Infected hepatic cyst complicating urinary sepsis.

Congenital hepatic cysts are a common disorder. Usually they are asymptomatic and do not have to be treated. However, some serious complications can occur. We report here the case of an 86-year old patient who has been treated by a percutaneous drainage for an infected solitary hepatic cyst due to urinary sepsis. She was admitted to the Department of Internal Medicine for epigastric pain with fever and chills. The patient was treated for a urinary tract infection 3 weeks ago by her General Practitioner. On admission, blood tests showed 21 620 neutrophils per microliter with a C-reactive protein level at 443.7 mg/L, procalcitonin > 200 ng/mL, total bilirubin at 1.43 mg/dL, lactate dehydrogenase at 666 U/L and alanine aminotransferase at 227 U/L. Urinalysis and hemocultures highlighted the presence of Escherichia coli and Streptococcus constellatus. The abdominal tomodensitometry indicated the presence of a left hepatic biliary cyst with banal appearance. She was first treated with intravenous amoxicillin clavulanic acid. After a few days, another abdominal tomodensitometry with contrast pinpointed a large abscess of 11 centimeters in diameter extending to liver segments II and IV with a similar small lesion in segments IV and V. clindamycin per os was added to the treatment because of its good diffusion in tissues. Percutaneous drain was inserted under tomodensitometric control and stayed in place until the follow-up at three weeks. Bacteriologic culture on the fluid sample demonstrated the presence of Escherichia coli and Streptococcus constellatus. The abscess completely regressed after 6 weeks of treatment and the biologic abnormalities resolved at the same time.

Chronic lymphocytic leukemia with portal hypertension and without liver involvement: a case report underlining the roles of increased spleno-portal blood flow and "protective" sinusoidal vasoconstriction.

We report the case of a 72-year-old woman with well-controlled chronic lymphocytic leukemia (CLL) and splenomegaly who developed portal hypertension with bleeding oesophageal varices in the absence of liver fibrosis or regenerative nodular hyperplasia at surgical wedge liver biopsy. The hepatic venous pressure gradient (HVPG) was elevated and splenectomy resulted in both its normalisation and the regression of oesophageal varices. This case shows the potential for an increased spleno-poral flow to generate severe portal hypertension likely through a "protective" sinusoidal vasoconstriction.

The single-breath diffusing capacity for carbon monoxide in obstructive sleep apnea and obesity.

BACKGROUND: We have observed high values of single-breath diffusing capacity for carbon monoxide (Dco) in patients with obstructive sleep apnea (OSA). STUDY OBJECTIVES: To confirm this observation and to determine the factors influencing diffusion indices in patients with OSA. As weight excess was found to be the major determinant of increased diffusion indices, the adequacy of various prediction equations was evaluate in obese subjects. DESIGN: Retrospective data collection. SETTING: University hospital. METHODS: DCO was measured in patients with OSA and in nonapneic subjects who served as control SUBJECTS: The results were expressed with respect to our own reference values and also to other prediction equations. RESULTS: In moderate/severe OSA (apnea/hypopnea index [AHI] > or = 30), both DCO and transfer coefficient (KCO) were increased and KCO was positively correlated with AHI and body mass index (BMI). Diffusion indices were not different between patients with moderate/severe OSA and nonapneic control subjects matched for age and BMI. In the latter group, KCO was also correlated with BMI. In our obese patients (BMI, 36.7 +/- 5.6 kg/m2), DCO was about 10% and KCO was 20 to 25% greater than predicted by standard reference equations. CONCLUSIONS: DCO and KCO are increased in a typical population of patients with moderate/severe OSA. This appears to be due to weight excess and not to OSA itself. In obese subjects, whether apneic or not, BMI is a determinant of diffusion indices that are higher than predicted by equations relying on age and stature alone.