Assuntos
Abscesso/diagnóstico por imagem , Mucosa Esofágica/lesões , Lacerações/diagnóstico por imagem , Abscesso/complicações , Mucosa Esofágica/diagnóstico por imagem , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico por imagem , Esofagoscopia , Humanos , Lacerações/complicações , Masculino , Supuração/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Heme oxygenase-1 (HO-1) is an antioxidant protein implicated in tumor progression, metastasis, and resistance to therapy. Elevated HO-1 expression is associated with stemness in several types of cancer, although this aspect has not yet been studied in colorectal cancer (CRC). Using an in vitro model, we demonstrated that HO-1 overexpression regulates stemness and resistance to 5-FU treatment, regardless of p53. In samples from CRC patients, HO-1 and endothelin converting enzyme-1 (ECE-1) expression correlated significantly, and p53 had no influence on this result. Carbon monoxide (CO) activated the ECE-1/endothelin-1 (ET-1) pathway, which could account for the protumoral effects of HO-1 in p53 wild-type cells, as demonstrated after treatment with bosentan (an antagonist of both ETRA and ETRB endothelin-1 receptors). Surprisingly, in cells with a non-active p53 or a mutated p53 with gain-of-function, ECE-1-produced ET-1 acted as a protective molecule, since treatment with bosentan led to increased efficiency for spheres formation and percentage of cancer stem cells (CSCs) markers. In these cells, HO-1 could activate or inactivate certain unknown routes that could induce these contrary responses after treatment with bosentan in our cell model. However more research is warranted to confirm these results. Patients carrying tumors with a high expression of both HO-1 and ECE-1 and a non-wild-type p53 should be considered for HO-1 based-therapies instead of ET-1 antagonists-based ones.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Flebite/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Abscesso Hepático/induzido quimicamente , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Flebite/induzido quimicamente , Tomografia Computadorizada por Raios XRESUMO
We present a patient who underwent cryoballoon ablation for symptomatic atrial fibrillation, with gastroparesis five days later. The case was resolved with conservative measures such as prokinetics. The case was a 72-year-old female with a history of symptomatic paroxysmal atrial fibrillation treated with edoxaban. Pulmonary vein isolation using a cryoballoon catheter was performed. Five days later, she presented with upper abdominal pain, bloating and vomiting.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Gastroparesia , Veias Pulmonares , Idoso , Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Feminino , Gastroparesia/diagnóstico por imagem , Gastroparesia/etiologia , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento , VômitoRESUMO
The case was an 86-year-old male with multiple cardiovascular comorbidites, including anticoagulated atrial fibrillation, who underwent a colonoscopy due to acute lower gastrointestinal bleeding and anemia. Colonoscopy only showed some small angiodysplasias in the cecum. A few hours later, the patient presented with abdominal pain and hemodynamic instability. An abdominal computed tomography was performed, which showed a splenic laceration and hemoperitoneum. An expectant attitude was decided, with a good evolution from the abdominal point of view. There was no sign of active splenic bleeding in a control computed tomography. However, he developed decompensated heart failure and finally died.
Assuntos
Ruptura Esplênica , Idoso de 80 Anos ou mais , Colonoscopia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Masculino , Esplenectomia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum (DDP), in the absence of choledocholithiasis or tumor. DDP are pseudodiverticula without a muscle layer within a radius of 2-3 centimeters from the ampulla of Vater. They rarely cause obstructive jaundice, although the prevalence is estimated at up to 22 % according to the sensitivity of the diagnostic test. They are usually incidental findings, but up to 1-5 % can be complicated with diverticulitis, bleeding, perforation, obstructive jaundice (Lemmel syndrome), choledocholithiasis, pancreatitis or cholangitis.
Assuntos
Ampola Hepatopancreática , Colangite , Divertículo , Duodenopatias , Icterícia Obstrutiva , Ampola Hepatopancreática/diagnóstico por imagem , Ampola Hepatopancreática/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Humanos , Icterícia Obstrutiva/etiologiaRESUMO
A 52-year-old female was referred for a study of a left intrahepatic bile duct dilation with an initial suspicion of Klatskin. Analytically, there was no cholestasis and tumor markers were negative. On echoendoscopy, there was dilation of the intrahepatic bile duct to the confluence at the level of the left hepatic lobe, with no evidence of a lesion that could be biopsied by fine needle aspiration (FNA).
Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Cisto do Colédoco , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Cisto do Colédoco/diagnóstico por imagem , Cisto do Colédoco/cirurgia , Dilatação Patológica , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We present the case of a 79-year-old male who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with sharpening of the distal bile duct, with no obvious cause. There was no bile flow after sphincterotomy, no stone after sweeping the duct with a balloon and the brush did not expand properly when trying to obtain cytologic material. Finally, a plastic stent was placed and purulent bile flowed. Biopsies of the papilla were taken due to the suspicion of tumor infiltration. The next day, the patient had pain in the right upper quadrant and blood tests highlighted mild anemization.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Hepatopatias , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Esfinterotomia EndoscópicaRESUMO
A 52-year-old Senegalese male presented due to abdominal pain and fever, with findings suggestive of a stenosing tumor of the right colon. Biopsies during colonoscopy were compatible with adenocarcinoma and infiltration into neighboring organs was observed during the surgery. New biopsies were taken that did not show dysplasia but granulomatous foci that were suggestive of a non-filiated infection. Thus, tuberculosis was ruled out.
