1/45. Fatal haemorrhage from Dieulafoy's disease of the bronchus.A 70 year old woman with a previous history of healed tuberculosis and suspected chronic obstructive pulmonary disease presented with recurrent haemoptysis and respiratory failure from a lobar pneumonia. Massive bleeding occurred when biopsy specimens were taken during bronchoscopy which was managed conservatively, but later there was a fatal rebleed from the same site. Two different Dieulafoy's vascular malformations were found in the bronchial tree at necropsy, one of which was the biopsied lesion in the left upper lobe. This report confirms the possibility that vascular lesions occur in the bronchial tree. It is suggested that, if such lesions are suspected at bronchoscopy, bronchial and pulmonary arteriography with possible embolotherapy should be performed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/45. Antiperistaltic Roux-en-Y biliary-enteric bypass after bile duct injury: a technical error in reconstruction.Bilioenteric reconstruction using a Roux limb of jejunum is a well-established surgical option for the reconstruction of the proximal bile duct. Previous studies discussing short- and long-term complications of biliary-enteric anastomosis have focused on technical aspects, such as the use of anastomotic stenting or the level of the biliary tree used. We report two cases of previously unreported complications after hepaticojejunostomy that resulted from a technical error in constructing the Roux limb. Within a 3-month period, two patients were referred to our institution with recurrent cholangitis after biliary reconstruction for injuries sustained during laparoscopic cholecystectomy. Reexploration disclosed major technical flaws in the construction of the Roux limb used for biliary drainage. Antiperistaltic limbs had been constructed in both patients: one from the distal ileum and one from the conventional location in the jejunum. In both cases, isoperistaltic reconstruction of the Roux limbs resolved the recurrent cholangitis. cholangitis after biliary-enteric bypass can arise from a variety of etiologies and lead to anastomotic narrowing or ineffective drainage of the biliary tree. review of the literature failed to disclose reports of technically flawed Roux limb construction as a cause of cholangitis. We present these cases to highlight the devastating consequences of antiperistaltic construction of the Roux limb. We hope that by publishing the role of this avoidable error in recurrent cholangitis after biliary-enteric bypass we may help prevent its future occurrence.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/45. Recurrent bacteremia with enteric pathogens in recessive polycystic kidney disease.Eight children with autosomal recessive polycystic kidney disease (ARPKD) and recurrent bacteremia with enteric pathogens are described. Typical clinical features of bacterial cholangitis were absent, although in five patients histological and/or microbiological data indicated that the bacteremic episodes originated in the biliary tree. bacteremia with enteric pathogens or recurrent culture-negative febrile illness in a child with ARPKD should raise suspicion of cholangitis, even in the absence of typical clinical findings.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
4/45. Esophagobronchial fistula following redo Nissen fundoplication.Gastrobronchial fistula is a rare complication of antireflux surgery, whereas esophagobronchial fistula as a complication of Nissen fundoplication has, to the best of our knowledge, not been reported previously. We report on a case of esophagobronchial fistula in a patient with left subphrenic abscess following redo Nissen fundoplication. Chest radiographs suggested an unresponsive pneumonia of the left lower lobe. Computed tomography (CT) of the abdomen showed partial consolidation of the left lower lobe and contrast filling of the left bronchial tree from a left subphrenic abscess. CT diagnosis of fistula originating from the region of fundoplication was confirmed by Gastrografin follow-through.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
5/45. Identification of a unique helicobacter species by 16S rRNA gene analysis in an abdominal abscess from a patient with X-linked hypogammaglobulinemia.A unique helicobacter species, MZ640285, was isolated from a patient with X-linked hypogammaglobulinemia suffering from recurrent abdominal abscesses and was identified by 16S rRNA gene sequence analysis. In the phylogenetic tree, the isolate fell into a cluster which included Flexispira rappini, helicobacter bilis, and helicobacter sp. strain Mainz. Helicobacters are being increasingly recognized as pathogens in immunocompromised hosts. These fastidious bacteria are not easily cultured in the routine diagnostic laboratory, and this is the first report of their identification by 16S rRNA gene sequencing performed directly from a clinical specimen.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
