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One hundred and ten adult patients hospitalized with dengue haemorrhagic fever (DHF) during the recent outbreak in North India were prospectively studied. Of these, 48 (43.6%) were grade I, 40 (36.4%) grade II, 10 (9.1%) grade III and 12 (10.9%) grade IV DHF. Dengue shock syndrome (DSS) was seen in 22 (20%) patients. Fever, headache, myalgias and arthralgias were the common symptoms seen in 100%, 80.9%, 76.2% and 52.3% patients, respectively. Spontaneous bleeding was seen in 62 patients (56.4%) with mucocutaneous bleeding being the most common (46 patients). Gastrointestinal bleeding was seen in 38 (34.5%) patients. In as many as 40 patients, the haemorrhagic manifestations occurred after the fever had come down. Fifty-five patients (50%) required platelet transfusions. Twelve patients died, giving a mortality rate of 10.9% in the present study. Prompt recognition and supportive treatment can be lifesaving. 相似文献
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Rajesh Gupta Jai Dev Wig Deepak Kumar Bhasin Paramjit Singh Sudha Suri Mandeep Kang Surinder Singh Rana Satyawati Rana 《Journal of gastrointestinal surgery》2009,13(7):1328-1336
Background The present study reports functional and morphological changes noted over long-term follow-up in patients with severe acute
pancreatitis.
Methods Thirty patients who had completed at least 6 months after recovery were included. Fecal fat, urinary d-xylose, blood sugar, C-peptide, pancreatic changes, and recurrences were studied.
Results Etiology was gallstones (12), alcohol (10), both gallstone and alcohol (3), and idiopathic (5). Five patients were managed
conservatively while 25 underwent surgery. Mean follow-up was 31.3 months. Exocrine and endocrine insufficiencies were noted
in 12 (40%) and were more common in no-necrosis group compared to necrosis group (p = 0.04 and 0.28, respectively) and infected compared to sterile pancreatitis (45% vs. 25%, p = 0.55 and 50% vs. 12%, p = 0.15, respectively). Higher frequency was noted in nonvisualized, partly visualized, and dilated segment of duct. Significant
proportion (8/12) had both exocrine and endocrine abnormalities and their incidence decreased as duration of follow-up increased.
Urinary d-xylose excretion was abnormal in 16% and noted >1 year postrecovery. Thirty percent required >1 readmission and pain was
the commonest cause.
Conclusions Forty percent had functional abnormality; 16% had mucosal absorption abnormality while 30% required >1 readmission. Exocrine
and endocrine insufficiencies were more prevalent in first year, and a significant proportion had both. A trend for higher
functional insufficiency was observed in infected necrosis, complete or incomplete visualization of main pancreatic duct (MPD),
dilated segment of MPD, and pseudocyst. 相似文献
79.
Rakesh Kochhar Usha Dutta Rajat Shukla Birinder Nagi Kartar Singh Jai D. Wig 《Digestive diseases and sciences》2009,54(7):1578-1581
Endoscopic papillary balloon dilatation (EPBD) has been recently used in conjunction with endoscopic sphincterotomy (EST)
for the removal of common bile duct (CBD) stones. The present study was aimed at assessing the safety and outcome of sequential
EPBD following EST for CBD stones. A total of 74 patients (43 females, mean age 41 years) with ≥10-mm stone(s) in the CBD
were selected for the procedure, which included limited EST followed by EPBD with balloon dilators of 10–18 mm in size. Eleven
patients had undergone EST and unsuccessful stone removal earlier. Forty-nine patients had symptoms of CBD stones, while 25
were detected on imaging. Eleven patients had previous CBD stent in situ and four had T-tube in situ. The stone size was 10–12 mm
in 34, 13–14 mm in 26, and ≥15 mm in 14 patients. Thirty-one patients had a single stone, while 43 had ≥2 stones. The successful
removal of stones was achieved in 68 (91.9%) patients; 62 in the first attempt, five in the second, and one in the third.
Six patients were deemed to be “failures.” In two of them, the stones could be removed after mechanical lithotripsy. Complications
were seen in 16 patients, with self-limiting pain in 13, self-limiting ooze in five, melaena in one, and mild pancreatitis
in two. One patient had impaction of the dormia basket. We conclude that EPBD following EST is safe and effective in removing
stones ≥10 mm in size in over 90% of patients. 相似文献
80.
Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography 总被引:1,自引:0,他引:1
The objective of this study is to evaluate the efficacy of dynamic MRI with magnetic resonance cholangiopancreatography (MRCP) in the preoperative assessment of gall bladder carcinoma. Magnetic resonance imaging and MRCP were carried out in 15 patients with gall bladder carcinoma before surgery and the imaging findings correlated with surgical and pathological findings. Gall bladder carcinoma manifested as focal or diffuse wall thickening in 73% (11/15) and as a mass replacing the gall bladder in 27% (4/15). All tumours showed enhancement in the early phase, which persisted into the delayed phase. The sensitivity and specificity of MRI with MRCP in detecting hepatic invasion, lymph node metastasis and bile duct invasion was 87.5 and 86%, 60 and 90%, and 80 and 100%, respectively. Magnetic resonance imaging correctly diagnosed duodenal invasion in only 50% and in none of the two patients with peritoneal metastasis. In conclusion, dynamic MRI with MRCP is an accurate and a reliable method of showing gall bladder carcinoma and in assessing its local and regional extent as part of preoperative assessment. 相似文献