Effects of ezetimibe on lipid profiles and hemostatic markers in end-stage renal disease / 대한내과학회지

BACKGROUND/AIMS: Dyslipidemia is one of the major causes of cardiovascular disease in end-stage renal disease (ESRD) patients. Most of them are dyslipidemic despite the use of lipid-lowering agents. Ezetimibe is a novel chemical entity that inhibits the intestinal absorption of dietary and biliary cholesterol. This study evaluated the effects of ezetimibe on the lipid profile, inflammation markers, endothelial injury, and thrombogenesis in ESRD patients. METHODS: Sixty-five patients with serum low-density lipoprotein (LDL)-cholesterol levels > or =100 mg/d were recruited: 33 patients were on hemodialysis and 32 patients were on peritoneal dialysis. They were assigned randomly to the ezetimibe (10 mg) monotherapy group and the ezetimibe (10 mg) plus simvastatin (10 mg) combination therapy group. Both drugs were administered for 8 weeks. RESULTS: There were no significant differences in the baseline demographic and laboratory characteristics between the two groups. In the monotherapy group, the total and LDL-cholesterol levels were reduced by 14.7 and 21.9%, respectively. There were no changes in the high-density lipoprotein (HDL)-cholesterol or triglyceride levels. Fibrinogen increased significantly (p=0.04). In the combination therapy group, the total and LDL-cholesterol levels were reduced by 29.8 and 42.4%, respectively. There was an additional 15.1% reduction in total cholesterol and an additional 20.5% reduction in LDL cholesterol compared with monotherapy. Several patients complained of minor adverse effects and only one patient in the ezetimibe monotherapy group discontinued medication, because of diarrhea. CONCLUSIONS: In ESRD patients, ezetimibe used as combination therapy with a statin is more effective than ezetimibe monotherapy in ESRD patients.

Comparison of Erythropoietic Effect between Epoetin-alpha and Darbepoetin-alpha in Hemodialysis Patients: A Randomized Crossover Study / 대한신장학회지

PURPOSE: We aim to compare the erythropoietic effects of epoetin-alpha (EA, 4000 IU SC thrice a week) with those of darbepoetin-alpha (DA, 60ug IV weekly, conversion rate to EA=200:1). METHODS: Forty one stable hemodialysis patients were enrolled in this randomized crossover study. After a washout period of erythropoietin stimulating agents (ESA), the patients with hemoglobin (Hb) level of 11.0 g/dL, we stopped ESA. When Hb level decreased to 30% change in EA efficiency relative to DA efficiency. CONCLUSION: There was no significant difference in erythropoietic parameters for both EA and DA.

A Case of Interstitial Pneumonitis Associated with Sirolimus Treatment in Renal Transplantation Recipient / 대한신장학회지

Sirolimus is a promising immunosuppressive drug for renal transplantation to avoid nephrotoxicity of calcineurin inhibitor. However, it has been associated with uncommon but, important pulmonary toxicity. We present a case of sirolimus related dyspnea with abnormal chest radiographic finding in a 63 year old male renal transplantation recipient. There was no evidence of bacterial, fungal, or viral infection. Dose reduction of sirolimus resulted in a significant improvement of the symptoms and chest radiographic finding.

A Case of Pancreaticoportal Fistula Associated with Acute Severe Pancreatitis / 대한소화기학회지

Pancreatic fistulas are usually caused by the disruption of pancreatic duct. The majority of pancreatic fistulas are external fistulas and common causes of external and internal pancreatic fistulas are trauma and surgery. Internal pancreatic fistulas due to pancreatitis are rare. Internal pancreatic fistulas may communicate with peritoneal cavity, colon, small bowel, biliary system or pleural cavity. Among them, fistula between pancreatic duct and portal vein due to acute pancreatitis is rare. We report a case of 32-year-old male with fistula between pancreatic duct and portal vein as a complication of acute pancreatitis. Pancreaticoportal fistula was diagnosed by endoscopic retrograde cholangiopancreatography. He recovered after distal pancreatectomy with splenectomy and supportive care.

A Case of Multiple Myeloma Presenting as Non-obstructive Jaundice Due to Plasma Cell Infiltration of the Liver

Extraosseous manifestations are found in less than 5% of the patients with multiple myeloma. We reported here on a rare case of multiple myeloma presenting as non-obstructive jaundice due to diffuse plasma cell infiltration of the liver. A 70-year-old man was referred to our hospital because of general weakness, weight loss, jaundice, anemia and proteinuria. The laboratory studies showed: hemoglobin 8.5g/dL, calcium 10.3mg/dL, creatinine 1.3mg/dL, AST 41IU/L, ALT 26IU/L, alkaline phosphatase 304IU/L, total bilirubin 4.0mg/dL, direct bilirubin 2.3mg/dL and 24 hour urinary protein 1,120mg. The serologic tests for hepatitis B and C virus were negative. The abdominal CT scans were normal. The urinary protein studies revealed a M component of the lamda type light chain. The bone marrow biopsy showed atypical plasma cells, and the liver biopsy showed a diffuse sinusoidal infiltration of plasma cells.

Acute pericarditis caused by penetrated polymethylmethacrylate of the right ventricle after percutaneous vertebroplasty / 대한내과학회지

Percutaneous vertebroplasty (PVP) has been known as minimally invasive procedure to treat aggressive vertebral hemangioma, painful osteolytic vertebral tumors, and osteoporotic compression fractures. Some cases were reported to be associated with infrequent but serious complications of this procedure, such as severe arterial hypotension, pulmonary embolism, cerebral embolism, paraplegia, and bronchospasm. We report a case of acute pericarditis after PVP, which was treated successfully with open heart surgery.

The Clinical Course of ERCP-related Bowel Perforation / 대한소화기내시경학회지

BACKGROUND/AIMS: The management of small-bowel perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) is still controversial. The purpose of this study was to analyze the treatment and outcome of patients with ERCP-related perforations in a single tertiary medical center. METHODS: Of 18,379 cases of ERCPs performed between January 1990 and December 2003, twenty-six patients (0.14%) with perforation were identified and medical chart were reviewed retrospectively. RESULT: EST were performed in 10,231 patients and perforation occurred in 18 patients. Four out of 18 patients with small-bowel perforation related to EST underwent surgical operation and the rest 14 patients recovered with conservative treatment alone. Of the rest 8 perforation patients unrelated to EST, perforation occurred during the insertion of endoscope in 7 patients and catheter manipulation in 1 patient. All but one perforations associated with mechanical injury by endoscope itself were managed with an emergent laparotomy, and the one patient with perforation related to catheter manipulation recovered with conservative treatment. CONCLUSIONS: A small-bowel perforation related to endoscope per se usually required a surgery, but sphincterotomy related perforations rarely did so. The prevalence and mortality rate of small-bowel perforations associated with ERCP and/or EST were 0.14% and 0%, respectively, in a single tertiary medical center.