Background and Aims: According to American Association for the Study of Liver Diseases (AASLD) practice guidelines, Short-term antibiotic prophylaxis should be instituted in any patient with cirrhosis and gastrointestinal bleeding (GI) hemorrhage. Oral norfloxacin or intravenous ciprofloxacin and intravenous ceftriaxone are the recommended antibiotics but little has been known for intravenous cefazolin. This study aimed to compare cefazolin and ceftriaxone on the outcome of cirrhotic patients with acute variceal hemorrhage after endoscopic procedures.Methods: A cross-sectional, retrospective chart review study was conducted on cirrhotic patients with acute variceal bleeding who received endoscopic procedures in Kaohsiung Chang Gung Memorial Hospital in the periods from July 2009 to October 2010. Those patients with signs of infection, use of other kinds of antibiotics were excluded. They were then divided into two groups: cefazolin group (n=54, received intravenous Cefazolin 1g q8h for 2~7 days), and ceftriaxone group (n=22, received intravenous Ceftriaxone 1g q12h for 2~7 days). The end points were incidence of patients with infections, hospital days (began from the arrival at emergency room (ER) to the discharge day), time of rebleeding, death (died during hospitalization).Results: A total of 76 patients were enrolled (Male/Female=52/24, Age: 59.5±14.1). There were no significant differences in any of the clinical and laboratory data between cefazolin and ceftriaxone groups except for prolonged prothrombin time (12.7±1.4 vs. 16.0±6.4, P=.028). There were neither significant difference in infections rate (22.2% vs. 27.3%, P=.639), hospital days (11.3 ± 11.7 vs. 13.9 ± 11.6, P=.348), actuarial probability of remaining free of rebleeding (P=.348 by log-rank test) and mortality (7.4% vs. 13.6%, P=.325) between the two groups.Conclusion: Prophylactic intravenous cefazolin may have similar benefit as ceftriaxone in reducing infections, hospital days, rebleeding, and mortality in cirrhotic patients with acute variceal hemorrhage after endoscopic interventions. More large-scale studies are mandatory for this issue.
The impact of dengue on liver function was studied by biochemical tests on 125 male and 145 female patients diagnosed with this disease during an outbreak that extended from November 1987 to December 1988. Abnormal levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (G-GT) were observed in 93.3%, 82.2%, 7.2%, 16.3% and 83.0% of the patients, respectively. The elevation of transaminases was mild to moderate in most cases, but was 10-fold greater than the normal upper limit for AST and ALT in 11.1% and 7.4% of the patients, respectively. Initially, the level of AST was greater than that of ALT, increasing to maximum levels nine days after the onset of symptoms, then decreasing to normal levels within two weeks. Results of the biochemical tests did not differ significantly between the cases with and without hepatitis B or hepatitis C virus infection, but significantly higher elevations of AST, ALT, and G-GT were observed in patients with episodes of bleeding. Liver biopsies of two patients showed features of lobular hepatitis. Of the five fatal cases, three died of hepatic failure. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever infection should be considered in the differential diagnosis of hepatitis.
A 66-year-old male patient without a history of risk factors for pancreatitis suffered from pancreatitis and developed pseudocyst. During the course of treatment and follow-up, the pseudocyst was found to have migrated through the pancreatic tail, left hepatic lobe, caudate lobe, and spleen on abdominal sonography and computed tomography scan. Finally, emergent laparotomy was done for splenic abscess and removal of infected pseudocyst in the spleen and lesser sac of the abdomen. The patient made a full recovery after operation.
