A Case of Pleuroperitoneal Communication in Continuous Ambulatory Peritoneal Dialysis

We present a patient who developed a massive right-Sided hydrothorax two months after starting CAPD treatment, a 41-year-old female with IgA nephropathy who was followed up at our outpatient clinic. Due to deteriorating renal function, a peritoneal catheter was inserted on March 29, 1997．CAPD was implemented on the same day. At the time when CAPD was initiated, the patient was experienclng repeated episodes of nausea and vomiting, probably due to uremia. On May 27, she developed dyspnea. A chest X-ray Showed massive right-Sided hydrothorax. After extracorporeal ultrafiltration was performed, the patient's respiratory distress was rapidly relieved. Two days later, CAPD was esumed, but this resulted in almost immediate recurrence of massive right-sided hydrothorax. The property of the drained fluid from the right pleural cavity and scintigraphy uslng Technetium-99m macroaggregated albumin confirmed pleuroperitoneal communication. Increased intra-abdominal pressure due to frequent vomiting may be responsible for hydrothorax due to pleuroperitoneal communication

An Autopsy Case of Overwhelming Sepsis with Hypoglycemia in a Patient with Alcoholic Liver Cirrhosis

A 46-year-old man, unconscious, was admitted to our hospitalas an emergency case. He was known to have liver disease due to excessive alcohol intake. He had fallen while riding a motorcycle one week before admission. On arrival, he was comatose and in a state of shock. Petechiae and subcutaneous bleeding were observed on his trunk and extremities. His left upper and lower extremities were remarkably swollen, and a discolored, elevated, hard mass was found on the outer side of the left ankle joint. He was diagnosed as having disseminated intravascular coagulation complicated by renal and liver failure. Hypoglycemia(plasma glucose level 29 mg/dl), hyperammonemia and severe metabolic acidosis were found. He was treated with controlled ventilation, plasma expanders, blood transfusion, antibiotics, dopamine, noradrenaline, nafamostate gabexate and hypertonic glucose. Despite this intensive treatment, he died of irreversible shock 20 hours after admission. Postmortem examination revealed small vegetation in the aortic Valve and microabscesses in the kidney, heart, thyroid gland, and retroperitoneal adipose tissues. These findings suggest that he had developed sepsis stemming from cellulitis further to alcoholic liver cirrhosis. It is considered imperative that physicians consider the possibility of hypoglycemia in all patients with multiorgan failure

QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS

We evaluated the quality of life (QOL) in 268 patients with diabetes mellitus (NIDDM, 250 cases; IDDM, 10 cases; and other type of diabetes, 8 cases) to determine which aspects were adversely affected by the disease. Information concerning life satisfaction, social activities, ability to work, sexual problems and physical symptoms was obtained from a 30-item questionnaire. Clinical characteristics including duration of diabetes, glycemic control, current treatment, obesity, hypertension, hyperlipidemia, macro- and microvascular complications were obtained from medical records. Diminished QOL was most pronounced in patients who had had a long duration of disease, required insulin therapy, and whose health was disturbed by cerebrovascular disease, end-stage renal disease, mono- and autonomic neuropathy. A significant difference in the subdimensional QOL score was noted in life satisfaction, social activities, ability to work, sexual problems and physical symptoms under these circumstances

CLINICAL CHARACTERISTICS OF ISCHEMIC STROKE IN PATIENTS WITH DIABETES MELLITUS

To investigate the clinical characteristics of ischemic stroke and its associa- tions with hypertension, obesity, hyperlipidemia, and diabetic microangiopathy in patients with diabetes mellitus, we estimated the average period between onset of diabetes and ischemic stroke, and the incidences of complications. A total of 544 patients with diabetes mellitus who were admitted to our hospital over the past 10 years were analyzed, forty of whom were diabetic patients who suffered ischemic stroke as diagnosed by clinical exami- nation. As controles, 40 subjects matched for sex, age, and duration of diabetes were identified, one for each patient with ischemic stroke. The average period between onset of diabetes and ischemic stroke was significantly shorter for patients with hypertension than for normotensive patients ; however, there were no differences in the length of this period between the groups with and without obesity or hyperlipidemia. Hypertension was present in 63% of patients with ischemic stroke, and the incidence of hypertension was significantly higher in the stroke group than in the control group. There was no difference between the groups with and without ischemic stroke with respect to the incidence of obesity, hyper- lipidemia, retinopathy and nephropathy. We conclude that diabetic patients with hyperten- sion appear to be at high risk for ischemic stroke

HYPOURICEMIA IN HOSPITALIZED DIABETIC PATIENTS

To determine the incidepce and clinicopathological characteristics of hypouricemia in patients with diabetes mellitus, we studied 473 consecutive hospitalized diabetic patients. The incidence of hypouricemia, defined as a serum urate concentration below 2.0 mg/dl, was 1.9% (9 patients). In this group (2 males, 7 females), there were no patients receiving drugs known to reduce serum urate concentration. Two of the 9 patients had neoplastic disease, while the others suffered from no other disorder known to affect serum urate levels. Four patients exhibited glomerular hyperfiltration. Three of the 9 patients were studied in more detail by renal biopsy, and all had mild to moderate glomerular diffuse lesions and tubulointerstitial lesions, such as interstitial fibrosis or mononuclear cell infiltration. These findings suggest that the glomerular hyperfiltration which accompanies diabetic nephropathy and functional abnormality of tubular urate handling due to tubulointerstitial involvement contribute to hypouricemia in diabetic patients