A Case of Tubulointerstitial Nephritis and Uveitis Syndrome in An Old Age Female / 대한신장학회지

We report a case of tubulointerstitial nephritis and uveitis (TINU) syndrome in an old age female. A 66-year-old woman presented with nonspecific systemic symptoms and severe renal dysfunction. Renal biopsy showed acute interstitial nephritis and ophthalmologic examination revealed bilateral panuveitis. Evaluations for connective tissue diseases and infectious diseases were negative. She was treated with total eight sessions of hemodialysis, oral steroids and topical steroids. Renal function had improved significantly and remained stable at follow-up, although it did not fully recovered yet. TINU syndrome should be considered in cases of unexplained tubulointerstitial nephritis, especially in the presence of ocular symptom.

A Case of Needle Tract Seeding of Hepatocellular Carcinoma after Percutaneous Ethanol Injection Therapy; Needle Tract Seeding after Percutaneous Ethanol Injection Therapy / 대한간학회지

The tumor seeding after percutaneous ethanol injection (PEI) therapy has been considered to be a rare complication in hepatocellular carcinoma. We report a case of needle tract implantation of hepatocellular carcinoma following PEI manifested as subcutaneous nodule. A 57-years old male patient had been treated with PEI for hepatocellular carcinoma. Thirteen months after completion of the PEI session, a subcutaneous nodule was palpated at the site of the needle puncture. A CT scan showed that the subcutaneous nodule was 1.7 cm in size and enhanced in the early phase. The nodule was surgically removed. Microscopic examination showed hepatocellular carcinoma.

Analysis of Elderly Patients who visited Emergency Room

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.

A Case of Functional Upper Airway Obstruction Due to Vocal Cord Dysfunction in Obstructive Pulmonary Disease / 결핵

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.

A Case of Empyema and Retropharyngeal Abscess Complicated by Acute Epiglottitis / 감염

After the introduction of antibiotics, empyema is a rare complication of retropharyngeal abscess caused by acute epiglottitis. But once it occurs, it may be a fatal outcome. Retropharyngeal abscess may spread to mediastinum and pleural cavity along the deep cervical fascia, then it can induce pneumonia, mediastinitis, empyema, and sepsis. Because of its fatal complication, early diagnosis and intensive surgical treatment, such as incision and drainage, is necessary. Now we have a experience of empyema caused by retropharyngeal abscess in a 56-year old diabetic patient with nephropathy. He was admitted to our hospital because of hoarseness and sore throat due to acute epiglottitis. Several days after his admission, he complained of swelling of neck, which was diagnosed as retropharyngeal abscess by the computerized tomography. Retropharyngeal abscess was managed with antibiotics, incision and drainage and culture revealed Peptostreptococcus prevotii. Subsequently empyema developed in his right chest, which was managed with closed thoracotomy, though, he expired due to progression of sepsis.

Exogenous pulmonary surfactant replacement therapy in a neonate with pulmonary hypoplasia accompanying congenital diaphragmatic hernia: a case report

Pulmonary hypoplasia(PH) commonly occurs in association with oligohydramnios and other congenital anomalies, especially congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is an important factor, as persistent pulmonary hypertension, in the prognosis of CDH. In some reports, there is a decrement of pulmonary surfactant in PH accompanying CDH. Recently, there are some reports that exogenous pulmonary surfactant therapy is effective in experimental animal model and neonatal respiratory distress with PH. We report a case of a 5 day-old male neonate, who had shown dyspnea and diagnosed as left pulmonary hypoplasia accompanying CDH. The CDH was surgically treated and the ipsilateral PH, with intratracheal administration of exogenous pulmonary surfactant postoperatively. After exogenous pulmonary surfactant application, the left lung volume was increased on chest roentgenogram and lung perfusion scan findings, and there was an improvement in oxygenation and clinical manifestations. We suggest that postoperative exogenous pulmonary surfactant replacement therapy is effective in the case of PH and further trials are needed to clarify the optimal dose and timing of supplementation of surfactant for treatment of infants with PH accompanying CDH.