No abstract available.
Diagnosis* ; Female ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography*

Wunderlich syndrome is a spontaneous rupture of the kidney. It is a rare but potentially life-threatening event. The causes are tumor, vascular disease, infection and preeclampsia. Subcapsular hepatic and renal hematoma are rare complications of pregnancy associated with preeclampsia or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Acute fatty liver of pregnancy (AFLP) is rare, but is a fatal complication of the third trimester of pregnancy. The clinical picture consists of liver failure with coagulopathy, encephalopathy and hypoglycemia. Early recognization of the disorder, rapid termination of pregnancy, and intensive supportive care have improved the prognosis. AFLP should be distinguished from HELLP syndrome. AFLP is usually not associated with renal subcapusular hemorrhage. In this report, we describe a 36-year-old nullipara with twin male fetus at 35 weeks of gestation who had developed renal subcapsular hemorrhage in AFLP.
Adult ; Fatty Liver ; Female ; Fetus ; HELLP Syndrome ; Hematoma ; Hemorrhage ; Humans ; Hypoglycemia ; Kidney ; Liver ; Liver Failure ; Male ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Prognosis ; Rupture, Spontaneous ; Vascular Diseases

Primary aldosteronism is defined as hypertension, hypokalemia, increased serum aldosteron, decreased serum renin activity. It has been known that prolonged hypokalemia, renal cyst formation and impairment of renal function. However, nephrocalcinosis associated with primary aldosteronism is rarely reported. A 31-year-old male was admitted to our hospital because of abdominal pain and uncontrolled hypertention which developed 2 years earlier. At admission, blood pressure 180/100 mmHg. Biochemical findings indicated sodium 146 mEq/L, potassium 2.3 mEq/L, BUN 8.2 mg/dL, creatinine 1.1 mg/dL, calcium 10.7 mg/dL, phosphate 5.7 mg/dL, magnesium 1.8 mg/dL. Twenty-four hour urine collection indicated sodium 108 mEq, potassium 32 mEq, calcium 75 mg, phosphate 72 mg, magnesium 8.0 mg. The hormone study revealed PTH 22.7 pg/mL (normal: 9~55 pg/mL), ACTH 8 pg/mL (normal: 6~56.7 pg/mL), aldosterone 51.0 ng/dL (normal: 1~16 ng/dL), plasma renin activity below 0.01 ng/mL/hr (normal: 0.15~233 ng/mL/hr). Abdominal sonography showed homogenous increased medullary echoes and multiple calcification. The abdomen CT showed adrenal mass (1 x 1 cm) consistent with adrenal tumor. Adrenalrectomy was performed on the 16th hospital day and clinical symptoms, blood pressure and hypokalemia improved shortly after operation.
Abdomen ; Abdominal Pain ; Adrenocorticotropic Hormone ; Adult ; Aldosterone ; Blood Pressure ; Calcium ; Creatinine ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Magnesium ; Male ; Nephrocalcinosis* ; Plasma ; Potassium ; Renin ; Sodium ; Urine Specimen Collection

Acute bilateral renal cortical necrosis (BRCN) is a rare cause of renal failure. It has been reported that contrast-enhanced computed tomography provides characteristic findings of BRCN which correlates well with the histopathology making it an important non-invasive diagnostic modality during early phase of BRCN, improving survival rate and prognosis with early diagnosis and treatment. This report presents a case of 73-year old woman with BRCN due to hemolytic uremic syndrome. The patient recovered from anuria and showed complete recovery to normal renal function of her age and serum creatinine level after early initiation of hemodialysis. Furthermore, a normal radiologic finding of kidney was obtained after 52 days from onset of the disease by contrast-enhanced computed tomography. At present, she is preserved within the normal range renal function without renal replacement therapy.
Anuria ; Creatinine ; Early Diagnosis ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Kidney ; Kidney Cortex Necrosis ; Prognosis ; Reference Values ; Renal Dialysis ; Renal Insufficiency ; Survival Rate

Aortic dissection is clinically suspected from the typical symptoms and signs and may be confirmed by computed tomography or aortography. But atypical presentations can be seen in a minority of cases, such as SVC syndrome, right pulmonary artery stenosis etc. We present a case which was initially suspected to be a right atrial tumor because of a large filling defect in the right atrium on radionuclide angiocardiography but finally confirmed to be dissection of ascending aorta by computed tomography.
Angiocardiography ; Aorta ; Aortography ; Constriction, Pathologic ; Heart Atria ; Pulmonary Artery

Ischemic colitis is generally considered a disease of the elderly. The causes of ischemic colitis include low-flow states due to cardiac dysfunction or hypovolemia and certain medications including estrogen. Here we report a case of ischemic colitis in a 26-year-old woman. She had no specific medical history except taking oral-contraceptives for a long time. The mechanism of estrogen-induced ischemic colitis is not clearly understood. But we recommend that oral-contraceptives should be considered as a cause of ischemic colitis in young women.
Adult ; Aged ; Colitis, Ischemic ; Contraceptives, Oral ; Estrogens ; Female ; Humans ; Hypovolemia

