Although gastrointestinal manifestations are very common in patients with Henoch-Sch nlein purpura, protein losing enteropathy is a rare complication. We here report a case of protein losing enteropathy in a patient with Henoch-Sch nlein purpura. A 52-year old woman presented with lower abdominal pain, purpura and edema on lower extremity. Serum albumin was 1.9g/dL and 24 hour urine protein was 4.7g/ day. Skin and kidney biopsy revealed leukocytoclastic vasculitis and mesangial proliferative glomerulonephritis consistent with Henoch-Sch nlein purpura, respectively. Colonoscopy showed diffuse mucosal erosion at right colon. 99mTc-human serum albumin scintigraphy and fecal alpha-1-antitrypsin clearance confirmed protein losing enteropathy. The protein losing enteropathy improved with steroid treatment.
Abdominal Pain ; Biopsy ; Colon ; Colonoscopy ; Edema ; Female ; Glomerulonephritis ; Humans ; Hypoalbuminemia ; Kidney ; Lower Extremity ; Middle Aged ; Protein-Losing Enteropathies* ; Purpura* ; Radionuclide Imaging ; Serum Albumin ; Skin ; Technetium Tc 99m Aggregated Albumin ; Vasculitis

Acyclovir is a remarkably safe drug with potent antiviral effect against herpes virus. The two most serious adverse effects are neurotoxicity and nephrotoxicity. We here report the case of a 64-year old woman with acyclovir induced acute interstitial nephritis. She developed non-oliguric acute renal failure following the administration of oral acyclovir(800mg five times per day) to treat herpes zoster of left 2nd and 3rd thoracic nerves. We documented a normal serum creatinine level just before exposure to the drug. On admission, serum creatinine level was 2.4 mg/dL(baseline level; 0.8mg/dL). Percutaneous renal biopsy revealed interstitial infiltration of lymphocyte and eosinophil with interstitial edema, but there was no crystal formation in the tubules or collecting ducts. After withdrawal of the acyclovir, renal function returned to normal within 1 week.
Acute Kidney Injury ; Acyclovir* ; Biopsy ; Creatinine ; Edema ; Eosinophils ; Female ; Herpes Zoster ; Humans ; Lymphocytes ; Middle Aged ; Nephritis, Interstitial* ; Thoracic Nerves

BACKGROUND: The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care. METHODS: In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis. RESULTS: Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals. CONCLUSION: Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
Ambulatory Care Facilities ; Behavioral Sciences ; Clinical Medicine ; Congresses as Topic ; Family Practice ; Gastroscopy ; Humans ; Inpatients ; Internship and Residency ; Korea ; Outpatients ; Pain Management ; Physicians, Family ; Preventive Medicine ; Quality Improvement ; Referral and Consultation