ABSTRACT
Systemic lupus erythematosus(SLE) is the prototypic immune complex disease which involves various organs. Chronic interstitial cystitis and protein-losing enteropathy are uncommon manifestations of SLE and have good response to steroid. Only one case of SLE associated with chronic interstitial cystitis and protein-losing enteropathy has been reported which was resistant to steroid treatment but dramatically responded to cyclophosphamide. We describe a case of a female patient who developed systemic lupus erythematosus associated with chylothorax, interstitial cystitis and protein-losing enteropathy with literature review. This case was initially resistant to steroid but with the addition of cyclophosphamide, chylothorax, chronic interstitial cystitis and protein-losing enteropathy markedly improved. This is the first case of SLE that developed chylothorax as well as chronic interstitial cystitis and protein-losing enteropathy.
Subject(s)
Female , Humans , Chylothorax , Cyclophosphamide , Cystitis, Interstitial , Immune Complex Diseases , Lupus Erythematosus, Systemic , Protein-Losing EnteropathiesABSTRACT
The majority of undiagnosed diaphragmatic ruptures are associated with a high mortality rate if not treated immediately. A high index of suspicion for diaphragmatic injury during initial evaluation is the most important factor. A case was experienced involving delayed presentation of a traumatic diaphragmatic hernia, in a 49 year old female injured in a road traffic accident a year prior to admission. She was admitted with complaints of left side chest pain, nausea, and vomiting for 7 days. She was diagnosed as a diaphragmatic hernia on her left side by several diagnostic tests including a gastroscopy and CT scan. Her medical history was carefully examined as well. Surgical repair was performed.
Subject(s)
Female , Humans , Middle Aged , Accidents, Traffic , Chest Pain , Diagnostic Tests, Routine , Gastroscopy , Hernia, Diaphragmatic , Hernia, Diaphragmatic, Traumatic , Mortality , Nausea , Rupture , Tomography, X-Ray Computed , VomitingABSTRACT
BACKGROUND/AIMS: Transarterial chemoembolization (TACE) has been reported to be one of the useful palliative treatments in patients with unresectable hepatocelluar carcinoma. However, Bile duct injuries following TACE have been reported occasionally. In this study, we intended to clarify the incidence, pathogenic mechanisms and clinical implications of bile duct injuries following TACE. METHODS: A total of 950 consecutive patients with hepatocellular carcinoma (HCC) were subjected. 807 patients were treated with TACE. The remaining 143 were treated with transarterial chemoinfusion (TACI) of cisplatin. RESULTS: None of 143 HCC patients treated with TACI revealed to have any ischemic biliary injury radiologically. In contrast, out of 807 with TACE, 17 (2%) appeared to have biliary complications. Twelve out of 17 (71%) had bilomas at subcapsular area, three out of 17 (18%) had focal strictures at common hepatic duct or common bile duct with marked dilatation of intrahepatic bile ducts and two out of 17 (11%) had diffuse mild dilatation of intrahepatic bile ducts. Interestingly, two (17%) out of 12 bilomas were found at the lobe which was not embolized with Gelfoam. The median sessions of TACE to the occurrences of focal strictures tended to be longer compared with those of bilomas (median: 6 vs. 2.5; p=0.08). All three patients with focal strictures and four (33%) out of 12 patients with bilomas were associated with serious bacterial infections at presentation. CONCLUSIONS: Biloma seems to be caused by lipiodol rather than Gelfoam; focal strictures of large bile ducts by Gelfoam. It is suggested that adjustments of the amounts of lipiodol or Gelfoam and the sites or embolization may be required to reduce the ischemic biliary injuries following TACE.
Subject(s)
Humans , Bacterial Infections , Bile Ducts , Bile Ducts, Intrahepatic , Bile , Carcinoma, Hepatocellular , Cisplatin , Common Bile Duct , Constriction, Pathologic , Dilatation , Ethiodized Oil , Gelatin Sponge, Absorbable , Hepatic Duct, Common , Incidence , Palliative CareABSTRACT
Fairly specific and important duodenoscopic findings for diagnosing mucinous ductal ectasia (MDE) of pancreas include a prominant ampulla, patulous ampullary orifice and extrusion of mucin through the ampulla. However, we have experienced two cases of mucinous ductal ectasia without these pathognomonic appearance of ampulla. Initially, two cases were admitted for evaluation of pancreatic multicystic lesions, and MDE was incidentally found. Their pancreatographic findings showed normal main duct and cystic dilatation confined to the branch ducts. On gross findings of surgical specimens, a duct dilatation with gelatinous mucin was localized at the uncinate process of the pancreas. Microscopically, the ductal epithelia containing mucin were lined with well-differentiated tall columnar cells showing focal hyperplastic change. We report these unusual cases of MDE with review of the literatures.
Subject(s)
Dilatation , Dilatation, Pathologic , Gelatin , Mucins , PancreasABSTRACT
Superior mesenteric artery (SMA) syndrome results from compression of the third portion of the duodenum by the superior mesenteric artery or one of its branches where this vessel crosses over the duodenum as it descends from the aorta. Recently 2 cases of SMA syndrome were experienced. A 43-year-old female and a 41-year-old male were admitted due to complaints of frequent postprandial abdominal distension and vomiting for 4 months. An UGI series and abdominal CT scan revealed distension of stomach and duodenum with a cut-off in the duodenal third portion. Both patients underwent duodenojejunostomy with successful symptom relief.
Subject(s)
Adult , Female , Humans , Male , Aorta , Duodenum , Mesenteric Artery, Superior , Stomach , Superior Mesenteric Artery Syndrome , Tomography, X-Ray Computed , VomitingABSTRACT
BACKGROUNDS AND STUDY AIMS: Multiple biliary papillomatosis (MBP) is an uncommon disease. This study was undertaken to review cases with respect to describing clinical features and characteristical cholangiographic findings, and to define the role of cholangioscopy in the diagnosis and treatment of this disorder. PATIENATS AND METHODS: from 1990 to 1997, nine patients (mean age; 57.3 years, 6 men and 3 women) were diagnosed as having MBP arnong 5,361 cases of endoscopic retrograde cholangiography (ERC) conducted at our center. A retrospective analyses of the cholangiographic and cholangioscopic findings as well as clinieal features were performed.