ABSTRACT
Ticlopidine inhibits platelet aggregation and provides beneficial secondary prevention of cerebrovascular and coronary artery disease. Frequently reported adverse effects of ticlopidine include diarrhea, nausea, and rash. However, to our knowledge, there are only a few published reports of the simultaneous occurrence of cholestatic hepatitis and pure red cell aplasia. Here we report a patient with simultaneous severe cholestatic hepatitis and pure red cell aplasia associated with ticlopidine. Although these adverse effects are rare, periodic hematological and liver function tests are recommended after starting ticlopidine.
Subject(s)
Female , Humans , Middle Aged , Acute Disease , Cholestasis/chemically induced , Chemical and Drug Induced Liver Injury/diagnosis , Liver Function Tests , Platelet Aggregation Inhibitors/adverse effects , Red-Cell Aplasia, Pure/chemically induced , Ticlopidine/adverse effectsABSTRACT
Dengue fever is an acute febrile disease caused by the dengue virus, which belongs to the flaviviridae family, and this virus is transmitted by the bite of the mosquito Aedes aegypti. It occurs in the tropical climates of the South Pacific, Southeast Asia, India, Africa and the subtropical zone of America. Imported cases of Dengue fever and Dengue hemorrhagic fever are rapidly increasing as many Koreans are now traveling abroad. Liver injury is usually detected by laboratory investigation according to a surveillance protocol. Although liver injury by dengue virus has been described in Asia and the Pacific islands, the pathogenic mechanisms are not yet fully clarified. It is usually expressed in a self-limiting pattern and the patient has a complete recovery. We report here on a case of a young woman who presented with general weakness, nausea and significant elevation of the aminotransferase levels, and she was diagnosed with dengue fever.
Subject(s)
Adult , Female , Humans , Acute Disease , Severe Dengue/complications , Dengue Virus/isolation & purification , Hepatitis, Viral, Human/diagnosisABSTRACT
PURPOSE: inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. METHODS: 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-alpha, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-alpha and IL-10 were measured for the evaluation of immune response by external stimuli. RESULTS: As uremia was reduced by initiating dialysis, serum level of TNF-alpha was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. CONCLUSION: Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
Subject(s)
Humans , Adiponectin , Atherosclerosis , C-Reactive Protein , Cytokines , Dialysis , Inflammation , Interleukin-10 , Interleukins , Kidney Failure, Chronic , Malnutrition , Mortality , Nutritional Status , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , Renal Insufficiency, Chronic , Serum Albumin , Tumor Necrosis Factor-alpha , UremiaABSTRACT
Obscure gastrointestinal bleeding is defined as an intermittent or continuous loss of blood in which the source has not been identified after an upper endoscopy and colonoscopy. Small bowel bleeding is one of the most common causes of obscure gastrointestinal bleeding and constitutes 2~10% of all gastrointestinal bleeding. As the small intestine lies in the mid-portion of the intestine and has a long length, it is difficult to diagnose and treat small bowel bleeding using conventional endoscopy. Although the development of wireless capsule endoscopy has increased the diagnosis rate of small bowel disease, the use of capsule endoscopy has some limitations. The use of capsule endoscopy depends on intestinal peristalsis, and while visual diagnosis is possible, obtaining a biopsy or providing treatment is not possible with the use of the procedure. Capsule endoscopy has a few other limitations, such as the lack of air insufflation and the unavailability of rinsing. The use of the new double balloon enteroscopy procedure has advantages over the use of capsule endoscopy. With this method, it is possible to obtain biopsies and it is possible to perform therapeutic procedures, rinsing and air insufflation. We report a case of a vascular mass of the small bowel with recurrent bleeding, which was treated with endoscopic sclerotherapy.
Subject(s)
Biopsy , Capsule Endoscopy , Colonoscopy , Diagnosis , Double-Balloon Enteroscopy , Endoscopy , Hemorrhage , Insufflation , Intestine, Small , Intestines , Methods , Peristalsis , SclerotherapyABSTRACT
Intestinal tuberculosis is a common disease of extrapulmonary tuberculosis. A diagnosis of intestinal tuberculosis is difficult as the symptoms and laboratory findings are not specific for the disease. Intestinal tuberculosis may cause various complications, such as intestinal obstruction, intestinal perforation, intraabdominal abscess, intestinal hemorrhage and fistula formation. A duodenal fistula caused by tuberculosis is an especially rare condition. We experienced a case of intestinal tuberculosis with a duodenal fistula as a complication. The patient was a 25-year-old man that presented with weight loss and diarrhea. Esophagogastroduodenoscopy showed a deep ulcerative lesion on the third portion of the duodenum with a fistula opening. A histological finding revealed granulomatous inflammation with multinucleated giant cells. In addition, the result of a Tb PCR assay was positive. After two months of treatment with the appropriate medication, the symptoms improved and the fistula has closed completely. We report the case with a review of the literature.
Subject(s)
Adult , Humans , Abscess , Diagnosis , Diarrhea , Duodenum , Endoscopy, Digestive System , Fistula , Giant Cells , Hemorrhage , Inflammation , Intestinal Obstruction , Intestinal Perforation , Polymerase Chain Reaction , Tuberculosis , Ulcer , Weight LossABSTRACT
A double or bilobed gallbladder is a rare congenital anomaly, occurring at a rate of 1/4,000~5,000. We encountered a case of a double gallbladder that was diagnosed by an endoscopic retrograde cholangiogram. In view of the paucity of this anomaly, we report the case of a patient with a double gallbladder (Y duplication) accompanied by a common bile duct (CBD) stone. We also discuss the characteristics, classification, embryology and treatment of the double gallbladder.