Benedict Maliakkal - Academia.edu (original) (raw)

Papers by Benedict Maliakkal

Research paper thumbnail of Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

World Journal of Gastroenterology

To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to iden... more To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to identify risk factors for the development of CIN. We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography (CT) with intravenous contrast at the University of Rochester between the years 2000-2005. We retrospectively examined factors associated with a high risk for CIN, defined as a decrease in creatinine clearance of 25% or greater within one week after receiving contrast. Twenty-five percent of our patients developed CIN, and 74% of these patients had ascites seen on CT. Of the 75% of patients who did not develop CIN, only 46% had ascites. The presence of ascites was a significant risk factor for the development of CIN (P = 0.0009, OR 3.38, 95% CI 1.55-7.34) in multivariate analysis. Patient age, serum sodium, Model for End-stage Liver Disease score, diuretic use, and the presence of diabetes were not found to be significant risk fact...

Research paper thumbnail of 373 The Predictive Role of Hepatic Venous Pressure Gradient and QTc Interval; New Correlates for Pulmonary Arterial Systolic Pressure and Clinical Outcomes After Tips

Research paper thumbnail of Sa1013 Predictors of Mortality for Patients With Acute Decompensated Cirrhosis Transferred From Outside Hospitals to a Tertiary Care Center

Research paper thumbnail of Tu2048 Early Palliative Care Consultation Results in Shorter Length of Stay for Patients With Acute Decompensated Cirrhosis Transferred From Outlying Hospitals

Research paper thumbnail of Major Neurologic, Renal and Cardiac Complications Post Liver Transplant in Recipients Over 65 Yrs of Age - Single Center Experience

Transplantation Journal, 2010

Research paper thumbnail of Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

World Journal of Gastroenterology, 2009

To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to iden... more To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to identify risk factors for the development of CIN.

Research paper thumbnail of Metabolic Risk Factors - Influence on Survival and Recurrence of HCC Post Liver Transplant

Transplantation Journal, 2010

ABSTRACT METABOLIC RISK FACTORS – INFLUENCE ON SURVIVAL AND RECURRENCE OF HCC POST LIVER TRANSPLA... more ABSTRACT METABOLIC RISK FACTORS – INFLUENCE ON SURVIVAL AND RECURRENCE OF HCC POST LIVER TRANSPLANT R. Kashyap1, S. Safadjou1, G. Connolly2, S. Ramalingam1, S. Agarwal1, M. Vetter1, L. Grinnell-Merrick3, B. Maliakkal1, G. Ramaraju4, C. Marroquin5, C. Barry1, M. Orloff1 1Solid Organ Transplant, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 2Hematology/oncolgy, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 3Solid Organ Transplant, University of Rochester, Rochester/UNITED STATES OF AMERICA, 4Gastroenterology And Hepatology, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 5Surgery, University of Pennsylvania, Philadelphia/UNITED STATES OF AMERICA Introduction: Metabolic risk factors appear to be independent risk factors in liver carcinogenesis however little is known of their influence on recurrence of hepatocellular carcinoma and survival post liver transplant. Aim: To examine influence of metabolic risk factors on recurrence of hepatocellular carcinoma and survival post liver transplant Method: 158 patients who underwent liver transplant at our center for HCC between December 1995 and February 2009 were included for the study. The mean age of the patients was 57.4 ± 9.1 and 83% of these were males. Patients were divided into two groups namely those within Milan criteria 48.7% (Group 1) and those outside Milan criteria 51.3% (Group 2). Both groups had similar demographic characteristics. Metabolic risk factors such as Diabetes, BMI, Steatosis, Hypercholesterolemia and Hypertension were examined with respect to tumor recurrence and post transplant survival. Results: One, three and five years actuarial patient survivals for within Milan Criteria group was 84%, 71.7%, 63.7% and for those outside Milan criteria group was 71.1%, 46.4%, 37.4% respectively. Also one, three, and five year actuarial tumor free survival for within Milan Criteria group was 95.7%, 79.8%, 74.8% and for outside Milan Criteria group was 69.1%, 59.3%, 47.2% respectively. Diabetes Mellitus, Hypertension, Obesity, Steatosis, and Hypercholesterolemia were not found to have a significant impact on tumor recurrence in either group [Recurrence: Diabetes Mellitus, 27.3% Vs 72.7% (CI 0.22 - 3.66) (P value: 1.00), Hypertension, 15% Vs 85% (CI 0.05 - 1.12) (P value: 0.08), Steatosis: 14.3% Vs 85.7% (CI 0.23 - 2.18) (P value: 0.36), BMI, 25% Vs 75% (CI 0.13 - 4.82) (P value: 1.00)]. However the post transplant survival appeared to be lower in the patients with either one or all risk factors.. [Survival: Diabetes Mellitus, 29.7% Vs 70.3% (CI 0.21-1.66) (P value: 0.43), Hypertension, 22.6% Vs 77.4% (CI 0.13 - 1.21) (P value: 0.17), Steatosis, 40% Vs 60% (CI 0.34 - 4.06) (P value: 1.00), BMI, 25% Vs 75% (CI 0.14 - 2.41) (P value: 0.52)]. Conclusion: Risk factors for metabolic syndrome although not impacting the tumor recurrence rates, appear to lower the post transplant survival. Disclosure: All authors have declared no conflicts of interest.

