1/1089. Haemosuccus pancreaticus: a clinical challenge.BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.- - - - - - - - - - ranking = 1keywords = tract, upper (Clic here for more details about this article) |
2/1089. Percutaneous pyelolithotomy. A new extraction technique.Recurrent renal calculous disease is often troublesome to treat because of technical difficulties associated with reoperation. Attempts to dissolve the stones by irrigation with various solutions has not had much success. A new extraction technique has therefore been devised whereby the stones can be removed through a percutaneous nephrostomy umder radiological control. Three cases are described.- - - - - - - - - - ranking = 3.9045933075942keywords = tract (Clic here for more details about this article) |
3/1089. Reactivation of herpes virus after surgery for epilepsy in a pediatric patient with mesial temporal sclerosis: case report.OBJECTIVE: This case report is presented to raise the awareness of the potential risk of reactivation of herpes simplex virus (HSV) encephalitis after intracranial surgery. CLINICAL PRESENTATION: The case of an 8-year-old male patient who suffered a reactivation of HSV encephalitis after undergoing amygdalohippocampectomy for complex partial seizures is reported. This patient had previously contracted HSV 1 meningoencephalitis at the age of 16 months. Six years later, a left amygdalohippocampectomy was proposed after the development of intractable partial epilepsy associated with left mesial temporal lesions. During the postoperative period, the patient suffered severe clinical deterioration with partial status epilepticus, aphasia, and hyperthermia, which resolved after intensive antiepileptic treatment supported by acyclovir. CONCLUSION: We advise prophylactic pre-, peri-, and postoperative treatment with acyclovir for patients with known histories of HSV encephalitis who undergo intracranial procedures.- - - - - - - - - - ranking = 1.5618373230377keywords = tract (Clic here for more details about this article) |
4/1089. Watermelon stomach--an unusual cause of recurrent upper gastrointestinal bleeding in a uremic patient receiving estrogen-progesterone therapy: case report.A 50-year-old woman who had been on maintenance hemodialysis for 5 years developed severe anemia resistant to treatment with iron supplements and erythropoietin 4 months prior to hospital admission. Her stool occult blood test was positive, and an initial panendoscopy revealed evidence of possible antral gastritis. However, repeated administration of sucralfate, H2 blockers and a proton pump inhibitor was not effective in preventing further gastrointestinal tract blood loss and subsequent refractory anemia. She required multiple blood transfusions and hospital admissions during this period. There was no obvious coagulopathy or thrombocytopenia. After her third admission, a second panendoscopy demonstrated the typical picture of watermelon stomach. A trial of hormone therapy with estrogen and progesterone increased the hemoglobin level within a month without further evidence of active gastrointestinal bleeding. From our experience with this case, we found that the diagnosis of antral vascular ectasia (watermelon stomach) with bleeding requires a high degree of clinical alertness and careful endoscopic examination. Estrogen and progesterone therapy may provide a good option for treating the disease in uremic patients without an obvious complication. To the best of our knowledge, this is the first report demonstrating the use of maintenance hormone therapy in a female uremic patient to successfully treat watermelon gastric bleeding.- - - - - - - - - - ranking = 1.2190813384812keywords = tract, upper (Clic here for more details about this article) |
5/1089. Unusual case of Munchausen's syndrome: factitious vesical lithiasis.We report an uncommon case of a 38-year-old woman who admitted for bladder lithiasis undergoing repeated surgical management and being apparently recurrent. The intravenous pyelography and retrograde urethrocystography clear the urinary tract. Biologic evaluation eliminates any metabolic or endocrine cause. The confirmation of a factitious origin is given by fluorescence X analysis of the extracted stones which conclude to calcium carbonate structure and psychiatric care. The self-intromission of these calculi into the bladder is due to the personality disorder being in the frame of Munchausen's syndrome. Two years later, no recurrence is noted and an excellent psychiatric care is achieved.- - - - - - - - - - ranking = 1.5618373230377keywords = tract (Clic here for more details about this article) |
