A case of ectopic parathyroid carcinoma presenting with renal failure and anemia / 대한내과학회지

Parathyroid carcinoma is an uncommon cause of PTH-related hypercalcemia with a reported incidence of 0.4% to 5% of all cases of primary hyperparathyroidism. Even though the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma than in those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma preoperatively. Parathyroid carcinomas are usually larger and firmer than parathyroid adenomas and patients with parathyroid carcinoma have a higher incidence of renal dysfunction, bone disease and gastrointestinal symptoms. Anemia is an uncommon clinical feature of parathyroid carcinoma. There have been no prior cases of ectopic parathyroid carcinomas reported to date. In this article, we report the case of a 26-year-old man who developed severe anemia and acute renal failure due to an ectopic parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. His serum calcium levels returned to normal and the anemia resolved postoperatively.

A Case of Glomerulonephritis Associated with POEMS Syndrome / 대한신장학회잡지

A POEMS syndrome(polyneuropathy, organomegaly, endocrinopathy, monoclonal M protein, and skin lesion) is a rare multisystem disease of unknown cause with varying clinical manifestations. POEMS- associated renal disease is also a rare condition. We experienced a 42-year-old male who had been suffered from generalized edema, low extremity weakness and pain. He also had a significant hematuria, proteinuria, azotemia, hepatospenomegaly, intraperitoneal lymph node enlargement, hypothyroidism, IgA lamda type monoclonal gammopathy, specific skin change and ascites. In renal biopsy, membranoproliferative features with enlarged glomeruli, mesangial proliferation, capillary wall thickening and paucity of immune deposit was noted. We suppose that renal insufficiency could come from POEMS syndrome. His symptoms such as low extremity pain, azotemia and generalized edema were improved by hemodialysis and use of prednisolone. At present, he is under the treatment of prednisolone and melphalan.

A case of sclerosing encapsulating peritonitis presenting a huge pseudocyst formation in end stage renal failure on the maintenance hemodialysis / 대한내과학회지

Sclerosing encapsulating peritonitis(SEP) is now a well-recognised, but uncommon complication of chronic ambulatory peritoneal dialysis(CAPD). The etiology is unclear, but SEP is believed to be multifactorial. The most important factors seem to be the length of time on peritoneal dialysis and previous episodes of peritonitis. Anorexia, nausea, vomiting, weight loss, abdominal pain, and a reduction of the ability of the peritoneum to act as a dialyzing membrane are the usual presenting problems. We experienced one case of SEP presenting a huge pseudocyst in the patient of end stage renal failure on the maintenance hemodialysis for 5 years, even though he had a history of CAPD for 5 years. So we report this case with review of the literature.

Usefulness of Renal Computerized Tomography in Acute Pyelonephritis / 대한신장학회잡지

We carried out a prospective study with three aims:(1) to observe the renal computed tomography (CT) patterns in APN; (2) to compare the radiological imaging techniques used for the diagnosis of APN(renal CT and DMSA scintigraphy); (3) to correlate the clinical manifestations with CT findings in APN. Between 1 April 1997 and 31 March 1998, all adults who were admitted to our internal medicine ward with APN were included in this study. They presented with symptoms and signs of upper UTI, accompanied by pyuria and bacteriuria. All patients with renal abscess, or uropathy on the ultrasound (US) examination, were excluded from the study. 23 cases of APN were evaluated. There were 22 females and 1 male. The mean age of 23 cases was 45+/-19 years old(from 20 to 79 years old). Two cases we re diabetics. On the basis of postcontrast- enhanced CT findings, 23 cases were grouped into (1) Group I(6 cases), no abnormal lesions; (2) Group II(13 cases), wedge-shaped lesions (focal or diffuse); (3) Group III(2 cases), focal mass-like lesions; and (4) Group IV(2 cases), diffuse mass-like lesions. The incidences of CT and DMSA scintigraphy abnormalities were 74%(17/23) and 68%(13/19), respectively. A significant correlation was demonstrated between the clinical parameters(including duration of flank pain and fever, ESR, serum creatinine, and degree of pyuria) and the pattern of renal parenchymal findings detected on CT(P<0.05). In conclusion, we classify APN into four subgroups according to CT findings, and suggest that renal CT is useful in the diagnosis and assessment of severity of APN.

