1/27. Foreign body reaction to a metal clip causing a benign bile duct stricture 16 years after open cholecystectomy: report of a case.We present herein a case where a benign bile duct stricture developed 16 years after an open cholecystectomy and without any prior symptoms. The patient was thought to have a Klatskin tumor both pre- and intraoperatively and was treated with a resection of the mass and bile duct confluence, while hepaticojejunostomies were also performed to both ducts separately. A pathologic examination of the specimen revealed extensive fibrosis, chronic inflammation, and a nonnecrotizing granulomata. Any hilar mass presenting after upper abdominal surgery should therefore be considered to be potentially a benign bile duct stricture, even with a long symptom-free interval.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/27. Chronic granulomatous disease with gastric antral narrowing: a study and follow-up by MRI.We report the case of a boy with chronic septic granulomatosis (CSG) who presented with a marked gastric antrum narrowing which was evaluated by MRI after oral intake of magnetic contrast particles, and after gadolinium i.v. administration. In particular, a mammillated aspect of the gastric wall in the antral region was seen. Follow-up by MRI clearly showed the gradual resolution of hyperemic wall thickness, after medical management. The antral stenosis resolved after 3 months. magnetic resonance imaging provides detailed evaluation of gastric wall inflammation in course of CSG.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
3/27. Temporal arteritis: a spectrum of ophthalmic complications.Seven patients of temporal arteritis with eye involvement have been presented. These cases represent a spectrum of disease from intermittent diplopia with minimal 6th nerve weakness through mild retinal ischemia with recovery to permanent bilateral blindness. Temporal arteritis should be suspected when any form of ocular ischemia is suspected by history or found on examination of an elderly person. An early diagnosis may protect the vision in both eyes if vision is normal at the time of diagnosis. If vision in one eye is decreased because of ischemia, the vision in the other eye can usually be retained if proper therapy is instituted. Furthermore, adequate therapy may even result in improvement in vision in the involved eye. patients with biopsy proven temporal arteritis should be continued on steroid therapy until the active disease is quiescent. Inactivity should be determined by carefully monitoring the ESR while steroids are being tapered. If the ESR rises, it is indicative of continued inflammation and if steroids are not continued, the eyes remain at risk as seen in Case 5. If the ESR remains elevated for a year or more despite continuation of high steroid levels, consideration should be given to repeating the temporal artery biopsy. Temporal arteritis should be considered in the differential diagnosis of any multisystem disease in older patients. Even central nervous system involvement may occur concomitantly, since the intracranial vessels are not immune from the disease process. tuberculosis, systemic syphilis and more recently the collagen vascular diseases have been dubbed the "great imitators" and "the protean diseases." We suggest that the same terminology can be applied to temporal arteritis. Temporal arteritis can affect any organ. Moreover, there is a wide spectrum of variation in the degree of involvement of any particular tissue as illustrated by these 7 cases of ocular involvement.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
4/27. Unusual causes of benign biliary strictures with cholangiographic features of cholangiocarcinoma.Focal strictures occurring at the hepatic duct confluence, or within the common hepatic duct or common bile duct in patients without a history of prior surgery in that region or stone disease, are usually thought to represent cholangiocarcinoma until proved otherwise. However, not uncommonly, patients undergo surgical exploration for a preoperative diagnosis of cholangiocarcinoma, based on the cholangiographic appearance of the lesion, only to find histologically that the stricture was benign in nature. Despite sophisticated radiographic, endoscopic, and histologic studies, it is often impossible before laparotomy to distinguish malignant from benign strictures when they have the characteristic radiographic appearance of cholangiocarcinoma. Even at the risk of overtreating some benign cases, most agree that aggressive surgical resection is the treatment of choice, given the serious consequences resulting from a failure to diagnose and adequately treat cholangiocarcinoma. Four patients who presented to our institution between February 1991 and June 2000 underwent laparotomy for a preoperative diagnosis of biliary tract malignancy based on clinical presentation and cholangiographic findings. The final pathology report in all patients showed marked fibrosis and inflammation of the biliary duct without evidence of malignancy. A review of the patient data and the relevant literature identified benign causes of focal extrahepatic biliary strictures associated with concomitant disease processes in two of the four patients. We present these cases and discuss the benign etiologies with emphasis on the role of surgery in both diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
5/27. Laryngotracheal involvement of relapsing polychondritis in a Korean girl.We describe a young girl presenting with acute dyspnea because of laryngotracheal involvement of relapsing polychondritis (RP). RP, a multisystemic disorder of unknown etiology, is a very rare disease in children. It is characterized by inflammation and destruction of the cartilaginous structure of many organs, including the respiratory tract. Early respiratory tract involvement in younger patients is the greatest threat to life, and aggressive therapy, including tracheostomy and intravenous high-dose steroids, is advocated.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