Research paper thumbnail of Stereotactic Body Radiation Therapy Treatment for Patients With Hepatocellular Carcinoma Awaiting Liver Transplant

Transplantation Journal, 2010

Research paper thumbnail of Primary Liver Team or Local Team for Liver Procurement: Can This Impact Graft Outcome?

Transplantation Journal, 2010

Research paper thumbnail of Effective Treatment Strategies for Down Staging HCC for Liver Transplantation

Transplantation Journal, 2010

Research paper thumbnail of The Three-Month Readmission Rate Remains Unacceptably High in a Large North American Cohort of Cirrhotic Patients

Hepatology (Baltimore, Md.), Jan 21, 2015

In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-c... more In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-center perspective study is lacking. To evaluate the determinants of 3-month readmissions in cirrhotic inpatients using the prospective 14-center NACSELD (North American Consortium for the Study of End-Stage Liver Disease) cohort. Cirrhotics hospitalized for non-elective indications were consented and followed for 3-months post-discharge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions, and for hepatic encephalopathy (HE), renal/metabolic and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. 1353 patients were enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n=535;316 with one, 219 with ≥2), w...

Research paper thumbnail of Gastrointestinal: Complications of colonoscopy

Journal of Gastroenterology and Hepatology, 2005

Research paper thumbnail of Systemic sarcidosis presenting as a granulomatous tatoo reaction secondary to interferon-a treatment for chronic hepatitis C and review of the literature

Digestive Diseases and Sciences

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involv... more Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.

Research paper thumbnail of Risk of cardiovascular disease in HIV, hepatitis C, or HIV/hepatitis C patients compared to the general population

International Journal of Clinical Practice, 2013

Research paper thumbnail of 575 The 3-Month Readmission Rate Remains Unacceptably High in a Large Multi-Center Cohort of Cirrhotic Patients

Research paper thumbnail of Short Communication: Risk of Elevated Total Cholesterol/High-Density Lipoprotein Cholesterol Ratio After Antiretroviral Therapy in HIV/Hepatitis C Virus Patients

