PURPOSE: We report a case of optic neuropathy in a patient who was treated with pre-extensively drug-resistant tuberculosis(pre-XDR TB) treatment with linezolid.CASE SUMMARY: A 61-year-old male patient with no other underlying disease was diagnosed with pre-XDR Tb 6 months before and took the TB drug at another hospital. Ethambolol was not prescribed because it was resistant from the beginning of TB treatment. Threrefore, linezolid was included for treatment of pre-XDR TB. The patient's best corrected visual acuity was 20/400 in both eyes at the time of outpatient visit. In Ishihara color vision test, both eyes showed complete color blindness. There was no detectable relative afferent pupillary defect, and fundus examination showed hyperemic optic discs and visual field examination showed both central visual field defects. Linezolid induced optic neuropathy was suspected, the drug was discontinued. After one month, the patient's best corrected visual acuity recovered to 20/20 in both eyes, and visual field and color vision returned to normal at 3 months. CONCLUSIONS Linezolid is a broad spectrum antibiotic and is a useful drug for the treatment of broad-spectrum tuberculosis. However, since long-term use may cause optic neuropathy, the possibility of optic neuropathy should always be considered. If optic neuropathy is suspected, prompt drug withdrawal is required and reversible clinical changes can be expected.

PURPOSE: We report a case of spontaneous recovery of an iris cyst with only tuberculosis medication and conservative eye drops when uveitis and angle closure occurred because of a cyst in a patient with peritoneal tuberculosis. CASE SUMMARY: A 49-year-old female who was diagnosed with iritis and treated with steroid eye drops visited our clinic because of decreased visual acuity 1 month prior. There were anterior chamber inflammation cells and an iris cyst completely obstructing the anterior chamber at 12 o'clock. At the time, the patient had been diagnosed with peritoneal tuberculosis in the Department of Internal Medicine and Gynecology and had been treated with surgery and medication. The patient had no past history of glaucoma, but when the iris cyst developed, the intraocular pressure increased to 29 mmHg and anterior inflammatory cells were seen in the range of +1 to +2. The primary lesion of tuberculosis improved and the iris cyst disappeared with treatments involving medication for tuberculosis, steroid eye drops, and glaucoma eye drops, without invasive treatments such as alcohol curettage, laser treatment, or cyst resection. CONCLUSIONS: If an iris cyst is a new lesion of the eye, it is necessary to identify the pattern and cause of the iris cyst first, and if a secondary benign iris cyst is suspected, the primary treatment of the causative disease is necessary rather than prompt invasive treatment.
Anterior Chamber ; Curettage ; Female ; Glaucoma ; Gynecology ; Humans ; Inflammation ; Internal Medicine ; Intraocular Pressure ; Iris ; Iritis ; Middle Aged ; Ophthalmic Solutions ; Peritonitis, Tuberculous ; Tuberculosis ; Uveitis ; Visual Acuity

Toxoplasmosis is an infection caused by Toxoplasma gondii. It can be lethal in immunocompromised hosts, such as a transplant recipients or patients infected with human immunodeficiency virus. In solid organ transplant recipients, toxoplasmosis results mainly from transmission of the parasite with an allograft in cases of serological mismatch. Toxoplasmosis in an immunocompromised host is associated with high mortality. Thus, early diagnosis and treatment is very important. We report on a case of toxoplasmosis in a 51-year-old male patient who had undergone deceased donor kidney transplantation. He suffered from fever of unknown origin. He was finally diagnosed with toxoplasmosis, and treated successfully with trimethoprim-sulphamethoxazole.
Early Diagnosis ; Fever ; Fever of Unknown Origin ; HIV ; Humans ; Immunocompromised Host ; Kidney Transplantation* ; Kidney* ; Male ; Middle Aged ; Mortality ; Parasites ; Tissue Donors ; Toxoplasma ; Toxoplasmosis* ; Transplantation ; Transplantation, Homologous ; Transplants

A 67-year-old male renal transplant patient presented with a right inguinal bulging mass, and was diagnosed with a right indirect inguinal hernia. The day following inguinal herniorrhaphy, serum creatinine became elevated. The patient was oliguric and had abdominal pain on the first day after inguinal herniorrhaphy with a mesh. We diagnosed him with acute renal failure and subsequently performed acute hemodialysis. The kidney computed tomography showed hydronephroureter, with distal ureter obstruction. With urgent percutaneous nephrostomy, we were able to relieve the obstructive uropathy with distal ureteral stenosis. Subsequently, hernia repair was performed with removal of the mesh, followed by the antegrade ureteral stent insertion. Renal function was recovered after ureteral stent insertion. This case shows that acute renal failure can occur due to ureteral obstruction, complicated by an inguinal hernia repair, and this can be successfully treated with percutaneous nephrostomy and inguinal hernia repair with mesh removal.
Abdominal Pain ; Acute Kidney Injury ; Aged ; Constriction, Pathologic ; Creatinine ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Kidney ; Male ; Nephrostomy, Percutaneous ; Renal Dialysis ; Stents ; Transplants ; Ureter ; Ureteral Obstruction

