Duodenal hematoma following endoscopic duodenal biopsy: a case report and review of the existing literature.

Duodenal hematoma is a rare complication of endoscopic duodenal biopsy that occurs mainly in children or adults with impaired coagulation. The clinical presentation consists of signs of intestinal obstruction, and pancreatitis and direct hyperbilirubinemia are possible complications caused by ampullary obstruction. A case of a six-year-old girl who presented with a duodenal hematoma and acute pancreatitis after having an endoscopic duodenal biopsy is reported. A review of the literature and data from all similar cases reported so far are briefly presented and discussed.

Pseudotumor inflamatório do fígado: um diagnóstico diferencial raro de massa hepática / Inflammatory pseudotumor of the liver: a rare differential diagnosis of liver mass

Os pseudotumores inflamatórios são um conjunto de lesões raras, caracterizadas histologicamente por proliferação de fibroblastos e células inflamatórias permeadas por estroma fibroso. Nos casos de localização hepática, estas massas são difíceis de diferenciar de outras lesões, especialmente de neoplasias primárias ou secundárias. Descrevemos um caso em que os achados clínicos-laboratoriais e as imagens da ultrassonografia e da tomografia computadorizada de abdomen não foram suficientes para afastar uma neoplasia, e só foi possível estabelecer o diagnóstico através da biópsia direta, mediante ressecção cirúrgica da lesão. Diante de um paciente sem antecedentes dignos de nota, com massa hepática e marcadores tumorais negativos, o pseudotumor inflamatório de fígado deve ser lembrado sempre como um possível diagnóstico diferencial.

The inflammatory pseudotumors are a rare group of lesions characterized histologically by proliferation of fibroblasts and inflammatory cells penetrated by fibrous stroma. In cases of liver location, these masses are difficult to differentiate from other lesions, especially from the primary or secondary tumors. We described a case in which the abdomen clinical, laboratory, and the images of ultrasound and computed tomography findings were not sufficient to rule out a neoplasia and it was only possible to establish the diagnosis directly by biopsy with surgical excision of the lesion. When a patient has no history worth mentioning, negative liver mass and tumor markers, inflammatory pseudotumors of the liver should always be remembered as a possible differential diagnosis.

Peripheral insulin resistance during treatment of chronic hepatitis C with peguilated interferon plus ribavirin.

UNLABELLED: Patients with hepatitis C virus (HCV) infection present higher risk of developing type-2 diabetes mellitus (DM). However, the mechanism of this association and the role of antiviral treatment are still unclear. The objective of this study was to investigate the relationship between the use of peguilated interferon and the development of insulin resistance (IR) in these patients. METHODS: HOMA index was evaluated in 30 HCV-infected patients just before and during the first 6 months of treatment with peguilated interferon plus ribavirin. Anthropometrical parameters and glucose/cholesterol profile were also monitored. RESULTS: No changes in HOMA after 6 months of treatment were observed. Glucose levels decreased but not significantly (P = 0.059). Patients with higher HOMA index after 6 months of treatment also presented higher aminotransferase levels (P = 0.03), higher fat index on computed tomography (P = 0.011), longer time of exposure to the virus (P = 0.021), and a positive smoking history when compared to non-insulin resistant patients (P = 0.045). There was no influence of fibrosis stage on liver biopsy in the insulin-resistance development. CONCLUSIONS: No changes in the IR were observed after 6 months of treatment. Insulin resistance is related to the abdominal fat and anthropometrical parameters rather than to the antiviral treatment.

Liver lesions: manganese-enhanced MR and dual-phase helical CT for preoperative detection and characterization comparison with receiver operating characteristic analysis.

PURPOSE: The purpose of this study was to compare, by means of receiver operating characteristic (ROC) analysis, dual-phase helical computed tomography (CT) and manganese-enhanced magnetic resonance (MR) imaging in the detection and characterization of hepatic lesions in patients prior to surgery. MATERIALS AND METHODS: Twenty-five patients known to have or suspected of having hepatic lesions who were eligible for surgery underwent dual-phase (ie, arterial and portal phase) helical CT and phased-array MR imaging (ie, unenhanced fast spin-echo T2-weighted imaging and gradient-echo T1-weighted imaging performed before and after administration of mangafodipir trisodium). All images were reviewed independently by three off-site blinded reviewers who separately reviewed the CT scans and MR images. The standard of reference was findings at surgery, intraoperative ultrasonography (US), and histopathologic examination. ROC curves were established to analyze the results for each reader and modality. RESULTS: Ninety-four lesions (77 malignant and 17 benign) were revealed at surgery, intraoperative US, and/or histopathologic examination. The overall rate of lesion detection for the three readers at CT was 81.9% +/- 7.8, 90.4% +/- 5.9, and 76.6% +/- 8.6. At MR imaging, the detection rates were 72.3% +/- 9.0, 71.3% +/- 9.1, and 69.1% +/- 9.3 (P =.001 for the difference between MR and CT). The average rate of false-positive diagnoses in patients was 14.1% at CT and 6.4% at MR imaging (P =.06 for the difference between MR and CT). The mean areas under the alternative-free-response ROC curves were 0.74 for MR and 0.72 for CT (P =.751, not significant). CONCLUSION: In detection and characterization of liver lesions, manganese-enhanced MR imaging and dual-phase helical CT were not statistically different.

Comprometimento do interstício pulmonar em portadores de esclerose sistêmica progressiva: estudo de uma série de 58 casos / Interstitial lung disease in patients with progressive systemic sclerosis: a study of 58 cases

OBJETIVO: Estimar a freqüência de doença intersticial pulmonar em um grupo de indivíduos com esclerose sistêmica progressiva e descrever suas características clínicas, funcionais e radiológicas. MÉTODOS: Após confirmação diagnóstica, 58 pacientes com esclerose sistêmica progressiva foram estudados com tomografia computadorizada de alta resolução, provas de função pulmonar, bem como pesquisa do anti-Scl 70. Foram feitas comparações entre os pacientes com e sem comprometimento intersticial pulmonar e pesquisados possíveis fatores preditivos deste acometimento através de análise multivariada. RESULTADOS: Do total, 51,7 por cento apresentaram evidências de doença intersticial pulmonar na tomografia computadorizada de alta resolução. Dispnéia e tosse foram os sintomas mais relatados, (65,5 por cento e 39,7 por cento, respectivamente). Bronquiolectasias e faveolamento foram as anormalidades tomográficas mais comuns (83,3 por cento e 80,0 por cento respectivamente). Quando comparados com os indivíduos sem doença intersticial pulmonar, os pacientes com este acometimento apresentaram freqüência semelhante de sintomas pulmonares e extrapulmonares, porém apresentaram esclerose sistêmica progressiva de maior duração, estertores crepitantes mais freqüentes, maior positividade de anti-Scl 70, e capacidade vital forçada e pulmonar total reduzidas. Somente uma capacidade vital forçada < 80 por cento apresentou tendência a predizer presença de doença intersticial pulmonar. CONCLUSÃO: Doença intersticial pulmonar foi freqüente neste grupo com esclerose sistêmica progressiva. Não ocorreu associação com sintomas. Houve associação entre doença intersticial pulmonar e presença de estertores crepitantes e anti-Scl 70. Contudo, somente redução da capacidade vital forçada foi preditora de doença intersticial pulmonar.