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A Case of Adult onset Bartter Syndrome with Nephrocalcinosis.

Min Gyu PARK ; Tae Won LIM ; Hee Taek OH ; Seung Un SONG ; Dong HEO ; Hark RIM

Kosin Medical Journal.2014;29(1):75-79. doi:10.7180/kmj.2014.29.1.75

Bartter syndrome is a renal tubular defect in electrolyte transport characterized by hypokalemia, metabolic alkalosis, hyperreninemia, hyperaldosteronism, normal blood pressure, and other clinical symptoms. As a clinical and genetical heterogeneous disorder, this syndrome can be classified into two clinical variants, antenatal Bartter syndrome and classic Bartter syndrome according to the onset age. Nephrocalcinosis is common in antenatal Bartter syndrome, but is rare in classic Bartter syndrome. It can also be classified into five genetic subtypes by the underlying mutant gene, all of which are expressed in the tubular epithelial cells of the thick ascending limb of the loop of Henle. Patients with Bartter syndrome type 1, 2 and 4 present at a younger age than classic Bartter syndrome type 3. We have experienced a case of Bartter syndrome with nephrocalcinosis in a 42-year-old woman diagnosed by biochemical and radiologic studies. We had successful response with potassium chloride and spironolactone.
Adult* ; Age of Onset ; Alkalosis ; Bartter Syndrome* ; Blood Pressure ; Epithelial Cells ; Extremities ; Female ; Humans ; Hyperaldosteronism ; Hypokalemia ; Loop of Henle ; Nephrocalcinosis* ; Potassium Chloride ; Spironolactone

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A Case of Lead Migration Caused by Involuntary Movement in Implanted Spinal Cord Stimulation.

Ju Deok KIM ; Jeong Gil LEE ; Sang Su KIM ; Hye Young SHIN

Kosin Medical Journal.2014;29(1):69-73. doi:10.7180/kmj.2014.29.1.69

Spinal cord stimulation (SCS) is a reliable clinical option for treatment of refractory chronic pain. It is known to be effective method for treating sympathetic pain, failed back surgery syndrome, and complex regional pain syndrome etc. The devices and implantation techniques for SCS are already highly developed and continuously improving, but there are some complications that can not be corrected easily. Lead migration is the most common complication after SCS. It can cause failure of SCS that can make discomfort to patients. Here we describe our experience of lead migration in implanted SCS which was inserted to a patient with complex regional pain syndrome patient.
Chronic Pain ; Dyskinesias* ; Failed Back Surgery Syndrome ; Humans ; Spinal Cord Stimulation*

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A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman.

Young Shin SHIN ; Eun Hee SIM ; Chang Woo YEO ; Jin Doo KANG ; Ji Yeon KIM ; Seon Ja PARK

Kosin Medical Journal.2014;29(1):63-68. doi:10.7180/kmj.2014.29.1.63

Isoniazid is one of the most commonly used antituberculosis drug. Acute into xication is characterized by repetitious convulsions, high anion gap metabolic a cidosis and coma. The basis of theraphy consists of parental pyridoxine admi nistration in a dose equivalent to that of isoniazid ingested. Here we present a case of seizure and metabolic acidosis due to only renal adjustment dosage of Isoniazid in an elderly woman.
Acid-Base Equilibrium ; Acidosis* ; Aged* ; Coma ; Female ; Humans ; Isoniazid* ; Parents ; Pyridoxine ; Seizures*

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A Case of Oliguric Mannitol Induced Acute Kidney Injury Early Treated by Continuous Renal Replacement Therapy.

