbonitrile , Survival Rate , Ureter , Ureteral Obstruction , Urinary DiversionABSTRACT
Extracorporeal shock wave lithotripsy (ESWL) is a non-contact, non-invasive technique for disintegrating urinary tract calculi into sand-sized particles which can be passed spontaneously by a patient during normal urine flow. ESWL with an Edap lithotriptor which uses piezoelectric elements, was performed in 465 cases with urinary calculi from May 1987 to October 1988. The overall success rate of ESWL in 465 cases was 92.7% and renal stones were more successfully (95.9%) treated than ureteral stone (86.7%) main complications of ESWL for urinary calculi were hematuria (70.8%), hypertension(8.0 %). renal colic (2.6%), ileus (2.5%) and fever (1.2%) and then they were controlled without specific treatment. ESWL using ultrasonic localization was effective for treatment of the urinary stones.
Subject(s)
Humans , Calculi , Fever , Hematuria , Ileus , Lithotripsy , Renal Colic , Shock , Ultrasonics , Ureter , Urinary Calculi , Urinary TractABSTRACT
Rigid ureteroscopy is now an established technique for the management of ureteral stones and the diagnostic procedure of ureteral lesions. From July 1987 to August 1988, 23 patients underwent transurethral ureteroscopic procedure. The following results were obtained. 1. The success rates of ureteral stone removal were 84.6 %(11 among 13 cases) in lower ureter, 66 % (2 among 3 cases) in mid ureter and 50 % (2 among 4 cases) in upper ureter. In diagnostic procedure, the success rate was 100 % (3 among 3 cases). Overall success rate was 78.3 % (18 among 23 cases). 2. The success rates were 70 % (7 among 10 cases) of smaller than 1 cm and 80 % (8 among 10 cases) of larger than 1 cm. 3. Anesthetic methods were general(47.8 %), spinal (21.7 %) and epidural (30.8 %). 4. Average operating time was 118 minutes(from 40 minutes to 240 minutes) and mean hospitalization was 5.2 days. 5. Operative failure occurred in 4 cases : a case of false instrumental handling, a case of upward migration, a case of ureteral perforation and a case of severe ureteral kinking. 6. Complications occurred in 4 cases : a case of ureteral avulsion, a case of stone migration, a case ofureteral perforation and a case of flank pain for 2 weeks.