A Case of Recurrence after Endoscopic Submucosal Dissection of Esophageal Adenocarcinoma Arising from Barrett's Esophagus / 대한소화기내시경학회지

Surgery is the primary treatment for adenocarcinoma arising from Barrett's esophagus. However, in order to avoid the high risk of complications of surgical resection, many physicians try various endoscopic treatments in cases of early adenocarcinoma and high-grade dysplasia of Barrett's esophagus. Endoscopic submucosal dissection (ESD) is a recently highlighted technique because of its high rate of en bloc resection, but there is controversy about ESD because of the uncertain long-term effect. There is a high risk of local recurrence after endoscopic treatments especially in a long-segment Barrett's esophagus, but there are no reports about this in Korea. This case we report on shows that the early adenocarcinoma arising from a long-segment Barrett's esophagus was curatively removed by ESD, but recurred high-grade dysplasia was detected on the remnant Barrett's esophagus after one year. We report here on a case of recurred esophageal malignancy after successful endoscopic resection of adenocarcinoma from a Barrett's esophagus.

Continuous renal replacement therapy for the treatment of acute kidney injury

BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been widely used for treating critically ill patients with acute kidney injury (AKI). Whether CRRT is better than intermittent hemodialysis for the treatment of AKI remains controversial. We sought to identify the clinical features that can predict survival for the patients who are treated with CRRT. METHODS: We analyzed the data of 125 patients who received CRRT between 2005 and 2007. We identified the demographic variables, the underlying diagnoses, the duration of CRRT, the mean arterial blood pressure (ABP) and the Simplified Acute Physiology Score (SAPS) II. The classification/staging system for acute kidney injury (AKI) was applied to all the patients, who were then divided into stage 1-3 subgroups. RESULTS: The average age of the patients was 61.414.3 years and the mortality rate was 60% (75 of 125 patients). The survivors had a significantly higher mean ABP and a higher mean serum bicarbonate level, which were measured the day after CRRT, than the nonsurvivors (86.723.7 vs. 69.224.6 mm Hg, respectively, 21.43.5 vs. 16.45.4 mmol/L, respectively,; p<0.05 for each). The stage 3 AKI patients showed the worst parameters for the SAPS II score and the serum levels of creatinine and blood urea nitrogen. The mortality rate was higher for the stage 3 subgroup than the other groups (70.5%, p<0.05). CONCLUSIONS: The patients with AKI and who require CRRT continue to have a high mortality rate. A higher mean ABP and a higher serum bicarbonate level measured the day after CRRT may predict a more favorable prognosis. The staging system for AKI can improve the ability to predict the outcomes of CRRT patients.