摘要:

A 79-year-old woman developed collagenous sprue, a rare small intestinal mucosal disorder. Later, extensive T-cell lymphoma was documented, a neoplasm known to complicate celiac disease. Although the precise relationship of collagenous sprue to celiac disease has been debated and remains controversial, the findings here provide additional evidence that collagenous sprue and celiac disease are closely linked. In the past, long-term survival with collagenous sprue may have been compromised due to severe pan-malabsorption. With improved treatment measures, including modern nutritional support, it is likely that there will be an increased opportunity in future for improved appreciation of the complications of collagenous sprue, specifically, lymphoma.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Mycobacterium fortuitumis a rapidly growingMycobacterium, which usually colonizes the soil, dust and water. It commonly causes skin and soft tissue infections especially in patients who have preceding trauma. We report a case of perianal fistulae caused byM. fortuitum.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an hereditary disorder that results in fibrovascular dysplasia with the development of telangiectasias and arteriovenous malformations. It predominantly involves the skin, mucous membranes, viscera, lungs, and brain. Hereditary hemorrhagic telangiectasia shows great genetic heterogeneity, and its phenotypes have been classified based on the recently identified mutated genes: endoglin (HHT-1) and activin-like kinase receptor-1 (HHT-2). Other families with phenotypic HHT do not bear these mutations; therefore, other genes are probably involved as well. Liver involvement is reported in up to 30% of persons affected by HHT. Large arteriovenous malformations in the liver can lead to significant complications, including high-output congestive heart failure, portal hypertension, hepatic encephalopathy, biliary ischemia, and liver failure. Embolization of large arteriovenous malformations in the liver remains controversial; however, liver transplantation can successfully eradicate these complications.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

To determine the natural history of chronic pancreatitis (CP), we retrospectively studied 193 consecutive patients who had at least one hospitalization for the control of pain or a complication of CP by examining the hospital records and by using a standard questionnaire. Alcohol (66%) was the major cause of CP and the cause was unknown in 21%. Pain was the presenting symptom in 93%. Pancreatic calcification was observed in 41% (alcoholic 54% vs. nonalcoholic 19%; OR = 6.7, CI = 2.7, 14.3;p< 0.0001). Diabetes (28%), malabsorption (16%), pseudocysts (21%) and pancreatic (3%) or extrapancreatic malignancy (5%) were the main complications. 43% had surgical intervention for pain relief, 10% had either endoscopic sphincterotomy or surgical sphincteroplasty and 16% had surgery for complications. Surgical or endoscopic intervention was more commonly performed in nonalcoholics compared with alcoholics (OR = 12.8, CI = 3.6, 53.9;p< 0.0001). However, if sphincterotomy and sphincteroplasty were excluded, the total number of surgical procedures for pain relief was similar in both groups. Complete follow-up information was available in 107 patients with a mean duration of follow-up of 10 years (range, 1–28 years); 27 patients died during the follow-up; 5, 10 and 15 year mortality was 14%, 18% and 20% respectively. The mortality was significantly higher in patients with alcoholic CP than in nonalcoholic CP (35% vs. 10%; OR = 1.4, 18.7;p= 0.005). Of the 80 patients who were alive and had complete long-term follow-up, pain improved in 62 patients, remained unchanged in 17 and worsened in one. Pain improved in 34 of 41 (83%) patients who had surgical intervention for pain, 7 of 9 patients (78%) who had surgery for complications, 4 of 7 (57%) who had sphincter ablation and 17 of 23 patients (74%) who had nonprocedural treatment. Long-term pain relief was similar in patients with alcoholic and nonalcoholic pancreatitis.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundAcute acalculous cholecystitis (AAC) tends to have a fulminant course and be associated with critically ill diseases, there have been reports of AAC without any risk factors but good prognosis.GoalsTo assess the risk factors, clinical features and prognosis of AAC.StudyAll patients who had a cholecystectomy due to acute cholecystitis at Pundang Jesaeng General Hospital during a 43-month period were prospectively enrolled. AAC was defined by ultrasonographic, intraoperative and pathologic findings of acute cholecystitis without evidence of gallstones. Clinical features and pathologic findings were analyzed and outcome was assessed.Results156 patients with acute cholecystitis were enrolled and 14% (22 of 156) met the criteria of AAC. Fifteen (68%) of the patients with AAC were male and the average age was 63 year old. Twenty patients were presented with AAC as outpatients of whom seven of them (35%) had atherosclerotic vascular disease. Laparoscopic cholecystectomy was performed in 126 patients (80.8%) with acute cholecystitis but was possible in only 12 patients (54.5%) with AAC. AAC was associated with a high incidence of gangrene (59%) but no patients died of acute cholecystitis.ConclusionsWe conclude that AAC frequently occurs in elderly male outpatients without critical illness and gangrene is common but the prognosis is better than reported previously.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsWe assessed the effect of HCV infection and abstinence from alcohol on survival in a cohort of patients with alcoholic cirrhosis.BackgroundHepatitis C virus (HCV) infection may be an important cofactor for liver disease in chronic alcoholics.StudyThe study population consisted of 213 patients with the diagnosis of alcoholic cirrhosis, 72 of these patients were infected by HCV. Complete alcohol abstinence after diagnosis of alcoholic cirrhosis was recorded in 86 patients. The reference group consisted of 89 patients with anti-HCV positivity who had never consumed alcohol. Survival was analyzed by the Kaplan and Meier method and predictors of survival by the Cox's multiple regression model.ResultsHCV infection was not a determinant factor for survival in alcoholic cirrhosis. Age and Child-Pugh grade at the time of diagnosis of cirrhosis and persistence of alcohol consumption after diagnosis were independent predictors of poor outcome. The cumulative survival curve in abstinent alcoholics was significantly different from that of alcoholics who maintained the same pattern of alcohol consumption (log-rank = 4.30,p= 0.0381). Moreover, the cumulative survival in patients with anti-HCV–positive cirrhosis who stopped drinking after diagnosis was similar to that in patients with HCV-positive cirrhosis who had never consumed alcohol (log-rank 0.26,p= 0.61).ConclusionsCumulative survival in alcoholic cirrhosis does not seem to be influenced by the presence or absence of markers of HCV infection. Once liver cirrhosis has been diagnosed in the alcoholic patient, complete alcohol abstinence should be strongly recommended.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

