RESUMEN
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.
Asunto(s)
Carcinoma Hepatocelular , Colangitis , Cirrosis Hepática Biliar , Neoplasias Hepáticas , Humanos , Masculino , Ácido Ursodesoxicólico/uso terapéutico , Colagogos y Coleréticos/uso terapéutico , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/etiología , Cirrosis Hepática Biliar/complicaciones , Cirrosis Hepática Biliar/epidemiología , Cirrosis Hepática Biliar/tratamiento farmacológico , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/etiologíaAsunto(s)
Apendicectomía , Apendicitis/complicaciones , Enfermedades del Ciego/diagnóstico , Leiomioma/diagnóstico , Pólipos/diagnóstico , Enfermedad Aguda , Apendicitis/cirugía , Enfermedades del Ciego/complicaciones , Femenino , Humanos , Hallazgos Incidentales , Leiomioma/complicaciones , Ilustración Médica , Persona de Mediana Edad , Pólipos/complicacionesRESUMEN
Dietary supplements are unregulated medications that can lead to serious liver injury. Despite this, many people take vitamin supplements believing they are safe because they do not require prescriptions. We are reporting a case of an African American man who took large doses of vitamin supplements leading to noncirrhotic portal hypertension. The case highlights the importance of detailed history taking to diagnose and treat patients properly.
Asunto(s)
Fiebre/etiología , Neoplasias Hepáticas/diagnóstico , Hígado/patología , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Sarcoma/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Quimioterapia Adyuvante , Diagnóstico Diferencial , Hepatectomía , Humanos , Hígado/diagnóstico por imagen , Hígado/cirugía , Absceso Hepático/complicaciones , Absceso Hepático/diagnóstico , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Masculino , Neoplasias de Células Germinales y Embrionarias/complicaciones , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Sarcoma/complicaciones , Sarcoma/patología , Sarcoma/terapia , Sepsis/complicaciones , Sepsis/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
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.
RESUMEN
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).
Asunto(s)
Fosfatasa Alcalina/sangre , Biomarcadores/sangre , Cirrosis Hepática Biliar/diagnóstico , Complicaciones del Embarazo/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Pruebas de Función Hepática , Embarazo , PruritoRESUMEN
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.
Asunto(s)
Quistes/complicaciones , Hepatopatías/complicaciones , Taquicardia/etiología , Disfunción Ventricular Derecha/etiología , Obstrucción del Flujo Ventricular Externo/etiología , Anciano , Función del Atrio Derecho , Quistes/diagnóstico por imagen , Quistes/cirugía , Drenaje , Femenino , Humanos , Laparoscopía , Hepatopatías/diagnóstico por imagen , Hepatopatías/cirugía , Taquicardia/diagnóstico por imagen , Taquicardia/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/fisiopatología , Función Ventricular Derecha , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/fisiopatologíaAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/mortalidad , Hispánicos o Latinos , Diabetes Mellitus/etnología , Diabetes Mellitus/mortalidad , Hepatopatías Alcohólicas/etnología , Hepatopatías Alcohólicas/mortalidad , Pronóstico , Factores de Tiempo , Comorbilidad , Ciudad de Nueva York/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Medición de Riesgo , Hospitales Comunitarios , Hipertensión/etnología , Hipertensión/mortalidad , Hepatopatías Alcohólicas/diagnósticoAsunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Hispánicos o Latinos , Hepatopatías Alcohólicas/etnología , Hepatopatías Alcohólicas/mortalidad , Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/mortalidad , Comorbilidad , Diabetes Mellitus/etnología , Diabetes Mellitus/mortalidad , Femenino , Hospitales Comunitarios , Humanos , Hipertensión/etnología , Hipertensión/mortalidad , Hepatopatías Alcohólicas/diagnóstico , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Prevalencia , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de TiempoAsunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Latente/terapia , Lupus Eritematoso Sistémico/complicaciones , Síndrome de Sjögren/complicaciones , Tuberculosis Osteoarticular/terapia , Adulto , Artritis Infecciosa/diagnóstico , Artrocentesis , Artroplastia de Reemplazo de Cadera , Diagnóstico Diferencial , Femenino , Articulación de la Cadera/microbiología , Articulación de la Cadera/cirugía , Humanos , Articulación de la Rodilla/microbiología , Articulación de la Rodilla/cirugía , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Senegal , Tuberculosis Osteoarticular/complicaciones , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/microbiologíaRESUMEN
Hepatitis C infection and its treatment have been associated with extrahepatic manifestations, including different skin conditions. Over the past decades, a greater number of drugs have been implicated as triggers for drug-induced subacute cutaneous lupus erythematosus. We report a case of a 42-year-old Hispanic man who developed a forehead violaceous rash during treatment with pegylated interferon alpha-2a as part of his therapy against hepatitis C infection that subsequently resulted to be subacute cutaneous lupus erythematosus. The skin lesion improved with discontinuation of medication and some topic therapy.
Asunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Lupus Eritematoso Cutáneo/inducido químicamente , Oligopéptidos/efectos adversos , Polietilenglicoles/efectos adversos , Ribavirina/efectos adversos , Adulto , Humanos , Lupus Eritematoso Cutáneo/patología , Masculino , Proteínas Recombinantes/efectos adversosRESUMEN
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.
Asunto(s)
Antifúngicos/administración & dosificación , Aspergillus fumigatus/aislamiento & purificación , Tos/etiología , Hemoptisis/etiología , Aspergilosis Pulmonar/complicaciones , Tuberculosis Pulmonar/complicaciones , Voriconazol/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Aspergilosis Pulmonar/tratamiento farmacológico , Recurrencia , Resultado del Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/fisiopatologíaRESUMEN
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.
Asunto(s)
Insuficiencia Cardíaca/complicaciones , Péptido Natriurético Encefálico/metabolismo , Fragmentos de Péptidos/metabolismo , Derrame Pleural/metabolismo , Anciano , Tubos Torácicos , Comorbilidad , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión Pulmonar/diagnóstico , Derrame Pleural/terapia , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/metabolismo , Atelectasia Pulmonar/terapia , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Carcinoma Hepatocelular/patología , Leucemia Linfocítica Crónica de Células B/patología , Neoplasias Hepáticas/patología , Neoplasias Primarias Múltiples/patología , Anciano , Femenino , HumanosRESUMEN
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.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Citomegalovirus/aislamiento & purificación , Hepatitis/etiología , Hígado/patología , Enfermedad Aguda , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aspartato Aminotransferasas/sangre , Femenino , Hepatitis/enzimología , Hepatitis/patología , Humanos , Hígado/enzimología , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaRESUMEN
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+.