RESUMO
Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.
Assuntos
Imunossupressores/efeitos adversos , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Úlceras Orais/induzido quimicamente , Adulto , Antibacterianos/uso terapêutico , Ciclosporina/uso terapêutico , Feminino , Humanos , Resistência a Meticilina , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Resultado do TratamentoRESUMO
BACKGROUND: Drug induced liver disease (DILD) is common and of difficult diagnosis. AIM: To report the clinical, laboratory and pathological findings in 33 patients with DILD. PATIENTS AND METHODS: We revised 1,164 liver biopsies and 57 were selected as suspicious of DILD. In these, the scale proposed by Maria et al was applied to assess the possibility of hepatotoxicity reactions and 33 were selected. RESULTS: The 33 cases had a mean age of 48 +/- 18 years and 14 were male. Forty eight medications were involved, with an average of 1.4 drugs per patient. The main drugs were antimicrobials, antineoplastics-immunosuppressives and non-steroidal antiinflammatory drugs. The clinical presentations in order of frequency were cholestasis, hepatitis, asymptomatic, fulminant hepatitis and cirrhosis. The laboratory alterations observed in cases with hepatitis were 20 fold transaminase and bilirubin elevation. In cholestasis, moderate elevations of alkaline phosphatases and gamma glytamyl transferase were observed. Pathology showed hepatocellular damage, cholestasis and mixed damage, but also submassive necrosis and cirrhosis in one case. CONCLUSIONS: The present study confirms that DILD is frequently unpredictable and that it can cause a wide variety of clinical and pathological presentations, that can even evolve to chronicity.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hepatopatias/induzido quimicamente , Doença Hepática Induzida por Substâncias e Drogas , Hepatopatias/diagnósticoRESUMO
BACKGROUND: Intravenous drug use, sexual promiscuity and a longer cohabitation period are considered risk factors for familial transmission of hepatitis C virus. The relative importance of this type of transmission is a subject of controversy. AIM: To study familial clustering of hepatitis C virus infection and its risk factors. MATERIAL AND METHODS: HCV positive patients (91 with chronic hepatitis, 88 with cirrhosis, nine with hepatic carcinoma and 29 hemophiliacs) were the index cases. HCV antibodies were measured by ELISA and the type of relationship with the index case was investigated in 317 family members. RESULTS: Positive anti HVC antibodies were detected in 12 of 243 family members of patients with chronic liver disease and in none of the family members of patients with hemophilia. Of these, five were couples of an index case with a long cohabitation period. Ten members had an index case with a severe liver disease (three with Child C cirrhosis and seven with liver carcinoma). CONCLUSIONS: Family transmission of HCV infection is uncommon in Chile. The association of severe liver disease and family transmission could be due to a higher viral load as responsible for transmission during the early periods of a long lasting disease.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Transmissão Vertical de Doenças Infecciosas , Hepatite C Crônica/transmissão , Transmissão de Doença Infecciosa , Anticorpos Anti-Hepatite C/isolamento & purificação , Chile , Fatores de Risco , Hepacivirus/imunologiaRESUMO
BACKGROUND: The prevalence of gallstones is increased in patients with cirrhosis. However the presence of cirrhosis has been generally considered a relative contraindication to cholecystectomy. AIM: To investigate the complications and the outcomes of laparoscopic and open cholecystectomy in patients with cirrhosis. PATIENTS AND METHODS: Sixty seven patients with gallstones with well-documented cirrhosis undergoing cholecystectomy (laparoscopic cholecystectomy (LC) in 35 and open cholecystectomy (OC) in 32), were studied. The mean age was 57.7 + 10.3 years for LC and 58.9 + 11.6 years for OC. In the LC group, 26 were classified as Child-Pugh class A, 8 as Child's B class and 1 as Child's class C. In the OC group, 12 were classified as Child's class A, 15 as Child's B and 5 as Child's C. RESULTS: Complications occurred in 4 of 35 (12.3 per cent) LC patients (1 patients was Child A and 3 were B). In the OC group 14 of 32 patients had complications (4 Child A, 7 B and 3 C, 43.7 per cent p < 0.05 as compared with LC group). Three patients in the OC group died (9.4 per cent). Mean hospital stay was 2.8 + 1.9 and 13 + 12 days in LC and OC patients, respectively (p < 0.05). CONCLUSIONS: LC has a lower rate of complications than OC and is a reasonable option for Child's class A and B patients with cirrhosis and gallstones.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cirrose Hepática/cirurgia , Colecistectomia/métodos , Colelitíase/cirurgia , Chile , Cirrose Hepática/etiologia , Colecistectomia Laparoscópica , Colecistectomia , Estudos Retrospectivos , Prevalência , Resultado do TratamentoRESUMO
BACKGROUND: Gastric Antral Vascular Ectasia or Watermelon stomach is a rare cause of chronic gastrointestinal bleeding, often presenting as a chronic iron deficiency anemia. This condition can be associated with some other diseases such as cirrhosis, autoimmune diseases and others. We report two patients treated with Argon Plasma Coagulation, a 68 years old male with an ethanol related cirrhosis and a 72 years old female with an idiopathic Gastric Antral Vascular Ectasia. The characteristic endoscopic features were mistaken for many years as gastritis. Both patients presented with severe anemia requiring multiple transfusions as treatment. Due to the poor operative risk, both patients were treated with Argon Plasma Coagulation with good results.