Hearng loss in chronic renal failure patients / 대한내과학회지

OBJECTIVES: Hearing loss, mainly a sensorineural hearing loss (SNHL), was frequently observed in patient with chronic renal failure. Although several causes and prevalence of this hearing loss had been proposed, the etiology and prevalence are still controversial. The purpose of the present study was another study to determine the prevalence, type and comparative degree of hearing loss in chronic renal failure according to various parameters. METHODS: Subjects for this study were 39 patients with hemodialysis and 10 chronic renal failure patients before hemodialysis. Pure tone audiometry was performed and pure tone average(PTA) was estimated. At same time, pure tone threshold were estimated at the range from 250 to 500(low frequency range), from 1000 to 2000(middle frequency range) and from 4000 to 8000 Hz(high frequency range). Significant hearing loss of PTA as well as the significant loss in pure tone threshold of each frequency range was defined when the loss of hearing ability was 25dB more than the normal value. The effect of alteration in age, sex, hemoglobin, lipid profile, duration of hemodialysis, underlying diseases and ototoxic drugs were evaluated. RESULT: 1) The main type of hearing loss was SNHL and it was asymptomatic and progressive. The prevalence of SNHL by means of PTA was 76% in the patient with chronic renal failure. The SNHL of high frequency range(89%), SNHL of middle frequency range(18%) and SNHL of low frequency range (45%) were observed on the basis of the pure tone threshold. 2) There was no significant difference of SNHL according to various parameters of sex, hemoglobin, lipid profile, BUN, and underlying diseases except age. 3) The patients under hemodialysis exhibited the more SNHL over all frequency ranges than those without hemodialysis and there was the more SNHL in patients of more than 2 years of hemodialysis and those of less than 2 years of hemodialysis 4) Furosemide was significantly ototoxic in patients with chronic renal failure. CONCLUSION: The type of hearing loss was mainly sensori-neural and high tone loss. The degree was slight to moderate. The prevalence was the higher than expected. Regular hemodialysis treatment seems to affect hearing loss during even 2 years of treatment. Therefore, hearing loss appeared to be related to the duration of hemodialysis. The more precise and regular audiometric monitorings were recommanded in hemodilalysis patients.

The Expression of Apoptosis in Lupus Nephritis / 대한내과학회지

BACKGROUND: A few researches on apoptosis in proliferative glomerulonephritis including lupus nephritis, have been reported on the basis of animal experimental models and human renal biopsy tissues. Systemic lupus erythematosus has been reported as a disease with an apoptosis defect of lymphocyte, so that it leads to the decreased immunologic tolerance and activated autoimmunity. The lupus nephritis is frequently accompanied with a interstitial fibrosis and tubuloepithelial change, as compared to other nephitis. In addition to that, the pathologic evolution from one class to other class is also feasible and these things make us to think that the lupus nephritis is tightly linked to the apoptosis. METHOD: We evaluated the relationship between the apoptosis and pathologic characteristics, which was focused on class IV, in 22 patients with clinically and biopsy proven lupus nephritis by comparing with control specimens. The study on the apoptosis was observed through in situ DNA nick end-labeling method and the review on the medical history. RESULTS: 1) An apoptosis in glomerulus was observed in only five patients (zero in Class II, 50% in Class IV) of proliferative glomerulonephritis. But 14 patients (50% in Class II, 75% in Class IV) were detected on the site of tubulo-interstitium. 2) The apoptosis detected in tubulo-interstitial area was significantly correlated with nephrotic syndrome (P<0.025), but correlations with the complement serum level, renal function and the used amount of steroid was not determined. CONCLUSION: The apoptosis of glomerulus in the lupus nephritis was observed in 50% of proliferative cases (especially, in class IV), but in the area of tubulointerstitium, the higher rate (more than 50%) of apoptotic expressions were observed in class II and class IV. The observation on apoptosis in renal tissue could be another prognostic factor.

Changes of Cardiac Function by the Arteriovenous Fistula in End Stage Renal Failure Patients

A hemodialysis arteriovenous fistula may cause high output cardiac state by volume overload and decreased systemic vascular resistance. Arteriovenous fistulas for hemodialysis consist usually of either a radiocephalic fistula at the wrist or a more proximal brachiocephalic fistula at the antecubital fossa. In this study the contribution of arteriovenous fistula to cardiac function has been evaluated by comparing cardiac performance before and after the point occlusion of the anastomotic site. The results suggest that the occlusion of arteriovenous fistula may decrease end-diastolic left ventricular volume (VOLd), increase end-systolic left ventricular volume (VOLs), decrease stroke volume (SV), decrease ejection fraction (EF) and decrease cardiac output (CO). This study shows that arteriovenous fistula influences directly to cardiac performance, so careful determination of dialysis option is required for the end stage renal failure patients with marginal heart function.