Background and Aims: Foreign object ingestion and food bolus impaction are common clinical problems even among adults. However, local literature is scarce. We report our real world clinical experience using endoscopic management to treat adult foreign body ingestion and food bolus impaction.Methods: A retrospective chart review study was conducted on adult patients with foreign body ingestion and food bolus impaction who presented at Kaohsiung Chang Gung Memorial Hospital between November 2010 and October 2011. The clinical variables analyzed were age, gender, the type, number and location of the foreign bodies, associated upper gastrointestinal diseases, the endoscopic method used, the accessory device used and any symptoms and complications during the removal procedure.Results: A total of 50 patients (53 incidents) met the inclusion/exclusion criteria and were included in the study (male/female: 1/1.08; age 53 ± 18 years). Among them, 36 foreign bodies were found successfully (67.9%). Most of the foreign bodies were located in the esophagus (66.7%). Food bolus impaction was the most common finding (38.9%). The majority of foreign bodies in current study were successfully extracted (94.4%) and only one case required surgical intervention. A comparison between the symptomatic and asymptomatic patients revealed that a male gender, a sharp foreign body and the location of foreign body in the pharynx/esophagus were the significant relevant factors. Early endoscopic intervention seems to increase the detection rate.Conclusions: Endoscopic management is a safe and highly effective procedure when treating foreign body ingestion and food bolus impaction.
To evaluate the sonographic patterns of smooth muscle tumors of the gastrointestinal tract, we analyzed 25 patients with histologically confirmed smooth muscle tumors. Sonography revealed no abdominal mass in seven patients (sonogram-negative), and abdominal masses in 18 patients (sonogram-positive). The mean size of tumors in the sonogram-negative group (4.5 +/- 1.5 cm) was smaller than that in the sonogram-positive group (11.4 +/- 3.5 cm). We classified the various sonograms into three patterns. Comparing the sonograms with the computed tomographic pictures of each pattern, we theorized that the different patterns on sonograms may be caused by tumor necroses of different sizes with or without gas in the necrotic cavity. For the necrotic tumors, the size of the necrotic area did not correspond to the size of the tumor. However, the tumors with necroses were significantly larger than those without necroses. A central necrosis was found in cases exhibiting both leiomyosarcoma and leiomyoma. On comparing the sonogram-positive and sonogram-negative groups, we found that the size and location of a tumor may affect the detection rate of that tumor by sonography.
Summary of Trial Design. Lengthy exposure to quinolone-containing triple therapy in Helicobacter pylori eradication leads to the development of drug resistance. Sequential therapy with a quinolone and metronidazole -containing regimen appears to be an effective treatment option. This randomized controlled trial aimed to compare the efficacy of 5-plus 5 days' levofloxacin and metronidazole-containing sequential therapy (EALM) with that of 10-day levofloxacin-containing triple therapy (EAL) in second-line H pylori eradication treatment. One hundred and sixty-four patients who had failed the H pylori eradication attempts using the standard triple therapy (proton pump inhibitor bid, clarithromycin 500 mg bid, amoxicillin 1 g bid × 7 days) were randomly assigned to either an EALM therapy group (n = 82; esomeprazole 40 mg bid and amoxicillin 1 g bid for 5 days, followed by esomeprazole 40 mg bid, levofloxacin 500 mg qd, and metronidazole 500 mg tid, for 5 days) or a 10-day EAL therapy group (n = 82; levofloxacin 500 mg qd, amoxicillin 1 g bid, and esomeprazole 40 mg bid). One patient was lost to follow-up in each group. Follow-up for H pylori status was performed 4 to 8 weeks later. Eradication rates for the EALM and EAL groups were 90.2% (74/82, 95% confidence interval [CI] = 83.7%–96.8%) and 80.5% (66/82, 95% CI = 71.7%–89.2%, P = 0.077) in the intention-to-treat analysis; and 91.4% (74/81, 95% CI = 85.1%–97.6%) and 81.5% (66/81, 95% CI = 72.8%–90.1%, P = 0.067) in the per-protocol analysis. The adverse events for the EALM and EAL groups were 23.5% versus 11.1%, P = 0.038 but were all very mild and were well tolerated except for 1 patient with poor compliance. The compliances were 98.8% and 100%, respectively, between the 2 groups. An antibiotic resistance to levofloxacin was the clinical factor influencing the efficacy of H. pylori eradication therapy in the EAL group, and dual resistance to levofloxacin and metronidazole in the EALM group. Levofloxacin and metronidazole-containing sequential therapy achieved a >90% eradication rate as a second-line H pylori therapy. Dual antibiotic resistance to levofloxacin and metronidazole was the clinical factor influencing the efficacy of H pylori eradication therapy in the sequential therapy (ClinicalTrials.gov number: NCT02596620).
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