AIDS Research and Human Retroviruses, 2012

Dyslipidemia from highly active antiretroviral therapy (HAART) use has been reported to be less s... more Dyslipidemia from highly active antiretroviral therapy (HAART) use has been reported to be less severe among persons with HIV and hepatitis C (HCV) compared to those with HIV monoinfection. However, the effect on lipoprotein ratios is less clear. The total cholesterol/high-density lipoprotein ratio (TC/HDL-C ratio) is a robust measure of cardiovascular disease (CVD) risk but has not been examined in the context of HIV/HCV-coinfected patients. We compared the TC/HDL-C ratio before HAART initiation and after at least 6 months on HAART between patients monoinfected with HIV and coinfected with HIV and HCV. Pre- and post-HAART TC, HDL-C, and non-HDL-C were also assessed. Although TC, HDL-C, and non-HDL-C significantly increased after HAART initiation in both HIV and HIV/HCV patients, the TC/HDL-C ratio did not. In addition, although the pre- and post-HAART TC, HDL-C, non-HDL-C, and TC/HDL-C ratio were significantly different between HIV and HIV/HCV patients, the magnitude in the change from pre- to post-HAART was not significantly different between infection groups. These results persisted after controlling for age, sex, race, current pharmacotherapy for lipoproteins, body mass index, and current CD4 cell count. The magnitude of change in the TC/HDL-C ratio after HAART initiation is not significantly different between HIV and HIV/HCV patients, suggesting subsequent CVD risk in HIV/HCV patients may be greater than currently appreciated.

Research paper thumbnail of 591 Validation of Infection-Related Acute-on-Chronic Liver Failure (I-ACLF) Definition for 30-Day Mortality Prediction in Infected and Uninfected Hospitalized Cirrhotic Patients

Research paper thumbnail of Mo1892 Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

Research paper thumbnail of Systemic sarcoidosis presenting as a granulomatous tattoo reaction secondary to interferon-alpha treatment for chronic hepatitis C and review of the literature

Digestive diseases and sciences, 2002

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involv... more Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.

Research paper thumbnail of Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

BMC gastroenterology, Jan 18, 2002

Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage ... more Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

Research paper thumbnail of Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

World Journal of Gastroenterology

To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to iden... more To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to identify risk factors for the development of CIN. We performed a retrospective review of 216 consecutive patients with cirrhosis who underwent computed tomography (CT) with intravenous contrast at the University of Rochester between the years 2000-2005. We retrospectively examined factors associated with a high risk for CIN, defined as a decrease in creatinine clearance of 25% or greater within one week after receiving contrast. Twenty-five percent of our patients developed CIN, and 74% of these patients had ascites seen on CT. Of the 75% of patients who did not develop CIN, only 46% had ascites. The presence of ascites was a significant risk factor for the development of CIN (P = 0.0009, OR 3.38, 95% CI 1.55-7.34) in multivariate analysis. Patient age, serum sodium, Model for End-stage Liver Disease score, diuretic use, and the presence of diabetes were not found to be significant risk fact...

Research paper thumbnail of 373 The Predictive Role of Hepatic Venous Pressure Gradient and QTc Interval; New Correlates for Pulmonary Arterial Systolic Pressure and Clinical Outcomes After Tips

Research paper thumbnail of Sa1013 Predictors of Mortality for Patients With Acute Decompensated Cirrhosis Transferred From Outside Hospitals to a Tertiary Care Center

Research paper thumbnail of Tu2048 Early Palliative Care Consultation Results in Shorter Length of Stay for Patients With Acute Decompensated Cirrhosis Transferred From Outlying Hospitals

Research paper thumbnail of Major Neurologic, Renal and Cardiac Complications Post Liver Transplant in Recipients Over 65 Yrs of Age - Single Center Experience

Transplantation Journal, 2010

Research paper thumbnail of Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis

World Journal of Gastroenterology, 2009

To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to iden... more To evaluate the incidence of contrast-induced nephropathy (CIN) in cirrhotic patients and to identify risk factors for the development of CIN.

Research paper thumbnail of Metabolic Risk Factors - Influence on Survival and Recurrence of HCC Post Liver Transplant

