Résumé
Bezafibrate, a fibric acid derivative related to clofibrate, is being used increasingly in the treatment of hypertriglycemia. It is relatively well tolerated at usual dosage, and has a low incidence of adverse reactions. But we had recently observed a reversible deterioration of renal function requiring hemodialysis, presumed to be caused by bezafibrate treatment in a patient with diabetic nephropathy. A 55 year old man was admitted with complaints of general weakness and painful lower extremities. He had taken bezafibrate (200 mg every 12 hours) for the previous 4 months because of hypertriglycemia. After admission, the drug was withdrawn, and he was treated conservatively management with hydration and diuretics for bezafibrate induced rhabdomyolysis. Nevertheless, his symptom was not improved, so he was taken even hemodialysis. These findings suggested that bezafibrate should be admistered with great caution to patient with renal insufficiency. When it is admistered, CK, LDH, aldolase, and sGOT levels have to be checked for early detection of potential side effect.
Sujets)
Humains , Adulte d'âge moyen , Aspartate aminotransferases , Bézafibrate , Clofibrate , Néphropathies diabétiques , Diurétiques , Fructose bisphosphate aldolase , Incidence , Membre inférieur , Dialyse rénale , Insuffisance rénale , RhabdomyolyseRésumé
Renal tubular dysfunctions have been observed in hydronephrosis, resulting in metabolic acidosis, hyperkalemia and excessive free water diuresis. These findings are occasionally found in infant and children. Batle et al. first reported distal tubular acidosis associated with low potassium excretion resulting from aldosterone resistance in adults with obstructive uropathy. We have experienced a case of transient hyperkalemia and hyperaldosteronism secondary to hydronephrosis in 63-year-old female patient. The causes of hyperkalemia were examined under the impression of secondary adrenal insufficiency due to corticosteroid abuse or hyporeninemic hypoaldosteronism due to diabetic nephropathy. But it proved to be resulted from hyperaldosteronism due to hydronephrosis. The hyperkalemia resulting from hyperaldosteronism is rare in adults. It may result from aldosterone resistance at distal nephron due to obstructive uropathy or the defect of distal nephron in hydrogen and potassium secretion in the distal nephron rather than from aldosterone deficiency. After she underwent percutaneous nephrostomy, serum potassium was maintained within normal range. She performed total cystectomy with ureterocutaneostomy in purpose for treatment of bladder cancer. So we report this case with a review of literature.
Sujets)
Adulte , Enfant , Femelle , Humains , Nourrisson , Adulte d'âge moyen , Acidose , Insuffisance surrénale , Aldostérone , Cystectomie , Néphropathies diabétiques , Diurèse , Hydrogène , Hydronéphrose , Hyperaldostéronisme , Hyperkaliémie , Hypoaldostéronisme , Néphrons , Néphrostomie percutanée , Potassium , Valeurs de référence , Tumeurs de la vessie urinaire , EauRésumé
The authors analyzed 72 cerebral stroke with diabetes mellitus who were admitted to our hospital during 1989 to 1993. Pathophysiology and clinical characteristic complication and mortality was analyzed. Followings are results: 1) Among 398 total cerebral stroke who were hospitalized to our hospital during 1989 to 1993, there were 72 cerebral stroke with diabetes(18%). 2) The rate of cerebral infarction and hemorrhage was 67% and 33%. The infarction rate was much higher compared with it of general cerebral stroke. 3) Various complications were presented and mortality rate was 24.% which was regarded higher than it of general cerebral stroke. 4) Association of mortality, prognostic index and other variables were analyzed.
Sujets)
Humains , Hémorragie cérébrale , Infarctus cérébral , Diabète , Hémorragie , Infarctus , Mortalité , Accident vasculaire cérébralRésumé
Heart failure is the most common cause of death of infective endocarditis. The contributing factors of heart failure include valve destruction, myocarditis, coronary artery emboli with myocardial infarction and abscess. Recently, we experienced a thiry nine year-old man who was hospitalized at Inha University Hospital because of fever, chill and dyspnea (NYHA functional class I-II). The grade IV/Vi systolic murmur was heard at the right upper sternal border and the apex and the grade III/VI diastolic murmur was heard at Erb's area. No crackles were heard. Blook cultures grew Streptococcus viridans. Chest X-ray showed mild cardiomegaly without pulmonary congestion sign. Echocardiogram showed aortic valve vegetations, abscess and grade II/IV aortic regurgitation. Aortic valve replacement and abscess removal were performed. Findings included henegg sized abscess which reduced 70% of cross sectional area of left ventricular outflow tract and located between posterior wall of left ventricle and right and left coronary rings.
Sujets)
Abcès , Valve aortique , Insuffisance aortique , Cardiomégalie , Cause de décès , Vaisseaux coronaires , Dyspnée , Endocardite , Oestrogènes conjugués (USP) , Fièvre , Défaillance cardiaque , Souffles cardiaques , Ventricules cardiaques , Coeur , Infarctus du myocarde , Myocardite , Bruits respiratoires , Souffles systoliques , Thorax , Streptocoques viridansRésumé
We studied 193 Diabetics without any symptoms of coronary artery disease and 39 Normal healthy subjects as Control group, using treadmill exercise test and obtained following results. 1) The positive rate was significantly higher in Diabetics(19.4% in Normal ECG groups and 25.4% in total Diabetics)than Control groups(5.1%)(0.010.05). 5) There was no difference in HbAIC, Total cholesterol and Triglyceride between positive and negative groups(P>0.05). In summary, with exercise test, the positive rate was higher in Diabetics than in Normal control groups and it seemed to be treadmill exercise test is a useful screening method for evaluation of coronary artery disease as well as for assesment of treatment and follow up care.
Sujets)
Pression sanguine , Cholestérol , Maladie des artères coronaires , Diabète , Électrocardiographie , Equidae , Épreuve d'effort , Rythme cardiaque , Dépistage de masse , TriglycérideRésumé
The clinical observations regarding cutaneous manifestations of in-and outpatients with diabetes mellitus was performed in the Diabetic Clinic, Seoul National University Hospital during the period of 11 months from April, 1979 to March, 1980. The number of patients were total 525, 268 in male and 257 in female. The average age of patients was 51. 1 year-old. Results were as follows, 1. In the 525 patients, 270 patients (51. 1%) revealed various cutaneous manifestations. 2. There were statistical significant differences in sex distributions of infection, pruritus, shin spots, rubeosis and bullosis diabeticorum. 3. Systemic complications sush as retinopathy, neuropathy, nephropathy and hypertension were more frequently observed in the patients with skin microangiopathy than with infection or pruritus. 4. There were not any correlations between fasting blood sugar and cutaneous manifestations