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(A) Focused radial endoscopic ultrasound (EUS) at the level of the papilla, illustrating a formal double duct sign with the pancreatic duct (PD) measuring 5 mm and the common bile duct (CBD) measuring 10 mm with stone material in the distal (arrow) and papillary CBD segments (asterisk). (B) Duodenoscopic visualization of the papilla during endoscopic retrograde cholangiography (ERC) confirming papillary stone impaction underlying acute biliary pancreatitis.

“Endoscopic Ultrasound First Policy” in Acute Pancreatitis of Presumed Biliary Origin

A 61-year-old patient without significant alcohol history presented with epigastric pain of 2 days’ duration, most recently aggravating and radiating into the back. Laboratory analysis indicated acute pancreatitis (ie, serum lipase 1839 U/L; procalcitonin 11.1 ng/mL) as well as moderately elevated liver function tests (ie, bilirubin 1.6 mg/dL). Abdominal ultrasound demonstrated gallbladder stones with normal […]

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Computed tomography of the neck.

An Overlooked Cause of Polyuria

A 40-year-old woman presented to the Outpatient Department with complaints of frequent urination and excessive thirst for 3 months. She was passing large volumes of urine throughout the day and night, but she denied dysuria, urgency, or hesitancy. She used to consume 2 cups of tea in a day. Twenty-four-hour urine output was 6 L, […]

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Fecal Microbiota Transplantation in Inflammatory Bowel Disease: A Primer for Internists

Inflammatory bowel disease is characterized by an aberrant immune activation in genetically susceptible individuals, leading to gut inflammation. Despite recent therapeutic advances in inflammatory bowel disease, a substantial proportion of patients do not respond to the currently available drugs. Moreover, there are concerns regarding potential long-term consequences of immunosuppressive therapy. Thus, researchers have sought methods […]

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Acute Epigastric Pain as the Cause of Urgent Gastrectomy in a Healthy Patient

A 63-year-old man with no surgical history, taking no medication,was referred to the emergency department for epigastric pain and nausea that had started afew hours earlier. A sore throat had begun 24hours previously. Physical examination revealed normal temperature, hemodynamic stability, a distended abdomen with abdominal guarding that was very painful on palpation, and no mass […]

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doctor gives a physical examination of a patient

Gas Within the Bladder

To the Editor: An 83-year-old woman with a medical history of hypertension, chronic renal failure, and diabetes mellitus came to the emergency department of our clinic after 2 days of fever, asthenia, adynamia, and hypogastric abdominal pain associated with dysuria, polyuria, and bladder tenesmus. Her family reported that she had been increasingly fatigued in the […]

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doctor putting on gloves

Schistosoma Japonicum and Colon Polyps

We read the report on Schistosoma japonicum with great interest.1 Kiyani et al reported a case of “hyperplastic polyps with numerous parasite eggs most consistent with Schistosoma japonicum” detected from colorectal cancer screening.1 Indeed, S. japonicum infection is an important fluke infestation. The colon abnormality in the patient with S. japonicum infection is sporadically reported. Imai et al mentioned that “Colonic schistosomiasis is a probable independent […]

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