Clinical Study of Acute Renal Failure / 대한내과학회지

OBJECTIVE: Acute Renal Failure is a clinical syndrome characterized by a sudden decrease in renal function which was previously normal. Despite advances in medical care, prognosis in ARF is variable according to the influence of demographic factors, severity of ARF, nature of disease causing ARF, coexisting disease, treatments applied, and complications. We studied the recent changes of clinical feature of ARF. METHODS: We studied retrospectively 245 patients with ARF who had been hospitalized at Kyung Hee University Hospital between February 1988 and March 1993. RESULTS: 1) Male to female sex ratio was 1.8 : 1, and the incidence was high in above fifth decade (67.8%). 2) Acute renal failure was classified, according to clinical background, into medical group 79.6% (195 cases) and surgical group 20.4% (50 cases), and oliguric group 40.8% (100 cases) and non-oliguric group 59.2% (145 cases). 3) Acute renal failure due to medical causes included ARF by hemorrhagic fever with renal syndrome (25.6%), drugs and chemicals (17.9%), sepsis (17.4%) and systemic infection (7.7%) etc. ARF due to surgical causes included ARF by multiple trauma (34%), various surgical procedures (30%), surgical sepsis (14%), burn (12%) etc. 4) During admission, the expired patients had more severe biochemical and clinical characteristics including high BUN and serum potassium (p<0.01), lower serum albumin (p<0,01) than those of survivor. 5) Infections as the cause of ARF were 107 cases (43.7%), which included hemorrhagic fever with renal syndrome 50 cases, sepsis 31 cases, urinary tract infection 7 cases and respiratory tract infection 6 cases etc. The most common infecting organism was Hantavizus (50.5%). There was a greater number of gram-negative organisms than gram-positive organisms (34.1% vs 9.9%). 6) The overall mortality rate in patients with ARF was 31.4Fo. The presumptive causes of death were underlying disease (59.7%) such as sepsis, acute poisoning, cardiogenic and hypovolemic shock, and respiratory failure (14.3%), hyperkalemia (9.1%), pulmonary edeme (6.5%), and metabolic aidosis (2.6%) in order of frequency. 7) The highest mortality rate was 42.6% in patients above 50 years old. Mortality rate in patients with ARF due to surgical causes (52.0%) was significantly high than that of medical causes (26.2%) (p<0.05). Among the expired patients, oliguric group was 72.7%. In conclusion, there have been major trends in the clinical features of acute renal failure in this study. Especially, significant increase in the number of elderly patients, non-oliguric patients, and medical causes such as hemarrhagic fever with renal syndrome or sepsis were observed. Survival rate significantly decreased with increasing age, in acute renal failure by surgical causes, in oligurie patients, and in the presence of complicating factors such as sepsis or shock.

An Adult Case of Congenitally Corrected Transposition of the Great Arteries Associated with Paroxysmal Atrial Fibrillation and Heart Failure

Congenitally corrected transposition of the great arteries is a rate congenital heart disease. In this discase, there is discordance between both the atria and ventricles and the ventricles and great vessels. The anatomic left ventricle lies on the rightside and is connected to the pulmonic trunk, whereas the anatomic right ventricles lies on the left side and functions as the systemic ventricle. Most patients have associated another cardiac anomalies and conduction disturbance.Less commonly, ventricular extrasystoles, paroxismal supraventricular tachycardia, WPW preexitaion and atrial fibrillation may be obserced. We report an adult case of congenitally corrected transposition of great arteries associated with paroxysmal atrial fibrillation and heart failure.

Patterns of Pulmonary Venous Flow in the Patients with Mitral Stenosis using Transesophageal Echocardiography

OBJECTIVES: In mitral stenosis, there is an alteration of normal left atrial hemodynamics because the narrowed mitral valve prolongs the decay in diastolic pressure, and atrial function may be impaired secondary to atrial fibrillation. In this study, we purposed to evaluation of the pulmonary venous flow patterns in the patients with mitral stenosis using transesophageal echocardiography. METHODS: The study was performed on 35 patients(13 men and 22 women, mean age 51±13.1 years) with mitral stenosis. We measured the left ventricular end-diastolic and end-systolic dimension, left atrial dimension, mitral valve area by planimetry method and the mean pressure gradient by transthoracic echocardiography. Systolic and diastolic peak velocities, atrial reversal and diastolic pressure half time of pulmonary venous flow by transesophageal echocardiography were evaluated. RESULTS: 1) The pulmonary venous peak systolic and diastolic flow velocities were 27.5±7.0cm/sec, 28.2±9.3cm/sec in patients with sinus rhythm, and 23.9±7.6cm/sec, 27.1±8.3cm/sec in patients with artial fibrillation. But there was no difference between patients with sinus rhythm and with atrial fibrillation. 2) The lesser mitral valve area, the more decreased peak systolic velocity and systolic to diastolic flow ratio. Especially, the systolic to diastolic flow ratio was significantly decreased(1.16±0.26, 0.95±0.23, 0.68±0.20, p < 0.05). But there was no difference at the peak diastolic velocity. 3) The thrombus or spontaneous echo contrast in the left atrium was not influence on the pulmonary venous flow pattern. CONCLUSION: In mitral stenosis, systolic flow and systolic to diastolic flow ratio decrease with the decrease of mitral valve area and diastolic flow becomes predominant, which may be useful in assessing the hemodynamics of mitral stenosis.

A Cavitary Lesion Changed to Pulmonary Nodule / 결핵

We have experienced a case of pulmonary adenocarcinoma looked like cavitary lesion of pulmonary tuberculosis in 49-year-old male patient. He has taken antituberculous medication for 5 months under the impression of pulmonary tuberculosis with cavity at local hospital. The cavitary lesion was changed nodular mass on follow-up chest X-ray. Transthoracic fine needle aspiration was done and cytologic specimen suggested squamous cell carcinoma. Right middle lobectomy was performed. The nodular mass, which was confirmed as adenocarcinoma on microscopic examination, had central cavity filled with hemorrhage.