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Kaohsiung J Med Sci

Ultrasound-guided percutaneous transhepatic drainage of gallbladder followed by cholecystectomy for acute cholecystitis--10 years experience.

Year 1998
Wong SR. Lee KT. Kuo KK. Chen JS. Ker CG. Sheen PC.
Department of Surgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
Acute cholecystitis is a common disease which may carry the risk of complications, including empyema, perforation, abscess, peritonitis and sepsis. Percutaneous transhepatic drainage of the gallbladder (PTGBD) with antibiotics can provide prompt decompression of gallbladder in acute cholecystitis and interrupt the natural history of the disease effectively. From July 1986 to June 1996, 154 patients with acute cholecystitis were reviewed retrospectively in Kaohsiung Medical College Hospital. The chief symptoms and signs were pain (98.1%), fever (57.1%) and jaundice (37.7%). WBC count more than 10,000 was noted in 116 (75.3%) patients. Associated diseases included empyema: 42 (27.3%), septic shock: 14 (9.1%), diabetes mellitus: 13 (8.4%), pancreatitis: 10 (6.5%), perforation: 7 (4.5%), liver cirrhosis: 6 (3.9%) and respiratory failure: 1 (0.6%). All of them underwent ultrasound-guided PTGBD immediately after the diagnosis was established. The symptoms and signs disappeared soon after this procedure. Bacterial culture was found positive in 104 (67.5%) of 154 patients in which Escherichia coli (51.9%) was the most common organism, followed by Klebsiella pneumonia (20.2%). After acute stage, 138 patients obtained the cholangiography via PTGBD tube. Gallbladder stones were only noted in 56 (40.6%) patients, gallbladder stone concomitant with common bile duct stone in 26 (18.8%), cystic duct obstruction in 25 (18.1%), acalculous cholecystitis in 21 (15.2%), gallbladder perforation in 1 (0.7%), choledochocyst in 1 (0.7%), and cholecystocolonic fistula in 1 (0.7%). There were 135 patients to undergo surgery after the clinical condition was stable. The operative findings included gallbladder stones only in 88 (65.2%), gallbladder stone concomitant with common bile duct stone in 34 (25.2%), acalculous cholecystitis in 13 (9.6%), choledochocyst in 1 (0.7%), and cholecysto-colonic fistula in 1 (0.7%). The postoperative complications included wound infection 8 (5.9%), UGI bleeding 3 (2.2%), acute renal failure 1 (0.7%) and acute respiratory failure 1 (0.7%). The postoperative mortality rate was 0.7% (1/135), which was much lower than those of previous reports, which not undergoing PTGBD initially. It led us to conclude that PTGBD, as an initial preoperative modality to treat acute cholecystitis, is effective in decreasing postoperative morbidity and mortality.

Anticardiolipin antibody-related Budd-Chiari syndrome: report of a case.

Year 1998
Tsai MS. Cheng NY. Wang CK. Liao LY. Wang CS.
Department of Internal Medicine, Taipei Municipal Jen-Ai Hospital, Taiwan, Republic of China.
We report a case of a 37-year-old female who suffered from upper abdominal pain, progressive abdominal distention, shortness of breath, palpitation and pitting edema of lower legs for more than one month. Abdominal sonography showed small caliber of hepatic veins, mild hepatosplenomegaly and moderate ascites. Computed tomography of abdomen disclosed extensive thrombi in bilateral femoral veins, ovarian veins and inferior vena cava. Ascites was transudate with normal cell count. Laboratory data showed hypoalbuminemia, mild elevation of total bilirubin and iron deficiency anemia. Anti-cardiolipin antibody was positive and antinuclear antibody was negative. The histopathological features, including sinusoidal dilatation with atrophic change of adjacent hepatocytes, slight congestion and hemosiderin-like material within the cytoplasm of Kupffer cells, were compatible with the criteria of Budd-Chiari syndrome. Heparin was intravenously administered immediately to prevent further progression of thrombosis. The ascites was successfully controlled with diuretics (spironolactone and furosemide). After a two-week course of treatment, she was discharged in good condition and on warfarin anti-coagulant medication.

Cavernous sinus syndrome and hepatoma metastasis.

Year 1998
Kao HJ. Cheng ST. Chen WH. Yin HL.
Department of Neurology, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
A 46-year-old man presented with left cavernous sinus syndrome and subsequent right leg pain proved clear cell type hepatocellular carcinoma metastasis. An initial liver function test was normal and alpha-fetoprotein was only 15 ng/ml but they increased rapidly and he progressed to hepatic failure 2 weeks later. Therefore, a subclinical hepatoma with metastasis should be differentiated in cavernous sinus syndrome, even in cases of normal hepatic enzymes, because hepatoma is prevalent in Taiwan.

Gastric duplication cyst: report of a case.

Year 1998
Wang JY. Huang TJ. Hsieh JS. Huang YS. Huang CJ. Hou MF. Chan HM. Chuan CH. Chen FM.
Department of Surgery, Kaohsiung Medical College, Taiwan, Republic of China.
Gastric duplication cyst is a rare disease entity, especially in the adult population. We report a case of 33-year-old female patient who presented with epigastric pain, postprandial fullness and nausea for the past several months. Gastroendoscopy showed a submucosal mass with normal overlying gastric mucosa. Upper gastrointestinal series confirmed a extrinsic compression of mass in the fundus of the stomach. Endoscopic ultrasonography and computerized tomography demonstrated the lesion to be a cyst in nature. The surgical procedure consisted of total excision without violation of the gastric lumen. Gastric mucosa was found by the histologic study of the excised cyst.

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