Kyungo HWANG ; Yeo Jin KANG ; Eun Jin BAE ; Se Ho CHANG ; Dong Jun PARK

Kosin Medical Journal.2014;29(1):59-62. doi:10.7180/kmj.2014.29.1.59

We report oliguric mannitol-induced acute kidney injury (AKI) early treated by continuous renal replacement therapy. A 70-year-old woman was admitted to the Department of Neurology with diagnosis of acute intracranial hemorrhage. Mannitol was infused for intracranial pressure control. At admission third day, urine output was abruptly decreased to 57 ml during first 6 hours and blood urea nitrogen (BUN) and serum creatinine was increased to 54.2 mg/dL and 5.3 mg/dL respectively. Plasma osmolality was 340 mOsm/kg and osmolar gap was 70. Mannitol was immediately withdrawn and continuous renal replacement therapy (CRRT) was performed to remove mannitol rapidly. Urine output was increased 6 hours later after continuous veno-veno hemodiafiltration (CVVHDF) start. BUN and creatinine was decreased to 21.4 and 1.2 mg/dL at admission ninth day. Mannitol can develop oliguric AKI and CRRT may be of more benefit than conventional hemodialysis in the case of increased intracranial pressure.
Acute Kidney Injury* ; Aged ; Blood Urea Nitrogen ; Creatinine ; Diagnosis ; Female ; Hemodiafiltration ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Mannitol* ; Neurology ; Oliguria ; Osmolar Concentration ; Plasma ; Renal Dialysis ; Renal Replacement Therapy*

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A Case of Hydrothorax Aggravated by Peritoneal Dialysate Leakage in Compensated Liver Cirrhosis Patient with Ascites.

Gain YOU ; Ho Sik SHIN ; Yeon Soon JUNG ; Hark RIM

Kosin Medical Journal.2014;29(1):53-57. doi:10.7180/kmj.2014.29.1.53

The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.
Ascites* ; Caregivers ; Diagnostic Imaging ; Drainage ; Humans ; Hydrothorax* ; Liver Cirrhosis* ; Peritoneal Dialysis ; Pleural Effusion

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Characteristics of Peripheral versus Central Lung Cancer Since 2000.

So Young OCK ; Tae Won JANG ; You Jin HAN ; Go Eun YEO ; Eun Jung KIM ; Won Hyoung LEE ; Nam Kyu KIM

Kosin Medical Journal.2014;29(1):47-52. doi:10.7180/kmj.2014.29.1.47

OBJECTIVES: The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer. METHODS: We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010. RESULTS: The age of patients increased significantly during the last decade (P < 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (P < 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; P < 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (P < 0.05). CONCLUSIONS: The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.
Adenocarcinoma ; Bronchoscopy ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Incidence ; Lung ; Lung Neoplasms* ; Retrospective Studies

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Results of Bypass Surgery in Patients with Atherosclerosis Obliterans of the Lower Extremities.

Seong Ho CHO

Kosin Medical Journal.2011;26(2):161-166.

OBJECTIVES: This study was performed to study the outcomes of operations in the patients with atherosclerosis obliterans of lower extremities. METHODS: Forty patients underwent vascular bypass operations from January 2006 to December 2010 and were analyzed retrospectively with clinical records. RESULTS: Forty six bypassing procedures were performed in 40 limbs. The type of operations were femoro-popliteal bypass in 29 limbs, femoro-femoral bypass in 15 patiens and popliteo-posterior tibial bypass in 2 limbs. Forty three procedure were done with polytetrafluoroethylene(PTFE) graft and 3 were done with great saphenous vein. The cumulative patency rates of 5years was 58.9% respectively. In two patients, amputations of the lower extremities were done. Reoperations were performed in 9 patients. CONCLUSIONS: A thoughtful management can prevent the progress of atherosclerosis obliterans(ASO) and may preserve the function of lower limb. In this study, bypass surgery using PTFE and great saphenous vein as conduit revealed acceptable patency rate.
Amputation ; Atherosclerosis ; Extremities ; Humans ; Lower Extremity ; Polytetrafluoroethylene ; Retrospective Studies ; Saphenous Vein ; Transplants

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Isolation Trend of Nontuberculosis Mycobacteria at a Tertiary-care Hospital in 2003-2011.

Hee Young YANG

Kosin Medical Journal.2011;26(2):155-160.

