Hemodialysis reduces the viral load in uremic patients with chronic hepatitis B infection.

BACKGROUND AND AIMS: The effect of hemodialysis (HD) to change the viral load of hepatitis B virus (HBV) in uremic patients with chronic HBV infection has never been studied. In this study, we investigated the HBV viral loads and their changes between the HD procedure in the uremic patients. PATIENTS AND METHODS: A total of 38 chronic HBV-infected uremic patients were enrolled, but eight cases were excluded due to HCV co-infection and under anti-viral therapy. To evaluate the HBV DNA levels and their changes through the course of HD, we quantified serial serum samples from each patient immediately before HD, at the end of HD, and 48 hours later--immediately before the next HD. RESULTS: Most of our HBV-infected uremic patients had a relatively lower HBV viral load; 80% cases with HBV DNA

Idiopathic pulmonary hemosiderosis: favorable response to corticosteroids.

A 50-year-old Taiwanese woman had a history of massive hemoptysis occurring every 6 months for the past 4 years. After each bout of hemoptysis, chest roentgenography would show diffuse alveolar infiltration of bilateral lungs, which would usually resolve within 7 days. Transbronchial biopsy revealed diffuse alveolar hemorrhage and hemosiderin-laden macrophage infiltration. Idiopathic pulmonary hemosiderosis was diagnosed by excluding other glomerular, cardiac and immunological disorders. An initial dose of 20 mg prednisolone daily was tapered to 10 mg daily 1 month later. The patient is currently undergoing steroid therapy, and there have been no further episodes of hemoptysis.

Inadvertent tracheobronchial placement of feeding tube in a mechanically ventilated patient.

Nasogastric (NG) tube misplacement into the airways is a rare complication. The presence of a cuffed endotracheal or tracheostomic tube often gives primary care providers a false sense of security. This report presents a case of inadvertent NG tube insertion into the right lower lobe bronchus of a 79-year-old patient with advanced chronic obstructive pulmonary disease, resulting in pneumonia and septic shock. In this report, the literature is reviewed, the influence of tube size on complications is compared, and the reliability of different methods to verify correct tube position is discussed. We conclude that a cuffed tracheostomic tube does not prevent advancement of a large-bore feeding tube into the tracheobronchial system. If any doubt exists regarding proper tube position, a chest radiograph should be obtained prior to initiation of feeding.

Primary pulmonary cryptococcosis presenting as endobronchial tumor with left upper lobe collapse.

Primary pulmonary cryptococcosis is difficult to diagnose because the symptoms and radiologic findings are non-specific. Further, pulmonary cryptococcal infections are extremely rare in individuals with normal immunity. This case report describes a case of primary pulmonary cryptococcosis in an immunocompetent individual who presented with left upper lobe collapse due to endobronchial occlusion.