Clinical Characteristics of Severe Hypertensive Patients with Improved Renal Dysfunction after Blood Pressure Control / 대한신장학회잡지

BACKGROUND: Mild renal dysfunction is relatively common in patients with long standing primary hypertension, ranging from 10% to 40% in various studies. The presence of renal dysfunction is associated with high cardiovascular mortality and morbidity rates of patients with primary hypertension. The purpose of this study is to analyze the clinical characteristics of patients with severe hypertension and reVersible renal dysfunction after blood pressure control. METHODS: This retrospective study enrolled 14 patients with severe hypertension and reVersible renal dysfunction after blood pressure control, between January 1993 and December 2002 at Kangnam St. Mary's Hospital and St. Paul's Hospital. We investigated the laboratory data using Wilcoxon signed rank test, and analysed renal biopsy findings and antihypertensive drugs. RESULTS: The mean age of the patients was 38+/-9 years and the number of male patients was 8. During 33.5+/-28.8 months of mean follow-up period, there was a significant decrease in mean arterial pressure and serum creatinine level, and significant increase in hematocrit level. But there was no significant changes in the level of uric acid, total cholesterol, and triglyceride. Each patient took more than 3 antihypertensive drugs consisting angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (22%), calcium channel blocker (21%), and beta blocker (21%). Renal biopsy was done in 6 cases, and histologic diagnosis resulted in 4 cases of benign hypertensive nephrosclerosis and 2 cases of IgA nephropathy. The typical morphological features of hypertensive nephrosclerosis were seen in all cases, and there were varying degrees of glomerular sclerosis from 0% to 92%. But the percent of glomerular sclerosis was not related to the level of initial serum creatinine, mean arterial pressure, and amount of proteinuria per day. CONCLUSION: Careful monitoring of renal function and effective treatment of blood pressure are therefore mandatory in treating young patient with severe hypertension with renal dysfunction.

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.

A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.

Tuberculous Spondylitis in a Hemodialysis Patient / 대한신장학회잡지

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.

Clinical Usefulness of Procalcitonin in Febrile Patients ; Comparison with Erythrocyte Sedimentation Rate and C-Reactive Protein / 감염

BACKGROUND: Procalcitonin (PCT) is a propeptide of calcitonin which is found in elevated concentration in the serum during systemic bacterial, fungal or protozoal infection. To evaluate clinical value of PCT for early differential diagnosis of causes in febrile patients, its levels were serially measured and compared with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). METHODS: Thirty-six patients meeting criteria for the systemic inflammatory response syndrome with fever were allocated into four groups. Sera were collected to measure PCT (immunoluminometric assay), ESR (Westergren method) and CRP (nephelometry) at the onset of fever and twice thereafter at 48 hours intervals. Group I included nineteen patients with bacterial infection who were diagnosed as acute pyelonephritis (n=7), sepsis (n=6), pneumonia (n=2), soft tissue infection (n=3) and infective endocarditis (n=1). Group II included patients diagnosed as viral meningitis (n=2), chickenpox (n=1), cryptococcal meningitis (n=1), and tuberculosis (n=4). Group III included four patients with malaria. Group IV included non-infectious febrile patients diagnosed as adult onset Still's disease (n=2), Kikuchi's disease (n=2) and drug fever (n=1). RESULTS: Patients in group I (median 1.34 ng/mL) and III (2.41 ng/mL) had markedly elevated serum PCT concentrations at the onset of fever, whereas patients in group II (0.20 ng/mL) and IV (0.11 ng/mL) had normal range PCT levels at the onset of fever (P<0.01). All the groups had elevated ESR and CRP levels at the onset of fever. After 48 hours and 96 hours, in patients group I and III, elevated PCT levels were declined with time course (P<0.05). But all the measured ESR and CRP levels had not changed significantly (ESR; P=0.89, CRP; P=0.23). CONCLUSION: Procalcitonin is a more useful serum marker than ESR and CRP for initial differential diagnosis of febrile systemic inflammatory response syndrome. It also provide patient's information earlier than ESR and CRP in febrile patients with bacterial infection and malaria.

A Case of Nonbacterial Thrombotic Endocarditis in Small Ventricular Septal Defect

Nonbacterial thrombotic endocarditis is characterized by the presence of valve-leaflet or endocardial vegetation composed chiefly of fibrin and trapped platelets, without an associated inflammatory reaction or evidence of microorganism. Recent emphasis has been affixed to the significant morbidity and mortality rates as a results of major systemic arterial embolization and infective endocarditis. It is seen most commonly in patients with malignant neoplasms, disseminated intravascular coagulopathy, uremia, burn, SLE, cardiac valve disease. We experienced a case of nonbacterial thrombotic endocarditis developed in patient with small congenital ventricular septal defect, and vegetation on the left ventricular septum other than right ventricle as known most commonly affected.