Assuntos
Ectasia Vascular Gástrica Antral/cirurgia , Fotocoagulação a Laser/métodos , Idoso , Anemia/complicações , Argônio , Feminino , Seguimentos , Ectasia Vascular Gástrica Antral/complicações , Ectasia Vascular Gástrica Antral/patologia , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Humanos , MasculinoRESUMO
BACKGROUND: Hypertriglyceridemia over 1,000 mg/dl can provoke acute pancreatitis and its persistence can worsen the clinical outcome. On the contrary, a rapid decrease in triglyceride level is beneficial. Plasmapheresis has been performed in some patients to remove chylomicrons from the circulation, while heparin and/or insulin have been administered in some other cases to rapidly reduce blood triglycerides. Heparin and insulin stimulate lipoprotein-lipase activity and accelerate chylomicron degradation. AIM: To report five patients with acute pancreatitis treated with heparin and insulin. PATIENTS AND METHODS: Five patients (4 females and 1 male) seen in the last two years, who suffered acute pancreatitis induced by hypertriglyceridemia are reported. Initial blood triglyceride levels were above 1,000 mg/dl (range 1,590-8,690 mg/dl). Besides the usual treatment of acute pancreatitis, heparin and/or insulin were administered intravenously in continuous infusion. Heparin dose was guided by usual parameters of blood coagulation, and insulin dose, by serial determinations of blood glucose. Pancreatic necrosis was demonstrated in 4 patients. RESULTS: Serum triglyceride levels decreased to < 500 mg/dl within 3 days in all cases. No complication of treatment was observed and all patients survived. Early and late complications of pancreatitis occurred in one patient. CONCLUSION: Administration of heparin and/or insulin is an efficient alternative to reduce triglyceride levels in patients with acute pancreatitis and hypertriglyceridemia.
Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Hipertrigliceridemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Pancreatite/tratamento farmacológico , Doença Aguda , Adulto , Quilomícrons/efeitos dos fármacos , Feminino , Humanos , Hipertrigliceridemia/complicações , Lipase Lipoproteica/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Triglicerídeos/sangueRESUMO
Retractile mesenteritis is a rare condition in which the inflammation process of the mesentery is the characteristic pathological. The histologic changes are variable proportions of fat necrosis, chronic inflammation and fibrosis. The clinical presentation of this process is diverse, also the natural history is variable, ranging from a benign to fatal disease. We reviewed 4 cases of retractile mesenteritis and evaluated the clinical manifestations. There was no gender predominance. The patients aged range was 63-69 years (average 65) Patients more often presented with abdominal mass (cases n: 1 and n: 4), and chronic diarrhea (cases n: 1 and 3). The etiology is unknown, the treatment is empirical, including corticosteroids, colchicine, immunosuppressive drugs and oral progesterone.
