Diagnostic Accuracy of Computed Tomography for the Lymph Node Staging of Endoscopically Resectable Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Accurate staging of the lymph nodes (LNs) before endoscopic mucosal resection (EMR) is important. We evaluated the accuracy of CT for LN staging in patients the endoscopically resectable early gastric cancer (EGC). METHODS: The medical records of 155 EGCs patients who had undergone an operation were analyzed. The pre-operatively performed multidetector CT scans and the post-operative histopathologic findings were reviewed for comparing the LN staging with that using the Japanese classification system. Endoscopically resectable EGC was defined as EGC without LN metastasis and also the EGC that satisfied the EMR criteria according to the Japanese guideline. RESULTS: The diagnostic efficacy of CT for LN staging of all the enrolled EGC patients was as follow: accuracy 65.2%, overstaging rate 29.7%, understaging rate 5.2%. The overall accuracy and the overstaging rate of CT for LN staging of endoscopically resectable EGC were as follows: EGC without LN metastasis [69.8% (97/139), 30.2% (42/139)], EGC satisfying extended criteria [72.5% (58/80), 27.5% (22/80)] and EGC satisfying limited criteria [79.2% (19/24), 20.8% (5/24)]. The accuracy of the EMR criteria for predicting node negative EGC were as follows: the extended criteria 98.8% (79/80), the limited criteria 100% (24/24). CONCLUSIONS: Our study showed that prediction of LN metastasis before EMR according to CT staging had limited value due to the tendency of overestimation. Therefore, we should preferentially consider the treatment strategy according to the EMR criteria.

Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Angiography and its Clinical Characteristics / 대한신장학회지

PURPOSE: Contrast media-induced nephropathy (CIN) following coronary angiography is associated with an increased mortality and morbidity. We investigated the incidence of nephrotoxicity, clinical characteristics, laboratory characteristics and risk factors of CIN in patients undergoing coronary angiography. METHODS: We retrospectively evaluated the medical records of 555 patients who had undergone coronary angiography at the Sanggye Paik Hospital, from January 2004 to December 2005. We defined CIN as any increase in the creatinine value of more than 0.5 mg/dL or 50% of baseline value. RESULTS: Among 555 patients, CIN developed in 10 of 48 patients (20.8%) with renal insufficiency (serum creatinine > or =1.4 mg/dL) and in 7 of 507 patients (1.4%) without renal insufficiency (p or =65 years were the significant predictors of CIN. There were no statistical differences in contrast type and volume according to the development of CIN. CONCLUSION: Our data supported the assumption that renal insufficiency, congestive heart failure, hyperuricemia and anemia may be the risk factors of developing CIN.

Strangulated Umbilical Hernia Misdiagnosed as CAPD Peritonitis / 대한신장학회지

Abdominal wall hernias are a common problem in patients treated with continuous peritoneal dialysis. Although most patients with abdominal wall hernia are asymptomatic, some patients may present with abdominal pain or, if the hernia is incarcerated or strangulated, with signs and symptoms of peritonitis. It is often difficult to differentiate abdominal catastrophe such as peritonitis secondary to strangulated hernia from CAPD peritonitis. Because their clinical manifestations are similar, several biochemical markers including amylase and lactic acid have been recently used as an indicator of abdominal catastrophe. We report a case of strangulated umbilical hernia with perforation misdiagnosed as CAPD peritonitis. The patient was operated 36 hours after the first inspection but expired due to overwhelming sepsis, 257 days after the admission to hospital.

Early Detection of Perforation of the Right Ventricle by a Permanent Pacemaker Lead

Ventricular perforation is a rare complication of permanent cardiac pacemaker implantation. We report here on a 68-year-old woman with a dual chamber permanent pacemaker that had been implanted one month earlier, and she suffered cardiac perforation from the pacemaker lead. Frequent follow-up via12-lead surface electrocardiography and chest radiography and the proper work-up for pacemaker implantation are needed for detecting rare complications after pacemaker implantation.

A Case of Extramedullary Progression Despite of Serologic Improvement in a Patient Treated with Thalidomide for Multiple Myeloma

Thalidomide is an anti-angiogenic agent widely used in patients with multiple myeloma. The response to therapy is commonly monitored using serum and/or urine M protein, as these are known to reflect the tumor burden. Although extramedullary plasmacytomas are tissues with high neovascularization, it has been suggested in some reports that the response to thalidomide in these patients may be inferior, despite changes in the serum M protein level. Herein, we report the case of a patient who newly developed hepatosplenic extramedullary plasmacytoma, despite reduction in the serum M protein level following thalidomide treatment.