Leptospirosis is a spirochetal infectious disease caused by Leptospira interrogans, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of Leptospira. Renal disorders caused by Leptospira infection vary from an abnormality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.
Acute Kidney Injury ; Asymptomatic Infections ; Communicable Diseases ; Humans ; Hypovolemia ; Incidence ; Jaundice ; Jaundice, Obstructive ; Kidney ; Leptospira ; Leptospira interrogans ; Leptospirosis ; Rhabdomyolysis ; Urinalysis

PURPOSE: To assess the current status of endourology and laparoscopy in Korea. MATERIALS AND METHODS: Using the database directory of the Korean Urological Association, 83 urology training hospitals were identified. A detailed questionnaire was designed and sent by post and e-mail. The questionnaire included questions regarding the number of various endourological and laparoscopic procedures between 1998 and 2002. The questionnaires of those responding were analyzed. RESULTS: Responses were received from 45 hospitals (response rate 54.2%). 133 antegrade and 626 retrograde endourological procedures for urinary strictures were performed during the period of the study in 12 and 35 hospitals, respectively. 42 hospitals (93.3%) were performing shock wave lithotripsy for urinary stone disease. 29 hospitals (64.4%) reported having performed more than one laparoscopic procedure during the five years. The annual total numbers of laparoscopic procedures increased from 217 in 1998 to 725 in 2002. Simple laparoscopic nephrectomy was the most widely accepted procedure, and was being performed in 18 hospitals. Laparoscopic adrenalectomy, radical nephrectomy, diagnostic laparoscopy, laparoscopic renal cyst marsupialization, nephroureterectomy and donor nephrectomy were performed in more than 10 hospitals. However, the actual number of laparoscopic procedures was limited in most hospitals. More than 40 laparoscopic procedures per year were performed by only four hospitals. CONCLUSIONS: This survey revealed an increasing number of endourological and laparoscopic procedures. However, laparoscopy seems to be mainly a larger hospital-based technology in Korea. These results can be utilized as fundamental data for establishing future developmental requirements of endourology and laparoscopy in Korea.
Adrenalectomy ; Constriction, Pathologic ; Electronic Mail ; Endoscopy ; Humans ; Korea ; Laparoscopy* ; Lithotripsy ; Nephrectomy ; Surveys and Questionnaires ; Shock ; Surgical Procedures, Minimally Invasive ; Tissue Donors ; Urinary Calculi ; Urology*

A multiple endocrine neoplasia type 2B(MEN2B) is the most distinct and aggressive form of the MEN type 2 variants. We report a case of a 24-years-old woman with MEN2B. The patient had previously undergone a Duhamel's operation due to a megacolon at 6 years old, minor surgery to remove small tumors on the lip at 8 years old, and a bilateral osteotomy of the femur, due to coxa valga, at 15 years old. She underwent a total thyroidectomy and neck dissection, due to a growing thyroid nodule, despite thyroxine treatment, at 19 years old. The pathology revealed a medullary thyroid carcinoma. There was no history of MEN 2B in her family. She had prominent lips, multiple oral mucosal masses, and marfanoid habitus. During the subsequent follow-up, a positron emission tomogram was taken due to a persistently high level of serum calcitonin, despite repeated neck dissections, which revealed a mass in the right adrenal gland. Adrenomedullary function tests showed high levels of urinary catecholamine metabolites, and a genetic analysis of the peripheral leukocyte showed a codon 918 mutation (Met918Thr) at exon 16 of the RET proto-oncogene. The patient underwent a right adrenalectomy and the pathology revealed a pheoch-romocytoma.
Adolescent ; Adrenal Glands ; Adrenalectomy ; Calcitonin ; Child ; Codon ; Coxa Valga ; Electrons ; Exons ; Female ; Femur ; Follow-Up Studies ; Humans ; Leukocytes ; Lip ; Male ; Megacolon ; Multiple Endocrine Neoplasia Type 2b* ; Multiple Endocrine Neoplasia* ; Neck Dissection ; Osteotomy ; Pathology ; Pheochromocytoma ; Proto-Oncogenes* ; Surgical Procedures, Minor ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroxine ; Young Adult

