A Case of Post-radiotherapy Urethral Stricture with Spontaneous Bladder Rupture, Mimicking Obstructive Uropathy due to Cancer Metastasis

Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.

The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients

BACKGROUND: The composite summary score (range, 0-24) of abdominal aortic calcification (AAC) devised by Kauppila et al is a simple method of assessing AAC severity. However, few studies have been conducted to determine an optimal AAC cutoff score for the prediction of mortality or to investigate the relation between mineral metabolism and AAC progression using the scoring system. METHODS: The medical records of 112 patients on hemodialysis who had undergone simple lateral lumbar radiography every 6 months from August 2009 were reviewed. Patients were followed until November 2012, and the relationship between the degree of AAC at baseline and mortality was evaluated. In addition, the relationship between the progression of AAC and serum concentrations of calcium and phosphate was evaluated in the 75 patients who were successfully followed until November 2012. RESULTS: The mean AAC score at baseline was 5.5+/-4.8, and the cutoff calcification score for the prediction of mortality was 7.75 (sensitivity=61%, specificity=81%). Patients were allocated to Group A (baseline total calcification score 8.0, n=27), and multivariate analysis showed that Group B was an independent risk factor of all-cause mortality and cardiovascular events. Of the 75 patients successfully followed, 51 showed AAC progression (Group 1) and 24 showed no change or improvement (Group 2). Group 1 was found to have significantly higher mean serum corrected calcium levels during the 2nd year and 3rd year of follow-up than Group 2. Furthermore, repeated-measures analysis of variance showed higher monthly corrected calcium concentrations (P=0.099) and mean corrected calcium levels during the 1st year, 2nd year, and 3rd year of follow-up (P=0.062) in Group 1, but without statistical significance. The cutoff values of mean corrected calcium of the 2nd year and 3rd year for the prediction of AAC progression during follow-up years were 8.96mg/dL and 9.45mg/dL, respectively. Serum phosphate levels and corrected calciumxphosphate values were similar in Groups 1 and 2. CONCLUSION: Patients with an AAC score of>8 at baseline seem to be at higher risk of mortality during follow-up. Of the serum variables examined, such as corrected calcium, phosphate, and corrected calciumxphosphate, corrected calcium was found to be marginally associated with AAC progression. However, a larger-scale prospective study is required to confirm our findings.

A case of biopsy-proven chronic kidney disease on progression from acute phosphate nephropathy

Acute phosphate nephropathy (APhN) following oral sodium phosphate solution (OSP) ingestion as a bowel purgative has been frequently reported. It was recently suggested that APhN could progress to chronic kidney disease (CKD) and a history of APhN might be considered as one of the causes of CKD. However, there are few reports proving APhN as a cause of CKD. Here, we report a case of APhN that progressed to CKD, as proven by renal biopsy.

The Use of Single-pass Albumin Dialysis to Correct Severe Hyperbilirubinemia in Acute Hepatitis A: A Case Report / 대한신장학회지

In cases of acute liver failure or acute or chronic liver failure, extracorporeal albumin dialysis utilizing a Molecular Adsorbent Recirculating System has been used to treat liver failure and to reduce serum total bilirubin concentrations as a bridge therapy until either liver transplantation or spontaneous recovery. However, the procedure is expensive and is not easily administered in clinical practice. Recently, single pass albumin dialysis (SPAD) using continuous renal replacement therapy was introduced, but information is scarce regarding its efficacy in controlling serum bilirubin. The authors report a case of acute hepatitis A, in which SPAD was performed to correct severe hyperbilirubinemia.

Plasmablastic Lymphoma in a Human Immunodeficiency Virus-negative Patient: A Case Report and Review of the Literature / 대한혈액학회지

The plasmablastic lymphomas (PBLs) are an aggressive group of non-Hodgkin's lymphomas occurring primarily in human immunodeficiency virus (HIV)-infected individuals with absolute CD4 counts less than 200 per microliter. It was considered to be a diffuse large B-cell lymphoma with a unique immunophenotype and occurred primarily in the oral cavity. Recent studies report that PBLs also occur in patients without HIV infection. Herein we report an unusual case of plasmablastic lymphoma presenting in nasal cavity in a 74-year-old, HIV-negative woman. Cytologic and histologic examinations demonstrated a large cell lymphoma with plasmacytic differentiation. The tumor cells were positive for CD79a, CD38, however lacked expression of leukocyte common antigen, T-cell, and B-cell markers. Epstein-Barr virus-encoded RNA transcripts were identified by in situ hybridization. To our best knowledge, this is the second case of plasmablastic lymphoma in HIV-negative patient in Korea.

A Case of Pseudomembranous Colitis Associated with Rifampicin Therapy in a Patient with Rectal Cancer and Gastrointestinal Tuberculosis / 대한소화기학회지

Pseudomembranous colitis (PMC) is known to be associated with the administration of antibiotics which alter normal gastrointestinal flora and allow overgrowth of Clostridium difficile. Most cases of rifampicin-induced PMC are seen in patients with pulmonary tuberculosis, but not with gastrointestinal tuberculosis. We report a case of PMC associated with rifampicin therapy in a patient with gastrointestinal tuberculosis. A 65-year-old female patient with rectal cancer and gastrointestinal tuberculosis was admitted due to abdominal pain and diarrhea. She was treated with anti-tuberculosis agents containing rifampicin. On colonoscopic examination, mucoid exudates and yellowish plaque lesions were observed. Anti-tuberculosis agents were stopped, and the patient was treated with metronidazole. Symptoms were relieved and did not recur when all the anti-tuberculosis agents except rifampicin were started again. When a patient complains of abdominal pain or diarrhea while taking rifampicin, the physician should consider the possibility of rifampicin-associated PMC.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.