Horng-Rong Chang

Cytomegalovirus ischemic colitis of a diabetic renal transplant recipient

Abstract:  We report a diabetic renal transplant recipient with cytomegalovirus (CMV) disease who presented with tarry stool diarrhea because of multiple colonic ulcerations. Histopathology revealed diffuse colonic ulcers following a process of ischemic vasculitis. The colonic ulcers disappeared dramatically after 2 wk of intravenous ganciclovir therapy. Hyper‐immunosuppression was initially suspected but acute rejection (AR) developed after immunosuppressive reduction during the ganciclovir therapy. The AR was successfully reversed and the dosage of cyclosporine was returned to the same level prior to the onset of CMV disease. Our experience suggests that ganciclovir is quite effective for healing colonic ulcers caused by CMV and acute allograft rejection may occur during therapy.

Use of Pulsed-Field Gel Electrophoresis in the Analysis of Recurrent Staphylococcus aureus Infections in Patients on Continuous Ambulatory Peritoneal Dialysis

Background/Aim: The purpose of this study was to evaluate pusled-field gel electrophoresis (PFGE) for distinguishing between relapse and reinfection of Staphylococcus aureus infections in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods: Between July 1993 and May 1997, 4 patients with recurrent CAPD-associated infections caused by S. aureus we enrolled in this study. There were nine episodes of peritonitis, one episode of temporary double lumen catheter infection, and one episode of Hickman catheter infection. A total of eleven S. aureus isolates were collected from peritoneal fluid (n = 9) and blood (n = 2). PFGE typing was applied. Results: In our study, from PFGE typing, the 11 S. aureus isolates were classified into seven patterns. Antibiogram profiling classified only four patterns. Patient A had a reinfection by another strain of S. aureus, and patient B had three episodes of peritonitis caused by the same strain of S. aureus due to exit site infections. Patient C had two episodes of CAPD peritonitis caused by two different strains, respectively. Patient D had four episodes of S. aureus infection (three CAPD peritonitis and one bacteremia); the first two episodes of peritonitis were caused by an identical strain of S. aureus, whereas the subsequent two infections were caused by other organisms. Conclusion: PFGE has a high discriminatory power and can be an assistant method to antibiogram profiling for distinguishing relapse from reinfection in CAPD-associated peritonitis.

Peritoneal-dialysis-associated penicillium peritonitis.

Accessible online at: www.karger.com/journals/ajn Dear Sir, Fungal peritonitis carries a high mortality and morbidity rate and is a significant cause of treatment failure [1] in patients on continuous ambulatory peritoneal dialysis (CAPD). We report a case of unusual fungal peritonitis caused by Penicillium sp. in a 56year-old female undergoing CAPD. Penicillium are blue-green, saprophytic molds with several hundred species identified, but only a few are known to cause human diseases. The other 4 cases of Penicillium peritonitis reported in the English language literature are also reviewed. A favorable outcome for Penicillium peritonitis may be feasible if the catheter is removed early after identification of this organism followed by antifungal therapy. A 56-year-old female with diabetic nephropathy in the uremic stage who had received CAPD with a Tenckhoff catheter for 18 months without experience of peritonitis before was admitted to Taichung Veterans General Hospital with turbid peritoneal effluent and a decreased fluid amount for about 2 weeks. She had presented with abdominal pain for 2 weeks and had received intraperitoneal antibiotic therapy with cefazolin and gentamicin at another hospital for 1 week prior to this admission. The color of the peritoneal effluent became clear once but returned to cloudy again. On the day of admission, she did not have abdominal pain but low-grade fever could be noticed. The

Evaluation of the severity of traumatic rhabdomyolysis using technetium-99m pyrophosphate scintigraphy

A quantitative scoring method was designed to assess the extent of muscle damage. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy was performed for 9 patients experiencing crush injury in the Chichi (Taiwan) earthquake. The magnitude of muscle uptake of 99mTc-PYP was graded as follows: grade 0, less than bone radioactivity (BRA); grade 1, equal to BRA; grade 2, higher than BRA; or grade 3, greatly higher than BRA. The area of muscle injury was estimated according to the rule of nines. The sum of the muscle injury size multiplied by its corresponding grading was defined as the anterior or posterior score according to the anterior or posterior images. Each image was interpreted by two physicians and average anterior and posterior scores were calculated. The muscle score was defined as the geometric mean of the average anterior and posterior scores. Significant correlations were obtained between the muscle score and duration of time trapped (r = 0.868, p < 0.01), peak serum creatine kinase level (r = 0.866, p < 0.01), peak serum phosphorus level (r = 0.877, p < 0.01) and number of hospital days (r = 0.875, p < 0.01). A negative correlation between the muscle score and blood pH (r = –0.706, p < 0.01) was also observed. We concluded that this scoring method may be used as an adjunct for evaluating the locations of trauma and the severity of crush syndrome, and for predicting the duration of hospital stay.