Magnetic resonance imaging of bone marrow for TAFRO syndrome.

We report two cases of TAFRO syndrome, which is characterized by thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly. Magnetic resonance imaging (MRI) of the spine showed a dark medullary pattern in the bone marrow on the T1- and T2-weighted images of both patients. One patient showed complete resolution after treatment. Serial MRIs of the improved patient revealed a transition to a normal marrow pattern on both images, which might represent resolution of the disease.

Hypotension and Bradycardia Caused by the Inadvertent Ingestion of Rhododendron japonicum.

A 61-year-old man was transferred to our hospital with the complaints of dizziness, severe nausea and abdominal discomfort after consuming approximately 50 g of the flowers of Rhododendron japonicum. On admission, hypotension and sinus bradycardia were evident. Symptoms including hypotension and bradycardia completely recovered within 12 hours following normal saline infusion and intravenous atropine. The ingestion of certain types of Rhododendron species can cause intoxication, referred to as "mad honey poisoning", due to the action of grayanotoxins. This is the first local case of acute intoxication caused by Rhododendron japonicum.

Crowned Dens Syndrome as an Initial Manifestation of Crystalline Deposition Disease.

An 88-year-old woman presented with fever and acute posterior neck pain. A CT scan revealed calcification of the transverse ligament and crown-like calcification around the odontoid process. According to the clinical and radiological findings, she was diagnosed with crowned dens syndrome (CDS). Her symptoms drastically improved following treatment with oral nonsteroidal anti-inflammatory medication. An X-ray of her wrist, elbow, shoulder and knee joints showed asymptomatic calcium deposits, suggesting underlying crystalline deposition disease. CDS may occur as the initial presentation of crystalline deposition disease. The measurement of procalcitonin and an X-ray survey of the major joints may be helpful for the diagnosis of CDS.

[Pulmonary thromboembolism during the Niigata Chuetsu earthquake in 2004].

We encountered 2 cases of pulmonary thromboembolism developed during refuge for Niigata Chuetsu earthquake in 2004. Case 1 was a 76-year-old woman who moved to the back seat of a car for refuge since the earthquake struck on October 23rd, 2004. When she emerged from the car on the morning of October 25th, she felt sudden dyspnea and lost consciousness. On arrival at the hospital, she had low blood pressure and hypoxemia, hypocapnia, and metabolic acidosis. Based on her clinical history and her symptoms, pulmonary thromboembolism was suspected and heparinization was begun immediately. In our hospital, the chest CT angiography proved the diagnosis. She was transferred to a university hospital for further treatment. Case 2 was a 79-year-old woman. She spent only one night in a car. Fifteen days after the earthquake, chest tightness and dyspnea occurred. Although her symptoms were improved and disappeared, she came to our hospital. Chest CT images confirmed pulmonary thromboembolism, and treatment with heparin was begun. We think this pulmonary thromboembolism was related to the knee-bending position she had assumed in the car and decreased activity during refuge. This is a clinical condition which could happen during disasters in the future. We should recognize the likelihood of pulmonary thromboembolisms in the disasters in the future.

Thrombosis in inferior vena cava (IVC) due to intra-cystic hemorrhage into a hepatic local cyst with autosomal dominant polycystic kidney disease (ADPKD).

A 76-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted complaining of severe edema of bilateral lower extremities. Computed tomography (CT) of his abdomen revealed an enlarged hepatic cyst with intra-cystic hemorrhage, and massive thrombosis in the inferior vena cava (IVC). The extrinsic mechanical stress on the IVC seemed to induce thrombosis within the IVC, and the thrombosis was likely the cause of severe edema in lower extremities. In this report, we present a rare case of IVC thrombosis due to an enlarged cyst in ADPKD successful treated with anticoagulant therapy.

High peritoneal clearance of small molecules did not provide low serum beta2-microglobulin concentrations in peritoneal dialysis patients.

OBJECTIVE: Although early reports demonstrated that serum beta(2)-microglobulin (s-beta(2)m) concentrations in patients on peritoneal dialysis (PD) were lower than those in patients on hemodialysis (HD), more recent studies demonstrated lower s-beta(2)m concentrations in HD patients treated mainly with high-flux synthetic membranes. We therefore compared s-beta(2)m concentrations between patients on PD and on HD, and also analyzed the relationship between s-beta(2)m concentrations and other parameters in patients on PD. PATIENTS AND METHODS: We investigated 24 patients who had been undergoing PD [11 on continuous ambulatory peritoneal dialysis, 13 on continuous cycling peritoneal dialysis] for 4.3 +/- 2.7 years, and 24 patients who had been undergoing HD with high-flux synthetic membranes for 6.1 +/- 3.2 years. Concentrations of s-beta(2)m in the PD patients were compared to concentrations in the HD patients. In patients on PD, we also analyzed the relationship between s-beta(2)m concentration and other parameters, including residual renal function, total weekly Kt/V urea, total weekly creatinine clearance (CCr), and dialysis schedules. RESULTS: We found no significant difference in s-beta(2)m concentrations between the PD and HD patients (33.6 +/- 10.4 mg/L vs 30.3 +/- 10.5 mg/L respectively). Concentrations of s-beta(2)m in PD patients rose with PD duration and were significantly inversely correlated with residual renal function (r = -0.71, p < 0.0001). Unexpectedly, concentrations of s-beta(2)m in anuric PD patients rose as peritoneal CCr increased. And most of the patients with high s-beta(2)m levels fell into the high or high-average transport categories according to a peritoneal equilibration test. CONCLUSIONS: Concentrations of s-beta(2)m in patients on PD did not differ significantly from concentrations in HD patients who were using high-flux synthetic membranes. The contribution of residual renal function to removal of beta(2)m was more important than the contribution of peritoneal clearance. High peritoneal clearance of small molecules did not result in low s-beta(2)m concentrations, especially in anuric patients with accelerated peritoneal permeability.