摘要:

Gastrointestinal blood loss in elderly atherosclerotic patients may be due to cholesterol crystal embolization (CCE) leading to ischemic lesions in the gastrointestinal tract. The diagnosis of CCE is favored by accompanying clinical or biochemical signs, such as blue toes, renal insufficiency, and eosinophilia. Our report describes the clinical data of four patients with gastrointestinal blood loss due to CCE. In two the bleeding source was in the duodenum, and in the other two the source was in the distal colon. The diagnosis was made by histological examination of endoscopic biopsies in three and of a sigmoid resection specimen in one. Provoking factors were anticoagulant therapy in one, anticoagulant therapy and aortography in another, and aortography followed by aorta bifurcation prosthesis implantation in the third, whereas no provoking factor could be identified in the remaining patient. Accompanying signs included eosinophilia in one, a blue toe with renal insufficiency in one, and retinal cholesterol crystals in another patient. Our findings, in line with previous reports, highlight the importance of CCE in the differential diagnosis of gastrointestinal blood loss in elderly patients.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Expression of 40- and 47-kDa proteins recognized by anti–60-kDa heat shock protein antibody was investigated in colorectal adenocarcinoma tissue. In all cases of colorectal adenocarcinoma tissue (n = 9), 40- and 47-kDa proteins were detected by immunoblot analysis. However, expression of these two proteins was extremely low or was not expressed in control tissue. There was no correlation between the quantity of these two bands and histologic type or the location of the tumors. Our results first demonstrate the accumulation of structurally altered 60-kDa heat shock protein-associated antigens in carcinoma tissue and suggest that these two proteins could be a possible candidate for tumor-specific 60-kDa heat shock protein-related protein antigens.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Torulopsis glabrata, a fungus commensal with the human gastrointestinal tract, so far has not been recognized as a cause of pancreatic sepsis. We report the cases of two patients with pancreatic pseudocysts that became infected withT. glabrata. A 20-year-old woman 6 weeks postpartum had acute gallstone pancreatitis complicated by pseudocyst formation and pancreatic sepsis. Pseudocyst fluid obtained at cystogastrostomy showed a pure culture ofT. glabrata. A 52-year-old man with multiple medical problems showed signs of an infected pseudocyst 9 days after he was hospitalized for alcoholic pancreatitis. Computed tomography (CT)–guided aspiration of the pseudocyst fluid confirmedT. glabrataas the infecting organism. Neither patient had a history of endoscopic or surgical manipulation. Prolonged therapy with broad-spectrum antibiotics and parenteral hyperalimentation were implicated as risk factors, and other possible pathogenic mechanisms were considered. Both patients were treated successfully with a combination of percutaneous or surgical drainage and amphotericin B, which appears to be the most active drug in vitro. The efficacy of other antifungal agents is discussed. In the context of pancreatitis and/or pseudocysts, empiric therapy with broad-spectrum antibiotics should be minimized because it predisposes patients to superinfection by opportunistic pathogens.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The existence of four genotypes of hepatitis C virus (HCV) — types 1a, 1b, 2a, and 2b — has been suggested based on variations in nucleotide sequences of the core region. The aim of this study was to investigate the prevalence of HCV genotypes in chronic type C liver disease in Taiwan and correlate distinct genotypes to severity of liver disease. The genotypes of 175 patients with chronic type C liver disease were determined by a polymerase chain reaction with type-specific primers. The prevalence of each genotype in Taiwan was as follows: type 1a, n = 1 (0.6%); 1b, n = 125 (71.4%); 2a, n = 21 (12%); 2b, n = 6 (3.4%); mixed types, n = 18 (10.3%); and unclassified, n = 4 (2.3%). The demographic and clinical features were comparable between patients with different genotypes, except that the mean peak serum transaminase levels of patients with double viruses and type 1b HCV infections were significantly higher than were those of patients with type 2a virus. Moreover, type 1b HCV was more prevalent in patients with liver cirrhosis alone or with hepatocellular carcinoma. In conclusion, type 1b virus is the predominant genotype in chronic hepatitis C in Taiwan, and type 1b virus and mixed infection may trigger more severe liver disease.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We reviewed the records and statistics of 560 patients hospitalized with hepatocellular carcinoma (HCC) over a 5-year period. One hundred and forty-one patients (26%) had spontaneous rupture of their HCCs. Different characteristics of the rupture (R) and nonrupture (NR) groups were compared; there were statistically significant differences (p < 0.05) in the size of the tumor (R, 9.83 ± 4.36 cm, and NR, 7.67 ± 4.01 cm; p < 0.001), the presence of the “hump sign” (R, 87.8%, and NR, 45.7%; p < 0.0001), and the minimal thickness of peritumor liver parenchyma (R, 0.03 ± 0.20 cm, and NR, 0.30 ± 0.70 cm; p < 0.001). The percentage of left-lobe tumors was significantly higher in the rupture group than in the nonrupture group (p < 0.05). In addition, the Child-Pugh's score and serum transaminase levels were higher, and the prothrombin times more prolonged, in the rupture group. Factors that were not statistically significant included sex, age, etiology of cirrhosis, platelet count, portal vein thrombosis, and the presence of a varix. Multivariate logistic regression analysis indicated that the tumor size, the presence of a hump sign, and the Pugh's score correlated the best with HCC rupture (p < 0.05). Ninety-four patients from the rupture group died during hospitalization. The mortality rate was 66.7%. We conclude that (a) spontaneous rupture of HCC is a likely sequel of progressive expansion of tumor that finally protrudes outside the liver surface and hemorrhages, (b) leftlobe tumor presents a higher risk of rupture, and (c) portal hypertension does not play a major role in the pathogenesis of tumor rupture.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We report this rare recurrence of biopsy-proven acute fatty liver of pregnancy. In two successive pregnancies, an emergency cesarean section was performed with delivery of healthy babies and rapid maternal recovery with complete normalization of liver function. This is the third such report.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Fourteen patients underwent magnetic resonance imaging (MRI) examination (16 studies) and clinical evaluation concurrently. MRI studies included gadolinium enhancement and Tl-weighted fat-suppressed spin echo. Separate investigators determined the severity of disease on MR images and on clinical evaluation in a blinded fashion. MRI studies were evaluated for percentage of mural contrast enhancement, wall thickness, and length of diseased bowel. An MR product was generated using these parameters. Clinical evaluation used the Crohn's Disease Activity Index (CDAI) and modified Index of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD). Linear correlation was found between the MR product and clinical indexes of disease activity. The correlation between MR product and the modified IOIBD index was statistically significant (R2=0.633, p=0.0012). The correlation of MR product and CDAI was less close (R2=0.274, p=0.0373). Among individual MR parameters, length of diseased bowel showed the greatest correlation with CDAI (R2=0.537, p=0.0012). Percentage contrast enhancement and bowel wall thickness showed significant correlation to the modified IOIBD index (R2=0.739, p=0.021) but not to the CDAI (R2=0.004, p=0.825). The results of this study show that the product of mural contrast enhancement, wall thickness, and length of diseased bowel correlated with clinical indexes of disease activity in Crohn's disease. Our findings suggest that MRI may be useful in evaluating the severity of Crohn's disease and may provide information complementary to clinical evaluation.

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1995

数据来源: OVID