ABSTRACT
BACKGROUND: Although hypoalbuminemia is common in patients with tsutsugamushi disease, acute rickettsial infectious disease, its impact on the severity of disease is not reported. Therefore, we studied the role of hypoalbumiemia as a marker of the severity of disease in patients with tsutsugamushi disease. METHODS: We retrospectively reviewed clinical data of 95 patients with tsutsugamushi disease who were admitted between January 1994 and December 1999 at Uijongbu St. Mary's hospital. We compared clinical and laboratory findings, complications, and mortality between hypoalbuminemic group (serum albumin or = 3.0 g/dL). RESULTS: Of the total 95 patients, 50 patients (52.6%) had hypoalbuminemia. In hypoalbuminemic group, the incidence of hypotension was higher (20.0% vs 2.2%, p=0.006) and the duration of admission was longer (12.0+/-4.5 vs 8.8+/-2.7 days, p<0.001), compared to control. The degree of thrombocytopenia in hypoalbuminemic group was severer than that in control (84,000+/-46,000 vs 138,000+/-75,000/mm3, p<0.001). Hypoalbuminemic group showed higher incidence of interstitial pneumonia (64.0 vs 13.3%, p<0.001), hypoxia (40.0 vs 6.6%, p<0.001), metabolic acidosis (12.0 vs 0%, p=0.018), and acute renal failure (18.0 vs 4,4%, p=0.038), compared to control. Four patients who had hypoalbuminemia died due to septic shock and multiorgan failure. CONCLUSION: This study shows that hypoalbuminemia could be used as a marker of the severity of disease in patients with tsutsugamushi disease.
Subject(s)
Humans , Acidosis , Acute Kidney Injury , Hypoxia , Communicable Diseases , Hypoalbuminemia , Hypoproteinemia , Hypotension , Incidence , Lung Diseases, Interstitial , Mortality , Retrospective Studies , Rickettsia , Scrub Typhus , Shock, Septic , ThrombocytopeniaABSTRACT
Protein-losing enteropathy is characterized by excessive protein loss into the intestinal tract in association with various disorders. We report a case of reversible protein-losing enteropathy as a cause of severe hypoalbuminemia in a patient with multiple renal abscesses. A 61-year-old woman presented with high fever and left flank pain. Abdominal computed tomography showed multiple abscesses in the left kidney. E. coli was cultured from her blood. Although hypoalbuminemia was severe (1.9 g/dL), the liver function tests including prothrombin time were normal and urine protein was negative. The results of 99mTc-human serum albumin scintigraphy were compatible with protein-losing enteropathy. Alpha-1 -antitrypsin clearence was 89 ml/24 hours (normal range <13 ml/24 hours). After the renal abscess was improved with antibiotic therapy, serum albumin increased to normal range and protein-losing enteropathy disappeared.
Subject(s)
Female , Humans , Middle Aged , Abscess , Escherichia coli , Fever , Flank Pain , Hypoalbuminemia , Kidney , Liver Function Tests , Protein-Losing Enteropathies , Prothrombin Time , Radionuclide Imaging , Reference Values , Serum Albumin , Technetium Tc 99m Aggregated AlbuminABSTRACT
Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration.
Subject(s)
Duodenoscopy , Duodenum , Esophagus , Hemorrhage , Intestines , Jejunum , Pancreas , StomachABSTRACT
Tuberculous bronchoesophageal fistula is a rare disease. We experienced a case of the tuberculous bronchoesophageal fistula, which was found by endoscopy and surgically confirmed. A sixty seven years old female patient complained of foreign body sensation in the throat and frequent aspiration, especially after liquid meal. Esophagoscopic ex- aminatian showed the orifice of the fistula in the midesophagus at the level of 28 cm from the incisors. Esophagogram showed bronchoesophageal fistula between midesophagus and the right intermediate bronchus. A bronchoscopy visualized fistulous tract with granulation in the right intermediate bronchus. Biopsy specimens obtained from the bronchus revealed the esophageal tissue with granulation and multinucleated giant cells. Fistulectomy with wrapping procedure was performed successfully. Surgical pathologic findings confirmed a small focal granuloma and chronic inflammations, compatible with tuberculosis. There was no evidence of malignancy at the specimens. She was treated with anti-tuberculous agents and became well.
