ABSTRACT
Current management of short bowel syndrome (SBS) revolves around the use of home TPN (HPN). Complications include liver disease, catheter-related infections or occlusions, venous thrombosis, and bone disease. Patient survival with SBS on TPN is 86% and 75% at 2 and 5 years, respectively. Surgical management of SBS includes nontransplant surgeries such as serial transverse enteroplasty and reanastomosis. Small bowel transplant has become increasingly popular for management of SBS and is usually indicated when TPN cannot be continued. Posttransplant complications include graft-versus-host reaction, infections in an immunocompromised patient, vascular and biliary diseases, and recurrence of the original disease. Following intestinal-only transplants, patient and graft survival rate is 77% and 66% after 1 year. After 5 years the survival figures are 49% and 34%, respectively. Future improvements in survival and quality of life will enhance small bowel transplant as a viable treatment option for patients with SBS.
Subject(s)
Intestine, Small/transplantation , Parenteral Nutrition, Home , Short Bowel Syndrome/therapy , Graft Rejection , Humans , Parenteral Nutrition, Home/adverse effects , Postoperative Complications , Short Bowel Syndrome/mortality , Survival Rate , Transplantation, HomologousSubject(s)
Enteral Nutrition/standards , Pancreatitis/therapy , Parenteral Nutrition, Total/standards , Acute Disease , Cost-Benefit Analysis , Enteral Nutrition/economics , Female , Follow-Up Studies , Humans , Length of Stay , Male , Pancreatitis/diagnosis , Parenteral Nutrition, Total/economics , Probability , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Treatment OutcomeABSTRACT
We describe a patient with diffuse polycystic disease of the liver. The patient's polycystic liver disease was found to be due to liver metastases from squamous cell carcinoma of the uterine cervix. No evidence of discrete masses was found in the liver using abdominal CT scan. Pseudocystic formation in the liver secondary to squamous cell carcinoma is very rare and has not previously been reported as a first presentation of a cervical cancer. Metastatic neoplasms need to be considered in the differential diagnosis of hepatic cysts.
Subject(s)
Carcinoma, Squamous Cell/secondary , Cysts/etiology , Liver Diseases/etiology , Liver Neoplasms/secondary , Uterine Cervical Neoplasms/pathology , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Female , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Middle Aged , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/diagnostic imagingABSTRACT
INTRODUCTION: ERCP has been a significant advance in the diagnosis and treatment of pancreatic and biliary diseases. However, anatomic variations may prevent successful ERCP. METHODS: Advancement of a duodenoscope during ERCP was impeded in 4 patients by anatomic alterations of the esophagus and/or the stomach. The overtube, 80 cm length, was used to allow passage of a duodenoscope to the papilla. RESULTS: All overtube assisted ERCP procedures were completed successfully and included sphincterotomy (2), bile duct stone extraction (2), and placement of a metal expandable stent (1). CONCLUSION: Use of an overtube allows safe and successful passage of a duodenoscope in patients with anatomic alterations of the esophagus and/or the stomach.
Subject(s)
Biliary Tract Diseases/diagnostic imaging , Biliary Tract Diseases/pathology , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Duodenoscopes , Esophagus/abnormalities , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/pathology , Stomach/abnormalities , Aged , Aged, 80 and over , Biliary Tract Diseases/surgery , Female , Humans , Male , Pancreatic Diseases/surgeryABSTRACT
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.
Subject(s)
Antiviral Agents/adverse effects , Granuloma/immunology , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Sarcoidosis/immunology , Adult , Antiviral Agents/therapeutic use , Female , Granuloma/chemically induced , Humans , Interferon-alpha/therapeutic use , Sarcoidosis/chemically induced , Skin Diseases/chemically induced , Skin Diseases/immunology , TattooingABSTRACT
BACKGROUND: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. CASE PRESENTATION: We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. CONCLUSION: We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.
