RESUMO
Focal nodular hyperplasia (FNH) of the liver is a lesion characterized by a well circumscribed region of hyperplastic liver tissue with stellate fibrosis. The pathogenesis of FNH is unknown but various authors consider that this lesion may be a response to a preexisting vascular abnormality. A 27-year-old woman was referred because of large liver lesion detected by ultrasound abdominal examination. Doppler ultrasound, computed tomography and magnetic resonance suggested this was FNH. The patient was conducted to resection of the tumor because of size of the tumor and presence of clinical signs and symptoms. Pathological examination of the surgical resection confirmed diagnosis of FNH. Follow-up after 1 and 2 years showed that the patient remained well but she complained of general weakness and we found unexplained elevation of GGT. Liver biopsy was performed 1 year after resection of the tumor and histopathological examination showed only minimal reactive changes.
Assuntos
Hiperplasia Nodular Focal do Fígado/diagnóstico , Hiperplasia Nodular Focal do Fígado/cirurgia , Adulto , Feminino , Hiperplasia Nodular Focal do Fígado/patologia , Humanos , Imageamento por Ressonância Magnética , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler , gama-Glutamiltransferase/sangueRESUMO
Interferon alpha (INF) is routine treatment in patients with chronic hepatitis C. Many controlled investigations were evaluated to establish the optimal schedule of treatment with sustained virological and biochemical response. Recently, multicentre meta-analyses suggest that combination therapy (INF + Ribavirin) was more effective than treatment with interferon alone. The aim of this study was to compare the efficacy of four schedules of antiviral treatment in 445 patients with chronic hepatitis C. Combination therapy (INF + Ribavirin) given for 6 mo. and monotherapy (INF) for 18 mo. were more effective than interferon alone given for 6 mo. Treatment with INF alone for 6 mo. was demonstrated to be insufficient.
Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Ribavirina/administração & dosagem , Antivirais/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Interferon-alfa/efeitos adversos , Masculino , Polônia/epidemiologia , Ribavirina/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
Clinical and epidemiological analysis of Lyme disease cases treated at the Infectious Diseases Clinic of the Medical University of Gdansk and the District Hospital of Infectious Diseases in the years 1993-1995 was done. The results were compared to data presented in the literature. The material consisted of 184 patients, 169 in I stage of the disease and 15 in the II stage. Out of 15 in the II stage, 2 patients presented with lymphocytoma benigna cutis, 7 with arthritis and 6 with neuroboreliosis. The Lyme disease diagnosis was confirmed with positive serological tests in 45% of patients in the I stage and in 100% of patients in the II stage. Over the analysed time interval, 1993-1995, the incidence of Lyme disease has increased markedly; 1993-38 cases, 1994-50 cases and 96 cases in 1995.
Assuntos
Doença de Lyme/diagnóstico , Doença de Lyme/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Doença de Lyme/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Testes SorológicosRESUMO
Examination was performed in a group of 539 adult patients with diarrhea admitted to the Department of Infectious Diseases in Gdansk from 1991 to 1994. The group of 17 patients with antibiotic-associated colitis (AAC) was analysed. The antibiotics responsible for AAC were lincosamides, cephalosporins and penicillins. AAC was diagnosed by anamnesis, medical examination and detection of toxin A Clostridium difficile in stool samples. The contrast enema, colonoscopy and histopathological examination of colon mucosa were performed only in severe, protracted cases. The course of disease was mild in 2 cases, moderate in 13 and severe in 2 patients. Relapses of AAC were observed in 2 cases. Initial treatment of AAC included discontinuation of the antibiotic therapy that precipitated the disease and the replacement of fluid and electrolyte losses. Moreover, oral metronidazole and oral vancomycin were administered. All patients made a complete recovery.
Assuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Enterocolite Pseudomembranosa/induzido quimicamente , Penicilinas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/terapia , Feminino , Humanos , Lincosamidas , Macrolídeos/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Hepatotropic viruses HBV and HCV are capable of triggering autoimmune reactions (AIH). The aim of the study was the assessment of clinical course of AIH in patients with HBV and HCV, and the revision of treatment methods employed in these cases. MATERIAL AND METHODS: Among 120 patients with AIH and those qualified for antiviral therapy, 21 (17.5%) subjects were selected, including 16 with HCV (7 men and 9 women) and 5 with HBV (including 2 men and 3 women). AIH diagnosis was based on international criteria taking into account biochemical tests, autoantibodies and morphological picture of the liver. HBV infection was confirmed with the determination of HBV markers and HCV--with the presence of antiHCV and HCV RNA. RESULTS: The duration of infection at AIH diagnosis was difficult to assess in patients with HCV. AIH was diagnosed when patients were qualified for antiviral treatment. Three patients displayed high anti-LKM1, 8--ANA and SMA, two pts--ANA, two pts--SMA, one pt--ANA + pANCA and one--SMA + pANCA. Nine patients did not show hyperproteinaemia, and hypergammaglobulinaemia was not observed in 2 patients. Six patients suffered from other immunity disorders--thrombocytopenia, vasculitis, arthritis, visceral lupus erythematosus. The diagnosis of chronic hepatitis was confirmed by morphological examinations in 15 patients. Ten subjects received adrenocortical hormones, 3 patients were treated with adrenocortical hormones and azathioprine, 4 received interferon and 3 received no treatment. All patients with HBV proved HBeAg(-). In these patients, AIH symptoms developed 5-18 years after the diagnosis of HBV infection. Liver biopsy confirmed the diagnosis in 4 patients. SMA was observed in 2 subjects, ANA and SMA--in the remaining patients. All the subjects manifested typical biochemical changes as well as high IgG values. Extrahepatic exponents of immune process were observed in 3 patients. Three subjects were treated with Encorton (Prednisone), while 2 patients received Encorton and Azathioprine. CONCLUSIONS: Patients with HBV and HCV infections may manifest the features of AIH in the course of the disease, which requires careful attention while selecting treatment.
Assuntos
Doenças Autoimunes/virologia , Hepacivirus/metabolismo , Vírus da Hepatite B/metabolismo , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , RNA Viral/metabolismo , Fatores de TempoRESUMO
BACKGROUND: Helicobacter pylori (H. pylori) is an important factor responsible for chronic inflammatory conditions of the gastric mucosa. It has been demonstrated in numerous animal studies that some Helicobacter species may cause parenchymatous liver damage. The aim of the study was to investigate whether there is any correlation between the incidence of parenchymatous liver damage, and the incidence and degree of colonization of the gastric mucosa by H. pylori. MATERIAL AND METHODS: The study was carried out in the group of 30 patients (14 females, 16 males) whose mean age was 37 years, hospitalized because of parenchymatous liver damage without clinical symptoms of cirrhosis. All the patients had gastroscopy and urease tests performed, and mucosal biopsies were taken for immunomorphological investigations. The patients were divided into groups, group I comprising those with positive, and group II with negative urease test results. RESULTS: Positive urease tests were obtained in 26/30 patients (group I), 18/26 of whom demonstrated macroscopic changes of the gastric mucosa visible in gastroscopy. Group II with negative urease test results comprised 4/30 patients, 2/4 of whom had detectable changes in the gastric mucosa. The presence of H. pylori antigens was demonstrated by gastric mucosa immunomorphology in all 30 patients. The degree of invasion of H. pylori was visualized by immunofluorescence, which allowed to differentiate deep mucosal invasion of H. pylori (bacterial antigens present in lymph follicles and at the base of muciferous glands) observed in group I in 14/26 and in group II in 1/4 cases and superficial invasion (epithelium and mucosal surface) observed in group I in 12/26, in group II in 3/4. CONCLUSIONS: The obtained results may suggest more frequent H. pylori infections in subjects with parenchymatous liver damage than in the population without liver damage. Immunofluorescence seems to be a highly sensitive method allowing for detection of even small degrees of gastric mucosa colonization by H. pylori.