Patients with erythropoiesis-stimulating agent (ESA)-induced pure red cell aplasia (PRCA) should not routinely be switched to an alternative ESA or to darbepoetin-alpha because anti-erythropoietin (anti-EPO) antibodies cross-react with all kinds of recombinant ESAs. We present a case of ESA-induced PRCA in a 69-year-old man on hemodialysis whose anemia improved with reintroduction of darbepoetin-alpha following immunosuppressive therapy. The patient developed severe anemia after 15 months of subcutaneous administration of erythropoietin-alpha. After the diagnosis of PRCA, erythropoietin-alpha was discontinued and immunosuppressive therapy with a combination of prednisolone and oral cyclophosphamide was initiated. After 4 months of immunosuppressive therapy, the anti-EPO antibody titer was markedly decreased; however, esophageal candidiasis developed. Additional therapy with cyclosporine alone instead of prednisone and cyclophosphamide was performed, and anti-EPO antibody was subsequently not detected. Darbepoetin-alpha was then reintroduced, and the patient's anemia improved without red cell transfusion. In conclusion, ESA-induced PRCA was successfully treated with reintroduction of darbepoetin-alpha following immunosuppressive therapy.
Anemia ; Antibodies ; Candidiasis ; Cyclophosphamide ; Cyclosporine ; Dialysis ; Erythropoietin ; Humans ; Prednisolone ; Prednisone ; Red-Cell Aplasia, Pure ; Renal Dialysis

Foamy urine is widely regarded as a sign of proteinuria. However, there is no objective definition of foamy urine and there are no reports on the proportion of involved patients who have overt proteinuria or microalbuminuria. We performed this study to investigate this proportion and to identify possible risk factors for these two conditions. We reviewed all new outpatients from 1 November 2011 to 30 April 2012 and identified patients complaining of foamy urine. Their demographic data and medical records were examined. In particular, we tabulated the patients' spot urinary protein to creatinine ratio, spot urinary microalbumin to creatinine ratio (ACR), blood urea nitrogen (BUN), and serum levels of creatinine (Cr), uric acid, calcium, phosphate, and glucose. In addition, we calculated estimated glomerular filtration rates (eGFRs) by using the CKD-EPI equation. We also performed risk factor analysis with the Chi-squared test and by logistic regression. Seventy-two patients (6.3% of total new outpatients) complained of foamy urine; of these, there were 59 males with a median age of 65.5 years (range, 36-87 years). Of the 72 patients, 16 (22.2%) had overt proteinuria. We found that diabetes, poor renal function (high Cr, BUN, low eGFR), increased serum phosphate, and increased serum glucose were associated with overt proteinuria. Multiple logistic regression analysis showed that serum Cr and serum phosphate were associated with overt proteinuria. The ACR was available for 38 patients, and in this subgroup, 12 (31.6%) showed microalbuminuria or overt proteinuria. In this subgroup, a high serum Cr was the only statistically significant risk factor. Among patients who complained of foamy urine, approximately 20% had overt proteinuria, and increased serum Cr and phosphate were statistically significant risk factors.
Blood Urea Nitrogen ; Calcium ; Creatinine ; Glomerular Filtration Rate ; Glucose ; Humans ; Logistic Models ; Male ; Medical Records ; Outpatients ; Phosphates ; Proteinuria ; Risk Factors ; Uric Acid

Spontaneous rupture of the bladder is usually associated with a history of recent trauma, instrument injury, or existing bladder disease. However, there are also occasional reports of bladder rupture associated with pregnancy, most of which are complications of cesarean section. However, spontaneous bladder rupture following normal vaginal delivery is very rare. Patients with bladder rupture need a rapid, sensitive diagnosis and treatment because of a high risk of mortality and morbidity. We report a case of bladder rupture after normal vaginal delivery, which was successfully managed. A patient with small bladder rupture and ascites after normal vaginal delivery was treated by urethral catheterization and use of antibiotics, without operation.
Anti-Bacterial Agents ; Ascites ; Cesarean Section ; Delivery, Obstetric ; Diagnosis ; Female ; Humans ; Mortality ; Pregnancy ; Rupture* ; Rupture, Spontaneous ; Urinary Bladder Diseases ; Urinary Bladder Fistula ; Urinary Bladder* ; Urinary Catheterization ; Urinary Catheters