Immature Reticulocyte Count as an Indicator of Erythropoiesis in CRF / 대한신장학회잡지

Transfusion requirement or hemoglobin level has been a major indicator of the erythropoiesis of CRF patients. However, the more objective and earlier detectable parameters to monitor the erythropoiesis has been required. We investigated the significance of immature reticulocyte count(IRC) with flowcytometry in CRF patients as a convenient index of erythropoietin(EPO) therapy. We evaluated CRF patients undergoing hemodialysis(n=35) and normal control group(n=14). The 26 patients of CRF have been under EPO therapy, the others(n=9) have not been under therapy. 1) The response of IRC to EPO therapy : IRC increased daily 4.95% in average upto 3rd day and decreased daily 3.7% in average since then. 2) The similar IRC was maintained in similar hemoglobin state : IRC, total reticulocyte count(TRC) and hemoglobin were compared between CRF patients with low dose EPO therapy and those who weren't needed EPO administration from the beginning. 3) The increase of IRC depends on the dose of EPO : 4) Correlation between IRC and other hematologic parameters : IRC was significantly correlated with TRC and serum iron level(R value : 0.736, 0.522 respectively). Taken together, these results suggest that maintenance of IRC level, 8-10%, was necessary at a minimum to obtain 8g/dL of hemoglobin level. However, IRC level could be readjusted more than 20% with higher EPO therapy to maintain 8g/dL of hemoglobin in severe case. In conclusion, the measurement of IRC in CRF is clinically more objective, useful, earlier indicator for estimating erythropoiesis than hemoglobin and TRC.

Compared studies of rabbit renal pathologic changes in glycerol-inuced rhabdomyolysis and anthracite coal briquette gas exposure / 대한신장학회잡지

No abstract available.

A case of myopathy associated with hyperthyroidism / 대한내분비학회지

No abstract available.

Experimentally induced viral myocarditis in mouse / 대한내과학회지

No abstract available.

A case of hepatoma with hot uptake of Tc-DISIDA to spleen / 대한핵의학회잡지

No abstract available.

Flow cytometric analysis of nuclear DNA in hypertrophied hearts of human / 대한내과학회지

No abstract available.

Urinalysis finding in traumatized patients / 대한신장학회잡지

No abstract available.

Graves' disease Associated with Idiopathic Thrombocytopenic Purpura and Iron Deficiency Anemia / 영남의대학술지

Since 1931, sporadic reports have appeared noting an apparent association between hyperthyroidism and idiopathic thrombocytopenic purpura. Recent various studies suggested that these two diseases may share a similar immunologic background, but the exact mechanism is still a matter of speculation. This 22-year-old female patient visited this hospital because of general weakness and purpura of legs for 2 months. The laboratory findings were compatible with Graves' disease associated with idiopathic thrombocytopenic purpura. The platelet count was 16000/mm³, hemoglobin was 10.9 g/dl and MCV was 60.1fL. T3 was 490.53 ng/dL, T4 was 24 ug/dL and free T4 was 5.66 ng/dL. Antiplatelet antibody and antimicrosomal antibody were positive. The bone marrow findings were compatible with iron deficiency anemia and idiopathic thrombocytopenic purpura. The thyroid biopsy showed adenomatous goiter. She was administered with propylthiouracil, Beta-blocker, iron and prednisolon. On the 10th hospital day, platelet count was 184000/mm³, hemoglobin was 12.0 gm/dL and MCV was 67.5 fL. On the 20th hospital day, T4 was 10.35 ug/dL and free T4 was 2.30 ng/dL. Therefore she was discharged and followed up.

A Clinical Study on the Patients with Pyuria / 영남의대학술지

To evaluate the features of pyuria related to the bacteriuria, 140subjects were studied from Jan. 1987 to Dec. 1987. They pyuria was frequently developed from the age 30 to 60 years old, and male to female ratio was 1:1.41. The most common disease was urethrocystitis that was shown 42.8%. Common precipitating factors were urethral catheterization (25%) and urinary tract obstruction (11.4%). Through the observation, symptomatic pyuric patients were 66 subjects (47.1%), and the subjects with significant urine culture were 121 subjects (86.4%). In the urine culture, the most common bacteria was E. coli (41.4%), and the next was Pseudomonas (19.3%). A large percentage of E. coli and Pseudomonas was susceptible of amikin. The pyuria due to S. epidermidis and Accinatobacter was well treated. High therapeutic rate was observed in the acute pyelonephritis (71%) and urethrocystitis (67%). In the persistent urinary tract infection, there were relapsing (22 cases) and recurrent urinary tract infection (16 cases).