ABSTRACT
No abstract available.
ABSTRACT
No abstract available.
ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is a safe procedure with life-threatening complications rarely occurring after the procedure. There are several reports of complications with ERCP, including bleeding, perforation, pancreatitis, cholangitis and cholecystitis. In our case, an umbilical hernia was strangulated after therapeutic ERCP had been performed in a patient with acute pancreatitis by a biliary stone, which required a surgical resection. To the best of our knowledge, this is the first report of such a case in Korea. This case highlights the need for close and careful observations for the early detection of possible complications after ERCP.
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystitis , Hemorrhage , Hernia, Umbilical , Korea , PancreatitisABSTRACT
BACKGROUND: Many protease inhibitors show a protective effect for acute pancreatitis as seen in animal models. In previous studies, the protease inhibitors were administered before induction of pancreatitis, and there are few published reports examining effects when these agents were administered after induction of pancreatitis. The timing of drug administration may provide an explanation for the ineffectiveness of protease inhibitors for the treatment of patients with acute pancreatitis. Herein, we assessed the protective effect of nafamostat mesilate (NM), a potent protease inhibitor, in a mouse model of cerulean-induced pancreatitis and compared the results of administering the drug before and after the induction of pancreatitis. METHODS: Cerulein, a cholecystokinin analogue, was injected into mice intraperitoneally to induce pancreatitis. The mice received intravenous NM administration before and after the induction of pancreatitis. The serum concentration of amylase and lipase was measured, histological changes were measured, and the tissue expression of myeloperoxidase was measured to assess the degree of inflammation. Expression of p38 MAPK (mitogen-activated protein kinase), phospho-p38 MAPK, and IL-6 (interleukin-6) in tissue was evaluated. RESULTS: Acute pancreatitis was induced successfully by intraperitoneal injection of cerulein. Acute pancreatitis could be prevented when NM was administered before the induction of pancreatits. However, the effect was not guaranteed when given after the induction of pancreatitis. For a group of mice with induced pancreatitis, tissue expression of phospho-p38 MAPK was prominent and there was no marked difference in the expression of IL-6 between groups with or without induced pancreatitits. CONCLUSIONS: Although the efficacy of NM for treatment of acute pancreatitis is doubtful, pretreatment with NM for an expected condition like endoscopic retrograde cholangiopancreatography (ERCP), might be helpful for the prevention of pancreatitis.
Subject(s)
Animals , Humans , Mice , Amylases , Ceruletide , Cholangiopancreatography, Endoscopic Retrograde , Cholecystokinin , Inflammation , Injections, Intraperitoneal , Interleukin-6 , Lipase , Mesylates , Models, Animal , p38 Mitogen-Activated Protein Kinases , Pancreatitis , Peroxidase , Protease InhibitorsABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly performed endoscopic procedure for the diagnosis and treatment of pancreatobiliary disease. ERCP is a relatively safe procedure. However, there are chances of potentially severe complications such as pancreatitis, hemorrhage, infection and perforation. Duodenal perforation is an uncommon, but serious complication of ERCP, and this has occurred in 0.3 to 1.1% of most of the previous series. There are various clinical course and treatments depending on the cause of perforation. However, the development of pneumothorax in patients undergoing ERCP is rare. There are no reports of tension pneumothorax complicating ERCP in Korea. We experienced a case of tension pneumothorax with complicating duodenal microperforation following ERCP, and the patient (a 77 year old female with suspicious dysfunction of the sphincter of Oddi) was treated with conservative treatment.
Subject(s)
Aged , Female , Humans , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis , Hemorrhage , Korea , Pancreatitis , PneumothoraxABSTRACT
The third generation cephalosporin is widely used in treatment of spontaneous bacterial peritonitis (SBP). Resistance to the third generation cephalosporin was associated with poor outcome in patients with SBP. Thus it is necessary to know the changes in resistance rate. We planned to investigate retrospectively on resistance rate of the third generation cephalosporin of gram negative bacteria isolated in patients with SBP, who visited Seoul National University Hospital between 1998 and 2006. The Clinical and Laboratory Standards Institute guidelines were applied for antibiotic susceptibility test. A total of 269 consecutive episodes of clinically and microbiologically proven SBP was identified during the study period and 209 cases were caused by gram negative organisms. Among 209 isolates, 22 (10.5%) showed resistance to the third generation cephalosporin. The prevalence of resistance was decreasing during the study period (P=0.014).
Subject(s)
Humans , Cephalosporin Resistance , Gram-Negative Bacteria , Liver Cirrhosis , Peritonitis , Prevalence , Retrospective Studies , SeoulABSTRACT
The third generation cephalosporin is widely used in treatment of spontaneous bacterial peritonitis (SBP). Resistance to the third generation cephalosporin was associated with poor outcome in patients with SBP. Thus it is necessary to know the changes in resistance rate. We planned to investigate retrospectively on resistance rate of the third generation cephalosporin of gram negative bacteria isolated in patients with SBP, who visited Seoul National University Hospital between 1998 and 2006. The Clinical and Laboratory Standards Institute guidelines were applied for antibiotic susceptibility test. A total of 269 consecutive episodes of clinically and microbiologically proven SBP was identified during the study period and 209 cases were caused by gram negative organisms. Among 209 isolates, 22 (10.5%) showed resistance to the third generation cephalosporin. The prevalence of resistance was decreasing during the study period (P=0.014).
Subject(s)
Humans , Cephalosporin Resistance , Gram-Negative Bacteria , Liver Cirrhosis , Peritonitis , Prevalence , Retrospective Studies , SeoulABSTRACT
BACKGROUND/AIMS: Needle knife sphincterotomy (NKS) following repeated probing due to difficult cannulation during ERCP increase the risk of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis are not well-known. The aim of this study is to investigate the incidence and risk factors of post-ERCP pancreatitis in patients who underwent NKS. We also evaluated the effect of gabexate on the prevention of post-ERCP pancreatitis. METHODS: Medical records from a total of 200 patients who underwent NKS following repeated probing during ERCP were reviewed retrospectively. The potential risk factors for post-ERCP pancreatitis were investigated. The effect of gabexate infusion after ERCP procedure on the incidence of post-ERCP pancreatitis was also evaluated. RESULTS: A total of 13 (6.5%) patients out of 200 patients developed post-ERCP pancreatitis. Gender, age, the presence of pancreatitis at procedure, underlyng disease, direction of sphincterotomy, success or failure of cannulation, diameter of CBD, pancreatic duct status and the presence of acinar filling were proved unrelated with pancreatitis. Post-ERCP pancreatitis developed in 9 out of 38 (23.7%) when gabexate was given, while 4 out of 160 (2.5%) experienced pancreatitis without administration of gabexate. CONCLUSIONS: We couldn't determine any risk factor for pancreatitis in patients who underwent NKS following repeated probing during ERCP. The gabexate infusion after ERCP procedure might be associated with the increased risk of pancreatitis.