scholarly journals The Difficult Path to Correct Diagnosis of Hepatolithiasis: A Case Report

2021 ◽  
Vol 64 (2) ◽  
pp. 125-128
Author(s):  
Peter Mikolajčík ◽  
Alexander Ferko ◽  
Michal Demeter ◽  
Martin Vorčák ◽  
Ľudovít Laca
Keyword(s):  
Clinical Picture ◽  
Correct Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Good Prognosis ◽  
Definitive Treatment ◽  
Stone Extraction ◽  
Laboratory Findings ◽  
Biliary Ducts ◽  
Obstructive Cholangitis

Hepatolithiasis is a benign disease, where stones are localized proximal to the confluence of hepatic ducts. The clinical picture may differ depending on whether the stones cause complete, partial, or intermittent biliary obstruction. The course can vary from asymptomatic to fatal, thus, early diagnosis and treatment is critical for a good prognosis. The gold standard in imaging is magnetic resonance cholangiopancreatography (MRCP). However, correct diagnosis can be challenging due to atypical clinical picture and laboratory findings. We present a case where hepatolithiasis was misdiagnosed initially due to incomplete reporting and documentation of MRCP. Choledocholithiasis was diagnosed based on initial MRCP, and endoscopic stone extraction was indicated. However, an unusual post-interventional course and signs of obstructive cholangitis led to an endoscopic re-intervention, which confirmed absence of pathology in extrahepatic biliary ducts. The cholangitis recurrence required intensive antibiotic treatment, and CT examination revealed intrahepatic S3 bile duct dilatation. Thus, a re-evaluation of initial MRCP and repeated MRCP confirmed hepatolithiasis. Further, laparoscopic bisegmentectomy was chosen as the definitive treatment due to the location of the lesion. The patient recovered and remained symptom free upon a 12 month follow up.

Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years

2017 ◽  
Vol 27 (2) ◽  
pp. 357-363 ◽  
Author(s):  
Caio Augusto Hartman ◽  
Julio Cesar Teixeira ◽  
Sergio Bruno Barbosa ◽  
Stephanye Mariano Figueiredo ◽  
Liliana Aparecida Lucci De Angelo Andrade ◽  
...  
Keyword(s):  
Residual Disease ◽  
Disease Free Survival ◽  
Cervical Neoplasia ◽  
Good Prognosis ◽  
Positive Cone ◽  
Definitive Treatment ◽  
Younger Women ◽  
Grade 3 ◽  
Almost All

ObjectiveThe aim of this study was to evaluate the prognosis and recurrence of microinvasive squamous cervical (MIC) cancer stage IA1 in women treated conservatively or by hysterectomy, and followed-up to 20 years.MethodsIt was studied in a cohort of 139 women with MIC, 41 definitively managed by conization and 98 by hysterectomy from January 1994 to December 2003 and followed-up until 2013. The definitive treatment, age, conization technique (loop electrosurgical excision procedure or cold knife conization), cone margin, residual disease in hysterectomy specimen, and the association with recurrence (intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse, and microinvasive or worse) were analyzed.ResultsThere were 2.5 times more conservative treatment in younger women than older (>40 years), and high proportion of residual disease in hysterectomy specimens (67% of intraepithelial cervical neoplasia grade 3 or worse), more common if positive cone margin (74% vs 35%, P < 0.002). There were 2.3% (3/133) recurrences detected as microinvasive or worse, and 6% (8/133) recurrences detected as intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse: 7.3% (3/41) in the conization group and 5.4% (5/92) in the hysterectomy group (P = 0.701). Almost all recurrences (88%, 7/8) were diagnosed until 36 months after treatment, and they were not associated with conization technique. There were no differences in risk of recurrence and overall disease-free survival time related to type of treatment.ConclusionsThis study demonstrates the good prognosis of MIC, regardless the treatment. When fertility is not a concern, hysterectomy should be considered as definitive treatment to avoid the risk of residual disease. Regular follow-up for a long period should be maintained.

scholarly journals Pancreatite Auto-Imune: O Papel da Imagem no Diagnóstico

2015 ◽  
Vol 28 (5) ◽  
pp. 667
Author(s):  
João Ressurreição ◽  
Maria Bali ◽  
Celso Matos
Keyword(s):  
Clinical Picture ◽  
Crucial Role ◽  
Correct Diagnosis ◽  
Diagnostic Process ◽  
Imaging Findings ◽  
Imaging Studies

Auto-immune pancreatitis is an uncommon and underdiagnosed pathology. Its clinical picture is not specific and the diagnosis is therefore difficult. Imaging studies have a crucial role in the diagnostic process and also in the follow-up of treatment. With the objective of emphasizing the importance of imaging in the correct diagnosis of this pathology, the authors report the case of a patient with longterm unspecific abdominal complaints that was diagnosed as auto-immune pancreatitis after laboratorial and imaging investigation. Assuming this diagnosis it was instituted treatment with oral methylprednisolone, which succeeded, with progressive resolution of the clinical, laboratorial and imaging findings.

scholarly journals Nonoperative Management of Perforated Diverticulitis of the Duodenum: Report of Three Cases and Review of Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Rutger Franken ◽  
Martijn Möllers ◽  
Alexander de Mol van Otterloo ◽  
Julien Puylaert
Keyword(s):  
Correct Diagnosis ◽  
Good Condition ◽  
Acute Onset ◽  
Perforated Diverticulitis ◽  
Review Of Literature ◽  
Laboratory Findings ◽  
Duodenal Diverticula ◽  
Duodenal Diverticulitis ◽  
Upper Abdomen

Duodenal diverticula are relatively frequent but complications are uncommon. The mortality rate of perforated duodenal diverticulitis is high, and its management is controversial. We report three patients with a perforated duodenal diverticulitis who were successfully treated with conservative antibiotic therapy. The clinical presentation in all three patients was acute onset of pain in the upper abdomen. In all cases, ultrasound showed no abnormalities, but computed tomography revealed the correct diagnosis. All three were treated with broad-spectrum antibiotics and total parenteral nutrition. They recovered clinically and laboratory findings normalized. During follow-up visit, all patients were asymptomatic. This study contributes another three patients to the small number of successful conservatively treated cases of perforated duodenal diverticulitis described in literature. We suggest that in patients in good condition with no septic signs, conservative treatment with close clinical follow-up should be the treatment of choice.

scholarly journals Radiation Stricture of the Biliary Ducts: An Emerging New Entity?

HPB Surgery ◽  
1992 ◽  
Vol 5 (4) ◽  
pp. 267-270 ◽  
Author(s):  
A. Halevy ◽  
A. Adam ◽  
G. Stamp ◽  
I. S. Benjamin ◽  
L. H. Blumgart
Keyword(s):  
Radiation Therapy ◽  
Obstructive Jaundice ◽  
Clinical Picture ◽  
Biliary Tree ◽  
Recurrent Tumour ◽  
Radiation Stricture ◽  
Biliary Ducts ◽  
Extrahepatic Biliary Tree ◽  
Malignant Condition

Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant condition. As no recurrent tumour was detected in either of the patients the strictures were considered to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who are well at follow up one and ten years after the procedure.

scholarly journals Secondary Sclerosing Cholangitis and Hodgkin's Lymphoma

2015 ◽  
Vol 8 ◽  
pp. CCRep.S23665 ◽  
Author(s):  
Seyed Hassan Abedi ◽  
Maryam Ghassami ◽  
Mahsa Molaei ◽  
Zhaleh Mohsenifar ◽  
Amir Houshang Mohammad Alizadeh
Keyword(s):  
Sclerosing Cholangitis ◽  
Viral Infections ◽  
Histological Finding ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Secondary Sclerosing Cholangitis ◽  
Extrahepatic Bile Ducts ◽  
Vanishing Bile Duct

Context Liver damage is relatively common in patients affected by HL, but paraneoplastic cholestasis is an uncommon presenting symptom in HL. Case Report We report the case of a 38-year-old man who came to our hospital with jaundice, pruritis, nausea, vomiting, weight loss, and recurrent episodes of fever without any hepatosplenomegaly or lymphadenopathy. Laboratory findings showed abnormal liver functioning with mixed hepatocellular and cholestatic patterns. Sonographic evaluation of the biliary tract was normal. We ruled out viral infections, autoimmune process, and hemochromatosis. The patient was put on ursobile and NAC ( N-acetyl-systeine) and prednisolone treatment. In magnetic resonance cholangiopancreatography examination, there were multiple strictures in the intrahepatic and extrahepatic bile ducts with mild dilatation. Histologic finding of liver biopsy was compatible with sclerosing cholangitis or drug-induced cholestasis. General condition and laboratory examination results of the patient became better, but we found lymphadenopathy on monthly follow-up examination. Histological finding of the lymph node was compatible with HL. Conclusion This report emphasizes that HL can be presented with different paraneoplastic symptoms and that one of them is secondary sclerosing cholangitis. It has better prognosis than vanishing bile duct syndrome, and perhaps steroid treatment can be suggested.