Transplantation Journal, 2010

ABSTRACT METABOLIC RISK FACTORS – INFLUENCE ON SURVIVAL AND RECURRENCE OF HCC POST LIVER TRANSPLA... more ABSTRACT METABOLIC RISK FACTORS – INFLUENCE ON SURVIVAL AND RECURRENCE OF HCC POST LIVER TRANSPLANT R. Kashyap1, S. Safadjou1, G. Connolly2, S. Ramalingam1, S. Agarwal1, M. Vetter1, L. Grinnell-Merrick3, B. Maliakkal1, G. Ramaraju4, C. Marroquin5, C. Barry1, M. Orloff1 1Solid Organ Transplant, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 2Hematology/oncolgy, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 3Solid Organ Transplant, University of Rochester, Rochester/UNITED STATES OF AMERICA, 4Gastroenterology And Hepatology, University of Rochester, Rochester/NY/UNITED STATES OF AMERICA, 5Surgery, University of Pennsylvania, Philadelphia/UNITED STATES OF AMERICA Introduction: Metabolic risk factors appear to be independent risk factors in liver carcinogenesis however little is known of their influence on recurrence of hepatocellular carcinoma and survival post liver transplant. Aim: To examine influence of metabolic risk factors on recurrence of hepatocellular carcinoma and survival post liver transplant Method: 158 patients who underwent liver transplant at our center for HCC between December 1995 and February 2009 were included for the study. The mean age of the patients was 57.4 ± 9.1 and 83% of these were males. Patients were divided into two groups namely those within Milan criteria 48.7% (Group 1) and those outside Milan criteria 51.3% (Group 2). Both groups had similar demographic characteristics. Metabolic risk factors such as Diabetes, BMI, Steatosis, Hypercholesterolemia and Hypertension were examined with respect to tumor recurrence and post transplant survival. Results: One, three and five years actuarial patient survivals for within Milan Criteria group was 84%, 71.7%, 63.7% and for those outside Milan criteria group was 71.1%, 46.4%, 37.4% respectively. Also one, three, and five year actuarial tumor free survival for within Milan Criteria group was 95.7%, 79.8%, 74.8% and for outside Milan Criteria group was 69.1%, 59.3%, 47.2% respectively. Diabetes Mellitus, Hypertension, Obesity, Steatosis, and Hypercholesterolemia were not found to have a significant impact on tumor recurrence in either group [Recurrence: Diabetes Mellitus, 27.3% Vs 72.7% (CI 0.22 - 3.66) (P value: 1.00), Hypertension, 15% Vs 85% (CI 0.05 - 1.12) (P value: 0.08), Steatosis: 14.3% Vs 85.7% (CI 0.23 - 2.18) (P value: 0.36), BMI, 25% Vs 75% (CI 0.13 - 4.82) (P value: 1.00)]. However the post transplant survival appeared to be lower in the patients with either one or all risk factors.. [Survival: Diabetes Mellitus, 29.7% Vs 70.3% (CI 0.21-1.66) (P value: 0.43), Hypertension, 22.6% Vs 77.4% (CI 0.13 - 1.21) (P value: 0.17), Steatosis, 40% Vs 60% (CI 0.34 - 4.06) (P value: 1.00), BMI, 25% Vs 75% (CI 0.14 - 2.41) (P value: 0.52)]. Conclusion: Risk factors for metabolic syndrome although not impacting the tumor recurrence rates, appear to lower the post transplant survival. Disclosure: All authors have declared no conflicts of interest.

Research paper thumbnail of Stereotactic Body Radiation Therapy Treatment for Patients With Hepatocellular Carcinoma Awaiting Liver Transplant

Transplantation Journal, 2010

Research paper thumbnail of Primary Liver Team or Local Team for Liver Procurement: Can This Impact Graft Outcome?

Transplantation Journal, 2010

Research paper thumbnail of Effective Treatment Strategies for Down Staging HCC for Liver Transplantation

Transplantation Journal, 2010

Research paper thumbnail of The Three-Month Readmission Rate Remains Unacceptably High in a Large North American Cohort of Cirrhotic Patients

Hepatology (Baltimore, Md.), Jan 21, 2015

In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-c... more In smaller single-center studies, cirrhotic patients are at a high readmission risk but a multi-center perspective study is lacking. To evaluate the determinants of 3-month readmissions in cirrhotic inpatients using the prospective 14-center NACSELD (North American Consortium for the Study of End-Stage Liver Disease) cohort. Cirrhotics hospitalized for non-elective indications were consented and followed for 3-months post-discharge. The number of 3-month readmissions and their determinants on index admission and discharge were calculated. We used multivariable logistic regression for all readmissions, and for hepatic encephalopathy (HE), renal/metabolic and infection-related readmissions. A score was developed using admission/discharge variables for the total sample, which was validated on a random half of the total population. 1353 patients were enrolled, 1177 were eligible on discharge and 1013 had 3-month outcomes. Readmissions occurred in 53% (n=535;316 with one, 219 with ≥2), w...

