Internal medicine
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Small cell carcinoma of the bile duct system is extremely rare, and surgical procedures have been complicated by early hematogenous dissemination. In this study, we report a patient with small cell carcinoma of the bile duct system presenting with jaundice. ⋯ We performed radiation therapy of a total of 30 Gy, resulting in a marked decrease of serum neuron specific enolase levels and amelioration of jaundice, which had been resistant to drainage procedures. The patient was then treated with combined chemotherapy of cisplatin and CPT-11, which resulted in the disappearance of the tumor mass by image tests.
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A 51-year-old woman suffered from xerophthalmia and xerostomia for 3 years without being medically examined. In July 2006, she was referred to our hospital for the evaluation of chest roentgenogram showing slight pleural effusion in the right lung. A chest CT scan revealed multiple nodules, enlarged mediastinal and hilar lymph nodes, and bilateral slight pleural effusions. ⋯ Histological examination of the specimen from the nodular lesion by video-assisted thoracoscopic biopsy revealed noncaseating epithelioid cell granuloma containing giant cells, which confirmed the diagnosis of sarcoidosis. Although the coexistence of Sjögren's syndrome and sarcoidosis has been reported occasionally, cases with histological evidence of sarcoidosis have been rare. Pulmonary sarcoidosis should be considered in the differential diagnosis of pulmonary multiple nodules in patients with Sjögren's syndrome.
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Fleet enema (sodium phosphate, C. B. Fleet Co., Inc., Lynchburg, Virginia) is widely used for bowel preparation or constipation relief in the hospital and over the counter. ⋯ The patients with older age, bowel obstruction, small intestinal disorders, poor gut motility, and renal disease are contraindicated or should be administered with caution. We present a patient with old age and chronic renal failure who developed severe hyperphosphatemia and hypocalcemic tetany with coma after sodium phosphate enema. We recommend the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high risk patients.
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Review Case Reports
Pancytopenia complicated with peripheral neuropathy due to copper deficiency: clinical diagnostic review.
Only a dozen cases of pancytopenia caused by copper deficiency have been reported. We report the case of an 81-year-old man who underwent total gastrectomy for gastric cancer. ⋯ The administration of copper into TPN led to rapid improvement in anemia and neutropenia. We review 11 previous cases of copper-deficient cytopenia, categorized into two groups according to etiology, and define the characteristic symptom of copper malabsorption caused by excess Zn as peripheral neuropathy.