RESUMO
Colon barotrauma can be mostly caused by elevated intraluminal pressure. Air insufflation during colonoscopy procedure is the most common cause of iatrogenic colon barotrauma. Cat scratch colon can usually be seen in the mild type of colon barotrauma, and colon perforation can be seen in the severe type. We presently report a case of non-iatrogenic colon barotrauma caused by industrial compressed air. Multiple linear mucosal ulcers were noted in the recto-sigmoid colon, but the colon was not perforated. The patient was discharged without any further complications after conservative treatments.
Assuntos
Animais , Gatos , Humanos , Barotrauma , Colo , Colonoscopia , Ar Comprimido , Insuflação , ÚlceraRESUMO
Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is a precancerous lesion with a well-described adenocarcinoma sequence. The rate of progression of IPMN appears to be very slow; however, patients with IPMN may be at increased risk for extrapancreatic malignancies. A 55-year-old female was diagnosed with IPMN of the pancreas and a duodenal polyp in 2004. After an approximate 3 year loss to follow-up, she was readmitted for managing abdominal pain and underwent Whipple's operation. Herein, we report a case of a patient with malignant IPMN accompanied by duodenal adenocarcinoma arising from a duodenal polyp.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Dor Abdominal , Adenocarcinoma , Neoplasias Duodenais , Seguimentos , Mucinas , Neoplasias Primárias Múltiplas , Pâncreas , Neoplasias Pancreáticas , PóliposRESUMO
Anti-glomerular basement membrane (Anti-GBM) nephritis is an autoimmune disorder characterized by rapidly progressive crescentic glomerulonephritis (RPGN). The treatment of anti-GBM nephritis with plasmapheresis, steroids and immunosuppressant has improved outcomes. An early diagnosis is essential for the survival of patients and a recovery of renal function. The diagnosis of anti-GBM disease has been traditionally based on the demonstration of linear deposits of immunoglobulins along the glomerular basement membrane by immunofluorescence (IF) microscopy. However, a kidney biopsy cannot always be easily performed in such ill patients. Recent development of specific enzyme immunoassays for anti-GBM antibody in the serum has made possible a provisional diagnosis without a kidney biopsy. A 46-year-old male patient with hypertension and hepatitis B presented with generalized edema and general weakness. Laboratory findings were compatible with acute renal failure and nephrotic syndrome with positive serum anti-GBM antibodies. After plasmapheresis with steroid pulse therapy, renal biopsy was performed and diagnosed as membranoproliferative glomerulonephritis (MPGN) with granular deposit of Ig G and C3. Follow-up antibody titers were negative. This case demonstrates the possibility of false-positive anti-GBM antibody in the serum. Therefore, enzyme immunoassay for anti-GBM antibody should be used only as a screening or follow-up test in patients that have been confirmed positive by IF microscopy.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Injúria Renal Aguda , Doença Antimembrana Basal Glomerular , Anticorpos , Autoanticorpos , Membrana Basal , Biópsia , Diagnóstico Precoce , Edema , Reações Falso-Positivas , Imunofluorescência , Seguimentos , Membrana Basal Glomerular , Glomerulonefrite , Glomerulonefrite Membranoproliferativa , Hepatite B , Hipertensão , Técnicas Imunoenzimáticas , Imunoglobulinas , Rim , Programas de Rastreamento , Microscopia , Nefrite , Síndrome Nefrótica , Plasmaferese , EsteroidesRESUMO
PURPOSE: Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. METHODS: One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. RESULTS: Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p= 0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. CONCLUSION: Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.