RESUMO
Pancreatic pseudocysts are focal fluid collections that develop as a result of inflammatory diseases of the pancreas. They are managed conservatively or with a drainage procedure. Their radiological appearance can mimic cystic neoplasms of the pancreas. Pancreatic cystic neoplasms include various neoplasms with a wide range of malignant potential. Here, we report a patient with a pancreatic pseudocyst that presented with macrocystic attributes on endoscopic ultrasound.
Assuntos
Humanos , Drenagem , Hidrazinas , Pâncreas , Cisto Pancreático , Pseudocisto PancreáticoRESUMO
Primary pancreatic lymphoma is rare, comprising 0.2~4.9% of all pancreatic malignancies and less than 1% of cases of non-Hodgkin's lymphoma. Many patients are diagnosed with lymphoma after radical resection. We report a rare presentation of diffuse large B cell lymphoma, appearing as a primary tumor of the pancreas. A 61-year old female was admitted to the hospital with the complaint of right upper abdominal pain. Computed tomography of the abdomen showed a well defined mass located at the head of the pancreas. A frozen section of pancreas, during laparotomy, revealed lymphoma. The patient received 6 cycles of chemotherapy and is currently in complete remission. This case underscores the importance of differentiating primary lymphoma from the more common adenocarcinoma of the pancreas as treatment and prognosis differ significantly. Primary pancreatic lymphoma should be considered in the differential diagnosis of pancreatic tumors and an attempt to obtain a tissue diagnosis is always necessary before proceeding to radical surgery, especially on young patients.
Assuntos
Pessoa de Meia-Idade , Humanos , Feminino , Neoplasias Pancreáticas/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma de Células B/diagnósticoRESUMO
BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Assuntos
Adulto , Humanos , Abscesso , Apendicite , Ceftriaxona , Infecções Intra-Abdominais , Metronidazol , Estudos ProspectivosRESUMO
BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.
Assuntos
Adulto , Humanos , Abscesso , Apendicite , Ceftriaxona , Infecções Intra-Abdominais , Metronidazol , Estudos ProspectivosRESUMO
PURPOSE: Acute limb ischemia is not only a limb-threatening but also a life-threatening condition. Despite the use of surgical and/or thrombolytic therapy for this urgent treatment -requiring condition, it is still reported to carry high morbidity and mortality rates. METHODS: We analyzed the treatment outcomes of 118 limbs (11 upper limbs, 107 lower limb) with acute limb ischemia treated for 103 patients (age, median: 64, male 89 female 14) at the Department of Surgery, Kyungpook National University Hospital, from March 1993 to March 1999. The underlying causes of acute limb ischemia included 62 limbs with acute arterial embolism in 51 patients, 39 limbs with acute arterial thrombosis in 37 patients, 15 limbs with graft occlusion in 14 patients, and 2 limbs of undetermined cause of limb ischemia in 1 patient. The retrospective, nonrandomized study was done. RESULTS: The underlying causes of acute limb ischemia were arterial embolism in 52.5%, arterial thrombosis in 33.1%, bypass graft occlusion 12.7%, and undetermined cause in 1.7%. Severity of ischemia according to the SVS/ISCVS classification, 107 limbs (90.7%) were classified as category II and 9 limbs (7.6%) were in category III. For the limbs with embolisms, 47 embolectomies (including 6 cases treated with adjuvant thrombolytic therapy) and 10 arterial bypasses were performed. For the limbs with thromboses, 23 arterial bypasses, 5 thrombectomies, and 4 catheter directed thrombolytic therapies were performed. For the patients with acute graft occusion, 8 redo bypasses, 4 thrombolytic therapies, and 2 thrombectomies were performed. We experienced major limb amputations in 8.1%, hospital mortality in 13.7% and recurrence of ischemic symptoms in 16.1% during the follow-up period in the embolism patients and limb amputations in 2.7%, hospital mortality in 14.3%, and recurrence of ischemic symptoms in 8.3% of the thrombosis patients. Of the patients with category II ischemia, major limb amputation and hospital mortality rates were 4.7% and 9.2%, respectively. CONCLUSION: In dealing with acute limb ischemia, prompt and appropriate selection of treatment modalities, if needed in combined modes, is critically important in improving the treatment outcomes.