ABSTRACT
Rhabdomyolysis is defined as necrosis of the skeletal muscle fibers with release of the intracellular muscle constituents, including myoglobins,into the blood and urine. Severe myoglobinemia causes obstruction and necrosis of the renal tubule, resulting in acute renal failure (ARF). In this case, a patient with rhabdomyolysis-induced ARF was in recovery phase after treatment with fluid replacement and continuous renal replacement therapy (CRRT). However, a sudden relapse of severe myoglobinemia occurred during CRRT. To remove myoglobinas rapidly as possible, we applied two sessions of plasmapheresis (total plasma exchange, TPE) in addition to CRRT for two days. The myoglobin level of the patient successfully decreased by 91%, and clinical symptoms and laboratory-measuredabnormalities subsequently improved. If severe myoglobinemia is persistent, or if relapse in spite of CRRT occurs, it would be reasonable to consider TPEas an additional therapy.
Subject(s)
Humans , Acute Kidney Injury , Muscle Fibers, Skeletal , Myoglobin , Necrosis , Plasma Exchange , Plasmapheresis , Recurrence , Renal Replacement Therapy , RhabdomyolysisABSTRACT
Beauveria bassiana is a hyaline Hypomycetes, which is known as an insect pathogen causing infections in silkworm. It is a rare opportunistic pathogen of human accounted for pulmonary infection, keratitis, and deep tissue infection. We report the first case of B. bassiana keratitis in Korea. A 64-year-old man with a 10-year history of herpetic keratitis was referred for the treatment of infectious keratitis in the right eye. Corneal scrapings showed septate hyaline hyphae on calcoflour white-KOH preparation and their cultures grew B. bassiana. At the beginning, the patient was treated empirically with an antiviral and antibiotics, and then the treatment was changed with antifungal agents including voriconazole, when the culture results were available. Since the inflammation had been aggravated despite medical treatments, he underwent a penetrating keratoplasty (PKP). The excised button of cornea showed the hyphae. The treatment with voriconazole was continued until 2 months after PKP, and fungal keratitis did not relapse during a 6-month follow-up period.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Antifungal Agents , Beauveria , Bombyx , Cornea , Follow-Up Studies , Fungi , Hyalin , Hyphae , Inflammation , Insecta , Keratitis , Keratitis, Herpetic , Keratoplasty, Penetrating , Korea , RecurrenceABSTRACT
Primary cervical neuroblastoma is very rare disease in neonates and should be distinguished with other diseases, which cause stridor in neonate, including laryngomalacia, vocal cord paralysis, laryngeal web, laryngotracheal esophageal cleft, laryngotracheal stenosis, etc. It is characterized by cough, stridor, dysphagia, neck mass, Horner syndrome and heterochromia iridis. Survival rate is high even in the advanced cases, in which the residual mass is remained after partial resection, without further therapy. A 1-day-old girl showed severe dyspnea with inspiratory stridor after birth. At first, she was misdiagnosed as a case of laryngomalacia, but later proved to have stage I primary neuroblastoma by plain X-ray film of lateral view of the neck, flexible nasolaryngoscopy, and computerized tomography. She has been well without relapse after total resection for 1 (1/2) year. We report this case as the first case in Korea.
Subject(s)
Female , Humans , Infant, Newborn , Constriction, Pathologic , Cough , Deglutition Disorders , Dyspnea , Horner Syndrome , Korea , Laryngomalacia , Neck , Neuroblastoma , Parturition , Rare Diseases , Recurrence , Respiratory Sounds , Survival Rate , Vocal Cord Paralysis , X-Ray FilmABSTRACT
BACKGROUND AND OBJECTIVES: Tracheotomy, although an inevitable procedure in some situations, is often avoided in pediatrics for its frequent and serious complications. So, authors studied clinical characteristics of tracheotomy as observed in pediatrics. MATERIALS AND METHODS: 138 children who underwent tracheotomy during the past twenty years since 1977 were investigated. We analyzed distribution of age and gender, annual frequency, causative disorders for tracheotomy and complications. RESULTS: 1) Number of tracheotomy performed tended to be decreased with time: 2) Tracheotomy was performed two times more frequently in males than in females, and most frequently below eight years old: 3) Most frequent causative disease was head injury (27.5%): 4) Most frequent indication of tracheotomy was ventilator support (49.3%): 5) The history of endotracheal intubation before tracheotomy was 86.2%: 6) The complications of the tracheotomy developed in 39.9%, with the most frequent complications being granulation formation (18.1%), followed by tracheal stenosis (17.4%). 7) Frequency of late complication was relatively lower in the shorter intubation period group (22.9%) than in the longer intubation period groups (51.5% and 33.3%): 8) Late complications were lower in the group who had not been supported by a ventilator: 9) Late comlications did not occurre in cases who were decannulated before 1 month. CONCLUSION: We found that factors associated with complications were duration of endotracheal intubation before tracheotomy, history of ventilator care and timing of decannulation.
Subject(s)
Child , Female , Humans , Male , Craniocerebral Trauma , Intubation , Intubation, Intratracheal , Pediatrics , Tracheal Stenosis , Tracheotomy , Ventilators, MechanicalABSTRACT
Four clinical patterns of generalized pustular phase were apparent and have been named the Zumbusch, annular, localized and exanthematic types. Other reported 10 types of pustular psoriasis including the poriasis with generalized pustules. We report a case of psoriasis with generalized pustules in a 18-year-old women, who has numerous scattered pustules with mild fever and leukocytosis. She was treated sucessfully with tetracycline 2.0 gm a day for 4 wks.