RESUMO
Hepatocellular carcinoma (HCC) is potentially fatal complication affecting patients with primary biliary cholangitis (PBC). The incidence of HCC is 13 per 1000 person-years in patients with PBC cirrhosis, but much lower at 2.7 per 1000 person-years among patients with PBC without cirrhosis. Risk factors for the development of HCC in PBC include the presence of advanced fibrosis or cirrhosis and male sex, with some studies suggesting that treatment with ursodeoxycholic acid (UDCA) and UDCA response may reduce risk.
Assuntos
Carcinoma Hepatocelular , Colangite , Cirrose Hepática Biliar , Neoplasias Hepáticas , Humanos , Masculino , Ácido Ursodesoxicólico/uso terapêutico , Colagogos e Coleréticos/uso terapêutico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Cirrose Hepática Biliar/complicações , Cirrose Hepática Biliar/epidemiologia , Cirrose Hepática Biliar/tratamento farmacológico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologiaAssuntos
Apendicectomia , Apendicite/complicações , Doenças do Ceco/diagnóstico , Leiomioma/diagnóstico , Pólipos/diagnóstico , Doença Aguda , Apendicite/cirurgia , Doenças do Ceco/complicações , Feminino , Humanos , Achados Incidentais , Leiomioma/complicações , Ilustração Médica , Pessoa de Meia-Idade , Pólipos/complicaçõesAssuntos
Febre/etiologia , Neoplasias Hepáticas/diagnóstico , Fígado/patologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Sarcoma/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Abscesso Hepático/complicações , Abscesso Hepático/diagnóstico , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Imageamento por Ressonância Magnética , Masculino , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Sarcoma/complicações , Sarcoma/patologia , Sarcoma/terapia , Sepse/complicações , Sepse/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Cholesterol crystal embolism can be spontaneous or iatrogenic, and it can involve any organ of the gastrointestinal tract, presenting with common gastrointestinal symptoms such as bleeding, perforation, obstruction, and inflammation. It is therefore considered the "great masquerader," requiring a high level of suspicion because the condition is associated with increased morbidity and mortality. We present a 69-year-old man who presented with gastrointestinal bleeding and azotemia. He was found to have cholesterol crystal embolization in the kidney and a duodenal leiomyoma, the latter being an uncommon site to embolize.
RESUMO
A 34-year-old woman was referred to the hepatology clinic for evaluation of an increased serum alkaline phosphatase (ALP) level. She was gravida 5 and in her 38th week of gestation. Her obstetric history was significant for 2 uncomplicated spontaneous term vaginal deliveries resulting in live births and 2 spontaneous abortions. The patient reported generalized pruritus for 2 months prior to the visit. She had no comorbidities and denied any other symptoms. She reported no family history of liver disease or complications during pregnancy in relatives. The patient did not smoke or drink, and had come to our hospital for her prenatal care visits. The physical exam revealed normal vital signs, no jaundice, a gravid uterus, and acanthosis nigricans on the neck and axilla with scattered excoriations on the arms, legs, and abdomen. Her serum ALP level was 1093 U/L (normal: 50-136 U/L). Immediately before this pregnancy, her serum ALP had been normal at 95 U/L, but it had since been increasing with a peak value of 1134 U/L by 37 weeks' gestation. Serum transaminase activities and albumin and bilirubin concentrations were normal, as was her prothrombin time. The rest of her lab tests were also normal, including her fasting serum bile acid concentration, which was 9 mcmol/L (normal: 4.5-19.2 mcmol/L).
Assuntos
Fosfatase Alcalina/sangue , Biomarcadores/sangue , Cirrose Hepática Biliar/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Testes de Função Hepática , Gravidez , PruridoRESUMO
Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.
Assuntos
Cistos/complicações , Hepatopatias/complicações , Taquicardia/etiologia , Disfunção Ventricular Direita/etiologia , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Função do Átrio Direito , Cistos/diagnóstico por imagem , Cistos/cirurgia , Drenagem , Feminino , Humanos , Laparoscopia , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Taquicardia/diagnóstico por imagem , Taquicardia/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologiaAssuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/mortalidade , Hispânico ou Latino , Diabetes Mellitus/etnologia , Diabetes Mellitus/mortalidade , Hepatopatias Alcoólicas/etnologia , Hepatopatias Alcoólicas/mortalidade , Prognóstico , Fatores de Tempo , Comorbidade , Cidade de Nova Iorque/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Medição de Risco , Hospitais Comunitários , Hipertensão/etnologia , Hipertensão/mortalidade , Hepatopatias Alcoólicas/diagnósticoRESUMO
Pulmonary aspergillosis presents with a variety of clinical forms including invasive pulmonary aspergillosis, chronic necrotising aspergillosis, aspergilloma, chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Haemoptysis is a devastating complication of pulmonary aspergillosis and a common indication for surgery. We report a case of a 54-year-old man with a history of pulmonary tuberculosis and diabetes mellitus, who presented with productive cough and haemoptysis for 2â months. Chest CT revealed a 30â mm diameter soft tissue mass in the upper lobe of the right lung. Haemoptysis subsided with conservative measures, but 2â weeks later the patient developed a new episode of persistent haemoptysis, which was only partially controlled with bronchial arterial embolisation. He underwent right upper and middle lobectomy. Histology examination confirmed the presence of a fungal cavitary lesion. The patient was started on voriconazole, and recovered with no recurrence at 18â months follow-up.
