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Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.
장폐색은 임신 중 급성 복증의 매우 드문 원인 중 하나인데, 주 증상인 오심과 구토 및 복통이 정상임신에서도 흔히 나타나는 것들이며, 임신기간 중에는 가능한 한 X-ray검사는 피하려고 하기 때문에 진단이 무척이나 어렵다. 만약 진단이 늦어 질 경우에는 장괴사를 유발하여 산모의 사망률과 이환율이 증가하며 조기진통 및 태아 손실을 초래할 수도 있다. 임신 중 장폐색은 자궁 크기의 변화가 심한 16~20주, 32~36주 및 산욕기에 주로 발생하며 임신 중기와 산욕기에 발생한 경우는 있으나 임신 초기에는 보고된 적이 없다. 본 저자들은 과거 우측 난소-난관 절제 수술을 받은 경력이 있는 임신 7주 산모에서 소장폐색으로 장괴사가 발생하여 응급수술 후 자연유산 된 1예를 문헌고찰과 함께 보고하는 바이다. Intestinal obstruction occurs rarely as a cause of acute abdominal pain during pregnancy. It is very difficult to make diagnosis, as nausea, vomiting and abdominal pain are commonly associated with pregnancy, and X-rays are avoided if possible. However, delayed diagnosis can cause intestinal strangulation, which results in a high incidence of maternal morbidity, mortality, premature labor, and fetal loss. The incidence of intestinal obstruction seems to increase at the time of rapid uterine size changes such as between 16~20 weeks, 32~36 weeks or even in the puerperium. The possibility of intestinal obstruction must always be kept in mind when a pregnant woman with an operation scar on her abdomen develops abdominal pain. We present a case of small bowel obstruction during early pregnancy with a brief review of the literature who had the history of right salpingo-oophorectomy and appendectomy operation.
The aim of this study was to compare the serum cholesterol level between patients with and without gallbladder stones. Serum cholesterol levels were analyzed in 126 patients with gallbladder stones and in 99 controls. The analysis by t-test showed that patients with gallbladder stones had higher serum cholesterol level than controls in both sexes. Patients with gallbladder stones over 40 years of age had higher serum cholesterol levels than controls of same age in both sexes, but, there were no differences in serum cholesterol level between the patients with gallbladder stones and the controls below 40 years of age.
Plasma clearance rate of indocyanine green (ICG) is the most important parameter to evaluate the hepatic reserve function for liver resection. To study the relationship between ICG concentration and bilirubin concentration or GPT activity in plasma, we determined these parameters before and after the ligation of bile duct. we ligated the bile duct of rats to induce hyperbilirubinemia and high GPT activity. Before and after the ligation (one day. three days. or fourteen days). we sampled 0.5 ml blood from portal vein to determine the concentration of bilirubin and GPT activity. After removing the ligation. we injected indocyanine green (0.5 mg/kg, 0.5 mg/ml) for 30 seconds through portal vein and sampled 0.5 ml of blood from the abdominal vein to determine ICG concentration after 15 minutes. From these data, we calculated the correlation coefficient. We calculated statistical significance of these parameters of different days after the ligation and the significance between two correlation coefficients. We confirmed the linearity too. All of these parameters were significantly higher than those before ligation(p<0.05). However GPT activity showed peaks after one day, while the concentration of bilirubin and ICG showed peaks after 3 days. The correlation coefficient was 0.884 between the concentration of ICG and bilirubin, but 0.721 between the concentration of ICG and GPT activity. These correlation showed significant linearity with p<0.001 and significant difference with p<0.05. These results suggest that ICG clearance can be negatively influenced by bilirubin concentration more than by GPT activity in the plasma. Therefore, care should be taken in determining the hepatic reserve function by ICG clearance rate for patients with hyperbilirubinemia.
Ultrasound is very useful in evaluation of obstructive jaundice. We retrospectively evaluated the useful findings of ultrasonography in differentiating benign extrahepatic duct obstruction from malignant diseases. Among the 36 patients, 25 patients were benign extrahepatic obstruction and 11 patients were malignant obstruction. The shapes of extrahepatic dilatation were classified into fustiform, meniscus, and abrupt cut off by bowel gas. The diameter, length, and bile duct wall-interface were compared between benign and malignant groups and serum bilirubin and alkaline phosphatase were also compared between two groups retrospectively. The results were as follows. The most common form of extrahepatic dilatation was meniscus(10 of 26 patients, 38%) in benign obstruction, and fusiform(8 of 11 patients, 73%) in malignant obstruction. No significant difference was noted in diameter, length, serum bilirubin, and alkaline phosphatase between benign and malignant groups. Only one case showed decreased bile duct wall-interface in benign obstruction, but loss or decrease of bile duct wall-interface were 8 patients in malignant obstruction. The combined findings of fusiform dilatation and loss of bile duct wall-interface in ultrasonography will be helpful in differential diagnosis of malignant extrahepatic bile obstruction from benign conditions.