A Case of Idiopathic Sigmoid Colonic Perforation in a Hemodialysis Patient / 대한신장학회잡지

Many hemodialysis patients, because of low fiber diet, water restriction, phosphate binder and endocrine-metabolic disturbance, suffer from chronic constipation. In a state of chronic constipation, a large amount of hard fecal mass often results in fecal impaction. Megacolon, urinary obstruction and perforation of the large bowel rarely develop as a complication of fecal impaction. The authors experienced a case of idiopathic sigmoid colonic perforation, with fecal impaction, in a 66-year-old woman having undergone hemodialyis of 6 years duration. The clinical features of the case are presented, with a review of the literatures.

Carboplatin, ifosfamide, and etoposide chemotherapy for extensive-disease small cell lung cancer / 대한내과학회지

BACKGROUND: This prospective phase II study assessed the efficacy and toxicity of the combination of carboplatin, ifosfamide and etoposide for previously untreated patients with extensive-disease small cell lung cancer (ED-SCLC). METHODS: Patients with ED-SCLC received a combination chemotherapy with carboplatin AUC 6.0 on day 1, ifosfamide 1200 mg/m2 on day 1-3, and etoposide 100 mg/m2 on day 1-3. RESULTS: Forty-one patients received a median of six cycles of chemotherapy. A complete response was seen in 5 patients and a partial response was seen in 33 patients (overall response 95%). The median duration of the response was 5.1 months (95% CI; 3.4-6.8 months). The median time to progression and overall survival were 7.4 months (95% CI; 6.1-8.6 months) and 10.7 months (95% CI; 6.9-14.6 months), respectively, providing the one-year survival rate of 43.9%. Grade 3~4 anemia, neutropenia and thrombocytopenia occurred in 14%, 7% and 6% in a total of 212 cycles, respectively. Non-hematologic toxicities were generally mild and manageable. No treatment related death was observed. CONCLUSIONS: The combination chemotherapy of carboplatin, etoposide and ifosfamide showed an effective response rate and acceptable toxicity.

Is the Angiodysplasia Significant as the Cause of Upper Gastrointestinal Hemorrhage in Patients with Chronic Renal Failure? / 대한신장학회잡지

PURPOSE: The role of angiodysplasia as a main cause of upper gastrointestinal hemorrhage (UGH) in patients with chronic renal failure (CRF) is controversial. We investigated the sources of UGH and the clinical characteristics of UGH in patients with CRF. METHODS: We reviewed the medical and endoscopic records of 574 patients who were admitted to Gil Medical Center from November 1999 to November 2004. UGH was defined as hematemesis, or nasogastric aspirate showing fresh or old blood, or melena associated with acute drop in hematocrit. CRF was defined as a serum creatinine clearance < or =59 mL/min for at least 3 months before and after the bleeding episode or the patients who have undergone dialysis or received renal transplantation. RESULTS: Thirty-two of 574 patients were CRF group. 19 of the CRF patients have received dialysis (18 paitents-hemodialysis; 1 patient-peritoneal dialysis). The mean age of CRF group was 56+/-13.65 years old and 16 patients were male. The causes of UGH in CRF patients, in order of frequency, was duodenal ulcer (37.5%), gastric ulcer (34.4%), unknown (12.5%). No angiodyplasia was found in CRF group. The sources of bleeding did not differ significantly between the two groups. The prevalence of taking ulcerogenic drugs in CRF patients was higher than that in control group (59.4% vs 29.7%, p=0.001). The prevalence of Helicobacter pylori (H. pylori) infection in CRF patients with peptic ulcer and gastritis was lower than that in control group (16.7% vs 42.3%, p=0.017). The mean length of hospital stay and the mean numbers of blood transfusions required were higher in the CRF group than control group. However, no differences were seen between the two groups in mortality, recurrent bleeding and surgery for control of bleeding. CONCLUSION: The common cause of UGH in patients with CRF was peptic ulcer disease and no angiodysplasia was found.

A Case of Third Degree Complete Atrio-Ventricular Block During Catheterization of an Internal Jugular Vein for Hemodialysis / 대한신장학회잡지

Cardiac arrhythmias are a potential complication in the placement of central venous catheter for hemodialysis. These arrhythmias are typically benign and can be resolved by withdrawing the offending guide-wire or repositioning the catheter tip. We report a case of unusual arrhythmia, a complete 3rd degree atrioventricular block (3rd AVB). A 47-year-old man was admitted with clinical findings suggestive of end stage renal disease. His electrocardiography revealed a complete left bundle branch block. During the placement of the wire for a hemodialysis catheter via the right internal jugular vein, he developed 3rd AVB and hypotension. Despite the withdrawal of the wire, the hemodynamic instability and 3rd AVB had been sustained, leading to the insertion of a temporary pac emaker. On the 7th day after the insertion of the temporary pacemaker, the 3rd AVB was spontaneously resolved. To the best of our knowledge, a 3rd AVB related to the insertion of a hemodialysis catheter has not been reported in Korea.