Uremic Encephalopathy with Basal Ganglia Lesions in a Diabetic Hemodialysis Patient / 대한신장학회잡지

Uremic encephalopathy is usually applied to cortical involvement in uremic patients. The syndrome of acute bilateral basal ganglia lesions very rare occurs in uremic patents, especially diabetic patients. We here report a case of acute uremic encephalopathy with bilateral basal ganglia lesions in a diabetic hemodialysis patient. A 63-year-old woman with diabetes mellitus on chronic hemodialysis treatment for 3 years admitted due to dysathria, facial palsy and gait disturbance, and temporary loss of consciousness. Brain MRI demonstarted low signal in T1 image and high signal in T2 image in both ganglia. With conservative care including regular hemodialysis, the manifestations completely disappeared.

Delayed Maturation of Arteriovenous Fistula due to Radial Artery Obstruction in a Patient Receiving Radiocephalic Arteriovenous Fistula / 대한신장학회잡지

Although radiocephalic arteriovenous fistula (AVF) is the method of choice for hemodialysis (HD) vascular access, it continues to have a high incidence of early failure due to delayed or failed venous maturation. Here we report an unusual case of delayed maturation of AVF due to radial artery obstruction in a patient receiving radiocephalic AVF. A 53-year-old woman had received radiocephalic AVF operation for hemodialysis. Venous maturation of the AVF did not occur 2 months after the operation. Fistulography via brachial artery approach demonstrated non- visualization of radial artery, anastomosis of radial side of palmar arch and cephalic vein and mild stenosis of the anastomosis site at left wrist area. We thought that we could not use the AVF for HD due to inadequate arterial blood flow and decided to make new vascular access. The patient received brachial-basilic AVF operation again. Adequate maturation of the AVF was successfully made 1 month after the operation. Therefore, we think that radial artery obstruction may be a possible cause of delayed maturation of AVF.

A Case of Adult-onset Still's Disease associated with Congestive Heart Failure / 대한류마티스학회지

Adult onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by several distinguished manifestations including high spiking fever, evanescent salmon-colored skin rash, arthralgia/arthritis, hepato-splenomegaly, lymphadenopathy, sore throat, serositis, and leukocytosis. The frequently noticed cardiopulmonary manifestation is pleuritis, pneumonitis, and pericarditis. Diffuse myocardial dysfunction is uncommon in AOSD, but it may be the cause of life-threatening heart failure. We have experienced a case of AOSD with acute heart failure in 20-year-old female complained of high fever and skin rash. On echocardiogram, the wall motion of left ventricle was globally decreased with a marked diminished ejection fraction (<25%). Two weeks after treatment with high dose steroid and intravenous immunoglobulin, her symptoms and cardiac function on echocardiogram was completely resolved. To our knowledge, this is the first case of AOSD with acute heart failure reported in Korea.