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1 100 [] ; 23: ketamine, cystitis, pelvic inflammatory disease (ketamine) [1] 1990 [2] 19 6 [3] Kspecial K K [4] [5,6] [1] 2007Shahani (ketamineassociated ulcerative cystitis) [5] [1,5-16]

2 / high power field (HPF) 26-45/ HPF > / H P F 16-25/HPF(aspartate aminotransferase(ast)31.6 IU/L, alanine aminotransferase(alt)168.7 IU/L)

3 Taiwan J Fam Med Vol.23 No Shahani [5] [1, 5-16] (lower urinary tract symptoms) [5-15] [7,8,12,15] [10] 30% [10-12] [9,13] [7,9,13] [8] [8] [8,10] [1,12,14] [5-10, 12-15] [7,8,15] [7,9,10] [5,6,10,15] (voiding cystourethrography) [7] [7,9,10,12,15] [10,16,17] [10,12] [10,12] [13] [10] [8,13] pentosan polysulphate [13] [10] [10] (percutaneous nephrostomy)

4 [10,13] [8] [18] [5,10,12] [19] [20] (biopsychosocial model) 1. Morgan CJ, Curran HV: Ketamine use: a review. Addiction 2012; 107: No http:// tw/tc/site.aspx?sid= Shahani R, Streutker C, Dickson B, Stewart RJ: Ketamine-associated ulcerative cystitis: a new clinical entity. Urology 2007; 69:

5 Taiwan J Fam Med Vol.23 No.2 6. Colebunders B, Van Erps P: Cystitis due to the use of ketamine as a recreational drug: a case report. J Med Case Reports 2008; 2: Chen CH, Lee MH, Chen YC, Lin MF: Ketamine-snorting associated cystitis. J Formos Med Assoc 2011; 110: Huang YC, Jeng CM, Cheng TC: Ketamineassociated ulcerative cystitis. Tzu Chi Med J 2008; 20: Tsai TH, Cha TL, Lin CM, et al: Ketamineassociated bladder dysfunction. Int J Urol 2009; 16: Chu PS, Ma WK, Wong SC, et al: The destruction of the lower urinary tract by ketamine abuse: A new syndrome? BJU Int 2008; 102: Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJ, Curran HV: Journey through the K-hole: phenomenological aspects of ketamine use. Drug Alcohol Depend 2008; 95: Kalsi SS, Wood DM, Dargan PI: The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use. Emerg Health Threats J 2011; 4: Middela S, Pearce I: Ketamine-induced vesicopathy: a literature review. Int J Clin Pract 2011; 65: Chu PSK, Kwok SC, Lam KM, et al: 'Street ketamine'-associated bladder dysfunction: a report of ten cases. Hong Kong Med J 2007; 13: Ho CCK, Pezhman H, Praveen S, et al: Ketamine-associated ulcerative cystitis: a case report and literature review. Malays J Med Sci 2010; 17: Huang PW, Meng E, Cha TL, Sun GH, Yu DS, Chang SY: 'Walking-stick ureters' in ketamine abuse. Kidney Int 2011; 80: Lu CC: A contracted painful bladder related to abuse of ketamine - the intravenous urogram presentation. Incont Pelvic Floor Dysfunct 2011; 5: Oxley JD, Cottrell AM, Adams S, Gillatt D: Ketamine cystitis as a mimic of carcinoma in situ. Histopathology 2009; 55: Centers for Disease Control and Prevention (CDC): Sexually transmitted diseases treatment guidelines, MMWR 2010; 59 (No. RR-12): Gerber GS, Brendler CB: Evaluation of the urologic patient: history, physical examination, and urinalysis. In: Wein AJ ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier, 2011: 74.

6 [Case Report] 105 Ketamine-associated Ulcerative Cystitis: A Case Report Jing-Tang Lin 1, Po-Chung Chen 1, Jui-Chun Chen 1 and Cheng-Kuo Lin 2 The chronic harmful effects of ketamine abuse include cognitive impairment, depression, psychosis, and K-cramps. Ketamine-associated ulcerative cystitis is a newly-discovered clinical entity. This paper reports a 28-year-old female who sustained intractable lower abdominal pain, frequency, and dysuria for a period of one month. Under the diagnostic impression of pelvic inflammatory disease and urinary tract infection, she underwent antibiotic treatment. Since her symptoms exacerbated, she was admitted for diagnostic laparoscopy. However, her laparoscopy only noted mild pelvic adhesions. Gross hematuria was visualized in the Foley catheter during the operation. Cystoscopy was performed and revealed diffuse erythematous change, fibrosis, ulceration, and multiple active bleeding points through the vesical mucosa. After the operation, she admitted taking ketamine for approximately 6 months. As ketamine abuse increases, we anticipate greater numbers of patients reporting ketamineassociated ulcerative cystitis. We suggest that if a patient has symptoms similar to either a urinary tract infection or pelvic inflammatory disease unresolved after empiric treatment, clinicians should investigate for a history of drug abuse and approach the patient biopsychosocially. This case can be a useful example for preventing ketamine abuse. (Taiwan J Fam Med 2013; 23: ) Departments of Family Medicine 1 and Obstetrics and Gynecology 2, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, R.O.C. Received: January 15, 2013; Accepted: March 13, 2013.

氯胺酮 (K 粉 ) 相关性膀胱炎 3 例诊治分析并文献复习黄亮, 等 967 cessation of ketamine use, with the addition of steroids or hydrodistension, the symptoms in

氯胺酮 (K 粉 ) 相关性膀胱炎 3 例诊治分析并文献复习黄亮, 等 967 cessation of ketamine use, with the addition of steroids or hydrodistension, the symptoms in 966 中南大学学报 ( 医学版 ) J Cent South Univ (Med Sci) 2013, 38(9) http://www.csumed.org; http://xbyx.xysm.net CASE ANALYSES 临床病例讨论 DOI:10.3969/j.issn.1672-7347.2013.09.017 http://xbyx.xysm.net/xbwk/fileup/pdf/201309966.pdf