Assuntos
Paniculite Peritoneal/diagnóstico , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paniculite Peritoneal/patologia , Paniculite Peritoneal/terapiaRESUMO
A Multiple Myeloma (MM), IgG-lambda stage III-A was diagnosed in a 41-year-old-man. After VAD cycles IgG decreased from 7.5 to 2.4 g/dL. were mobilized with cyclophosphamide and 10 micrograms/Kg G-CSF. Three days after the collection of peripheral stem cell, the patient had fever, nausea, vomiting, liquid stools, shoulder and knee arthralgia and dehydration. Upper GI endoscopy showed esophageal candidiasis and ulcerative necrotic lesions both in stomach and duodenum; the biopsy confirmed necrosis. Simultaneously, the appearance of purpura with maculopapular lesions of diverse sizes appeared in the feet progressing to the limbs and trunk. Hematuria and proteinuria were also observed. Skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed focal and segmental glomerulonephritis. Serum ANCA, cryoglobulins, anti-HCV and RF were negative, and serum monoclonal IgG was 1290 mg/dL. Daily treatment with i.v. methylprednisolone pulses for 3 days improved skin lesions and digestive involvement. Macroscopic hematuria and proteinuria improved after two months of steroid treatment.
Assuntos
Vasculite por IgA/etiologia , Mieloma Múltiplo/complicações , Adulto , Humanos , Vasculite por IgA/patologia , Masculino , Mieloma Múltiplo/patologia , Paraproteinemias/diagnóstico , Paraproteínas/análiseRESUMO
Most nonsteroidal antiinflammatory drugs can produce hepatotoxicity. We report a 22 years old female who presented with an acute cholestatic hepatitis after a prolonged period of piroxicam use. Hepatitis was attributed to this drug since all markers for hepatitis virus (A, B, C, E, Epstein Barr, Cytomegalovirus and Herpex Simplex) were negative, autoimmune markers were negative, serum iron and ceruloplasmin were normal, there was a temporal relationship between the administration of piroxicam and the hepatitis, the histological picture was compatible with this etiology and the patient had a favorable evolution after the discontinuance of the drug. This type of hepatotoxicity is not common but it must be born in mind when patients must receive nonsteroidal antiinflammatory drugs for prolonged periods.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/induzido quimicamente , Piroxicam/efeitos adversos , Adulto , Doença Hepática Induzida por Substâncias e Drogas/patologia , Colestase/patologia , Feminino , Humanos , SalivaRESUMO
BACKGROUND: some studies have suggested that the elevation of serum globulins in patients with chronic autoimmune hepatitis, paraproteinemias and rheumatoid arthritis could affect the determination of false positive hepatitis C virus antibodies (anti-HCV). AIM: to study the relationship between positive anti-HCV and serum levels of globulins in patients with liver disease. PATIENTS AND METHODS: one hundred thirty one patients with liver disease, 49 alcoholic, 38 cryptogenetic, 17 autoimmune and 27 with other causes, were studies prospectively measuring simultaneously anti-HCV and serum levels of total, gamma and immuno-globulins (IgA, IgG and IgM). These levels were compared between anti-HCV positive and negative groups and correlated with the ratio between serum optical density/cutoff optical density of the anti HCV assay. RESULTS: Twenty eight patients (21.3%) were anti-HCV positive, no differences in serum globulins between these patients and anti-HCV negative patients and no correlations between serum globulins and anti-HCV optical densities were observed. CONCLUSIONS: the hypergamma-globulinemia observed in these patients with liver diseases would not be responsible for positive hepatitis C virus antibodies.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatopatias/sangue , Soroglobulinas/análise , Ensaio de Imunoadsorção Enzimática , Humanos , Hepatopatias/imunologia , Estudos ProspectivosRESUMO
Three cases of post-sinusoidal hepatic blood flow obstruction as the main feature of antiphospholipid syndrome are reported. Clinically, these patients developed jaundice, malaise, ascites and hepatomegaly. Ultrasonography-Doppler and hepatic venography showed small hepatic vein disease in two and partial occlusion in the suprahepatic segment of inferior vena cava in the remaining patient. In all, anticardiolipin antibodies were positive and activated partial thromboplastin time was prolonged. This experience emphasizes that in patients with post sinusoidal portal hypertension, a systematic search for antiphospholipid syndrome must be carried out.
