Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report.

Although exudative pleural effusion can be caused by infections, malignancies, and connective tissue diseases, we need to consider uremic pleural effusion and pleuritis in differential diagnosis of exudative lymphocyte predominant pleural effusion in patients with chronic kidney disease not receiving dialysis.

A relationship of intradialytic blood pressure variability with vascular access outcomes in patients on hemodialysis.

INTRODUCTION: Vascular access dysfunction is a major cause of morbidity in patients with end-stage renal disease (ESRD) on hemodialysis (HD). Thus, identifying risk factors for vascular access failure is important. Patients on HD are routinely exposed to high blood pressure variability (BPV) during HD. However, the impact of intradialytic BPV on vascular access outcomes is unknown. Therefore, we investigated the association of intradialytic BPV with vascular access outcomes in patients on HD. METHODS: One hundred and thirty patients with ESRD who created vascular access for HD were evaluated. We examined 12 dialysis sessions per patient and recorded BP five times for each session. BPV was assessed using residual standard deviation derived from the linear regression model. The patients were divided into two groups according to a level below or above the median value of intradialytic BPV and compared. The primary outcome was primary unassisted vascular access patency. FINDINGS: The median time to loss of primary unassisted patency was significantly longer in low intradialytic BPV group than in high intradialytic BPV group (52 months vs. 21 months, P < 0.001) during the mean follow-up of 3.7 years. After adjustment for other variables, high intradialytic BPV was significantly associated with loss of primary unassisted vascular access patency (hazard ratio, 2.605; 95% confidence interval, 1.462-4.643; P = 0.001). DISCUSSION: Our study revealed a significant correlation between intradialytic BPV and vascular access patency. Further studies are needed to identify methods for lowering BPV.

Prediction of hemodialysis vascular access failure using segmental bioimpedance analysis parameters.

PURPOSE: Segmental bioimpedance analysis (BIA) can identify fluid volume changes in the arms of patients on hemodialysis (HD) after vascular access surgery. We investigated whether the difference in fluid volumes between the arms of the patients using segmental BIA is associated with vascular access outcome. METHODS: Body composition measurements were taken for 127 patients on HD with segmental, multi-frequency BIA equipment (InBody 1.0, Biospace Co. Ltd, Seoul, Korea). The difference in fluid volume between the arms of the patients was calculated from the fluid volume of the arm with the vascular access minus that of the other. The primary outcome was the loss of vascular access patency within 3 months of BIA measurement. RESULTS: The median absolute and relative inter-arm fluid volume differences were 150 ml [interquartile range (IQR) 90-250 ml] and 9.6% (IQR 4.9-14.4%), respectively. Within 3 months of BIA measurement, 38 patients (30.0%) experienced vascular access failure. When the patients were divided into three groups based on the tertiles of relative inter-arm fluid volume differences (lowest tertile: < 6.8%; middle tertile: 6.8-12.7%; highest tertile: > 12.7%), greater difference in relative inter-arm fluid volume differences was associated with higher vascular access failure rates (14 vs. 28 vs. 48%, p value for trend across tertiles = 0.003). CONCLUSIONS: We conclude that segmental BIA may be used as a tool that can predict vascular access failure in patients on HD by calculating the relative difference in fluid volume between the arms of the patients with and without vascular access.

A Case of Posterior Mediastinal Plasmacytoma Confounded by Community-Acquired Pneumonia.

Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.

Apolipoprotein B Is Related to Metabolic Syndrome Independently of Low Density Lipoprotein Cholesterol in Patients with Type 2 Diabetes.

BACKGROUND: Increased low density lipoprotein cholesterol (LDL-C) level and the presence of metabolic syndrome (MetS) are important risk factors for cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Recent studies demonstrated apolipoprotein B (apoB), a protein mainly located in LDL-C, was an independent predictor of the development of CVD especially in patients with T2DM. The aim of this study was to investigate the relationship between apoB and MetS in T2DM patients. METHODS: We analyzed 912 patients with T2DM. Fasting blood samples were taken for glycated hemoglobin, high-sensitivity C-reactive protein, total cholesterol, triglyceride (TG), high density lipoprotein cholesterol, LDL-C, and apoB. MetS was defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria. We performed a hierarchical regression analysis with apoB as the dependent variable. Age, sex, the number of components of MetS and LDL-C were entered at model 1, the use of lipid-lowering medications at model 2, and the individual components of MetS were added at model 3. RESULTS: Seventy percent of total subjects had MetS. ApoB level was higher in subjects with than those without MetS (104.5±53.3 mg/dL vs. 87.7±33.7 mg/dL, P<0.01) even after adjusting for LDL-C. ApoB and LDL-C were positively correlated to the number of MetS components. The hierarchical regression analysis showed that the increasing number of MetS components was associated with higher level of apoB at step 1 and step 2 (ß=0.120, P<0.001 and ß=0.110, P<0.001, respectively). At step 3, TG (ß=0.116, P<0.001) and systolic blood pressure (ß=0.099, P<0.05) were found to significantly contribute to apoB. CONCLUSION: In patients with T2DM, apoB is significantly related to MetS independently of LDL-C level. Of the components of MetS, TG, and systolic blood pressure appeared to be determinants of apoB.

A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis.

Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. (99m)Tc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hürthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy.