RESUMEN
Inflammatory myopathy is a common cause of bilateral muscular weakness in adults. Although not as common as polymyositis, inclusion body myositis (IBM) is a form of inflammatory myopathy characterized by chronic progressive muscle inflammation and often goes undiagnosed and untreated. IBM patients most commonly present with proximal lower extremity weakness and may have normal creatine kinase (CK) levels. A high level of clinical suspicion is required for prompt and accurate diagnosis of IBM, which is diagnosed definitively with a muscle biopsy. The patient described in this case report is a 68-year-old man who initially presented with both bilateral symmetric proximal lower extremity and distal upper extremity weakness. IBM was suspected through history, electromyography, and definitively diagnosed with muscle biopsy. The patient was subsequently initiated on prednisone therapy and physical therapy, with improvement in muscular strength after 2 months. In patients presenting with bilateral extremity weakness and normal CK level, the diagnosis of IBM should be included in the differential diagnosis and muscle biopsy performed for appropriate cases.
Asunto(s)
Debilidad Muscular/etiología , Miositis por Cuerpos de Inclusión/complicaciones , Anciano , Extremidades , Humanos , Masculino , Miositis por Cuerpos de Inclusión/diagnósticoRESUMEN
One hundred and two liver transplants have been performed since the program's inception in Hawai'i in 1993. Viral hepatitis continues to be the primary indication for liver transplant, though hepatocellular cancer is involved in 23.5% of cases. One, 3 and 5-year patient survival rates have been 88%, 79%, and 74% respectively which is comparable to mainland centers and national data.
Asunto(s)
Hepatopatías/cirugía , Trasplante de Hígado , Adulto , Femenino , Humanos , Trasplante de Hígado/métodos , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Estudios Retrospectivos , Tasa de Supervivencia , Recolección de Tejidos y Órganos , Obtención de Tejidos y ÓrganosRESUMEN
Although many report the importance of case volume in complex cases, liver transplantation (LT) can be carried out successfully in a small centre. During a 11.5-yr period, 88 patients underwent LT in a single transplant centre in Hawaii. Indications for LT were primarily hepatitis C (n = 49) and hepatitis B (n = 13) and 22 patients (25%) had hepatocellular cancer (HCC) on explanted liver. There was no primary graft nonfunction, one retransplant for recurrent hepatitis C and two late hepatic artery thromboses, which did not require a retransplant. One patient developed partial portal vein thrombosis related to a hypercoagulable state and was rescued with anticoagulation. Of the 22 patients with HCC, 18 are alive, two died from recurrent disease (253 and 1428 d post-LT, respectively), one died because of a ruptured hepatic artery aneurysm (151 d) and one from complications caused by noncompliance (723 d). One-, 3- and 5-yr survival rates were 89%, 82% and 71%, respectively. Mean survival was 3034.9 d. During this time period, 142 liver resections, 77 pancreatic resections and 43 splenorenal shunts were performed by this group of surgeons. Because of the recent explosion of information on case volumes and centres of excellence, LT can be performed successfully at a small centre. Other major hepatobiliary/transplant procedures can help the surgeons maintain their operative skills. A smaller LT program may require a longer period of evolution, but it can provide a service for a geographically isolated population that would otherwise have limited opportunity for LT.