Idiopathic Spontaneous Renal Rupture

Spontaneous renal rupture is a rare, but important, clinical problem that heralds a variety of kidney abnormalities. Tumors are the most common cause, followed by vascular disease, infection, nephritis and blood dyscrasia. In some cases, no underlying abnormality of the kidney can be found. The patients usually present with an acute onset of flank pain, a tender mass, and common symptoms and signs of shock. In most cases rapid surgical intervention is necessary and nephrectomy remains the treatment of choice in cases of a ruptured tumor. A 47 year-old female, who had been in good health previously, was hospitalized because of a sudden onset of left flank pain for one day. There was no history of trauma. Physical examination revealed marked tenderness and guarding over the left flank abdomen. A perirenal hematoma on the left side was seen with abdominal sonography. Computerized tomography demonstrated a large perirenal hematoma and a kidney rupture caudally. Selective renal angiography demonstrated an active bleeding over the lower pole, so a coil embolization and nephrectomy were performed. The histological examination of the kidney revealed no underlying abnormality. We report a case of idiopathic spontaneous renal rupture, along with a literature review.

A case of The Primary Aldosteronism with Hypokalemic Periodic Paralysis

Primary aldosteronism is a syndrome characterized by hypertension, hypokalemia, suppressed plasma renin activity, and elevated serum aldosterone levels. Conn first described it 1955 in association with adrenal cortical adenoma(Conn's syndrome). Today, it can be divided into at least six distinctive subgroups. The diagnosis of primary aldosteronism is usually suspected when the patient presents with poorly controlled hypertension with hypokalemia. The main issues in the evaluation of primary aldosteronism are to differentiate an adenoma from hyperplasia and to localize the adenoma. Basic hormonal studies and computed tomographic(CT) scanning can be used effectively for that differentiation. An adenoma is one of a few potentially curable forms of hypertension, and it is best treated by removing the adrenal tumor. We experienced a case of a typical adrenal adenoma. The patient was a 37-year-old male who had experienced in both his legs over a period of several days a weakness due to hypokalemia. He was diagnosed using basic hormonal studies and adrenal CT scanning. After, he received laparoscopic adrenalectomy and was discharged with improved condition.

A Case of Primary Central Nervous System Lymphoma with Panhypopituitarism

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranialspinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5~1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immuno-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.

Cutaneous Graft versus Host Reaction: Clinicopathologic Study / 대한피부과학회지

BACKGROUND: Graft-versus-host disease(GVHD) frequently produces cutaneous and systemic complications in patients receiving allogenic bone marrow transplantation. Familiarity with these reactions and their treatment is important to dermatologists involved in the care of bone marrow transplant recipients. OBJECTIVE: Our purpose was to find the clinical and histopathological features of cutaneous graft versus host reaction(GVHR). METHODS: We retrospectively reviewed patients who had undergone cutaneous GVHR after allogenic bone marrow transplantation in our institute over ten years. RESULTS AND CONCLUSION: 1.We found GVHD in 40% patients with allogenic bone marrow transplantation. 2.There was cutaneous GVHR in 86.5%, liver GVHR in 44.2% and gastrointestinal systems involvement in 34.6% of all GVHD patients. 3.Acute cutaneous GVHR presented as a generalized maculopapular exanthem and chronic cutaneous GVHR appeared as generalized maculopapular eruptions or lichenoid lesions. 4.Histopathologically, in 65.4%(17/26) of acute GVHR showed characteristic changes such as basal cell degeneration, dyskeratotic cells in epidermis, spongiosis, subepidermal cleft, and inflammatory cell infiltration and in 78.3% of chronic GVHR revealed acute GVHR-like or lichenoid change. 5.Treatment of moderate to severe GVHD consisted of high-dose corticosteroids and cyclosporine. There were 23.1% mortality due to sepsis in GVHD patients.

