RESUMO
OBJECTIVE: To describe the etiology, symptoms and management of portal vein thrombosis associated with biliary tract infection and to compare our findings with classical causes of pylephlebitis. MATERIAL AND METHODS: We performed a retrospective descriptive study of 10 patients in a tertiary hospital. RESULTS: Portal vein thrombosis was associated with biliary tract infection in seven patients and with classical causes of pylephlebitis in three. In both groups, symptoms consisted of fever and abdominal pain accompanied by leukocytosis and increased liver enzymes. Blood cultures were positive in most patients and the main complication was liver abscess. The therapeutic management and outcomes were similar in both groups. CONCLUSIONS: Portal vein thrombosis can be associated with biliary tract infection. Clinical presentation and outcomes are highly similar to those in classical causes of pylephlebitis.
Assuntos
Colangite/complicações , Flebite/complicações , Veia Porta/patologia , Trombose Venosa/etiologia , Dor Abdominal/etiologia , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Aspartato Aminotransferases/sangue , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Carcinoma Hepatocelular/complicações , Colangite/sangue , Colangite/diagnóstico , Colangite/tratamento farmacológico , Colangite/cirurgia , Terapia Combinada , Diagnóstico por Imagem/métodos , Drenagem , Feminino , Hepatectomia/métodos , Humanos , Leucocitose/etiologia , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Flebite/sangue , Flebite/tratamento farmacológico , Estudos Retrospectivos , Trombose Venosa/sangue , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , gama-Glutamiltransferase/sangueRESUMO
The value of serial lung ultrasound (LUS) in patients with COVID-19 is not well defined. In this multicenter prospective observational study, we aimed to assess the prognostic accuracy of serial LUS in patients admitted to hospital due to COVID-19. The serial LUS protocol included two examinations (0-48 h and 72-96 h after admission) using a 10-zones sequence, and a 0 to 5 severity score. Primary combined endpoint was death or the need for invasive mechanical ventilation. Calibration (Hosmer-Lemeshow test and calibration curves), and discrimination power (area under the ROC curve) of both ultrasound exams (SCORE1 and 2), and their difference (DIFFERENTIAL-SCORE) were performed. A total of 469 patients (54.2% women, median age 60 years) were included. The primary endpoint occurred in 51 patients (10.9%). Probability risk tertiles of SCORE1 and SCORE2 (0-11 points, 12-24 points, and ≥25 points) obtained a high calibration. SCORE-2 showed a higher discrimination power than SCORE-1 (AUC 0.72 (0.58-0.85) vs. 0.61 (0.52-0.7)). The DIFFERENTIAL-SCORE showed a higher discrimination power than SCORE-1 and SCORE-2 (AUC 0.78 (0.66-0.9)). An algorithm for clinical decision-making is proposed. Serial lung ultrasound performing two examinations during the first days of hospitalization is an accurate strategy for predicting clinical deterioration of patients with COVID-19.
Assuntos
Colite/diagnóstico , Colite/microbiologia , Síndrome de Down/complicações , Ileíte/diagnóstico , Ileíte/microbiologia , Mycobacterium bovis , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/diagnóstico , Dor Abdominal/etiologia , Adulto , Ascite/etiologia , Diarreia/etiologia , Humanos , Imunocompetência , MasculinoAssuntos
Bolsas Cólicas/efeitos adversos , Enteropatias/etiologia , Litíase/etiologia , Idoso , Humanos , MasculinoRESUMO
Lipoprotein (a) [Lp(a)] is a lipoprotein defined by presenting a specific apolipoprotein, ApoA, linked to the ApoB-100 by different types of chemical bonds, including a disulfide bridge. Despite their atherogenic mechanism is not fully understood, its importance has been demonstrated in the development of premature aterosclerosis. Multiple studies have shown its role as a cardiovascular risk factor associated with heart disease and stroke. We report the case of a patient with a diagnosis of Takayasu arteritis in which a massive elevation of Lp(a) was detected. We emphasize its diagnostic and therapeutic implications.
