Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

A case of Acute Arsine Poisoning with Hemolytic Anemia and Acute Renal Failure / 대한산업의학회지

BACKGROUND: There has been no reported case of arsine poisoning in Korea so far. This article presents the first reported case of arsine poisoning with hemolytic anemia accompanied by acute renal failure. Initially we suspected an infectious agent to be the cause of this case but later discovered that it was arsine poisoning suffered while working at a zinc-smelting industry in the process of recovering the cadmium by-product. We report this case and discuss the arsine poisoning. CASE REPORT: A 27-year-old man employed at a zinc-smelting industry was exposed to arsine while working in the process to recover the cadmium by-product.On the 4th day at work, he had to redissolve defected by-product into a pot and began to experience febrile sensation, diarrhea, upper quadrant abdominal pain, jaundice, and anorexia.After he was admitted to a hospital, the laboratory results showed hemolytic anemia, acute renal failure and elevated concentration of arsenic. He was thus diagnosed as suffering from arsine-poisoning and underwent hem dialysisand supportive therapy.He recovered from the poisoning after51 days and was discharged from the hospital. DISCUSSION: When workers dealing with arsenic-containing material present with hematuria, nausea, vomiting, abdominal pain, and dyspnea followed by hemolysis with acute renal failure, arsine poisoning must be suspected and diagnosis followed by treatment must commence immediately. If any future cases occur, blood and urine samples should be kept in storage so any necessary analysis can be processed later.

A Case of Ascites Arising from Liver Cirrhosis Effectively Treated with Dai-kenchu-to / 日本東洋医学雑誌

We reported that a patient with ascites arising from liver cirrhosis was successfully treated with Dai-kentyu-to. The case was a 67-year-old woman who was diagnosed as having C-type chronic hepatitis. After the operation of gastric cancer, ascites appeared. She was treated by diureatics, but ascites increased. When she was operated on for an abdominal hernia, the liver was cirrhotic. She lost appetite and was fatigued. She visited our clinic to undergo Kampo therapy. Hochu-ekki-to, Gorei-san, Sho-kenchu-to were given for her symptoms, but had no effects. However, since she began taking Dai-kenchu-to for her cold and rumbling abdomen, her ascites decreased gradually, and diuretics were stopped.