摘要:

Background:Although the gastrointestinal tract is the most common site of extranodal non‐Hodgkin's lymphoma (NHL), primary small intestine lymphomas remain relatively rare, especially localized low‐grade follicular B‐cell lymphomas. When lymphomas do occur at this site, most are high grade and require aggressive therapy. We report three cases of small intestinal follicular lymphoma diagnosed on endoscopic biopsy and review the clinical history, pathologic features, and treatment outcome.Study:A review of the medical records and pathology from three cases of small intestine follicular NHL was performed. The pathology specimens were formalin‐fixed, paraffin‐embedded tissues processed for routine microscopic examination, immunohistochemical staining, and molecular analysis.Results:Histologic and immunophenotypical studies were diagnostic of grade 1 follicular lymphoma (Revised European‐American Lymphoma classification/World Health Organization classification). All cases expressed bcl‐2 protein, and polymerase chain reaction analysis supported the diagnosis in two cases with adequate DNA. With 23.3 months' median follow‐up, one untreated and one treated patient were alive without symptoms; a third untreated patient died of a nonlymphoma cause.Conclusion:Isolated indolent lymphomas of the small intestine are rare. Accurate pathologic staging and histologic classification are paramount in delineating treatment options.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Giant intraabdominal cysts masquerading as ascites are not uncommon. We present a unique case of a giant intraabdominal pseudocyst that resulted in acute abdominal compartment syndrome, leading to anuria and acute renal failure. A 52‐year‐old woman with known severe cardiac dysfunction presented with generalized edema, marked abdominal distension, and decreased urine output. She was initially presumed to have congestive heart failure with refractory ascites. She became completely anuric. A diagnosis of intraabdominal compartment syndrome from a giant cyst was ultimately made after careful review of her abdominal imaging. Urgent drainage and subsequent marsupialization of the giant pseudocyst resulted in immediate diuresis and a subsequent return to her baseline renal function. As this case illustrates, differentiation of pseudoascites from true ascites may be difficult in a clinical setting or using laboratory studies. A clear differentiation can usually be made using imaging studies, mainly magnetic resonance imaging, computerized axial tomography, or ultrasound. To our knowledge, this is the first case report of a nonrenal pseudocyst or cyst leading to acute renal failure from extrinsic compression. Abdominal compartment syndrome needs to be considered in the differential diagnosis of patients with acute renal failure and presumed large‐volume ascites.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Collagenous colitis is a diarrheal illness of unknown cause. The purpose of this report is to describe a case of collagenous colitis related to lansoprazole exposure.Study:Case report.Results:A patient is described who developed clinical and pathologic findings of collagenous colitis during treatment with lansoprazole and omeprazole. Symptoms of diarrhea and histopathologic abnormalities resolved after drug withdrawal and recurred with re‐exposure to lansoprazole.Conclusions:The observations are compatible with collagenous colitis or lymphocytic colitis associated with exposure to lansoprazole.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;The assessment of the severity of acute pancreatitis (AP) is a critical early step in its management, as severity of AP predicts prognosis. A range of options are available for assessment of severity in AP, including clinical evaluation, standardized prognostic criteria, computed tomography (CT), and biochemical markers. Clinical assessment has limited accuracy for predicting severity early in the course of AP. Therefore, additional assessment using biochemical and radiologic criteria in combination with standardized criteria is appropriate to determine severity and prognosis in AP; a strategy emphasizing daily assessment of severity should be used. The APACHE II is the scoring system of choice for evaluating severity in AP, although it remains an imperfect tool. Computed tomographic grading of AP and the development of the CT severity index allow for heightened accuracy in the prediction of severity. C‐Reactive protein is the standard for serum marker assessment of severity and prognosis in AP; other markers, including interleukin‐6, polymorphonuclear elastase, and trypsinogen activation peptide, hold promise. The focus of this review is to examine the role of diagnostic tests in evaluating severity and predicting prognosis among patients with AP and to provide a diagnostic algorithm for initial management.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Kinetic studies have demonstrated a more rapid reduction in hepatitis C virus (HCV) RNA levels among patients taking high daily doses of interferon compared with those taking standard‐dose interferon.Goals:To compare the efficacy and safety of high‐dose interferon alfa‐2b and ribavirin with standard‐dose interferon alfa‐2b and ribavirin in chronic hepatitis C patients previously treated with interferon.Study:One hundred seven patients (30 interferon relapsers and 77 interferon nonresponders) were randomized to take either high‐dose interferon alfa‐2b in combination with ribavirin (group A) (consisting of 5 MU/d for 4 weeks, 5 MU three times weekly for 8 weeks, and then 3 MU three times weekly for 36 weeks) or standard‐dose interferon alfa‐2b and ribavirin (group B) for 48 weeks. Serum alanine transaminase (ALT), HCV RNA levels, and safety data were prospectively collected and compared during treatment and at week 24 of follow‐up.Results:The mean serum ALT and HCV RNA levels, as well as the proportion of patients with genotype 1 and cirrhosis and who were African American, were similar in the two treatment groups at study entry. The rates of suppression of HCV RNA to undetectable levels at weeks 4, 12, and 48 were similar. In addition, the sustained virologic response rates at week 24 of follow‐up were similar in groups A and B (29% vs. 39%, respectively,p= 0.277). Clinical variables that correlated with a sustained virologic response included a history of relapse to previous interferon therapy and non‐1 HCV genotype (p< 0.01).Conclusions:Short‐term, high‐dose interferon alfa‐2b and ribavirin failed to demonstrate a tangible benefit compared with standard‐dose interferon alfa‐2b and ribavirin. However, our study results and others suggest that standard‐dose interferon and ribavirin for 48 weeks should be considered for selected patients who did not respond to previous interferon therapy.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:Hepatic clonorchiasis is endemic in areas of the Far East, including Taiwan, where people commonly eat raw or partially cooked freshwater fish.Goals:To analyze and explore the cholangiographic findings of hepatic clonorchiasis with respect to the clinical data.Study:From February 1990 to May 1999, 64 patients were diagnosed with hepatic clonorchiasis in the Kaoshiung Veterans General Hospital. Eighteen of the 64 patients were indicated for endoscopic retrograde cholangiopancreatography (ERCP). The final diagnosis was confirmed by identification of ova in bile or worms in the biliary tract.Results:Fifteen (83%) of 18 patients had history of raw fish consumption and seven patients (39%) came from an endemic area. Clinically, cholangitis (8 of 18) was the most frequent indication for ERCP. All of the patients were diagnosed by the presence of ova in bile. Only seven (39%) patients had peripheral eosinophilia, and seven (39%) had ova in stool. The most characteristic cholangiographic finding of hepatic clonorchiasis in ERCP is filamentous or elliptic filling defects of the biliary tract (16 of 18).Conclusion:When presented with biliary symptoms, a history of raw fish consumption in an endemic area should arouse suspicion of hepatic clonorchiasis. Filamentous filling defects in ERCP with bile analysis may confirm the diagnosis.

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2002

数据来源: OVID