Recombinant human erythropoietin is a synthetic glycoprotein hormone and has the effect on bone marrow erythroid progenitor cells. Therefore, recombinant human erythropoietin has been frequently used as an agent treating anemia in chronic renal failure patients. However, Stockenhuber reported that recombinant human erythropoietin also affected other bone marrow progenitor cells (colony- forming unit-granulocyte-erythrocyte-macrophage, colony-forming-gra-nulocyte-macrophage). This reports may suggest a possible casual relationship between acute myeloid leukemia and erythropoietin. Acute myeloid leukemia is a rare disease in patients with chronic renal failure especially on erythropoietin treatment. By this time only a case of acute leukemia in chronic renal failure was reported by Campistrus in 1995. Campistrus's case was on the remission state of acute myeloid leukemia, and erythropoietin was administered to treat anemia of chronic renal failure. Also no previous case of acute myeloid leukemia developed in chronic renal failure patients on erythropoietin treatment was yet reported in Korea. So, we report a case of acute myeloid leukemia developed in a pre-dialysis chronic renal failure patient but on erythropoietin treatment.
Anemia ; Bone Marrow ; Erythroid Precursor Cells ; Erythropoietin* ; Glycoproteins ; Humans ; Kidney Failure, Chronic* ; Korea ; Leukemia ; Leukemia, Myeloid, Acute* ; Rare Diseases ; Renal Insufficiency ; Stem Cells

Acute interstitial nephritis may result from a variety of causes and may present a variety of clinical and laboratory findings. If there was or going deterioration of renal function in patients with glomerular disease but without any evidence of other causes for that especially after administration of drug, acute interstitial nephritis should be considered as one possible causes for that Acute interstitial nephritis may be progressing more rapidly than expected but since acute interstitial nephritis is reversible with withdrawal of the drug, its early detection is very important. Acute interstitial nephritis induced by furosemide is rarely reported. But furosemide is a well know drug commonly used in the management of edema due to various causes. Therefore considering furosemide as one possible cause of acute interstitial nephritis is clmicaly important. We experienced a case of acute interstitial nephritis in a 29 year old man with nephrotic syndrome after treatment of furosemide. On admission, physical examination lower extremities revealed severe pitting edema. Serum creatinine level was 1.2 mg/dL. For edema control, we started furosemide therapy. After furosemide therapy, his serum creatinine level was elevated to 3.5mg/dL. He had mild but transient fever. Peripheral eosinophilia, eosinophiluria, skin rash were not observed and threr was no evidence of any infection. Definite diagnoisis was established by renal biopsy and renal biopsy revealed a diffuse interstitial nephritis with dense infiltration by lymphocytes and plasma cells. In addition, moderate tubular atrophy and diffuse interstitial edema was present. The patient recovered promptly after withdrawal of furosemide and with steroid therapy.
Adult ; Atrophy ; Biopsy ; Creatinine ; Edema ; Eosinophilia ; Exanthema ; Fever ; Furosemide* ; Humans ; Lower Extremity ; Lymphocytes ; Nephritis ; Nephritis, Interstitial* ; Nephrotic Syndrome* ; Physical Examination ; Plasma Cells

The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Microvascular thromboses in HUS may involve intestine, pancreas, skeletal muscle, and heart. Microinfarcts in the pancreas may cause acute pancreatitis and rarely insulin-dependent diabetes mellitus. Acute pancreatitis is a relatively common complication of HUS in children, but rare (2%) in adults. We have experienced a 43 year-old woman with HUS complicating acute pancreatitis. She presented with hemolytic anemia, thrombocytopenia and acute renal failure. During hemodialysis, she complained of left side abdominal and back pain. On laboratory study, levels of serum amylase and lipase were elavated. The size and shape of pancreas was normal on abdominal ultrasonography and computed tomography. We present this case with a review of literature.
Acute Kidney Injury ; Adult ; Amylases ; Anemia, Hemolytic ; Back Pain ; Child ; Diabetes Mellitus, Type 1 ; Female ; Heart ; Hemolytic-Uremic Syndrome* ; Humans ; Intestines ; Lipase ; Muscle, Skeletal ; Pancreas ; Pancreatitis* ; Renal Dialysis ; Thrombocytopenia ; Thrombosis ; Ultrasonography

