A 50-year-old woman who had been on maintenance hemodialysis for 5 years developed severe anemia resistant to treatment with iron supplements and erythropoietin 4 months prior to hospital admission. Her stool occult blood test was positive, and an initial panendoscopy revealed evidence of possible antral gastritis. However, repeated administration of sucralfate, H2 blockers and a proton pump inhibitor was not effective in preventing further gastrointestinal tract blood loss and subsequent refractory anemia. She required multiple blood transfusions and hospital admissions during this period. There was no obvious coagulopathy or thrombocytopenia. After her third admission, a second panendoscopy demonstrated the typical picture of watermelon stomach. A trial of hormone therapy with estrogen and progesterone increased the hemoglobin level within a month without further evidence of active gastrointestinal bleeding. From our experience with this case, we found that the diagnosis of antral vascular ectasia (watermelon stomach) with bleeding requires a high degree of clinical alertness and careful endoscopic examination. Estrogen and progesterone therapy may provide a good option for treating the disease in uremic patients without an obvious complication. To the best of our knowledge, this is the first report demonstrating the use of maintenance hormone therapy in a female uremic patient to successfully treat watermelon gastric bleeding.

Estrogens↗

PubMed1998

Adrenal extramedullary hematopoietic tumor in a patient with beta-thalassemia.

We report a case of adrenal extramedullary hematopoiesis in a 27-year-old woman with beta-thalassemia. She underwent cholecystectomy for gallstones and splenectomy for splenomegaly at the age of 20 years. In January 1996, she was admitted to our hospital because of a palpable nontender mass in the right subcostal area. Ultrasound, computed tomography, and magnetic resonance imaging disclosed a right suprarenal mass 7.5 x 5.8 cm in size. Surgical exploration and biopsy confirmed the diagnosis of extramedullary hematopoietic (EMH) tumor. The tumor was left in situ. Subsequent follow-up showed no increase in the size of the tumor and no progression of anemia. The patient remained asymptomatic, and no additional EMH tumor developed. Surgery or radiotherapy should be performed only when EMH tumors cause symptoms, such as during spinal cord compression. Adrenal EMH tumors should be considered in thalassemia patients with an adrenal mass, to avoid unnecessary surgical procedures.

Adrenal Gland Neoplasms↗

PubMed1998

Continuous venovenous hemodialysis in multiple organ systems failure patients with acute renal failure.

BACKGROUND: Continuous renal replacement therapies have become the preferable methods for treating critically ill patients with acute renal failure. We studied the use of continuous venovenous hemodialysis (CVVHD) for the management of multiple organ failure patients with acute renal failure. MATERIALS AND METHODS: Forty patients in intensive care units were studied. Their mean age was 50.5 (range 21 to 82) years. The mean of number of organ system failures per patient was 4.9 (range 4 to 6). All patients required mechanical ventilation. CVVHD was performed from the femoral vein via a double-lumen catheter. Blood flow was maintained via blood pump at rate of 120 to 150 ml/min. Bicarbonate solution was delivered to the dialysate ports of the filter at rate of 700 to 900 ml/hour. Any complications during therapy were recorded. RESULTS: The mean urea clearance was 14.7 ml/min and the mean creatinine clearance was 15.4 ml/min. Electrolytes were all within the normal ranges. There were two episodes of extracorporeal circuit blood clotting and one patient experienced hypothermia. Seven of the 40 patients (17.5%) survived. CONCLUSION: CVVHD is a safe, effective, easily established therapy for managing the multiple organ failure patients with acute renal failure, offering good metabolic, electrolyte, and fluid control.

Acute Kidney Injury↗

PubMed1997

Blue toe syndrome associated with rapidly progressive glomerulonephritis: ultimately revealed essential mixed cryoglobulinemia.

