RESUMEN
Herein, we report a case of cholangitis with granulocytic epithelial lesion associated with pancreatitis in a 22-year-old patient. The association of bile duct lesions and pancreatitis is usually very suggestive of IgG4 related disease. However, in our case, we found no IgG4 tissue infiltration and we found a granulocytic epithelial on the liver biopsy. Recently, cholangitis with granulocytic epithelial lesion was described in the literature. This entity is identified in 2 % of patients with sclerosing cholangitis. Patients are more likely children or young adults and often have an associated inflammatory bowel disease or rarely a pancreatitis. It is defined by the presence of neutrophilic bile duct lesions on a liver biopsy. Although rare, the diagnosis of cholangitis with granulocytic epithelial lesion is important because of its excellent response to immunosuppressive treatment.
Asunto(s)
Corticoesteroides/uso terapéutico , Enfermedades Autoinmunes/patología , Colangitis/patología , Granulocitos/patología , Inmunosupresores/uso terapéutico , Pancreatitis Crónica/patología , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/tratamiento farmacológico , Biomarcadores , Colangitis/complicaciones , Colangitis/tratamiento farmacológico , Colestasis Extrahepática/etiología , Colitis/tratamiento farmacológico , Colitis/patología , Enfermedades del Conducto Colédoco/patología , Diagnóstico Diferencial , Epitelio/patología , Humanos , Inmunoglobulina G , Hígado/patología , Imagen por Resonancia Magnética , Masculino , Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/tratamiento farmacológico , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the biliary penetration of ciprofloxacin and cefotaxime in patients with obstructed bile ducts and to determine simple predictive markers of effective biliary concentrations of these drugs. METHODS: Sixty-two patients treated with endoscopic biliary drainage were prospectively included in a nonrandomized way and received intravenous ciprofloxacin (200 mg twice daily) or cefotaxime (1 g three times a day) for more than 24 h before exploration. Blood and bile samples were collected at the time of drainage. Ciprofloxacin and cefotaxime concentrations were measured using high-performance liquid chromatography. Biliary penetration was assessed by the bile-to-plasma ratio of the concentrations of both antibiotics. RESULTS: Biliary penetration ranged from 0.06 to 42.7 for ciprofloxacin and from 0.01 to 1.14 for cefotaxime. The ratio was more than one in only 10 patients (35%) and three patients (9%) in ciprofloxacin and cefotaxime groups, respectively. Biliary concentration of the drug was more than 10 times the minimal inhibitory concentration in only 10 patients (35%) and in 12 patients (35%) in ciprofloxacin and cefotaxime groups, respectively. Serum bilirubin, alkaline phosphatase or gamma-glutamyl-transpeptidase were not good predictive markers of the biliary diffusion of the antibiotics. CONCLUSION: In patients with obstructed bile ducts, the biliary penetration of ciprofloxacin is poor and reaches effective biliary concentrations in a minority of patients. Cefotaxime biliary penetration is even poorer. No liver test can predict accurately the biliary penetration of the drugs.
Asunto(s)
Antibacterianos/farmacocinética , Cefotaxima/farmacocinética , Colangitis/tratamiento farmacológico , Colestasis/metabolismo , Ciprofloxacina/farmacocinética , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bilis/metabolismo , Bilirrubina/sangre , Cefotaxima/uso terapéutico , Colangiopancreatografia Retrógrada Endoscópica , Colangitis/etiología , Colangitis/metabolismo , Colestasis/etiología , Colestasis/cirugía , Cromatografía Líquida de Alta Presión/métodos , Ciprofloxacina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We report the case of a 17 year old man who presented with several episodes of acute pancreatitis due to a duodenal duplication. This was successfully treated by an incision by sphincterotome during interventional duodenoscopy. The patient is symptom free without recurrence 20 months after endoscopic treatment.
Asunto(s)
Duodenoscopía , Duodeno/anomalías , Duodeno/cirugía , Pancreatitis/etiología , Enfermedad Aguda , Adolescente , Humanos , MasculinoRESUMEN
UNLABELLED: To optimize the management of patients with chronic hepatitis C virus (HCV) infection, noninvasive tests to determine the degree of hepatic fibrosis have been developed. The aims of this study were (1) to validate a simple, inexpensive, noninvasive test called FIB-4, which combines standard biochemical values (platelets, ALT, AST) and age, in a series of 847 liver biopsies performed in HCV-monoinfected patients; and (2) to compare the results of 780 FIB-4 and FibroTests performed the same day in a series of 592 HCV-infected patients. The FIB-4 index enabled the correct identification of patients with severe fibrosis (F3-F4) and cirrhosis with an area under the receiver operating characteristic curve of 0.85 (95% CI 0.82-0.89) and 0.91 (95% CI 0.86-0.93), respectively. An FIB-4 index <1.45 had a negative predictive value of 94.7% to exclude severe fibrosis with a sensitivity of 74.3%. An FIB-4 index higher than 3.25 had a positive predictive value to confirm the existence of a significant fibrosis (F3-F4) of 82.1% with a specificity of 98.2%. Using these ranges, 72.8% of the 847 liver biopsies were correctly classified. The FIB-4 index was strongly correlated to the FibroTest results for a score <1.45 or >3.25 (kappa = 0.561, P < 0.01). A FIB-4 value <1.45 or >3.25 (64.6% of the cases) was concordant with FibroTest results in 92.1% and 76%, respectively. CONCLUSION: For values outside 1.45-3.25, the FIB-4 index is a simple, accurate, and inexpensive method for assessing liver fibrosis and proved to be concordant with FibroTest results.