Acute interstitial nephritis often caused by drugs and infection. Interstitial nephritis by drugs is a kind of idiosyncratic reaction and is caused independently of dosage. This disease developed within several days or weeks after taking medicine but improved if discontinue medication. Adrenocortical hormone may shorten the period of disease if renal dysfunction continued. Acute interstitial nephritis by carbamazepine that is used for epilepsy cure is rarely reported. A 49-year-old male was admitted to our hospital because of skin rash and decreased urine volume which developed 10 days ago. Patient was diagnosed intracranial hemorrhage 6 months ago and was taking carbamazepine because of tingling sensation to lower extremity before 2 months. At admission, blood pressure 120/80 mmHg, hemoglobin 12.6 g/dL, WBC 232,000/mm3, eosinophil count 2,790/mm3, platelet 166,000/mm3. Urine findings indicated protein 1+, blood 2+ and eosinophil was observed in microscopic examination. Abdominal sonography showed increase of both kidney size, shade of renal cortex and Resistance index (RI). Renal biopsy showed inflammatory cell consisted of lymphocyte, eosinophil in parenchyme was seen with tubular necrosis partially. Renal function was improved after carbamazepine withdrawal and adrenocortical hormone medication.
Biopsy ; Blood Platelets ; Blood Pressure ; Carbamazepine* ; Eosinophils ; Epilepsy ; Exanthema ; Humans ; Intracranial Hemorrhages ; Kidney ; Lower Extremity ; Lymphocytes ; Male ; Middle Aged ; Necrosis ; Nephritis ; Nephritis, Interstitial* ; Renal Insufficiency ; Sensation

BACKGROUND/AIMS: The purpose of this study was to determine the clinical parameters for a differential diagnosis between a malignant and benign stricture of the ampulla of Vater with a grossly normal appearance and to evaluate the diagnostic accuracy of the use of an endoscopic biopsy for the prognosis of ampulla of Vater cancers. METHODS: Medical records and cholangiograms were retrospectively reviewed. In order to determine the clinical parameters useful for a differential diagnosis, clinical manifestations, laboratory findings and the common bile duct diameter were compared between malignant and benign strictures. The diagnostic accuracy of the use of an endoscopic biopsy and the clinical features of patients with an ampulla of Vater cancer were analyzed. The survival rate after management was also evaluated. RESULTS: Nine patients with a benign stricture and 15 patients with a malignant stricture were included in this study. The levels of serum bilirubin, alkaline phosphatase and alanine aminotransferase were significantly higher in patients with a malignant stricture than in patients with a benign stricture (p<0.05). Of the patients who underwent surgical management, 93% had stage I or II disease. All of the patients were alive up to a mean follow-up period of 50 months. CONCLUSIONS: Liver function tests and the use of an endoscopic biopsy are useful in the differential diagnosis of a stricture of the ampulla of vater with a grossly normal appearance. Cancer patients typically present with an early stage and the prognosis is relatively good.
Alanine Transaminase ; Alkaline Phosphatase ; Ampulla of Vater ; Bilirubin ; Biopsy ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Liver Function Tests ; Medical Records ; Prognosis ; Retrospective Studies ; Survival Rate

Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. These foreign bodies can penetrate the bowel wall and cause severe complications. The peristalsis of the esophagus is not strong enough to prevent it from retaining swallowed objects. Hence, perforation from a foreign body is more likely to occur in the esophagus than in the rest of the gastrointestinal tract. A razor blade is a rare foreign body of the esophagus. Its sharpness and large size make it difficult to remove. A razor blade was very firmly impacted in the esophageal wall in our case, and the razor blade had not moved from the upper esophagus. A standard overtube has limitations to remove a razor blade inside the overtube's lumen. We report here on a case of using a wedge resected overtube made it possible to successfully extract a razor blade and no serious complications occurred after extraction of the razor blade.
Esophagus ; Foreign Bodies ; Gastrointestinal Tract ; Peristalsis

BACKGROUND: Hemodialysis (HD) patients with functional iron deficiency often develop resistance to recombinant human erythropoietin (rhEPO). Recent studies have shown that intravenous ascorbic acid (IVAA) administration could override rhEPO resistance in HD patients. This study was undertaken to test the effects of IVAA in HD patients with normoferritinemic functional iron deficiency accompanied by EPO-hyporesponsive anemia. METHODS: Fifty-eight HD patients with normoferritinemic anemia (between 100 and 500 microg/L) were included and divided into the control (N=25) and IVAA (N=33) groups. IVAA patients received 500 mg of IVAA with each dialysis session for 3 months and an additional 4-month follow-up after the end of the therapy. RESULTS: Twenty patients had a response to IVAA with a significant increase in hemoglobin level (Hgb4>1.0 g/dL) and reduction of weekly rhEPO dosage compared with the control group after 3 months of treatment (P<0.05). Compared with non-responders, transferrin saturation (TSAT) was significantly decreased in the responders group (26+/-11 vs. 35+/-14%, P<0.05) on baseline data. There was a significant increase in serum iron and TSAT (baseline vs. 3 months, serum iron 57+/-22 vs. 108+/-22 microg/dL, TSAT 26+/-11 vs. 52+/-7%, P<0.05) and a decrease in serum ferritin (377+/-146 vs. 233+/-145 ng/mL, P<0.05) in the responders group (N=20), but no significant changes in the control and non-responders groups (N=13) at 3-month treatment. CONCLUSION: IVAA can be a potent and effective adjuvant therapy for HD patients with rhEPO-resistant normoferritinemic anemia. In addition, IVAA can reduce the dosage of rhEPO for anemia correction.
Anemia ; Ascorbic Acid ; Dialysis ; Erythropoietin ; Ferritins ; Follow-Up Studies ; Hemoglobins ; Humans ; Iron ; Renal Dialysis ; Transferrin