Subject(s)
Female , Humans , Biopsy , Bronchi , Bronchoscopy , Endoscopy , Fistula , Foreign Bodies , Giant Cells , Granuloma , Incisor , Inflammation , Meals , Pharynx , Rare Diseases , Sensation , TuberculosisABSTRACT
Foreign bodies in the stomach are usually ingested by children under the age of 5 years, persons with dentures and alcoholics or mentally disturbed individuals. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metal, fish bones and etc. A toothpick in the stomach has been rarely reported in an alert adult. Here, we present a case of a patient with toothpick stuck in the stomach, that she did not realize she had swallowed. It was removed by an endoscopy without any complications. A 57 year-old woman was admitted to Uijoagbu St. Mary's hospital because of epigastric pain for 10 days. The pain persisted constantly in the epigastrium and aggravated after meals. Sbe had an episode of vomiting during these days. A yellowish white, thin, stiff material 1.5 cm long was found by an endoscopic examination stuck at the less curvature of the antrum. It was removed by the endoscopic biopsy forceps and was proved to be an wooden toothpick, sharp at both ends, with a length of 6.6cm and a diameter of 0.2 cm. There was a small ulcer at the site of the removed toothpick and mild bleeding from the ulcer. The epigastric pain was relieved after the removal of the toothpick. She did not realize she had swallowed the toothpick. Four days later, a follow-up endoscopic examination revealed closed ulcer and no bleeding. She was discharged without complications.
Subject(s)
Adult , Child , Female , Humans , Middle Aged , Alcoholics , Biopsy , Dentures , Endoscopy , Follow-Up Studies , Foreign Bodies , Hemorrhage , Meals , Numismatics , Parents , Stomach , Surgical Instruments , Ulcer , VomitingABSTRACT
It is well known that the main source of upper gastrointestinal(UGI) bleeding in patients with liver cirrhosis is the variceal rupture of esophagus. But, peptic ulcer disease, congestive gastrophathy, and gastric varices are frequently found by endoscopic examination in patients with liver cirrhosis. These lesions are related to UGI bleeding. It is necessary to verify the causes of bleeding in liver cirrhosis, and evaluate the influencing factors related with UGI bleeding, and define the endoscopic findings of bleeding in liver cirrhosis. We reviewed the records of 145 episodes of UGI bleeding in cirrhosis, with endoscopy performed within 24 hours of entry, and report here the bleeding sites, influencing factors related with UGI bleeding, and endoscopic findings. The most common bleeding site was the esophageal varices(66.9%). Other bleeding lesions included gastric ulcer(8.3%), congestive gastrophathy(6.9%), undetermined origin(6.9%), duodenal ulcer(6.2%), gastric varices(2.1%), esophageal varices+gastric ulcer(1.4%), and esophageal varices+duodenal ulcer(1.4%). Endoscopic features of bleeding esophageal varices were identified as Spurting(2.1%), Oozing(11.3%), Red plugh(10,3 %), White plugh(14.4%), and Red-color sign(61.9%). In bleeding esophageal varices, gradeIV varices(41.2%) had a significantly higher association with bleeding than gradeI varices(2.1%), gradeII varices(22.7%), and gradeIII varices(34.0%). Endoscopic features of bleeding gastric ulcer were identified as Spurting(8.3%), Oozing(25.0%), Blood clots(58.3%), and Exposed blood vessels on ulcer base(41.7%). Endoscopic features of bleeding duodenal ulcer were identified as Oozing(44.4%), Blood clots(55.6 %), and Exposed blood vessels on ulcer base(55.6%). We found no difference in the bleeding sources according to etiology of cirrhosis(P>0.05). Bleedings due to the variceal rupture of esophagus were more frequently found in Child class B(71.2%) and C(75.0%) than A(34.8%)(P<0.05).
Subject(s)
Child , Humans , Blood Vessels , Duodenal Ulcer , Endoscopy , Esophageal and Gastric Varices , Esophagus , Estrogens, Conjugated (USP) , Fibrosis , Hemorrhage , Liver Cirrhosis , Liver , Peptic Ulcer , Rupture , Stomach Ulcer , UlcerABSTRACT
Both duodenal ulcer and gastric cancer are common, and it is well known that the pathophysiology of the two is different. The presence of a duodenal ulcer is believed to protect against the development of a gastric malignancy. However gastric cancer may occur in the presence of active or chronic duodenal ulcer disease. Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician must be alert to the strange association of duodenal ulcer and gastric cancer. Here, we present 3 cases with coexistence of duodenal ulcer and gastric cancer, diagnosed by endoscopy.
Subject(s)
Duodenal Ulcer , Endoscopy , Incidence , Stomach NeoplasmsABSTRACT
Endoscopic variceal ligation(EVL) is an accepted alternatives to endoscopic injection sclero- therapy(EIS) in many patients with bleeding esophageal varices. Esophageal hematoma is rare and an unusual complication after EVL or EIS. We present a patient with liver cirrhosis who developed an obstructive esophageal hematoma after EVL.