Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: A case-series report.

BACKGROUND: The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricular function, pulmonary artery systolic pressure (PASP), and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF). METHODS: A case series of 21 (17 males, age 70 ± 11 years) consecutive patients with HF along with diuretic resistance and right ventricular dysfunction (median renal failure duration 60 months, range 13-287 months, mean ejection fraction 36 ± 11%) having been engaged in PD; 76% of the patients were under automated peritoneal dialysis (APD), whereas the rest were under continuous ambulatory PD (CAPD). Patients' PASP and central venous pressure (CVP) - through compression sonography - and body weight were evaluated before initiating the PD program and at 6 and 12 months. RESULTS: During the follow-up period, the mortality rate was 8 deaths out of 21 patients (38%) A significant reduction by 29.9% in PASP levels (p = 0.013) and by 42% in CVP levels (p < 0.001), and in right ventricular function assessed by tricuspid annulus tissue Doppler velocity (p = 0.04) was observed, whereas patients' weight increased by 3.7% (p = 0.001). New York Heart Association class improved in 12 patients, whereas in the remaining patients, it remained constant (p = 0.046). In 8 patients, complications were reported (mainly presence of Staphylococcus aureus). In conclusion, PD seems to confer a substantial benefit in clinical status, which is in line with improvement in venous congestion and right ventricular systolic pressure among elderly patients with HF along with CRS.

Esophageal remnant cancer 35 years after acidic caustic injury: A case report.

INTRODUCTION: Esophageal squamous cell carcinoma has been described as a long-term consequence following ingestion of corrosive substances. PRESENTATION OF CASE: We report a rare case of a 62-year-old female patient with a history of acidic caustic injury 35 years ago, for which she had undergone near total esophagogastrectomy with right colon interposition. Recently, she presented with worsening dysphagia, weight loss, neck swelling and chest pain. After the diagnostic workup, an invasive squamous cell carcinoma of the esophagus was confirmed. To our knowledge, this is the first such report in the literature. DISCUSSION: The risk for esophageal carcinoma increases substantially after ingestion of caustic substances. It is notable that distinct patterns of carcinogenesis between acids and alkalis may be postulated, since the corresponding pathophysiological impact of each one differ significantly. Although such esophageal cancers tend to have good prognosis due to early detection, both the diagnostic and therapeutic strategy may be challenging due to the limited available data in this field. Surgical treatment does not seem to eliminate the risk of cancer, as evident upon the present case report. CONCLUSION: Optimal management of esophageal corrosive injuries remains a debatable issue in terms of choosing between conservative therapy and surgical intervention. For this reason, the need for long-term follow up regardless the ingested substance and the preferred therapeutic approach is highlighted.