A 17-year-old female patient with features of epilepsy was treated with valproic acid. Two years later, hypoglycemia and hyperinsulinemia appeared. Transabdominal ultrasonography, spiral computed tomography, and indium-111 Octreoscan were performed without positive results. Endoscopic ultrasonography identified an oval tumor in the pancreatic tail with a color Doppler hypervascular pattern. Surgical enucleation decreased levels of insulin and C-peptide within 20 min, and the patient became free of symptoms and medications.

Adolescent↗

PubMedDate not supplied

Incidence of post-endoscopic retrograde-cholangiopancreatography/sphincterotomy pancreatitis depends upon definition criteria.

BACKGROUND: The reported incidence of post-endoscopic retrograde-cholangiopancreatography/sphincterotomy pancreatitis ranges between 1.3% and 12.8%. This may likely reflect different definitions of pancreatitis and methods of data collection, rather than differences in patient populations, indications and endoscopic expertise. AIMS: The present study evaluated the incidence of post-endoscopic retrograde-cholangiopancreatography/sphincterotomy pancreatitis using different definition criteria and different data collection methods. PATIENTS: The 24-hour clinical and enzymatic course of 1185 procedures was recorded. METHODS: Pancreatic-like pain and hyperamylasaemia were evaluated either 6 to 8 hours or 24 hours after the procedure; computed tomography scan was performed in those patients with 24-hour pancreatic pain associated with hyperamylasaemia more than three times the upper normal limit. Results. Computed tomography scan findings consistent with pancreatitis were observed in 1.9% of cases, only among those patients with 24-hour pancreatic-like pain and hyperamylasaemia over five times the upper normal limit. The 6-8-hour and 24-hour pancreatic-like pain was associated with serum amylase levels at least three times higher in 11.7% and 6.6% and five times higher or more in 7.4% and 5.1%, respectively; 6-8 and 24-hour hyperamylasaemia higher than five times the upper normal limit, irrespective of pancreatic-like pain, was reported in 8.3% and in 6.9% of cases. No patients with serum amylase values lower than three times the upper normal limit had clinical symptoms. CONCLUSIONS: The incidence of post-procedure pancreatitis ranged from 1.9% to 11.7% depending on the definition criteria adopted.

Adolescent↗

PubMedDate not supplied

Reoperation for retained and recurrent bile duct stones.

The results obtained in 45 patients who underwent 48 common bile duct reoperations for retained or recurrent choledocholithiasis are reported. The preoperative diagnosis was based on intravenous cholangiography and, in jaundiced patients, on echography and percutaneous transhepatic cholangiography with a Chiba needle. The operations performed on the biliary tract were choledocholithotomy and sphincterotomy (46%), choledocholithotomy (21%), sphincterotomy (16%), choledochoduodenostomy (15%) and Roux-Y choledochojejunostomy (2%). There were three (6.6%) operative deaths: one biliary fistula and two massive digestive hemorrhages. Follow-up lasting from six months to 16 years was carried out in 83% of the patients: 73% reported complete well-being. The causes of "secondary" calculosis are analysed with a critical review of the cholangiographic data and the technique performed. The authors conclude that routine operative cholangiography with the possible addition of choledochoscopy, and adequate biliary drainage are sufficient to prevent "secondary" choledocholithiasis.

Adult↗

PubMedDate not supplied

[Anesthesia in the pregnant myasthenic patient (considerations on 2 cases of voluntary interruption of pregnancy)].

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Abortion, Therapeutic↗