Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases.

Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas.

Schistosomiasis of liver graft as a differential diagnosis of abnormal liver tests after transplantation: report of two cases

ABSTRACT Schistosomiasis is a major health problem that affects over 200 million people worldwide. There are few reports of Schistosoma mansoni found in liver transplants as well as scarce information about the course of the disease and the long-term effects on the graft. Herein, we report two cases of schistosomiasis in liver transplant recipients who presented abnormal serum liver enzymes, with evidence of gradual improvement after antiparasitic treatment. Furthermore, we discuss the possible role of screening the parasite infection in potential liver transplant recipients from endemic areas.

Visceral Leishmaniasis: A Case Report of a Challenging Diagnosis After Orthotopic Liver Transplantation.

Leishmaniasis is a disease caused by a protozoan and transmitted by sandfly species in several emerging countries. Visceral leishmaniasis is a serious complication, especially in immunosuppressed patients, and is uncommon after liver transplantation. We report the case of a 48-year-old female patient who underwent liver transplantation owing to polycystic liver disease. Six months after the procedure, she was hospitalized with diarrhea, acute kidney failure, and leukopenia. She had been off steroids for 3 months and was taking mycophenolate and tacrolimus. She had already been treated for cytomegalovirus, which was negative on admission. During hospitalization, fever, splenomegaly, ascites, and pancytopenia appeared. Serology for Leishmania by indirect immunofluorescence was negative. Then, bone biopsy and molecular testing for Leishmania diagnosed it as visceral leishmaniasis. Amphotericin therapy was initiated with resolution of fever after 4 days of treatment and gradual recovery from pancytopenia. This case highlights the challenge of early diagnosis of visceral leishmaniasis in liver transplant recipients with diarrhea and leukopenia, which can be caused by immunosuppression or more prevalent viral diseases. Late onset of fever, splenomegaly, and a first negative serologic test also made early diagnosis difficult. The aim of the report is to emphasize the suspicion of visceral leishmaniasis in symptomatic patients from emerging countries and to question the benefit of including protozoan screening in liver transplant donors and recipients in endemic areas.

Fístula duodenal traumática tratada por duodenostomia endoscópica percutânea ecoguiada / Traumatic duodenal distula treated by percutaneous endoscopic duodenostomy ecoguiada

A conduta frente a uma fístula duodenal recidivada de alto débito é de difícil manejo. Uma nova cirurgia poderia aumentar as já elevadas taxas de morbimortalidade inerentes a esta situação. Para evitar isto, procedimentos alternativos, minimamente invasivos, têm sido relatados com sucesso para o tratamento das fístulas enterocutâneas. Apresentaremos um caso de fístula duodenal traumática recidivada após diverticulização duodenal em Y de Roux, que permaneceu com débito inalterado após 40 dias de tratamento conservador. A realização de uma duodenostomia endoscópica percutânea ecoguiada propiciou o fechamento da fístula. Nenhum relato de fístula duodenal tratada por esta técnica foi encontrado. Apesar deste procedimento ter se mostrado factível e seguro, mais fístulas deverão ser fechadas usando esta técnica para demonstrar que este será um instrumento seguro para se lidar com este problema.

Management of high output duodenal fistula is a difficult problem; another surgery would be associated with higher rates of morbidity and mortality. To avoid this, several minimal invasive alternative methods have been reported for the treatment of enterocutaneous fistulae. A case of a duodenal fistula following a blunt abdominal trauma, treated unsuccessful duodenal suture, followed by another surgery - duodenal exclusion using Roux - en - Y is reported. The fistula persisted for 40 days of conservative management. Echo guided percutaneous endoscopic duodenostomy was successfully performed leading to the obliteration of the fistula. No previous report of the closure of a duodenal fistula by this technique was found. This procedure showed simple and safe. Further experience may be necessary to demonstrate that it is an effective tool in dealing with this complex problem.

Fístula duodenal traumática tratada por duodenostomia endoscópica percutânea ecoguiada: relato de caso / Traumatic duodenal fistula treated by echo-guided percutaneous endoscopic duodenostomy

A conduta frente a uma fístula duodenal recidivada de alto débito é de difícil manejo; uma nova cirurgia poderia aumentar as já elevadas taxas de morbimortalidade inerentes a essa situação. Para evitar isto, procedimentos alternativos, minimamente invasivos, têm sido relatados com sucesso para o tratamento das fístulas enterocutâneas. Os autores apresentam caso de fístula duodenal traumática recidivada após diverticulização duodenal em Y de Roux que permaneceu com débito inalterado após 40 dias de tratamento conservador. A realização de uma duodenostomia endoscópica percutânea ecoguiada propiciou o fechamento da fístula. Nenhum relato de fístula duodenal tratada por esta técnica foi encontrado. Apesar de este procedimento ter-se mostrado factível e seguro, mais fístulas deverão ser fechadas usando esta técnica para demonstrar que este será um instrumento seguro para se lidar com este problema.

Prevalência de hipertansäo arterial sistêmica e dislipidemia em funcionários do Hospital das clínicas da Universidade Federal de Pernambuco / Prevalence of primary systemic hypertension dand dislipidemia in employes of the Clinical Hospital in the Federal University of Pernambuco

A proposta do presente estudo foi levantar a prevalência de hipertensäo arterial sistêmica (HAS) e analisar o perfil epidemiológico, numa amostra de funcionários do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), no que concerne a associaçäo de hipertensäo e dislipidemia. Foi realizado um estudo descritivo, com delineamento transversal, em 117 funcionáriosdos serviços de limpeza e manutençäo do HC-UFPE. Todos os representantes da amostra foram avaliados por três observadores ,um caradiologista e dois acadêmicos de medicina, devidamente treinados, en duas etapas distintass a determinaçäo dos níveis de pressäo arterial e a quantificaçäo dos níveis séricos de TG, CT, LDL-c, HDL-c e das relações CT/HDL-c E LDL-c/HDL-c (índices de Castelli I e II respectivamente). O percentual de hipertensos na amostra foi de 37,6por cento (44 de 117). Houve um maior percentual de HAS nos funcionáarios com perfil lipídico indesejável (40,9por cento - 18 de 44). Constatou-se que, nos indivíduos hipertensos da amostra estudada, houve associaçäo significante com o perfil lipídico indesejável, concordante com os da literatura pertinente