A patient with Shiga toxin-associated hemolytic uremic syndrome who developed hyperkalemia in the recovery period

We report an 11-year-old girl who presented with episodes of hyperkalemia during the period of recovery, from hemolytic uremic syndrome (HUS) induced by Shiga toxin-producing Escherichia coli. She developed moderate azotemia but continued to pass urine. However, hyperkalemia was observed on days 11 and 25 of clinical course, although hemolysis and renal insufficiency had recovered by that time. Nafamostat mesilate (NM), continuously infused to relieve thrombotic microangiopathy, may have elevated serum potassium level by decreasing urinary potassium excretion. However, a direct effect of Shiga toxin on distal nephron segments was also suggested. Hyperkalemia should be considered in patients with Shiga toxin-associated HUS, not only in the acute phase but also in the recovery period. Received: May 31, 2000 / Accepted: October 10, 2000     

Huge retroperitoneal leiomyosarcoma: a case report

This is a case report of retroperitoneal leiomyosarcoma in a 61-year-old woman. She presented with a chief complaint of back pain. Computed tomography showed a left huge retroperitoneal tumor. The tumor was removed with left nephrectomy and left hemi-colectomy. Histological examination demonstrated leiomyosarcoma 26 x 20 x 16 cm in diameter and, 3.84 kg in weight. She died of local recurrence causing ileus 2 months after the surgery. Fifty-four cases of retroperitoneal leiomyosarcoma including the present case in the Japanese literature are reviewed.     

Large spontaneous intrahepatic arterioportal fistula demonstrated by rapid sequential computed tomographic scan. Report of two cases

A huge spontaneous intrahepatic arterioportal shunt with regurgitation through the portal vein trunk was demonstrated by computed tomography and confirmed by angiography in 2 patients with liver cirrhosis. Rapid sequential computed tomographic scanning was very useful in the diagnosis and follow-up after arterial embolization. Early visualization of the portal vein and increased attenuation in the ipsilateral lobe bearing the fistula were demonstrated in 1 case, and the same findings were also demonstrated by computed tomography and angiography in the other case.     

Responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) in patients with hallux valgus

Background

In this study, we investigated the responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient's assessment before and after hallux valgus surgery.

Assessment of single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urologic surgery

A single-dose ofantimicrobial prophylaxis (AMP) was administered parenterally for prevention of perioperative infection in a total of 206 urologic surgeries including 114 endoscopic-instrumental, 92 clean, and 20 clean-contaminated procedures between January and December, 2007, and surgical site infections (SSI), urinary tract infections (UTI), and remote infections (RI) were prospectively surveyed. The definition of a single-dose of AMP allowed the administration of a second dose of an antimicrobial during a surgical procedure that exceeded 3 hours but not parenteral or oral administration at the end of the procedure, in the recovery room, or at a later time over a period of more than 24 hours. UTI was observed in 3 cases (2.7%) after endoscopic-instrumental procedures and in 1 case (5%) after clean-contaminated procedures while no case was associated with UTI in clean procedures. SSI was seen in 1 case each after clean procedures (1.1%) and after clean-contaminated procedures (5%), and RI was seen in 2 cases (2.2%) after clean procedures. A single-dose regimen of AMP was effective for prevention ofperioperative infections including SSI, UTI, and RI in endoscopic-instrumental, clean, and clean-contaminated surgical procedures in urology.     

A case report of bladder hernia associated with prostate cancer

We report a case of bladder hernia. A 68-year-old man was admitted to our hospital for the management of prostate cancer. An egg-sized soft mass was palpated at his right inguinal region. Magnetic resonance imaging and cystography revealed that the mass was a bladder hernia. During radical prostatectomy, we had to resect the bladder hernia for safe regional lymphadenectomy. This hernia was the extraperitoneal type. The stage of prostate cancer was pT3b N0 M0. This is the third reported case of inguinal bladder hernia associated with prostate cancer in Japan.     

Diagnostic accuracy of a volume-rendered computed tomography movie and other computed tomography-based imaging methods in assessment of renal vascular anatomy for laparoscopic donor nephrectomy

To evaluate the diagnostic accuracy of computed tomography (CT)-based imaging methods for assessing renal vascular anatomy, imaging studies, including standard axial CT, three-dimensional volume-rendered CT (3DVR-CT), and a 3DVR-CT movie, were performed on 30 patients who underwent laparoscopic donor nephrectomy (10 right side, 20 left side) for predicting the location of the renal arteries and renal, adrenal, gonadal, and lumbar veins. These findings were compared with videos obtained during the operation. Two of 37 renal arteries observed intraoperatively were missed by standard axial CT and 3DVR-CT, whereas all arteries were identified by the 3DVR-CT movie. Two of 36 renal veins were missed by standard axial CT and 3DVR-CT, whereas 1 was missed by the 3DVR-CT movie. In 20 left renal hilar anatomical structures, 20 adrenal, 20 gonadal, and 22 lumbar veins were observed during the operation. Preoperatively, the standard axial CT, 3DVR-CT, and 3DVR-CT movie detected 11, 19, and 20 adrenal veins; 13, 14, and 19 gonadal veins; and 6, 11, and 15 lumbar veins, respectively. Overall, of 135 renal vascular structures, the standard axial CT, 3DVR-CT, and 3DVR-CT movie accurately detected 99 (73.3%), 113 (83.7%), and 126 (93.3%) vessels, respectively, which indicated that the 3DVR-CT movie demonstrated a significantly higher detection rate than other CT-based imaging methods (P < 0.05). The 3DVR-CT movie accurately provides essential information about the renal vascular anatomy before laparoscopic donor nephrectomy.     

Association of interferon-gamma and tumor necrosis factor alpha polymorphisms with susceptibility to vitiligo in Iranian patients

Vitiligo is a common skin disorder that is caused by selective destruction of melanocytes, resulting in disfiguring loss of pigment. There are convincing evidences that cytokines and T cell mediated immunity may have a role in its pathogenesis. Given the fact that cytokine production is under genetic control, in this study, we have investigated IFN-γ +874 T/A and TNF-α −308 G/A gene polymorphisms in a total of 176 vitiligo patients and 545 controls. IFN-γ +874 T/A and TNF-α −308 G/A gene polymorphisms were genotyped via Allele Specific Oligonucleotide PCR (ASO-PCR) method. The results showed that the TNF-α −308 G/A polymorphism was more common in vitiligo patients than controls (P = 0.0004). This difference was only significant between female patients and controls (P < 0.0001), while there was no significant difference between male patients and male controls (P = 0.90). The distribution of IFN-γ genotypes in vitiligo patients did not differ significantly from that in control subjects (P = 0.56). Since the presence of A nucleotide at position −308 of TNF-α gene is associated with increased cytokine production, therefore, the higher frequency of TNF-α −308 A allele in vitiligo patients compared to controls may be considered as a genetic susceptibility factor towards the development of vitiligo.