[Rectal Mucosa-associated Lymphoid Tissue Lymphoma Treated with Endoscopic Resection].

A primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical-pathological entity that develops in diverse anatomic locations. However, colorectal involvement is rare. The authors encountered a case of a MALT lymphoma of the rectum in a 69-year-old woman who complained of up to 3 kg weight loss during 3 months. A colonoscopy demonstrated a 1.0×1.0 cm sized subepithelial tumor (SET) at the lower rectum. The patient underwent an endoscopic mucosal resection with ligation for the SET. Pathological analysis revealed marked small to medium-sized lymphocytic infiltration. Immunohistochemistry revealed neoplastic cells positive for CD20 and bcl-2. A polymerase chain reaction detected immunoglobulin H gene rearrangement. Finally, rectal MALT lymphoma was diagnosed. Computed tomography and positron emission tomography scans showed that there was no lymph node metastasis or other organ involvement. A bone marrow biopsy was found to be negative for any neoplastic process. Therefore, the Ann Arbor stage was IeB. Helicobacter pylori (H. pylori) was not detected in the gastric biopsy specimens. Thus far, she has had no relapse since the endoscopic resection. The incidence of rectal MALT is very rare, and treatment is unclear. This paper reports a case of rectal MALT lymphoma treated successfully with only an endoscopic resection.

Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding.

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.

The effect of injection speed on remifentanil-induced cough in children.

BACKGROUND: Remifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC. METHODS: One hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 µg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 µg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 µg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion. RESULTS: The incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups. CONCLUSIONS: When intravenous remifentanil 1.5 µg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.