A suspected case of sugammadex-induced anaphylactic shock: A case report

We describe a case involving a 69-year-old woman who developed anaphylatic shock caused by a clinical dose of sugammadex (2 mg/kg, 100 mg intravenously) 5 minutes after its administration. She developed redness and welts all over her body, and complained of an oropharyngeal itching sensation with dyspnea and dizziness. Her vital signs were closely monitored. She also experienced a sudden onset of hypotension (from 110/70 to 49/40 mmHg) and tachycardia (from 75 to 120 bpm). We diagnosed anaphylactic shock on the basis of these clinical manifestations. After 20 min of traditional treatment (hydration, ephedrine, cortisol, and phenylephrine), her vital signs returned to normal. No postoperative complications were evident, and the patient was discharged from the hospital. Although the prevalence of anaphylactic reactions to sugammadex is rare, physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.

Effects of Ficus carica paste on constipation induced by a high-protein feed and movement restriction in beagles / 한국실험동물학회지

Constipation is one of the most common functional digestive complaints worldwide. We investigated the laxative effects of figs (Ficus carica L) in a beagle model of constipation induced by high protein diet and movement restriction. The experiments were consecutively conducted over 9 weeks divided into 3 periods of 3 weeks each. All 15 beagles were subjected to a non-treatment (control) period, a constipation induction period, and a fig paste treatment period. We administered fig paste (12 g/kg daily, by gavage) for 3 weeks following a 3-week period of constipation induction in dogs. Segmental colonic transit time (CTT) was measured by counting radiopaque markers (Kolomark) using a radiograph performed every 6 h after feeding Kolomark capsules, until capsules were no longer observed. Fig paste significantly increased fecal quantity in constipated dogs, and segmental CTT was also reduced following fig paste administration. There were no significant differences in feed intake, water intake, body weight, or blood test results, between the constipation and fig paste administration periods. Our results demonstrate that fig is an effective treatment for constipation in beagles. Specifically, stool weight increased and segmental CTT decreased. Fig pastes may be useful as a complementary medicine in humans suffering from chronic constipation.

A Case of Systemic Lupus Erythematosus Involving the Kidneys in a Patient with IgA Nephropathy / 대한류마티스학회지

Renal involvement in systemic lupus erythematosus (SLE) is a typical manifestation of the disease. The occurrence of non-lupus nephritis, especially IgA nephropathy (IgAN), in patients with SLE has rarely been reported. We describe the case of a 21-year-old woman who was diagnosed with IgAN and subacute necrotizing lymphadenitis, and her renal lesion biopsy was typical of lupus nephritis (ISN/RPS Class III). Although IgAN and lupus nephritis share some common physiopathological characteristics, their laboratory, histopathologic findings, and the extra-renal clinical manifestations are different and support a different pathogenesis. Our case highlights the importance of a renal biopsy in patients with lupus and urinary alterations despite underlying IgAN. A correct diagnosis would permit the most appropriate immunosuppressive treatments to be considered.

Isolated Polyarteritis Nodosa of Uterine Cervix: A Case Report / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a multisystem necrotizing vasculitis affecting small and medium-sized arteries. A forty-four year old Korean woman underwent a laparoscopic total hysterectomy for uterine myoma, and routine histopathologic examination showed PAN involving arteries of the uterine cervix. Investigation for systemic involvement of PAN did not show any other organ involvement. The patient has not received glucocorticoid or any immunosuppressive agents after a laparoscopic total hysterectomy and has been doing well without any evidence of recurrence. To our knowledge, this is the first case of isolated uterine cervix PAN in Korea.

Listeria Monocytogenes Meningitis in a Patient with Systemic Lupus Erythematosus: A Case Report / 대한류마티스학회지

In systemic lupus erythematosus (SLE) patients, immunosuppressive treatment with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. Several opportunistic infections such as toxoplasmosis, nocardiosis, and cryptococcal meningitis have been reported to occur in patients with SLE and these can mimic neuropsychiatric lupus. Listeria monocytogenes is one of the pathogens of bacterial meningitis that is less commonly identified than Neisseira meningitidis and Streptococcus pneumoniae in adults, and shows the clinical manifestations, such as headache, fever, nausea, vomiting, neck stiffness, mental changes and seizures similar to symptoms and signs of neuropsychiatric lupus. We report a case of Listeria monocytogenes meningitis in a patient with SLE who was admitted because of headache, nausea, vomiting and poor oral intake.

Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

Two Cases of HHH Syndrome in Siblings

Hyperornithinemia-hyperammonemia-homocitrullinuria(HHH) syndrome is a rare autosomal recessive disorder caused by a defect in the urea cycle. Protein intolerance, mental retardation, seizure, ataxia, and stupor are characteristic symptoms. Patients showing these symptoms may also present symptoms of acute hepatic disease at the same time. When fed with a high protein diet, they may refuse to eat, vomit, become lethargic, or go into coma. After childhood, most patients avoid meats or milk spontaneously and eat a low protein diet. The liver and spleen are normal or slightly enlarged. The coagulation time is prolonged and sometimes there is a deficiency in factor VII and X. Treatment is aimed at preventing hyperammonemia after meals by restricting daily protein intake to 1.2 g/kg/day and this lowers serum ornithine concentration. Prolonged ornithine supplement(0.5 to 1.0 mM/kg/day; i.e., 66 to 132 mg/kg/day divided into three doses) improved patients' protein intolerance and accelerated growth. Since Shih and coworkers first reported this syndrome in 1969, there have been 40 cases reported worldwide but not yet in Korea. We, for the first time in Korea, report two cases of HHH syndrome in brothers.

Clinical and Molecular-Biologic Study of Extended Spectrum beta-lactamase Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

PURPOSE: Extended spectrum beta-lactamase (ESBLs) producing Klebsiella pneumoniae has recently been increasingly responsible for infections. Considering the characteristics of the neonatal intensive care unit (NICU), the increase in such colonies is to be an important factor in the treatment and outcome of neonatal patients. Therefore, we performed this study in order to investigate the incidence of this colony and the clinical characteristics that are helpful in diagnosing these infections. METHODS: We performed a double disk synergy test and randomly amplified polymorphic DNA (RAPD) analysis of which 12 was resistant or intermediate to cefotaxime, and 4 colonies isolated from rectal swab taken in 14 patients between July and August, 1997. Also, we compared the annual isolation rate of K. pneumoniae, from those admitted to the Soonchunhyang University Chunan Hospital NICU from July, 1997 to June, 2000. We retrospectively studied the medical records and the clinical characteristics of those 79 cases from whom 110 colonies were isolated. RESULTS: From July to August, 1997, there was a K. pneumoniae outbreak in the NICU. Fifteen out of a total of sixteen isolates were positive in the double disk synergy test and turned out to be ESBL producing K. pneumoniae. Also the RAPD analysis of thirteen isolates which were from the NICU proved eleven isolates to have similar band pattern on RAPD typing. In those who were admitted to our NICU from July, 1997 to June, 2000, 110 colonies of K. pneumoniae resistant or intermediate to cefotaxime were isolated from 79 patients. Though patient group infected by the ESBLs producing K. pneumoniae had significantly no difference in gestational age or birth weight, they had a longer hospitalization period compared to the control group. CONCLUSION: It is possible that ESBLs producing K. pneumoniae be responsible for outbreaks in the NICU. The emerging of these can affect the morbidity in neonates and also can put great limits in the choice of antibiotics.

Successful Immunosuppression with Cyclosporine after Renal Transplantation in a Patient with Chronic Renal Failure Due to Postpartum Hemolytic Uremic Syndrome / 대한이식학회지

Hemolytic uremic syndrome is characterized by the symptoms of microangiopathic hemolytic anemia, thrombocytopenia and renal failure. The incidence of hemolytic uremic syndrome associated with pregnancy is 10 to 25 percent. Hemolytic uremic syndrome is treated with adjunctive therapies, such as anti-platelet agents, glucocorticoid and plasma exchange. However, many patients experience a residual impairment in renal function and some of them progress to end-stage renal disease requiring dialysis or renal transplantation. Immunosuppression with cyclosporine has been implicated as a significant risk factor for post- transplant hemolytic uremic syndrome. A number of reports on transplant recipients have recognized cyclosporine-induced hemolytic uremic syndrome as a distinct entity and a potentially serious complication of cyclosporine administration.We report a case of a patient with successful renal transplantation using cyclosporine who had a severe case of post-partum hemolytic uremic syndrome that progressed to end-stage renal disease. After cadaver-donor renal transplantation using cyclosporine, mycophenolate mofetil and prednisolone her graft function at two years is normal with serum creatinine 1.0 mg/dl.