Asunto(s)
Biomarcadores/sangre , Hepatitis C/diagnóstico , Adulto , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Hepatitis C/sangre , Hepatitis C/patología , Humanos , Cirrosis Hepática/virología , Pruebas de Función Hepática , Persona de Mediana Edad , Selección de Paciente , Recuento de Plaquetas , Valor Predictivo de las Pruebas , ARN Viral/sangre , Valores de Referencia , Reproducibilidad de los Resultados , Carga ViralRESUMEN
HIV infection worsens the course and the natural history of chronic hepatitis B (HBV) leading to rapid progression to cirrhosis and to end-stage liver disease. Highly active antiretroviral therapy (HAART) regimens including nucleoside and/or nucleotide analogues with activity against both HIV reverse transcriptase and hepatitis B virus polymerase have clearly improved the survival rates of HIV/HBV-coinfected patients. How HAART beneficially affects the natural course of chronic hepatitis B in coinfected patients is not known. We report a biopsy-proven case of reversal of HBV-related cirrhosis in a coinfected patient, paralleling long-term suppression of HBV replication with tenofovir disoproxil fumarate as part of a HAART. Pathological reversibility of cirrhosis was ascertained by normalization of biochemical (platelet count) and morphological (abdominal ultrasonography and gastrointestinal endoscopy) tests as well as non-invasive markers of fibrosis. In conclusion, a HAART regimen including tenofovir disoproxil fumarate in a HBV/HIV-coinfected cirrhotic patient might lead to sustained HBV viral suppression and result in cirrhosis reversal.
Asunto(s)
Adenina/análogos & derivados , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Hepatitis B Crónica/complicaciones , Cirrosis Hepática/tratamiento farmacológico , Organofosfonatos/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adenina/farmacología , Adenina/uso terapéutico , Adulto , Alanina Transaminasa/sangre , Fármacos Anti-VIH/farmacología , Terapia Antirretroviral Altamente Activa , ADN Viral/sangre , Infecciones por VIH/tratamiento farmacológico , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/genética , Hepatitis B Crónica/sangre , Hepatitis B Crónica/tratamiento farmacológico , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/patología , Cirrosis Hepática/virología , Masculino , Organofosfonatos/farmacología , Recuento de Plaquetas , Inhibidores de la Transcriptasa Inversa/farmacología , Tenofovir , Resultado del Tratamiento , Carga Viral , Replicación Viral/efectos de los fármacosRESUMEN
We report the case of a 67-year-old man presenting with an isolated 3 cm mass of the pancreatic tail revealed by weight loss. Distal pancreatectomy and splenectomy were performed. Microscopically, the tumor filled the main pancreatic duct, extending into the smaller ducts and was associated with a minor adenocarcinomatous invasive component. The intraductal tumor showed a cribriform pattern, atypical cells without mucus and a MUC1+, MUC2-, MUC5AC- phenotype, all characteristics of intraductal tubular carcinoma, a new entity described by Japanese authors. The differential diagnosis and its relationship with intraductal papillary-mucinous tumors are discussed.
Asunto(s)
Carcinoma Ductal Pancreático/patología , Neoplasias Pancreáticas/patología , Anciano , Carcinoma Ductal Pancreático/cirugía , Diagnóstico Diferencial , Humanos , Inmunohistoquímica/métodos , Masculino , Pancreatectomía/métodos , Neoplasias Pancreáticas/cirugíaRESUMEN
Autoimmune hepatitis is a disorder of unknown aetiology. Imatinib belongs to a new class of anticancer agents with high selectivity toward a specific molecular target. Its main indications are chronic myeloid leukaemia and gastrointestinal tumours. We report here, for the first time to our knowledge, imatinib mesylate-induced hepatitis with autoimmune features.
Asunto(s)
Antineoplásicos/efectos adversos , Hepatitis Autoinmune/etiología , Piperazinas/efectos adversos , Pirimidinas/efectos adversos , Enfermedad Aguda , Adolescente , Antiinflamatorios/uso terapéutico , Antivirales/uso terapéutico , Benzamidas , Quimioterapia Combinada , Femenino , Hepatitis Autoinmune/diagnóstico , Humanos , Mesilato de Imatinib , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Pruebas de Función Hepática , Polietilenglicoles/uso terapéutico , Prednisona/uso terapéutico , Proteínas RecombinantesRESUMEN
Echinococcus multilocularis induced liver infection was diagnosed in a Moroccan patient. Diagnosis was based on CT scan results and Western Blot test. Contamination probably occurred in France, in the Cherbourg area where the patient travelled frequently and ate wild berries. This case and other recently reported cases outside the usual endemic areas (Besançon and the Massif Central) suggest that the Echinococcus multilocularis epidemic has moved towards the west of France. French gastroenterologists should be aware of this parasitic disease.