A Prospective Comparison of Sulfate Free Polyethylene Glycol versus Sodium Phosphate Solution for Precolonoscopic Bowel Preparation / 대한소화기내시경학회지

BACKGROUND/AIMS: Polyethylene glycol (PEG) solution is commonly used for precolonoscopic preparation because of its safety and effectiveness. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the efficacy and patient compliance of SF-PEG and sodium phosphate (NaP) solutions for preparing the bowel before colonoscopy. METHODS: From February through April in 2007, 534 patients who underwent colonoscopy were prospectively enrolled. The efficacy of bowel cleansing was assessed by a doctor's questionnaire and the patient's compliance was assessed by a patient's questionnaire. RESULTS: There was no significant difference between the groups for the "stools and fluids" assessment of bowel cleansing (2.07 vs. 2.14, respectively, p=0.149). However, SF-PEG was more effective on the "air bubbles" assessment (1.34 vs. 1.71, respectively, p<0.001) and the overall assessment (0.72 vs. 0.91, respectively, p=0.010) than NaP. The patients preferred SF-PEG rather than NaP for "Taste" (1.34 vs. 2.25, respectively, p=0.148). However, the patients significantly preferred NaP rather than SF-PEG for "Quantity" (2.46 vs. 1.18, respectively, p<0.001). CONCLUSIONS: The SF-PEG solution showed more effectiveness for bowel cleansing as compared to the NaP solution. SF-PEG tastes better than NaP, but patients are still required to consume 4 liters for the standard preparing regimen.

Hyponatremic Encephalopathy Following a Sulfate Free Polyethylene Glycol-based Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

Hyponatremia associated with the use of both a sodium phosphate (NaP) and polyethylene glycol (PEG) solution for colonoscopy preparation has been reported in patients with impaired renal handling of water. A PEG solution is believed to affect serum electrolytes less than NaP, but the use of a PEG solution can lead to nausea, vomiting, intestinal hyperactivity and dehydration, often resulting in a raised plasma antidiuretic hormone (ADH) concentration. Non-osmolar stimuli such as pain, stress, nausea, and vomiting can stimulate ADH release. We report a case of severe hyponatremic encephalopathy after sulfate-free PEG ingestion for a colonoscopy in a healthy middle-aged woman. We think that physicians should be familiar with the medical history and current medication schedule of patients prior to bowel preparation. The levels of serum electrolytes should be checked in patients with impaired ability to excrete free water and any mental aberrations before undertaking colonoscopy procedures.

A Case of Primary Leiomyosarcoma of the Liver Presenting with Acute Bleeding / 대한소화기학회지

Leiomyosarcoma is a rare tumor of the liver. It usually arises from many other organs including uterus, gastrointestinal tract, retroperitoneum, and soft tissues. Primary hepatic leiomyosarcoma progresses very slowly and is not associated with chronic liver disease. When the tumor is detected early enough to be treated by operation, the prognosis is favorable. While several cases of primary hepatic leiomyosarcoma have been reported in Korea, there was no case associated with acute bleeding. We report a 80-year old male patient with huge primary hepatic leiomyosarcoma, who presented with acute bleeding and IVC obstruction. The patient was treated by embolization and IVC stenting.

A Case of Endoscopic Unroofing after Detachable Snare Ligation of a Duodenal Duplication Cyst / 대한소화기내시경학회지

A duodenal duplication cyst is rare congenital anomaly, which accounts for 5% of all gastrointestinal duplication cysts. Most of the duodenal duplication cysts are usually found during infancy or early childhood, and present with obstructive symptoms. The most common clinical manifestations are an intestinal obstruction or, less commonly, hemorrhage, perforation, biliary obstruction or pancreatitis. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment of a duodenal duplication cyst have been previously reported recently in the literature. Moreover, endoscopic treatment of a duodenal duplication cyst has not been reported in Korea. We report our first experience of a duodenal duplication cyst, including diagnosis and endoscopic management with a detachable snare.

Efficacy of Niti-S ComVi Stents for Palliation of Malignant Gastrointestinal Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: Niti-S ComVi stents are flexible and retain the shape-memory of the original configuration. ComVi stents are effective in preventing tumor ingrowth because polytetrafluoroethylene is inserted between two stent wires. The aim of this study was to examine the efficacy of Niti-S ComVi stents for the palliation of a malignant gastrointestinal obstruction. METHODS: Between April 2004 and April 2006, 17 patients (20 cases) underwent Niti-S ComVi stenting, using a through-the- scope method. The technical and clinical success, complication, and outcome were analyzed. RESULTS: Stent insertion was technically successful in 18 cases (90%). Malposition to the afferent loop occurred in 2 cases. Symptomatic improvement was achieved in 14 cases (70%). The mean gastric outlet obstruction score was 0.2 before stenting and 1.6 after stenting. The complications encountered were stent migration (2 cases) and obstruction (5 cases), which were treated by re-stenting and balloon dilatation. Twelve patients died with a median survival of 67 days. Five patients were still alive with a median follow up of 151 days. The overall median stent patency time was 60 days. The mean waist diameter of the stents was expanded to 57% of full expansion immediately after deployment, and 77% after 36 hours. CONCLUSIONS: Niti-S ComVi stenting is an effective palliative technique for inoperable or postoperative recurrent tumors, and significantly improves the quality of life.

Meaning of TCO2 in the Diabetic and Non-diabetic Patients Undergoing Long-term Hemodialysis / 대한신장학회잡지

OBJECTIVE: Various degrees of metabolic acidosis are accompanied by the decrease in the kidney function. It is known that dialysis patients' long-term convalescences and complications are related to metabolic acidosis. It is generally known that the extreme acidosis of the dialysis patients should be corrected but on the contrary, there are reports on hemodialysis patients with slight acidosis have better nutritional condition. However, the research results are rare compared to the ratio of diabetic patients among dialysis patients. Therefore, in this paper we tried to reach a conclusion by comparing and analyzing the total carbon dioxide of the serum and other nutrition parameters of the diabetic patients among long-term hemodialysis patients with the non-diabetic patients. METHODS: We divided 50 patients, who have been hemodialysis for longer than three months, into 21 patients with diabetes and 29 patients with non-diabetes. And we compared and analyzed the TCO2 in addition to measuring other parameters based on the blood tests carried out on the beginning of every month from January of 1999 to December of 2000. RESULTS: TCO2 showed a inverse correlation with nPCR, serum albumin, blood urea nitrogen, and creatinine on the correlation analysis of the total target patients. And blood urea nitrogen and age were the independent factors in the independent factor analysis using multiple regression analysis. When we divided and compared the total target patients into diabetic patients and non-diabetic patients, there were no significant differences between various kinds of nutrition parameters and dialysis parameters. And TCO2 showed a inverse correlation with nPCR, nPCR being the independent factor in the diabetic patients. In addition, TCO2 showed a inverse correlation with serum creatinine, serum creatinine being the independent factor in the non-diabetic patients. CONCLUSION: Increase of ingestion of protein was one of the important factors in inducing metabolic acidosis, but the TCO2 and improved nutritional condition resulting from ingesting sufficient protein could be preserved in the diabetic patients. Therefore we think that the diabetic patients' nutritional condition and supervision of their ingestion of protein is more needed as sufficient ingestion of protein is a major factor in balancing acid-base for diabetic patients than non-diabetic patients.

A Phase II Study of Vinorelbine, Mitomycin C and Cisplatin Chemotherapy for Advanced Non-Small Cell Lung Cancer

BACKGROUND: This prospective phase II trial was performed to determine the efficacy and toxicity of mitomycin C, vinorelbine and cisplatin combination chemotherapy for patients with previously untreated stage IIIB or IV non-small cell lung cancer (NSCLC). METHODS: Between January 1999 and April 2001, 30 patients with chemotherapy- naive stage IIIB or IV NSCLC were entered into this study. Mitomycin C at a dose of 7 mg/m2, vinorelbine at a dose of 25 mg/m2 and cisplatin at a dose of 75 mg/m2 on day 1 and vinorelbine at a dose of 25 mg/m2 on day 8 were administered. This regimen was repeated every 4 weeks. RESULTS: 29 patients out of 30 patients were assessable. Among the assessable patients, 15 (51.7%) patients had a partial response. The median duration of response and survival was 22 weeks and 39 weeks, respectively. Grade 3 or 4 leukopenia and thrombocytopenia were observed in 28.3% and 4.7% of all the cycles, respectively. Nausea and vomiting of grade 3 occurred only in 2.4% of all the cycles. CONCLUSION: The regimen of mitomycin C, vinorelbine and cisplatin for non-small cell lung cancer is active against advanced NSCLC with tolerable toxicities.