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( Saurabh Galodha ),( Rajneesh K Singh ),( Anu Behari ),( Ashok Kumar Gupta ),( V K Kapoor ),( Rajan Saxena ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Portal hypertension (PHT) and secondary biliary cirrhosis (SBC) are found in 7-20% patients of postcholecystectomy benign biliary strictures (BBS), which can lead to significant morbidity and mortality. This study was done to look for factors associated with PHT and SBC in BBS and its effect on perioperative morbidity and final outcomes. Methods: A retrospective analysis of 613 patients of BBS managed between January 1989 and December 2012 was done. Preoperative and intraoperative parameters and perioperative morbidity were registered. Outcomes were analyzed with McDonald grading with grades A and B considered as success. Results: A retrospective analysis of 613 patients of BBS managed between January 1989 and December 2012 was done. Preoperative and intraoperative parameters and perioperative morbidity were registered. Outcomes were analyzed with McDonald grading with grades A and B considered as success. Nineteen patients of BBS with PHT were operated. PHT was seen more commonly in BBS grade III and above (n=12,63%). The median time to repair in patients with PHT was more than 4 times that of patients without PHT (826 days vs. 210 days). Two patients with PHT had strictured previous primary repair in the form of Roux-en Y hepaticojejunostomy (RYHJ). In all patients RYHJ with liver biopsy was performed. None of the patients required prior portosystemic shunting. In patients with PHT mean operating time (4.6 ± 2.8 vs. 3.5 ± 2 hours) as well as median blood loss (400 ml vs. 200 ml) was increased but there was no significant increase in perioperative morbidity. Median follow up for these patients was 54 months. Success rate for RYHJ was 89% and only 1 patient required a revision RYHJ due to stricture and recurrent cholangitis. Conclusions: Delayed repair, higher grade of BBS and failed primary repair are factors associated with development of PHT in BBS. RYHJ is feasible without need of portosystemic shunting in all these patients with minimal morbidity and good long-term results.
( Amith R ),( Girish Ramteke ),( Dharmendra Jhavar ),( Lalan Pratap Singh ),( Anu Daber ),( Manoj Gupta ),( Nd Punjabi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Antithyroid drugs are used to treat toxic multinodular goitre(TNG). Carbimazole is usually the drug of choice except in pregnancy where propylthiouracil is used. It is well tolerated and common side effects include allergy, upper GI upset, rarely agranulocytosis. Hepatitis is rare but serious complication.We report a 55yr female with TNG, who developed cholestatic hepatitis after carbimazole therapy for 2 months. She recovered completely following withdrawal of the drug.Toxic multinodular goitre (Plummer`s disease) is a 2nd most common cause for hyperthyroidism after Grave`s disease, 15-30% cases, (>50 years) and women. Unlike Grave`s disease which is autoimmune and antithyroids are started universally, TNG is not known to recur after therapy. So surgery or radioiodine are treatment of choice. Antithyroids are used for symptomatic relief in patients waiting surgery. Side effects are mild, include allergic reactions, upper GI intolerance, agranulocytosis, vasculitis-like reaction particularly propylthiouracil. Hepatotoxicity is rarebut serious side-effect with both carbimazole and propylthiouracil (PTU). Histology with PTU shows toxic hepatitis &necrosis and it is cholestatic hepatitis with carbimazole. Our case demonstrates carbimazole induced cholestatic hepatitis in patient with TNG. Clinical,biochemical fi nding with relevant review of literature is presented. Patient was put on propranolol, prednisolone in the interim for her thyrotoxicosis and exophthalmosis. Liver function tests improved signifi cantly following stoppage of carbimazole. The high degree of alkaline phosphatase could also be due to effect of hyperthyroidism on bone resorption. She is currently euthyroid. In summary, jaundice as a complication of thionamide treatment of hyperthyroidism is rare, this complication cannot be predicted by deranged liver enzymes at presentation, but typically occurs within three months of therapy, it can be fatal, particularly when there are additional hepatotoxic factors, and the drug must be withdrawn immediately and alternative therapy, such as radioiodine must be considered in appropriate patients.