Postoperative Hyponatremia after Total Hysterectomy in an Old-aged Woman / 대한신장학회잡지

Postoperative hyponatremia is common clinical problem, which frequently develops in hospitalized patients. We experienced a case of postoperative hyponatremia with mental confusion and nausea after total hysterectomy in an old aged woman. Her mental status became alert and plasma sodium level was corrected after infusing 3% hypertonic saline for 24 hours. Postoperative hyponatremia is usually attributed to several factors: the infusion of excessive amounts of electrolyte-free water and second actions of antidiuretic hormone to prevent excretion of this electrolyte-free water. When hyponatremic encephalopathy develops, postmenopausal women more likely to either have mild symptoms or good response of treatment than menstruant women. The reasons for having much less morbidity among elderly women than menstruant women are thought that the increasement of brain's adaptation against hyponatremia and the absence of inhibition of such adaptation by estrogen. In summary, postoperative hyponatremia can develop in an old aged woman infused with isotonic solution, but can recovered safely with early detection and proper management. Thus, every effort should be made to avoid hyponatremia and measure plasma sodium level frequently in postoperative period. when hyponatremia developed, it needs proper management.

Clinical characteristics and outcome in renal transplant recipients with bladder cancer / 대한내과학회지

BACKGROUND: With the rise in the number of renal transplantation procedures in the past years, the incidence of bladder cancer in transplant recipients has increased. This study undertaken to evaluate the clinical characteristics and outcome in renal transplant recipients with bladder cancer. METHODS: Since 1969, 1343 renal transplantations has been performed at catholic university medical college of korea. Of these patients, Nine developed bladder cancer with histologically confirmed by cystoscopic biopsy. We reviewed the medical records of nine renal transplant recipients who had bladder cancer retrospectively. RESULTS: Nine of 1343 renal transplant recipients developed bladder cancer. All patients were diagnosed histologically as bladder cancer. The median patient age at diagnosis of bladder cancer was 48 years, and the median interval between renal transplantation and diagnosis of malignancy was 8 years. The male/female ratio was 4/5. one patient received cadaver kidney and eight recieved living donor kidney. Seven patients had urothelial carcinoma and two had Kaposi sarcoma. Seven patients had a graft dysfunction and advanced stage of bladder cancer at the time of diagnosis of malignancy. All patients has microscopic or gross hematuria. They underwent operation only or operation and chemotherapy or operation and postoperative radiotherapy. Three patients died of progressive disease at a l year after diagnosis of malignancy, 1 patients were lost to follow-up, and 5 were still alive. CONCLUSION: Bladder cancer is not rare, and its occurrence is relatively young in renal transplant recipients. We recommend early workup of hematuria in the renal transplant recipient using the radiographic and cystoscopic evaluation.