Hyperglycemic hyperosmolar state associated with invasive rhino-orbital aspergillosis in a patient with end-stage renal disease

No abstract available.

Enterocolic Fistula caused by Acute Colitis in a Hemodialysis Patient / 대한내과학회지

Enterocolic fistulas are commonly associated with previous surgery, Crohn's disease, diverticulitis, radiation therapy, and malignancy. Here, we report a rare case of enterocolic fistula caused by acute colitis in a hemodialysis patient. A 62-year-old man on maintenance hemodialysis underwent a radical nephrectomy via a paramedian incision due to spontaneous right kidney rupture and was treated with prophylactic antibiotics. On the 16th day of antibiotic therapy, he complained of abdominal pain and diarrhea. Abdominal computed tomography (CT) and ascitic fluid culture revealed acute bacterial peritonitis and sigmoidoscopy showed acute colitis. After treating these diseases with adequate antibiotics, the abdominal pain and ascites were relieved, but the diarrhea persisted. Abdominal CT obtained 7 days later showed an enterocolic fistula. To our knowledge, this is the first case of enterocolic fistula due to acute colitis in Korea.

A Case of Severe Arterial Steal Syndrome with Skin Necrosis Developing after Percutaneous Angioplasty / 대한내과학회지

Arterial steal syndrome is a rare but serious complication that disrupts antegrade flow distal to an arteriovenous fistula (AVF) because of excess blood flow through the AVF. A 65-year-old woman with diabetes mellitus and undergoing hemodialysis was admitted for coldness and pain in the right hand ipsilateral to an AVF. AVF stenosis had developed 6 months after an upper-arm AVF operation. These manifestations developed 2 days after a successful radiological intervention for a stenotic lesion in the AVF, which became worse until the skin on her hand ulcerated. The symptoms became aggravated, particularly during dialysis. Fistulography revealed that the AVF anastomosis site was patent but blood flow toward the forearm had decreased severely. Arterial steal syndrome developing after percutaneous angioplasty for an AVF stenosis was suspected, and the AVF was ligated, which resolved the hand pain and ulceration.

A giant carotid aneurysm with intrasellar extension: a rare cause of panhypopituitarism

No abstract available.

Idiopathic acute eosinophilic pneumonia in a 14-month-old girl / 소아과

Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.

Relationships between Fraction of Nitric Oxide, Airway Hyperresponsiveness, Blood Eoshinophil Counts and Serum Eosinophil Cationic Protein in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients. METHODS: Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test. RESULTS: The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R2=0.07, P=0.029) and after (R2=0.059, P=0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R2=0.086, P=0.001) and after (R2=0.141, P=0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R2=0.112, P=0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation. CONCLUSION: The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.

Validity of Cough-Holter Monitoring for the Objective Assessment of Cough and Wheezing in Children with Respiratory Symptoms / 소아알레르기및호흡기학회지

PURPOSE: Cough and wheezing are the most common respiratory symptoms in children. Recently, the cough-holter monitoring has been used to estimate the frequency and intensity of cough and wheezing, objectively. In this study, we aimed to evaluate the validity of cough-holter monitoring for the objective assessment of cough and wheezing in the hospitalized children with respiratory symptoms. METHODS: Cough-holter monitoring was performed in 59 children who suffered from cough and/or wheezing. We obtained the information on the frequency and intensity of cough and wheezing from the parents, a pediatrician, and cough-holter monitoring. Visual Analogue Scale (VAS) scores were taken by parents, and the pediatrician estimated the wheezing score by using a stethoscope. We assessed a relationship between the VAS scores, wheezing score, and cough-holter monitoring data. RESULTS: The frequencies and intensities of cough correlated positively with the VAS scores (r=0.301, P=0.032; and r=0.540, P=0.001, respectively) and the frequencies and intensities of wheezing also correlated positively with the Wheezing scores. (r=0.335, P=0.011; and r=0.457, P=0.001, respectively) The wheezing intensity did not correlate with the Wheezing score in wheezing children. (r=0.321, P=0.089) CONCLUSION: Cough-holter monitoring correlated positively with the VAS scores and the wheezing scores. Cough-holter monitoring appears to be a useful objective assessment tool for the children who have suffered from cough and/or wheezing.

Assessment of Bronchodilator Responsiveness Following Methacholine-Induced Bronchoconstriction in Children With Asthma

PURPOSE: The aim of this study was to investigate bronchodilator responsiveness (BDR) following methacholine-induced bronchoconstriction and to determine differences in BDR according to clinical parameters in children with asthma. METHODS: The methacholine challenge test was performed in 145 children with mild to moderate asthma, and the provocative concentration causing a 20% decline in FEV1 (PC20) was determined. Immediately after the challenge test, patients were asked to inhale short-acting beta2-agonists (SABAs) to achieve BDR, which was assessed as the change in FEV1% predictedx100/post-methacholine FEV1% predicted. For each subject, the asthma medication, blood eosinophil count, serum total IgE, serum eosinophil cationic protein level, and skin prick test result were assessed. RESULTS: The FEV1 (mean+/-SD) values of the 145 patients were 90.5+/-10.9% predicted, 64.2+/-11.5% predicted, and 86.2+/-11.2% predicted before and after methacholine inhalation, and following the administration of a SABA, respectively. The BDR did not differ significantly according to asthma medication, age, or gender. However, BDR in the atopy group (37.4+/-17.7%) was significantly higher than that in the non-atopy group (30.5+/-10.7%; P=0.037). Patients with blood eosinophilia (38.6+/-18.1%) displayed increased BDR compared with patients without eosinophilia (32.0+/-13.8%; P=0.037). CONCLUSIONS: In children with mild to moderate asthma, the responsiveness to short-acting bronchodilators after methacholine-induced bronchoconstriction was not related to asthma medication, but was higher in children with atopy and/or peripheral blood eosinophilia.