Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura.

Peliosis hepatis is a rare condition that can cause hepatic hemorrhage, rupture, and ultimately liver failure. Several authors have reported that peliosis hepatis develops in association with chronic wasting disease or prolonged use of anabolic steroids or oral contraceptives. In this report we describe a case in which discontinuation of steroid therapy improved the condition of a patient with peliosis hepatis. Our patient was a 64-year-old woman with a history of long-term steroid treatment for idiopathic thrombocytopenic purpura . Her symptoms included abdominal pain and weight loss; the only finding of a physical examination was hepatomegaly. We performed computed tomography (CT) and magnetic resonance imaging (MRI) of the liver and a liver biopsy. Based on these findings plus clinical observations, she was diagnosed with peliosis hepatis and her steroid treatment was terminated. The patient recovered completely 3 months after steroid discontinuation, and remained stable over the following 6 months.

Acute variceal hemorrhage in patients with liver cirrhosis: weekend versus weekday admissions.

PURPOSE: Little is known about the impact of weekend admission on acute variceal hemorrhage (AVH). Thus, we investigated whether day of admission due to AVH influenced in-hospital mortality. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 294 patients with cirrhosis admitted between January 2005 and February 2009 for the management of AVH. Clinical characteristics were compared between patients with weekend and weekday admission, and independent risk factors for in-hospital mortality were determined by multivariate binary logistic regression analysis. RESULTS: No demographic differences were observed between patients according to admission day or in the clinical course during hospitalization. Seventeen (23.0%) of 74 patients with weekend admission and 48 (21.8%) of 220 with weekday admission died during hospitalization (p=0.872). Univariate and subsequent multivariate analysis showed that initial presentation with hematochezia [p=0.042; hazard ratio (HR), 2.605; 95% confidence interval (CI), 1.038-6.541], in-patient status at the time of bleeding (p=0.003; HR, 4.084; 95% CI, 1.598-10.435), Child-Pugh score (p<0.001; HR, 1.877; 95% CI, 1.516-2.324), and number of endoscopy sessions for complete hemostasis (p=0.001; HR, 3.864; 95% CI, 1.802-8.288) were independent predictors for in-hospital mortality. CONCLUSION: Weekend admission did not influence in-hospital mortality in patients with cirrhosis who presented AVH.

Clinical characteristics and treatment outcomes of hepatocellular carcinoma with inferior vena cava/heart invasion.

BACKGROUND: The prognosis and treatment outcomes of hepatocellular carcinoma (HCC) with inferior vena cava (IVC)/heart invasion have not been established. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCC extending to IVC/heart and ascertained whether active treatment beyond best supportive care (BSC) can prolong overall survival. PATIENTS AND METHODS: We retrospectively reviewed 50 patients with HCC extending to IVC/heart who were admitted from November 1987 to November 2010. They were stratified into a control group with BSC alone (n=18) and a treated group with active treatment more than BSC (n=32). RESULTS: The mean age was 56.5 years and male gender predominated (n=39, 78.0%). Treatment modalities in the treated group included systemic chemotherapy using 5-fluorouracil with/without cisplatin (n=10, 31.3%), transarterial chemoembolization (n=8, 25.0%), intra-arterial chemotherapy (n=3, 9.4%), concurrent chemoradiation therapy (n=3, 9.4%), radiation (n=2, 6.2%), surgery (n=1, 3.1%), and of the combination above (n=5, 15.6%). Active treatment more than BSC was the only independent predictor of overall survival and the overall survival of the treated group was significantly better than that of the control group (median 4.0 vs. 2.0 months, p=0.003). CONCLUSION: The prognosis of HCC with IVC/heart invasion is poor. However, if patients are cautiously selected, active treatment beyond BSC might provide a survival benefit in patients with HCC extending to IVC/heart.

[A case of acinar cell carcinoma of pancreas, manifested by subcutaneous nodule as initial clinical symptom].

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.