PURPOSE: Carcinomas arising in the gall bladder (GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5- year survival rates are less than 10%. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct. MATERIALS AND METHODS: From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy (median 44.25Gy), and three patients received additional intraluminal brachytherapy (range, 25Gy to 30Gy). Twenty-seven patients received a postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin. RESULTS: Median follow up period was 8.5 months (range 2-97 months). The overall 2-year and 5-year survival rates in all patients were 29.9% and 13.3% respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were 34.5% and 27.8% respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation (43.8% vs. 20.7%). albeit, statistically insignificant (P>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance (P<0.05). Patients with good performance status in the beginning showed significantly better survival rates than those with worse status (P<0.05). The 2-year survival rates in combined chemotherapy group and radiation group were 40.5% and 22.6% respectively. There was no statistical differences in two groups (P>0.05). CONCLUSION: The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical operation and/or chemotherapy. More radical treatment strategies, such as total resection with intensive radiation and/or chemotherapy may offer a better chance for cure in selective patients with carcinoma of gall bladder and extrahepatic biliary ducts.
Biopsy ; Brachytherapy ; Chemotherapy, Adjuvant ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Gallbladder ; Humans ; Leucovorin ; Mitomycin ; Particle Accelerators ; Prognosis ; Radiotherapy* ; Retrospective Studies* ; Survival Rate ; Urinary Bladder*

PURPOSE: To evaluate the potential advantage for "sandwich" technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. METHODS AND MATERIALS: Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx. followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6weeks was delivered. Patients were followed for median period of 25 months. RESULTS: The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. CONCLUSION: The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT.Key Words : Rectal cancer, Sandwich technique, Radiotherapy
Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Neoplasm Metastasis ; Radiotherapy* ; Rectal Neoplasms ; Recurrence ; Seoul ; Survival Rate

PURPOSE: To evaluate the role of combination therapy of external radiotherapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. METHODS AND MATERIALS: A retrospective review of evaluable 55 esophageal cancer patients referredto the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul. 1983 and Dec.1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group(ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fiffy patients had squamous cell carcinomas. Radiation doses of 2520-6480cGy were delivered over a period of 4-7weeks. using 4MV LIVAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1,2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. RESULTS: Median follow up period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months(20 days-73 months) in B group. The 1,2 YSRs were 26.7%, 8.9% in A group. 12.7%, 4.3% in B group (p>0.05), respectively. The 1,2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose(5000cGy more or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000cGy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were 43.8%, 25.0%, respectively. Complete response rate of 25.0% in A and 8.3% in B were achieved. The local failure and distant metastsis were 52.4%, 23.8% in A group. 64.3%, 14.3% in B group, respectively. The combination therapy revealed more freguent leukopenia and nausea/vomiting than radiation alone group, but degree of side effects was only mild to modereate. CONCLUSION: The combined external radiotherapy and chemotherapy for advanced esophageal cancer appears to improve the response rate, local control rate and survival rate, but the improvement was not statistically significant. The side effects of combined modalities were mild to moderate without significant morbidity. Therefore it may be worthwhile to continue the present combined external radiotherapy and chemotherapy in the management of advanced esophageal cancer to confirm our result.
Aged ; Carcinoma, Squamous Cell ; Drug Therapy ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Leukopenia ; Male ; Middle Aged ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate

Endoscopic variceal ligation(EVL) was developed to provide a safer alternative than injection sclerotherapy for treatment of bleeding esophageal varices. EVL adds a new indication that will significantly increase the use of overtubes. overtube itself may have a role in predisposing to esophageal perforation but only one report has been published regarding an esophageal perforation related to the placement of an overtube. Recently, we experienced a case of esophageal perforation caused by overtube placement during endoscopic variceal ligation. So we report this case with review of relevant literatures.
Esophageal and Gastric Varices ; Esophageal Perforation* ; Hemorrhage ; Ligation* ; Sclerotherapy

No abstract available.
Cervical Ripening* ; Female ; Pregnancy

No abstract available.
Fistula*

No abstract available.
Osteoarthritis*