A 59-year-old woman underwent orthotopic heart transplantation 4 years earlier. At the time of transplantation, she was receiving pravastatin at a dose of 20 mg per day; she tolerated subsequent combination with immun...A 59-year-old woman underwent orthotopic heart transplantation 4 years earlier. At the time of transplantation, she was receiving pravastatin at a dose of 20 mg per day; she tolerated subsequent combination with immunosuppression(cyclosporine A, prednisone,mycophenolatemofetil) very well throughout the 4 years. After switching from pravastatin to simvastatin, she developed severe muscular weakness and laboratory evidence of muscle break down. Biochemical markers of rhabdomyolysis did not subside until after repeat hemodialysis and normalized after 2 months in conjunction with improved renal function. Clinical improvement was not apparent until after 5 months.展开更多
AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into t...AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile duct.METHODS:Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever,and showed signs of inflammatory reaction and marked rise of hepatobiliary enzymes.These symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on MRCP.All these patients were subjected to ERCP within 3 d of MRCP to check for the presence of stones.RESULTS:No stones were detected by ERCP in any patient,confi rming the results of MRCP.CONCLUSION:When clinical symptoms improve,blood biochemical parameters have normalized,and MRCP shows there are no stones in the common bile duct,it can be considered the stone has spontaneously passed and thus ERCP is not necessary.展开更多
文摘A 59-year-old woman underwent orthotopic heart transplantation 4 years earlier. At the time of transplantation, she was receiving pravastatin at a dose of 20 mg per day; she tolerated subsequent combination with immunosuppression(cyclosporine A, prednisone,mycophenolatemofetil) very well throughout the 4 years. After switching from pravastatin to simvastatin, she developed severe muscular weakness and laboratory evidence of muscle break down. Biochemical markers of rhabdomyolysis did not subside until after repeat hemodialysis and normalized after 2 months in conjunction with improved renal function. Clinical improvement was not apparent until after 5 months.
文摘AIM:To investigate the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in cases of suspected spontaneous passage of stones into the common bile duct.METHODS:Thirty-six patients with gallbladder stones were clinically suspected of spontaneous passage of stones into the common bile duct because they presented with clinical symptoms such as abdominal pain and fever,and showed signs of inflammatory reaction and marked rise of hepatobiliary enzymes.These symptoms resolved and they showed normalized values of blood biochemical parameters after conservative treatment without evidence of stones in the common bile duct on MRCP.All these patients were subjected to ERCP within 3 d of MRCP to check for the presence of stones.RESULTS:No stones were detected by ERCP in any patient,confi rming the results of MRCP.CONCLUSION:When clinical symptoms improve,blood biochemical parameters have normalized,and MRCP shows there are no stones in the common bile duct,it can be considered the stone has spontaneously passed and thus ERCP is not necessary.
