RESUMO
The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Ampola Hepatopancreática , Asma , Biópsia , Tumor Carcinoide , Colangiografia , Ducto Colédoco , Diabetes Mellitus , Diagnóstico , Dilatação , Resistência à Insulina , Linfonodos , Metástase Linfática , Obesidade , Ductos Pancreáticos , Reação em Cadeia da Polimerase , PPAR gama , Tomografia Computadorizada por Raios XRESUMO
Myositis caused by mumps virus is very rare. Mumps virus has been suggested as a causative agent of inclusion body myositis, but there has been no definite evidence. We experienced a case of severe myositis associated with mumps virus infection. A 21-year old man was admitted because of myalgia, headache, fever, and chill for 2 months. The cerebrospinal fluid analysis performed at a local clinic showed findings compatible with viral meningitis. His blood chemistry results revealed elevated levels of serum creatine kinase, lactate dehydrogenase, and serum myoglobin. On the 5th day of admission, the patient showed pain and swelling of parotid gland and scrotum. Electromyography was compatible with inflammatory myopathy. Muscle biopsy of his calf muscle revealed necrotizing (leukocytoclastic) vasculitis and multifocal myolysis with multinucleation. We suspected mumps virus infection because of his symptoms of meningitis, epididymo-orchitis and parotitis. Mumps virus was isolated in throat culture. The past medical history of the patient's mumps virus vaccination was unclear. After 2 weeks of supportive treatment, the patient's condition was improved.
Assuntos
Humanos , Adulto Jovem , Biópsia , Líquido Cefalorraquidiano , Química , Creatina Quinase , Eletromiografia , Febre , Cefaleia , L-Lactato Desidrogenase , Meningite , Meningite Viral , Vírus da Caxumba , Caxumba , Mialgia , Mioglobina , Miosite , Miosite de Corpos de Inclusão , Glândula Parótida , Parotidite , Faringe , Escroto , Vacinação , VasculiteRESUMO
Scrub typhus can invade central nervous system. The most common findings of CNS involvement are those of low grade meningitis, however, meningoencephalitis with coma and generalized seizure are also reported to occur in scrub typhus but only rarely. A 47-year old male was admitted to our hospital because of consciousness disturbance. The patient had a fever and rash for seven days before admission. He had been treated for diabetes mellitus for three years. Generalized seizure occurred six times after admission. CSF revealed increase of leukocytes (648/mm3) and protein level, and diffuse slow wave was found on electroencephaolography. The magnetic resonance image of the brain showed dural thickening. We diagnosed his illness as tsutsugamushi disease complicated by meningoencephalitis. After treatment with clarithromycin and an anticonvulsant, he recovered without neurological sequelae. O. tsutsugamushi should be considered as one of the causes of meningoencephalitis in endemic areas.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Encéfalo , Sistema Nervoso Central , Claritromicina , Coma , Estado de Consciência , Diabetes Mellitus , Exantema , Febre , Leucócitos , Meningite , Meningoencefalite , Tifo por Ácaros , ConvulsõesRESUMO
METHODS: We investigated and compared the epidemiologic characteristics of the E. cloacae isolation in the period of outbreak (April-June, 1998) with those in the control period (January-March, 1998). To identify the risk factors for E. cloacae sepsis, we retrospectively conducted a chart review for the patients who had E. cloacae sepsis during the period of outbreak. On the basis of these results, environmental culture was performed hospital wide. RESULTS: Ten clinical isolates E. cloacae were recovered from the blood of ten patients from April to June. 1998. Seven out of 10 patients recieved ERCP procedure just before E. cloacae sepsis. Hence, we performed surveillance study in the endoscopy room before and after the procedure. The survey showed that distilled water which was used for washing the endoscopy was contaminated with E. cloacae, which was suspected to be the common source of this outbreak. Therefore, we changed distilled water into sterilized distilled water on washing the endoscopy. After this correction was performed, the incidence of ERCP-associated E. cloacae sepsis declined markedly (P<0.011). CONCLUSION: We investigated an outbreak of ERCP-related E. cloacae sepsis and the outbreak was successfully controlled by removing the source of infection.