查看更多>>摘要：This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes (MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.
Ji Hun KimJae Hyuck ChangSung Min NamMi Jeong Lee...
5990-5993页
查看更多>>摘要：A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss.He had a large illdefined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bile duct.Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy.Total serum immunoglobulin G level was slightly elevated,but IgG4 level was normal.After the 2-wk 40 mg prednisolone trial,the patient's symptoms and bilirubin level improved significantly.A follow-up computed tomography (CT) scan showed a dramatic resolution of the pancreatic lesion.A low dose steroid was continued.After six months he self-discontinued prednisolone for 3 wk,and was presented with jaundice again.ACT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation.The patient' s IgG4 level was elevated to 2.51 g/L.Prednisolone was started again,after which his serum bilirubin level became normal and the thickening of the bile duct was resolved.This case suggests that autoimmune pancreatitis can progress to other organs that are not involved at the initial diagnosis,even with sustained pancreatic remission.
查看更多>>摘要：Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.
查看更多>>摘要：Peliosis hepatis (PH) is a rare benign condition characterized by the presence of multiple,randomly distributed,blood filled cystic areas of variable size within the liver parenchyma.PH is difficult to recognize and may be mistaken for neoplasm,metastases or multiple abscesses.A 75-year-old female with a previous history of colon cancer was admitted when a liver mass in the right liver lobe was found 11 mo after surgery during the follow-up period.Computed tomography and magnetic resonance imaging scan of the abdomen were performed.The initial possible diagnosis was metastatic hepatocellular carcinoma.The patient underwent excision of the hepatic segment where the nodule was located.The pathological diagnosis of the surgical specimen was PH.PH should be considered in the differential diagnosis of new liver lesions in patients whose clinical settings do not clearly favor metastasization.Clinicians and radiologists must recognize these lesions to minimize the probability of misdiagnosis and inappropriate treatment.
查看更多>>摘要：Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models.A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE) systems (PillCam(R) and MiroCam(R)) was performed.The oral cavity/aero-digestive tract (i.e.,tongue,uvula and/or epiglottis) was captured/identified in almost all (99％)of PillCam(R) videos but in none of MiroCam(R) cases,P ＜0.0001.Furthermore,oesophageal images (i.e.,from the upper oesophageal sphincter to the Z-line were captured in 99％ of PillCam(R) videos (mean ± SD,60.5 ±334.1 frames,range:0-3329 frames) and in 66％ of Mirocam(R) cases (mean ± SD,11.1 ± 46.5 frames,range:0-382 frames),P ＜ 0.0001.The Z-line was identified in 42％ of PillCam(R) videos and 17％ of MiroCam(R),P =0.0002.This information might be useful when performing SBCE in patients with high risks for aspiration.
NETL
NSTL
万方数据
维普