A Case of Tunneled Cuffed Catheter Dysfunction Treated with Fibrin Sheath Stripping / 대한신장학회잡지

With the increasing proportion of elderly and diabetic dialysis patients, permanent dual lumen catheters are becoming popular. One of the most frequent causes for the failure of hemodialysis in CRF patients with the tunneled cuffed catheter is the catheter dysfunction. It is thought to be due to encasement of the catheter by fibrin sleeve or fibrin sheath, kinking or malposition of the catheter. Catheter dysfunction due to fibrin sheath formation could sometimes be managed by reversal of arterial and venous lines, urokinase lock or infusion, and catheter exchange. Recently percutaneous fibrin sheath stripping (PFSS) became another modality of salvaging failing tunneled cuffed catheter before attempting catheter exchange. There was no report of applying PFSS to salvage the permanent dual lumen catheter in Korea. Authors recently experienced a case of successful application of PFSS to extend the life of catheter in a CRF patients as a last resort after failure of repeated urokinase trials. It is thought that PFSS is a simple and effective procedure which extends the longevity of permanent dual lumen catheter.

A case of gingival hyperplasia caused by amlodipine / 대한내과학회지

Calcium channel blockers are used to treat hypertension. Unwanted side effects associated with calcium channel blockers are facial flushing, headache, palpitation, dizziness, peripheral edema, constipation, indigestion, nausea, gingival hyperplasia, facial edema and fatigue. Gingival hyperplasia is a rare adverse effect of calcium channel blockers. Calcium channel blockers are known to contribute to gingival hyperplasia. Among all calcium-channel blockers, the prevalence of gingival hyperplasia is highest with nifedipine. Amlodipine is used extensively for the management of hypertension. Several cases have been published since 1994 indicating that amlodipine may also promote gingival hyperplasia. Amlodpine-induced gingival hyperplasia has not reported yet in Korea. We report a case of gingival hyperplasia caused by amlodipine.

Left Pulmonary Artery Agenesis Accompanied with Fistula of Left Circumplex Artery to Left Bronchial Artery

Left pulmonary artery agenesis, accompanied by a coronary arterial fistula, is a very rare anomaly. Although unilateral pulmonary artery agenesis is associated with other cardiovascular defects, like as ventricular septal defect, patent ductus arteriosus, and tetralogy of fallot, this anomaly, accompanied by a coronary arterial fistula, has not yet been reported. Most patients with no associated cardiac anomalies have only minor, or absent, symptoms, and survive to adulthood, but some patients may suffer from recurrent respiratory infections and hemoptysis. The vessel to the affected lung in many of the proved cases has been described as arising from either the bronchial artery or the aortic arch. The blood supply from the coronary artery to the affected lung has never been reported. Recently, a case of left pulmonary artery agenesis, accompanied with a coronary arterial fistula was experienced, which was diagnosed by coronary angiography and a chest CT, which is presented, with the review of relevant literature.

A Case of Gastric Mucinous Adenocarcinoma Presenting as a Characteristic Mucin Pool / 대한소화기내시경학회지

Mucinous adenocarcinoma is a rare histologic type of gastric carcinoma. Most mucinous gastric carcinoma is diagnosed by histology after surgical resection. However, in this report, we preoperatively predicted the type of a tumor (mucinous type) from its characteristic endoscopic finding. An endoscopic examination showed a cauliflower-like mass on the upper body of the posterior wall. At first we could not find the mass because it was covered with a thick mucin-like substance. After gastric lavage and mucin aspiration we found a tumor mass which was surrounded with a characteristic mucin pool. Abdominal CT showed a 6 cm sized-mass connected with the gastric fundus. Total gastrectomy with esophagojejunostomy was performed. The pathology of the tumor proved to be a mucinous adenocarcinoma.