RESUMEN
Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Gastrointestinal (GI) mucormycosis is very rare and occurs primarily in highly malnourished patients, especially in infants and children. A 55-year-old man with end-stage renal disease due to diabetic nephropathy, who had undergone deceased donor kidney transplantation 2 years prior, complained of abdominal pain and distension with a 3-day duration. Computed tomography revealed diffuse gastric wall thickening, and a huge amount of grey colored necrotic debris surrounded by erythematous erosive mucosa was observed at the antrum to upper body by GI endoscopy. The microscopic examination obtained from a GI endoscopic specimen demonstrated peptic detritus with numerous non-septate mucor hyphae in the mucosa and submucosa. Mucormycosis was diagnosed based on the clinical findings and morphological features. A total gastrectomy was performed and an antifungal agent was administered. A microscopic examination of the surgical specimen demonstrated invasive mucormycosis with numerous fungal hyphae with invasion into the mucosa to subserosa. The patient and graft were treated successfully by total gastrectomy and antifungal therapy.
Asunto(s)
Niño , Humanos , Lactante , Persona de Mediana Edad , Dolor Abdominal , Nefropatías Diabéticas , Endoscopía , Gastrectomía , Hifa , Fallo Renal Crónico , Trasplante de Riñón , Riñón , Mucor , Mucormicosis , Membrana Mucosa , Estómago , Donantes de Tejidos , Receptores de Trasplantes , TrasplantesRESUMEN
This correction is being published to correct the order of the first and second authors' names in the above article.
RESUMEN
Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Mucormycosis of the gastrointestinal tract manifests with features similar to ischemic colitis. A 48-year-old man with end-stage renal disease due to diabetic nephropathy underwent deceased donor kidney transplantation. He complained of abdominal pain and distension on postoperative day 17. A computed tomography (CT) scan revealed symmetrical wall thickening of the ascending colon, which was consistent with ischemic colitis. However, a follow-up CT scan showed a localized wall-off colon perforation in the hepatic flexure and segmental mural gas in the ascending colon. Microscopic examination obtained from a surgical specimen demonstrated numerous fungal hyphae and spores in the mucosa and submucosa. A total colectomy was performed, but the patient died 36 days later due to multiple organ failure, despite antifungal agents. Clinicians should be informed about fungal infection, such as colonic mucormycosis mimicking ischemic colitis, in kidney transplant patients with diabetes mellitus, and treatment should be initiated at the earliest.
Asunto(s)
Humanos , Persona de Mediana Edad , Dolor Abdominal , Antifúngicos , Colectomía , Colitis Isquémica , Colon , Colon Ascendente , Diabetes Mellitus , Nefropatías Diabéticas , Estudios de Seguimiento , Tracto Gastrointestinal , Hifa , Fallo Renal Crónico , Trasplante de Riñón , Riñón , Mucormicosis , Membrana Mucosa , Insuficiencia Multiorgánica , Esporas , Donantes de Tejidos , Tomografía Computarizada por Rayos X , Receptores de TrasplantesRESUMEN
Drug-induced interstitial nephritis is one of the causes of acute kidney injury. Although methomyl is widely used as an insecticide in many countries, methomyl-induced interstitial nephritis has not been reported thus far in the general population. We report a case of a 39-year-old male patient with acute allergic tubulointerstitial nephritis due to methomyl intoxication. He took methomyl 250 mL to commit suicide. He was treated with hemodialysis, but his renal function continued to deteriorate. Kidney biopsy demonstrated mononuclear cell and some eosinophils infiltration into the renal interstitium with tubular invasion. Immediate steroid pulse therapy, appropriate education, and conservative management resulted in gradual restoration of his renal function. This case suggests that methomyl may be a causative allergen inducing acute interstitial nephritis in some patients.
Asunto(s)
Adulto , Humanos , Masculino , Lesión Renal Aguda , Biopsia , Educación , Eosinófilos , Riñón , Metomil , Nefritis , Nefritis Intersticial , Diálisis Renal , SuicidioRESUMEN
Although tumor necrosis factor (TNF)-alpha antagonist is a successful treatment modality for various autoimmune diseases, including rheumatoid arthritis (RA), ankylosing spondylitis and psoriatic arthritis, many adverse effects have been reported. Cutaneous adverse reactions of TNF-alpha antagonist include skin rash, urticaria, lupus like rash, seborrheic dermatitis and different kinds of psoriasiform dermatitis. We report a case of psoriasiform dermatitis during TNF-alpha antagonist treatment in a 50-year-old woman with RA. The patient has been treated with adalimumab. After 2 months, she developed pruritic erythematous eruption and desquamative lesions on the head and limbs, which were defined as psoriasiform change by a skin biopsy. These skin lesions are successfully treated with combination therapy, including cessation of adalimumab, corticosteroid and phototherapy.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Anticuerpos Monoclonales Humanizados , Artritis Reumatoide , Enfermedades Autoinmunes , Biopsia , Dermatitis , Dermatitis Seborreica , Exantema , Extremidades , Cabeza , Fototerapia , Piel , Factor de Necrosis Tumoral alfa , Urticaria , AdalimumabRESUMEN
Ceramic-on-polyethylene components have better wear characteristics than metal-on-polyethylene components in total hip arthroplasty (THA), and thus, extensive wear resulting in penetration of the femoral head through the acetabular cup is rare after ceramic-on-polyethylene THA. However, several reports have been issued regarding catastrophic polyethylene failure in ceramic-on-polyethylene systems. Here, the authors report the first case of bilateral complete polyethylene wear failure with acetabular cup perforation after ceramic-on-polyethylene THA.
