ABSTRACT
Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Afferent Loop Syndrome , Drainage , Endoscopes , Endoscopy , Head and Neck Neoplasms , Jaundice , Pancreatic Neoplasms , Pancreaticoduodenectomy , StentsABSTRACT
BACKGROUND/AIMS: The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD) and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. We aimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality in Korean patients with cirrhosis and ascites. METHODS: We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the Konkuk University Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were compared using the predictive value of the 3-month mortality, as assessed by the Child-Pugh score. RESULTS: In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most common etiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were 0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patients with persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among the Child-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients with persistent ascites (P=0.039). CONCLUSIONS: Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients with cirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite the known relationship between hyponatremia and mortality in cirrhotic patients with ascites.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Alcohol Drinking , Area Under Curve , Ascites , End Stage Liver Disease/complications , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/complications , Models, Theoretical , ROC Curve , Retrospective Studies , Severity of Illness Index , Survival AnalysisABSTRACT
Ciprofloxacin is a broad-spectrum antibiotic used to treat a variety of infections. However, acute kidney injury is a rarely reported side effect. Ciprofloxacin-related nephrotoxicity typically manifests as acute tubulointerstitial nephritis. To the best of our knowledge, few cases of acute tubular necrosis as a complication of ciprofloxacin have been reported to date. We herein describe a case involving a 41-year-old woman treated with intravenous ciprofloxacin at 200 mg twice daily for gastroenteritis. One day after initiation of treatment, her serum creatinine level increased from 0.95 to 3.83 mg/dL and she experienced impaired hearing. Five days later, renal biopsy demonstrated acute tubular necrosis. The acute tubular necrosis encountered in this patient resolved; however, short-term hemodialysis was required. This is the first reported case of acute kidney injury associated with ciprofloxacin use in Korea.
Subject(s)
Adult , Female , Humans , Acute Kidney Injury , Administration, Intravenous , Biopsy , Ciprofloxacin , Creatinine , Gastroenteritis , Hearing , Hearing Loss , Korea , Necrosis , Nephritis, Interstitial , Renal DialysisABSTRACT
No abstract available.
Subject(s)
Aged, 80 and over , Female , Humans , Biopsy , Carcinoma, Papillary/chemistry , Immunohistochemistry , Liver Neoplasms/chemistry , Pancreatic Neoplasms/chemistry , Biomarkers, Tumor/analysisABSTRACT
Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to).
Subject(s)
Anti-Arrhythmia Agents , Antineoplastic Agents , Herbal Medicine , Lung Diseases, Interstitial , PneumoniaABSTRACT
Pulmonary thromboembolism (PTE) originating from a renal vein thrombosis (RVT) is very rare, especially in relatively healthy young women. The patient described herein presented with a syncope-associated massive PTE. She was previously healthy, except for termination of an ectopic pregnancy with methotrexate 4 months before. The only medication she was taking was an oral contraceptive (OC), which was started 3 months before the PTE. She had no family history of venous thromboembolism (VTE) or any other underlying risk factors. We report the case of a woman who had a PTE originating from a RVT associated with OC use after an ectopic pregnancy.
Subject(s)
Female , Humans , Pregnancy , Contraceptives, Oral , Methotrexate , Pregnancy, Ectopic , Pulmonary Embolism , Renal Veins , Risk Factors , Thrombosis , Venous ThromboembolismABSTRACT
No abstract available.