GoalsTo investigate the relationships between gastric emptying and autonomic dysfunction in hepatic cirrhosis and to assess the effects of cisapride on gastric emptying in cirrhotic patients.StudyTwenty-four cirrhotic patients (8 patients in each Child–Pugh classification) and 25 healthy controls were enrolled. All the patients had viral (B or C) hepatitis. Patients with DM, alcoholic cirrhosis, active peptic ulcer, gastric malignancy and pyloric obstruction were excluded by esophagogastroduodenoscopy. Parasympathetic and sympathetic functions were assessed by the criteria set forth by Ewing and Clark. Drugs affecting GI motility and smoking were discontinued 48 hours and 12 hours prior to the study respectively. A solid-phase of gastric emptying study was conducted by scintigraphic method for the calculation of gastric half-emptying time (GET1/2).ResultsThe study revealed that 9 patients with Child–Pugh B and C cirrhosis had autonomic neuropathy and none of Child–Pugh A cirrhosis had autonomic neuropathy. Prolonged GET1/2was noted in cirrhotics compared with the control group (p< 0.05). However, there was significant difference between 9 patients (Child B-C) with autonomic neuropathy compared with patients 15 patients without autonomic neuropathy. Again there was a significant difference in GET1/2between Child A cirrhotic and Child B-C cirrhotic whether they had autonomic neuropathy or not. Cisapride decreased GET1/2significantly in cirrhotic patients (Child B-C cirrhotic). Clearly, patients with autonomic neuropathy in Child B-C cirrhosis had significantly reduced GET1/2after cisapride administration. Even though cisapride decreased GET1/2in patients with Child B-C cirrhosis without autonomic neuropathy, this was not significant.ConclusionAutonomic neuropathy in advanced cirrhosis from viral hepatitis may cause prolonged gastric emptying. Cisapride can shorten gastric emptying time in such patients.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We observed a 45-year-old man with acute hepatitis B while receiving treatment of chronic graft-versus-host disease (GVHD) of the liver. When he developed a sudden elevation of serum aminotransferases 17 months after bone marrow transplantation, he was under immunosuppressive therapy consisting of cyclosporin A against chronic GVHD of the liver. Serologic tests for hepatitis B virus (HBV) showed no reactivation but de novo acute infection. The serum levels of aminotransferases after elevation of biliary tract enzymes increased mildly. However, icterus was not observed in his sequential course. A liver biopsy specimen revealed mild acute liver injury accompanied by slight degeneration of bile ducts. It is presumed that owing to immunosuppressive therapy, his liver dysfunction was relatively mild, and the hepatitis became quiescent without becoming serious. On the other hand, the serum of the patient remained hepatitis B surface antigen positive for more than 1 year after the onset of the hepatitis, which suggested chronicity of HBV infection.

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:2003

数据来源: OVID