Assuntos
Síndrome Antifosfolipídica/complicações , Síndrome de Budd-Chiari/complicações , Adulto , Síndrome de Budd-Chiari/patologia , Feminino , Humanos , Fígado/patologia , MasculinoRESUMO
Collagenous and microscopic colitis have been described as causes for abundant watery diarrhea with a normal radiologic and endoscopic aspect of the colonic mucosa. Microscopic colitis is characterized by diffuse intraepithelial lymphocytic infiltration and collagenous colitis by thickening of subepithelial collagen layer greater than 15 microns with or without inflammatory changes of the mucosa. Here are reported 5 patients with microscopic colitis and 4 with collagenous colitis. The mean age was 52 years (range 40 to 68) with an equal sex distribution. Diarrhea was of longstanding duration without weight loss, anemia or hypoalbuminemia. Occasionally the volume of diarrhea was over 1 L a day. One patient had steatorrhea that proved resistant to a gluten free diet. Endoscopic and radiologic findings were normal in every patient and the diagnosis was based on typical histology. Azulfidine therapy was successful in 7 patients and prednisone in another. Colonic biopsy should be performed in every patient with chronic diarrhea.
Assuntos
Colite/classificação , Adulto , Idoso , Chile , Colite/metabolismo , Colite/patologia , Colágeno/biossíntese , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
One hundred and twenty consecutive patients with liver cirrhosis and ascites were prospectively studied in order to analyze the frequency, clinical and bacteriological features, recurrence, and prognosis of spontaneous bacterial peritonitis (SBP). Two variants of SBP were defined: culture positive SBP and culture negative neutrocytic ascites (CNNA). During a follow-up of 6 +/- 2 months, thirty three episodes in 23 patients were identified. Nineteen episodes had ascites positive cultures (58%). The total mortality rate associated with SBP was 39%. (47% for culture positive form and 29% for CNNA). Seven of 15 cirrhotics who had recovered from a first episode of SBP (46%) had 10 recurrences. Mortality associated with SBP recurrence was 50%. Six-month survival probability was 65% in patients with sterile ascites and 33% in SPB (p < 0.05). Impairment of liver function was present in 23 episodes (70%) but abdominal complaints occurred only in one/third and 4 (12%) were asymptomatic. E coli was the most frequent agent involved in culture positive SBP. We confirm that SBP is a frequent, recurrent and severe complication of ascites in cirrhotics. Episodes of SBP without abdominal symptoms or with a silent course are not infrequent. Then, SBP recognition requires ample use of diagnostic paracentesis.
Assuntos
Ascite/complicações , Infecções Bacterianas , Cirrose Hepática/complicações , Peritonite/etiologia , Adulto , Idoso , Chile , Feminino , Humanos , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Peritonite/microbiologia , Peritonite/mortalidade , Prognóstico , Estudos Prospectivos , Recidiva , Taxa de SobrevidaRESUMO
We studied the incidence of tuberculosis in 37 renal transplant patients. Mean age was 37 years and immune suppression therapy had been used for a mean of 37 months. Tuberculosis-free cases had received prednisone at a mean dose of 10 +/- 4 mg/day and azathioprine, 96 +/- 35 mg/day. 28% of patients had a positive tuberculin test, 24% a healed tuberculous lung lesion and 40% received chemoprophylaxis. Four patients developed tuberculosis, 10 times the incidence expected for the general population. Fever was present in all patients. Two patients had a disseminated form and one a laryngeal location. None of the patients had received chemoprophylaxis and the dose of prednisone was higher (18 +/- 9 mg/day) than that received by non-infected patients. Thus, chemoprophylaxis for tuberculosis appears warranted in all renal transplant recipients, regardless of tuberculin test results or chest X ray findings.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Chile/epidemiologia , Feminino , Humanos , Terapia de Imunossupressão/métodos , Terapia de Imunossupressão/estatística & dados numéricos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Tempo , Tuberculose Pulmonar/prevenção & controleRESUMO
We performed a prospective study including cytochemical, bacteriologic and pathologic observations in 25 patients with ascites of different causes. Activity of adenosine deaminase in ascitic fluid was higher in tuberculous (103 +/- 61 mu/l) than in neoplastic (16 +/- 8), inflammatory (16 +/- 13) and portal hypertension (15 +/- 6) etiologies (p less than 0.05). Inflammatory cases included patients with lupus and spontaneous peritonitis. Activity of adenosine deaminase was higher in every patient with tuberculosis than in any other patient. Thus, a high sensitivity and specificity of this test in the diagnosis of tuberculous peritonitis is confirmed.