The blue toe syndrome is a rare presentation in a number of medical disorders. We report a 35-year-old woman who initially presented with blue toe syndrome and rapidly progressive glomerulonephritis. Essential mixed cryoglobulinemia with vasculitis and renal failure was documented by laboratory tests and renal biopsy. She was on maintenance hemodialysis as renal failure persisted after steroid and immunosuppressive agents therapy. Her gangrenous changes of bilateral toes were autoamputated symmetrically and uneventfully.

Adult↗

PubMed1997

IgA myeloma associated with decreased anion gap and renal failure.

The anion gap in myeloma patients had been well studied. IgG myeloma usually has decreased anion gap, whereas IgA myeloma always presents with normal anion gap. We report an unusual presentation of IgA myeloma with decreased anion gap and renal failure due to superimposing of acetazolamide-related bicarbonate loss.

Acid-Base Equilibrium↗

PubMed1997

Unusual presentations of extrapulmonary tuberculosis in three hemodialysis patients.

We report three patients who received maintenance hemodialysis and suffered from extrapulmonary tuberculosis with unusual presentations. The first patient presented with fever of unknown origin. All studies showed negative findings except high erythrocyte sedimentation rate and high value of C-reactive protein. He failed to response to broad-spectrum antibiotics but showed a complete response to antituberculosis therapy. The second patient presented with right supraclavicular lymphadenopathy and weakness. Lymph node biopsy revealed caseating granuloma with positive acid-fast bacilli. The third patient presented with tumor mass of left sternoclavicular joint for which malignancy was suspected initially. Ultimately, tuberculosis was documented by histopathologic studies showing caseating granuloma. All three patients had normal findings of chest x-ray and did not have previous history of tuberculosis and diabetes mellitus.

Adult↗

PubMed1996

Midodrine hydrochloride in patients on hemodialysis with chronic hypotension.

Chronic hypotension, volume nonresponsive, is not rare in hemodialysis patients and is usually refractory to various therapies. Midodrine hydrochloride is an alpha-mimetic drug acting directly on the peripheral alpha-receptor and increases blood pressure. We studied 10 uremic patients on hemodialysis with chronic hypotension to evaluate efficacy and safety of midodrine. Midodrine hydrochloride was administered at a dose of 2.5 mg twice on the dialytic day, 1.25 mg twice on the nondialytic day. Subjective symptoms and objective parameters were evaluated and compared before and after midodrine treatment. Midodrine significantly increased systolic pressure from 73.0 +/- 10.5 mm Hg to 90.5 +/- 12.3 mm Hg (p < 0.01); and diastolic blood pressure from 44.0 +/- 8.4 mm Hg to 55.4 +/- 7.9 mm Hg (p < 0.01) before dialysis. Orthostasis, dizziness, fatigue, blurred vision, dullness, headache, and depression improved an average of 62%. All patients tolerated midodrine treatment well. Only mild side effects were noted, including flush sensation, neck soreness, and headache. We conclude that midodrine may be another choice for uremic patients on hemodialysis with chronic hypotension which responds poorly to other conventional management.

Administration, Oral↗

PubMed1996

Tertiary hyperparathyroidism after renal transplantation.

Explore the source record for details and available documents.

Adult↗

PubMed1996

Distal renal tubular acidosis associated with non-autoimmune hypothyroidism.

Explore the source record for details and available documents.

Acidosis↗

PubMed1996

Apparent neoplasm of the clavicle of a dialysis patient, ultimately revealed as tuberculosis.

Explore the source record for details and available documents.

Adult↗

PubMed1996

Urinary tract tuberculosis: a 10-year experience.

Ninety-seven patients with urinary tract tuberculosis were reviewed from January 1983 to December 1993 at our hospital. Aside from two cases of military tuberculosis and three cases with coexisting active pulmonary tuberculosis, most urinary tract infections developed from a previous primary lung infection. Patients usually exhibited local symptoms. Fever, weight loss and anorexia were uncommon. Eighty-nine percent of the patients had abnormal urinalysis (hematuria and/or pyuria). Eight percent of the patients also had genital involvement, whereas 38% of these patients had normal intravenous pyelogram and urinalysis. Pyelograms disclosed abnormalities in 94% of the 97 patients and most revealed late changes, which were correlated with higher incidence of azotemia and anemia noted at diagnosis. Chemotherapy is the mainstay of treatment and at least three antituberculous drugs are required for initial therapy due to high drug resistance rate. Reconstructive surgery is warranted to salvage renal function. Except 6 patients run into maintenance hemodialysis, the renal functions of all patients remained stable during the period of follow-up, either receiving chemotherapy alone or combined surgery. Renal calcification may not represent inactive process, which requires further evaluation.