Anti-arrhythmic Effect of Melatonin in Reperfusion-induced Arrhythmia

BACKGROUND: Recently, a few studies demonstrated that melatonin reduced the severity of myocardial reperfusion injuries, such as reperfusion arrhythmias. However, it is uncertain whether the melatonin reduces reperfusion arrhythmias in thus anesthetized animals because results were obtained using isolated hearts. Thus, to see whether melatonin reduces reperfusion arrhythmias in anesthetized animals, we examined the effect of melatonin on the incidence of reperfusion arrhythmias in an anesthetized-cat model of regional ischemia. METHOD: Adult mongrel male cats(n=30, 2.9~4.2 kg) were anesthetized under positive-pressure artificial ventilation with room air. The animals of the control group(n=15) were subjected to 20-minute left anterior descending coronary artery(LAD) occlusion followed by abrupt reperfusion. The animals in experimental group(n=15) were divided into two. Group I(n=6) was pretreated with melatonin, 1 mg/kg, before occluding the LAD. Group II(n=9) was pretreated with melatonin, 10 mg/kg. The animals in experimental group were subjected to ischemia/reperfusion insult following drug treatment: melatonin was applied intra-peritoneally for 3 minutes just before LAD coronary artery ligation. The Fisher's exact test was used to compare the data from different animal groups. p<0.05 was considered significant. RESULTS: The incidence of ventricular fibrillation(VF) during the reperfusion phase in group II(pretreated with melatonin, 10 mg) was significantly smaller than that in the control group(p-value = 0.0029). However, no statistically significant difference of VF incidence was found between group I(pretreated with melatonin, 1 mg) and the control group. CONCLUSION: Employing an anesthetized-cat model of regional cardiac ischemia, we investigated the dose-dependant effects of melatonin on reperfusion-induced arrhythmia. The cats pretreated with 10 mg/kg of melatonin before ischemia had a significantly reduced incidence of lethal reperfusion-induced arrhythmia, but there was no difference between the cats pretreated with 1 mg/kg of melatonin before ischemia and the control group.

Protective effect of 17beta-Estradiol Against Reperfusion Arrhythmias in Cats

BACKGROUND: Although reperfusion certainly prevents tissue ischemia from possible cardiac death, several lines of evidence suggest that reperfusion may paradoxically aggravate the frequency of serious reperfusion-induced lethal arrhythmias. It has been reported that acute administration of estrogen at physiological concentrations reduced with myocardial ischemic injury in women with coronary heart disease. In studies with canines, acute administration by either the intra-muscular or the intra-coronary route similarly prevented ischemia and reperfusion dysrhythmias and also reduced the infarct size because the estrogen increased the distal coronary perfusion pressure, scavenged free radicals and had other effects during both ischemia and reperfusion. However, the canine heart is notoriously well collateralized. 17beta-estradiol induces very little vasorelaxation in cat coronary rings, suggesting that increased ischemic myocardial blood flow dose not contribute to the protective effect. In the present study, employing a cat model of regional cardiac ischemia, we examined whether reperfusion rendered after acute administration of 17beta-estradiol could lower the incidence of reperfusion-induced lethal arrhythmia and the death rate. METHOD: Adult mongrel male cats(n=31, 2.7~4.5 kg) were anesthetized under positive-pressure artificial ventilation with room air. Electrocardiograms were recorded. The animals of the control group(n=15) were subjected to 20-minute left anterior descending coronary artery(LAD) occlusion followed by abrupt reperfusion. The animals in the experimental 17beta-estradiol(2 or 20 microgram/kg) group were subjected to ischemia/reperfusion insult following drug treatment: 17beta-estradiol was applied intravenously within the 60 seconds just before LAD ligation followed by abrupt reperfusion. The Fisher's exact test was used to compare the data from different animal groups(p<0.05). RESULTS: The number of arrhythmias(ventricular premature beat, ventricular tachycardia and ventricular fibrillation) emerging during the reperfusion phase were not statistically different from that in the control group. The death rate in the 17beta-estradiol 20 microgram/kg group was lower from that in the control group(P value = 0.039). CONCLUSION: Acute administration of 17beta-estradiol at a supraphysiological concentration might produce cardioprotective effects, not by modificating the coronary blood flow into the threatened myocardial region, but by other mechanisms that directly or indirectly increase the intrinsic myocardial ischemic tolerance in the cat during the reperfusion phase.