Research paper thumbnail of Gastrointestinal: Complications of colonoscopy

Journal of Gastroenterology and Hepatology, 2005

Research paper thumbnail of Systemic sarcidosis presenting as a granulomatous tatoo reaction secondary to interferon-a treatment for chronic hepatitis C and review of the literature

Digestive Diseases and Sciences

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involv... more Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.

Research paper thumbnail of Risk of cardiovascular disease in HIV, hepatitis C, or HIV/hepatitis C patients compared to the general population

International Journal of Clinical Practice, 2013

Research paper thumbnail of 575 The 3-Month Readmission Rate Remains Unacceptably High in a Large Multi-Center Cohort of Cirrhotic Patients

Research paper thumbnail of Short Communication: Risk of Elevated Total Cholesterol/High-Density Lipoprotein Cholesterol Ratio After Antiretroviral Therapy in HIV/Hepatitis C Virus Patients

AIDS Research and Human Retroviruses, 2012

Dyslipidemia from highly active antiretroviral therapy (HAART) use has been reported to be less s... more Dyslipidemia from highly active antiretroviral therapy (HAART) use has been reported to be less severe among persons with HIV and hepatitis C (HCV) compared to those with HIV monoinfection. However, the effect on lipoprotein ratios is less clear. The total cholesterol/high-density lipoprotein ratio (TC/HDL-C ratio) is a robust measure of cardiovascular disease (CVD) risk but has not been examined in the context of HIV/HCV-coinfected patients. We compared the TC/HDL-C ratio before HAART initiation and after at least 6 months on HAART between patients monoinfected with HIV and coinfected with HIV and HCV. Pre- and post-HAART TC, HDL-C, and non-HDL-C were also assessed. Although TC, HDL-C, and non-HDL-C significantly increased after HAART initiation in both HIV and HIV/HCV patients, the TC/HDL-C ratio did not. In addition, although the pre- and post-HAART TC, HDL-C, non-HDL-C, and TC/HDL-C ratio were significantly different between HIV and HIV/HCV patients, the magnitude in the change from pre- to post-HAART was not significantly different between infection groups. These results persisted after controlling for age, sex, race, current pharmacotherapy for lipoproteins, body mass index, and current CD4 cell count. The magnitude of change in the TC/HDL-C ratio after HAART initiation is not significantly different between HIV and HIV/HCV patients, suggesting subsequent CVD risk in HIV/HCV patients may be greater than currently appreciated.

Research paper thumbnail of 591 Validation of Infection-Related Acute-on-Chronic Liver Failure (I-ACLF) Definition for 30-Day Mortality Prediction in Infected and Uninfected Hospitalized Cirrhotic Patients

Research paper thumbnail of Mo1892 Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

Research paper thumbnail of Systemic sarcoidosis presenting as a granulomatous tattoo reaction secondary to interferon-alpha treatment for chronic hepatitis C and review of the literature

Digestive diseases and sciences, 2002

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involv... more Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Immune alterations involving heightened T-helper-1 responses have been proposed to play a major role in the pathogenesis of sarcoidosis. Interferon-alpha therapy and hepatitis C infection have been implicated in the development of a variety of autoimmune diseases. However, despite the wide use of IFN-alpha therapy for hepatitis C, only a few cases of sarcoidosis have been reported in this context. We report the case of a 42-year-old white female with hepatitis C, who developed systemic sarcoidosis shortly after therapy with IFN-alpha2b. The disease was heralded by the appearance of a cutaneous sarcoid/ foreign body granulomatous reaction at the site of an old tattoo. The sarcoidosis responded to a short course of oral prednisone therapy. We also reviewed the other reported cases and discussed the possible immunological mechanisms involved.

Research paper thumbnail of Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

BMC gastroenterology, Jan 18, 2002

Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage ... more Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.