ABSTRACT
BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP. METHODS: A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done. RESULTS: We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test's sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%. CONCLUSIONS: The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Ascitic Fluid/chemistry , Bacterial Infections/diagnosis , English Abstract , Liver Cirrhosis/complications , Peritonitis/diagnosis , Predictive Value of Tests , Reagent Strips , Sensitivity and SpecificityABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
Acute recurrent pancreatitis results most commonly from gallstone disease. Although transabdominal ultrasound is a common procedure for evaluating biliary tract, it may not be effective in minilithiasis. We here report a case of acute recurrent pancreatitis, in which endoscopic ultrasonography revealed minilithiasis in the gallbladder with a review of the literature. A 57-year-old woman had suffered from idiopathic recurrent pancreatitis four times for the past 4 months. While transabdominal ultrasonography and abdominal computerized tomography revealed no evidence of bliary stones, but EUS exhibited minilithiasis in the gallbladder. After laparoscopic cholecystectomy, no further events of pancreatitis happened.
Subject(s)
Female , Humans , Middle Aged , Biliary Tract , Cholecystectomy, Laparoscopic , Endosonography , Gallbladder , Gallstones , Pancreatitis , UltrasonographyABSTRACT
Acute recurrent pancreatitis results most commonly from gallstone disease. Although transabdominal ultrasound is a common procedure for evaluating biliary tract, it may not be effective in minilithiasis. We here report a case of acute recurrent pancreatitis, in which endoscopic ultrasonography revealed minilithiasis in the gallbladder with a review of the literature. A 57-year-old woman had suffered from idiopathic recurrent pancreatitis four times for the past 4 months. While transabdominal ultrasonography and abdominal computerized tomography revealed no evidence of bliary stones, but EUS exhibited minilithiasis in the gallbladder. After laparoscopic cholecystectomy, no further events of pancreatitis happened.
Subject(s)
Female , Humans , Middle Aged , Biliary Tract , Cholecystectomy, Laparoscopic , Endosonography , Gallbladder , Gallstones , Pancreatitis , UltrasonographyABSTRACT
In the past, most hepatolithiasis had been brown pigment stones in Korea. However, stones with high cholesterol content are found with increasing frequency. Abdominal ultrasonography is superior to CT for detection of cholesterol hepatolithiasis. The characteristic gross morphology of pure cholesterol hepatolithiasis shown by cholangioscopy is diagnostic. An effective medical management consists of stone removal by percutaneous transhepatic cholangioscopy and ursodeoxycholic acid for the prevention of recurrence. We here report a case of primary pure cholesterol hepatolithiasis with a review of the literature. A 29-year-old woman presented with right upper quadrant pain. Abdominal ultrasonography showed right intrahepatic duct stones. A cholangioscopy revealed typical cholesterol stones, mucosal hyperemia, and mild narrowing in stone-bearing intrahepatic duct. Cholangioscopic stone removal via the percutaneous transhepatic route was successfully performed. To prevent recurrence, ursodeoxycholic acid was administered.
Subject(s)
Adult , Female , Humans , Cholesterol , Hyperemia , Korea , Recurrence , Ultrasonography , Ursodeoxycholic AcidABSTRACT
Garlic(Allium sativum) is recognized as a sensitizing agent responsible for allergic contact dermatitis with food handlers and housewives. Lymphomatoid contact dermatitis, which is a type of allergic contact dermatitis, shows similar histologic features to Mycosis Fungoides. We report a 66-year-old male, who had applied garlic extract to both lower extremities and the trunk for 8 months for relieving his symptoms of arthralgia and generalized pruritis. He had complained of variable sized multiple erythematous pruritic papules on both lower extremities and the trunk and lymphadenopathy of both inguinal and axillary area. Skin biopsy was performed and the histological exam presented microscopically abnormal lymphocyte infiltration in the upper dermis. T-cell marker studies revealed strong CD3 positivity and increased CD4/CD8 ratio. The results of PCR-heteroduplex analysis showed negative for T-cell receptor- gene rearrangement and abscence of T-cell monoclonality. We could diagnose his skin lesion and generalized lymphadenopathy as lymphomatoid contact dermatitis which represented as a T-cell pseudolymphoma histologically. He was treated with local steroid injection and phototherapy and the skin lesion were improved without recurrence.
Subject(s)
Aged , Humans , Male , Arthralgia , Biopsy , Dermatitis, Allergic Contact , Dermatitis, Contact , Dermis , Garlic , Gene Rearrangement , Lower Extremity , Lymphatic Diseases , Lymphocytes , Mycosis Fungoides , Phototherapy , Pruritus , Pseudolymphoma , Recurrence , Skin , T-LymphocytesABSTRACT
Primary sclerosing cholangitis (PSC) is a rare disease entity. The medical therapy for PSC has not been reasonably beneficial. Thus liver transplantation is known to be the ultimate therapy. Because liver transplantation for PSC has been performed rarely in Korea, we report a case of liver transplantation for PSC with a review of the literature. A 35-year-old male was admitted to our hospital with recurrent jaundice for seven years. ERCP showed multiple strictures of intrahepatic duct and an irregularity of the extrahepatic duct wall. Despite medication and endoscopic treatment, liver functions did not imporve and clinical status got worsened. Thus liver transplantation was performed for the correction of hepatic failure. Two months after transplantation, liver functions and general weakness gradually improved and now, one year after liver transplantation, the patient is in normal life.
Subject(s)
Adult , Humans , Male , Cholangitis, Sclerosing/diagnosis , Liver TransplantationABSTRACT
Eosinophilic pancreatitis is a rare disorder that may only be diagnosed after pancreatic resection under the suspection of a pancreatic tumor. We experienced a 65-year-old female patient whose initial presentation suggested pancreatic cancer. Radiologic evaluation revealed a pancreatic mass-like lesion which was obstructing the main pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed double duct strictures involving the distal common bile duct and the main pancreatic duct. Serum IgE level was elevated. Percutaneous core needle biopsy with an 18-gauge needle was performed targeting the pancreatic lesion. The biopsy specimen revealed fibrotic interlobular septum and intralobular fibrosis with prominent eosinophilic infiltration. The patient was treated with oral prednisolone (40 mg/day). A plastic stent was inserted into the narrowed common bile duct. After three months of oral steroid therapy, symptoms and signs improved rapidly and serum IgE level was decreased. Abdominal computed tomography and ERCP revealed remission of pancreatic mass-like lesion.