A randomized crossover study of single biweekly administration of epoetin-alpha compared with darbepoetin-alpha in chronic kidney disease patients not receiving dialysis

BACKGROUND: Recent evidence demonstrates that high doses of epoetin-alpha (EPO-alpha) can be administrated at extended intervals, despite its relatively short serum half-life. However, no prospective randomized trials on the effects of extended dosing intervals of EPO-alpha compared with darbepoetin-alpha (DA-alpha) have been performed. This study was designed to investigate whether a single biweekly (Q2W) administration of a high dose of EPO-alpha is as effective as DA-alpha for anemia in chronic kidney disease (CKD) patients not receiving dialysis. METHODS: Sixty non-dialysis CKD patients were equally randomized to either Q2W subcutaneous EPO-alpha (10,000 unit) or DA-alpha (50microg) therapy groups for the first 6 weeks. After a 6-week washout period, the participants of the EPO-alpha and DA-alpha treatment groups switched to the alternate regimen for 6 weeks. The mean hemoglobin (Hb) levels after erythropoiesis stimulating agent (ESA) therapy and percentage change in Hb levels from baseline to the end of the study were analyzed. RESULTS: The mean Hb levels of postESA therapy increased significantly compared with those of preESA therapy in both ESA regimens. The percentage increase in Hb levels and erythropoietin resistance index did not show a significant difference between the different ESA regimens. No difference was observed between the regimens regarding mean Hb levels after ESA therapy. Additionally, there were no serious adverse effects leading to withdrawal from treatment. CONCLUSION: Biweekly high doses of EPO-alpha therapy may be equally as effective as Q2W DA-alpha therapy in maintaining target Hb levels in non-dialysis CKD patients.

A Case of Complete Stent Facture at Proximal and Distal Site in One Drug Eluting Stent / 대한내과학회지

A patient came to the hospital with chest pain and was diagnosed with acute myocardial infarction. Coronary angioplasty was performed at the right coronary artery (RCA) and left anterior descending artery (LAD). A bare metal stent (BMS) was inserted in the RCA and a drug eluting stent (DES) was inserted in mid-LAD. The patient was discharged and was followed up as an outpatient without any symptoms. After 6 years, the patient complained of intermittent chest pain. A treadmill test was performed, and the results were positive. Follow-up coronary angiography was performed, and it showed that the DES inserted in mid-LAD had a complete stent fracture at the distal and proximal sites of the stent. Thus, we report a case of complete stent fracture at the proximal and distal sites in one drug eluting stent.

A Case of Variant Angina Developing Transient Collateral Circulation During Vasospasm

Variant angina is characterized by spontaneous episodes of angina, usually occurring in the morning and having ST segment elevation on the electrocardiogram. However, in the case presented here, vasospasm and angina was shown by ergonovine without ST elevation. The patient was a 60-year-old man who presented with a 2-year history of frequent chest pain. There were no abnormalities in coronary angiography. When ergonovine (100 microg) was injected, total occlusion of the proximal right coronary artery was seen, without ST elevation at the electrocardiogram. The cause was collateral from left anterior descending artery to distal right coronary artery at the left coronary angiography. Therefore, in a patient with variant angina without ST elevation, a transient collateral circulation during vasospasm should be considered.

A Solid Pseudopapillary Tumor Presenting as Hematemesis / 대한내과학회지

Solid pseudopapillary tumors are rare primary neoplasms of the pancreas that have a relatively favorable prognosis, with a low malignant potential. Most patients present with non-specific clinical features, such as vague abdominal discomfort and a palpable abdominal mass. A 50-year-old woman who presented with hematemesis had an incidental pancreatic cystic mass on abdominal computed tomography (CT). We performed several tests, including upper endoscopy and angiography, but we could not find the bleeding focus. Therefore, we performed a pancreaticoduodenectomy. At laparotomy, there was a 10-cm encapsulated pancreatic mass with duodenal invasion, which showed a bleeding ulcer. A solid pseudopapillary tumor was diagnosed pathologically. We report a solid pseudopapillary tumor that presented with gastrointestinal bleeding.