We devised and evaluated a clinical pathway (CP) protocol for patients with bleeding peptic ulcers (BPU). Patients without severe comorbidities, who had been diagnosed with BPU and who had undergone endoscopic treatment, were enrolled in our study. The CP adaptation rate for BPU patients was 78.8% (89/113). The variance rate was 13.5% (12/89). The median length of admission was 10.0±4.6 days (n=78) before and 7.4±2.9 days (n=77) after introducing CP. Our CP for BPU was safe and resulted in shorter hospital stays and, therefore, cost reductions. In elder patients, our CP was also successful, but the variance rate was higher than in younger patients.
We experienced the case that used S-1 for small intestinal cancer with peritoneal dissemination. A 51-year-old man admitted for fatigability and anemia. Small bowel series showed a stenosis lesion at the 15cm anal side from Treiz ligament, and the oral intestinal dilatasion was shown. CT showed the thickening of small intestinal wall and rectal wall. In addition, a rectal stenosis was shown by barium enema. It was diagnosed as small intestinal cancer with peritoneal dissemination, and an operation was performed. Peritoneal dissemination was recognized in the intraperitoneal whole, so jejunum partial resection was performed for primary cancer lesion. After an operation, internal use of S-1 was performed in an outpatient department. One course was assumed administration for four weeks and withdrawal for two weeks, and three courses was performed. There was not a side effect, and barium enema showed improvement of a rectal stenosis, and CT showed improvement of thickening of a rectal wall. A lesion worsened afterwards, and he died in postoperative six months.
A 39-year-old man diagnosed as Crohn's disease suffered steroid induced psycosis during treatment for Crohn's disease on July 2001. He was admitted on May 2002, because of progressing high fever, abdominal pain and diarrhea. He was treated with infriximab (5mg/kg) together with mesalazine without steroid. The treatment induced rapid improvement of systematic symptoms together with laboratory data and colonoscopic findings. He kept remission for more than 10 months after a single administration of infliximab (5mg/kg). The case is suggestive of wider indication of infliximab for Crohn's disease.
A 60-year old man admitted our hospital due to abdominal pain, melena and arthralgia. There was purpura on his legs. On admission, the abdominal CT showed segmental mural thickening of terminal ileum and ascites. On the 4th hospital day, the abdominal CT showed severe mural thickening of the third portion of duodenum. On the 8th hospital day, the abdominal CT showed severe mural thickening of terminal ileum. We reported a rare case of Henoch-Schnlein purpura with relapse of ileitis and duodenitis for a short period which could be examined on the abdominal CT.
The patient was a 45-year-old man, with no complaints. It was pointed out that he had a cystic lesion in the liver by abdominal ultrasonography at routine medical check-up. With close examinations, the tumor was multilocular cystic lesion in the right lobe of the liver, whose size was 35mm in diameter. We supposed it was a biliary cystadenoma (adenocarcinoma), echinococcosis, or degenerated hemangioma. And we performed partial hepatectomy. Finally, it was diagnosed as pure type monolobar Caroli's disease by pathological examination. This was a rare case of Caroli's disease which arose limitedly in monolobe. And we could curatively resect it by hepatectomy.