Cases reported "Acute Disease"

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1/41. Successful nonoperative management of neonatal acute calculous cholecystitis.

    Acute cholecystitis in the neonate is rare and usually treated by cholecystectomy. A 1-day-old full-term girl had clinical and sonographic features of acute calculous cholecystitis. This was successfully managed nonoperatively with intravenous fluids and antibiotics, leading to complete resolution of the condition. The infant currently is thriving and asymptomatic with a sonographically normal biliary tree. Spontaneous resolution of cholelithiasis may occur in neonates, even in the presence of acute cholecystitis.
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2/41. Acute cholecystitis secondary to hemobilia.

    Invasive diagnostic and therapeutic techniques such as percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), transjugular intrahepatic portosystemic shunting, and laparoscopic cholecystectomy have led to a rise in hemobilia. Most complications from hemobilia are attributable to acute blood loss; other complications are secondary to thrombus formation in the biliary tree. We present a case report of acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. The role of ERCP in the diagnosis and treatment of this exceedingly rare event is discussed.
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3/41. Alfuzosin-induced hepatotoxicity.

    Drug-induced hepatic injury is a potential complication of virtually all drugs because the liver is central to the metabolic disposition of almost all drugs, although precise mechanisms often are unknown. We report a case of severe acute mixed hepatitis (cholestatic and hepatocellular), probably induced by alfuzosin. This event has not been reported previously (medline 1990, March 1999). Viral causes, autoimmune hepatitis and biliary tree obstruction were excluded. After discontinuation of the drug, liver function test results returned to normal.
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4/41. Acute pancreatitis complicating anterior lumbar interbody fusion.

    Postoperative pancreatitis may occur following surgery in regions remote from the pancreas and the biliary tree. Though uncommon, it carries a high mortality rate. pancreatitis complicating spinal surgery is extremely rare. This report describes a case of acute pancreatitis following an anterior lumbar interbody fusion and discusses the possible mechanisms of pancreatic cellular injury.
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5/41. Acute self-limiting hepatitis c after possible sexual exposure: sequence analysis of the E-2 region of the infected patient and sexual partner.

    We describe a case of symptomatic acute infection with HCV in a woman whose sexual partner had chronic hepatitis c. The patient cleared HCV rna 8 weeks after the onset of acute hepatitis and was found to be persistently HCV-rna negative during 90 weeks of follow-up. Part of the E-2 region of HCV was directly sequenced in the patient and her sexual partner. Four local controls with subtype-1a infection and 9 1a isolates obtained from GenBank were analyzed. The average nucleotide divergence between the sequences of the infected patient and her sexual partner was 5.1%, compared with an average nucleotide divergence of 19.4% (range 16.6-21.8%) between the sequences of the patient and those of controls. Comparison of the phylogenetic trees in the partial E-2 region showed that the sequence of the patient was closely related to that of her sexual partner. Our findings suggest that the infection was transmitted to the patient from her sexual partner. The resolution of acute hepatitis c in this case was probably related to the host rather than to intrinsic characteristics of the HCV genome.
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6/41. The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma.

    Computed tomography (CT) has revolutionized the diagnosis and management of head-injured patients, and its increasing availability has led to its liberal use. CT scanning provides excellent anatomic detail of the brain as fixed static images, but the dynamic nature of human physiology means that many injury patterns will evolve in time. We describe an 8-year-old child who had fallen 8 feet from a tree. He had a brief loss of consciousness but a normal neurologic evaluation on arrival to the emergency department (ED). He underwent expedited cranial CT scanning, which revealed no acute brain injury. Two and one half hours later, the patient had a mild depression in consciousness, prompting a second CT scan in the ED, which revealed an acute epidural hematoma. He had acute surgical evacuation of the hematoma and made a full neurologic recovery. This case illustrates that a single early CT examination may at times provide a false sense of security and underscores the importance of serial neurologic examinations.
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7/41. Rapid progress of acute suppurative cholangitis to secondary sclerosing cholangitis sequentially followed-up by endoscopic retrograde cholangiography.

    A 66-year-old man was admitted to our hospital because of right hypochondralgia and fever after colonic polypectomy. Endoscopic examination revealed purulent bile excretion from the duodenal papilla orifice; based on this finding, acute suppurative cholangitis was diagnosed. An endoscopic retrograde cholangiography revealed no abnormality in the biliary tree. However, chronic cholestasis persisted, and endoscopic cholangiography performed 4 months later disclosed a beaded appearance of the intrahepatic bile ducts; this sign is a characteristic finding of sclerosing cholangitis. This is the first report of rapid progression of acute suppurative cholangitis to secondary sclerosing cholangitis sequentially followed-up by endoscopic retrograde cholangiography.
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8/41. Decision-making process in long term acute cholecystitis.

    OBJECTIVE: To demonstrate that the categorization of different therapeutic options is essential for the decision-making applied to clinical management. METHOD: This paper compares the usefulness of percutaneous echo-guided cholecystostomy as the first therapeutic option in acute long-term cholecystitis versus the exclusive surgical or clinical management. RESULT: We have analyzed the usefulness of different therapeutic options in a case of long term acute cholecystitis and we have obtained the following results: isolated intravenous antibiotic therapy (0.76), surgery (0.73) and echo-guided cholecystostomy (0.93). This last option has provided good clinical-radiological results. CONCLUSION: decision trees are a good methodological option as support of surgical and non surgical therapeutic procedures.
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9/41. Mild hypothermia for hemispheric cerebral infarction after evacuation of an acute subdural hematoma in an infant.

    The use of mild hypothermia to treat hemispheric infarction after evacuation of an acute subdural hematoma in an infant is reported. The patient, a 2-year-old boy, presented with a deteriorating level of consciousness after a fall from a tree. Computed tomography (CT) scan revealed an acute subdural hematoma on the right side with marked midline shift, and emergency evacuation of the hematoma was performed. The postoperative course was uneventful until the patient's intracranial pressure (ICP) rose and his condition deteriorated 3 days after surgery. CT scan revealed a hemispheric infarction on the injured side. Mild hypothermia was induced to control the ICP and protect the brain. While the hypothermia was effective in lowering the elevated ICP, it failed to arrest progression of the infarction. The patient was discharged with mild disability 2 months after the injury. No serious complications occurred during or after the hypothermia. Our experience indicates that hypothermia can be a useful procedure for controlling the ICP in children with severe traumatic brain injury including acute subdural hematoma, although its capability to protect the brain from severe, progressive ischemia appears to be limited.
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10/41. Acute pancreatitis with hemobilia following percutaneous liver biopsy.

    hemobilia following liver biopsy is rare and acute pancreatitis associated with hemobilia in such a situation is rarer. We report a 55-year-old man with ulcerative colitis and hepatitis c-positive liver disease who developed acute pancreatitis following liver biopsy. Surgical removal of blood clots from the biliary tree led to recovery.
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