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陳 X 貞 45-year-old female

陳 X 貞 45-year-old female. GI Radiology: case 1. PH:. HCC found via abdominal echo s/p Right lobectomy Tumor size: 2x1.6cm. 2003, 成大. 1999, 高醫. HBV (+) OPD F/U. Elevated AFP 66.8 Abdominal echo: left hepatic nodule 1cm in size, R/O hemangioma MRI: no recurrence. 94-8 AFP=1900.

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陳 X 貞 45-year-old female

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  1. 陳X貞 45-year-old female GI Radiology: case 1

  2. PH: HCC found via abdominal echo s/p Right lobectomy Tumor size: 2x1.6cm 2003, 成大 1999, 高醫 HBV (+) OPD F/U Elevated AFP 66.8 Abdominal echo: left hepatic nodule 1cm in size, R/O hemangioma MRI: no recurrence

  3. 94-8 AFP=1900 02631717 2005-08-09 14:49:15 S/P Rt lobectomy of liver and cholecystectomy. A cystic mass at the resection site, suspect biloma or seroma. Chronic liver parenchymal disease with splenomegaly. Suspicious an ill-defined mass in S3, suggest further evaluation. Small hepatic hyperechoic nodules, suspect regeneration nodules or hemangiomas, suggest follow up. Indistinct pancreatic head with gas block.

  4. 2005-08-15 11:01 R/O A faint nodular opacity at Rt lower lung. 2005-09-12 15:18 (-)

  5. 2005-08-19 14:31:35 MR T1(+) arterial phase: 5mm in S2 2005-09-13 angio 09:12:21 (-) 2005-09-13 CTAP 09:51:02 one in S2.

  6. Post-OP: AFP 2005/10: 3498 2005-11-11 US 15:38:01 Post Rt lobectomy and cholecystectomy with residual fluid collection. Chronic parenchymal change of Lt lobe. Splenomegaly. 2005-11-7 Chest (-)

  7. AFP 2005/10: 3498 2005/12: 5030 2006/1: 7510 2006-1-27 US 14:21:01 1.s/p Rt lobectomy and cholecystectomy. 2.Liver parenchymal disease. Small hepatic hyperechoic nodules, suspect regeneration nodules, suggest follow up. R't hepatic cystic lesion, without interval change as compared with the US on 2005/08/09. 4.Splenomegaly. 2006-2-14Chest (-)

  8. 95-2-9 PET-CT positive .A focus of increased FDG uptake, 2.6 X 2.1 X 1.5 cm, SUV 3.05, in the superior posterior aspect of the resection margin of right lobectomy. 2006-2-14 angio AP shuntening 95-2-14 CTAP(-) 2006-2-14 CTAP No recurrence

  9. 95-2-27 US (-),建議CTHA或追蹤

  10. 57 y/o M. s/s: watery diarrhea, 3-4 times/ day, mucus-like, 3 weeks ago Bloody stool and fever developed later LLQ pain .Hx of AML, s/p C/T with complete remission 8 year ago GI Radiology: case 2

  11. Admitted to 斗六 H with antibiotics and IVF supplement S/A: WBC 0-1 RBC 3-5 stool culture: negative 94-12-29 Abdominal CT: S-colon wall thickening and stricture with A, T and D-colon dilatation.

  12. 95-1-3 Refer from斗六 ER: unremarkable except LLQ pain, no rebounding pain, soft, distention T/P/R: 37.7/ 110/24 BP: 116/75 mmHg • Lab: S/A RBC >100 Pus >100 WBC:16.3 k Hb 11.7 Plt 457k PT 16.4/12.35 aPTT34.3/29.8 Band 53 Seg 36 BUN/Cr: 6/1.0 Na/K: 130/3.0 GOT/GPT: 23/19 glu: 95

  13. 11308549 56Y/O, M 95-1-3 13:38:27 KUB shows Gaseous bowel distention. Small bowel ileus. Degenerative changes of the lumbar spine. Calcified pelvic phlebolith. 舒惠芳醫師-放診專 337 (95-1-10)

  14. <病理組織切片報告> 檢查:95/01/04 組織 81210178 Age: 57 Sex: M PATHOLOGICAL DIAGNOSIS: Colon, sigmoid, endoscopic biopsy: Ulcer, compatible with ischemic change GROSS FINDING: The specimen consists of multiple pieces of gray tissue fragments, measuring 0.5x0.4x0.2 cm in average. Submitted in toto, one cassette. MICROSCOPIC FINDING: Section shows colonic mucosal tissue with mucosal necrosis, granulation tissue, mild crypt atrophy, hemorrhage, & infiltration of acute & chronic inflammatory cells. A focus of crypt abscess is noted. There is no glandular branching or well-formed granuloma. The microscopic picture is compatible with that of ischemic change, although there is no hemosiderin or hyaline thrombus in small vessels. Please correlate with clinical features.