6/45. Treatment of plastic bronchitis in a Fontan patient with tissue plasminogen activator: a case report and review of the literature.Plastic bronchitis is a condition in which large, bronchial casts with rubber-like consistency develop in the tracheobronchial tree and cause airway obstruction. We describe a 4-year-old girl who had Fontan physiology and who developed plastic bronchitis and report for the first time the use of aerosolized tissue plasminogen activator for treatment of this condition. The literature is reviewed with emphasis placed on the occurrence of this disorder in patients with single ventricle physiology.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
7/45. Recurrent pyogenic cholangitis.A 26-year-old male presented with jaundice and recurrent cholangitis. ultrasonography revealed dilated intra- and extrahepatic biliary tree packed with multiple calculi. Endoscopic retrograde cholangiopancreatography and computerised tomography scan confirmed the findings and a diagnosis of recurrent pyogenic cholangitis was made. cholecystectomy, choledocholithotomy with removal of stones and Roux-en-Y choledochojejunostomy were performed.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
8/45. Second varicella infections: are they more common than previously thought?OBJECTIVE: To describe the epidemiology and clinical characteristics of varicella reinfections reported to a surveillance project. methods: We investigated varicella cases reported to a surveillance project between January 1, 1995, and December 31, 1999--with more extensive investigation of cases reporting previous varicella with onset between January 1, 1998, and September 30, 1998--to provide a more detailed description of first and second varicella infections. A simple decision tree was used to assess the likelihood that reported first and second infections were varicella. RESULTS: Among varicella cases reported to the surveillance project, 4.5% of cases in 1995 and 13.3% of cases in 1999 reported previous varicella. More than 95% of first infections were physician diagnosed, epidemiologically linked to another case, or had a rash description consistent with varicella; the same was true for reported second infections. People who reported reinfections were generally healthy. There was a family history of repeat infections in 45% of people who reported reinfections. CONCLUSIONS: Clinical varicella reinfections may occur more commonly than previously thought. Additional studies of the predictive value of a positive varicella history and laboratory studies of reported reinfections are indicated to guide varicella vaccination policy.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
9/45. Needle-knife sphincterotomy.Choledochocele, now classified as choledochal cyst type III, is a rare anomaly of the terminal biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally, the therapy for this malformation has been surgery. Recently, endoscopic therapy has been used alternatively for the treatment of choledochocele mainly in adults. We report two patients with recurrent episodes of acute pancreatitis found to be caused by a large choledochocele; both patients were treated by needle-knife sphincterotomy without complications. They remained asymptomatic at 1 and 2 years' follow-up, respectively. Despite the fact that the risk of bleeding seems to be higher using needle-knife sphincterotomy, when the Choledochocele is large, our experience suggests that needle-knife sphincterotomy can be performed accurately and safely. Further studies are necessary to confirm the safety and effectiveness of needle-knife sphincterotomy in large choledochocles.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
10/45. Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration.A 70-year-old man with recurrent undiagnosed episodes of bronchial cast expectoration and pulmonary infiltrates on chest radiography for 15 years is described. The diagnosis of chyloptysis was established by chemical analysis of the bronchial aspiration. We emphasize the radiological findings of this rare observation. The CT-associated lymphangiography showed mediastinal lymphangiectasis with retrograde opacification of mediastinal and hilar lymph nodes as well as submucosal lymphatic vessels protruding into the lumen of the tracheo-bronchial tree without evidence of thoracic duct obstruction as well as a "crazy-paving appearance." Congenital incompetence of the valves of the lymphatic vessels originating from the thoracic duct is held to be the cause. Chyloptysis and pulmonary lymphatic disorder should be sought in cases of bronchial cast expectoration.- - - - - - - - - - ranking = 0.5keywords = tree (Clic here for more details about this article) |
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