Incidental Finding of Gastric Schwannoma in a Renal Failure Patient - Managed by a Minimally Invasive Procedure: Report of a Rare Case

Comparison of Combined Hemodialysis and Hemoperfusion with Hemoperfusion Alone in 106 Patients with Diabetic Ketoacidosis and Acute Renal Failure: A Retrospective Study from a Single Center in China

Background

Acute kidney injury with acute renal failure is associated with severe diabetic ketoacidosis. This retrospective study was conducted at a single center in China and aimed to compare combined hemodialysis and hemoperfusion (hemodialysis+hemoperfusion) with hemoperfusion alone in 106 patients with diabetic ketoacidosis and acute renal failure.

Material/Methods

The 106 patients were divided into 2 groups according to different dialysis programs, with 53 cases in each group. Hemodialysis was performed using a single-pass 4008S FX8 HeLix-One hollow fiber hemodialyzer (Fresenius Medical Care, St. Wendel, Germany). Hemoperfusion was performed using HA130 resin adsorbents.

Results

There were no significant differences in terms of sex, age, duration of diabetes, A1c, pH, and admission blood glucose between the 2 groups (P=0.54, 0.564, 0.53, 0.78, 0.82, 0.51). There were no significant differences in fasting blood glucose, blood urea nitrogen, osmotic pressure, and creatinine between the 2 groups before treatment (P=0.146, 0.978, 0.786, 0.983). After treatment, blood urea nitrogen and creatinine in the dual-treatment group were lower than in the control group, and the osmotic pressure was higher than that in the control group (P=0.000, 0.000, 0.000). The dual-treatment group experienced a lower prevalence of dizziness (5.7%), anemia (7.5%), bone pain (7.5%), hypertension (3.8%), and pruritus (5.7%) than the control group (P<0.05).

Conclusions

Compared with hemoperfusion alone, hemodialysis+hemoperfusion significantly reduced pruritus and anemia, improved renal function, and was associated with significantly fewer adverse events in patients with diabetic ketoacidosis and acute renal failure.

Clinical Characteristics and Surgical Management of Gastrointestinal Schwannomas

Objectives

Schwannomas are tumors arising from Schwan cells of the neural sheath. Gastrointestinal schwannomas (GS) are rare and easily confused with a heterogeneous group of neuroectodermal or mesenchymal neoplasms. The aim of the present study is to analyze the clinicopathological features, surgical management methods, and long-term prognoses of GS patients.

Methods

Between August 2004 and July 2019, 51 patients with GS were treated at the Peking Union Medical College Hospital. The medical records were reviewed retrospectively. A database containing demographic characteristics, clinical symptoms, imaging tests, operation details, pathological results, and prognoses was constructed and analyzed.

Results

GS accounted for 2.0% of all schwannomas. The cohort comprised 19 men (37.3%) and 32 women (62.7%). The mean age was 55.7 ± 11.4 years. The most common symptom was abdominal pain (29.4%). Twenty-seven patients (52.9%) were asymptomatic and diagnosed incidentally. The most common tumor location of GS was the stomach (90.2%). S-100 had the highest positive rate (100%) in immunohistochemical staining. Forty-six patients (90.2%) were followed-up at a mean period of 49.5 ± 41.4 months. Forty-four patients (95.7%) survived without tumor, 1 patient survived with tumor, and 1 patient died. The 5-year cumulative overall survival rate and cumulative disease-free survival rate were 97.5% and 95.2%, respectively.

Conclusion

GS are rare gastrointestinal tumors with favorable prognoses after surgical resection. Stomach is the most common site. Definitive diagnosis is determined by postoperative pathology. S-100 expression has diagnostic significance.