  15. Tx as ischemic colitis antibiotics with IVF supplement low grade fever persisted 9-Jan: WBC 11400, Hb 11.1, albumin: 1.9 diarrhea: 1-7 times/ day

  16. 95-1-6 09:54:32 Persisted pneumoperitoneum (95/1/10 X-ray report) 95-1-3 19:06:07 Chest PA shows Tortuous descending thoracic aorta. Intimal calcification at the aortic arch. Lower lobe air-space disease. A large amount of free air under the right hemidiaphragm. 舒惠芳醫師-放診專 337 (95-1-10)

  17. 95-1-14 20:20:28 CT no: 34408 (95-1-15 16:30) Clinical history: R/O hallow organ perforation. Abdominal CT with and without contrast medium showed: 1. The liver is normal in size with small hepatic cyst.No hepatic tumor can be seen. 2. The GB is distended with GB stones. 3. The spleen and pancreas are normal in size. 4. Both kidneys are normal in size and shape with Lt renal stone, but no evidence of hydronephrosis. 5. There are free air over intraperitoneum. The stomach is not distended, no evidence of perforation. 6. No para-aortic, iliac and inguinal lymph node can be seen. 7. The bowel loop is not dilated. The colon id dilated with thick wall. 8. The urinary bladder is distended with smooth in wall. IMP: 1) Colon wall thickening, R/O ulcerative colitis. 2) Pneumoperitoneum, but difficult to demonstrated perforation site. 蔡宏名醫師-放診專 259

  18. 95-1-21 KUB 11:07:09 Persisted distended colon 95-1-24 Chest 21:26:35 Post-OP

  19. <病理組織切片報告> 檢查:95/01/24 組織 8121038623 Age: 57 Sex: M PATHOLOGIC DIAGNOSIS: 1. Colon, total proctocolectomy and ileostomy: Acute and chronic inflammation with crypt abscesses, compatible with ulcerative colitis. 2. Duodenum, duodenorrhaphy: Perforated peptic ulcer 3. Appendix, total proctocolectomy: Acute periappendicitis 4. Lymph node, regional, dissection: Lymphoid hyperplasia (0/63) GROSS FINDING: The specimen consists of a total segment of colon (103cm long) with ileal-cecal valve, an appendix (8.0 cm long, 1.8 cm in diameter). The colon is studded with thousands of polyp-like structure. The density of the polyps is increased from proximal ileal-cecal valve to distal parts sigmoid. Proximal ileum resection distance to lesion is 2.5 cm and distal sigmoid resection distance to the lesion is 12 cm. The mesenteric nodes are marked and are dissected. The cut surface of lymph nodes and appendix are unremarkable. MICROSCOPIC FINDING: Sections show inflammatory infiltrate in the lamina propria, which is composed of neutrophils, lymphocytes, and plasma cells. Crypt abscesses are noted. There is destruction of the mucosal glands which show irregular shapes with decreased cytoplasmic mucus. Ulcer material with nearby granulation tissue are noted. Pseudopolyp formation is evident. The picture is compatible with ulcerative colitis. The distal sigmoid end shows multiple foci of crypt abscess and basal plasmacytosis involvement. The proximal ileum end ileocecal valve also show necrotic mucosa and abscess presence but it is near the polyps grossly. The duodenum tissue (section 1) reveals ulcer material with acute inflammation and no mucosal component is seen. A perforated ulcer is considered. The appendix (section 11) shows acute inflammation cell infiltrating mainly in the serosal layer. The regional lymph nodes show reactive hyperplasia without evidence of malignancy (0/63).

  20. <細菌檢查報告> 醫師: 林博文 檢查:95/01/25 全血 82409 BLOOD CULTURE REPORT 菌 名 1.Enterococcus faecium 2.Candida albicans S:Susceptible R:Resistant I:Intermediate M:Moderate Susceptible <外科部內視鏡檢查報告> 檢查:95/01/26 Sigmoidoscopy: The scope was inserted 25cm until S-colon. Necrotic mucosa over 15cm and above, The mucosa of area below 15cm is better but 3 to 4 deep ulcer over 12cm area. Area below 10cm is normal. Imp:Severe colitis with necrosis Expired on Jan. 26, 2006

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