Assuntos
Aterosclerose/patologia , Lipoproteína(a)/sangue , Arterite de Takayasu/patologia , Adulto , Aterosclerose/sangue , Aterosclerose/diagnóstico , Doenças Cardiovasculares/etiologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Fatores de Risco , Arterite de Takayasu/sangue , Arterite de Takayasu/diagnósticoRESUMO
BACKGROUND AND OBJECTIVE: Bexarotene is a synthetic selective X receptor rexinoide approved for the systemic treatment of cutaneous T-cell lymphoma. During treatment is very frequent the occurrence of hypothyroidism and severe mixed hyperlipidemia, both are reversibles and dose-dependent adverse events. Increase of triglycerides and LDL-cholesterol level (up to even higher levels have been associated with pancreatitis in some cases) is widely described (as is the case with other retinoids) but decrease in HDL-cholesterol is poored know. We review our experience with the use of bexarotene. MATERIAL AND METHODS: We present a serie of 3 clinical report of patients treated with bexarotene in whose, in addition to these well-known adverse event, a serious lowering of HDL-cholesterol was observed. RESULTS: The 3 patients studied had metabolic complications like central hypothyroidism and severe mixed hyperlipidemia; with special emphasis on the sharp fall (mean decrease>83%) in the HDL-cholesterol level. Cholesterol lowering medication and substitutive hormonal replacement with levotiroxine resulted in an improvement of the biochimical parameters without reaching the correct goals. CONCLUSIONS: Bexarotene produce as predictable side effects severe mixed hyperlipidemia with marked decrease in HDL-cholesterol levels and central hypothyroidism, being the both reversible and dose-dependent. A reflection on the possible aetiological mechanisms and implications of this phenomenon are included.
Assuntos
Antineoplásicos/efeitos adversos , Hiperlipidemias/induzido quimicamente , Hipotireoidismo/induzido quimicamente , Micose Fungoide/tratamento farmacológico , Síndrome de Sézary/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Tetra-Hidronaftalenos/efeitos adversos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bexaroteno , HDL-Colesterol/sangue , Terapia Combinada , Humanos , Hiperlipidemias/sangue , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Hipotireoidismo/sangue , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico , Radioterapia Adjuvante , Terapia de Salvação , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/terapia , Tetra-Hidronaftalenos/administração & dosagem , Tiroxina/uso terapêuticoRESUMO
Resumen La enfermedad de Erdheim-Chester es una histiocitosis celular diferente a la histiocitosis de Langerhans, de origen incierto. Se caracteriza por una implicación multi-orgánica debida a la infiltración de los histiocitos CD68+/CD1a-, en forma de xantogranulomas, que afectan principal y comúnmente a la metáfisis y diáfisis de huesos largos. El diagnóstico se realiza mediante biopsia, donde se revelan histiocitos CD68+/CD1a-, carencia de proteína S, y presencia de gránulos de Birbeck. Se ha subestimado la implicación cardiovascular. Reportamos un caso de un varón de 67 años con la enfermedad de Erdheim-Chester e infarto de miocardio agudo, debido a implicación coronaria, además de enfermedad ósea, vascular, pituitaria y retroperitoneal. Revisamos la literatura relevante y describimos el tratamiento clínico de estos pacientes.
Abstract Erdheim-Chester disease is a non-Langerhans cell histiocytosis of uncertain origin. It is characterized by multiorgan involvement due to infiltration of CD68+/CD1a- histiocytes, in the form of xantogranulomas, most commonly affecting the metaphysis and diaphysis of long bones. The diagnosis is made by biopsy showing CD68+/CD1ahistiocytes, lack of S protein and Birbeck granules. Cardiovascular involvement is underestimated. We report a case of a 67 year-old man with Erdheim-Chester disease and acute myocardial infarction due to coronary involvement, in addition to bone, vascular, pituitary and retroperitoneal disease. We review relevant literature and describe the clinical management of these patients.