BACKGROUND: Recently, the phannacologic and therapeutic significance of various types of potassium channels are being realized. Thus it was attempted to delineate the role of voltage-gated K+ -channels on the excitation-contraction coupling in skeletal muscle. METHODS: The effects of tetraethylammonium, a well known K+ -channel blocker, on the electrically-evoked twitch response, train-of-four and tetanic stimulation, and the influence of various agents on the these effects were studied in the isolated rat hemi-diaphragm preparation. RESULTS: Tetraethylammonium (1 & 3 mM) increased the electrically-evoked twitch response, but the large dose (10 mM) decreased the twitch response. And tetraethylammonium decreased the TOF- and tetanus-ratio in a dose-related fashion. d-Tubocurarine(1 microM) decreased the twitch response, and tetraethylammonium recovered the d-tubocurarine-induced-depression of twitch response. When the Ca++(6x) and K+ (2x) concentration of the medium were increased, the twitch response caused by tetraethylammonium were slightly inhibited than that observed in the normal solution, but the fade phenomenon was potentiated. The tetraethylammonium (10 mM)-induced depression of twitch response were reduced by reducing the stimulus frequency to 0.01 Hz and choline (400 microM) treatment. And N-ethylmaleimide inhibited the tetraethylammonium-induced increment of twitch response and also potentiated the tetraethylammonium-induced fade phenomenon. However, it is noteworth the 4-aminopy- ridine, another K+ -channel bloker, potentiated the electrically-evoked twitch response but did not affect the TOF-and tetanusratio. CONCLUSION: These result indicate that tetraethylammonium elicited two districtive types of response in the rat phrenic-hemidiaphragm preparation. The potentiating effects of twitch response is mediated by blocking delayed K+ -rectifier channel and decreasing effects of twitch response, TOF-and tetanus-ratio is may be due to decreased the acetylcholine release from presynaptic nerve terminal.
Acetylcholine ; Animals ; Choline ; Depression ; Ethylmaleimide ; Muscle, Skeletal ; Potassium Channels ; Rats* ; Tetraethylammonium*

The effects and interactions of pipecuronium and atracurium with diltiazem and verapalmil on the electrically-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat phrenic-hemidiaphragm preparation. Pipecuronium (3X10(-7) -4X10(-6)) and atracurium (10(-6) -3X10(-5) M) decreased the electrically-evoked twitch response, train-of-four and tetanus ratio in a dose-related fashion and the pipecuronium was more potent than atracurium. The inhibitory effects of pipecuronium and atracurium were potentiated by pretreatment of 5 uM diltiazem and verapamil, Ca++-channel blokers, in which the concentration of diltiazem or verapamil has no obvious effect on the twitch response itself. Futhermore, it is noteworthy that the inhibitory effects of pipecuronium and atraeurium were markedly potentiated by 150 uM hemicholinium pretreatment. On the basis of these findings, the results of present study suggests that the muscle relaxation by pipecuronium and atracurium is mediated by pre- and post-junctional receptor blockade, and that diltiazem or verapamil intensifies neuromuscular blockade produced by these musele relaxants. The potentiating effect of diltiazem or verapamil may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.
Acetylcholine ; Animals ; Atracurium ; Calcium ; Diltiazem* ; Hemicholinium 3 ; Muscle Relaxation ; Neuromuscular Blockade* ; Pipecuronium ; Rats ; Tetanus ; Verapamil*

The effects of diltiazem and verapamil on the electrically-evoked twitch response, train-of- four and tetanic stimulation were studied in the isolated rat hemidiaphragm preparation. Diltiazem(3-150 pM) and verapamil(3-100 pM) increased the electrically-evoked(nerve stimulation, 0.1 Hz, 0.5 ms, 10 V) twitch responses in a dose-related fashion and diltiazem was more potent than verapamil. But, the large doses of diltiazem(150-300 uM) and verapamil(100-300 uM) decreased the twich responses. And the effects of diltiazem and verapamil were not effected by reducing the extracellular calcium from 2.5 to 1.25 mM. Diltiazem and verapamil decreased the train-of-four and tetanus ratio as well as the d-tubocurarine in a dose-related fashion. d-Tubocurarine, a specific nicotinic antagonist, decreased twitch response, and the potentiating twitch response of diltiazem was significantly inhibited by pretreatment of d-tubocura- rine. Furthermore, it is noteworth that the inhibitory effects of d-tubocurararine were markedly potentiated by diltiazem. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, diltiazem and verapamil decreaaed the electrically-evoked twitch response with dose dependently. These results indicate that diltiazem and verapamil elicited two distinctive types of twitch response in the rat phrenic-hemidiaphragm preparation. The potentiating effect of twitch response is mediated by the acetylcholine release from the prejunctional nerve terminal and the inhibiting effect may be due to blcking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals.
Acetylcholine ; Animals ; Calcium ; Diltiazem* ; Rats* ; Tetanus ; Tubocurarine ; Verapamil*