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.
Aged* ; Asthma ; Auscultation ; Humans ; Lung ; Methacholine Chloride ; Motor Activity ; Respiratory Sounds* ; Surveys and Questionnaires

BACKGROUND: In Korea, paraquat accounts for most of fatal poisoning with 500 or more deaths per year. It has been known that patients who ingested more than 1/2 mouthful of 20% concentrate paraquat usually die of multiorgan failure and pulmonary fibrosis. But the effect of charcoal hemoperfusion which can enhance elimination of paraquat remains controversial. Because acute paraquat poisoning is also characterized by multiorgan failure including kidney and marked rebound in plasma paraquat level after hemoperfusion, Continuous veon-venous hemofiltration(CVVH) may have theoretical benefits in the treatment of paraquat poisoning. So we evaluated the effect of early charcoal hemoperfusion and prophylactic CVVH after hemoperfusion in patients with paraquat poisoning. METHODS: There were 80 patients with paraquat poisoning admitted within 24 hours after ingestion (August 1996 - March 1998). All of them were treated with hemoperfusion (duration of hemoperfusion, 6.4+/-3.0 hours) within 24 hours of ingestion. The amount of ingestion was 2.1+/-1.0 mouthful (as 20% concentrate) and 78 (98%) were urine sodium dithionite test positive which is a poor prognosis factor. Forty-four patients received hemoperfusion only and 36 were followed by CVVH (duration, 50.4+/-20.9 hours; ultrafiltration volume, 33.8+/-3.9 L/day) after hemoperfusion. RESULTS: There was no difference between the hemoperfusion group and hemoperfusion+CVVH group in age, sex, initial serum creatinine, arterial oxygen saturation, severity of poisoning (as assessed by serum paraquat level determined by HPLC and amount of ingestion), or in the time elapsed from ingestion to the beginning of hemoperfusion. The total mortality was 65% (52/80) with no difference between the hemoperfusion group (64%, 28/44) and hemoperfusion+CVVH group (67%, 24/36). The mortality according to amount of ingestion was as follows: < 1 mouthful, 0% (0/5); 1 mouthful, 53% (8/15); 2 mouthful, 65% (11/17); > or = 3 mouthful, 82% (27/33); unknown, 60% (6/10). CONCLUSION: Early hemoperfusion can be effective in reducing mortality in patients who ingest less than 2 mouthful. Even though prophylactic CVVH after hemoperfusion has no additional benefit in reducing mortality in paraquat poisoning, it prolonged the time to death after ingestion.
Charcoal ; Chromatography, High Pressure Liquid ; Creatinine ; Dithionite ; Eating ; Hemofiltration* ; Hemoperfusion* ; Humans ; Kidney ; Korea ; Mortality ; Mouth ; Oxygen ; Paraquat* ; Plasma ; Poisoning* ; Prognosis ; Pulmonary Fibrosis ; Ultrafiltration

