Two Cases of Acute Respiratory Distress Syndrome with Pulmonary Hemorrhage Induced by Injection of Silicone at Perineum / 결핵

Silicone fluid is a biomaterial widely used in modern cosmetic procedures because there are few side effects, considerable chemical stability and predictable physical properties. However, many local and systemic adverse reactions have reported. In particular some serious pulmonary complications have been reported such as pulmonary thromboembolism, acute respiratory distress syndrome with some cases leading to mortality. Most of the serious complicated cases were induced by an illegal silicone fluid injection. We experienced two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone fluid injection. The patients were 41 & 51 year old women, who complained of dyspnea. The chest X-ray and HRCT scan findings showed a bilateral ground glass attenuation on the bilateral dependent portion of the upper and middle lung zone. The patients clinical symptoms and the radiologic and other laboratory findings were compatible with acute respiratory distress syndrome induced by the silicon fluid injection. Here we report two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone injection with a review of the relevant literature.

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.

Pulmonary Infection after Kidney Transplantation / 대한이식학회지

The infectious complications after renal transplantation remain as an important causes of both mortality and graft loss. The lung is the most common target for post-transplant infection. We analyzed the causative agents, treatments and outcomes of post-transplant pulmonary infections. From 1990 to 1998, 192 renal allografts were performed at Hallym University Hospital. Seven cases (3.6%) of 5 males and 2 females developed serious pulmonary infections and required hospitalization. The mean age was 42.6 years. The onsets of pulmonary infections were from a month to 6 months in 3 cases, from 6 months to a year in one case and after a year in 3 cases. Triple therapy regimen was used in 4 cases as an immunosuppression therapy. Acute rejections developed in 6 cases. Causative organisms were Cytomegalovirus in 2 cases, Mycobacteria in 2 cases, Aspergillus in a case, Nocardia in a case and unknown in a case. Despite appropriate antibiotics, four patients did not respond to the treatment and died. The early recognition of infection and appropriate therapy is important to reduce fatal consequence.

Clinical Experience of Kidney Transplantation in the Hallym University Hospital / 대한이식학회지

Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out of which were lost during follow-up period and excluded from the study. The mean age of recipients was 37.1 years. The male to female ratio was 1.5:1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%) and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and 43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22 cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at 1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5% at 3 year span.

An Analysis of the Process to Organ Donation in Brain-dead Patients / 대한이식학회지

Organ procurements were performed in 9 brain-dead patients at our hospital since 1995. They were 7 males and 2 females. The causes of brain death were trauma in 7 patients and CVA in 2 patients. When brain death was confirmed, hypernatremia over 145 mEq/L was showed in 6 and hypothermia in all. Blood transfusion was done in 6 patients for correction of anemia preoperatively. The time intervals from brain death confirmation to organ procurement were from 1 hour to 2 days. Multi-organ harvests were done in 4 patient, 60 year-old female and 2 patients who received the cardioversion before harvest were given up to procure liver and heart preoperatively. And 2 patients were not procured heart and liver because of pathologic findings of intraoperative frozen biopsy. Among 22 recipients, 1 kidney recipient died postoperatively. We conclude that the intensive care should be performed in the brain dead donor for multi-organ harvest and better results of organ transplantations. Beside the organ procurement and transplantation team, another intensive care team for brain dead donor should be composed if possible.

Wilms' tumor:Changes of CT findings after chemotherapy

When the tumor is advanced with distant metastasis or unresectable initially, preoperative chemotherapy could be applied in the treatment of Wilms' tumor We experienced 6 cases of favorable type of Wilms' tumor, 1 case of clear cell sarcoma and 1 case of renal cell carcinoma. They were treated with preoperative chemotherapy and underwent CT Scans before and after the therapy. Pathologic changes after chemotherapy in Wilms' tumor were known from previous reports as subtotal hemorrhagic necrosis, cystic change, clusters of foamy histiocytes, granulation tissue formation, primitive nephrogenic tissues and peripherally remained focal areas of blastemal infiltration. Changes of CT findings after chemotherapy were internal necrosis(6/6), decrease in size(5/6), decrease and absence of regional lymph node enlargement(4/6) and improved or disappeared metastatic lesions(3/3). Although our study had some limitations such as small numbers of cases and all cases were favorable types, we thought that there were good correlations between change of CT findings and subtotal hemorrhagic necrosis after preoperative chemotherapy in Wilms' tumor.