Intra-abdominal hypertension does not predict renal recovery or in-hospital mortality in critically ill patients with acute kidney injury

BACKGROUND: Although emerging evidence suggests that intra-abdominal hypertension (IAH) is a predictor of the development of acute kidney injury (AKI), it remains unclear whether the presence of IAH is a predictor of prognosis in patients with AKI. The purpose of this study was to assess whether the presence of IAH could predict prognosis in critically ill patients with AKI. The prognostic value of urinary biomarkers was also determined. METHODS: In this prospective observational study, we enrolled 57 patients with established AKI, who were admitted to the intensive care unit between February 2012 and June 2014. IAH was defined as a sustained elevation in intra-abdominal pressure of > or =12 mmHg, in three consecutive measurements performed daily on the first 3 days. Urinary neutrophil gelatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein, and simplified acute physiology score II score at the time of admission were also examined. RESULTS: IAH was observed in 78.9% of patients. The in-hospital mortality was 21.1%, and renal recovery during hospitalization was achieved in 40.4% of patients. Although high urinary NGAL [odds ratio (OR), 1.015] and liver-type fatty acid-binding protein (OR, 1.003) were found to be independent predictors of renal recovery, IAH was not. High urinary NGAL (OR, 1.003) and a high simplified acute physiology score II score (OR, 1.102) were independent predictors of in-hospital mortality, while IAH or urinary liver-type fatty acid-binding protein was not. CONCLUSION: Although IAH is prevalent in critically ill patients with AKI, it did not predict AKI prognosis. However, urinary NGAL was found to be a useful predictor of both renal recovery and in-hospital mortality.

Pure red-cell aplasia and autoimmune hemolytic anemia in a patient with acute hepatitis A

Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) have rarely been reported as an extrahepatic manifestation of acute hepatitis A (AHA). We report herein a case of AHA complicated by both PRCA and AIHA. A 49-year-old female with a diagnosis of AHA presented with severe anemia (hemoglobin level, 6.9 g/dL) during her clinical course. A diagnostic workup revealed AIHA and PRCA as the cause of the anemia. The patient was treated with an initial transfusion and corticosteroid therapy. Her anemia and liver function test were completely recovered by 9 months after the initial presentation. We review the clinical features and therapeutic strategies for this rare case of extrahepatic manifestation of AHA.

A Case of a Deep Neck Space Candidial Abscess in an Immunocompetent Woman / 대한내과학회지

Deep neck space infections usually arise from infectious conditions of the upper aerodigestive tract. Candida albicans is a normal commensal of humans but usually causes invasive infections in immunocompromised patients. We report an immunocompetent 70-year-old woman with a Candida abscess in the deep neck space. She did not have dental or oropharyngeal disease, medication use, or medical illnesses that could cause an immunocompromised condition, except stable chronic hepatitis C. She was admitted to the hospital with fever, shortness of breath, a drowsy consciousness, and swallowing difficulty. Despite empirical antibiotic therapy, her signs and symptoms did not improve. A deep neck space abscess in the retropharyngeal space was revealed by computed tomography (CT). An abscess culture yielded C. albicans. She was treated with an antifungal agent rather then antibiotics. After 5 weeks of antifungal agent treatment and external drainage, follow-up CT scans showed substantial improvement in the abscess.

A Case of Invasive Thymoma with Endotracheal Polypoid Growth / 결핵및호흡기질환

Thymomas are one of the most common neoplasms of the mediastinum derived from thymic epithelium. It is common that invasive thymoma invades the lung, pericardium, and great vessels. Airway compression by mass effect also occurs, but direct polypoid tumor growth into the airway is extremely rare. Only 20 cases of invasive thymoma with endobronchial polypoid growth have previously been reported globally. However, there is no case report of invasive thymoma with endotracheal growth. Herein, we report a rare case of invasive thymoma with endotracheal polypoid growth in a 28-year-old woman.

A Case of Chronic Renal Failure after Exposure to Oral Sodium Phosphate Bowel Purgatives / 대한내과학회지

Renal failure due to nephrocalcinosis after large-bowel cleansing with sodium phosphate preparations before endoscopic procedures is an easily overlooked diagnosis. While it has been reported that acute renal failure can result from the use of oral sodium phosphate preparations, chronic renal failure has not yet been reported. We report a case of chronic renal failure due to oral sodium phosphate, in which a kidney biopsy was performed.

A Case of Intracardiac Thymic Carcinoma Presenting as Congestive Hepatopathy / 대한내과학회지

Thymic carcinoma is a rare but aggressive epithelial neoplasm with a strong propensity for early local invasion and widespread metastasis. It is common for thymic carcinomas to invade the lungs, pericardium, and great vessels. However, invasion of thymic carcinoma into the right atrium, right ventricle, mediastinum, and superior vena cava is very rare. There have been sporadic reports on intracardiac thymic carcinomas globally and only one case report in South Korea to date. We herein report a case of intracardiac thymic carcinoma presenting as right-sided heart failure with congestive hepatopathy.