ABSTRACT
Abernethy syndrome (AS or extrahepatic portosystemic shunt) is an uncommon congenital malformation consisting of agenesis or hypoplasia of the portal vein (PV) in such a way that splanchnic venous blood drains directly into the systemic circulation through aberrant communications, resulting in a portosystemic shunt that bypasses the liver AS is an underdiagnosed condition with unknown incidence and complication rate given that symptoms are usually absent. AS identification is increasingly common because of improved imaging techniques, hence prognostic implications and clinical management need be understood. This editorial reviews the natural history of AS and its diagnostic-therapeutic implications, illustrating the process with a series of cases from our institution.
Subject(s)
Liver Neoplasms , Vascular Malformations , Humans , Liver Neoplasms/complications , Vascular Malformations/complications , Portal Vein/diagnostic imaging , Portal Vein/abnormalities , Portasystemic Shunt, Surgical , SyndromeABSTRACT
Antecedentes y objetivosLas principales guías de práctica clínica recomiendan un adecuado manejo periprocedimiento de los fármacos antitrombóticos en caso de realización de técnicas invasivas. El principal objetivo de este estudio fue evaluar si existe mayor riesgo de eventos tromboembólicos por la supresión o la disminución de la dosis de anticoagulantes o antiagregantes en pacientes sometidos a una colangiopancreatografía retrógrada endoscópica (CPRE). Pacientes y métodos: Se realizó un estudio observacional prospectivo que incluyó 644CPRE realizadas con intención terapéutica durante el año 2019 en el Hospital Universitario Reina Sofía con un seguimiento de 30días posprocedimiento. Resultados: Seis pacientes presentaron un evento tromboembólico, no hallando diferencias entre la incorrecta retirada/reintroducción del tratamiento antitrombótico y una mayor proporción de eventos tromboembólicos o hemorrágicos tras el procedimiento (p>0,05). La incidencia de eventos trombóticos fue significativamente mayor en pacientes en tratamiento con heparina o apixabán (p=0,001), así como con antecedente de fibrilación auricular (p=0,05), valvulopatía reumática (p=0,037) y tromboembolismo pulmonar recurrente (p=0,035), siendo este además un factor de riesgo independiente. Asimismo, la incidencia de hemorragia en los 30días postesfinterotomía fue significativamente menor en aquellos con implantación de prótesis biliar (p=0,04).Conclusiones: El inadecuado manejo periprocedimiento de la terapia antitrombótica no se asocia a un aumento significativo de la incidencia de eventos tromboembólicos en los 30días posteriores a la CPRE. No obstante, se aconseja seguir las recomendaciones para una adecuada suspensión/reintroducción de fármacos antitrombóticos, realizando una vigilancia y un seguimiento estrechos tras el procedimiento en pacientes con factores que aumenten el riesgo trombótico.(AU)
Background and objectives: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.(AU)
Subject(s)
Humans , Male , Aged , Cholangiopancreatography, Endoscopic Retrograde , Thromboembolism , Platelet Aggregation Inhibitors , Anticoagulants/therapeutic use , Sphincterotomy , Gastroenterology , Gastrointestinal DiseasesABSTRACT
BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.
Subject(s)
Thromboembolism , Thrombosis , Humans , Anticoagulants/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Fibrinolytic Agents/adverse effects , Thromboembolism/epidemiology , Thromboembolism/etiology , Thromboembolism/prevention & control , Hemorrhage/etiology , Thrombosis/etiologyABSTRACT
Metastases in pancreas are uncommon, ranging from 2 to 5 % of pancreatic malignancies. Choroidal melanoma is rare, and less than 1% spread to the pancreas. It can cause obstructive jaundice if it affects the pancreatic head region. Advanced disease is associated with poor prognosis, however immunotherapy with PD-1 inhibitors (nivolumab or pembrolizumab), alone or in combination with anti-CTLA-4 antibodies (ipilimumab), has shown an increase in survival.
Subject(s)
Melanoma , Humans , Melanoma/drug therapy , Melanoma/pathology , Melanoma/secondary , Ipilimumab , Nivolumab , Pancreas/pathology , Antineoplastic Combined Chemotherapy ProtocolsABSTRACT
Las metástasis pancreáticas constituyen sólo el 2-5% de los tumores malignos de éste órgano. El melanoma coroideo es una neoplasia poco común, que en <1% de las ocasiones metastatiza en páncreas, pudiendo ocasionar ictericia obstructiva si afecta a la región de la cabeza pancreática. Las metástasis en este tipo de tumores conllevan mal pronóstico, no obstante la inmunoterapia con inhibidores de PD-1 (nivolumab y pembrolizumab) con o sin anticuerpos anti CTLA-4 (ipilimumab) ha demostrado un aumento de la supervivencia (AU)
Subject(s)
Humans , Male , Middle Aged , Melanoma/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Melanoma/drug therapy , Pancreatic Neoplasms/drug therapy , Antineoplastic Agents, Immunological , Magnetic Resonance Imaging , Neoplasm Metastasis , Fatal OutcomeABSTRACT
Mesalazine is the most widely used aminosalicylate for induction and maintenance of remission in patients with mild-to-moderate ulcerative colitis (UC). Drug-induced hypersensitivity pneumonitis is considered very rare (<1/10.000 patients). Due to its rarity and the scarce cases reported, mesalazine-induced lung injury needs to be highly suspected in a patient with onset of respiratory symptoms and UC under treatment with salicylates. It should make the clinician formulate a differential diagnosis that includes not only infections (tuberculosis, bacterial...) or the inflammatory bowel disease itself, but also the current coronavirus disease 2019 (COVID-19) since their clinical and radiological manifestations may be very similar.
Subject(s)
COVID-19 , Colitis, Ulcerative , Lung Diseases, Interstitial , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Colitis, Ulcerative/drug therapy , Humans , Lung Diseases, Interstitial/chemically induced , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/drug therapy , Mesalamine/adverse effectsABSTRACT
A 53-year-old female with a history of HLA-B27 positive polyarthritis underwent a splenectomy due to an incidental splenic lesion, which was confirmed as an inflammatory pseudotumor (IPT). Afterwards, two liver lesions were found and histopathological examination revealed inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS). The patient received NSAIDs, corticosteroids, antibiotics and azathioprine, with no response. Within the next few months, there was an abrupt clinical worsening due to rapid progression of the hepatic lesions and a massive hepatomegaly. New biopsies were obtained, showing undifferentiated sarcoma. The patient started chemotherapy with doxorubicin and eventually died.
