ABSTRACT
Hypertriglyceridemia (HTG) is a rare but well known cause of acute pancreatitis (AP), which can be a life- threatening complication if the degree of HTG is severe enough. It might be primary in origin or secondary to alcohol abuse, diabetes mellitus, pregnancy, or drugs. A serum triglyceride (TG) level of more than 1,000 to 2,000 mg/dL in patients with type I, IV, or V hyperlipidemia (Fredrickson's classification) is the identifiable risk factor. HTG-induced AP typically presents as an episode of AP or recurrent AP. The clinical course of HTG-induced AP is not different from other causes. Routine management of HTG-induced AP should be similar to other causes. A thorough family history of lipid abnormalities should be obtained, and an attempt to identify secondary causes should be made. The mainstay of treatment includes dietary restriction of fatty meal and lipid-lowering medications (mainly fibric acid derivatives). Although there are limited experiences with plasmapheresis, lipid apheresis, heparinization and insulin application, these can support the treatment of HTG- induced AP. We report two cases of HTG-induced AP which were successfully treated by plasmapheresis.
Subject(s)
Adult , Humans , Male , Acute Disease , Hypertriglyceridemia/complications , Pancreatitis/etiologyABSTRACT
A recent application of anal endosonography has been popularized in adult patients to access staging of the rectal cancer and other lesions of the anorectum; however, this study has not been familiar to pediatric surgeons. We performed anal endosonography in 30 children without anorectal disease in order to obtain standard morphology of the anorectum. Internal anal sphincter (IAS) was clearly identified as a homogeneous hypoechoic circular band, extending caudally to a level just proximal to anal verge. The external anal sphincter (EAS) showed mixed echogenicity and different architecture along anal canal ; the EAS had U-shape in the upper canal and it showed circular pattern in the lower canal. In the upper canal of girls, the perineal body and the vagina were shown just anterior of the anal canal, which made the U shape of the EAS, whereas in male the sphincter tapered anteriorly into two arcs that met in the midline. The perineal body was prominent in female. Posteriorly, the anococcygeal ligament showed triangular shadow in both sex. The thickness of the IAS was measured in 3 directions, left, right and posterior, at 3 levels, upper, middle and lower of the anal canal. The average thiskness was 0.86-2.40mm between 6 and 18 months of age (Group 1), 0.88-3.20mm between 19 and 36 (Group 2), 1.07-2.20mm between 37 and 54 (Group 3) and 1.18-2.42mm more than 54-month-old (Group 4). The thickness was correlated wtih the age of the children only in the right upper(p=0.008) and the left middle portion (p=0.015). We could obtain standard morphologic features of normal anal canal in children with anal endosonography and we also believe that this technique is a safe and an effective procedure to evaluate anorectal lesions in children.
Subject(s)
Adult , Child , Female , Humans , Male , Anal Canal , Endosonography , Ligaments , Rectal Neoplasms , VaginaABSTRACT
We evaluated the relationship between the clinical and pathologic characteristics in 37 patients with biopsy-proven lupus nephritis. The peak age at onset of the disease was in the 3rd(40.5%) and 4th(32.4%) decades. The male to female ratio was 1 : 8.3. According to the WHO classification, 18 patients(48.6%) were belonged to class IV, 11 patients(29.7%) to class V and 8 patients(21.6%) to class III. At initial evaluation, nephrotic syndrome was observed in 5 patients(62.5%) of class III, 10 patients(55.6%) of class IV, and 3 patients(27.3%) of class V. The hypertension was observed 11 patients (29.7%), among which 7 (38.9%) was belonged to class IV. In patients of class III, IV and V, the mean serum creatinine was within normal limit at initial evaluation, and it was not significant difference at final study. On biopsy, the occurance of anti-DNA antibody and ANA was 63.9% and 89.2%, retrospectively. In 28 patients who were followed for more than 6 months, patients with class III and class V could be managed effectively with oral steroid only, but those with class IV lesion required steroid pulse or oral cyclophosphamide therapy. Interestingly, complete remission was obtained in 4/15 patients(26.7%) of class IV, but none with class III or V. Death had occurred in 3 patients (2 in class IV and 1 in class V). The cause of death was extrarenal complication such as infection and vascular disease. In conclusion, the patients with class IV lupus nephritis showed higher serum creatinine level although not significant, higher incidence of hypertension and progression of chronic renal failure than the other classes. Though the patients with class IV needed for more aggressive treatment with steroid pulse or cyclophosphamide-steroid combination. Thus it is suggested that the improvement of proteinuria and clinical course is possible with careful immunosuppressive therapy in selected cases of class IV lupus nephritis.
Subject(s)
Female , Humans , Male , Biopsy , Cause of Death , Classification , Creatinine , Cyclophosphamide , Hypertension , Incidence , Kidney Failure, Chronic , Lupus Nephritis , Nephrotic Syndrome , Proteinuria , Retrospective Studies , Vascular DiseasesABSTRACT
Light chain deposition disease of kidney is characterized by deposition of monoclonal immunoglobulin light chain and electron-dense material in glomerular and tubular basement membrane and usually associated with multiple myeloma or other plasma cell dyscrasia. With light chain deposition disease affecting kidney, three clinical patterns have been recognized; nephrotic syndrome, rapidly progressive renal failure and slowly progressing chronic renal failure. The majority of patients present proteinuria and renal insufficiency. Cytotoxic therapy has been considered as treatment of choice. Favorable effect of melphalan given together with prednisone has been reported in a few cases. A 64-year-old male was admitted with generalized edema and exertional dyspnea, and was presumptively diagnosed as congestive heart failure and hypertension. He also presented increased serum creatinine and nephrotic range proteinuria. Urine protein electrophoresis and urine and serum immunoelectrophoresis revealed monoclonal gammopathy of IgG kappa type. Work up for multiple myeloma including bone marrow biopsy showed results compatible with smoldering myeloma. Renal biopsy showed findings of light chain deposition disease and Congo-red positive amyloidosis. After we treated the patient with melphalan and predinsone for two cycles, amount of proteinuria and serum creatinine were decreased.