Case of Acute Methemoglobinemia Caused by Nitrobenzene Ingestion / 대한내과학회지

Nitrobenzene is a poisonous agent, not commonly encountered in clinical practice, which belongs to the aniline dyes. Ingestion of nitrobenzene may cause methemoglobinemia, a condition in which the iron in hemoglobin is oxidized from the ferrous state to the ferric state, resulting in the inability to transport oxygen. A 41-year-old man presented with the clinical features of methemoglobinemia after drinking nitrobenzene. The patient was treated conservatively with intravenous methylene blue. We report a case of acute methemoglobinemia due to ingestion of nitrobenzene.

A Case of Asymptomatic, Localized, and Idiopathic Diffuse Alveolar Damage / 결핵및호흡기질환

Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.

A Case of Mycobacterium kansasii Lymphadenitis in HIV-infected Patient

Nontuberculous mycobacteria (NTM) are widely present in the environment, although they rarely cause infection in humans. However, infection by NTM has been increasingly recognized worldwide in the context of the human immunodeficiency virus (HIV) epidemic and therapeutic immunosuppression. Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium, which mainly causes pulmonary infection in patients with predisposing lung diseases, and, occasionally, disseminated infection with poor outcomes in immunocompromised patients. We report on the first case of lymphadenitis caused by infection with M.kansasii in an HIV-infected patient in Korea. The patient showed significant improvement after receiving antituberculous therapy (isoniazid, rifabutin) in combination with surgical drainage and highly active antiretroviral therapy (abacavir, lamivudine, and lopinavir/ritonavir).

Lymphobronchial Fistula of Tuberculous Lymphadenitis in Acquired Immunodeficiency Syndrome

Bronchial invasion of tuberculous lymphadenitis in children has been reported in areas of high tuberculosis (TB) prevalence as a complication due to primary pulmonary tuberculosis. However, it is rare in immunocompetent adults. When it appears, it often presents as a consequence of the reactivation of TB in the lung parenchyma. Primary TB occurs more frequently in patients with human immunodeficiency virus (HIV), with a history of organ transplants, or undergoing immunosuppressive treatments such as steroids. Furthermore, bronchial invasion of the bronchus by tuberculous lymphadenitis is considered to be very rare even among immunocompromised adults with primary TB, and has never before been reported in Korea. The authors report a case of bronchial invasion of the bronchus by tuberculous lymphadenitis, confirmed by bronchoscopy, in an Acquired Immunodeficiency Syndrome (AIDS) patient.

Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients

BACKGROUND: The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide (BNP) level in predicting postoperative in-hospital major adverse cardiac events (MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery. METHODS: Between March 2010 and September 2011, data from 156 patients (aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria. RESULTS: MACE occurred in 12 patients (7.7%). The BNP level was significantly higher in patients with MACE than in those without (median, 152.0; interquartile range [36.3 to 352.8] pg/mL vs. median, 36.8; interquartile range [15.5 to 98.1] pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score (r=0.300, p=0.001). In a receiver operating characteristic (ROC) analysis for MACE, the ROC for BNP was 0.746 (95% confidence interval, 0.602 to 0.891). At the optimal cut-off point (BNP=110 pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE (odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident. CONCLUSION: The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery.

Adherence of Slime / 대한정형외과학회잡지

There were many studies to investigate the pathogenesis and prevention of infection in artificial joint replacement due to the difficulty in management of infected arthroplasty in spite of using large amounts of antibiotics. Biomaterials play a major role in the development of infection because of the way the body responds to their chemical and physical characteristics. Exopolysaccharide glycocalyx or biofilm(slime) which is produced by organisms adhered to the biomaterials has been detected and regarded as an important factor in pathogenesis. The production of slime on the biomaterials in turn makes the pathogens resistant to the antibiotics and therefore they survive. The objects of this study are to evaluate which materials are more susceptible to the adherence by Staphylococcus epidermidis, to evaluate the amount of antibiotics needed to kill the S. epidermidis adhered to the biomaterials(Polymethymethacrylate, Titanium-6Aluminum-4Vanadium alloy, Ultrahigh molecular weight polyethylene), and to evaluate the timing of administration of the antibiotics(cephradine, gentamicin) and potadine for prevention of postoperative infection. The results are as follows. 1. The materials in order of greatest adherence due to the number of organisms colonized are poly- methylmethacrylate(PMMA), ultrahigh molecular weight polyethylene(UHMWPE), and titanium alloy(Ti-6A1-4V alloy) being the least adherent. 2. With the production of biofilm the S. epidermidis becomes resistant to even that of 4 times the minimum bactericidal concentration(MBC) of antibiotics. 3. For prevention of postoperative infection, the prophylactic administration of cephradine if effective when used within 4 hours after contamination and the gentamicin and potadine are effective when used within 8 hours after the contamination with S. epidermidis.