ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 25-year-old male physician with acute hepatitis C after needle-stick injury was treated with combination therapy including twice-a-day interferon-beta (IFN-β) and standard interferonalpha (IFN-α). The infecting strain was of genotype 1b. Pre-treatment hepatitis C virus (HCV) RNA levels were high. Because severe paresthesias occurred with initial daily administration of 5 million units (MU) of lymphoblastoid IFN-α, the dose was reduced to 3 to 6 MU of IFN-α2b three times a week. However, HCV RNA was not cleared from serum after 20 weeks of standard IFN-α2b treatment. A 4-week course with IFN-β, at the dosage of 3 MU twice daily IV drip, was then started and followed by an 18-week course with IFN-α2b, 6 MU thrice weekly. After IFN-β treatment, HCV RNA was cleared from serum without severe adverse effects, including paresthesias. Total amounts of IFN administered were 20 MU of lymphoblastoid IFN-α, 648 MU of IFN-α2b, and 252 MU of IFN-β. Complete response and avoidance of chronic HCV infection were achieved. Thus, combination therapy with twice-a-day IFN-β and standard IFN-α was effective in treating an acute hepatitis C patient with a high viral load and sensitivity to adverse effects of high-dose IFN-α.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Two cases of severe hepatitis in young women using Atrium and paroxetine are presented. Both patients presented jaundice, marked increase in aminotransferases activities, and pronounced prolongation in prothrombin time. In both cases, liver biopsy specimen examination revealed lesions compatible with drug-related injury. Other causes of hepatic injury were reasonably ruled out by complete careful screening. Outcome was marked by rapid complete recovery in one case and by slow recovery in the other. We suggest that simultaneous treatment with Atrium and paroxetine could increase each of these drugs' hepatotoxicity.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Mycosis fungoides is a cutaneous T-cell lymphoma that can disseminate to multiple organs. We report a patient who presented with obstructive jaundice caused by isolated involvement of the extrahepatic biliary tree by mycosis fungoides. Initially, endoscopic examinations and biopsies of the biliary tree and liver failed to reveal a cause for the obstructive symptoms. Finally, surgical resection of the gallbladder and extrahepatic ducts was performed. Examination revealed a dense, mixed lymphocytic infiltrate with atypical cells within the mucosa. Gene rearrangement studies confirmed the presence of a monoclonal T-cell population. The pattern of the gene rearrangement in the biliary tree was identical to that found in a previous skin biopsy that showed mycosis fungoides. Although liver involvement by mycosis fungoides is not uncommon, disease isolated to the extrahepatic biliary tree has not previously been reported. This case should alert clinicians and pathologists to yet another cause of obstructive jaundice.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Sarcoidosis is a relatively common, chronic, multisystem disease of unknown origin. It most commonly affects young adults and usually manifests with bilateral hilar lymphadenopathy or pulmonary infiltrates. Alternatively, it may present with protean manifestations. It has been documented in all organs of the body, with the exception of the adrenal gland.We describe a male patient who presented with hepatic sarcoidosis, with a sclerosing cholangitis-like picture, but without any pulmonary involvement. He was treated with prednisolone and cyclophosphamide, the latter as a steroid-sparing agent. A few years later, renal adenocarcinoma developed. We postulate that this could be related to cyclophosphamide treatment.We present this case history for two reasons: (1) sarcoidosis, selectively affecting the liver and lymph nodes but not the lung, with its hepatic involvement mimicking sclerosing cholangitis, has not previously been reported; and (2) although long-term cyclophosphamide treatment is known to be associated with malignancy, there is only one previous report of its association with a renal adenocarcinoma.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Cholangiocarcinoma is the second most common primary tumor of the liver after hepatocellular carcinoma and accounts for 5 to 25% of primary hepatic malignancies. Patients with intrahepatic or peripheral cholangiocarcinoma (ICC) most often present at an advanced stage leading to a poor prognosis. A review of the literature has produced only 10 patients who have survived over five years. We review the case of a young woman with a large cholangiocarcinoma, who has been disease free for eight years.The patient was treated with a right hepatic lobectomy, and received 4 cycles of 5-fluorouracil and levamisole postoperatively. Known factors associated with longer survival in patients with ICC include lack of evidence of local invasion (i.e. capsular, lymphatic, or vascular), negative margins, mucoblia, and well differentiation of the tumor, as well as the absence of lymph node metastases. Our patient had negative margins and lymph nodes, and showed no local invasion. However, no mucobilia was noted, and the tumor was only moderately differentiated. Young age has never been associated with increased survival.ICC remains a relatively uncommon tumor with an insidious onset and late presentation contributing to poor survival. Surgical resection remains the only therapeutic option. Since few patients are potentially resectable at the time of presentation, efforts at early diagnosis and options for adjuvant therapy are imperative.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A case of early carcinoma of the distal second part of the duodenum, in a 74-year-old man, is presented. Endoscopic retrograde cholangiopancreatography was performed for diagnosis of a common bile duct stone. During this procedure, small elevated lesions were found incidentally in the distal second part of the duodenum, and the histologic examination of a biopsy specimen showed adenocarcinoma. The lesions were removed by wedge resection, and pathologic examination revealed duodenal carcinoma limited to the lamina propria. Although carcinoma of the duodenum, other than of the ampulla of Vater region, is very rare, it is sometimes possible to detect asymptomatic early tumors. However, this requires careful observation of the entire duodenal mucosa, including that of the distal duodenum, at duodenoscopy.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Type IV congenital cyst of bile duct represents about 10% of all bile duct congenital cysts in adulthood. Clinical presentation is usually related to recurrent jaundice and abdominal pain. No cases of type IV bile duct cyst presenting with acute pancreatitis have been described so far. We herein report two cases of such association; both patients recovered from acute pancreatitis. The relevant world literature is reviewed.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We present one case with pancreatitis that synchronized with manifestations of ulcerative colitis, in which an improvement of stricture of the main pancreatic duct was observed. A 27-year-old man, having a history of nonalcoholic acute pancreatitis, complained of anal bleeding and pain in the epigastric region. The treatment for pancreatitis relieved the pain and decreased the serum levels of pancreatic enzymes to within normal ranges. Colonoscopy and histopathologic examination revealed ulcerative colitis in the rectum, and treatment with steroid enema made proctitis quiescent. Endoscopic retrograde pancreatography demonstrated a remarkable and short stricture of the main pancreatic duct, which improved at follow-up pancreatography. In a 20-month follow-up period, active proctitis relapsed with a episode of recurrent pancreatitis once, and without pancreatitis once.

ISSN:0192-0790    

出版商:OVID    

年代:1999

数据来源: OVID