RESUMO
Duodenal lipoma is relatively rare, and usually located in the second portion of the duodenum. Most lipomas of the small intestine are asymptomatic and incidentally found. However, epigastric pain, intussusception, ulcer, intestinal obstruction and rarely severe hemorrhage can occur depending on the size or location. Duodenal lipoma is mostly confirmed by surgical removal with histopathologic valuation because it is difficult to make a differential diagnosis of duodenal lipoma from malignant tumor or other submucosal tumor based only on the findings of radiology or endoscopy. Endoscopic ultrasonography can so help for the differential diagnosis of the submucosal tumor. We report a case of duodenal lipoma accompanied by upper gastrointesinal hemorrhage, treated by both endoscopic resection and surgical operation and confirmed by histopathologic diagnosis.
Assuntos
Diagnóstico , Diagnóstico Diferencial , Duodeno , Endoscopia , Endossonografia , Hemorragia , Obstrução Intestinal , Intestino Delgado , Intussuscepção , Lipoma , ÚlceraRESUMO
BACKGROUND: The prevalence of acute viral liver injury is decreasing, but drug induced liver injury by herbal medicine and health foods is on an increasing trend after introduction of vaccination. Nevertheless, there is no consensus of diagnostic method and causality assessment for acute liver injury. Therefore, the cause, clinical features, prevalence and pattern of acute liver injury caused by herbal medicine and health foods in Gyeongju area were analyzed. Moreover, Council for International Organization of Medical Science (CIOMS) scale and Maria and Victorino (MandV) scale, clinical scales for causality assessment in hepatotoxicity were compared. METHODS: 78 patients in whom there was definite evidence of taking medicine and there was one more increase of over 2N (upper limit of the normal range) in alanine aminotransferase (ALT) or total bilirubin (TB) or alkaline phosphatase (ALP) and self-remitted after drug stop were selected excluding patients with previous liver disease history and history of alcohol, metabolic liver disease and hapatobiliary disease and viral, autoimmune, unknown origin hepatitis among 150 patients of admission due to acute liver injury, from April 1997 to March 2001. Each case was investigated retrospectively about taken medicine, the pattern of liver injury, recovery period after drug stop, history of alcohol, other hepatobiliary disease, pregnancy, recent hypotension, rechallenge and viral markers of hepatitis, aspartate aminotransferase (AST), ALT, TB, ALP. Also, herbal medicine and western medicine groups were compared and consistency with CIOMS scale and MandV scale were investigated. RESULTS: For four years, among 150 cases, drug-induced liver injury were 78 cases (52.0%), occurred the highest prevalence. In taken medicine, western medicine were 39 cases (50.0%), herbal medicine and health foods were 39 cases (50.0%), too. Among those cases, herbal medication were 23 cases (58.9%), pellet 5 cases (12.8%), In-jin-ssuk 3 cases (7.7%), deer extract 3 cases (7.7%), kitosan 2 cases (5%) and pumpkin extract, carp, plant roots was 1 case (2.5%) respectively. In the pattern of liver injury, hepatocellular liver injury were 48 cases (61.5%), occurred the highest prevalence. Between CIOMS and MandV scale, best correlation were only 2 cases (2.6%), therefore, their agreement was very low. CONCLUSION: The prevalence of drug induced liver injury is on an increasing trend in Gyeongju area and acute liver injury caused by herbal medicine and health foods had very high incidence was ascertained. Therefore, we should attend to indiscreet use of herbal medicine and health foods and should give a warning to our society. And a new clinical scale suitable for characteristic of our country that had high prevalence of liver injury caused by herbal medicine and health food is needed.
Assuntos
Humanos , Gravidez , Alanina Transaminase , Fosfatase Alcalina , Aspartato Aminotransferases , Bilirrubina , Biomarcadores , Carpas , Consenso , Cucurbita , Cervos , Doença Hepática Induzida por Substâncias e Drogas , Alimentos Orgânicos , Hepatite , Medicina Herbária , Hipotensão , Incidência , Hepatopatias , Fígado , Raízes de Plantas , Prevalência , Estudos Retrospectivos , Vacinação , Pesos e MedidasRESUMO
The accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade. This complication may be fatal if it is not recognized and treated promptly. We report a case of cardiac tamponade caused by acute pancreatitis, which resolved after catheter drainage.
Assuntos
Tamponamento Cardíaco , Catéteres , Drenagem , Pancreatite , PericárdioRESUMO
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the term applied to arginine vasopressin (AVP) excess associated with hyponatremia without edema in the absence of physiologic or pharmacologic stimuli to AVP secretion. SIADH is associated with various conditions such as malignant tumors, infection, central nervous system disorders, and different pharmacological agents. The patient was 73-year-old female. She was admitted to the hospital because of persistent cough, dizziness, general weakness and confusion. On admission, her serum osmolality was 253 mOsm/kg, urine osmolality was 416 mOm/kg, and urine Na concentration was 159 mEq/L. Her Chest X-ray and CT scan of lung showed about 4x3.5 cm sized mass at posterior basal segment of left lower lobe of the lung, and CT-guided percutaneous needle aspiration revealed small round cell with clusters of malignant squamous cells. She was treated by salt restriction, hypertonic saline infusion and demeclocycline. We planned chemotherapy for advanced combined lung cancer, but she was discharged because of poor general condition and associated pneumonia without cancer chemotherapy. We report a rare case of SIADH in small cell cancer of lung combined with squamous cell cancer of lung.