BACKGROUND: To the best of our knowledge, the report on Amanita subjunquillea poisoning has not been found in the medical literature. We investigated the clinical aspects of Amanita subjunquillea poisoning. METHODS: Sixteen subjects who had ingested the mushroom (A. subjunquillea) were examined for clinical features, laboratory and radiologic findings prospectively. RESULTS: The mean incubation period was 11.5 hours(range: 3 to 17 hours). The initial presentations were gastrointestinal symptoms which persisted for 2 to 4 days. The transaminase levels were elevated in all subjects and peaked on day 3 after ingestion of the mushrooms (mean AST/ALT levels : 3241 IU/L and 3741 IU/L, respectively). Biochemical evidence of pancreatitis and disseminated intravascular coagulation were frequent (83.3% and 62.5%, respectively). Liver ultrasonography and scintigraphy revealed abnormalities in most cases. Massive hepatic necrosis was confirmed by liver biopsy in one subject. The overall mortality was 12.5%. CONCLUSION: Clinical manifestations of A. subjunquillea poisoning were similar to those of other poisonous Amanitaceae intoxication. However, the mortality rate was lower in A. subjunquillea poisoning. Our data showed strong evidence that A. subjunquillea should be classified in the group of poisonous mushrooms.
Agaricales ; Amanita* ; Biopsy ; Disseminated Intravascular Coagulation ; Eating ; Liver ; Massive Hepatic Necrosis ; Mortality ; Pancreatitis ; Poisoning* ; Prospective Studies ; Radionuclide Imaging ; Ultrasonography

Hepatobiliary scintigraphy using Tc-labelled radiopharmaceuticals is employed primarily for the diagnosis ofacute cholecystitis and for demonstration of biliary tract patency. We conducted a retrospective study of 55patients with hepatobiliary disease from Jun. '84 to Sep. '84 at Taegu Catholic Hospital and tried to determinethe etiology and fine the possible differential points by analyzing the scintigraphic findings. The followingresults were obtained: 1. Tree-like photon defect on hepatic parenchyme was suggested characteristic of completeobstructive biliary diseases, but could be seen in either benign or malignant etiology. 2. The grade of hepatocyteclearance was not useful in detemining whether the cause of obstructive biliary disease was benign or malignant inthis study. 3. Hepatocyte clearance was more severely impaired in hepatocellular disease than in obstructivebiliary disease. 4. The photon defect in porta hapatis with complete biliary obstruction was suggestedcharacteristic of common bile duct cancer. 5. The meniscus appearance at obstructed site of common bile duct waspathognomonic sign of choledocholithiasis. 6. When the gallbladder was not visualized, the differential diagnosisbetween acute and chronic cholecystitis was possible without delayed image by observing the transist time tobowel. The delayed transit to bowel was a favorable of chronci cholecystitis rather than of acute cholecystitis.7. Acute pancreatitis could be easily differentiated from partial biliary obstruction by clinical and laboratoryexamination, but the finding of abrupt narrowing of pancreatic common bile duct with sligt proximal dilatation oncholescintigraphy was also a key point in acute pancreatitis. 8. The segmental dilatation of intrahepatic duct wasthought meaningful sign of clonorchiasis.
Biliary Tract ; Cholecystitis ; Choledocholithiasis ; Clonorchiasis ; Common Bile Duct ; Daegu ; Diagnosis ; Dilatation ; Gallbladder ; Hepatocytes ; Pancreatitis ; Radionuclide Imaging ; Radiopharmaceuticals ; Retrospective Studies

PURPOSE: We report seven cases of pancreas transplantation, first performed in Korea, in the context of postsurgical radiologic studies. MATERIALS AND METHODS: All patients with insulin-dependent diabetes mellitus received transplants from cadevaric(n=6) or living related donor(n=1). Retrospective analysis of 27 US(including 19 Duplex US), two CT, four MRi, and three scintigraphy for these patients was made with surgico-pathological correlation in five cases. RESULT:Of the seven patients, three-month graft survival was five and one-year survival was two. One patient died of abdominal abscess following surgery. US gave the valuable informations regarding the graff swelling, vascular complication, and perigraff fluid collection. RBC bleeding scan was effective of the presence or absence and location of intestinal bleeding. CT was useful in determining the extent and severity of the pancreatitis. MRI gave a little information about functional status of the grafted pancreas. CONCLUSION: The choice of appropriate imaging modalities for postsurgical work up in patients who had pacreas transplantation depends on the clinical conditions of the patients and complications suspected. Further prospective studies appear to be necessary to eatablish the interval and modality choice for early detection of the complication.
Abdominal Abscess ; Diabetes Mellitus, Type 1 ; Graft Survival ; Hemorrhage ; Humans ; Korea ; Magnetic Resonance Imaging ; Pancreas Transplantation* ; Pancreas* ; Pancreatitis ; Radionuclide Imaging ; Retrospective Studies ; Transplants

We report the first case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid cyst in a 67-year-old man. Laboratory investigation revealed increased serum amylase and lipase, increased serum ionized calcium and parathyroid hormone (PTH) levels, and decreased serum phosphate, indicating pancreatitis and primary hyperparathyroidism (PHPT). Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration and fluid collection around the pancreatic tail. Ultrasonography and CT of the neck showed a cystic lesion at the inferior portion of the left thyroid gland, suggesting a parathyroid cyst. There was no evidence of parathyroid adenoma by 99mTc sestamibi scintigraphy. PHPT caused by a functioning parathyroid cyst was suspected. The patient underwent surgical resection of the functioning parathyroid cyst owing to his prolonged hypercalcemia. At 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. At the follow-up examinations, he has remained asymptomatic.
Aged ; Amylases ; Calcium ; Follow-Up Studies ; Head ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Lipase ; Neck ; Pancreatitis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Radionuclide Imaging ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Ultrasonography

The aim of the present study was to evaluate the ability of Tl-201 abdominal SPECT to differentiate between chronic focal pancreatitis and pancreatic malignancy. Seventeen patients (12 men, 5 women; mean age, 56 years; 9 pancreatic cancer, 8 chronic pancreatitis) with pancreatic mass were prospectively investigated with Tl-201 abdominal SPECT. In all patients, CT and/or US could not clarify the nature of the pancreatic mass. Focal hot uptake was present in 8 of 9 patients with pancreatic cancer, while it was present in 2 of 8 patients with chronic pancreatitis. Therefore, the sensitivity and specificity of the present study were 89% and 75%, respectively. A significant difference of Tl-201 uptakes was noted between benign and malignant masses (p& 0.05). Therefore, we concluded that Tl-201 abdominal SPECT was a useful test in differentiation of malignant from benign pancreatic mass, especially when the differentiation could not be made by other imaging modalities
Abdomen/*radionuclide imaging ; Chronic Disease ; Diagnosis, Differential ; Evaluation Studies ; Female ; Follow-Up Studies ; Human ; Male ; Middle Age ; Pancreatic Neoplasms/*radionuclide imaging ; Pancreatitis/*radionuclide imaging ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Support, Non-U.S. Gov't ; Thallium Radioisotopes/*diagnostic use ; Tomography, Emission-Computed, Single-Photon/methods