Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis.

With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed. We highlight TIPS as a management strategy in patients with PHD for whom less invasive measures are not effective.

Liver Cholestasis Secondary to Syphilis in an Immunocompetent Patient.

Liver involvement is a known feature of secondary syphilis. The prevalence of hepatitis in secondary syphilis ranges broadly from 1 to 50%. We report a case of a 37-year-old man with type 1 diabetes mellitus and sickle cell trait presenting with jaundice and acute liver cholestasis. Abdominal ultrasound revealed mild hepatic fatty infiltration. RPR and Treponema pallidum IgG results were positive with a reflex titer of 1:64. Liver biopsy revealed chronic hepatitis with normal hepatic architecture, Kupffer cell hyperplasia, hepatic cholestasis, and ductal proliferation suggestive of syphilitic hepatitis.

The Effect of Payer Status on Survival of Patients with Stage I/II Non-small Cell Lung Cancer: NCDB 1998-2011.

BACKGROUND: One of the challenges to improving access to care is identifying disparities in health care. To determine the influence of insurance status on outcome for patients with non-small cell lung cancer (NSCLC), we analyzed data from the National Cancer Data Base (NCDB) from 1998-2011. MATERIALS AND METHODS: Data from 299,914 patients diagnosed with NSCLC registered in the NCDB were analyzed. Overall survival (OS) was the outcome variable, and payer status was the primary predictor variable. Other variables included stage, grade, lymph node status, age, race, Charlson Comorbidity Index, income, education, distance travelled, cancer program, diagnosing/treating facility, treatment delay, surgery, chemotherapy and radiation therapy. Multivariate Cox regression was used to investigate the effect of payer status on OS while adjusting for secondary predictive factors. RESULTS: The majority of patients diagnosed at stage I-II had Medicare (61.72%), while less than one third were privately insured (29.57%). In univariate analysis, the median OS was 2.90, 3.42, 3.86, 4.19, and 6.23 years for Medicare, Medicaid, uninsured, unknown, and privately insured patients, respectively. Multivariate analysis revealed a statistically significant relationship between insurance status and OS. Interaction effects of treatment between radiation and surgery were statistically significant: patients receiving radiation in addition to surgery had a 37% increased mortality compared to patients undergoing surgery alone. Compared to receiving no treatment (radiation, surgery, chemotherapy), the 5-year direct adjusted survival probability increased by 44.70%, 40%, 3.91%, 9.42%, 31.56% and 33.20% for patients treated with surgery and chemotherapy, surgery alone, chemotherapy alone, radiation alone, radiation plus surgery, and radiation plus surgery and chemotherapy, respectively. CONCLUSION: Insurance status proved to be a statistically significant predictor of OS, which remained true after adjusting for all other factors. Uninsured and Medicaid patients had the highest mortality. Multivariate analysis revealed that chemotherapy in addition to surgery provided the best 5-year direct adjusted survival probability.