Southern medical journal
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Southern medical journal · Apr 2010
Case ReportsBiliary fascioliasis mimicking sphincter of Oddi dysfunction.
Fasciola hepatica, a liver fluke of livestock, rarely presents as chronic biliary tract infection in humans. We report a 38-year-old woman from Ethiopia who presented with right upper quadrant pain and a dilated common bile duct on ultrasound and magnetic resonance cholangiopancreatography (MRCP) without other abnormalities. ⋯ She underwent endoscopic retrograde cholangiopancreatography (ERCP) and had a fluke, diagnosed as Fasciola hepatica, in the common hepatic duct. This report confirms the diagnostic and therapeutic role of ERCP in the management of biliary fascioliasis, and highlights the need to include fascioliasis in the differential diagnosis of biliary pain in patients emigrating from areas where this infection is endemic.
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Southern medical journal · Mar 2010
Randomized Controlled TrialIntrathecal sufentanil for intraoperative and postesophagectomy pain relief.
The present study compares the analgesic properties of intrathecal (IT group) and intravenous (IV group) sufentanil in postoperative pain relief. ⋯ Preoperative IT sufentanil can be used as a booster to achieve rapid and effective analgesia not only during the operation but also during the immediate postoperative period.
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Southern medical journal · Mar 2010
Case ReportsMetformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy.
Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. ⋯ Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. To my knowledge, this is the first report of metformin-induced vitamin B12 deficiency causing neuropathy.