Ascaris lumbricoides is the most widespread cause of helminthic infestations in developing countries. It is more prevalent and its course more serious in children than in adults (1). The parasite most commonly settles in the mid-section of the ileum and jejunum in the intestines. Intestinal infection is generally asymptomatic. However, serious complications may occur, such as ascending cholangitis, acute acalculous cholecystitis, obstructive jaundice, pancreatitis, liver abscesses, and septicemia, with the settlement of the parasite in the biliary tract ascending upwards from the intestines (2,3). Due to the narrow and tortuous structure of the biliary tract, it is rare for the parasite to invade the gallbladder or the pancreatic duct (1). This presentation evaluates the diagnosis and follow-up findings with ultrasonography (US) of a rare case of ascariasis settled in the gallbladder, choledochus and pancreatic duct, causing cholangitis and pancreatitis. CASE REPORTA 15-year-old female living in a rural area presented to our hospital with complaints of abdominal pain, nausea, vomiting, fever, anorexia, and weight loss. The patient had sensitivity in the right hypochondriac and epigastrium and hepatomegaly. Her laboratory examinations revealed: leukocytosis (18000/μl), significant increases in aspartate aminotransferase (AST) 55 (<37) IU/L, alanine aminotransferase (ALT) 107 (<40) IU/L and amylase 340 (<83) IU/L. They also showed slight increases in alkaline phosphatase 94 (32-92)
A case of complete heart block induced by octreotide Oktreotid ile indüklenen bir tam kalp blo¤u olgusuTo the Editor, Acute variceal bleeding is one of the major complications of portal hypertension in cirrhotic patients. The current recommended hemostatic treatment of variceal bleeding is to start a vasoactive drug from admission or upon the patient's transfer to the hospital and associated endoscopic therapy at the time of diagnostic endoscopy (1). The combination of sclerotherapy and octreotide infusion has been advocated in some studies (2). However, it may have effects on cardiac conduction (3).A 53-year-old female was admitted to our hospital due to overt hematemesis. She had been under treatment for cirrhosis associated with hepatitis B for 26 months. Blood pressure, pulse rate, and hematocrit (Htc) were 80/60 mmHg, 85/min and 32.4%, respectively. After an intravenous bolus of 50 mcg octreotide, 50 mcg/hr octreotide infusion was started. Bradycardia (heart rate 32 bpm) and hypotension (70/40 mmHg) developed at the 60 th hour of octreotide infusion. The electrocardiography revealed complete atrioventricular (AV) block ( Figure 1A). Although heart rate and blood pressure improved after atropine administration and saline infusion (45-50 bpm), AV block failed to resolve. The patient was monitored, and since hemodynamics were stable, we did not proceed with pacing. Electrolytes were within normal limits. Transthoracic echocardiography was normal. Angiography was performed to eliminate underlying ischemic heart disease but coronary arteries were normal. Six days after cessation of octreotide infusion, the patient was out of complete AV block and in normal sinus rhythm ( Figure 1B). Mild bradycardia has been described after octreotide administration, though not frequent (4). In a small series of patients with acromegaly receiving octreotide subcutaneously, the mean heart rate decreased, and the mean systemic vascular resistance increased (5).Dilger et al. (3) reported an octreotide-induced third-degree heart block during surgical resection of a carcinoid tumor after a large bolus administration. Herrington et al. (4) described a patient who was receiving octreotide subcutaneously and developed bradycardia (38 bpm) without heart block. In several other reports, octreotide administration did not consistently demonstrate a reduction in heart rate (6).
Background:The aim is to present our experiences on the treatment and follow-up in the injuries of corrosive intake. Materials and methods:Twelve patients who were admitted to clinics because of swallowed corrosive substance between year 2005 and 2010 were evaluated retrospectively.Results: According to the findings of esophagogastroduodenoscopies performed in the first in 12 to 24 hours, none of the patients had grade III esophageal injuries but only one patient who had grade III stomach injury was operated urgently and total gastrectomy + Roux-en-Y esophagojejunostomy was performed. The others that were grades I and II were managed conservatively. During the follow-up period, all patients were controlled with clinic and endoscopic examinations in 1st and 3rd months.Conclusion: These patients were managed by the teams of general surgeon, and head and neck surgeons urgently. Early esofagogastroscopy was so important for the treatment strategy of these patients.
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