HEREDITARY NONSPHEROCYTIC HEMOLYTIC ANEMIA PRESENTING AS HEMOLYTIC DISEASE OF THE NEWBORN INFANT

PEDIATRICS ◽  
1954 ◽  
Vol 13 (1) ◽  
pp. 41-43
Author(s):  
OGDEN C. BRUTON ◽  
WILLIAM H. CROSBY ◽  
ARNO G. MOTULSKY
Keyword(s):  
Hemolytic Anemia ◽  
Newborn Infant ◽  
Clinical Picture ◽  
Family Study ◽  
Correct Diagnosis ◽  
Red Cell ◽  
Laboratory Studies ◽  
Hemolytic Disease ◽  
Laboratory Findings ◽  
Cell Defect

A case of hereditary nonspherocytic hemolytic disease is reported. The patient presented the clinical picture of hemolytic disease of the newborn infant at birth; however, laboratory studies confirmed the correct diagnosis. Family study revealed the mother to have a similar but milder hemolytic anemia. Splenectomy in the patient at 10 months of age was not beneficial. Differential diagnosis is briefly discussed. The nature of the red cell defect responsible for the condition is unknown. This study points out that hereditary nonspherocytic hemolytic anemia should be considered in patients with the clinical picture of erythroblastosis fetalis who fail to have the expected laboratory findings of that disease.

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

scholarly journals Appendiceal Neuroendocrine Tumours - Experience of One Service

2021 ◽  
Author(s):  
Vítor Devezas ◽  
Laura Elisabete Barbosa
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumours ◽  
Adult Population ◽  
Right Hemicolectomy ◽  
Good Prognosis ◽  
Alive Today

AbstractTumours of the appendix are rare and tend to be diagnosed incidentally, in cases of acute appendicitis. For some authors, appendiceal neuroendocrine tumours (ANETs) are the most frequent neoplasm of the appendix, observed in 0.3% to 0.9% of cases acute appendicitis. The present is a unicentric retrospective study conducted between January 2005 and March 2017. Out of a total of 3,007 surgeries for appendiceal pathologies performed in the adult population at the hospital where the present study was conducted, there were 70 (2.33%) malignant cases, 20 (28.6%) of which were ANETs. The patients had a median age of 44 years (range: 18 to 85 years), and were predominantly women (there were 1.9 times more women than men). In 16 cases (80%), a simple appendicectomy was performed (1 patient was submitted to a right hemicolectomy later). The cases of ANETs had a good prognosis in our series: 85% of the patients are either alive today or were alive after 5 years of follow-up. Despite the fact that ANETs are described as the most frequent tumor of the appendix, this was not confirmed in our series, in which they only represented 28.6% of the cases; adenocarcinoma was the most frequent tumor (65.7%) among our sample.

scholarly journals Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Seon Lee ◽  
Joong-Gon Kim ◽  
Soyoung Lee
Keyword(s):  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Long Term Outcomes ◽  
Childhood Onset ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Long Term Prognosis ◽  
Digital Amputation

AbstractChildhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

scholarly journals A Case Study Supporting Lack of SARS-CoV-2 Spread to a 3-Month Old Infant Through Exclusive Breastfeeding

2021 ◽  
pp. 089033442199107 ◽  
Author(s):  
Wei Liu ◽  
Yujie Liu ◽  
Zhenjun Liu ◽  
Changxin Hong ◽  
Jian Liu ◽  
...  
Keyword(s):  
Male Infant ◽  
Computed Tomography Imaging ◽  
Full Data ◽  
Laboratory Findings ◽  
Global Pandemic ◽  
Breast Pump ◽  
Acid Test ◽  
Maternal And Newborn

Introduction During the Coronavirus Disease 2019 global pandemic, maternal and newborn wellbeing has received much attention. Detailed reports of infected women breastfeeding their infants are uncommon. Due to incomplete information available, full data about those infants’ outcomes are lacking, and evidence of infectivity through breastfeeding has not been documented. Main Issue Here, we report about a mother who breastfed her infant until she was confirmed with the SARS-Cov-2 infection. After follow-up, we have confirmed that the infant, who was breastfed by the infected mother, was not infected. Methods A 33-year-old woman gave birth to a full-term male infant on November 8, 2019. Since birth, she had been exclusively breastfeeding the baby until she was confirmed with the SARS-Cov-2 infection on February 8, 2020. She was hospitalized, isolated from her baby, and stopped breastfeeding. Even though she remained asymptomatic, her milk was expressed using a breast pump and discarded. The mother’s milk sample was collected on February 9, 2020, and the result of the nucleic acid test for COVID-19 was negative. Her infant was asymptomatic and remained virus negative. Her laboratory findings and chest Computed Tomography imaging was normal. She was treated according to the national protocol with aerosolized interferon α2β, lopinavir/ritonavir and ribavirin. Her serum SARS-CoV-2 specific antibodies(IgG and IgM) tested positive when discharged. She returned to breastfeeding after discharge. Conclusion Our findings suggest that breastfeeding may be less of a risk than anticipated. Additional research is needed to explore this possibility.

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