Adult↗

PubMed1996

Non-traumatic rhabdomyolysis and acute renal failure.

Thirty-one patients (26 males, 5 females) with mean age 35 +/- 19 years (range 8 to 85 years) were diagnosed as non-traumatic rhabdomyolysis by clinical findings and elevation of serum creatine kinase (CK) between January 1989 and December 1993. Causes, laboratory measures, clinical courses, and outcome were reviewed retrospectively. Drug abuse, seizure, and excessive activity are the most common etiologies for non-traumatic rhabdomyolysis. Twelve patients presented with muscular pain and seven patients with muscle weakness. Twenty eight patients had urinalysis and five of them (18%) had negative orthotolidine dipstick test. Only seven patients (25%) were detected positive orthotolidine test without microscopic hematuria. Patients with acute renal failure had higher levels of potassium and uric acid. The patients who developed acute renal failure after admission had significantly higher levels of uric acid. The peak levels of CK did not correlate with development of acute renal failure. There was no episode of hyercalcemia. Seventeen patients (55%) had acute renal failure. Hemodialysis was required in nine cases. All survivors recovered with normal renal function except one who needed maintenance hemodialysis after two months follow-up. Two patients died of multi-organ failure and sepsis.

Acute Kidney Injury↗

PubMed1996

Cholera associated with acute renal failure and rhabdomyolysis: a case report.

While cholera is not endemic in Taiwan, the number of imported cases is increasing. We report a 59-year-old Taiwanese male who developed severe diarrhea and vomiting, two days after returning from Bali. The patient admitted drinking a beverage with ice purchased from a street vendor. On admission he was weak and dehydrated. The patient suffered from hypovolemic shock and acute renal failure. Elevated creatine phosphokinase indicated rhabdomyolysis. Fluid replacement with Ringer's lactate solution was instituted. Dyspnea and pulmonary edema developed, and hemodialysis was begun to remove excess fluid due to decreased urinary output. Isolation of Vibrio cholerae O1 from stool confirmed the diagnosis of cholera, and doxycyline was begun. The patient's condition stabilized, with increased urinary output, and resolution of diarrhea, vomiting and dyspnea. Cholera, although rare in Taiwan, can be lethal if left untreated. Rapid intervention with fluid replacement is essential to prevent hypovolemic shock and circulatory collapse in severe cases.

Acute Kidney Injury↗

PubMed1994

[Clinical experience of automated peritoneal dialysis].

For uremic patients on continuous ambulatory peritoneal dialysis who are complicated with peritonitis, hernia or burn out of meticulous procedure, automated peritoneal dialysis (APD) is a new alternative therapy. We started our APD program by continuous cyclic peritoneal dialysis (CCPD) method from October, 1991 and this study included 3 CAPD patients. Our studies showed high dose CCPD was better than CAPD in ultrafiltration and urea clearance with similar weekly creatinine clearance and weekly KT/V urea. During the one year treatment course, there was no signs of fluid overload. We performed once to twice day time exchange by low volume dialysate (1500-1600ml) There was no events of abdomen discomfort due to increase intraabdominal pressure or recurrent hernia in susceptible patient. The decrease in day time exchange frequency obviously reduced patients'loading. One patient changed to high dose CCPD due to underdialysis after stand CCPD therapy. Two patients returned to hemodialysis due to severe peritonitis and technique method, but careful assessment of dialysis adequacy with PET test and KT/V evaluation is mandatory.

Adult↗