“Bouveret's syndrome” presenting with acute pancreatitis a very rare and challenging variant of gallstone ileus

INTRODUCTIONBouveret's syndrome is a rare variant of gallstone ileus and describes gastric outlet obstruction secondary to an impacted stone in the duodenum. Its presentation is vague and clinical diagnosis is often difficult resulting in a delay in diagnosis.PRESENTATION OF CASEWe report a patient who presented initially with non-specific symptoms and subsequently with features in keeping with acute pancreatitis, but eventually was found to have Bouveret's syndrome.DISCUSSIONDifferent treatment strategies are discussed. Although endoscopic treatment combined with many newer modalities like lithotripsy have been tried, surgery remains the definitive management in the vast majority of cases.CONCLUSIONBouveret's syndrome is a rare condition, can also present as pancreatitis and often difficult to diagnose initially, but with appropriate treatment has a good outcome.     

Treatment of Children with Steroid Refractory Idiopathic Nephrotic Syndrome: The Kuwaiti Experience

The aim of this study is to evaluate histopathological findings induced by N^Ω‐nitro‐L‐arginine methyl ester (L‐NAME) and molsidomine (MOL) on the kidney of bile duct ligated rats. Forty Sprague–Dawley rats, each weighing 125 to 140 g, were included in the study. Extent of histological glomerular injury scores (GIS), arterial injury scores (AIS), and tubulointerstitial injury scores (TIS) in each animal were graded. Alpha‐smooth muscle actin (α‐SMA), tenascin, lectin (Ulex europaeus agglutinin‐1), and vimentin were used to determine extent of the injury. The cholestasis was evidenced by a significant increase in the levels of serum total bilirubin in BDL rats (p < 0.01). Malondialdeyde MDA levels increased by the bile duct ligation (BDL) to 12.10 ± 0.45. This value was significantly higher than the other groups (p < 0.01). Changes in the BDL kidney were marked at 7 days after surgery. GIS were observed to have the highest score, especially at juxtamedullary region in BDL/L‐NAME rats, and AIS were also the highest score in this region. These observations were lower in BDL/MOL rats. There is a correlation between GIS and AIS scores (r = .2, p < .01). TIS revealed that BDL/L‐NAME rats were significantly more damage than rats in the other groups (p < .001). MOL‐treated rats showed considerably fewer lesions in the tubules and interstitium (p < .001). The tubular injuries observed in BDL and BDL/L‐NAME rats were significantly attenuated by MOL treatment. Lectin was more and extensively stained in tubular epithelia of the BDL/L‐NAME group than in the other (p < .05). Expression of tenascin in tubular epithelia was significantly higher in BDL and BDL/L‐NAME as compared with controls (p < .01). Fibrous tissue was only observed in the BDL and BDL/L‐NAME group. These areas were weakly stained with vimentin. α‐SMA staining was more reduced in the L‐NAME‐treated arterioles than in BDL/MOL (p < .05). In conclusion, the analysis of cell injury based on a histological grading system in the model of BDL kidney allows the quantification of the degree of injury.     

锥形束CT在鼻泪管阻塞性疾病辅助诊断中的应用价值

目的 探讨锥形束CT （CBCT）在鼻泪管阻塞性疾病辅助诊断中的应用价值。方法 选取2018年1月至2020年8月在中国人民解放军总医院眼科门诊就诊的鼻泪管阻塞性疾病患者104例，按随机数字表法分为观察组及对照组，各52例，观察组患者采用CBCT检查鼻泪管，对照组采用CT泪道造影检查鼻泪管。观察并比较两组患者鼻泪管的影像解剖形态、解剖参数（骨性鼻泪管长度、中段管径最小横径、管径最小面积）及剂量长度乘积。结果 两种成像方法均可清楚观察患者骨性鼻泪管的解剖形态，清晰显示骨性鼻泪管的阻塞情况及周围组织结构。两组患者鼻泪管斜冠状位的长度、中段最窄处的横径及横截面积比较，差异均无统计学意义（P<0.05）。观察组患者剂量长度乘积为50.35 mGy.cm，是对照组剂量长度乘积的1/6左右。结论 与CT泪道造影比较，CBCT成像可以精准显示鼻泪管阻塞性疾病患者鼻泪管引流状态，明确阻塞部位和程度，且具有辐射剂量低、空间分辨率高等优点。     

