RESUMO
BACKGROUND: Gangrenous cholecystitis has a high risk of perforation and sepsis; therefore, cholecystectomy in the early stage of the disease is recommended. However, during the novel coronavirus disease 2019 (COVID-19) pandemic, the management of emergent surgeries changed to avoid contagion exposure among medical workers and poor postoperative outcomes. CASE PRESENTATION: A 56-year-old man presented to our hospital with abdominal pain. Computed tomography revealed intraluminal membranes, an irregular or absent wall, and an abscess of the gallbladder, indicating acute gangrenous cholecystitis. Early laparoscopic cholecystectomy seemed to be indicated; however, a COVID-19 antigen test was positive despite no obvious pneumonia on chest computed tomography and no symptoms. After discussion among the multidisciplinary team, antibiotic therapy was started and percutaneous transhepatic gallbladder drainage (PTGBD) was planned for the following day because the patient's vital signs were stable and his abdominal pain was localized. Fortunately, the antibiotic therapy was very effective, and PTGBD was not needed. The cholecystitis improved and the patient was discharged from the hospital on day 10. One month later, laparoscopic delayed cholecystectomy was performed after confirming a negative COVID-19 polymerase chain reaction test result. The postoperative course was uneventful, and the patient was discharged on postoperative day 2 in satisfactory condition. CONCLUSION: We have reported a case of acute gangrenous cholecystitis in a patient with asymptomatic COVID-19 disease. This report can help to determine treatment strategies for patients with gangrenous cholecystitis during future pandemics.
RESUMO
A new tritiated water measurement method with plastic scintillator pellets (PS-pellets) by using a conventional liquid scintillation counter was developed. The PS-pellets used were 3 mm in both diameter and length. A low potassium glass vial was filled full with the pellets, and tritiated water was applied to the vial from 5 to 100 µl. Then, the sample solution was scattered in the interstices of the pellets in a vial. This method needs no liquid scintillator, so no liquid organic waste fluid is generated. The counting efficiency with the pellets was approximately 48â % when a 5 µl solution was used, which was higher than that of conventional measurement using liquid scintillator. The relationship between count rate and activity showed good linearity. The pellets were able to be used repeatedly, so few solid wastes are generated with this method. The PS-pellets are useful for tritiated water measurement; however, it is necessary to develop a new device which can be applied to a larger volume and measure low level concentration like an environmental application.
Assuntos
Monitoramento de Radiação/métodos , Contagem de Cintilação/instrumentação , Trítio/análise , Água/análise , Monitoramento de Radiação/instrumentaçãoRESUMO
Fungus balls have been rarely implicated as a cause of urinary tract obstruction. Here, we report a case of Candida albicans fungus balls in the urinary tract after the treatment of Candida endophthalmitis that has enough periods and adequate amount of antifungal agents. The patient completely recovered from this rare complication by irrigating through single-J stent and changing antifungal agents. Here we emphasize that we should take into account not only the susceptibility test results but also the difference in excretion route and tissue distribution of antifungal agents.