Assuntos
Antifúngicos/administração & dosagem , Aspergillus fumigatus/isolamento & purificação , Tosse/etiologia , Hemoptise/etiologia , Aspergilose Pulmonar/complicações , Tuberculose Pulmonar/complicações , Voriconazol/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/tratamento farmacológico , Recidiva , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/fisiopatologiaRESUMO
Aim. The aim of the paper is to determine association between H. pylori and colonic adenomatous polyps and to explore whether treatment or chronic PPI use can mitigate this risk. Methods. This case-control study included 943 patients who had H. pylori testing and underwent colonoscopy. Presence of polyps was the outcome of interest, whereas age, sex, race, H. pylori infection, triple therapy, and chronic PPI use were independent variables. Multivariate regression analysis was used to calculate odds ratios at 95% confidence intervals. This study was approved by the New York Medical College Institutional Review Board. Results. H. pylori was associated with increased odds of colonic adenomatous polyps (adjusted OR 1.43, 95% CI 1.04-1.77), with stronger association among patients older than 50 (OR 1.65, 95% CI 1.18-2.33). Triple therapy (OR 0.69, 95% CI 0.44-1.07) or chronic PPI use (OR 0.69, 95% CI 0.43-1.09) decreased odds of polyp formation. Analysis revealed a statistically significant reduction in patients who received both triple therapy and chronic PPI, lowering the odds by 60% (adjusted OR 0.43, 95% CI 0.27-0.67). Conclusion. There is increased risk of colonic adenomatous polyps among H. pylori-infected patients. Triple therapy or chronic PPI use may mitigate this risk, with further reduction when these two interventions are combined.
RESUMO
A relationship between hepatocellular carcinoma and chronic lymphocytic leukaemia has been reported. This is a case of a 75-year-old woman with stable chronic lymphocytic leukaemia, not on treatment with an increased activity of serum alkaline phosphatase and negative liver disease work up. A liver biopsy revealed leukaemic infiltration without evidence of cirrhosis or fatty liver. Four years later, she presented with a rapidly progressive liver mass which was diagnosed as hepatocellular carcinoma histologically.
Assuntos
Carcinoma Hepatocelular/patologia , Leucemia Linfocítica Crônica de Células B/patologia , Neoplasias Hepáticas/patologia , Neoplasias Primárias Múltiplas/patologia , Idoso , Feminino , HumanosRESUMO
A 52-year-old woman presented with a 1-week history of recurrent fevers and joint pains accompanied by abdominal and low back discomfort. She has a history of hypoparathyroidism and is on calcium supplements. Physical examination revealed fever and tachycardia. The rest of the examination was normal. Laboratory tests showed newly increased transaminase activity. Serum bilirubin and prothrombin time were normal. She was admitted for evaluation of acute hepatitis. Serology for hepatitis A, B, C and HIV were negative. Her serum acetaminophen and alcohol were undetected. Abdominal imaging was normal. Cultures were sterile. Additional tests for uncommon viral hepatitis included herpes simplex virus, cytomegalovirus and Epstein-Barr virus. Liver biopsy revealed non-specific inflammation. Subsequently, cytomegalovirus serology showed an IgM positive and negative IgG titre. Cytomegalovirus DNA qualitative PCR was also positive. No antiviral medication was given. She continued to have intermittent daily fever but reported no associated symptoms. She was discharged 9 days after admission in stable condition per her request with the advice to follow-up in the clinic in 1 week. Her serum hepatic profile returned to normal and she reported no more episodes of fever. Repeated titres of cytomegalovirus serology showed seroconversion.
Assuntos
Infecções por Citomegalovirus/complicações , Citomegalovirus/isolamento & purificação , Hepatite/etiologia , Fígado/patologia , Doença Aguda , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Feminino , Hepatite/enzimologia , Hepatite/patologia , Humanos , Fígado/enzimologia , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: Vitamin D has been postulated to play a role in colonic carcinogenesis by modulation of apoptosis and inhibition of angiogenesis. However, data supporting this theory are conflicting, and most studies include only Asians and Caucasians. This retrospective study aims to determine whether there is a correlation between an increased total vitamin D level and a lower incidence of carcinomatous polyps in a multi-race but predominantly Hispanic population in East Harlem, New York City. METHODS: A case-control study was conducted involving all patients who underwent colonoscopy at Metropolitan Hospital Center in 2011 and who also had serum total vitamin D levels taken within 1 month before or after the date of colonoscopy. Total vitamin D levels and the presence of carcinomatous polyps were the main variables studied. Colonic polyp-positive (CP+) samples were designated as the case group, while colonic polyp-negative (CP-) samples were assigned to the control group. Logistic regression analysis was used to estimate odds ratio at a 95% confidence interval. Adjusted variables were chosen a priori and included age, sex, race, smoking and alcohol history, body mass index, and folate and aspirin use. RESULTS: We identified 1,640 patients who underwent colonoscopy from January 1 to December 31, 2011. Of these, 136 also had a vitamin D serum level drawn within 1 month before or after the colonoscopy. Forty-three were CP+ and assigned to the cases group, and 93 were CP- and assigned to the control group. Thirty-five percent of the sample had total serum vitamin D levels of <20 ng/ml, and 65% had total serum vitamin D levels 20-29 ng/ml. Using <20 ng/ml as a cutoff point, the association of vitamin D with CP+ was statistically nonsignificant. In a multivariate model using vitamin D levels of <20 and <30, the association with CP+ appeared stronger, though, here too, the associations were not statistically not significant. A post hoc analysis was done excluding vitamin D levels of 20-29. In this analysis, the association between vitamin D levels and colonic polyps grew stronger with increased cutoff levels with vitamin D level of <20, suggesting a threshold effect. CONCLUSION: Vitamin D levels, using two established cutoffs, are not significantly associated with increased odds of membership in the CP+ group. However, our data suggest a possible threshold effect of vitamin D at <30 ng/ml associated with increasing odds of being CP+.