ABSTRACT
Anomalous union of the pancreaticobiliary duct (AUPBD) is a rare congenital anomaly, defined as the pancreaticobiliary ductal union located outside of the duodenal wall, usually forming a markedly long common channel. This anomaly is associated with congenital choledochal cyst, carcinoma of the biliary tract and pancreatitis, and is more commonly seen in Asian than in Western countries. AUPBD is frequently accompanied by biliary dilatation, but some patients with AUPBD have no biliary dilatation. The causal relationship between AUPBD and biliary dilatation associated with this anomaly has not been fully established. Here, we report a case of type IIIc2 AUPBD without biliary duct dilatation that was treated by drainage of major papilla.
Subject(s)
Humans , Asian People , Bile Ducts , Biliary Tract , Choledochal Cyst , Dilatation , Drainage , Pancreatic Ducts , PancreatitisABSTRACT
BACKGROUND/AIMS: Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA. METHODS: We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA. RESULTS: A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence. CONCLUSIONS: Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.
Subject(s)
Humans , Adenoma , Argon Plasma Coagulation , Colonic Polyps , Colonoscopy , Colorectal Neoplasms , Incidence , Medical Records , Mortality , Polyps , Prognosis , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
We present a case report of brain death caused by Salmonella enterica serovar Enteritidis bacteremia. A 53-year-old diabetic male was admitted to our hospital with stupor mentality and fever. No evidence of meningitis was found upon cerebrospinal fluid analysis, but diffuse brain edema was shown by magnetic resonance imaging. S. Enteritidis phage type 7 was isolated from blood cultures. We diagnosed the patient with encephalopathy associated with S. Enteritidis bacteremia and treated him by intravenous administration of ceftriaxone and dexamethasone. Fifteen days after admission, the patient was diagnosed with brain death and became a cadaveric donor. Although encephalopathy associated with S. Enteritidis bacteremia is rare, it should be considered as a serious and potentially lethal complication.
Subject(s)
Humans , Male , Middle Aged , Administration, Intravenous , Bacteremia , Bacteriophages , Brain , Brain Death , Brain Edema , Cadaver , Ceftriaxone , Dexamethasone , Fever , Magnetic Resonance Imaging , Meningitis , Salmonella , Salmonella enterica , Salmonella enteritidis , Stupor , Tissue DonorsABSTRACT
We present a case report of brain death caused by Salmonella enterica serovar Enteritidis bacteremia. A 53-year-old diabetic male was admitted to our hospital with stupor mentality and fever. No evidence of meningitis was found upon cerebrospinal fluid analysis, but diffuse brain edema was shown by magnetic resonance imaging. S. Enteritidis phage type 7 was isolated from blood cultures. We diagnosed the patient with encephalopathy associated with S. Enteritidis bacteremia and treated him by intravenous administration of ceftriaxone and dexamethasone. Fifteen days after admission, the patient was diagnosed with brain death and became a cadaveric donor. Although encephalopathy associated with S. Enteritidis bacteremia is rare, it should be considered as a serious and potentially lethal complication.
Subject(s)
Humans , Male , Middle Aged , Administration, Intravenous , Bacteremia , Bacteriophages , Brain , Brain Death , Brain Edema , Cadaver , Ceftriaxone , Dexamethasone , Fever , Magnetic Resonance Imaging , Meningitis , Salmonella , Salmonella enterica , Salmonella enteritidis , Stupor , Tissue DonorsABSTRACT
BACKGROUND: Tigecycline (TIG), a new broad-spectrum glycylcycline with anti-multidrug-resistant-(MDR)-pathogen activity, was launched in March 2009 in South Korea, but there are insufficient clinical studies on its use in the country. As such, this study was performed to analyze cases of severe MDR-pathogen-caused infections treated with TIG. METHODS: Patients treated with TIG within the period from May 2009 to June 2010 were enrolled in this study. Their clinical and microbiologic data were reviewed retrospectively. RESULTS: Twenty-one patients were treated with TIG for complicated skin and soft-tissue infections (cSSTIs) (42.9%), complicated intra-abdominal infections (cIAIs) (38.1%), or pneumonia (19.1%) caused by MDR pathogens like carbapenem-resistant Acinetobacter baumannii (76.2%), methicillin-resistant Staphylococcus aureus (61.9%), extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (38.1%), and penicillin-resistant Enterococcus species (33.3%). Thirteen patients (61.9%) had successful clinical outcomes while five (23.8%) died within 30 days. The rate of clinical success was highest in cSSTI (77.8%), followed by cIAI (50%) and pneumonia (50%), and the mortality rate was highest in pneumonia (50%), followed by cIAI (25%) and cSSTI (11.1%). CONCLUSION: Tigecycline therapy can be an option for the treatment of severe MDR-pathogen-caused infections in South Korea. Due to its high risk of failure and mortality, however, prudence is required in its clinical use for the treatment of severe infections like nosocomial pneumonia.
Subject(s)
Humans , Acinetobacter baumannii , Drug Resistance , Enterococcus , Escherichia coli , Intraabdominal Infections , Klebsiella pneumoniae , Methicillin-Resistant Staphylococcus aureus , Minocycline , Pneumonia , Republic of Korea , Skin , TetracyclinesABSTRACT
Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.