Congenital Duodenal Web in a Young Adult

Congenital duodenal web in adult life is an extremely rare condition, which results from an incomplete recanalization of the duodenum during early embryologic development. We report a case of congenital duodenal web in a 23-year-old man who complained of postprandial epigastric pain and fullness, as well as nausea since childhood. The plain abdomen showed a double-bubble sign. The UGI study showed a marked dilatation of the proximal duodenum and a delayed passage of barium into the third portion of the duodenum. Abdominal ultrasonography and CT revealed a marked dilatation of the proximal duodenum and a duodenal web with windsock deformity, which originated from the ampulla of Vater and extended to the third portion of the duodenum. A winsock web with a 0.9 cm eccentric aperture and a healed ulcer proximal to the ampulla of Vater were observed during a longitudinal duodenotomy. The web was excised circumferentially and the duodenum was closed transversely in a Heineke-Mikulicz fashion.

Patterns of Serum Interleukin-6 Concentration after Initial Successful Cardiopulmonary Resuscitation

OBJECTIVE: To investigate patterns of serial serum interleukin-6(IL-6) concentrations after initial successful cardiopulmonary resuscitation, and to access differences in serum IL16 concentrations in patients with Cerebral Performance Category(CPC, 1-2) and CPC(3-5) at the 5th day after cardiacpulmonary resuscitation(CPR). METHODS: We studied prospectively 12 patients with spontaneous circulation after cardiopulmonary resuscitation. Venous blood samples were taken 2,4,12,24,48 and 72 hours after restoration of spontaneous circulation to measure serum IL-6 levels by the enzyme-linked immunosorbent assay. RESULTS: Serum IL-6 concentrations in the severe neurologically disabled group(CPC, 3-5) were significantly increased at 2, 24 and 48 hours after restoration of spontaneous circulation compared with the less neurolgically disabled group. Also, serum IL-6 concentrations in the severe neurologic disabled group showed dual peak at 4 and 24 hours. CONCLUSION: Our study demonstrates significant incense of seam IL-6 in patients with CPC(3-5) after successful cardiopulmonary resuscitation and the significant correlation between early increase of serum IL-6 and poor neurologic outcome. It suggests that early increase of serum IL-6 can be used as a prognostic marker after successful cardiopulmonary resuscitation.