6/1089. Successful treatment of candidal osteomyelitis with fluconazole following failure with liposomal amphotericin b.A case of multiple relapses of candida albicans infection of deep tissues is described. Treatment was complicated by renal impairment, but therapy with a liposomal amphotericin product failed to eradicate the third recurrence which subsequently resolved after protracted exposure to oral fluconazole.- - - - - - - - - - ranking = 0.78091866151884keywords = tract (Clic here for more details about this article) |
7/1089. Treatment of upper abdominal malignancies with organ cluster procedures.Upper abdominal exenteration for upper abdominal malignancies was carried out in 15 patients with removal of the liver, spleen, pancreas, duodendum, all or part of the stomach, proximal jejunum and ascending and transverse colon. Organ replacement was with the liver, pancreas and duodenum plus, in some cases, a short segment of jejunum. Eleven of the 15 patients survived for more than 4 months; 2 died, after 61/2 and 10 months, of recurrent tumor. Of the 9 patients who are surviving after 61/2 to 14 months, recurrent tumor is suspected in only 1 and proven in none. Four patients with sarcomas and carcinoid tumors (2 each) have had no recurrences. The other 5 survivors had duct cell cancers (3 examples), a cholangiocarcinoma (1 example), and a hepatoma (1 example). The experience so far supports further cautious trials with this drastic cancer operation.- - - - - - - - - - ranking = 0.54770334620291keywords = upper (Clic here for more details about this article) |
8/1089. Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases.We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.- - - - - - - - - - ranking = 0.10954066924058keywords = upper (Clic here for more details about this article) |
9/1089. Enterovesical fistula complicating pregnancy. A case report.BACKGROUND: Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. To our knowledge, enterovesical fistula complicating pregnancy has not been reported before. CASE: A pregnant woman with recurrent urinary tract infections was evaluated. cystoscopy was suggestive of an enterovesical fistula, which was confirmed by charcoaluria following oral charcoal administration. The prenatal course was complicated by two episodes of hemorrhagic cystitis despite antibiotic prophylaxis. The patient had an uncomplicated term spontaneous vaginal delivery. An upper gastrointestinal series performed postpartum was suggestive of Crohn's disease and confirmed an enterovesical fistula. Surgical repair was successfully performed three months following delivery, revealing Crohn's disease. CONCLUSION: Enterovesical fistula may be an unusual cause of recurrent urinary tract infections in pregnancy. In this case, enterovesical fistula was the presenting symptom of Crohn's disease.- - - - - - - - - - ranking = 125.93895052247keywords = tract infection, tract, upper (Clic here for more details about this article) |
10/1089. angioedema presenting in the retropharyngeal space in an adult.PURPOSE: Hereditary angioedema is a rare disorder of deficient or dysfunctional C1-esterase inhibitor and usually manifests as edema of the face, tongue, supraglottis, extremities, or gastrointestinal tract. We report the case of a 40-year-old man with known hereditary angioedema who presented with a sore throat and a sensation of evolving airway obstruction. After a thorough search of the medical literature, we believe this to be the first reported case of angioedema manifesting in the retropharyngeal space. The pathophysiological factors of angioedema are discussed, along with its variable presentation and management issues. METHOD: Laryngoscopic examination was suggestive of posterior pharyngeal fullness; therefore, a computed tomographic scan of the neck was obtained, which showed a non-contrast-enhancing retropharyngeal edema from the base of the skull to below the level of the glottis. The patient had a history of multiple episodes of angioedema requiring hospitalization and three prior tracheotomies. RESULTS: Familiarity with the patient's history directed his rapid treatment course (including intravenous stanozolol, Solu-Medrol, and diphenhydramine), which significantly reduced his edema and avoided the need for tracheotomy. CONCLUSION: Hereditary angioedema may present in atypical locations, and expeditious treatment in a patient with a known history may avert the sequelae of evolving airway obstruction.- - - - - - - - - - ranking = 0.78091866151884keywords = tract (Clic here for more details about this article) |
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