Subject(s)
Central Nervous System Vascular Malformations/diagnosis , Dementia/diagnosis , Myoclonus/diagnosis , Aged , Central Nervous System Vascular Malformations/complications , Central Nervous System Vascular Malformations/therapy , Dementia/etiology , Dementia/therapy , Disease Progression , Embolization, Therapeutic , Female , Humans , Magnetic Resonance Imaging , Myoclonus/etiology , Myoclonus/therapySubject(s)
Bile Duct Diseases/diagnostic imaging , Bile Ducts/diagnostic imaging , Duodenal Ulcer/diagnostic imaging , Endosonography/methods , Gastrointestinal Hemorrhage/diagnostic imaging , Pancreatic Diseases/complications , Pancreatic Diseases/diagnostic imaging , Aged , Anti-Ulcer Agents/therapeutic use , Bile Duct Diseases/etiology , Colonic Pseudo-Obstruction/complications , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/etiology , Duodenal Ulcer/drug therapy , Duodenal Ulcer/etiology , Gastrointestinal Hemorrhage/drug therapy , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Omeprazole/therapeutic use , Pancreas/abnormalities , Pancreas/diagnostic imagingABSTRACT
During a 48 month period to December 1990, 367 patients, median age 75 years, with obstructive jaundice caused by common bile duct stones (201), malignant biliary obstruction (148), and benign biliary strictures (18), underwent therapeutic endoscopic retrograde cholangiopancreatography. Endoscopic biliary stenting and drainage was achieved in 343 of 367 patients attempted (93%), seven patients requiring a combined percutaneous endoscopic approach. Endoscopic stenting failed in 24 patients because of malignant duodenal infiltration (10), Billroth 2 gastrectomy (6), tight and extensive biliary strictures (6), peripapillary diverticulum (1), and technical failure (1). Prolonged follow up was available in 91% (311 of 343). The 30 day mortality was 5% (17 of 343), which included two procedure related deaths (0.6%) from fulminant pancreatitis and major sphincterotomy site bleeding. Early complications occurred in 14% (48 of 343) and late complications occurred in 11.9% (35 of 294) patients, as of the original 343, 17 had died within 30 days and another 32 were lost to follow up. Eighty patients with incomplete bile duct clearance and eight patients with benign biliary strictures had biliary stents inserted for 12-48 months (median 30). Endoscopic biliary stenting services are necessary in a district general hospital with technical success, death and morbidity rates comparable to other studies.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Gallstones/surgery , Stents , Adult , Aged , Aged, 80 and over , Cholestasis/surgery , Female , Follow-Up Studies , Gallstones/mortality , Hospitals, District , Hospitals, General , Humans , Male , Middle Aged , Postoperative Complications/mortality , Sphincterotomy, Endoscopic , Treatment OutcomeABSTRACT
AIMS: To investigate a female patient with a tumour mass of the terminal ileum, to define the nature of the tumour, and to correlate its morphology and behaviour with similar types of tumours of the large intestine and stomach. METHODS: Tissues obtained at colonoscopy, from hemicolectomy specimens, and from liver and peritoneal biopsy specimens were studied macroscopically, microscopically, histochemically, and immunohistochemically for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), neuron specific enolase (NSE), and S100 protein. RESULTS: Macroscopic examination showed a tumour of the terminal ileum protruding into the caecum. Microscopically the tumour showed two components, one adenoma with moderate dysplasia and the other carcinoid tumour. The adenomatous component stained positively for EMA and CEA and negatively for NSE. The carcinoid component stained positively for NSE and negatively for EMA and CEA. Histochemically the carcinoid area was argyrophil positive and argentaffin negative. Only the carcinoid had metastasised, to the liver, peritoneum, and the lymph nodes, at the time of diagnosis. CONCLUSION: The morphological, histochemical, and immunohistochemical findings confirm the diagnosis of a composite adenoma-carcinoid tumour of the terminal ileum.