Asunto(s)
Artroplastia , Cerámica , Cabeza , Cadera , Polietileno , TacrinaRESUMEN
Ceramic-on-polyethylene components have better wear characteristics than metal-on-polyethylene components in total hip arthroplasty (THA), and thus, extensive wear resulting in penetration of the femoral head through the acetabular cup is rare after ceramic-on-polyethylene THA. However, several reports have been issued regarding catastrophic polyethylene failure in ceramic-on-polyethylene systems. Here, the authors report the first case of bilateral complete polyethylene wear failure with acetabular cup perforation after ceramic-on-polyethylene THA.
Asunto(s)
Artroplastia , Cerámica , Cabeza , Cadera , Polietileno , TacrinaRESUMEN
Bilateral quadriceps tendon rupture is an unusual injury, but may be encountered in patients with various chronic diseases after minor trauma. This article presents a case of bilateral quadriceps tendon rupture of a 38-year-old woman with chronic renal failure. Surgical repair was performed using a bone tunnel technique with a nonabsorbable suture and a suture anchor. Postoperative magnetic resonance imaging confirmed complete healing of the repair site, and clinically active extension with 120 degrees of range of motion was achieved.
Asunto(s)
Adulto , Femenino , Humanos , Enfermedad Crónica , Fallo Renal Crónico , Imagen por Resonancia Magnética , Rango del Movimiento Articular , Rotura , Anclas para Sutura , Suturas , TendonesRESUMEN
BACKGROUND: Unlike that of adults, depression of adolescents need screening because learning ability, physical growth and social adaptation are seriously affected. But Beck Depression Inventory(BDI), the assessment tool for adults, is generally used for adolescents as well because only few are available. The purpose of this study is to examine the reliability of a Korean version of BDI(K-BDI) as a screening instrument of adolescent depression. METHODS: From May 1, 1998 to June 1, 1998 we visited two high schools (one male, one coeducation) in Sungnam city and K-BDI questionnaires were given. The subjects were 1,107 high school students. This study was to evaluate the reliability of BDI and to find out factor structure through analysis. RESULTS: The sex distribution of subjects was 929(83.9%) males and 178(16.1%) females. Cronbach's internal consistency and Spearman-Brown split half correlation coefficient was 0.85, 0.86, respectively, in the male group, 0.74, 0.86, respectively, in the female group and 0.85, 0.86, respectively,in the total group. By principal axis factoring, 4 factors were extracted. Which were factorI:Negative Self Attitude, factorII:Performance Difficulty, factorIII:Guilty and Psychomotor Retardation, and factorIV:Somatic Symptom. All of the correlations between total BDI score and the individual items showed positive correlation(P<0.001). Average BDI score and prevalence rate was 11.7+/-7.24, 11.4%, respectively, in the male group, 18.51+/-6.65, 34.8%, respectively, in the female group and 12.85+/-7.56, 15.2%, respectively, in the total group. CONCLUSION: The results suggest that the K-BDI is a reliable tool in adolescence. Therefore, it may be used as a screening tool for adolescent depression.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Vértebra Cervical Axis , Depresión , Aprendizaje , Tamizaje Masivo , Prevalencia , Distribución por Sexo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Total intravenous anesthesia(TIVA) with various kinds of sedatives and synthetic analgesics has many advantages such as no air pollution, no hepatic or renal toxicity and good postoperative pain relief compared with inhalation anesthesia. METHODS: TIVA with fentanyl and propofol was applied to the 25 patients in ASA class I and II. The changes of hemodynamics, arterial blood gas, blood sugar level, hepatorenal function and complications were evaluated perioperatively. RESULTS: Systolic blood pressure and mean arterial pressure decreased after induction, but intraoperatively systolic blood pressure became preoperative value while mean arterial pressure increased compared with preoperative value. Heart rate increased after induction and intraoperatively. At recovery room there were no clinically significant changes in the data of arterial blood gas. The blood sugar level slightly increased during postoperative period. There were no clinically significant changes in hepatic or renal function test of postoperative 3rd day compared with preoperative one. The chief complications of TIVA during anesthesia were pain on injection site and slight movement, while nausea or vomiting, dizziness and urinary retention were the major complications at postoperative period. CONCLUSIONS: TIVA with fentanyl and propofol is considered to have good controllability and it can be applied as one of the general anesthesia methods in the case of contraindications to N2O and volatile anesthetics, but further study will be required to quantify the appropriate dosage of propofol or fentanyl to minimize perioperative hemodynamic change and respiratory depression.