RESUMO
A 54-year-old man was admitted with obstructive jaundice. Computed tomography showed common bile duct stricture and a tumor around the celiac artery. Repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) as well as a laparotomic biopsy around the celiac artery were diagnostically unsuccessful. Since the bile duct stricture progressed, EUS-FNA and ERCP were performed a third time, finally leading to the diagnosis of diffuse large B-cell lymphoma. The treatment plan and prognosis of obstructive jaundice differ greatly depending on the disease. It is important to conduct careful follow-up and repeated histological examinations with appropriate modifications until a diagnosis is made.
Assuntos
Colestase , Icterícia Obstrutiva , Linfoma Difuso de Grandes Células B , Neoplasias Pancreáticas , Masculino , Humanos , Pessoa de Meia-Idade , Colangiopancreatografia Retrógrada Endoscópica/métodos , Icterícia Obstrutiva/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Constrição Patológica , Neoplasias Pancreáticas/patologia , Ductos Biliares/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagemRESUMO
Pruritus is known to be a common complication in hepatitis patients, but the exact frequency and degree are not fully elucidated. Thus, we evaluated pruritus of 450 patients with chronic liver disease at our hospital. Pruritus was observed in 240 (53%) of the patients. Pruritus was significantly associated with males (OR = 1.51, P = 0.038) and patients with alkaline phosphatase (ALP) ≥ 200 U/L (OR = 1.56, P = 0.0495) and was significantly less in HBsAg-positive patients (OR = 0.449, P = 0.004). Seasonally, there was no difference in the frequency of pruritus between summer and winter. Of the 24 refractory pruritus patients treated with nalfurafine, 17 (71%) indicated improvement of itch, which is defined as a decrease in the visual analog scale score ≥ 30 mm. Pruritus was improved by nalfurafine both during daytime and nighttime in the Kawashima's scores evaluation. All patients who received nalfurafine exhibited improved Kawashima's scores ≥ 1 point during the daytime or nighttime. In conclusion, pruritus occurred in > 50% of patients with chronic liver disease, and predictors of pruritus were males and ALP ≥ 200 U/L. Nalfurafine may be useful for pruritus, regardless of whether daytime or nighttime.
Assuntos
Doença Hepática Terminal/tratamento farmacológico , Morfinanos/administração & dosagem , Prurido/tratamento farmacológico , Compostos de Espiro/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Hepática Terminal/complicações , Doença Hepática Terminal/genética , Doença Hepática Terminal/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/complicações , Prurido/patologia , Resultado do Tratamento , Adulto JovemRESUMO
A 73-year-old man with worsened diabetes underwent abdominal computed tomography and was diagnosed with localized enlargement of the pancreatic tail. Based on the suspicion of autoimmune pancreatitis, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. A cytologic examination showed findings suggestive of adenocarcinoma. Due to discrepancies between the imaging and pathological findings, esophagogastroduodenoscopy was performed. An extensive early gastric cancer lesion was detected in the posterior wall of the gastric corpus. It was therefore likely that puncturing through the tumor resulted in the contamination with cancer tissue. The possibility of a concomitant malignancy should be considered in EUS-FNA, and thorough examinations should be conducted.