BACKGROUND: Acute renal failure is a reversible process in majority of cases but mechanisms of renal injury or recovery are poorly understood. Recently neutrophil infiltration is reported to potentiate inflammatory and cytotoxic cascade in ischemic renal injury and alpha-melanocyte stimulating hormone has been reported to have a potent anti-inflammatory properties in a variety of animal models. We examined the beneficial effects of alpha-MSH in acute ischemic renal injury in rats and tried to clarify its action mechanism. METHODS: After unilateral nephrectomy, renal artery of contralateral kidney was clamped for 40 minutes and reperfused in female Sprague-Dawley rats. alpha-MSH (50(mu)g) and vehicle was injected intraperitoneally immediately after and 6, 24 hours after reperfusion. Biochemical, histological data, ICAM-1 mRNA, protein expressions and polymorphonuclear cell infiltration were examined. RESULTS: alpha-MSH significantly attenuated the renal injury, measured by plasma BUN and creatinine level and also the degree of severity of histological injury (BUN 125.2+/-14.6 mg/dL : 46+/-19.6 mg/dL (p=0.004), creatinine 3.65+/-0.81 mg/dL : 1.47+/-0.5 mg/dL (p=0.005) at 24 hours after reperfusion, BUN 88+/-12.5 mg/dL : 25.5+/-15.8mg/dl (p=0.002), creatinine 2.76+/-0.5 mg/dL : 0.93+/-0.2 mg/dL (p=0.002) at 72 hours after reperfusion and 5.4+/-1.94/ 2.6+/-0.77 (p=0.006) at 24 hours after reperfusion in histilogical grading system). In the alpha-MSH treated groups, ICAM-1 mRNA expression decreased significantly compared to the vehicle treated ischemic group in 72 hours after reperfusion (0.49+/-0.01/0.31+/-0.2, p<0.008). ICAM-1 protein expression also decreased in alpha-MSH treated group, but it was not statistically significant. Polymorphonuclear cell infiltration showed a significant decrease in the alpha-MSH treated group at 24 hours after reperfusion (5.05+/-1.8/1.59+/-0.4, p=0.009). CONCLUSION: alpha-MSH attenuates ischemic renal injury by inhibiting the expression of ICAM-1 and subsequent polymorphonuclear cell infiltration. These results provide a rationale of alpha-MSH as a potential therapeutic drug in acute renal failure.
Acute Kidney Injury ; alpha-MSH ; Animals ; Creatinine ; Female ; Humans ; Intercellular Adhesion Molecule-1* ; Ischemia ; Kidney ; Models, Animal ; Nephrectomy ; Neutrophil Infiltration ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Renal Artery ; Renal Insufficiency* ; Reperfusion ; RNA, Messenger

Cholesterol polyps are the most common cause of the polypoid lesions of the gallbladder shown by ultrasonography (US). Cholesterol polyps are usually attached to the mucosal surface of the viscus with delicate, filammentous stalks so that they can be easily detached. Recently, laparoscopic cholecystectomy has been introduced to treat various gallbladder diseases. We have experienced four patients with ultrasonographically typical gallbladder polyps, that were not detected in the pathologic specimens removed by laparoscopic cholecystectomy. In each patients, intraluminal suction preceded the laparoscopic cholecystectomy, and the suction was presumed to have resulted in the detachment of cholesterol polyps having delicated and fragile stalks.
Cholecystectomy, Laparoscopic ; Cholesterol ; Gallbladder Diseases ; Gallbladder* ; Humans ; Polyps* ; Suction ; Ultrasonography

Retroperitoneal duodenal rupture is rare and is often difficult to diagnose on the plain abdominal x-ray. From a review of the plain abdomen films of 21 cases with retroperitoneal duodenal rupture, confirmed by operation, pneumoretroperitoneum was revealed in 16 cases; Air in the peritoneum was manifested as a bubbly shadow in 12 cases, a renal halo in 9 cases, air shadow along the right psoas margin in 2 cases, air along the diaphragmatic crus in 2 cases and air in the right properitoneal fat in 2 cases, US and CT also revealed air bubbles and fluid collection around the right kidney. We recommend the plain abdomen as a useful diagnostic method for detection of pneumoretroperitoneum.
Abdomen* ; Kidney ; Methods ; Peritoneum ; Retropneumoperitoneum ; Rupture*

No abstract available in English.
Arteriovenous Fistula* ; Heart Septal Defects, Ventricular*

Pulmonary histiocytosis X is a rare granulomatous disorder of unknown etiology that alters the interstitium of the lung. When confined to the lung, it is known as primary pulmonary histiocytosis X or eosinophilic granuloma of the lung. The chest radiograph shows characteristic nodular, reticular, and cystic abnormalities, which are most apparent in the upper and middle lung zones, but spare the costophrenic angles, The CT demonstrates innumerable small cysts with thin walls, and fine nodules. Recently we experienced pathologically proven primary pulmonary histiocystosis X in 35 years old male patients who had recurrent pneumothorax.
Eosinophilic Granuloma ; Histiocytosis, Langerhans-Cell* ; Humans ; Lung ; Male ; Pneumothorax ; Radiography, Thoracic