ABSTRACT
Four hundred and fifty-nine patients were studied to evaluate the role of diagnostic and therapeutic endoscopic retrograde cholangio-pancreaticrogram (ERCP) in their management before laparoscopic cholecystectomy (LC) when choledocholithiasis is suspected. Using bilirubin, liver function tests (LFTs) (alkaline phosphatase, SGOT, SGPT) and findings on ultrasound of a dilated common bile duct (CBD), 37 patients (8.1%) were suspected of having concomitant common bile duct stones preoperatively. These patients were subjected to the following diagnostic and therapeutic procedures: 25 ERCPs, 20 laparoscopic cholangiograms, and three extracorporeal shock wave lithotripsies. Preoperative ERCP was done on 19 patients, intraoperative ERCP-sphincterotomy was done on one patient, and postoperative ERCP-sphincterotomy was done on five patients. Fifteen laparoscopic cholangiograms were done as primary tests and five after preoperative ERCP. Sixteen patients (3.5%) had stones in their CBD. Four patients had their laparoscopic cholecystectomy cancelled, and one patient had laparoscopic common duct exploration that was converted to an open procedure. Three groups were identified: group I, patients with a high index of suspicion, included elevated bilirubin with elevation of all three LFTs, or normal bilirubin with elevation of all three LFTs with or without dilated CBD. Seventy-five per cent of this group had CBD stones. Group II, patients with a low index of suspicion, included normal bilirubin and normal CBD by ultrasound with elevation of the alkaline phosphatase alone or elevation of two of the three LFTs. Six per cent of this group had CBD stones. Group III, patients with no index of suspicion, were patients with normal preoperative laboratory test results and CBD. Two patients (0.47%) in this group had elevated LFTs postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Gallstones/surgery , Cholangiography , Cholecystectomy, Laparoscopic/methods , Female , Gallstones/diagnosis , Humans , Male , Time FactorsABSTRACT
Two patients developed fever, cholestasis, and neutropenia following chemotherapy for acute leukemia. Computed tomographic scans of the liver were nondiagnostic, but peritoneoscopy in each case showed diffuse studding of the liver surface with white plaques. Microbiological cultures of the biopsy specimens were negative, but direct immunofluorescence stains of deparaffinized sections of the biopsies confirmed candidiasis. Follow-up laparoscopy in 1 patient after 2 mo of treatment with amphotericin B showed development of diffuse perihepatic adhesions. Peritoneoscopy is valuable in the diagnosis and management of focal hepatic candidiasis, and an etiologic diagnosis can be provided by immunohistology when microbiological culture of the biopsy specimen is negative or unavailable.
Subject(s)
Candidiasis/diagnosis , Liver Diseases/diagnosis , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Candidiasis/etiology , Female , Fluorescent Antibody Technique , Humans , Immune Tolerance , Laparoscopy , Leukemia, Monocytic, Acute/drug therapy , Leukemia, Myeloid, Acute/drug therapy , Liver/pathology , Liver Diseases/etiology , MaleSubject(s)
Candidiasis, Cutaneous/etiology , Cellulitis/etiology , Cerebral Hemorrhage/complications , Deglutition Disorders/therapy , Endoscopes , Enteral Nutrition/instrumentation , Gastrostomy/instrumentation , Aged , Aged, 80 and over , Amphotericin B/administration & dosage , Candidiasis, Cutaneous/drug therapy , Cellulitis/drug therapy , Female , HumansABSTRACT
After an ultrasound-guided percutaneous liver biopsy, a 37-year-old woman developed a clinical syndrome suggestive of bile peritonitis, despite the presence of nondilated bile ducts and a surgically absent gallbladder. The diagnosis was established via hepatobiliary scintigraphy, which demonstrated aberrant biliary flow, as well as by culdocentesis, which yielded bilious fluid. The patient was managed medically and recovered uneventfully; follow-up biliary scanning established resolution of bile extravasation.
Subject(s)
Bile , Biopsy, Needle/adverse effects , Liver/pathology , Peritonitis/diagnosis , Adult , Biliary Tract/diagnostic imaging , Culdoscopy , Female , Humans , Peritonitis/etiology , Radionuclide ImagingABSTRACT
The cardiovascular complications of viral hepatitis are not widely recognized. Profound hypotension and a variety of dysrhythmias, including sinus arrest, have been reported in association with viral hepatitis, but most of these cases were described before the advent of specific viral serologic markers. Furthermore, previous instances of cardiovascular complications occurred during the course of an established viral syndrome. We report the cases of two previously healthy women who presented with unexplained hypotension and bradycardia as the initial manifestations of acute icteric hepatitis A. This phenomenon appears to represent a variant clinical presentation of a common viral entity.
Subject(s)
Bradycardia/complications , Hepatitis A/complications , Hypotension/complications , Syncope/complications , Acute Disease , Aged , Bradycardia/pathology , Female , Hepatitis A/pathology , Humans , Hypotension/pathology , Liver/pathology , Middle Aged , Pacemaker, Artificial , Syncope/pathologyABSTRACT
A case of acute renal failure in a chronic acetaminophen abuser receiving concurrent zomepirac therapy is reported. Zomepirac may have enhanced the negative effects of acetaminophen on renal medullary blood flow, so that the two drugs together were more likely to cause renal failure than either drug alone.
