The Suppressive Effect of Lentinus Edodes on Renal Scarring Secondary to Pyelonephritis / 대한비뇨기과학회지

PURPOSE: Lentinus edodes is used in both foods and drugs, and is also known to be an antioxidant agent. Some investigators have noted that renal scarring following pyelonephritis is closely related to inflammation or free oxygen radicals, rather than to direct injury due to bacterial infection. The efficiency of the antioxidant agent, lentinus edodes, in preventing the renal scarring caused by experimental pyelonephritis was evaluated in rats. MATERIALS AND METHODS: Twenty eight male Sprague Dawley rats (n=28) were injected into both renal parenchyma with 0.1ml of a solution containing Escherichia coli (10(8)/ml). The control group, consisting of 4 rats, received an injection of isotonic saline instead of the bacterial solution. Three days after surgery, the animals were given the following treatments: in the pyelonephritis group, 7 rats received isotonic saline for 5 days; in the antibiotics treatment group, 6 rats were treated with an antibiotic only, ciprofloxacin, for 5 days. In the lentinus edodes treatment group, 5 rats were treated with lentinus edodes only. In the combined group, 6 rats received both lentinus edodes and ciprofloxacin. The kidneys were harvested 6 weeks after infection, and histopathologically examined for renal scarring. RESULTS: Delayed treatment with antibiotics-only or lentinus edodes-only had no effect on the scarring compared with the untreated controls. However, the addition of lentinus edodes to the delayed antibiotic therapy significantly inhibited the renal scarring compared with the pyelonephritis, antibiotic-only treated and the lentinus edodes-only treated groups (p<0.05). CONCLUSIONS: The administration of lentinus edodes in combination with antibiotics significantly reduced the renal scar formation in pyelonephritis.

Hypereosinophilia Presenting as Eosinophilic Vasculitis and Multiple Peripheral Artery Occlusions without Organ Involvement

We report here a case with hypereosinophilia and peripheral artery occlusion. A 32-yr-old Korean woman presented to us with lower extremity swelling and pain. Angiography revealed that multiple lower extremity arteries were occlusive. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. She was prescribed prednisolone 60 mg daily. Her skin lesion and pain were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Cyanosis and pain of her fingers recurred. She had been treated with cyclophosphamide pulse therapy. Her eosinophilia was decreased, but the cyanosis and tingling sense were progressive. The extremity arterial stenoses were slightly progressed. Skin biopsy showed perivascular eosinophilic infiltration in the dermis and CD40 ligand (CD40L) positive eosinophilic infiltration. The serum TNF-alpha was markedly increased. These results suggest that CD40L (a member of TNF-alpha superfamily) could play a role in the inflammatory processes when eosinophil infiltration and activation are observed. We prescribed prednisolone, cyclophosphamide, clopidogrel, cilostazol, beraprost and nifedipine, and she was discharged.

Long-term clinical outcomes of newly implanted stents during intracoronary radiation / 대한내과학회지

BACKGROUND: New stent implantation during intracoronary brachytherapy is discouraged due to the high risk of late thrombosis. However, new stent implantation is inevitable in some cases due to the inadequate ballooning or major dissections. Long-term follow-up results of newly implanted stents during brachytherapy are not well-known. We performed this study to evaluate the long-term clinical outcomes of newly implanted stents during intracoronary brachytherapy. METHODS: In the Seoul national university Post-Angioplasty RhEnium irradiation (SPARE) trial, patients were treated with conventional catheter-based technique and then randomized to either beta- radiation (RG) or control group (CG). Radiation was performed with 188 -rhenium-filled conventional balloon catheter system. From 1999 to 2001, new stent implantation was performed in 58 and 56 patients in RG and CG, respectively. Clinical and angiographic follow up data were analyzed. RESULTS: In RG, short-term angiographic restenosis rate was lower than CG (28.6% vs 53%, p=0.03). In RG, late thrombosis was found in 3 patients. However, there was no late thrombosis in CG. Two year major cardiac event rates were not different between the 2 groups (RG: 25.9% vs CG: 28.3%). Independent predictors for major cardiac event in RG were major dissections (>or=type C) after stent implantation (beta=70, p=0.01) and longer administration of dual antiplatelets (aspirin+clopidogrel/ ticlopidine, >6 months, beta=0.07, p=0.04). CONCLUSION: Stenting during intracoronary brachytherapy seems to be ineffective in reducing long-term event rates. When new stent implantation is inevitable during brachytherapy, extreme attention is required not to make a dissection and long-term dual antiplatelet treatment should be followed after stent implantation.

Partial Anomalous Pulmonary Venous Return into Coronary Sinus with Intact Atrial Septum

We report a case of partial anomalous pulmonary venous return where the right upper and lower pulmonary veins drain into the coronary sinus with right-to-left shunt via patent foramen ovale. To our knowledge, this is the uncommon case where the interatrial septum is intact. The diagnosis was initially made by transthoracic echocardiography and transesophageal echocardiography with the infusion of agitated saline and confirmed by pulmonary artery angiography. Curative operation could not be performed because of the irreversible pulmonary hypertension.

A case of native valve endocarditis caused by Aspergillus fumigatus / 대한내과학회지

Fungal endocarditis is a rare but poor-prognostic disease. It typically occurs in patients with several predisposing factors such as open heart surgery, long term venous catheterization, antibiotic therapy, intravenous drug abuse, hematologic malignancy and AIDS. We report a case of native endocarditis caused by Aspergillus fumigatus, which has not been reported as a causative organism of native valve endocarditis in Korea. A 47 year-old female patients without significant past medical history except pulmonary tuberculosis was admitted because of headache and neck pain. After admission, she developed high feve, new cardiac murmur and signs of multiple systemic embolization. Echocardiography revealed large mobile vegetations. Emergent mitral valve replacement was performed and Aspergillus fumigatus was isolated from the resected vegetation. Despite postoperative amphotericin B therapy, she died of subarachnoidal hemorrhage.

A Case of Septic Pneumonia Secondary to Community: acquired Campylobacter fetus Bacteremia / 감염

Campylobacter f etus has been increasingly associated with extraintestinal infections in patients with underlying diseases. Pulmonary involvement in human by this organism is rare. We report a case of septic pneumonia secondary to community-acquired C. f etus bacteremia in a 67 year-old man with chronic renal failure.