Improvement of physical capacity and quality of life after liver transplantation: a longitudinal study

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Hypoalbuminemia as a risk factor for thromboembolic events in inflammatory bowel disease inpatients

Background/Aims Inflammatory bowel disease (IBD) are chronic entities characterized by local and systemic inflammation and may be associated with thrombosis. The aim of this study was to identify the prevalence of thromboembolic events (TEE) in hospitalized IBD patients and identify risk factors for their occurrence. Methods This retrospective, single-center study included patients treated at a Brazilian IBD referral unit between 2004 and 2014. Patients hospitalized for more than 48 hours due to active IBD and who did not receive prophylaxis for TEE during hospitalization were included. Patients were allocated to 2 groups: those with TEE up to 30 days or at the time of hospitalization (TEE-group) and patients without TEE (control-group). Clinical and laboratory characteristics were evaluated. Results Of 53 patients evaluated, 69,8% with Crohn’s disease (CD) and 30.2% with ulcerative colitis (UC). The prevalence of TEE 30 days before or during hospitalization was 15.1%, with 10.8% in CD and 25% in UC. In the TEE group, mean serum albumin was 2.06 g/dL versus 3.30 g/dL in the control group. Patients with albumin levels below 2.95 g/dL (43.18%) had a higher risk of developing TEE (relative risk, 1.72; 95% confidence interval, 1.17–2.53) (P<0.001). Conclusions Albumin levels were significantly lower in patients with TEE, and hypoalbuminemia was considered a risk factor for the development of TEE in this population

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Multiple hepatic metastases of cardiac angiosarcoma

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson’s capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcom

Avaliação da eficacia de um novo marcador tumoral, a desgamacarboxiprotrombina, no diagnostico do carcicoma hepatocelular

Orientadores: Elza Cotrim Soares, Jose Carlos ParejaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O objetivo deste trabalho foi avaliar a contribuição de um novo marcador tumoral, a desgamacarboxiprotrombina (DCP), no diagnóstico do carcinoma hepatocelular (CHC) e compará-Io com a alfafetoproteína (AF.P.). Foram estudados 124 pacientes, sendo 92 brasileiros e 32 japoneses. Os pacientes brasileiros foram divididos em cinco grupos: 19 pacientes com carcinoma hepatocelular (grupo I), 19 com cirrose hepática (grupo II), 17 com hemangioma hepático (grupo III), 17 com metástase hepática (grupo IV) e 20 com dispepsia, sem doença hepática (grupo V). Os pacientes japoneses constituíram um outro grupo com CHC. Os exames incluídos no protocolo foram: fosfatase alcalina, gamaglutamiltransferase, aspartato aminotransferase, alanina aminotransferase, tempo de protrombina (TP), expresso em RNI (Intemational Normalized Ratio), AF.P., DCP, ultra sonografia, tomografia computadorizada, sorologia para vírus B e C e biópsia hepática. Para o diagnóstico histológico do CHC, foi utilizado o grau de diferenciação histo1ógico segundo Edmondson-Steiner. A dosagem do nível plasmático da DCP foi realizada em todos os pacientes, utilizando-se o método de enzima imuno-ensaio (ElA) (E-1023: Eitest MONO - P - II, Eisai C., Ltd., Tokyo). A positividade da DCP nos pacientes com CHC foi de 57,9%. Nos outros grupos, de 13,7%. A sensibilidade e especificidade foram de 57,9% e 86,3%, respectivamente. O valor predição positivo, de 52,4 % e negativo, de 88,7%. A concentração plasmática da DCP apresentou-se elevada nos pacientes com tumores acima de 5,0 cm e naqueles com lesões ~ltinodulares. Houve associação entre o nível plasmático de DCP e o nível sérico de A.F.P. nos pacientes com CHC (n = 49; r = 0,58998; p = 0,0001). Concluíu-se que, a DCP é um marcado r tumoral complementar para o diagnóstico do carcinoma hepatocelular e que sua combinação com a AF.P. é importante, pois aumenta a taxa de positividade do diagnóstico do CHCAbstract: The aim of this work was to assess the usefulness of a new tumour marker, des')'-carboxy prothrombin (DCP), in the diagnosis of hepatocellular carcinoma (HCC), and to compare this with that of a-fetoprotein (AFP). The study involved 124 patients, divided into two groups (92 Brazilians and 32 Japanese). The Brazilian subject were further subdivided into tive groups: 19 patients with HCC (group I), 19 with hepatic cirrhosis (group 11), 17 with hepatic hemangioma (group 111), 17 with hepatic metastasis (group IV) and 20 with dyspepsia who were not affected by any hepatic disease (group V). The Japanese patients constituted a further HCC group. The medical and laboratory tests performed included a1kaline phosphatase (AP), ')'-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time, expressed by INR (International Normalized Ratio), AFP and DCP, determinations an ultrasound scan, a tomography, hepatitis B and C viruse serology and a hepatic biopsy. The histological diagnosis of HCC was based on the degree of Edmondson-Steiner histological differentiation. The plasma DCP levels were determined in ali patients using an immunoassay enzyme (ElA) (E-1023: Eitest MONO - P - 11, Eisai c., Ltd., Tokyo). Among the HCC patients, 57,9% were positive for DCP while in the other groups only 13,7% were positive.The sensitivity and specifity ofthe ElA were 57.9% and 86.3%, respectively, V{hile the predictive positive value was 52.4% and the predective negative value was 88,7%. ,A rise in the plasma concentration of DCP was observed in patients with tumours exceeding 5.0 cm in diameter and in those with multinodular lesions. There wàS a positive association between the plasma DCP ~~vels"..and the serum AFP levels in HCC patients (n = 49; r = 0.58998; p = 0.0001). We conclude that the determinations of DCP levels is a useful complementary tumour marker in the diagnosis of HCC and that the association between DCP and AFP is important because increases the frequency of positive HCC diagnoseDoutoradoMedicina InternaDoutor em Ciências Médica

Orocecal Transit Time In Patients With Functional Dyspepsia.

The importance of intestinal dysmotility in functional dyspepsia is a controversial issue. To investigate the orocecal transit time in patients with functional dyspepsia, as well as a possible association between intestinal transit and the presence of anxiety or Helicobacter pylori infection in these patients. The participants in this study were 23 patients with dysmotility-like functional dyspepsia and 24 control subjects. Orocecal transit time was measured by the lactulose hydrogen breath test. The presence of anxiety was assessed by the Hospital Anxiety and Depression (HAD) scale. No significant difference in orocecal transit times was found between patients (median, 55 minutes; 95% confidence interval [CI], 40-60 minutes) and control subjects (median, 50 minutes; 95% CI, 40-60 minutes; p = 1). In the assessment, 15 patients (73%) scored for anxiety on the HAD scale, and 15 patients (65%) had positive test results for H. pylori. There was no significant difference in orocecal transit times between the patients with (median, 55 minutes; 95% CI, 40-63 minutes) and those without H. pylori infection (50 minutes; 95% CI, 40-68 minutes; p = 0.85), or between the patients with (median, 45 minutes; 95% CI, 40-68 minutes) and those without (60 minutes; 95% CI, 40-63 minutes; p = 0.77) anxiety. Orocecal transit time is within the normal range in patients with functional dyspepsia. Anxiety and H. pylori infection do not seem to influence orocecal transit time in these patients.3521-