1/2. Fine-needle aspiration biopsy of an intra-abdominal inflammatory mass secondary to a penetrating duodenal ulcer mimicking neoplasm.Peptic ulcers complicated by penetration into the surrounding tissue and presenting as an intra-abdominal mass simulating a malignancy are uncommon. We report on a case of a 56-yr-old physician with a 40-yr history of peptic disease. Due to recent and transitory right flank pain, an ultrasound then a computed tomography scan demonstrated a 4-cm retropancreatic mass. A fine-needle aspiration biopsy (FNAB) of the mass showed an acute and chronic inflammatory exudate. After a course of medical treatment for peptic ulcer disease and 5 mo after the biopsy, the mass remarkably decreased in size. In view of the clinical and FNAB findings, the lesion likely developed as a result of penetration of the duodenal ulcer into the retropancreatic space. awareness of this uncommon complication of peptic gastroduodenal ulcer disease is helpful in the diagnosis of this benign lesion. A failure in making a firm diagnosis by considering the aspirate material as nonrepresentative may lead to an unnecessary repeat biopsy or an invasive procedure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Hemolytic anemia associated with the use of omeprazole.omeprazole is the first drug designed to block the final step in the acid secretory process within the parietal cell. It has been shown to be extremely effective in the treatment of peptic ulcer disease, reflux esophagitis, and the zollinger-ellison syndrome. Although clinical experience with omeprazole is still limited, many controlled studies have established the short-term safety of this drug. We report the first case of a serious short-term adverse reaction with the use of omeprazole: hemolytic anemia. The patient developed weakness, lethargy, and shortness of breath 2 days after starting therapy with omeprazole. Two weeks after the initiation of therapy, her hematocrit had decreased from 44.1% to 20.4%, and she had a positive direct Coombs antiglobulin test and an elevated indirect bilirubin. After she discontinued the omeprazole, her hemoglobin and hematocrit gradually returned to normal. The mechanism by which omeprazole caused the patient's hemolytic anemia is uncertain, but physicians should be alerted to this possible adverse effect.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |