Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective randomized trial was undertaken to determine if selective peroperative cholangiography resulted in greater morbidity and mortality from missed common bile duct (CBD) stones. Five hundred and thirty-nine consecutive cholecystectomies were performed over a 3-year period. Two hundred and fifty-four had indications for mandatory peroperative cholangiography and were excluded from the trial. The remaining 285 patients, without a history of jaundice, pancreatitis or abnormal liver function tests, were randomized blindly into two groups. Group 1 underwent peroperative cholangiography (PC) and group 2 did not. If the surgeon found a dilated CBD at surgery then these patients were also excluded from the trial. Selective peroperative cholangiography revealed an unsuspected CBD calculus in 16 of the 132 patients (12%). Up to the time of review no patient from group 2 presented with symptoms or complications from retained CBD stones. One patient in group 1 had endoscopic removal of a retained CBD calculus 16 months after cholecystectomy. All patients were sent a questionnaire at least three years after surgery and 210 responded (74%). One hundred and thirty (62%) of the respondents had peroperative cholangiography. There were 11 deaths from unrelated causes. No difference between the two groups was found for postoperative dietary habit, dyspepsia, pain, flatulence, diarrhoea or signs of biliary obstruction. It seems from these results that a policy of selective cholangiography in our hands may miss a 12% incidence of unsuspected stones but, importantly, this does not appear to influence postoperative morbidity or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Does selective peroperative cholangiography result in missed common bile duct stones? 769 32

In patients undergoing percutaneous coronary intervention and in those with acute coronary syndromes, clopidogrel plus aspirin is the first-line antiplatelet therapy for reducing cardiovascular events. Although clopidogrel is generally well tolerated, with rash, indigestion, vomiting, diarrhea, and bleeding being the most common adverse effects, rare but serious complications may occur. We describe a 78-year-old woman who underwent percutaneous coronary intervention with drug-eluting stents; clopidogrel and aspirin were started as antiplatelet therapy. Three weeks later, the patient developed mixed hepatocellular and cholestatic liver injury. Clopidogrel was discontinued, and her liver profile results began to improve. Her diagnostic work-up included screening for hepatitis, infectious mononucleosis, and rheumatologic diseases, as well as ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreaticography; all results were normal. On day 5 of hospitalization, because of the patient's risk for thrombosis secondary to the drug-eluting stents, clopidogrel was reintroduced; her liver enzyme levels increased. In the absence of any biliary obstruction or other obvious causes of hepatic injury, drug-induced hepatocellular injury and cholestatic jaundice were suspected, and clopidogrel was again discontinued. The patient's liver function tests gradually improved 3 days later and showed marked improvement at her 2-week follow-up visit after discharge. Use of the Maria and Victorino scale for diagnosis of drug-induced hepatotoxicity indicated a probable (score of 14) relationship between clopidogrel and mixed hepatocellular injury and cholestatic jaundice in this patient. Although routine liver function testing is not recommended in patients who receive clopidogrel, having a high index of clinical suspicion, drug rechallenge, and excluding other obvious causes are required to establish the diagnosis of a rare drug complication such as clopidogrel-induced hepatic injury.
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PMID:Clopidogrel-induced hepatocellular injury and cholestatic jaundice in an elderly patient: case report and review of the literature. 1939 67