RESUMEN
Endoscopic management of post cholecystectomy biliary leak is described in a 56-year-old patient who developed a cystic duct leak following open cholecystectomy.
Asunto(s)
Enfermedades de las Vías Biliares/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía/efectos adversos , Stents , Enfermedades de las Vías Biliares/etiología , Colelitiasis/cirugía , Drenaje/instrumentación , Drenaje/métodos , Humanos , Persona de Mediana EdadRESUMEN
Endoscopic management of post cholecystectomy biliary leak is described in a 56-year-old patient who developed a cystic duct leak following open cholecystectomy
Asunto(s)
Humanos , Persona de Mediana Edad , Stents , Colecistectomía/efectos adversos , Enfermedades de las Vías Biliares/terapia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colelitiasis/cirugía , Enfermedades de las Vías Biliares/etiología , Drenaje/instrumentación , Drenaje/métodosRESUMEN
Percutaneous endoscopic gastrostomy tube placement is rapidly becoming the preferred method of gastrostomy tube placement. We describe our experience with this procedure in nine patients. The main complications were minor and due to local infection. This report demonstrates the simplicity and safety of this technique
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Adolescente , Adulto , Persona de Mediana Edad , Endoscopía del Sistema Digestivo , Gastrostomía , Cateterismo , Acalasia del Esófago/complicaciones , Acalasia del Esófago/mortalidad , Acalasia del Esófago/terapia , Análisis de Supervivencia , Diseño de Equipo , Enfermedad de Crohn/mortalidad , Enfermedad de Crohn/terapia , Enfermedades del Sistema Nervioso/mortalidad , Enfermedades del Sistema Nervioso/terapia , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Nutrición Enteral , Reoperación , Resultado del Tratamiento , Trastornos de Deglución/etiología , Trastornos de Deglución/mortalidad , Trastornos de Deglución/terapia , Trinidad y Tobago/epidemiologíaRESUMEN
Percutaneous endoscopic gastrostomy tube placement is rapidly becoming the preferred method of gastrostomy tube placement. We describe our experience with this procedure in nine patients. The main complications were minor and due to local infection. This report demonstrates the simplicity and safety of this technique.
Asunto(s)
Endoscopía del Sistema Digestivo , Gastrostomía , Adolescente , Adulto , Anciano , Cateterismo , Preescolar , Enfermedad de Crohn/mortalidad , Enfermedad de Crohn/terapia , Trastornos de Deglución/etiología , Trastornos de Deglución/mortalidad , Trastornos de Deglución/terapia , Nutrición Enteral , Diseño de Equipo , Acalasia del Esófago/complicaciones , Acalasia del Esófago/mortalidad , Acalasia del Esófago/terapia , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/mortalidad , Enfermedades del Sistema Nervioso/terapia , Reoperación , Análisis de Supervivencia , Resultado del Tratamiento , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: Orthotopic liver transplantation for end-stage hepatitis-B-virus (HBV) infection is commonly complicated by recurrence of HBV. Lamivudine, a cytosine nucleoside analogue, has been shown to suppress HBV infection. We report the development of resistance to lamivudine in three patients who underwent transplantation for end-stage liver disease secondary to hepatitis B. METHODS: Two of the patients received lamivudine for recurrent HBV infection after transplantation, whereas the third patient began treatment 1 month before transplantation in an attempt to prevent HBV recurrence after transplantation. The three patients initially responded well to treatment, but viral recurrence occurred after 9-10 months of treatment in all patients. HBV DNA was amplified from serum and sequenced through a conserved polymerase domain-the tyrosine, methionine, aspartate, aspartate (YMDD) locus. We assessed the susceptibility of HBV to lamivudine by infecting primary human hepatocytes with serum taken before the start of treatment and after recurrence in varying concentrations of lamivudine. FINDINGS: DNA sequencing showed a common mutation within the YMDD locus of the HBV polymerase gene in all patients during lamivudine treatment. In hepatocyte cultures infected with pretreatment serum, HBV DNA concentrations were reduced to less than 6% of those in control cultures by addition of lamivudine in concentrations as low as 0.03 mumol/L. By contrast, in cultures treated with serum taken after recurrence, HBV DNA concentrations did not fall below 20% of control values, even with lamivudine at 30 mumol/L. INTERPRETATION: Resistance to lamivudine has been reported in HIV patients with mutations in the YMDD locus of the polymerase gene. Our findings indicate a common mechanism of lamivudine resistance for HIV and HBV that involves similar point mutations in homologous domains of the viral polymerases.