6/27. Fascicular torsion in the median nerve within the distal third of the upper arm: three cases of nontraumatic anterior interosseous nerve palsy.Three patients with nontraumatic anterior interosseous nerve palsy are presented. All patients also had paralysis of the pronator teres, flexor carpi radialis, and/or palmaris longus. One patient also had sensory disturbance and palsy of the thenar muscles. An hourglass-like constriction was seen within a 7-cm section of the nerve fascicles (2-9 cm proximal from the medial epicondyle of the humerus) in the median nerve trunk. All constrictions exhibited approximately 30 degrees of fascicular torsion. Because this nerve section is anatomically proximal to the branching point for the earlier mentioned motor branches and the anterior interosseous nerve, the nerve fascicles may have been structurally twisted before the onset of palsy. Structural abnormalities causing inflammation and edema of nerve fascicles as well as factors such as compression from surrounding small vessels may have maximized torsion, resulting in the formation of constrictions.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
7/27. Mid pouch strictureplasty for Crohn's disease after ileal pouch-anal anastomosis: an alternative to pouch excision.A 33-year-old female developed an isolated stricture of the mid portion of her ileal pouch nine years after proctocolectomy and J-ileal pouch-anal anastomosis for ulcerative colitis. Repeated episodes of pouchitis and partial small-bowel obstruction led to pouchoscopy and pouchography, which demonstrated pouch inflammation and a long, tight, midpouch stricture. Her diagnosis was changed to Crohn's disease and she was treated with azathioprine, budesonide, and infliximab. Repeat pouchoscopy demonstrated mucosal healing but a persistent fibrotic stricture. Pouch reconstruction was performed with a midpouch strictureplasty alleviating her obstructive symptoms. One year after surgery, the patient has no clinical evidence of obstruction and repeat pouchography demonstrates a wider pouch lumen across the strictureplasty site. Strictureplasty is an alternative to pouch excision in the management of patients with Crohn's disease who have an isolated pouch stricture.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/27. Post-reperfusion rapidly progressive glomerulonephritis in post-transplant IgA nephropathy.Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in renal transplant patients on immunosuppressive therapy. RPGN post ischemia-reperfusion has not been previously reported. We report a 62 year old male patient on azathioprine therapy, 9 years after left cadaveric renal transplantation due to end stage renal disease of unknown etiology, who presented with progressive deterioration in renal function and hematuria. Renal biopsy was consistent with IgAN. Duplex and CT scan demonstrated a decreased renal graft perfusion, due to severe atherosclerosis and stenosis of iliac arteries. The patient underwent left axilo-femoral bypass graft surgery with improvement in kidney graft perfusion and function. However, few weeks later, patient presented with pulmonary edema and advanced renal failure and he was initiated on hemodialysis. Repeated renal biopsy demonstrated crescentic GN. To the best of our knowledge, this is the first report of RPGN following reversal of ischemia and reperfusion. There was no evidence for atherembolic disease which is not uncommon after vascular surgery and it has been reported to be rarely associated to crescentic GN. Theoretical explanations for exacerbation of IgAN to crescentic GN, following successful reperfusion, could be enhancement of capillary damage, inflammation and oxidative stress. Putative mechanisms for these phenomena may be interaction of reperfusion-induced hyperfiltration, high intraglomerular capillary pressure, oxidative stress, increased polymorphonucler cells infiltration and inflammation; the presence of IgA immune deposits and azathioprine metabolites, both can also be associated to enhancement of oxidative stress.- - - - - - - - - - ranking = 2keywords = inflammation (Clic here for more details about this article) |
9/27. Benign nontraumatic inflammatory stricture of mid portion of common bile duct mimicking malignant tumor: Report of two cases.Benign nontraumatic inflammatory stricture of the common bile duct (CBD) may result in obstructive jaundice, which can be misdiagnosed as a malignant tumor of the CBD preoperatively. Two cases with strictures of the mid portion of the common bile duct presenting with obstructive jaundice are reported herein. Preoperative radiological studies prompted us to confidently make the diagnosis of cholangiocarcinoma. However, the postoperative diagnosis on histological examination of the resected lesions was chronic inflammation and fibrosis. The complications of chronic duodenal ulcer are considered as the etiology of these two disorders.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
10/27. Endoscopic ultrasound-assisted rendezvous maneuver to achieve pancreatic duct drainage in obstructive chronic pancreatitis.patients with mechanical obstruction of the pancreatic duct, which can be caused by chronic pancreatitis, suffer from recurrent attacks of pain and inflammation of the pancreas. We report a novel approach using an endoscopic ultrasound- (EUS-) assisted rendezvous technique, which allows drainage of the pancreatic duct in patients in whom primary management by transpapillary drainage during an endoscopic retrograde cholangiopancreatography (ERCP) procedure has failed. Transgastric puncture of the pancreatic duct was performed using a 19-gauge needle under EUS guidance, and a 0.035-inch guide wire was introduced into the duct and advanced through the papilla. This wire was pulled into the duodenum using a side-viewing duodenoscope. A papillotomy was performed using the standard technique and a plastic prosthesis was introduced. The patient tolerated the intervention well and was discharged with no further complaints. EUS-assisted drainage of the pancreatic duct using a rendezvous technique is an elegant and feasible minimally invasive endoscopic treatment for symptomatic patients with chronic pancreatitis, in whom transpapillary introduction of a catheter is not possible.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
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