Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.
Alcoholism/*complications ; Central Nervous System Diseases/complications/pathology ; Humans ; Male ; Middle Aged ; Pellagra/*complications/pathology ; Wernicke Encephalopathy/*complications/pathology

Marchiafava-Bignami disease (MBD) is a fatal disorder characterized by demyelination of the corpus callosum. MRI, suggestive of corpus callosum demyelination with associated white matter involvement in both cerebral hemispheres, indicates a diagnosis of MBD. In this case, MR diffusion-weighted findings taken at an acute stage of MBD revealed lesions not only in the corpus callosum but also in the cerebral cortex. Lower apparent diffusion coefficient values of the corpus callosum and cortical lesions were associated with poor clinical outcome.
Middle Aged ; Male ; Humans ; Demyelinating Diseases/*pathology ; Corpus Callosum/*pathology ; Brain/*pathology ; Alcoholism/complications

OBJECTIVE: To introduce recent progress on diagnosis and treatment of benign symmetric lipomatosis (BSL). METHOD: Detailed clinical data of 6 patients with BSL were reviewed and analyzed. We present a summary of the clinical symptoms, physical sign, diagnosis and therapeutic methods of BSL. And related literatures were discussed together. RESULT: All of 6 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had upper extremity localizations. Six patients had the complication of left ventricular diastolic function changes, glucose intolerance or diabetes mellitus, chronic hepatopathy, hyperuricemia and sleep apnea syndrome in one or more. One patients with several symptoms occur simultaneously, another one female patient was accompanied by all symptoms but chronic hepatopathy. Five male patient were alcohol abusers. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. One patient refused treatment. During a follow-up of 3 months to 4 years, one patients was relapsed again, and no recurrence was seen in another 4 patients. All patho logical results were nonencapsulated fat. CONCLUSION BSL is a lipodystrophy caused by diffuse fatty tissue, symmetry deposition in the neck and shoulder subcutaneous fascia space or deep fascial space. The highest incidence favors to middle-aged man who is alcoholic. Chronic alcohol addiction and typical clinical symptoms help to diagnosis BSL. Lipectomy represents a successful procedure in treating BSL.
Adult ; Alcoholism ; complications ; Fascia ; pathology ; Female ; Humans ; Lipectomy ; Lipomatosis, Multiple Symmetrical ; complications ; diagnosis ; surgery ; Male ; Middle Aged ; Neck ; pathology ; Shoulder ; pathology

Adult ; Alcoholism ; complications ; Humans ; Lipomatosis, Multiple Symmetrical ; diagnostic imaging ; etiology ; pathology ; surgery ; Male ; Neck ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed

No abstract available.
Aged ; Alcohol-Induced Disorders, Nervous System/etiology/*pathology ; Alcoholism/complications/*pathology ; Cerebellum/*pathology ; Diagnosis, Differential ; Early Diagnosis ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Reproducibility of Results ; Sensitivity and Specificity ; Spinocerebellar Degenerations/*etiology/*pathology

Adult ; Aged ; Alcohol Drinking ; adverse effects ; Alcoholism ; complications ; Hepacivirus ; physiology ; Hepatitis C, Chronic ; pathology ; virology ; Humans ; Interferon-alpha ; adverse effects ; therapeutic use ; Liver ; immunology ; pathology ; Liver Cirrhosis ; etiology ; pathology ; Male ; Middle Aged ; RNA, Viral ; biosynthesis ; Virus Replication ; drug effects

OBJECTIVETo assess the risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy.

METHODSFrom May 1999 to July 2007, 285 periampullary cancer patients underwent pancreaticoduodenectomy in our hospital. The clinical data, pathological results, type of operation, and postoperative treatment were retrospectively analyzed. Patients with stress-related ulcer and gastrointestinal hemorrhage were selected for risk factor analysis, and other patients were taken as control group.

RESULTS35 patients (12.3%) developed stress-related ulcer and gastrointestinal hemorrhage following pancreaticoduodenectomy. Pathological examination showed pancreatic cancer in 5 cases, duodenal cancer in 8, common bile duct cancer in 10, ampullary carcinoma in 11, and solid-pseudopapillary tumors in 1. Single variate analysis demonstrated that alcohol, preoperative bilirubin level, operation time, lymph node metastasis, prealbumin decrease after operation and other complication were significantly associated with the stress-related ulcer and gastrointestinal hemorrhage. Logistic regression in multivariate analysis revealed that preoperative bilirubin level, operation time, other complication, prealbumin decrease after surgery were independent risk factors.

CONCLUSIONStress-related ulcer and gastrointestinal hemorrhage are one of the most common complications after pancreaticoduodenectomy. Preoperative bilirubin level, operation time, other complications, and prealbumin decrease after operation are four independently risk factors.

Adolescent ; Adult ; Aged ; Alcoholism ; complications ; Ampulla of Vater ; Bilirubin ; blood ; Common Bile Duct Neoplasms ; complications ; pathology ; surgery ; Duodenal Neoplasms ; complications ; pathology ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms ; complications ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Peptic Ulcer ; etiology ; Prealbumin ; metabolism ; Retrospective Studies ; Risk Factors ; Stress, Psychological ; complications ; Young Adult

Adult ; Aged ; Alcohol Drinking ; adverse effects ; epidemiology ; Alcoholism ; complications ; pathology ; China ; epidemiology ; Female ; Humans ; Liver Cirrhosis, Alcoholic ; epidemiology ; etiology ; Liver Diseases, Alcoholic ; complications ; epidemiology ; Male ; Middle Aged ; Risk Factors

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.
Alcoholism/complications ; Diagnosis, Differential ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/radiography ; Esophageal Neoplasms/ultrasonography ; Esophagoscopy ; Gastritis/complications ; Helicobacter Infections/complications ; Hemangioma, Cavernous/diagnosis ; Human ; Incidental Findings ; Lymphoma, Mucosa-Associated Lymphoid Tissue/pathology* ; Lymphoma, Mucosa-Associated Lymphoid Tissue/radiography ; Lymphoma, Mucosa-Associated Lymphoid Tissue/ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology ; Neoplasm Invasiveness ; Smoking ; Thyroiditis, Autoimmune/complications

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.
Aged ; Alcoholism/*complications ; Antiparasitic Agents/administration & dosage ; Diarrhea/drug therapy/*etiology/parasitology/*pathology ; Humans ; Isospora/*isolation & purification ; Isosporiasis/*diagnosis/drug therapy/parasitology/*pathology ; Male ; Republic of Korea ; Sulfamethoxazole/administration & dosage ; Treatment Outcome ; Trimethoprim/administration & dosage