Comparison between Antegrade versus Retrograde Ureteral Stent Placement for Malignant Ureteral Obstruction

PurposeTo compare the technical success of antegrade uteral stent (AUS) and retrograde ureteral stent (RUS) placements in patients with malignant ureteral obstruction (MUO) and to determine the predictors of technical failure of RUS.Materials and MethodsThis study retrospectively included 61 AUS placements (44 patients) performed under fluoroscopic guidance and 76 RUS placements (55 patients) performed under cystoscopic guidance in patients with MUO from January 2019 to December 2020. Technical success rates of the 2 techniques were compared using inverse probability of treatment weighting (IPTW) analysis. Logistic regression was used to identify predictive factors for technical failures.ResultsTechnical success was achieved in 98.4% of the AUS group and 47.4% of the RUS group. After stabilized IPTW, the technical success rate was higher in the AUS group than in the RUS group (adjusted risk difference, 49.4%; 95% confidence interval [CI], 35.4%–63.1%). The independent predictors for technical failure of the RUS procedure were age of ≥65 years (odds ratio [OR], 5.56; 95% CI, 1.73–21.27), ureteral orifice invasion (OR, 4.21; 95% CI, 1.46–13.46), and extrinsic cancer (OR, 15.58; 95% CI, 2.92–111.81).ConclusionsThe technical success rate of AUS placement was higher than that of RUS placement in patients with MUO. RUS failure was associated with age of ≥65 years, cancer with ureteral orifice invasion, and extrinsic ureteral obstruction.     

S-1 monotherapy as second line chemotherapy in advanced gastric cancer patients previously treated with cisplatin/infusional fluorouracil

The treatment choice of advanced gastric carcinoma after failure from first-line therapy is quite limited. To evaluate the efficacy and toxicity of S-1 monotherapy in patients with advanced gastric cancer after failure of first line cisplatin and fluorouracil combination (CF). S-1 monotherapy as a second line treatment was given to the patients who had failed to CF combination in SC-101 study. The efficacy and toxicity of S-1 monotherapy were evaluated exploratory. The results indicated that forty-one patients received S-1 as a second line therapy after disease progression. The overall response rate and disease control rate were 14.6% and 41.5%, respectively. The median progression free survival (PFS) was 5.1 months (ange: 2.9~6.2 month). The median overall survival time was 6.4 months. The survival rates at 6 month and 1 year were 56% and 7.3%, respectively. Grade 3/4 adverse events were uncommonly occurred, including anemia (2.4%), neutropenia (2.4%), thrombocytopenia (4.9%) and rash (2.4%). There were no unexpected or life-threatening toxicities. Only one patient experienced dose reduction due to grade 3 rash. In conclusion, S-1 monotherapy provided a mild response rate and overall survival, and a favorable toxicity profile in the second line setting after the first line failure to cisplatin and fluorouracil combination.     

Approach to the baby with bilious vomiting

Bilious vomiting in the term neonate is a cardinal feature of a critical condition – intestinal malrotation – and may herald an impending abdominal crisis. It may also be due to a number of other surgical and medical causes, and there is a significant healthcare burden in excluding malrotation in the neonatal population. Health professionals caring for neonates need a sound knowledge of the assessment, diagnosis, and management of the neonate presenting with bilious vomiting. This review discusses the approach and immediate management, discusses uncertainties in evidence and offers practical advice for healthcare professionals who are faced with a baby with bilious vomiting.     

Peritonitis esclerosante encapsulante: hallazgos en imágenes de una entidad poco frecuente

ObjectivesTo describe the most characteristic imaging findings for sclerosing encapsulating peritonitis, with an emphasis on the computed tomography findings.ConclusionThe incidence of sclerosing encapsulating peritonitis is low. The pathophysiology of this condition is unclear. Two types are recognized: idiopathic and secondary; the secondary type is generally a complication of peritoneal dialysis. Its nonspecific clinical presentation and the absence of blood markers mean that sclerosing encapsulating peritonitis is usually diagnosed late. Thus, it is important to know the imaging signs; these include thickening and calcification of the peritoneum and dilation of bowel loops with thickening and calcification of bowel walls, whether in isolation or in association with loculated ascites. Although ultrasonography allows the complexity of the collections to be evaluated, computed tomography is the most useful technique for the general assessment of the signs mentioned above.