Malignant Hypertension with Pulmonary Alveolar Hemorrhage Needing Dialysis / 이화의대지

A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. His renal function was low, thus emergent renal replacement therapy was required. Malignant hypertension and acute kidney injury were diagnosed, and antihypertensive therapy and hemodialysis started immediately. Renal biopsy was performed to examine the underlying disease. Typical pathological changes of malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endoarteritis at the interlobular arteries were observed. His renal function improved gradually and pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Here, we report this rare case of malignant hypertension with pulmonary alveolar hemorrhage and speculate that the hemorrhage may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.

Regression of a Mucosa-Associated Lymphoid Tissue Lymphoma of the Urinary Bladder After Helicobacter pylori Eradication Therapy in an Elderly Patient

Primary low-grade lymphoma of the mucosa-associated lymphoid tissue (MALT) type lymphoma of the bladder is rare. A relationship between MALT lymphoma of the urinary bladder and chronic cystitis has been proposed by some reports. Additionally a relationship between MALT lymphoma of the urinary bladder and Helicobacter pylori has been reported. Here we present a case of regression of urinary bladder MALT lymphoma after antibiotic therapy, using H. pylori eradication protocol in an elderly patient, who had a high risk of treatment related mortality in curative systemic chemotherapy. The patient is a 74-year-old woman who had a history of chronic cystitis. She was diagnosed with stage IIA primary MALT lymphoma of the urinary bladder and was treated with H. pylori eradication triple therapy for 2 weeks. After 2 months, there was a marked regression of the bladder MALT lymphoma lesion in a computed tomography scan of the abdomen.

Four Cases of Carbapenem-Resistant Enterobacteriaceae Infection from January to March in 2014 / 가정의학회지

Infection with carbapenem-resistant Enterobacteriaceae (CRE) and other multidrug resistant bacteria has increased rapidly in Korea. The Korea Centers for Disease Control and Prevention reported 1,609 cases of CRE infection in the country in 2013. The risk factors for CRE infection include history of treatment with antibiotics such as cephalosporins or carbapenem, trauma, diabetes, cancer, and history of ventilator support. Herein, we report four cases of CRE infection seen during a 3-month period in our hospital in 2014. CRE infection is associated with a high mortality rate of 30% to 50%, even with combination antibiotic therapy. Prevention of CRE infection in hospital settings is fundamental to controlling its transmission. Key preventive measures include, contact precautions, hand hygiene, education of healthcare personnel, screening for CRE when indicated, and exercising discretion in prescribing carbapenem or cephalosporins.

Nanowastes treatment in environmental media

OBJECTIVES: This paper tried to review a recent research trend for the environmental exposure of engineered nanomaterials (ENMs) and its removal efficiency in the nanowaste treatment plants. METHODS: The studies on the predicted environmental concentrations (PEC) of ENMs obtained by exposure modeling and treatment (or removal) efficiency in nanowaste treatment facilities, such as wastewater treatment plant (WTP) and waste incineration plant (WIP) were investigated. The studies on the landfill of nanowastes also were investigated. RESULTS: The Swiss Federal Laboratories for Materials Science and Technology group has led the way in developing methods for estimating ENM production and emissions. The PEC values are available for surface water, wastewater treatment plant effluents, biosolids, sediments, soils, and air. Based on the PEC modeling, the major routes for the environmental exposure of the ENMs were found as WTP effluents/sludge. The ENMs entered in the WTP were 90-99% removed and accumulated in the activated sludge and sludge cake. Additionally, the waste ash released from the WIP contain ENMs. Ultimately, landfills are the likely final destination of the disposed sludge or discarded ENMs products. CONCLUSIONS: Although the removal efficiency of the ENMs using nanowaste treatment facilities is acceptable, the ENMs were accumulated on the sludge and then finally moved to the landfill. Therefore, the monitoring for the ENMs in the environment where the WTP effluent is discharged or biomass disposed is required to increase our knowledge on the fate and transport of the ENMs and to prevent the unintentional exposure (release) in the environment.