OBJECTIVES: This study was performed to investigate the prevalence of nontuberculous mycobacteria (NTM) species and to determine the clinical significance of NTM isolates. METHODS: From January 2003 to July 2011, NTMs were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) or reverse blot hybridization assay (REBA). And pulmonary NTM infection was diagnosed by clinical history, underlying disease, radiological and microbiological findings according to the diagnostic criteria of 2007 American Thoracic Society (ATS). RESULTS: Of the 697 AFB culture-positive specimens, NTM was detected in 149 (21.4%) specimens. Among 154 NTM isolates from 149 specimens, M. avium-intracellulare complex (MAC) (48.1%) was the most frequently isolated organisms followed by M. abscessus (13.6%), M. gordonae (9.1%), M. kansasii (8.4%), M. szulgai (3.9%), M. fortuitum complex (3.3%), M. scrofulaceum (2.0%), M. malmoense (1.3%), M. chelonae (1.3%), M. marinum (1.3%), M. genavense (1.3%), M. lentiflavum (1.3%) and M. mucogenicum (0.6%). Among 147NTM isolates from 142 respiratory specimens, 54 NTM isolates (36.7%) were causative organisms in NTM pulmonary infection. CONCLUSIONS: The isolation rate of NTM was 21.4% in clinical specimen, and in some cases NTM species results in pulmonary NTM infection. Because the treatment of pulmonary NTM infection depends on the infecting species, accurate identification and clinical significance of NTM are required for adequate treatment.
Chimera ; Gordonia Bacterium ; Nontuberculous Mycobacteria ; Prevalence

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High Sensitivity CRP, Fibrinogen and Homocysteine in Relation to Carotid Intima-media Thickness in Acute Ischemic Stroke.

Won Goo LEE ; Kwangsoo KIM

Kosin Medical Journal.2011;26(2):149-154.

OBJECTIVE: To evaluate the relationship of high sensitivity C-reactive protein (hs-CRP), fibrinogen and homocysteine to carotid intima-media thickness (IMT) in acute ischemic stroke. METHODS: Subjects were 347 patients with acute cerebral infarction. The carotid arterial wall thickness was measured using high resolution B-mode ultrasound. The serum levels of hs-CRP, fibrinogen and homocysteine were measured by latex-enhanced turbidimetric immunoassay, clot scattering method, and chemiluminescence immunoassay respectively. Univariate regression analysis was performed to evaluate the relationship between these levels and carotid IMT. RESULTS: In patients with acute ischemic stroke, carotid IMT was significantly correlated with increased serum levels of hs-CRP and fibrinogen (P < 0.05, P < 0.01, respectively). However association between serum homocysteine and carotid IMT was not statistically significant. CONCLUSIONS: Increased serum levels of hs-CRP and fibrinogen may be correlated with carotid IMT. Measurement of serum hs-CRP and fibrinogen may be helpful for predicting degrees of atherosclerosis in acute ischemic stroke.
Atherosclerosis ; C-Reactive Protein ; Carotid Intima-Media Thickness ; Cerebral Infarction ; Fibrinogen ; Homocysteine ; Humans ; Immunoassay ; Luminescence ; Stroke

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Results of Endovenous Laser Ablation for Varicose Vein: Laser Therapy of Varicose Vein.

Seong Ho CHO

Kosin Medical Journal.2011;26(2):145-148.

OBJECTIVES: Our retrospective study was designed to examine the efficacy of endovenous laser ablation (ELA) in patients with varicose vein. METHODS: One hundred and twenty-five patients (157 limbs) underwent ELA from June 2008 to June 2011. Age of patients, sex, location of lesions, postoperative complications and recurrence rate were analyzed. Follow up was performed by 1week, 4weeks and 8weeks after operation. RESULTS: The mean age of patients was 51.4 years old and men and women were 73 and 52. The prevalence of minor complications was 14.4% and the recurrence rate was 3.2%. CONCLUSIONS: ELA of the varicose vein is effective and safe methods. ELA is simple to perform, relatively atraumatic and well accepted by patients. In my opinion, ELA can be effectively implemented in surgical practice.
Female ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Postoperative Complications ; Prevalence ; Recurrence ; Retrospective Studies ; Varicose Veins

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