This Week in the Journal

January 31, 2002

Daily Hemodialysis and Outcome of Acute Renal Failure

Morbidity and mortality among patients with acute renal failureare high, despite the use of renal-replacement therapies. Thisstudy investigated two regimens of intermittent hemodialysis— a daily regimen and an alternate-day (conventional)regimen — in 160 patients with acute renal failure. Survivaltwo weeks after hemodialysis was the primary end point; theduration of acute renal failure and the rate of complicationswere secondary end points.

Daily hemodialysis was associated with better control of symptomsof uremia and longer survival than was conventional intermittenthemodialysis.

Related Editorial

Detection of APC Mutations in Fecal DNA

An early genetic change in the pathway to colorectal canceris a mutation in the adenomatous polyposis coli (APC) gene.On the basis of the premise that cells with mutant APC genesare shed into the feces, these investigators devised a powerfulmolecular method to find such genes in feces from patients withcolorectal cancer. Whereas feces from normal subjects had nodetectable mutant APC genes, stools from over half the patientswith colorectal cancer or colonic polyps contained such genes.

This study tested the feasibility of finding mutant APC genesin stools from patients with early colorectal cancer. The methoddeveloped for this purpose is a technical tour de force, akinto finding the proverbial needle in a haystack. Refinementsof this method may lead to a specific and sensitive screeningtest for colorectal cancer.

Related Perspective

Oral and Topical Corticosteroids for Bullous Pemphigoid

Bullous pemphigoid, the most common autoimmune blistering skindisease in elderly persons, is associated with substantial morbidityand mortality, in part owing to complications of systemic corticosteroidtherapy. This randomized, multicenter trial compared treatmentwith oral prednisone and therapy with topical clobetasol propionatecream. The primary outcome was overall survival. Topical therapysignificantly reduced mortality, the incidence of severe complications,and the length of hospital stays among patients with extensivedisease.

Topical corticosteroids should be considered as standard treatmentfor patients with extensive bullous pemphigoid.

Related Editorial

Gastropericardial Fistula after Laparoscopic Surgery for Reflux Disease

When patients with severe gastroesophageal reflux disease requiresurgery, the operation is frequently performed through a laparoscope.This case report describes a life-threatening gastropericardialfistula, which was a late complication of a laparoscopic Nissenfundoplication, as well as its repair.

Although gastropericardial fistula is rare, this report callsattention to the potential complications of laparoscopic antirefluxsurgery. Such complications might be minimized by improvementsin surgical technique and additional training of surgeons whoperform the procedure.

Clinical Practice: Antibiotic-Associated Diarrhea

A 53-year-old woman reports severe watery diarrhea with cramps.She is in her 7th day of a 10-day course of cefixime, prescribedfor bronchitis. How should she be evaluated and treated?

This article reviews the evaluation and management of antibiotic-associateddiarrhea, with particular attention to diarrhea associated withClostridium difficile infection.

Mechanisms of Disease: Production and Actions of Estrogens

Estrogens and estrogen-like substances are widely distributedin animals and plants, and it is now clear that estrogens haveboth nuclear and nonnuclear actions. This review article summarizesthe production, metabolism, and actions of estrogens, with particularattention to the nuclear actions of estrogens and the mechanismsthat underlie the different estrogen-agonist and estrogen-antagonistactions of selective estrogen-receptor–modulating drugs.

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