Impact of dialysis modality on technique survival in end-stage renal disease patients

BACKGROUND/AIMS: This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. METHODS: A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. RESULTS: The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. CONCLUSIONS: In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD.

A case of Klebsiella psoas abscess due to diverticulitis and intestinal tuberculosis / 대한내과학회지

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.

A case of Klebsiella psoas abscess due to diverticulitis and intestinal tuberculosis / 대한내과학회지

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.

A Case of Exogenous Lipoid Pneumonia after Ingestion of Squalene in Patients with Achalasia / 결핵및호흡기질환

Exogenous lipoid pneumonia (ELP) is a chronic inflammatory reaction of the lungs resulting from the aspiration of vegetable, animal or mineral oils. Squalene, is a derivative of shark liver oil that is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. Similar to the symptoms in most cases of oil aspiration, the symptoms of squalene-induced lipoid pneumonia are either absent or nonspecific. Hence, the disease is generally detected incidentally. Although many cases with predisposing factors have been reported, ELP with achalasia is quite rare. We report a 47-year old woman with achalasia who developed ELP after ingesting squalene. The patient was treated successfully by supportive care and surgical treatment of the achalasia.

A Case of Gastric Glomus Tumor / 대한소화기학회지

Glomus tumor is a tumor arising from glomus body, a nodular form of arteriolovenular anastomosis that functions to regulate blood flow according to temperature. Gastrointestinal glomus tumors are rare and most frequently occur in the stomach as a subepithelial tumor. A 46-year-old woman presented with an incidental finding of a subepithelial tumor in the stomach. Endoscopic ultrasonography (EUS) showed a 1.4x1 cm sized well circumscribed heterogeneous hypoechoic tumor with a few tubular structures in the fourth sonographic layer of the gastric wall. Characteristically, more hypoechoic halo equal to the echogenecity of proper muscle layer enclosed the tumor. Contrast enhanced abdominal computerized tomography (CT) revealed high enhancement of tumor up to the same level of portal vein in arterial phase and this enhancement persisted to portal phase. For histolgogic confirmation and treatment, endoscopic enucleation was attempted but failed due to fibrotic adhesion with the surrounding tissue. Histologic findings of biopsy specimen were compatible with glomus tumor. Although it is difficult to diagnose glomus tumor preoperatively, these characteristic findings in EUS and CT seem to be useful in distinguishing glomus tumor from other tumors arising from the fourth sonographic layer of gastric wall.

A Case of Pancreatic Acinar Cell Carcinoma / 영남의대학술지

Acinar cell carcinoma is a rare tumor that represents 1~2% of all pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease. Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-old man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased 18F-fluorodeoxyglucose (FDG) uptake. Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the pancreas. The patient underwent a total gastrectomy three months later because of gastric recurrence. Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy. During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabine.

A Case of Primary Mucinous Cystadenocarcinoma / 영남의대학술지

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy, and little is known concerning its pathogenesis, optimal treatment, and prognosis. A 29-year-old pregnant woman (21 weeks) presented with abdominal discomfort. CA 19-9, CA 125, and CEA were normal. Abdominal CT scanning revealed a 19x15x13 cm retroperitoneal tumor. Exploratory laparotomy and tumor excision were performed. Mucinous retroperitoneal implants were removed as completely as possible. Histologically, the tumor showed focal areas of capsular invasion, but free resection margins. The uterus and both ovaries were normal in appearance. No adjuvant therapy was pursued. Six months later, peritoneal and bilateral ovarian metastases were discovered.Hence, we report the details of this case of primary retroperitoneal mucinous cystadeno-carcinoma and present a review of the literature.