Identification of perirenal or renal splenosis from undetermined masses: case report and review of the literature.

The incidental finding of tumor-llke perirenal or renal splenosis (PRS) creates a challenge to the renal physicians, because its benign nature has to be distinguished from a malignancy. This paper describes the case of a 40-year-old man referred from a local clinic for further evaluation of an incidental finding of left abdominal masses by ultrasonogram suspecting neoplasm, but was eventually confirmed as PRS by obtaining a history of splenectomy that pointed to splenosis and subsequently by a fusion image from single photon emission computed tomography using 99mTc-labelled heat-denatured erythrocytes and computed tomography (hybrid SPECT/CT). In addition, a review of 27 cases of PRS in a MEDLINE search including the present case revealed the following: all the masses were found incidentally and were associated with a history of previous splenectomy or splenic injury; the initial impressions were neoplastic tumor/PRS (n = 9), PRS (n = 10), and neoplastic tumor without consideration of splenosis (n = 8); surgical exploration was undertaken in all the 8 cases of suspected neoplastic tumor only, whereas non-invasive radiological or radionuclide imaging confirmed splenosis in the rest of the cases (n = 19). To avoid unnecessary tests and invasive surgery for undetermined perirenal or renal masses accompanying previous splenic injury, we stress the paramount importance of careful history-taking, physical examination, and a high index of suspicion for splenosis. Also, fusion imaging of hybrid SPECT/CT was reconfirmed as a useful diagnostic technique for accurately detecting and localizing splenic tissues by PRS.

Electrolyte imbalances and nephrocalcinosis in acute phosphate poisoning on chronic type 1 renal tubular acidosis due to Sjögren's syndrome.

Although renal calcium crystal deposits (nephrocalcinosis) may occur in acute phosphate poisoning as well as type 1 renal tubular acidosis (RTA), hyperphosphatemic hypocalcemia is common in the former while normocalcemic hypokalemia is typical in the latter. Here, as a unique coexistence of these two seperated clinical entities, we report a 30-yr-old woman presenting with carpal spasm related to hypocalcemia (ionized calcium of 1.90 mM/L) due to acute phosphate poisoning after oral sodium phosphate bowel preparation, which resolved rapidly after calcium gluconate intravenously. Subsequently, type 1 RTA due to Sjögren's syndrome was unveiled by sustained hypokalemia (3.3 to 3.4 mEq/L), persistent alkaline urine pH (> 6.0) despite metabolic acidosis, and medullary nephrocalcinosis. Through this case report, the differential points of nephrocalcinosis and electrolyte imbalances between them are discussed, and focused more on diagnostic tests and managements of type 1 RTA.

Unintended cannulation of the subclavian artery in a 65-year-old-female for temporary hemodialysis vascular access: management and prevention.

Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.

The difference in clinical presentations between healthcare-associated and community-acquired pneumonia in university-affiliated hospital in Korea.

PURPOSE: Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, epidemiological studies for HCAP in South Korea are limited. This study aimed to reveal the differences between HCAP and community-acquired pneumonia (CAP), especially in elderly patients, in university-affiliated hospital in South Korea. MATERIALS AND METHODS: We conducted a retrospective observational study of patients with HCAP and CAP (older than 60 years old) who were hospitalized between January 2007 and December 2008. We compared the baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics, and clinical outcomes. RESULTS: A total of 210 patients were evaluated, including 35 patients with HCAP (17%) and 175 with CAP (83%). The most common causative organism was Streptococcus pneumoniae in CAP (33.3%), whereas, Staphylococcus aureus was most common pathogen in HCAP (40.0%). Initial inappropriate antibiotics (6.3% vs. 22.9%; p < 0.005) and initial treatment failure (15.4% vs. 31.4%; p = 0.018) were more frequent in HCAP than CAP. However, mortality (11.4% vs. 5.7%; p = 0.369) was not different between the two groups. CONCLUSION: The present study provides additional evidence that HCAP should be distinguished from CAP, even in elderly patients, in South Korea. Physicians should consider S. aureus and MDR pathogens in selecting initial empirical antibiotics of HCAP in South Korea.