Effect of 6% Hydroxyethyl Starch 130/0.4 as a Priming Solution on Coagulation and Inflammation Following Complex Heart Surgery

PURPOSE: Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery. MATERIALS AND METHODS: Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-alpha, interleukin-6, and interleukin-8) were performed. RESULTS: Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137+/-34 min, HES-HES; 136+/-47 min, albumin-nonHES; 132+/-39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups. CONCLUSION: Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.

A Case of Intraductal Papillary Mucinous Tumor of the Pancreas Accompanied by Gastric Cancer / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a distinct entity characterized by intraductal papillary growth and thick mucin secretion. Prolonged postoperative survival can be anticipated in many IPMT cases. However, IPMT of the pancreas was reported to be associated with a high incidence of nonpancreatic neoplasms and these nonpancreatic neoplasms have potential prognostic significance in patients with IPMT. Recently, we experienced a case of IPMT of the pancreas accompanied by gastric cancer in a 72-year-old woman. The main pancreatic duct was incidentally found to be dilated on an abdominal computed tomography performed for staging of gastric cancer. A subtotal gastrectomy and near-total pancreatectomy were carried out. Histopathologic examinations of the resected specimens confirmed the diagnosis of early gastric cancer (T1N1M0) and IPMT of the pancreas, carcinoma in situ, combined type. We report this interesting case with a review of the literature.

Two Cases of Achalasia associated with Microvascular Angina / 대한내과학회지

Achalasia is one of the most common esophageal motility disorder which is characterized by dysphagia and noncardiac chest pain. Esophageal motility disorder has been extensively investigated in recent years as a cause of noncardiac chest pain. The exclusion of cardiac disease is usually based on the presence of normal epicardial coronary arteries. However, myocardial ischemia can occur upon physical stress in patients with normal coronary arteries and is thought to be secondary to dynamic vasoconstriction of coronary artery microcirculation. The disturbances of vasomotor control and the abnormalities of sympathetic nervous system play a role in generation of microvascular angina. Some patients with achalasia exhibit an abnormality in the autonomic nerveous system that extends beyond the gastrointestinal tract. Recently, we experienced two cases of achalasia accompanied by microvascular angina. They had persistent chest pain even after successful endoscopic treatments for achalasia and showed microvascular angina on subsequent coronary angiography and/or exercise stress test.

Rectal Endometriosis: A Case Report of with a Clinical Analysis of Other Cases Reported in Related Korean Literature / 대한소화기내시경학회지

Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Involvement of the gastrointestinal tract is seen in 3~34% of patients affected by this condition. Although the commonest sites involved are the sigmoid colon and rectum, only 4 cases have been reported in Korea. The most frequent symptoms are lower abdominal and pelvic pain typically worsening at the time of menstruation. Bleeding per rectum is uncommon since the mucosa is rarely involved. Endoscopy has not been thought to be helpful in the evaluation of patients with suspected colonic endometriosis. However, endoscopy is often used as the first test in patients with rectal bleeding, excluding malignancy or other sources of bleeding. There are few reports of endoscopic documentation of colorectal endometriosis. A 26 year-old woman having a history of endometriosis with cyclic hematochezia and lower abdominal pain is herein reported. A flexible sigmoidoscopy revealed a protrusion of hyperemic mucosa with a surrounding fold formation on the rectum 8 cm above the anal verge. The subsequent biopsy of the lesion gave rise to a diagnosis of endometriosis.

A Case of Metastatic Gastric Cancer Resulting from Small Cell Lung Cancer / 대한소화기내시경학회지

Blood-borne metastatic cancer of the stomach is a rare occurrence according to a number of reports in the literature. Morever, it is extremely rare that gastric metastasis is man- ifested during life and most metastatic gastric tumors have been found at autopsy. The tumors most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. The frequency of metastatic gastric cancer from small cell lung cancer is 0.2-0.5% in the world literature. In Korea, there has been only one case reported on metastatic gastric cancer from small cell lung cancer. A 53-year-old man who had primary small cell lung carcinoma with brain metastasis complained of nausea, vomiting, and poor oral intake, An esophagogastroduodenoscopy revealed two submucosal tumors in the fundus and the mid body of the stomch. Pathologic examination revealed submucosal infiltration of small cell carcinoma. We report a case of metastatic gastric cancer, from small cell lung cancer that could be diaignosed during the subjectis followed by review of the life, literature.

A Case of Endobronchial Lipoma causing left lung collapse / 대한내과학회지

Endobronchial lipoma is a rare, benign neoplasm of the large bronchi, which makes up about 0.1 percent of all lung tumors. It can produce irreversible parenchymal lung damage or bronchiectasis if diagnosis and treatment are delayed. The treatment of endobronchial lipoma is early removal and surgical procedures depend on the status of distal parenchymal lung damage. We experienced a case of endobronchial lipoma in 53 year-old female patient, which caused total collapse of left lung and save left lung by enucleation of tumor via bronchotomy.

A Case of Formalin Therapy for Hemorrhagic Radiation Proctitis / 대한소화기내시경학회지

Hemorrhagic radiation proctitis is infrequently seen in patients receiving pelvic irradiation. The treatment of hemorrhagic ralation proctitis is often difficult. Many patients need reyeated hospitalizations and blood transfusions. Occasionally patiets will develop severe or recurrent rectal bleeding. In case of massive bleeding requiring excessive transfusion, colonic diversion by construction of a colostomy or excision of the diseased segment may be inevitable. However, surgical procedures in these patients are associated with a high mortality and morbidity. Moreover, medical therapy is usually ineffective. Recently formalin therapy has been introduced as a simple and effective treatment for hemorrhagic radiation proctitis. We experienced a 69 year-old woman patient who developed severe homorrhagic proctitis 1 year after radiotherapy for carcinoma of the cervix. She had not improved by conservative management and required blood tranafusions and repetitive hospitalizations. After local application of a 4% formalin solution in the diseased rectum under caudal anesthesia, the bleeding immediately stopped and the patient was discharged from the hospital, and no recurrence has been observed until now.