ABSTRACT
BACKGROUND/AIMS: Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. METHODS: A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. RESULTS: The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. CONCLUSIONS: When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
Subject(s)
Female , Humans , Male , Catheterization , Catheters , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Endoscopes , Gastrectomy , Gastroenterostomy , Sphincterotomy, EndoscopicABSTRACT
Amyloidosis is an acquired or inherited disorder with protein folding and degradation characterizing the deposition of the proteinaceous material in the extracellular matrix of one or several organs. Secondary amyloidosis resulting from the deposition of serum amyloid A protein, occurs 1-5% during the lifetime of patients with chronic inflammatory disorders such as rheumatoid arthritis and ankylosing spondylitis. In addition, chronic pyelonephritis and pressure sores in patient with spinal cord injury are documented as risk factors of secondary amyloidosis. Thus, the efforts to treat and prevent the development of secondary amyloidosis and to preserve the renal function should focus on avoiding the chronic inflammatory state and a pathologic study of doubtful organs for early diagnosis should be performed. We have experienced one case of secondary amyloidosis in patient with spinal cord injury which involves with kidney and thyroid gland.
Subject(s)
Humans , Amyloidosis , Arthritis, Rheumatoid , Early Diagnosis , Extracellular Matrix , Kidney , Pressure Ulcer , Protein Folding , Pyelonephritis , Risk Factors , Serum Amyloid A Protein , Spinal Cord Injuries , Spinal Cord , Spondylitis, Ankylosing , Thyroid GlandABSTRACT
BACKGROUND/AIMS: Although the majority of patients with Mallory-Weiss syndrome (MWS) have a benign course, MWS patients with recurrent bleeding have an unfavorable outcome and require intensive care. Therefore, this study was carried out to identify the risk factors for recurrent bleeding in MWS patients. METHODS: The medical records of patients with MWS between January 1999 and December 2003, were reviewed retrospectively. Demographics, initial clinical and laboratory parameters, and endoscopic findings of the patients with and without recurrent bleeding were compared and the potential risk factors predicting recurrent bleeding in MWS were evaluated. RESULTS: A total of one hundred and fifty-nine patients (22 women, 137 men, mean age 48.1 years old) were enrolled in the study. Recurrent bleeding was observed in 17 patients (10.7%). Those patients with recurrent bleeding showed higher frequency for the presence of shock at initial manifestation, combined liver cirrhosis and endoscopic findings of active bleeding, lower hemoglobin level and platelet count, higher amount of transfusions and epinephrine-mixed fluid injections, and longer hospital stay than those patients without recurrent bleeding. Significant risk factors predicting the recurrent bleeding in MWS were the presence of shock at initial manifestation (OR 3.71, 95% CI 1.07-14.90) and the evidence of active bleeding on endoscopic examination (OR 9.89, 95% CI 1.88-51.98) on multivariate analysis. CONCLUSIONS: Intensive care with close monitoring is required for the patients with shock on initial manifestation or with evidence of active bleeding on endoscopic examinations since these are independent risk factors predicting the recurrent bleeding in MWS patients.
Subject(s)
Female , Humans , Male , Middle Aged , Gastrointestinal Hemorrhage/etiology , Mallory-Weiss Syndrome/complications , RecurrenceABSTRACT
Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla-impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.
Subject(s)
Aged , Female , Humans , Ampulla of Vater , Amylases , Ascariasis , Ascaris lumbricoides , Ascaris , Bile , Cholangitis , Cholecystitis , Common Bile Duct , Developing Countries , Endoscopy , Hand Strength , Incidence , Korea , Liver Abscess , Pancreatic Ducts , Pancreatitis , Parasites , Sanitation , Surgical InstrumentsABSTRACT
OBJECTIVE: The prognosis of systemic lupus erythematosus (SLE) patients with pulmonary hypertension (PH) was reported to be very poor and the median duration of survival estimated to be within 2 years. This study was designed to assess the clinical outcome and risk factors for poor prognosis of patients with SLE combined with PH. MEHTODS: Two hundred ninety-two patients with SLE in whom echocardiography was performed were studied. The diagnosis of PH was made when the right ventricular systolic pressure (RVSP), measured by 2-dimensional echocardiography, was >30 mmHg. Demographic data, clinical manifestations, laboratory findings, and outcome of those with PH were evaluated. RESULTS: Twenty-one of 292 patients had PH. The mean age at diagnosis of PH was 33.8+/-12.5 years. The most frequent presenting symptoms were dyspnea on exertion and dyspnea. Eight of 21 patients died after 1.3+/-1.1 years from diagnosis of PH. Survival rate at first and third year were 86% and 66%, respectively, and the median duration of survival estimated 3.0 years. SLE disease activity index (SLEDAI) and damage index at diagnosis of PH were significantly higher in the deceased. Among the patients in whom sequential echocardiography was performed, RVSP were significantly lowered in the survivors. High SLEDAI and high damage index were independent risk factors for poor prognosis. CONCLUSION: The survival rates and the median duration of survival were slightly better than those of previous reports. The high SLEDAI and high damage index were risk factors for poor prognosis of patients with SLE combined with PH.
Subject(s)
Humans , Blood Pressure , Diagnosis , Dyspnea , Echocardiography , Hydrogen-Ion Concentration , Hypertension, Pulmonary , Lupus Erythematosus, Systemic , Prognosis , Risk Factors , Survival Rate , SurvivorsABSTRACT
Autoimmune thyroiditis in Turner syndrome is more prevalent in women with the X isochromosome karyotype, compared with other karyotypes. The cause of obesity in Turner syndrome is not to be sure, it may be related to metabolic syndrome inducing insulin resistance, hyperlipidemia, and cardiovascular diseases. Also the influence of each karyotypes on degree of obesity is unclear in Turner syndrome. We experienced a case of X isochromosome Turner syndrome with metabolic syndrome and autoimmune thyroiditis and report it with reviews of literatures.
Subject(s)
Female , Humans , Cardiovascular Diseases , Hyperlipidemias , Insulin Resistance , Isochromosomes , Karyotype , Obesity , Thyroiditis, Autoimmune , Turner SyndromeABSTRACT
Autoimmune thyroiditis in Turner syndrome is more prevalent in women with the X isochromosome karyotype, compared with other karyotypes. The cause of obesity in Turner syndrome is not to be sure, it may be related to metabolic syndrome inducing insulin resistance, hyperlipidemia, and cardiovascular diseases. Also the influence of each karyotypes on degree of obesity is unclear in Turner syndrome. We experienced a case of X isochromosome Turner syndrome with metabolic syndrome and autoimmune thyroiditis and report it with reviews of literatures.