Assuntos
Adenocarcinoma , Tuberculose Gastrointestinal , Colo , Colonoscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Gastrointestinal/diagnóstico por imagemRESUMO
The case was a 75-year-old female with dyspeptic symptoms of a 2 month duration. There was a polycystic lesion at the level of the uncinate pancreatic process of 44 x 42 x 34 mm on abdominal ultrasound and MRI, which caused a slight dilation of the main pancreatic duct. EUS was performed that identified a multicystic formation of 25x36 mm in the pancreatic body and FNA was performed of the lesion. The cytological analysis identified squamous epithelial cells with lymphoid tissue, which was compatible with a lymphoepithelial cyst, with no evidence of cell atypia or other signs of malignancy. Radiological control and monitoring of the lesion was performed and it has remained stable for 2 years.
Assuntos
Cisto Pancreático , Neoplasias Pancreáticas , Idoso , Feminino , Humanos , Tecido Linfoide , Imageamento por Ressonância Magnética , Pâncreas , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgiaRESUMO
We present the case of a 50-year-old male diagnosed with myasthenia gravis, secondary to thymoma or Lambert-Eaton syndrome during the study of repeated vomiting. Gastrointestinal symptoms persisted despite the treatment of the thymoma. He suffered from sigma volvulus that required sigmoidectomy 9 years after diagnosis. Neuromuscular junction disorders are not characterized by gastrointestinal involvement, as in our case. They have previously sporadically been related to intestinal motility dysfunction.
Assuntos
Síndrome Miastênica de Lambert-Eaton , Miastenia Gravis , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We present abdominal computed tomography and enteroscopy images of a 48-year-old male patient with a previous melanoma who presented with epigastric pain. The pain was not controlled with medical management. Abdominal computed tomography and a histological study of biopsies form enteroscopy confirmed the diagnosis of metastatic melanoma. The gastrointestinal involvement of melanoma is usually metastatic. Symptomatic gastrointestinal involvement occurs in less than 5% of melanomas, although postmortem analyses have reported up to 70%. The clinical presentation is variable and usually presents as abdominal pain. The diagnosis of small intestinal involvement of melanoma is a challenge due to its poor accessibility. The enteroscopy has a fundamental role as it allows a direct visualization and biopsies to be taken for histological study.
Assuntos
Laparoscopia , Melanoma , Dor Abdominal/etiologia , Endoscopia Gastrointestinal , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Doença Inflamatória Pélvica/complicações , Abscesso/complicações , Abscesso/diagnóstico , Abscesso/terapia , Doença Aguda , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/terapia , Laparoscopia , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/terapia , Doenças Ovarianas/complicações , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/terapia , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/terapia , Salpingite/diagnóstico , Salpingite/cirurgia , Aderências Teciduais/diagnóstico , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Descarga Vaginal/tratamento farmacológico , Descarga Vaginal/microbiologia , Descarga Vaginal/parasitologia , Adulto JovemAssuntos
Anemia Ferropriva/etiologia , Intestino Delgado/diagnóstico por imagem , Anti-Inflamatórios não Esteroides , Endoscopia por Cápsula , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Gastrite/diagnóstico por imagem , Humanos , Intestino Delgado/patologia , Masculino , Pessoa de Meia-IdadeAssuntos
Doenças do Esôfago/patologia , Penfigoide Mucomembranoso Benigno/patologia , Anti-Inflamatórios/uso terapêutico , Transtornos de Deglutição/etiologia , Doenças do Esôfago/complicações , Doenças do Esôfago/tratamento farmacológico , Feminino , Gastroscopia , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Penfigoide Mucomembranoso Benigno/complicações , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Estomatite Aftosa/complicações , Úlcera/etiologiaRESUMO
Sarcoidosis is a systemic granulomatous disease with an uncertain etiology, characterized by the production of non-necrotizing granulomas. The most frequent presentation is pulmonary and mediastinal, although it might affect any other organ. Hepatic alterations occur in 50 to 65% of the cases. Nevertheless, it is commonly subclinical or detected during a study of the alteration of liver enzymes. It is very unusual that disease onset occurs as an isolated hepatic tumor. A hepatic biopsy is usually required to confirm the diagnosis. A differential diagnosis must be established via any hepatic granulomatous disease, infectious or autoimmune disease as well as the exclusion of malignancy. We present a clinical case of a female diagnosed with an isolated hepatic sarcoidosis that simulated a unique hepatic metastatic lesion. The hepatic biopsy was diagnostic.
Assuntos
Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Sarcoidose/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Granuloma/diagnóstico , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoidose/diagnóstico por imagem , Sarcoidose/terapiaRESUMO
Pneumatosis cystoides intestinalis is characterized by multiple air-filled cysts in the intestine wall. A perforation causes pneumoperitoneum, frequently with minimal clinical affectation and do not require surgery at first in most cases. Recently, some cancer treatments, mainly molecular targeted therapy, have been associated with this complication. For this reason, radiologic findings of intestinal pneumatosis and/or secondary perforation during patient follow-up should be carefully interpreted. The clinical-analytical findings should always be considered. We report a case associated with the use of tyrosine kinase inhibitors in order to illustrate this point.